Notification of Changes for Business Entity
General Information
Business Entity Name:	FOCUS INS SERVICES, LLC
Incorporation / Formation Date:
FEIN:	20-8542484
Ohio License Number:	1079831
NPN:	17686073
DBA / Trade Name:
State of Domicile:	FL
County:	BROWARD
Business Address
Address 1:	1300 SAWGRASS CORPORATE PARKWAY, SUITE 300
Address 2:	SUITE 300
City:	SUNRISE
State:	FL
Zip:	33323
Phone:	954-331-4800
Fax:
Business Web Site Address:
Business Email Address:
Mailing Address
Address 1:	1300 SAWGRASS CORPORATE PARKWAY
Address 2:	SUITE 300
City:	SUNRISE
State:	FL
Zip:	33323
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
KATE WALLACE	AGENT	15120139		YES	08/17/18
STEPHANIE AYERS	AGENT	17067667		YES	08/17/18
ALESHIA WASHBURN	AGENT	17718566	YES		08/17/18
GAYLA RICHARDSON	AGENT	18494811	YES		08/17/18
GINA M.K. YOON	AGENT	17686073	YES		08/17/18
JILL N BASHANSCI	AGENT	16844469	YES		08/17/18
JULIE MICHELE NAVIN	AGENT	15479750	YES		08/17/18
TIMOTHY WILSON SHORE	AGENT	8831408	YES		08/17/18
VERONICA V FERGUSON	AGENT	17648450	YES		08/17/18
WANONA MARIE RODERICK	AGENT	17137458	YES		08/17/18

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:	ORION WHITLOCK
Title:	SECRETARY
Phone Number:	954-331-4800
Email Address:	SKIP.WHITLOCK@TEAMFOCUSINS.COM