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FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-1172800

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1. Safeway Inc. Political Action Committee (Safeway PAC)

    11555 Dublin Canyon Road
    Pleasanton, CA 94588

    NOTE: Address is different than previously reported

    Email: jonathan.mayes@albertsons.com

    NOTE: Email address is different than previously reported

2. Date: 07/18/2017

3. FEC Committee ID #: C00194084 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

Safeway Inc.
11555 Dublin Canyon Road
Pleasanton, California 94588
Affiliated Relationship Code: Connected Organization

Custodian of Records:

Jonathan Mayes
11555 Dublin Canyon Road
Pleasanton, CA 94588
Title: Treasurer
Phone # (925) 226-5353

Treasurer:

Jonathan Mayes
11555 Dublin Canyon Road
Pleasanton, California 94588
Title: Treasurer
Phone # (925) 226-5353

Designated Agent(s):

Carrie Cook
11555 Dublin Canyon Road
Pleasanton, California 94588
Title: Assistant Treasurer
Phone # (925) 226-5128

Banks or Depositories

Comerica Bank
P.O. Box 75000
Detroit, Michigan 48275

Signed: Jonathan Mayes
Date Signed: 07/18/2017

FORM TEXT-1

(End FEC FORM 1)

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