Notification of Changes for Business Entity
General Information
Business Entity Name:	STARR WRIGHT INSURANCE AGENCY, INC.
Incorporation / Formation Date:	12/27/1965
FEIN:	520819164
Ohio License Number:	12652
NPN:	687383
DBA / Trade Name:
State of Domicile:	DE
County:	NEW CASTLE
Business Address
Address 1:	405 SILVERSIDE ROAD
Address 2:	SUITE # 102B
City:	WILMINGTON
State:	DE
Zip:	19809
Phone:	302-375-1270
Fax:	302-483-0230
Business Web Site Address:	WWW.STARRCOMPANIES.COM
Business Email Address:	RASHIDA.WILSON@STARRCOMPANIES.COM
Mailing Address
Address 1:	405 SILVERSIDE ROAD
Address 2:	SUITE # 102B
City:	WILMINGTON
State:	DE
Zip:	19809
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
DARRELL A WEBER	VP-TPA RDA		YES		04/19/2017
DAVID C. ERMER	SECRETARY			YES	04/19/2017
DAVID ROBERT DAUSMAN	VP			YES	04/19/2017
DOMENICO SERRATORE	SECRETARY			YES	04/19/2017
GEORGE NAGATA POWERS	VP, TPA RDA			YES	04/19/2017
GREG FLOOD	PRESIDENT			YES	04/19/2017
MARC WILNER	VP			YES	04/19/2017
MICHAEL POLICASTRO	SECRETARY, OFFICER			YES	04/19/2017
PATRICIA M. KEEFE	PRESIDENT			YES	0419/2017
THOMAS MONAGHAN	VP			YES	04/19/2017
TPA RDA AGENT	TPA RDA			YES	04/19/2017
WILLIAM GLEASON	TREASURER			YES	04/19/2017

Members, Owners, Partners, Officers and Directors
Name	Title	Identifying #	Add	Delete	Eff. Date
DARRELL A. WEBER	AVP, TPA RDA	8171831	YES		04/19/2017
DAVID C. ERMER	SECRETARY			YES	04/19/2017
DAVID ROBERT DAUSMAN	VP			YES	04/19/2017
DOMENICO SERRATORE	SECRETARY			YES	04/19/2017
GEORGE NAGATA POWERS	VP, TPA RDA			YES	04/19/2017
GREG FLOOD	PRESIDENT			YES	04/19/2017
MARC WILNER	VP			YES	04/19/2017
MICHAEL POLICASTRO	SECRETARY, OFFICER			YES	04/19/2017
PATRICIA M. KEEFE	VP			YES	04/19/2017
THOMAS MONAGHAN	VP			YES	04/19/2017

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:	RASHIDA WILSON
Title:	LICENSING ANALYST
Phone Number:	6462276765
Email Address:	RASHIDA.WILSON@STARRCOMPANIES.COM