Notification of Changes for Business Entity
General Information
Business Entity Name:	INTUIT INSURANCE SERVICES, INC.
Incorporation / Formation Date:	11/15/2010
FEIN:	27-3061951
Ohio License Number:	41973
NPN:	15881685
DBA / Trade Name:
State of Domicile:	CA
County:	USA
Business Address
Address 1:	6888 SIERRA CENTER PARKWAY
Address 2:
City:	RENO
State:	NV
Zip:	89511
Phone:	7754248211
Fax:
Business Web Site Address:
Business Email Address:	WENDY_MOORE@INTUIT.COM
Mailing Address
Address 1:	6888 SIERRA CENTER PARKWAY
Address 2:
City:	RENO
State:	NV
Zip:	89511
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
DALTON EDWARD MAFFETT	RDA	9060020		YES	9-16-16
FAYE ANN SHEA	EMPLOYEE	15813510		YES	9-16-16
WENDY ELISE MOORE	RDA	17965242	YES		9-16-16
VERONICA ELIZABETH CASTRO	RDA	17963498	YES		9-16-16

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:	WENDY E. MOORE
Title:	SECRETARY
Phone Number:	775-424-8211
Email Address:	WENDY_MOORE@INTUIT.COM