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:	18014150579
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
ABBE G SEALOCK	AGENT	17023708		YES
ALEC WISCOMBE	AGENT	17324190		YES
AMANDA MARGARET BILTON	AGENT	17583400		YES
BILLIE JO THOMPSON	AGENT	4590341		YES
CHASE W BOYD	AGENT	17049557		YES
CHRISTIE BROWNE CARROLL	AGENT	18002254		YES
DEONA KAYLEE EARL	AGENT	18818154		YES
JESUS BARRAGAN	AGENT	18577618		YES
KELVIN BUDD PORTER	AGENT	18051308		YES
LAVON CHERI CARTER	AGENT	17055365		YES
MARK DWAYNE BURT	AGENT	17059281		YES
MARY ANN PAREDES CARROLL	AGENT	17037054		YES
MIRANDA GREGORY	AGENT	18848265		YES
OCTAVIA MARIE CHAMBERS	AGENT	18048372		YES
PEGGY O YOUNG	AGENT	16708518		YES

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)
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:	18014150579
Email Address:	LAC@WILLISTOWERSWATSON.COM