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FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-1476552

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1. Assurant Inc. Political Action Committee

    601 13th Street, NW, Suite 1010N
    Washington, DC 20005
    Email: keith.sheridan@assurant.com

2. Date: 12/02/2020

3. FEC Committee ID #: C00185694 This committee is a separate segregated fund. Its connected organization is a Corporation
     In addition, this committee is a Lobbyist/Registrant PAC.

Affiliated Committees/Organizations

Assurant Inc.
1 Chase Manhattan Plaza
New York, New York 10005
Affiliated Relationship Code: Connected Organization

Custodian of Records:

Keith Sheridan
260 Interstate North Circle, S.E.
Atlanta, GA 30339
Title: Treasurer
Phone # (770) 763-1814

Treasurer:

Keith Sheridan
260 Interstate North Circle, S.E.
Atlanta, Georgia 30339
Title: Treasurer
Phone # (770) 763-1814

Designated Agent(s):

Frank Payne
260 Interstate North Cir SE
Atlanta, Georgia 30339
Title: Assistant Treasurer
Phone # (770) 763-2921

Jackson Okello
260 Interstate North Cir SE
Atlanta, Georgia 30339
Title: Assistant Treasurer
Phone # (770) 763-2921

Banks or Depositories

Chain Bridge Bank
1445-A Laughlin Avenue
McLean, Virginia 22101

Signed: Keith Sheridan
Date Signed: 12/02/2020

(End FEC FORM 1)

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