Notification of Changes for Business Entity
General Information
Business Entity Name:	FIRST NIAGARA RISK MANAGEMENT, INC
Incorporation / Formation Date:
FEIN:	160976844
Ohio License Number:
NPN:	2004884
DBA / Trade Name:
State of Domicile:	NY
County:	ERIE
Business Address
Address 1:	726 EXCHANGE STREET, SUITE 900
Address 2:
City:	BUFFALO
State:	NY
Zip:	14210-1452
Phone:	7162708930
Fax:
Business Web Site Address:
Business Email Address:
Mailing Address
Address 1:	726 EXCHANGE STREET, SUITE 900
Address 2:
City:	BUFFALO
State:	NY
Zip:	14210-1452
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
JENNIFER HANEY	AGENT	17853404	YES		01/13/2017
ALISSA POWERS	AGENT	16762329	YES		01/13/2017
LINDA TAYLOR	AGENT	3282833	YES		01/13/2017

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:	BARBARA CAMPBELL
Title:	COMPLIANCE SPECIALIST
Phone Number:	254-729-8002
Email Address:	BCAMPBELL@ILSAINC.COM