Notification of Changes for Business Entity
General Information
Business Entity Name:	ESIX 3 LLC
Incorporation / Formation Date:
FEIN:	262822589
Ohio License Number:
NPN:
DBA / Trade Name:
State of Domicile:	OH
County:	COBB
Business Address
Address 1:	2727 PACES FERRY ROAD, BLDG TWO, SUITE 1500
Address 2:
City:	ATLANTA
State:	GA
Zip:	30339
Phone:	6783243300
Fax:
Business Web Site Address:
Business Email Address:
Mailing Address
Address 1:	21650 OXNARD ST. STE 2350
Address 2:
City:	WOODLAND HILLS
State:	CA
Zip:	91367
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
RANDY MELCHER	DESIGNATED PRODUCER	1110233	YES		6/29/2016
MIKE PRICE	DESIGNATED PRODUCER	53958		YES	6/29/2016

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:	KRISTIE WASHINGTON
Title:	PROJECT COORDINATOR
Phone Number:	254-729-6167
Email Address:	KWASHINGTON@ILSAINC.COM