Notification of Changes for Business Entity
General Information
Business Entity Name:	BOAT US INC
Incorporation / Formation Date:
FEIN:	541259466
Ohio License Number:	25856
NPN:
DBA / Trade Name:
State of Domicile:	VA
County:	FAIRFAX
Business Address
Address 1:	880 SOUTH PICKETT STREET
Address 2:
City:	ALEXANDRIA
State:	VA
Zip:	22304
Phone:	703-461-2578
Fax:
Business Web Site Address:
Business Email Address:
Mailing Address
Address 1:	PO BOX 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
RUSSELL DAY	PRODUCER	18262353		YES	03/21/2018
GRACE DOLAN	PRODUCER	17261059		YES	03/21/2018
MONIQUE BEALE	PRODUCER	5692785		YES	03/21/2018
CATHLEEN WARE	PRODUCER	13222971		YES	03/21/2018

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:	PAMELA ESCOBAR
Title:	LICENSING ASSISTANT
Phone Number:	703-461-2878
Email Address:	PESCOBAR@BOATUS.COM