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:	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
KEONA THOMAS	AGENT	16407921	YES		10/31/2016
KESI YOUNG	AGENT	16424273	YES		10/31/2016
KETA ODOM	AGENT	17998066	YES		10/31/2016
KEVIN RIVAS	AGENT	17245031	YES		10/31/2016
KEVIN STASZAK	AGNET	419220	YES		10/31/2016
KHANTHONGT CHANTHACHOUMP	AGENT	17056993	YES		10/31/2016
KIANA ZIMMERMAN	AGENT	17707185	YES		10/31/2016
KIANNA KNOX	AGENT	17248593	YES		10/31/2016
KIMBERLY RIEVELEY	AGENT	17081297	YES		10/31/2016
KITHARA TINSLEY	AGENT	18075868	YES		10/31/2016
KRYSTAL HAYDE	AGENT	17704572	YES		10/31/2016
KUTURA HUBBARD	AGENT	17532700	YES		10/31/2016
KYER BONNER	AGENT	8872163	YES		10/31/2016
LAINE LACAVA	AGENT	8394431	YES		10/31/2016
LAQUITA TAYLOR	AGENT	671592	YES		10/31/2016

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