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:	3049293259
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
STEPHANIE KACHOR	AGENT	17649902	YES		11/09/2016
STEVEN COTE	AGENT	17948993	YES		11/09/2016
STEVEN HARDY	AGENT	12311500	YES		11/09/2016
STEVEN JOHN	AGENT	6540453	YES		11/09/2016
STEVEN LEVY	AGNET	17703859	YES		11/09/2016
STEVEN SYLVESTER	AGENT	11732024	YES		11/09/2016
SUNDIATA SIMS	AGENT	16420679	YES		11/09/2016
SUSAN MARRA	AGENT	17696111	YES		11/09/2016
SUZANNE KNAULS	AGENT	18031264	YES		11/09/2016
SYLVIA SWABY	AGENT	8342148	YES		11/09/2016
TAKAYA ERWIN	AGENT	17992547	YES		11/09/2016
TANYA BURNEY	AGENT	620236	YES		11/09/2016
TARA DAVIS	AGENT	17654113	YES		11/09/2016
TAYLOR HOBBS	AGENT	17837468	YES		11/09/2016
TAYLOR TWITTY	AGENT	17973025	YES		11/09/2016

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