FEC Form 1 for Liberty Mutual Insurance Company - PACForm 1 for Liberty Mutual Insurance Company - PAC

FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-346365

1. Liberty Mutual Insurance Company - PAC

175 Berkeley Street
Boston, MA 02117
Email: kuai.chan@libertymutual.com

2. Date: 06/26/2008

3. FEC Committee ID #: C00171843 This committee is a separate segregated fund. Its connected organization is a Corporation

Affiliated Committees/Organizations

Committee ID# C00171843
Liberty Mutual Insurance Company
175 Berkeley Street
Boston, Massachusetts 02117
Affiliated Relationship Code: Connected Organization

Custodian of Records:

Paul Mattera
175 Berkeley Street
Boston, MA 02117
Title: Custodian of Records

Treasurer:

Laurance Yahia
175 Berkeley Street
Boston, Massachusetts 02117
Title: Treasurer
Phone # (617) 357-9500

Designated Agent(s):

Matthew Coyle
175 Berkeley Street
Boston, Massachusetts 02117
Title: Assistant Treasurer
Phone # (671) 357-9500

Banks or Depositories

Bank of America
100 Federal Street
Boston, Massachusetts 02110

Signed: Laurance Yahia
Date Signed: 06/26/2008

(End FEC FORM 1)

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