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
ADRIANA MINAS-BARRETTE	AGENT	18528175	YES		01/02/2018
ALYSSA GREEN	AGENT	17642439	YES		01/02/2018
AMARRI JONES	AGENT	17642439	YES		01/02/2018
ANDRE ROSADO	AGENT	10144493	YES		01/02/2018
ANDRES FONSECA NARANJO	AGENT	18441151	YES		01/02/2018
ANGELE RODGERS	AGENT	17621561	YES		01/02/2018
ANNA MARTINEZ	AGENT	17043638	YES		01/02/2018
ANTHONY LENCSAK	AGENT	17084407	YES		01/02/2018
ANTONIO BROWN	AGENT	18032023	YES		01/02/2018
ASHANTI GORDON	AGENT	18088823	YES		01/02/2018
ASHLEY KALETA	AGENT	18389621	YES		01/02/2018
ASHLEY MOORE	AGENT	17321583	YES		01/02/2018
AVIANNA PETERSON	AGENT	16910334	YES		01/02/2018
BETHANY LOCKHART	AGENT	18463060	YES		01/02/2018
BRADLEY HARRIS	AGENT	18493276	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