Notification of Changes for Business Entity
General Information
Business Entity Name:	EDGEWOOD PARTNERS INSURANCE CENTER
Incorporation / Formation Date:
FEIN:	943195221
Ohio License Number:
NPN:	757760
DBA / Trade Name:
State of Domicile:	CA
County:	SAN FRANCISCO
Business Address
Address 1:	135 MAIN STREET, 21ST FLOOR
Address 2:
City:	SAN FRANCISCO
State:	CA
Zip:	94105
Phone:	415-356-3900
Fax:
Business Web Site Address:
Business Email Address:
Mailing Address
Address 1:	135 MAIN STREET, 21ST FLOOR
Address 2:
City:	SAN FRANCISCO
State:	CA
Zip:	94105
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
JAMES DOUGLAS WATT	PRESIDENT, SOUTHWEST REGION	1262410	YES		1/16/2017

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:	MICHAEL GONTHIER
Title:	CHIEF ADMINISTRATIVE OFFICER
Phone Number:	415-356-3930
Email Address:	MIKE.GONTHIER@EPICBROKERS.COM