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:	BELGRUM
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:	LICENSING@TZINSURANCE.COM
Mailing Address
Address 1:	2200 FLETCHER AVE 4TH 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
BRADNON VOLKERT	AGENT	18392920	YES		01/02/2018
BRIAN BERRY	AGENT	16567358	YES		01/02/2018
BRIAN KALETA	AGENT	18463007	YES		01/02/2018
BRITTANY WILKERSON	AGENT	16967458	YES		01/02/2018
CARIN SIMMERMAN	AGENT	10283602	YES		01/02/2018
CHARLES JOHNSON	AGENT	11296566	YES		01/02/2018
CHARTINA BOOZE	AGENT	1766337	YES		01/02/2018
CHERYL FREEMAN	AGENT	19745097	YES		01/02/2018
CHINTANA PHONTHIPSAVATH	AGENT	13551271	YES		01/02/2018
CHRISTINA THOMAS	AGENT	17934654	YES		01/02/2018
CHRISTINE MERCURIO	AGENT	16388799	YES		01/02/2018
CHRISTOPGER BOYD	AGENT	18507224	YES		01/02/2018
CHRISTOPHER HOGU	AGENT	18467875	YES		01/02/2018
CHRISTOPHER COLEMAN	AGENT	15668996	YES		01/02/2018
CHRISTOPHER RUSSO	AGENT	18387905	YES		01/02/2018

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:	MICHELE LEASURE
Title:	LICENSING SPECIALIST
Phone Number:	2014826210
Email Address:	LICENSING@TZINSURANCE.COM