Notification of Changes for Business Entity
General Information
Business Entity Name:	ASSUREDPARTNERS OF ILLINOIS, LLC
Incorporation / Formation Date:	05/01/2015
FEIN:	38-3970092
Ohio License Number:	1067578, 1134708
NPN:	17586845
DBA / Trade Name:
State of Domicile:	IL
County:	COOK
Business Address
Address 1:	4 WESTBROOK CORPORATE CENTER STE 500
Address 2:
City:	WESTCHESTER
State:	IL
Zip:	60154
Phone:	6305716390
Fax:
Business Web Site Address:
Business Email Address:	SLAWRENCE@JAMISONGROUP.COM
Mailing Address
Address 1:	C/O HERBERT L. JAMISON & CO., LLC
Address 2:	20 COMMERCE DR., SUITE 200
City:	CRANFORD
State:	NJ
Zip:	07016
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
ANTHONY S PULGINE	VICE PRESIDENT	3200713	YES		01/12/2017

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)
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?
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:	ERIC ANDERSON
Title:	SVP
Phone Number:	9736692301
Email Address:	SLAWRENCE@JAMISONGROUP.COM