Notification of Changes for Business Entity
General Information
Business Entity Name:	SCOTTISH AMERICAN RISK SERVICES, LLC
Incorporation / Formation Date:
FEIN:	383872186
Ohio License Number:	961102
NPN:
DBA / Trade Name:
State of Domicile:	OR
County:	DESCHUTES
Business Address
Address 1:	1012 SE CLEVELAND SQUARE, LOOP #5
Address 2:
City:	BEND
State:	OR
Zip:	97702
Phone:	3032843225
Fax:
Business Web Site Address:
Business Email Address:
Mailing Address
Address 1:	1012 SE CLEVELAND SQUARE, LOOP #5
Address 2:
City:	BEND
State:	OR
Zip:	97702
Indicate the type of change you are seeking
Address Change:	YES
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:	NO

Licensed Producers
Name	Title	NPN	Add	Delete	Eff. Date
ARTHUR BALDWIN	VICE PRESIDENT			YES	02/01/2016

Members, Owners, Partners, Officers and Directors
Name	Title	Identifying #	Add	Delete	Eff. Date
ARTHUR BALDWIN	VICE PRESIDENT			YES	02/01/2016

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:	CAROL A. HILL
Title:	AUTHORIZED PERSON
Phone Number:	817.800.5694
Email Address:	CHILL@ARCLICENSING.COM