Notification of Changes for Business Entity
General Information
Business Entity Name:	TZ INSURANCE SOLUTIONS LLC
Incorporation / Formation Date:
FEIN:	271602268
Ohio License Number:
NPN:
DBA / Trade Name:
State of Domicile:	NJ
County:	BELGEN
Business Address
Address 1:	2200 FLETCHER AVE 4TH FLOOR
Address 2:
City:	FORT LEE
State:	NJ
Zip:	07024
Phone:	3049293257
Fax:
Business Web Site Address:
Business Email Address:
Mailing Address
Address 1:	2200 FLETCHER AVE $TH FLOOR
Address 2:
City:	FORT LEE
State:	NJ
Zip:	07024
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
CAROL MOORE	AGENT	13506614		YES	09/13/2016
CATHERINE WILTSHIRE	AGENT	501799		YES	09/13/2016
CHARLES VENABLE	AGENT	4789726		YES	09/13/2016
CHARLES JERLES	AGENT	7812148		YES	09/13/2016
CHRISTA JOHNSON	AGNET	17292433		YES	09/13/2016
CHRISTIAN NEAL	AGENT	8395451		YES	09/13/2016
CHRISTIANE EVERS	AGENT	17142685		YES	09/13/2016
CHRISTINE HOOVER	AGENT	17085759		YES	09/13/2016
CHRISTOPHER GASPARNIN	AGENT	8197378		YES	09/13/2016
CHRISTOPHER BOOKER	AGENT	17684931		YES	09/13/2016
CLIFFORD BAGOT	AGENT	17606850		YES	09/13/2016
COLLEEN TALTY	AGENT	17684955		YES	09/13/2016
CONNIE ALLEN	AGENT	442431		YES	09/13/2016
CYNTHIA WINTRICK	AGENT	17737780		YES	09/13/2016
DANIEL DIVINE	AGENT	1826122		YES	09/13/2016

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:	MICHELE LEASURE
Title:	LICENSING SPECIALIST
Phone Number:	3049293257
Email Address:	LICENSING@TZINSURANCE.COM