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FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-1024024

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1. PROFESSIONAL SERVICE INDUSTRIES, INC. POLITICAL ACTION COMMITTEE (PSI PAC)

    2350 KERNER BLVD., SUITE 250
    SAN RAFAEL, CA 94901
    Email: fecform1@nmgovlaw.com

    NOTE: Email address is different than previously reported

2. Date: 09/03/2015

3. FEC Committee ID #: C00498527 This committee is a separate segregated fund. Its connected organization is a Corporation

Affiliated Committees/Organizations

PROFESSIONAL SERVICE INDUSTRIES, INC.
1901 S. MEYERS ROAD, SUITE 400
OAKBROOK TERRACE, Illinois 60181
Affiliated Relationship Code: Connected Organization

Custodian of Records:

JASON D. KAUNE
2350 KERNER BLVD., SUITE 250
SAN RAFAEL, CA 94901
Title: Custodian of Records
Phone # (415) 389-6800

Treasurer:

JASON D. KAUNE
2350 KERNER BLVD., SUITE 250
SAN RAFAEL, California 94901
Title: Treasurer
Phone # (415) 389-6800

Designated Agent(s):

MARSHALL HAMMACK
1901 S. MEYERS ROAD, SUITE 400
OAKBROOK TERRACE, Illinois 60181
Title: Assistant Treasurer
Phone # (630) 691-1490

JACKIE TOKOS LENTZ
2350 KERNER BLVD., SUITE 250
SAN RAFAEL, California 94901
Title: Assistant Treasurer
Phone # (415) 389-6800

Banks or Depositories

BANK OF MARIN
504 TAMALPAIS DRIVE
CORTE MADERA, California 94925

Signed: JASON D. KAUNE
Date Signed: 09/03/2015

(End FEC FORM 1)

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