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FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-396618

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1. MOTORISTS MUTUAL INSURANCE COMPANY CIVIC FUND

    471 E BROAD ST
    COLUMBUS, OH 43215
    Fax: 8662252095
    Email: Laurie.Wright@motoristsgroup.com

2. Date: 01/20/2009

3. FEC Committee ID #: C00336834 This committee is a separate segregated fund. Its connected organization is a Corporation

Affiliated Committees/Organizations

Motorists Mutual Insurance Company
471 East Broad Street
Columbus, Ohio 43215
Affiliated Relationship Code: Connected Organization

Custodian of Records:

Charles R. Gaskill
1425 Briarmeadow Dr.
Columbus, OH 43235
Title: VP Corp Counsel
Phone # (614) 225-8593

Treasurer:

Michael L. Wiseman
90 Timberknoll Loop
Powell, Ohio 43065
Title: Treasurer
Phone # (614) 225-8294

Designated Agent(s):

Charles R. Gaskill
1425 Briarmeadow Dr.
Columbus, Ohio 43235
Title: Asst Treas of MICF
Phone # (614) 225-8593

Banks or Depositories

Motorists Insurance Emp Credit Union
471 East Broad Street
Columbus, Ohio 43215

Signed: Michael L. Wiseman
Date Signed: 01/20/2009
Official Committee FAX: 8662252095

(End FEC FORM 1)

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