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:	BERGEN
Business Address
Address 1:	2200 FLETCHER AVE
Address 2:	4TH FLOOR
City:	FORT LEE
State:	NJ
Zip:	07024
Phone:	201-242-3538
Fax:
Business Web Site Address:
Business Email Address:
Mailing Address
Address 1:	2200 FLETCHER AVE
Address 2:	4TH FLOOR
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
CIARA WILEY	AGENT	17658834	YES		01/19/2018
DEANGELA HARRIS	AGENT	16428877	YES		01/19/2018
DESTINY STEPHENS	AGENT	17652637	YES		01/19/2018
DIEDIRIUS JOHNSON	AGENT	18493589	YES		01/19/2108
DOMINIQUE CALDWELL	AGENT	18061127	YES		01/19/2018
ELIZABETH MARTINEZ	AGENT	17005717	YES		01/19/2018
GABRIELLE BEAM	AGENT	18093107	YES		01/19/2018
JAKENIA KIRKPATRICK	AGENT	17637177	YES		01/19/2018
JEFFREY HUTTON	AGENT	14871438	YES		01/19/2018
MALEEKA FLETCHER	AGENT	18002852	YES		01/19/2018
MEGHIN MCCRAY	AGENT	18027550	YES		01/19/2018
MELISSA BRICE	AGENT	17087267	YES		01/19/2018
MELISSA VICTORIN	AGENT	17022867	YES		01/19/2018
MONIKKA MOFFETT	AGENT	18477445	YES		01/19/2018
REYNARD WRIGHT	AGENT	6579494	YES		01/19/2018

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:	NICOLE GATES
Title:	LICENSING SPECIALIST
Phone Number:	3049293257
Email Address:	LICENSING@TZINSURANCE.COM