Notification of Changes for Business Entity
General Information
Business Entity Name:	NATIONAL RISK MANAGEMENT SERVICES, INC.
Incorporation / Formation Date:	04/09/1992
FEIN:	34-1705721
Ohio License Number:	2823
NPN:	2775616
DBA / Trade Name:
State of Domicile:	OH
County:	CUYAHOGA
Business Address
Address 1:	7181 CHAGRIN RD., SUITE 230
Address 2:
City:	CHAGRIN FALLS
State:	OH
Zip:	44023
Phone:	440-247-2708
Fax:	440-247-2714
Business Web Site Address:
Business Email Address:
Mailing Address
Address 1:	7181 CHAGRIN RD., SUITE 230
Address 2:
City:	CHAGRIN FALLS
State:	OH
Zip:	44023
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
DEBORAH JANE BARTOS	AGENT	11742309	YES		1/14/2016
LEO F. BOLKO, III	PRODUCER	2775791	YES		1/14/2016
MICHAEL J. BUSH	PRODUCER	17055656	YES		1/14/2016
SHERYL CZUCHRA	AGENT	16136472	YES		1/14/2016
JENNIFER GARRETT	AGENT	9305913	YES		1/14/2016
CHRISTINE DANIELLE HENDERSON	AGENT	2064147	YES		1/14/2016
THOMASINA MARIE LEAK	AGENT	8926039	YES		1/14/2016
SANDRA M. LESIAK	PRODUCER	2769627	YES		1/14/2016
STEVEN V. LIBERTORE	PRODUCER	1676022	YES		1/14/2016
TRACY GEDEON WEM	PRODUCER	2209593	YES		1/14/2016

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:	DONNA M. ZALLAR
Title:	ADMINISTRATIVE ASSISTANT
Phone Number:	440-247-2708
Email Address:	DZALLAR@NTLRISK.COM