Notification of Changes for Business Entity
General Information
Business Entity Name:	RIVER POINT INSURANCE SERVICES, LLC
Incorporation / Formation Date:
FEIN:	811065586
Ohio License Number:	1142888
NPN:	17837650
DBA / Trade Name:
State of Domicile:	OH
County:	OUT OF STATE
Business Address
Address 1:	8770 W. BRYN MAWR SUITE 1000
Address 2:
City:	CHICAGO
State:	IL
Zip:	60631
Phone:	7738400690
Fax:
Business Web Site Address:
Business Email Address:
Mailing Address
Address 1:	8770 W BRYN MAWR SUTIE 1000
Address 2:
City:	CHICAGO
State:	IL
Zip:	60631
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
VINCENT A DIBENEDETTO	RDA	8555324	YES		02/05/2018
DOMINIC VOLINI	RDA	10632806		YES	02/05/2018

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:	APRIL EATON
Title:	LICENSING ADMINISTRATOR
Phone Number:	812-886-0191
Email Address:	ADEATON@SUPPORTIVEIS.COM