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
ROBERT MCCANN	PRODUCER	3622655	YES		04/18/2017
SAKORIA OSBORNE	PRODUCER	17702995	YES		04/18/2017
SIERRA BROWN	PRODUCER	18069120	YES		04/18/2017
TARA DAVIS	PRODUCER	17654113	YES		04/18/2017
TERESA LIOCE	PRODUCER	6358313	YES		04/18/2017
THOMAS LEASE	PRODUCER	18331299	YES		04/18/2017
TRAVIS JONES	PRODUCER	8316916	YES		04/18/2017
TROY DUNNER	PRODUCER	11748668	YES		04/18/2017
VASHTI DEMERCADO	PRODUCER	17881294	YES		04/18/2017
VICTORIA LOUKOUMIS	PRODUCER	17834801	YES		04/18/2017
VINCENT HASKELL	PRODUCER	18343639	YES		04/18/2017
WENDY CANNELLA	PRODUCER	2308609	YES		04/18/2017
YAIMA TORRES	PRODUCER	17571310	YES		04/18/2017

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