Notification of Changes for Business Entity
General Information
Business Entity Name:	CATERPILLAR INSURANCE SERVICES CORPORATION
Incorporation / Formation Date:	06/24/1994
FEIN:	62-1572992
Ohio License Number:	26959
NPN:	963673
DBA / Trade Name:
State of Domicile:	TN
County:	DAVIDSON
Business Address
Address 1:	2120 WEST END AVENUE
Address 2:
City:	NASHVILLE
State:	TN
Zip:	37203
Phone:	615-341-8109
Fax:	615-341-8582
Business Web Site Address:
Business Email Address:	JULIE.BURGESS@CAT.COM
Mailing Address
Address 1:	2120 WEST END AVENUE
Address 2:
City:	NASHVILLE
State:	TN
Zip:	37203
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

Members, Owners, Partners, Officers and Directors
Name	Title	Identifying #	Add	Delete	Eff. Date
STEVEN B. RESNICK	VP, TREASURER, DIRECTOR	058448708		YES	12/31/15
JEFFRY D. EVERETT	VP, TREASURER, DIRECTOR	254025371	YES		12/31/15
JEFFREY L. PRIDGEN	VICE PRESIDENT	14328		YES	12/31/15
BRIAN N. MOORE	VICE PRESIDENT, DIRECTOR	960965	YES		12/31/15
DONALD J. MEYERS	SECRETARY	012546329		YES	12/31/15
F. MARIA SHEFFIELD	SECRETARY	259191209	YES		12/31/15
TIMOTHY S. WATTS	ASSISTANT VICE PRESIDENT	14512		YES	12/31/15
SANTIAGO GARCIA	ASSISTANT VICE PRESIDENT	966565	YES		12/31/15
PEGGY A. WARD	VICE PRESIDENT, DIRECTOR	538661497		YES	12/31/15
MICHAEL D. FAORO	VICE PRESIDENT	338368439		YES	12/31/15

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:	BRIAN N. MOORE
Title:	VICE PRESIDENT, DRLP
Phone Number:	615-341-8109
Email Address:	BRIAN.MOORE@CAT.COM