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:	BELGEN
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
AYANNA SHAW	PRODUCER	17327445	YES		03/28/2016
AZIKIWE BUSH	PRODUCER	17613437	YES		03/28/2016
BARBARA KNIBBS	PRODUCER	491293	YES		03/28/2016
BARBARA MIDDENDORF	PRODUCER	17843479	YES		03/28/2016
BARRINGTON CUMMINGS	PRODUCER	8733772	YES		03/28/2016
BARRY MCINTOSH	PRODUCER	9751762	YES		03/28/2016
BEAUREGARD RAY	PRODUCER	16629297	YES		03/28/2016
BENITO PEREZ	PRODUCER	7552557	YES		03/28/2016
BENJAMIN PIERCE	PRODUCER	1797584	YES		03/28/2016
BILLY CHATMAN	PRODUCER	17751614	YES		03/28/2016
BLAIRE JOHNSON	PRODUCER	17020592	YES		03/28/2016
BRIAN CASSISTA	PRODUCER	15878573	YES		03/28/2016
BRIAN COPELLO	PRODUCER	17264570	YES		03/28/2016
BRIAN REDFORD	PRODUCER	16608556	YES		03/28/2016
BRIAN REED	PRODUCER	6406987	YES		03/28/2016

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:	304-929-3257
Email Address:	LICENSING@TZINSURANCE.COM