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
ABIGAIL JOHSON	AGENT	17699819		YES	01/02/2018
AJA TURNER	AGENT	17560625		YES	01/02/2018
ALBERT BEATTY	AGENT	18114769		YES	01/02/2018
ALYSE NICASTRO	AGENT	740429		YES	01/02/2018
AMANDA FULLER	AGENT	17244701		YES	01/02/2018
ANDREIA DARIAN	AGENT	17247616		YES	01/02/2018
ANGELA ESTEP	AGENT	16137580		YES	01/02/2018
ANITA CAPIZZI	AGENT	3352561		YES	01/02/2018
ANN BRYSON	AGENT	17020689		YES	01/02/2018
ANTHONY TSIKITAS	AGENT	17415786		YES	01/02/2018
ARLENE NORRIS	AGENT	17431570		YES	01/02/2018
ARLENE MELGAR	AGENT	17958571		YES	01/02/2018
ASHLEY MOORE	AGENT	246591421		YES	01/02/2018
AUBREY LAMANNA	AGENT	17961640		YES	01/02/2018
AVA GREGORY	AGENT	16969638		YES	01/02/2018

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