Notification of Changes for Business Entity
General Information
Business Entity Name:	KWRW, INC
Incorporation / Formation Date:
FEIN:	880282158
Ohio License Number:	1091402
NPN:
DBA / Trade Name:
State of Domicile:	OH
County:	UNKNOWN
Business Address
Address 1:	7040 LAREDO ST STE# H
Address 2:
City:	LAS VEGAS
State:	NV
Zip:	89117
Phone:	702-360-8333
Fax:
Business Web Site Address:
Business Email Address:
Mailing Address
Address 1:	SAME AS ABOVE
Address 2:
City:	LAS VEGAS
State:	NV
Zip:	89117
Indicate the type of change you are seeking
Address Change:	NO
Business Entity Name Change:	NO	Old Business Entity Name:
New DBA/Trade Name:	YES	New DBA/Trade Name:	MOUNTAIN PACIFIC INS. AGCY.
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

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:	TAMMI SOTO
Title:	AGENCY MANAGER
Phone Number:	7023608333
Email Address:	SOTOT2@NATIONWIDE.COM