Notification of Changes for Business Entity
General Information
Business Entity Name:	ADVANCED E & S OF ILLINOIS LLC
Incorporation / Formation Date:
FEIN:	364186391
Ohio License Number:	39872
NPN:
DBA / Trade Name:
State of Domicile:	IL
County:	COOK
Business Address
Address 1:	333 WEST WACKER DR
Address 2:	SUITE 1200
City:	CHICAGO
State:	IL
Zip:	60606
Phone:	212-297-1487
Fax:
Business Web Site Address:
Business Email Address:	BROSE@RISK-STRATEGIES.COM
Mailing Address
Address 1:	420 LEXINGTON AVE SUITE 2700
Address 2:
City:	NEW YORK
State:	NY
Zip:	10170
Indicate the type of change you are seeking
Address Change:	YES
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

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:	BEATRICE HOOVER
Title:	LICENSING ADMINISTRATOR
Phone Number:	812-886-0191
Email Address:	BAHOOVER@SUPPORTIVEIS.COM