Notification of Changes for Business Entity
General Information
Business Entity Name:	FITZGIBBONS ARNOLD & COMPANY AGENCY, INC.
Incorporation / Formation Date:	02/28/1991
FEIN:	341675020
Ohio License Number:	1001
NPN:	764836
DBA / Trade Name:
State of Domicile:	OH
County:	CUYAHOGA
Business Address
Address 1:	25730 FIRST ST.
Address 2:
City:	WESTLAKE
State:	OH
Zip:	44145
Phone:	4408923636
Fax:
Business Web Site Address:
Business Email Address:
Mailing Address
Address 1:	PO BOX 45520
Address 2:
City:	WESTLAKE
State:	OH
Zip:	44145
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

Members, Owners, Partners, Officers and Directors
Name	Title	Identifying #	Add	Delete	Eff. Date
MATTHEW ARNOLD	PRESIDENT	2341785	YES		04/01/2018
RICHARD ARNOLD	PRESIDENT	816300		YES	04/01/2018

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:	JEFF LEDER
Title:	CLAIMS MANAGER
Phone Number:	4408923636
Email Address:	JLEDER@FITZARN.COM