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
MARSHAL VINES	PRODUCER	17955354	YES		04/19/2017
MELAYSIA KNIGHT	PRODUCER	17973058	YES		04/19/2017
MELISSA RUNIONS	PRODUCER	1013504	YES		04/19/2017
MIA SEYMORE	PRODUCER	17994068	YES		04/19/2017
MICHAEL KIRK	PRODUCER	6555098	YES		04/19/2017
MICHAEL MARTLING	PRODUCER	17822275	YES		04/19/2017
MICHELLE LOWREY	PRODUCER	17066730	YES		04/19/2017
MICHELLE MCRAE	PRODUCER	18041546	YES		04/19/2017
NICHOLAS GIFFING	PRODUCER	17967946	YES		04/19/2017
NICHOLAS PERILLO	PRODUCER	17995950	YES		04/19/2017
OLIVIA LYNCH	PRODUCER	16210683	YES		04/19/2017
PATRICE SHANKS	PRODUCER	7440953	YES		04/19/2017
RANDY HALL	PRODUCER	18367343	YES		04/19/2017
RICHARD BENEDICT	PRODUCER	17991992	YES		04/19/2017
ROBERT FRYE	PRODUCER	10643454	YES		04/19/2017

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