Notification of Changes for Business Entity
General Information
Business Entity Name:	SUPERIOR ACCESS INSURANCE SERVICES
Incorporation / Formation Date:
FEIN:	330725483
Ohio License Number:	39993, 23938
NPN:	1929753
DBA / Trade Name:
State of Domicile:	CA
County:	LOS ANGELES
Business Address
Address 1:	6500 RIVER PLACE BLVD., BIDG 5, SUITE 100
Address 2:
City:	AUSTIN
State:	TX
Zip:	78720
Phone:	8002727550
Fax:
Business Web Site Address:
Business Email Address:
Mailing Address
Address 1:	PO BOX 204389
Address 2:
City:	AUSTIN
State:	TX
Zip:	78720
Indicate the type of change you are seeking
Address Change:	YES
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:	NO

Licensed Producers
Name	Title	NPN	Add	Delete	Eff. Date

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:	BRIAN LAWLOR
Title:	SR VICE PRESIDET
Phone Number:	8002727550
Email Address:	BEVERLY@ALLIANCE-COMPLIANCE.COM