Notification of Changes for Business Entity
General Information
Business Entity Name:	KNIGHT TRANSPORTATION INSURANCE SERVICES, LLC
Incorporation / Formation Date:	06/19/2009
FEIN:	270873839
Ohio License Number:	1008272
NPN:	16550175
DBA / Trade Name:
State of Domicile:	DE
County:	COOK
Business Address
Address 1:	150 NORTHWEST POINT BLVD
Address 2:	2ND FLOOR
City:	ELK GROVE VILLAGE
State:	IL
Zip:	60007
Phone:	8477008100
Fax:
Business Web Site Address:
Business Email Address:
Mailing Address
Address 1:	150 NORTHWEST POINT BLVD
Address 2:	2ND FLOOR
City:	ELK GROVE VILLAGE
State:	IL
Zip:	60007
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
RONNA LARSON	PRODUCER	358887	YES		4/3/2017
THERESA SANCHEZ	PRODUCER	2722943	YES		4/3/2017

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:	MOLLY WARREN
Title:	SUBMITTER
Phone Number:	8009279801
Email Address:	BLINSURANCE@CSCGLOBAL.COM