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 DR 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:	YES

Licensed Producers
Name	Title	NPN	Add	Delete	Eff. Date
BRITTANY CALDWELL	AGENT	18030420	YES		8/21/2018
TAMIKA TAYLOR	AGENT	17444384	YES		8/21/2018
FAHJA BAPTIST	AGENT	18871488	YES		8/21/2018
JOHN BENDIXEN	AGENT	18780533	YES		8/21/2018
JESUS BARRAGAN	AGENT	18577618	YES		8/21/2018
RAGINE BENDER	AGENT	18082239	YES		8/21/2018
STEWART BENDIT	AGENT	768322	YES		8/21/2018
NIKKI BURGESS	AGENT	18864023	YES		8/21/2018
LEAH DAVIDSON	AGENT	18789644	YES		8/21/2018
SHARI EDWARDS	AGENT	17049632	YES		8/21/2018
MELISSA DOUGHERTY	AGENT	18784313	YES		8/21/2018
DEONA EARL	AGENT	18818154	YES		8/21/2018
MIRANDA GREGORY	AGENT	18848265	YES		8/21/2018
LESLIE HATCH	AGENT	18831519	YES		8/21/2018
OYAS JACKSON	AGENT	18328006	YES		8/21/2018

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