Notification of Changes for Business Entity
General Information
Business Entity Name:	RISK PLACEMENT SERVICES, INC
Incorporation / Formation Date:	10/05/1979
FEIN:	36-3110841
Ohio License Number:	23614
NPN:	2101845
DBA / Trade Name:
State of Domicile:	IL
County:	DUPAGE
Business Address
Address 1:	TWO PIERCE PLACE
Address 2:
City:	ITASCA
State:	IL
Zip:	60143
Phone:	630-773-3800
Fax:
Business Web Site Address:
Business Email Address:
Mailing Address
Address 1:	TWO PIERCE PLACE
Address 2:
City:	ITASCA
State:	IL
Zip:	60143
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
NORMAN J NUTON JR	PRODUCER	1018217		YES	9/29/2016

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)	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:	KIM WILLIAMS
Title:	LICENSING ADMINISTRATOR
Phone Number:	630-285-4276
Email Address:	KIM_WILLIAMS@RPSINS.COM