Notification of Changes for Business Entity
General Information
Business Entity Name:	RSC INSURANCE BROKERAGE
Incorporation / Formation Date:
FEIN:	16-1689464
Ohio License Number:
NPN:
DBA / Trade Name:
State of Domicile:	MA
County:	SUFFOLK
Business Address
Address 1:	160 FEDERAL ST 2ND FLOOR
Address 2:
City:	BOSTON
State:	MA
Zip:	02110
Phone:	212-297-1487
Fax:
Business Web Site Address:
Business Email Address:
Mailing Address
Address 1:	160 FEDERAL ST 2ND FLOOR
Address 2:
City:	BOSTON
State:	MA
Zip:	02110
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
PETER SCHLACTUS	EMPLOYEE	938839	YES		08-29-2017
HARVEY SHELDON	EMPLOYEE	82041	YES		08-29-2017
PETER SHOEMAKER	EMPLOYEE	7417091	YES		08-29-2017
DAVID SINGER	EMPLOYEE	1980919	YES		08-29-2017
ANDREA STEGMAIER	EMPLOYEE	3701250	YES		08-29-2017
JACK STEPHENSON	EMPLOYEE	551690	YES		08-29-2017
JOLYON STERN	EMPLOYEE	425791	YES		08-29-2017
PATRICIA SULLIVAN	EMPOLYEE	3479156	YES		08-29-2017
CATHRYN SUSSMAN	EMPLOYEE	1523890	YES		08-29-2017
LAURA TRAEGER	EMPLOYEE	486354	YES		08-29-2017
MICHAEL TSOTSIS	EMPLOYEE	396912	YES		08-29-2017
JEREMY VOLDRICH	EMPLOYEE	2776495	YES		08-29-2017
SUSAN WADE	EMPLOYEE	1869860	YES		08-29-2017
ROSEANN WARTH	EMPLOYEE	2343193	YES		08-29-2017
MICHAEL WATERS	EMPLOYEE	1722289	YES		08-29-2017

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:	KARI SMITH
Title:	LICENSING ADMIN.
Phone Number:	812-886-0191
Email Address:	KNSMITH@SUPPORTIVEIS.COM