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
BILLY CHATMAN	PRODUCER	17751614		YES	10/28/2016
BRIGITTE STOLL	PRODUCER	8112181		YES	10/28/2016
BRITTANIE CURRY	PRODUCER	17245099		YES	10/28/2016
DANIEL GLASS	PRODUCER	16218218		YES	10/28/2016
DANIELLE HUNT	PRODUCER	17705544		YES	10/28/2016
DARIUS LOWE	PRODUCER	17064480		YES	10/28/2016
DOROTHY SANDLIN	PRODUCER	17709637		YES	10/28/2016
ELIJAK HOLLOWAY	PRODUCER	17387092		YES	10/28/2016
ERIK AHRENS	PRODUCER	8898354		YES	10/28/2016
EVE LOSEK	PRODUCER	17682223		YES	10/28/2016
FABIAN ST-HUBERT	PRODUCER	17484810		YES	10/28/2016
FELICIA MCILWAIN	PRODUCER	17466114		YES	10/28/2016
GEORGE SKAFF	PRODUCER	8107712		YES	10/28/2016
GERRICK WILLIAMS	PRODUCER	11662247		YES	10/28/2016
HEATHER LOVE	PRODUCER	17345574		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