Notification of Changes for Business Entity
General Information
Business Entity Name:	BOAT/U.S., INC.
Incorporation / Formation Date:
FEIN:	54-1259466
Ohio License Number:
NPN:
DBA / Trade Name:
State of Domicile:	VA
County:	USA
Business Address
Address 1:	880 S PICKETT ST
Address 2:
City:	ALEXANDRIA
State:	VA
Zip:	22304
Phone:	7034612878
Fax:
Business Web Site Address:
Business Email Address:	BDULANTO@BOATUS.COM
Mailing Address
Address 1:	880 S. PICKETT ST., # 22381
Address 2:
City:	ALEXANDRIA
State:	VA
Zip:	22304
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
TORREY EVANS	PRODUCER	17287204	YES		1/6/16
JASON FALLIN	PRODUCER	3696896	YES		1/6/16
SANDRA FILER	PRODUCER	643920	YES		1/6/16
RICHARD GRANDINETTA	PRODUCER	2766196	YES		1/6/16
NATHAN GRANT	PRODUCER	16559818	YES		1/6/16
RADHA HAREWOOD	PRODUCER	13310560	YES		1/6/16
ADWOA HAYFRON-BENJAMIN	PRODUCER	16924248	YES		1/6/16
VALERIA HERNANDEZ	PRODUCER	16982733	YES		1/6/16
ERICA HUGGINS	PRODUCER	16692067	YES		1/6/16
HELEN IGLESIAS	PRODUCER	16604480	YES		1/6/16
KRISTA IZOR	PRODUCER	16494006	YES		1/6/16
DONNETTE JACKSON	PRODUCER	6415927	YES		1/6/16
LINDSEY JOHNSON	PRODUCER	16899429	YES		1/6/16
KATHRINE JOHNSON	PRODUCER	17179526	YES		1/6/16
JACKELYN JORDAN	PRODUCER	17128578	YES		1/6/16

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:	BLANCA DULANTO
Title:	SUPERVISOR
Phone Number:	7034612878
Email Address:	BDULANTO@BOATUS.COM