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
HELEN HEAVENER	AGENT	AGENT		YES	10/28/2016
JAMES LOCKETT	AGENT	AGENT		YES	10/28/2016
JANICE MILES	AGENT	AGENT		YES	10/28/2016
JEAN ELAICIN	AGENT	17511213		YES	10/28/2016
JEFF SNOW	AGNET	17558222		YES	10/28/2016
JENNIFER MITCHELL	AGENT	13593110		YES	10/28/2016
JEREMY BELK	AGENT	17323758		YES	10/28/2016
JOSHA SAFARI	AGENT	8708663		YES	10/28/2016
LEONARD JONES	AGENT	17749899		YES	10/28/2016
LICI GHALIEH	AGENT	17235684		YES	10/28/2016
NICHOLAS KAPPIRIS	AGENT	7270113		YES	10/28/2016
PAMELA MIMS	AGENT	16830641		YES	10/28/2016
ROGETS FERGUSON	AGENT	16417115		YES	10/28/2016
RONALD WLINTERS	AGENT	2424793		YES	10/28/2016
SHERRY MOTEN	AGENT	16960400		YES	10/28/2016

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