Notification of Changes for Business Entity
General Information
Business Entity Name:	INSPHERE INSURANCE SOLUTIONS, INC
Incorporation / Formation Date:
FEIN:	27-027777-1
Ohio License Number:	39897
NPN:	14412207
DBA / Trade Name:
State of Domicile:	DE
County:	TARRANT
Business Address
Address 1:	9151 BOULEVARD 26
Address 2:
City:	NORTH RICHLAND HILLS
State:	TX
Zip:	76180
Phone:	817-255-3454
Fax:
Business Web Site Address:
Business Email Address:	ONBOARDING@INSPHEREHQ.COM
Mailing Address
Address 1:	9151 BOULEVARD 26
Address 2:
City:	NORTH RICHLAND HILLS
State:	TX
Zip:	76180
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
ANDEW HADEN	PRODUCER	16423907	YES		01/20/2017
ARTHURENE LISA CARDWELL	PRODUCER	177275147	YES		01/20/2017
AUSTIN WAYNE FAVORS	PRODUCER	16616542	YES		01/20/2017
BRENDA RENEE MOORE	PRODUCER	17064143	YES		01/20/2017
BRYAN D CECILIO	PRODUCER	984049	YES		01/20/2017
CALVIN KING LEWIS	PRODUCER	8059597	YES		01/20/2017
DANIEL RONALD ZAWICKI	PRODUCER	16139890	YES		01/20/2017
DARSHAN SINGH BAMBRAH	PRODUCER	18106548	YES		01/20/2017
DAVID SCHAFER	PRODUCER	814828	YES		01/20/2017
DEVIN MIKEL MILLER	PRODUCER	17904085	YES		01/20/2017
ELAINA NOEL DEROSE	PRODUCER	18264448	YES		01/20/2017
ERIK RUSSELL GUSTAFSON	PRODUCER	10830014	YES		01/20/2017
FRECHELLE NICOLE RIVERS	PRODUCER	17329489	YES		01/20/2017
GARY KINNARD	PRODUCER	8340402	YES		01/20/2017
JODI DEVON NASH	PRODUCER	17658119	YES		01/20/2017

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)	NO
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?	NO
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:	JAMES C MASON
Title:	SR VICE PRESIDENT
Phone Number:	8172553454
Email Address:	ONBOARDING@INSPHEREHQ.COM