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
CORINTHIA MILLER	AGENT	16708234	YES		10/28/2016
CRISTEN DROZ	AGENT	17905383	YES		10/28/2016
CRYSTAL KENNEY	AGENT	16994296	YES		10/28/2016
DAJA JOHNSON	AGENT	17639285	YES		10/28/2016
DANA BLACKMON	AGNET	17711467	YES		10/28/2016
DANIEL MACRAE	AGENT	16789899	YES		10/28/2016
DAVID APONTE	AGENT	17532335	YES		10/28/2016
DAVID YOUNG	AGENT	7076656	YES		10/28/2016
DEANN HOLLISTER	AGENT	17452742	YES		10/28/2016
DIASIA BROWN	AGENT	17044327	YES		10/28/2016
DONARELL GREEN	AGENT	17887616	YES		10/28/2016
EMILY LOPP	AGENT	17339477	YES		10/28/2016
EVELYN MORRISON	AGENT	7957730	YES		10/28/2016
FELICIA POWERS	AGENT	2337353	YES		10/28/2016
FRITZ MAXI	AGENT	17948995	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