Notification of Changes for Business Entity
General Information
Business Entity Name:	EXTEND INSURANCE SERVICES, LLC
Incorporation / Formation Date:
FEIN:	202487260
Ohio License Number:
NPN:
DBA / Trade Name:
State of Domicile:	UT
County:	SALT LAKE
Business Address
Address 1:	10975 S STERLING VIEW DRIVE STE A1
Address 2:
City:	SOUTH JORDAN
State:	UT
Zip:	84095
Phone:	8014150579
Fax:
Business Web Site Address:
Business Email Address:	LAC@WILLISTOWERSWATSON.COM
Mailing Address
Address 1:	10975 S STERLING VIEW DRIVE STE A1
Address 2:
City:	SOUTH JORDAN
State:	UT
Zip:	84095
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:	NO

Licensed Producers
Name	Title	NPN	Add	Delete	Eff. Date
ALLEN KIRABO	AGENT	17670483	YES		07/05/2018
WYNETHA ALEXANDER	AGENT	16935069	YES		07/05/2018
CHRISTOPHER ARTHUR	AGENT	17063268	YES		07/05/2018
THOMAS BESHEARS	AGENT	16769589	YES		07/05/2018
ASHLEY BREWER	AGENT	17345026	YES		07/05/2018
JAZLEY CHAPPELLE	AGENT	17029858	YES		07/05/2018
JOE COPELAND	AGENT	1285674	YES		07/05/2018
FRANK FRANCIS	AGENT	17335667	YES		07/05/2018
KENDALL FURLONG	AGENT	17097608	YES		07/05/2018
SKYE GARCIA	AGENT	17328350	YES		07/05/2018
TWILA GIBSON	AGENT	18056802	YES		07/05/2018
JUDY GODWIN	AGENT	17063213	YES		07/05/2018
ALBERT JANEZIC	AGENT	3181889	YES		07/05/2018
TONI NELSON	AGENT	1633559	YES		07/05/2018
DANDRA NEWMAN	AGENT	1288630	YES		07/05/2018

Members, Owners, Partners, Officers and Directors
Name	Title	Identifying #	Add	Delete	Eff. Date
DAVID FEIL

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:	CAMERON LILJENQUIST
Title:	SVP & CHIEF TECHNOLOGY OFFICER
Phone Number:	8014150579
Email Address:	LAC@WILLISTOWERSWATSON.COM