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
JACQUELINE MABEL MARTIN	PRODUCER	8672418		YES	01/20/2017
JOHN ALIER	PRODUCER	17899835		YES	01/20/2017
JOHN CAMERON ROACH	PRODUCER	17434924		YES	01/20/2017
JOHN MARCUS REAL	PRODUCER	17604817		YES	01/20/2017
JOSEPH CHUBA	PRODUCER	16818327		YES	01/20/2017
JUANISHA S BRADFORD	PRODUCER	16717689		YES	01/20/2017
KENNETH KIRKPATRICK	PRODUCER	1852763		YES	01/20/2017
LAKIESHA LASHUNE STINSON	PRODUCER	16816386		YES	01/20/2017
LATONYA MARIE EPPS	PRODUCER	17797492		YES	01/20/2017
LAURICE NICOLE MARTINEZ	PRODUCER	17180254		YES	01/20/2017
LEAMECA SHUNYA DAVIS	PRODUCER	17936167		YES	01/20/2017
LEONA JEFFRIES	PRODUCER	17792528		YES	01/20/2017
LESLEY LEON TINOCO	PRODUCER	17654007		YES	01/20/2017
LOIS SCOTT GRIFFIN	PRODUCER	17987257		YES	01/20/2017
LORETTA MANGRAM DUPREE	PRODUCER	8731113		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:	817-255-3454
Email Address:	ONBOARDING@INSPHEREHQ.COM