Notification of Changes for Business Entity
General Information
Business Entity Name:	AAA ALLIED INSURANCE SERVICES INC
Incorporation / Formation Date:
FEIN:	311104973
Ohio License Number:
NPN:	686060
DBA / Trade Name:
State of Domicile:	OH
County:	HAMILTON
Business Address
Address 1:	15 W CENTRAL PKWY
Address 2:
City:	CINCINNATI
State:	OH
Zip:	45202
Phone:	513-345-5687
Fax:
Business Web Site Address:
Business Email Address:
Mailing Address
Address 1:	15 W CENTRAL PKWY
Address 2:
City:	CINCINNATI
State:	OH
Zip:	45202
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
AMY GOODE	SECRETARY (OLD)	2319911		YES	04/03/15
BRADLEY LUDLOW	AGENT	2346567		YES	09/05/14
DOTTIE E WENZ	EMPLOYEE	2213695		YES	04/07/16
DOUGLAS CAMPBELL	AGENT	16145483		YES	03/10/15
GERALD VINJE	AGENT	2557729		YES	09/27/16
MICHAEL ALAN DALEY	AGENT	2765978		YES	12/04/14
JANE SCHULTZ	AGENT	7198029		YES	03/21/17
TIMOTHY DEIBEL	AGENT	2831558		YES	03/16/16
LISA KLEBART	SECRETARY / EMPLOYEE	2308885	YES		05/22/17

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:	LISA KLEBART
Title:	DIRECTOR, INSURANCE OPERATIONS
Phone Number:	8605704212
Email Address:	LKLEBART@AAA-ALLIEDGROUP.COM