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
BEVERLY LINDQUIST	AGENT	17708268	YES		10/28/2016
BIANCA NAVARRO	AGENT	17098898	YES		10/28/2016
BRITTANY YOPP	AGENT	17948982	YES		10/28/2016
BRYAN ROJAS	AGENT	17965774	YES		10/28/2016
CHARLENE PHILLIP	AGNET	17631741	YES		10/28/2016
CHALRES BROOKS	AGENT	8911392	YES		10/28/2016
CHARLOTTE LANIE	AGENT	17471686	YES		10/28/2016
CHELSEA WAKER	AGENT	17363320	YES		10/28/2016
CHRISTINA THOMAS	AGENT	17934654	YES		10/28/2016
CHRISTINE DILPORT	AGENT	17569744	YES		10/28/2016
CHRISTINE MERCURIO	AGENT	16388799	YES		10/28/2016
CHRISTOPHER CAPUANO	AGENT	12130547	YES		10/28/2016
CHRISTOPHER MCMICHAEL	AGENT	17314787	YES		10/28/2016
CHRISTOPHER DUNLAP	AGENT	17931479	YES		10/28/2016
CHRISTOPHER	AGENT	KHAN	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