Notification of Changes for Business Entity
General Information
Business Entity Name:	HOFFMAN INSURANCE AGENCY, INC.
Incorporation / Formation Date:	11/14/1958
FEIN:	34-0834304
Ohio License Number:	876
NPN:	1926325
DBA / Trade Name:	THE HOFFMAN GROUP
State of Domicile:	OH
County:	CUYAHOGA
Business Address
Address 1:	2 BEREA COMMONS
Address 2:	SUITE 10
City:	BEREA
State:	OH
Zip:	44017
Phone:	440-826-0700
Fax:
Business Web Site Address:
Business Email Address:
Mailing Address
Address 1:	2 BEREA COMMONS
Address 2:	SUITE 10
City:	BEREA
State:	OH
Zip:	44017
Indicate the type of change you are seeking
Address Change:	NO
Business Entity Name Change:	NO	Old Business Entity Name:
New DBA/Trade Name:	NO	New DBA/Trade Name:
Amend DBA/Trade Name:	NO	Old DBA/Trade Name:
Add/Delete Producers, Members, Owners, Partners, Officers and/or Directors:	YES

Licensed Producers
Name	Title	NPN	Add	Delete	Eff. Date
JAMES M. KAHOE	AGENT	8993608		YES	07/14/2016

Members, Owners, Partners, Officers and Directors
Name	Title	Identifying #	Add	Delete	Eff. Date

Title Business Entities Only
1. Is any member, producer, owner, share holder, manager, partner, officer or director currently engaged in deriving income from or affiliated with (other than as a customer) any business or profession other than insurance? (i.e. banking, auto dealer, mortgage company)
2. Has any member, producer, owner, share holder, manager, partner, officer or director currently engaged in deriving income from or affiliated with (other than as a customer) any business or profession other than insurance since the filing of the previous CN-65 or the original application?
3. If the answer to questions #1 or #2 is yes, identify the business or profession and the nature of person's involvement

Submitted By
Submitted By:	PEGGY MCMULLEN
Title:	AGENCY LICENSING
Phone Number:	440-826-0700
Email Address:	PMCMULLEN@THEHOFFMANGRP.COM