Notification of Changes for Business Entity
General Information
Business Entity Name:	RENEW.COM INSURANCE SERVICES LLC
Incorporation / Formation Date:
FEIN:	611816067
Ohio License Number:	1192329
NPN:
DBA / Trade Name:
State of Domicile:	CA
County:	LOS ANGELES
Business Address
Address 1:	1411 5TH STREET
Address 2:	SUITE 300
City:	SANTA MONICA
State:	CA
Zip:	90401
Phone:	424-221-5771
Fax:
Business Web Site Address:
Business Email Address:
Mailing Address
Address 1:	1411 5TH STREET
Address 2:	SUITE 300
City:	SANTA MONICA
State:	CA
Zip:	90401
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
AUBREY WILLIS	PRODUCER	18079902	YES		9/24/18

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:	ELIZABETH EBINER
Title:	OPERATIONS ASSOCIATE
Phone Number:	909-646-0914
Email Address:	EBINER@RENEW.COM