FEC Form 1 for Independent Insurance Agents & Brokers of America, Inc. Political Action Committee (InsurPForm 1 for Independent Insurance Agents & Brokers of America, Inc. Political Action Committee (InsurP

FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-353360

1. Independent Insurance Agents & Brokers of America, Inc. Political Action Committee (InsurP

NOTE:Commmittee Name is different than previously reported

412 First Street, SE, Suite 300
Washington, DC 20003
Fax: 202-863-7015
Email: nathan.riedel@iiaba.net

2. Date: 07/01/2008

3. FEC Committee ID #: C00022343 This committee is a separate segregated fund. Its connected organization is a Trade Association

Affiliated Committees/Organizations

Independent Insurance Agents & Brokers of America, Inc.
127 South Peyton Street
Alexandria, Virginia 22314
Affiliated Relationship Code: Connected Organization

Custodian of Records:

Nathan M. Riedel
412 First Street, SE, Suite 300
Washington, DC 20003
Title: Vice President
Phone # (202) 863-7000

Treasurer:

Nathan M. Riedel
412 First Street, SE, Suite 300
Washington, DC 20003
Title: Vice President
Phone # (202) 863-7000

Designated Agent(s):

Banks or Depositories

InsurBanc
10 Executive Drive
Farmington, Connecticut 06032

Signed: Nathan M. Riedel
Date Signed: 07/18/2008
Official Committee FAX: 202-863-7015

FORM TEXT

(End FEC FORM 1)

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