Notification of Changes for Business Entity
General Information
Business Entity Name:	UNITED CAPITAL RISK MANAGEMENT LLC
Incorporation / Formation Date:
FEIN:	273089434
Ohio License Number:	41847
NPN:	15907756
DBA / Trade Name:
State of Domicile:	TX
County:	DALLAS
Business Address
Address 1:	125 E JOHN CARPENTER FWY STE 1200
Address 2:
City:	IRVING
State:	TX
Zip:	75062
Phone:	9724090885
Fax:
Business Web Site Address:
Business Email Address:
Mailing Address
Address 1:	125 E JOHN CARPENTER FWY STE1200
Address 2:
City:	IRVING
State:	TX
Zip:	75062
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
THAD DUNN	AGENT	5329416	YES		12212016
DAVID CASS	AGENT	363654	YES		12212016

Members, Owners, Partners, Officers and Directors
Name	Title	Identifying #	Add	Delete	Eff. Date
DAVID CASS	DIRECTOR	363654		YES	12212016
THADD DUNN	DIRECTOR	5329416		YES	12212016

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:	CANDY MCKINNEY
Title:	LICENSING REPRESENTATIVE
Phone Number:	8124942392
Email Address:	CWMCKINNEY@SUPPORTIVEIS.COM