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 $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
LARRY WOOD	AGENT	17130147	YES		10/31/2016
LATOYA BYNUM	AGENT	18071095	YES		10/31/2016
LAURA MEYER	AGENT	17294863	YES		10/31/2016
LAURA TOPLIFFE	AGENT	7713117	YES		10/31/2016
LAVERNE HYNEMAN-ARNOLD	AGNET	4596629	YES		10/31/2016
LEIGHANA MARINO	AGENT	17822110	YES		10/31/2016
LELIA MOORE	AGENT	7375683	YES		10/31/2016
LESLIE FISCHER	AGENT	9776961	YES		10/31/2016
LESLIE MOORE	AGENT	17388346	YES		10/31/2016
LINDA GHALEIH	AGENT	12805054	YES		10/31/2016
LISA CLOUGHER	AGENT	17075108	YES		10/31/2016
LIZA PEREZ-BICKERS	AGENT	14468524	YES		10/31/2016
LORA BALKA	AGENT	18037026	YES		10/31/2016
LORELLA ROHRER	AGENT	17181525	YES		10/31/2016
LOREN STARNES	AGENT	17356917	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