Notification of Changes for Business Entity
General Information
Business Entity Name:	AEGIS INSURANCE SERVICES INC
Incorporation / Formation Date:
FEIN:	222466904
Ohio License Number:
NPN:
DBA / Trade Name:
State of Domicile:	NJ
County:	BERGEN
Business Address
Address 1:	1 MEADOWLAND PLAZA
Address 2:
City:	EAST RUTHERFORD
State:	NJ
Zip:	07073
Phone:	201-508-2753
Fax:
Business Web Site Address:
Business Email Address:
Mailing Address
Address 1:	1 MEADOWLAND PLAZA
Address 2:
City:	EAST RUTHERFORD
State:	NJ
Zip:	07073
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

Members, Owners, Partners, Officers and Directors
Name	Title	Identifying #	Add	Delete	Eff. Date
ALAN MAGUIRE	OFFICER	145444021		YES	02/15/2017
EUGENE MCGRATH	DIRECTOR	070342525		YES	02/15/2017
GEORGE MAZANEC	DIRECTOR	328287474		YES	02/15/2017
R CASH	DIRECTOR	451661161		YES	02/15/2017
RICHARD REITEN	DIRECTOR	536368538		YES	02/15/2017
OWEN RYAN	DIR/CEO/COB/PRES	150686832	YES		02/15/2017
GREGORY ABEL	DIRECTOR	623281377	YES		02/15/2017
CHRISTOPHER CRANE	DIRECTOR	001408682	YES		02/15/2017
THOMAS FARRELL	DIRECTOR	226847188	YES		02/15/2017
CHARLES SCHROCK	DIRECTOR	371620556	YES		02/15/2017

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:	JANNA BELL
Title:	LICENSING ADMINISTRATOR
Phone Number:	812-886-0191
Email Address:	JBELL@SUPPORTIVEIS.COM