Notification of Changes for Business Entity
General Information
Business Entity Name:	EDISABILITY, LLC
Incorporation / Formation Date:
FEIN:	465551347
Ohio License Number:
NPN:
DBA / Trade Name:
State of Domicile:	CA
County:	SAN DIEGO
Business Address
Address 1:	11512 EL CAMINO REAL, SUITE 110
Address 2:
City:	SAN DIEGO
State:	CA
Zip:	92130
Phone:	(619) 808-3361
Fax:
Business Web Site Address:
Business Email Address:
Mailing Address
Address 1:	11512 EL CAMINO REAL, SUITE 110
Address 2:
City:	SAN DIEGO
State:	CA
Zip:	92130
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
KAREN FLECK	MANAGER			YES	12/12/2018

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:	BRIANA SALAZAR
Title:	LICENSING SPECIALIST
Phone Number:	2547298000
Email Address:	BSALAZAR@ILSAINC.COM