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FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-118382

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1. CEMEX Inc. Employees Political Action Committee

    840 Gessner
    Suite 1400
    Houston, TX 77024
    Fax: 713-722-5111
    Email: clairec.dai@cemexusa.com

2. Date: 04/27/2004

3. FEC Committee ID #: C00111880 This committee is a Separate Segregated Fund

Affiliated Committees/Organizations

CEMEX Inc.
840 Gessner
Suite 1400
Houston, Texas 77024
Relationship: Connected
Organization Type: Corporation

Custodian of Records:

Claire Dai
840 Gessner
Suite 1400
Houston, TX 77024
Title: Treasurer

Treasurer:

Claire Dai
840 Gessner
Suite 1400
Houston, Texas 77024
Title: Treasurer
Phone # (713) 722-5905

Designated Agent(s):

L Douglas Carpenter
3701 Sugar Spring Rd.
Gastonia, North Carolina 28054
Title: Assistant Treasurer
Phone # (704) 868-6333

Banks or Depositories

Bank of America N.A.
P.O. Box 831547
Dallas, Texas 75283

Signed: Claire Dai
Date Signed: 11/03/2003
Official Committee URL: N/A
Official Committee FAX: 713-722-5111

(End FEC FORM 1)

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