Notification of Changes for Business Entity
General Information
Business Entity Name:	TZ INSURANCE, INC.
Incorporation / Formation Date:
FEIN:	271602268
Ohio License Number:
NPN:
DBA / Trade Name:
State of Domicile:	OH
County:	BERGEN
Business Address
Address 1:	2200 FLETCHER AVE
Address 2:	4TH FLOOR
City:	FORT LEE
State:	NJ
Zip:	07024
Phone:	304-929-3257
Fax:
Business Web Site Address:
Business Email Address:
Mailing Address
Address 1:	2200 FLETCHER AVE
Address 2:	4TH FLOOR
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
ADRIANE MCNAMEE	PRODUCER	17585010	YES		03/18/2016
AJA TURNER	PRODUCER	17560625	YES		03/18/2016
ALESANDRA PAZ	PRODUCER	3305704	YES		03/18/2016
ALESSANDRO VELLA	PRODUCER	17404125	YES		03/18/2016
ALINDA SCAGLIONE	PRODUCER	9768779	YES		03/18/2016
ALISHA CROWDER	PRODUCER	17313384	YES		03/18/2016
ALLISON BLOOMFIELD	PRODUCER	17373050	YES		03/18/2016
AMANDA BABNICK	PRODUCER	17625520	YES		03/18/2016
AMANDA BRANDON	PRODUCER	17244701	YES		03/18/2016
AMANDA GRZECHOWIAK	PRODUCER	15848917	YES		03/18/2016
AMANDA MARTIN	PRODUCER	17867212	YES		03/18/2016
AMBER GOODING	PRODUCER	17312401	YES		03/18/2016
AMY KNIGHT	PRODUCER	17730947	YES		03/18/2016
ANDRE DUSSAN	PRODUCER	17044705	YES		03/18/2016
ANDROMADA DEBERRY	PRODUCER	16613434	YES		03/18/2016

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