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
ADRIENNE POWELL	PRODUCER	1751718	YES		04/21/2017
ANDREIA DARIAN	PRODUCER	17247616	YES		04/21/2017
BRIEN SULLIVAN	PRODUCER	732016	YES		04/21/2017
CHALRES JERLES	PRODUCER	7812148	YES		04/21/2017
CHRISTOPHER FERRERIS	PRODUCER	18337054	YES		04/21/2017
CHRISTOPHER GRIFFITH	PRODUCER	17367129	YES		04/21/2017
CLAIRE WARREN	PRODUCER	1/8372511	YES		04/21/2017
COURTNEY MCADOO	PRODUCER	17978968	YES		04/21/2017
CYNTHIA MASSEY	PRODUCER	14964954	YES		04/21/2017
DAMONTE GREENE	PRODUCER	18323790	YES		04/21/2017
DAVID ROBINETTE	PRODUCER	18316013	YES		04/21/2017
DONNA BARTLEY	PRODUCER	17701155	YES		04/21/2017
ESSENCE MCCLURE	PRODUCER	17666481	YES		04/21/2017
GIOVANNI MARBAN	PRODUCER	17724373	YES		04/21/2017
IEISHA HIGGINS	PRODUCER	17303684	YES		04/21/2017

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