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
ANN STOCK	PRODUCER	17918886	YES		01/11/2017
AUBREY LAMANNA	PRODUCER	17961640	YES		01/11/2017
BRAIN METZGER	PRODUCER	16328538	YES		01/11/2017
BRYAN TWIDWELL	PRODUCER	17655264	YES		01/11/2017
CAREEN CASHMAN	PRODUCER	9633757	YES		01/11/2017
CHARLES VENABLE	PRODUCER	4789726	YES		01/11/2017
CHARLOTTE LANIER	PRODUCER	17471686	YES		01/11/2017
CHRISTINE HOOVER	PRODUCER	17085759	YES		01/11/2017
CHRISTOPGER BOOKER	PRODUCER	17684931	YES		01/11/2017
DALE CLARK	PRODUCER	17929839	YES		01/11/2017
DANIEL DIVINE	PRODUCER	1826122	YES		01/11/2017
DUSTIN NOLEN	PRODUCER	8501961	YES		01/11/2017
ESTRELLA MARTIN	PRODUCER	17859367	YES		01/11/2017
JOSHUA JOHNSON	PRODUCER	17928360	YES		01/11/2017
KELLY CLAEK	PRODUCER	8195318	YES		01/11/2017

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