Notification of Changes for Business Entity
General Information
Business Entity Name:	ARTHUR J GALLAGHER & CO INS BROKERS OF CALIFORNIA INC
Incorporation / Formation Date:
FEIN:	94-3015711
Ohio License Number:
NPN:
DBA / Trade Name:
State of Domicile:	CA
County:	LOS ANGELES
Business Address
Address 1:	505 NORTH BRAND BOULEVARD
Address 2:	STE 600
City:	GLENDALE
State:	CA
Zip:	91203-3944
Phone:	949-349-9829
Fax:
Business Web Site Address:
Business Email Address:
Mailing Address
Address 1:	318 DEERFIELD AVE.
Address 2:
City:	IRVINE
State:	CA
Zip:	92606
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
JONATHAN PROCTOR	PRODUCER	16668303	YES		07/05/2017

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:	SHANNON TUTTLE
Title:	LICENSING SPECIALIST
Phone Number:	9196536701
Email Address:	SHANNON.TUTTLE@REGED.COM