Notification of Changes for Business Entity
General Information
Business Entity Name:	NATIONAL FLOOD SERVICES LLC
Incorporation / Formation Date:
FEIN:	81-0453933
Ohio License Number:
NPN:
DBA / Trade Name:
State of Domicile:	DE
County:	JOHNSON
Business Address
Address 1:	ATTN: AGENCY LICENSING
Address 2:	7701 COLLEGE BLVD
City:	OVERLAND PARK
State:	KS
Zip:	66210
Phone:	888-888-2169
Fax:
Business Web Site Address:
Business Email Address:
Mailing Address
Address 1:	ATTN: AGENCY LICENSING
Address 2:	7701 COLLEGE BLVD
City:	OVERLAND PARK
State:	KS
Zip:	66210
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
LUCY BACHLOTT	EMPLOYEE	551988	YES		11-19-2018
LAKISHA DAVIS	EMPLOYEE	6621764	YES		11-19-2018
JOCELYN LEE	EMPLOYEE	16684900	YES		11-19-2018
DENIS PIZZA	EMPLOYEE	3955782	YES		11-19-2018

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:	KARI SMITH
Title:	LICENSING ADMINISTRATOR
Phone Number:	812-886-0191
Email Address:	KNSMITH@SUPPORTIVEIS.COM