Notification of Changes for Business Entity
General Information
Business Entity Name:	THE FEDELI GROUP, INC.
Incorporation / Formation Date:
FEIN:	34-1310398
Ohio License Number:
NPN:
DBA / Trade Name:
State of Domicile:	OH
County:	CUYAHOGA
Business Address
Address 1:	5005 ROCKSIDE ROAD
Address 2:
City:	INDEPENDENCE
State:	OH
Zip:	44131
Phone:	216-328-8080
Fax:
Business Web Site Address:
Business Email Address:
Mailing Address
Address 1:	P O BOX 318003
Address 2:
City:	INDEPENDENCE
State:	OH
Zip:	44131
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
JEFF RICHMOND	AGENT	12132737	YES		09/2016
JENNIFER CZYRBA	ACCT MGR	8564772		YES	11/2016

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)	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:	ELAINE HUSTON
Title:	ADMIN/LICENSING
Phone Number:	216-328-8080
Email Address:	EHUSTON@THEFEDELIGROUP.COM