PROGRESSIVE

Customer Service 1-800-925-2886 24 hours a day, 7 days a week Personal Lines Progressive Insurance PO Box 6807 Cleveland, OH 44101 Fax: 1-800-229-1590

Commercial Auto Progressive Insurance PO Box 94739 Cleveland, Ohio 44101 Fax: 1-800-556-0014

Provide this information to make the policy changes you have requested. If you would like to change the independent agent/broker of record on your insurance policy, please provide this information.

The following information for the new agent:

Agency name: Blake Insurance Group LLC Agency code (can be provided by your agent/broker): 41620 Agent name: Blake Nwosu

Address: 3430 E Sunrise Dr STE 180 Tucson AZ 85718 Phone number: 520-402-6002

Please sign and return this form by fax or mail. Thank you. Please Note: After acquiring a policyholder, you must immediately obtain, from the prior agent or agency, all original signed applications (including selections, exclusions and rejections of optiona coverage) and all other records relating to that policy. Such records must be maintained in accordance with the terms of the producer's agreement and all applicable state laws. If attempts to obtain records from the prior agent or agency prove unsuccessful, you must obtain signed forms directly from the policyholder.