Notification of Changes for Business Entity
General Information
Business Entity Name:	INTELLIQUOTE INSURANCE SERVICES, LLC
Incorporation / Formation Date:
FEIN:	36-4770799
Ohio License Number:
NPN:
DBA / Trade Name:
State of Domicile:	FL
County:	PINELLAS
Business Address
Address 1:	2650 MCCORMICK DR STE 200S
Address 2:
City:	CLEARWATER
State:	FL
Zip:	33759
Phone:	7272160859
Fax:
Business Web Site Address:
Business Email Address:
Mailing Address
Address 1:	2650 MCCORMICK DR STE 200S
Address 2:
City:	CLEARWATER
State:	FL
Zip:	33759
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
GARY LARD	MANAGER	1437521		YES	02/18/2016
PHILIP DEAN RANGER	MANAGER	3131235	YES		02/18/2016

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)	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:	TIMOTHY NORTH
Title:	CEO AL MARKETING LLC ITS MGR
Phone Number:	7272160859
Email Address:	TDUNCAN@AMERILIFE.COM