Notification of Changes for Business Entity
General Information
Business Entity Name:	AEGIS RISK MANAGEMENT INSURANCE SERVICES, INC.
Incorporation / Formation Date:	04/16/1987
FEIN:	330236175
Ohio License Number:	38521
NPN:	1680171
DBA / Trade Name:
State of Domicile:	CA
County:	LOS ANGELES
Business Address
Address 1:	3424 CARSON STREET, SUITE 300
Address 2:
City:	TORRANCE
State:	CA
Zip:	90503
Phone:	3107931309
Fax:	3107931314
Business Web Site Address:	HTTP://WWW.AEGISRM.COM
Business Email Address:	EMAIL@AEGISRM.COM
Mailing Address
Address 1:	3424 CARSON STREET, SUITE 300
Address 2:
City:	TORRANCE
State:	CA
Zip:	90503
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
NARI TIEMAN	VICE PRESIDENT/COO	2737331	YES		7/31/2017

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)	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:	SHEILA SAY
Title:	ADMINISTRATIVE COORDINATOR
Phone Number:	3107931309
Email Address:	SHEILA.SAY@AEGISRM.COM