FEC FORM 1
STATEMENT OF ORGANIZATION
FILING FEC-973191
1. AMICA MUTUAL INSURANCE COMPANY/FED-POLITICAL ACTION COMMITTEE
PO BOX 6008PROVIDENCE, RI 02940
Email: sdolan@amica.com;rsuglia@amica.com
2. Date: 11/19/2014
3. FEC Committee ID #: C00268987 This committee is a separate segregated fund. Its connected organization is a CorporationAffiliated Committees/Organizations
Amica Mutual Insurance Company100 Amica Way
Lincoln, Rhode Island 02865
Affiliated Relationship Code: Connected Organization
Custodian of Records:
Stephen F. Dolan100 Amica Way
Lincoln, RI 02865
Title: Sr. Asst. VP
Phone # (800) 652-6422
Treasurer:
Stephen F. Dolan100 Amica Way
Lincoln, Rhode Island 02865
Title: Sr. Asst. VP
Phone # (800) 652-6422
Designated Agent(s):
Banks or Depositories
Bank of America Merrill LynchPO Box 15284
Wilmington, Delaware 19850