Notification of Changes for Business Entity
General Information
Business Entity Name:	CRISP INSURANCE ADVISORS, LLC
Incorporation / Formation Date:
FEIN:	900801053
Ohio License Number:	1138566
NPN:
DBA / Trade Name:
State of Domicile:	NJ
County:	SOMERSET
Business Address
Address 1:	1250 ROUTE 28 SUITE 201
Address 2:
City:	BRANCHBURG
State:	NJ
Zip:	08876
Phone:	9085661280
Fax:
Business Web Site Address:
Business Email Address:
Mailing Address
Address 1:	1250 ROUTE 28 SUITE 201
Address 2:
City:	BRANCHBURG
State:	NJ
Zip:	08876
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
ANDREW DOUGLAS	MANAGING ACCOUNT EXECUTIVE	216726634	YES		12/03/2018

Members, Owners, Partners, Officers and Directors
Name	Title	Identifying #	Add	Delete	Eff. Date
JANIE SELLERS

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:	JANIE SELLERS
Title:	COMPLIANCE SPECIALIST
Phone Number:	2547296136
Email Address:	JSELLERS@ILSAINC.COM