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FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-1590672

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1. Assurant Inc. Political Action Committee

    1101 Pennsylvania Ave, NW
    Suite 300
    Washington, DC 20004

    NOTE: Address is different than previously reported

    Email: keith.sheridan@assurant.com;AssurantPAC@assurant.com

    NOTE: Email address is different than previously reported

2. Date: 04/27/2022

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.
55 Broadway, Suite 2901
New York, New York 10006
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):

Heidi Star
260 Interstate North Circle, S.E.
Atlanta, Georgia 30339
Title: Assistant Treasurer
Phone # (786) 486-8281

Banks or Depositories

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

Signed: Keith Sheridan
Date Signed: 04/27/2022

(End FEC FORM 1)

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