Notification of Changes for Business Entity
General Information
Business Entity Name:	SPITZER AGENCY LLC
Incorporation / Formation Date:	04/29/2015
FEIN:	47-3865620
Ohio License Number:	1072538
NPN:
DBA / Trade Name:
State of Domicile:	OH
County:	CUYAHOGA
Business Address
Address 1:	13001 BROOKPARK RD
Address 2:
City:	BROOKPARK
State:	OH
Zip:	44130
Phone:	2162426590
Fax:
Business Web Site Address:
Business Email Address:
Mailing Address
Address 1:	13001 BROOKPARK RD
Address 2:
City:	BROOKPARK
State:	OH
Zip:	44130
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
DREW LUTHANEN	AGENCY MANAGER	15766241		YES	06152018
ANTHONY LIMOLI	AGENCY MANAGER	17885436	YES		06152018

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)	YES
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	AUTO DEALER

Submitted By
Submitted By:	ANDREW SPITZER
Title:	PROGRAM MANAGER
Phone Number:	3305922200
Email Address:	ANDREW@SPITZER.COM