Notification of Changes for Business Entity
General Information
Business Entity Name:	SUPERIOR VISION SERVICES, INC.
Incorporation / Formation Date:	03/17/1993
FEIN:	13-3741352
Ohio License Number:	950861
NPN:	663130
DBA / Trade Name:
State of Domicile:	DE
County:	NEW CASTLE
Business Address
Address 1:	11101 WHITE ROCK ROAD
Address 2:
City:	RANCHO CORDOVA
State:	CA
Zip:	95670
Phone:	800-923-6766 X2220
Fax:	916-859-6213
Business Web Site Address:	WWW.SUPERIORVISION.COM
Business Email Address:	SPARKINSON@SUPERIORVISION.COM
Mailing Address
Address 1:	ATTN: SANDRA PARKINSON, COMPLIANCE MANAGER
Address 2:	11101 WHITE ROCK ROAD
City:	RANCHO CORDOVA
State:	CA
Zip:	95670
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
GREG BECK	VICE PRESIDENT	1877629		YES	08/10/2017
GREG BECK	MANAGER	1877629	YES		08/10/2017
MARK WALLNER	AGENT	6477317	YES		08/10/2017
MARK WALLNER	MANAGER	6477317	YES		08/10/2017
ROBERT E FRATIANNE	RDA	1866154	YES		08/10/2017
ROXANNE KOOPMAN	RDA	5653698	YES		08/10/2017

Members, Owners, Partners, Officers and Directors
Name	Title	Identifying #	Add	Delete	Eff. Date
CHRISTOPHER J CROSBY	DIRECTOR	014-58-7963		YES	03/31/2016
KIMBERLY D HESS	OFFICER	512-62-4373		YES	12/31/2016
KIMBERLY D HESS	MANAGER	512-62-4373		YES	12/31/2016
NAUTIC PARTNERS VI LP	OWNER	20-5455960		YES	03/31/2016
NAUTIC PARTNERS VI-A LP	OWNER	20-5456028		YES	03/31/2016
RICKARD P CORBETT	STOCKHOLDER	274-50-2714		YES	04/01/2015
STEPHANIE J LUCAS	AGENT	1471008	YES		08/10/2017
SUPERIOR VISION HOLDINGS, INC.	OWNER	20-8963174	YES		03/31/2016

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:	BRUCE TAVEL
Title:	SR. VP, SECRETARY, GC, & CHIEF COMPLIANCE OFFICER
Phone Number:	800-243-1401 X7110
Email Address:	PLEE@SUPERIORVISION.COM