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:	YES

Licensed Producers
Name	Title	NPN	Add	Delete	Eff. Date
BRITTANEY ROBERSON MORRISON	AGENT	17641289	YES		07/05/2018
SARAH KLINGER	AGENT	16750007	YES		07/05/2018
ABBE SEALOCK	AGENT	17023708	YES		07/05/2018
JOSHUA ROBINSON	AGENT		YES		07/05/2018
JOHN WOOD	AGENT	13238039	YES		07/05/2018
JESSICA TURNER	AGENT	17696334	YES		07/05/2018
CASSIE GRAHAM	AGENT	17683302	YES		07/05/2018
TODD ROBINS	AGENT	9262191	YES		07/05/2018
LATASHA BANKS	AGENT	17608403	YES		07/05/2018
STEVEN BIASATTI	AGENT	14910480	YES		07/05/2018
KIMBERLIN WHITE	AGENT	17106276	YES		07/05/2018
CRYSTAL WILLIAMS	AGENT	17358699	YES		07/05/2018
SYLVIA MALONE	AGENT	17685860	YES		07/05/2018
JAERRME RAWSON GARCIA	AGENT	17328412	YES		07/05/2018
KIRT MONIZ	AGENT	17104847	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