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FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-1538396

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1. CBC COMPANIES INC PAC

    250 EAST BROAD STREET
    18TH FLOOR
    COLUMBUS, OH 43215

    NOTE: Address is different than previously reported

    Email: cbcpac@cbc-companies.com;cbc@regfile.co

    NOTE: Email address is different than previously reported

2. Date: 09/17/2021

3. FEC Committee ID #: C00410001 This committee is a separate segregated fund. Its connected organization is a Corporation

Affiliated Committees/Organizations

CBC Companies, Inc.
250 East Broad Street
18th Floor
Columbus, Ohio 43215
Affiliated Relationship Code: Connected Organization

Custodian of Records:

Mr. Keith Kotowicz
250 East Broad Street
18th Floor
Columbus, OH 43215
Title: Chief Acctng Officer
Phone # (614) 222-5514

Treasurer:

Mr. Keith Kotowicz
250 East Broad Street
18th Floor
Columbus, Ohio 43215
Title: Chief Acctng Officer
Phone # (614) 222-5514

Designated Agent(s):

Jonathan Price
1651 NW Professional Plaza
Columbus, Ohio 43220
Title: Assistant Treasurer
Phone # (614) 222-4084

Banks or Depositories

JPMorgan Chase Bank
100 East Broad Street
Columbus, Ohio 43215

Signed: Mr. Keith Kotowicz
Date Signed: 09/17/2021

(End FEC FORM 1)

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