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:	OH
Zip:	07024
Phone:	3049293257
Fax:	3049293259
Business Web Site Address:
Business Email Address:
Mailing Address
Address 1:	2200 FLETCHER AVE $TH 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
MELISSA VICTORIN	AGENT	17022867	YES		11/04/2016
MELODY CLEMMER	AGENT	17218389	YES		11/04/2016
MERCEDES STRAUBEL	AGENT	16446220	YES		11/04/2016
MICHAEL ALEXANDER	AGENT	17440136	YES		11/04/2016
MICHAEL DOHERTY	AGNET	1340105	YES		11/04/2016
MICHAEL FOSDICK	AGENT	17338246	YES		11/04/2016
MICHAEL HAMBY	AGENT	16546368	YES		11/04/2016
MICHAEL KIRK	AGENT	6555098	YES		11/04/2016
MICHAEL MARTLING	AGENT	17822275	YES		11/04/2016
MICHAEL MILLER	AGENT	18080379	YES		11/04/2016
MICHAEL MONTGOMERY	AGENT	17930806	YES		11/04/2016
MICHAEL PARSONS	AGENT	16880412	YES		11/04/2016
MICHAEL QUEMP	AGENT	10531035	YES		11/04/2016
MICHELLE FRONTADO	AGENT	17832065	YES		11/04/2016
MIKAELYA COFFEE	AGENT	17376944	YES		11/04/2016

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