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

FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-744193

1. Liberty Mutual Insurance Company - PAC

175 Berkeley Street
Boston, MA 02117
Email: brian.monteiro@libertymutual.com

NOTE: Email address is different than previously reported

2. Date: 09/09/2011

3. FEC Committee ID #: C00171843 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

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
Phone # (617) 357-9500

Treasurer:

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

Designated Agent(s):

Mark D'Amato
175 Berkeley Street
Boston, Massachusetts 02117
Title: Assistant Treasurer
Phone # (617) 357-9500

FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-744193

1. Liberty Mutual Insurance Company - PAC

NOTE: Email address is different than previously reported

2. Date: 09/09/2011

Affiliated Committees/Organizations

Custodian of Records:

Treasurer:

Designated Agent(s):

Banks or Depositories

Signed: Laurance Yahia
Date Signed: 09/09/2011

(End FEC FORM 1)

FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-744193

1. Liberty Mutual Insurance Company - PAC

NOTE: Email address is different than previously reported

2. Date: 09/09/2011

Affiliated Committees/Organizations

Custodian of Records:

Treasurer:

Designated Agent(s):

Banks or Depositories

Signed: Laurance Yahia Date Signed: 09/09/2011

(End FEC FORM 1)

Signed: Laurance Yahia
Date Signed: 09/09/2011