Notification of Changes for Business Entity
General Information
Business Entity Name:	PROPERTY SOLUTIONS INSURANCE AGENCY LLC
Incorporation / Formation Date:
FEIN:	352370769
Ohio License Number:	42321
NPN:
DBA / Trade Name:
State of Domicile:	UT
County:	UTAH
Business Address
Address 1:	2912 EXECUTIVE PARKWAY STE 100
Address 2:
City:	LEHI
State:	UT
Zip:	84043
Phone:	8778269700
Fax:
Business Web Site Address:
Business Email Address:
Mailing Address
Address 1:	2912 EXECUTIVE PARKWAY STE 100
Address 2:
City:	LEHI
State:	UT
Zip:	84043
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

Members, Owners, Partners, Officers and Directors
Name	Title	Identifying #	Add	Delete	Eff. Date
MICHAEL SWAN	RDA	16194591	YES		07/22/16
DANIEL BULLOCK	RDA	16344242		YES	07/22/16
KENDAHL ANDRADE	RDA	16518041		YES	07/22/16

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:	CANDY MCKINNEY
Title:	LICENSING REP
Phone Number:	8124942392
Email Address:	CWMCKINNEY@SUPPORTIVEIS.COM