Notification of Changes for Business Entity
General Information
Business Entity Name:	WILLIS OF FLORIDA, INC.
Incorporation / Formation Date:
FEIN:	650544419
Ohio License Number:
NPN:
DBA / Trade Name:
State of Domicile:	FL
County:	HILLSBOROUGH
Business Address
Address 1:	3407 W. MARTIN LUTHER KING JR.
Address 2:	SUITE 200
City:	TAMPA
State:	FL
Zip:	33607
Phone:	6158723447
Fax:
Business Web Site Address:
Business Email Address:
Mailing Address
Address 1:	3407 W. MARTIN LUTHER KING JR.
Address 2:	SUITE 200
City:	TAMPA
State:	FL
Zip:	33607
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
KARI LYNN MINUGH	PLACEMENT SPECIALIST	17002772	YES		12/27/2016

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)
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:	TRACIE HITE
Title:	LICENSING COMPLIANCE ANAYST
Phone Number:	6158723447
Email Address:	TRACIE.HITE@WILLISTOWERSWATSON.COM