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:	NO

Licensed Producers
Name	Title	NPN	Add	Delete	Eff. Date
DORIS STEPHENS	AGENT	17340922	YES		07/05/2018
RICHARD KOSGEI	AGENT	17328384	YES		07/05/2018
TIERRA LACY	AGENT	18083947	YES		07/05/2018
JOHN CARTER	AGENT	17080035	YES		07/05/2018
HEIDI MORIN	AGENT	17344990	YES		07/05/2018
JAMES WELLS	AGENT	17098639	YES		07/05/2018
NORMAN MACMANN	AGENT	17015409	YES		07/05/2018
SHERRY CLARK THOMAS	AGENT	17629957	YES		07/05/2018
VICTORIA MORRISON	AGENT	17715461	YES		07/05/2018
LASHUNDRA JOHNSON	AGENT	17335702	YES		07/05/2018
JESSIE WILKERSON	AGENT	17073546	YES		07/05/2018
ZEEKEITHIA COLLINS	AGENT	17677787	YES		07/05/2018
CHASTITY LEWIS	AGENT	17583481	YES		07/05/2018
MELODY ANDREWS	AGENT	17749819	YES		07/05/2018
ERIC MCCLELLAN	AGENT	17685891	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