Notification of Changes for Business Entity
General Information
Business Entity Name:	RENAISSANCE ALLIANCE INSURANCE SERVICES, LLC
Incorporation / Formation Date:
FEIN:	043456048
Ohio License Number:	34309
NPN:	3748814
DBA / Trade Name:
State of Domicile:	MA
County:	NORFOLK
Business Address
Address 1:	981 WORCESTER STREET
Address 2:
City:	WELLESLEY
State:	MA
Zip:	02482
Phone:	7814319800
Fax:
Business Web Site Address:
Business Email Address:	MARYLOU.FOSBERG@RENAISSANCEINS.COM
Mailing Address
Address 1:	981 WORCESTER STREET
Address 2:
City:	WELLESLEY
State:	MA
Zip:	02482
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
MATTHEW BARBAS	MANAGER	375983891	YES		09/19/2018
GUARAV BHANDARI	MANAGER	009727001	YES		09/19/2018
TOBIN WHAMOND	MANAGER	002501343	YES		09/19/2018
RANU DAYAL	MANAGER	231675764	YES		09/19/2018
KEVIN CALLAHAN	MANAGER/CHAIRMAN	090605851	YES		09/19/2018
LAC INV-RAIS LP	MEMBER	82-5330364	YES		09/16/2018
KENN R ALLEN	DIRECTOR	296462112		YES	09/19/2018
ROBERT GRUHL	CFO/ DIRECTOR	369463778		YES	09/19/2018
LYMAN BULLARD	SECRETARY	025363271		YES	09/19/2018
WILLIAM BEGLEY	DIRECTOR	022445024		YES	09/19/2018
PATRICK MCDONALD	DIRECTOR	039489124		YES	09/19/2018
STEVEN BERRY	DIRECTOR	083605632		YES	09/19/2018
DOUGLAS BRIGGS	MEMBER	026442524		YES	09/196/2018

Members, Owners, Partners, Officers and Directors
Name	Title	Identifying #	Add	Delete	Eff. Date
MATTHEW BARBAS	MANAGER		YES
GUARAV BHANDARI	MANAGER		YES
TOBIN WHAMOND	MANAGER		YES
RANU DAYAL	MANAGER		YES
KEVIN CALLAHAN	MANAGER/CHAIRMAN		YES
LAC INV-RAIS LP	MEMBER		YES
KENN R ALLEN	DIRECTOR			YES
ROBERT GRUHL	CFO/ DIRECTOR			YES
LYMAN BULLARD	SECRETARY			YES
WILLIAM BEGLEY	DIRECTOR			YES

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:	JANIE SELLERS
Title:	COMPLIANCE SPECIALIST
Phone Number:	2547296136
Email Address:	JSELLERS@ILSAINC.COM