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FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-1073886

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1. The Council of Insurance Agents & Brokers Political Action Committee

    701 Pennsylvania Avenue, NW
    Suite 750
    Washington, DC 200042608
    Email: ken.crerar@ciab.com

    NOTE: Email address is different than previously reported

2. Date: 05/20/2016

3. FEC Committee ID #: C00039578 This committee is a separate segregated fund. Its connected organization is a Membership Organization
     In addition, this committee is a Lobbyist/Registrant PAC.

Affiliated Committees/Organizations

Council of Insurance Agents & Brokers
701 Pennsylvania Ave., NW
Suite 750
Washington, DC 200042608
Affiliated Relationship Code: Connected Organization

Custodian of Records:

Ce Harrison
701 Pennsylvania Ave., NW
Suite 750
Washington, DC 200042608
Title: CFO
Phone # (202) 662-4422

Treasurer:

Ken A. Crerar
701 Pennsylvnia Ave., NW
Suite 750
Washington, DC 200042608
Title: President
Phone # (202) 783-4400

Designated Agent(s):

Cheryl Matochik
701 Pennsylvania Ave., NW
Suite 750
Washington, DC 200042608
Title: Sr Vice President
Phone # (202) 783-4400

Banks or Depositories

National Capital Bank of Washington
316 Pennsylvania Ave., SE
Washington, DC 20003

Signed: Ken A. Crerar
Date Signed: 05/20/2016

FORM TEXT-1

(End FEC FORM 1)

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