Notification of Changes for Business Entity
General Information
Business Entity Name:	BORDER CITY INSURANCE SERVICES INC
Incorporation / Formation Date:
FEIN:	46-2573678
Ohio License Number:	1030882
NPN:	17261002
DBA / Trade Name:
State of Domicile:	CA
County:	SAN DIEGO
Business Address
Address 1:	12463 RANCHO BERNARDO RD
Address 2:	#198
City:	SAN DIEGO
State:	CA
Zip:	92128
Phone:	415-737-0911
Fax:
Business Web Site Address:
Business Email Address:
Mailing Address
Address 1:	12463 RANCHO BERNARDO RD
Address 2:	#198
City:	SAN DIEGO
State:	CA
Zip:	92128
Indicate the type of change you are seeking
Address Change:	NO
Business Entity Name Change:	YES	Old Business Entity Name:	ATAS TRUCK INS AGENCY INC
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)	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:	DEAN WATTERS
Title:	PRESIDENT
Phone Number:	4150737-0911
Email Address:	DWATTERS@BORDERCITYINS.COM