Notification of Changes for Business Entity
General Information
Business Entity Name:	THE FARMINGTON COMPANY
Incorporation / Formation Date:	07/31/1980
FEIN:	06-1027593
Ohio License Number:	25376
NPN:	953619
DBA / Trade Name:
State of Domicile:	CT
County:	HARTFORD
Business Address
Address 1:	30 WATERSIDE DR
Address 2:	PO BOX 527
City:	FARMINGTON
State:	CT
Zip:	06032
Phone:	8606786782
Fax:
Business Web Site Address:
Business Email Address:
Mailing Address
Address 1:	30 WATERSIDE DR., 2ND FLOOR
Address 2:	PO BOX 527
City:	FARMINGTON
State:	CT
Zip:	06034
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

Members, Owners, Partners, Officers and Directors
Name	Title	Identifying #	Add	Delete	Eff. Date
DOUGLAS R. MANTZ	SECRETARY / DIRECTOR	964788	YES		01/01/2017
CHRISTOPHER S. THARAU	TREASURER / DIRECTOR	042-52-4391	YES		01/01/2017
CAROL S. ROSENBLATT	TREASURER / DIRECTOR	3945861		YES	01/01/2017

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)	NO
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?	NO
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:	ROBERT J. BURKE
Title:	PRESIDENT
Phone Number:	860-674-0501
Email Address:	KSPRONG@FARMINGTONCO.COM