Notification of Changes for Business Entity
General Information
Business Entity Name:	ARTHUR J GALLAGHER RISK MANAGEMENT SERVICES INC
Incorporation / Formation Date:
FEIN:	36-2102482
Ohio License Number:	25610
NPN:
DBA / Trade Name:
State of Domicile:	IL
County:	DUPAGE
Business Address
Address 1:	TWO PIERCE PLACE
Address 2:
City:	ITASCA
State:	IL
Zip:	60143
Phone:	6306945280
Fax:
Business Web Site Address:
Business Email Address:
Mailing Address
Address 1:	TWO PIERCE PLACE
Address 2:
City:	ITASCA
State:	IL
Zip:	60143
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
NICOLE CLARIDA	PRODUCER	2153288	YES		12/18/2015

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:	JULIETTE CASH
Title:	LICENSING SPECIALIST
Phone Number:	9196535459
Email Address:	JULIETTE.CASH@REGED.COM