Notification of Changes for Business Entity
General Information
Business Entity Name:	RSC INSURANCE BROKERAGE
Incorporation / Formation Date:
FEIN:	16-1689464
Ohio License Number:
NPN:
DBA / Trade Name:
State of Domicile:	MA
County:	SUFFOLK
Business Address
Address 1:	160 FEDERAL ST 2ND FLOOR
Address 2:
City:	BOSTON
State:	MA
Zip:	02110
Phone:	212-297-1487
Fax:
Business Web Site Address:
Business Email Address:
Mailing Address
Address 1:	160 FEDERAL ST 2ND FLOOR
Address 2:
City:	BOSTON
State:	MA
Zip:	02110
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
JOSEPH LEVY	EMPLOYEE	2057216	YES		08-29-2017
THOMAS MAGGS	EMPLOYEE	1639139	YES		08-29-2017
MARK MANZI	EMPLOYEE	4642328	YES		08-29-2017
JEAN MCNAMARA	EMPLOYEE	2772726	YES		08-29-2017
JONATHAN MOSSE	EMPLOYEE	2299870	YES		08-29-2017
JOYCE MRAZ	EMPLOYEE	9075340	YES		08-29-2017
AMBER NAGY	EMPLOYEE	16380691	YES		08-29-2017
CHARLES NEWTON	EMPLOYEE	1308463	YES		08-29-2017
JAMES OKONSKI	EMPLOYEE	1031251	YES		08-29-2017
NICOLE OLSON	EMPLOYEE	17257547	YES		08-29-2017
BRYAN PAULOZZI	EMPLOYEE	12935400	YES		08-29-2017
BRYAN PENDRICK	EMPLOYEE	2348020	YES		08-29-2017
BRONWYN ROCHFORD	EMPLOYEE	14687930	YES		08-29-2017
SCOTT SCHACHTER	EMPLOYEE	7395908	YES		08-29-2017
SHARON SCHEUERMANN	EMPLOYEE	950019	YES		08-29-2017

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:	KARI SMITH
Title:	LICENSING ADMIN.
Phone Number:	812-886-0191
Email Address:	KNSMITH@SUPPORTIVEIS.COM