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:
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
CHERYL ACQUAH-ROBERTSON	PRODUCER	10662325	YES		1/6/16
MARIEL ACOSTA	PRODUCER	15686533	YES		1/6/16
JESSIE ANSINK	PRODUCER	15845934	YES		1/6/16
JOHN BARTKOWSKI	PRODUCER	8625703	YES		1/6/16
SETH BUNDICK	PRODUCER	7945573	YES		1/6/16
SHERRY COLEMAN	PRODUCER	2367031	YES		1/6/16
WANDA COOPER	PRODUCER	15768647	YES		1/6/16
MATTHEW COVINGTON	PRODUCER	17368898	YES		1/6/16
KRISTINE DAVIS	PRODUCER	1023239	YES		1/6/16
GRACE DOLAN	PRODUCER	17261059	YES		1/6/16
MICHELLE DONOVAN	PRODUCER	9797550	YES		1/6/16
BRYAN DOVE	PRODUCER	16418910	YES		1/6/16
MORRISHA EVANS	PRODUCER	3898872	YES		1/6/16
CHRISTOPHER DOYLE	PRODUCER	16503764	YES		1/6/16
ANDRESS ESCOBAR	PRODUCER	16993559	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