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FEC Form 1 for AMICA MUTUAL INSURANCE COMPANY/FED-POLITICAL ACTION COMMITTEEForm 1 for AMICA MUTUAL INSURANCE COMPANY/FED-POLITICAL ACTION COMMITTEE

FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-1301009

1. AMICA MUTUAL INSURANCE COMPANY/FED-POLITICAL ACTION COMMITTEE

    PO BOX 6008
    PROVIDENCE, RI 02940
    Email: mbakerjr@amica.com;rsuglia@amica.com

    NOTE: Email address is different than previously reported

2. Date: 12/13/2018

3. FEC Committee ID #: C00268987 This committee is a separate segregated fund. Its connected organization is a Corporation

Affiliated Committees/Organizations

Amica Mutual Insurance Company
100 Amica Way
Lincoln, Rhode Island 02865
Affiliated Relationship Code: Connected Organization

Custodian of Records:

Michael L. Baker, Jr.
100 Amica Way
Lincoln, RI 02865
Title: Assistant VP
Phone # (800) 652-6422

Treasurer:

Michael L. Baker, Jr.
100 Amica Way
Lincoln, Rhode Island 02865
Title: Assistant VP
Phone # (800) 652-6422

Designated Agent(s):

Banks or Depositories

Bank of America Merrill Lynch
PO Box 15284
Wilmington, Delaware 19850

Signed: Michael L. Baker, Jr.
Date Signed: 12/13/2018

(End FEC FORM 1)


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