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
JESSICA MATHEWS	PRODUCER	1799405	YES		01/11/2017
JOHN HYLAND	PRODUCER	17006634	YES		01/11/2017
LAURA MEYER	PRODUCER	17294863	YES		01/11/2017
LAURA TOPLIFFE	PRODUCER	7713117	YES		01/11/2017
LINDA GREENE	PRODUCER	15317230	YES		01/11/2017
LORRAINE DARAMOLA	PRODUCER	8945091	YES		01/11/2017
LOUIS LAJARA	PRODUCER	18031271	YES		01/11/2017
LUIS BOMBINO	PRODUCER	16481720	YES		01/11/2017
MANNY FERNANDEZ	PRODUCER	18020095	YES		01/11/2017
MARCI VAUTERS	PRODUCER	17105281	YES		01/11/2017
MARQUES MCNAIR	PRODUCER	18033773	YES		01/11/2017
MEGAN STEVENSON	PRODUCER	18114777	YES		01/11/2017
ROBERT DOERR	PRODUCER	8925818	YES		01/11/2017
SAKESHA TAYLOR	PRODUCER	17394753	YES		01/11/2017
TIFFENE MAGAZINE	PRODUCER	16983310	YES		01/11/2017

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