Notification of Changes for Business Entity
General Information
Business Entity Name:	GUARANTEE UNDERWRITERS INC
Incorporation / Formation Date:	08/13/2009
FEIN:	205642483
Ohio License Number:	40046
NPN:	14070208
DBA / Trade Name:	GUI INSURANCE AGENCY
State of Domicile:	DE
County:	NEW CASTLE
Business Address
Address 1:	3411 WILMINTON ROAD TATNALL BLDG 104
Address 2:
City:	WILMINGTON
State:	DE
Zip:	19810
Phone:	9545561615
Fax:
Business Web Site Address:
Business Email Address:	KDAVIS@PATNAT.COM
Mailing Address
Address 1:	401 E LAS OLAS BLVD STE 1540
Address 2:
City:	FORT LAUDERDALE
State:	FL
Zip:	33301
Indicate the type of change you are seeking
Address Change:	YES
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
MOHAMED ARAFA	RDA			YES

Members, Owners, Partners, Officers and Directors
Name	Title	Identifying #	Add	Delete	Eff. Date
DAVID SKUP	TREASURER	266045788		YES	05/12/2017
CHARLES SCHUVER	DIRECTOR	17419374		YES	05/12/2017
CHRISTOPHER PIZZO	SECRETARY, DIRECTOR	550217633		YES	05/12/2017
JOSEPH BABIN	DIRECTOR	156766029	YES		05/12/2017
WILLIAM DOUGLAS GRIFFIN	TREASURER	200589638	YES		05/12/2017
ERIC DAWSON	DIRECTOR, EXISTING SECRETARY	288769638			05/12/2017

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)	NO
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?	NO
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:	WILLIAM DOUGLAS GRIFFIN
Title:	TREASURER
Phone Number:	9545561620
Email Address:	DGRIFFIN@GUARANTEEINS.COM