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:
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
LASHONDA YOUNGBLLOD	PRODUCER	17666236		YES	01/10/2017
LARRY WOOD	PRODUCER	16299762		YES	01/10/2017
LATOYA BYNUM	PRODUCER	18071095		YES	01/10/2017
LAURA MEYER	PRODUCER	17294863		YES	01/10/2017
LEIGHANA MARINO	PRODUCER	17822110		YES	01/10/2017
LORA BALKA	PRODUCER	18037026		YES	01/10/2017
LOREN STARNES	PRODUCER	17356917		YES	01/10/2017
MARIE SURRATT	PRODUCER	17142691		YES	01/10/2017
MATTHEW WARNG	PRODUCER	16661067		YES	01/10/2017
MELANIE BAIR	PRODUCER	4587044		YES	01/10/2017
MIKAELYA COFFEE	PRODUCER	17376944		YES	01/10/2017
MONIQUE MARTIN	PRODUCER	17663348		YES	01/10/2017
NATHAN HARRIS	PRODUCER	17890003		YES	01/10/2017
ORLANDO BROWN	PRODUCER	8080963		YES	01/10/2017
RABIYAH TOWNSEND	PRODUCER	18033812		YES	01/10/2017

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