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FEC Form 1 for Safelite Group Inc. PAC (aka Safelite PAC)Form 1 for Safelite Group Inc. PAC (aka Safelite PAC)

FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-813070


1. Safelite Group Inc. PAC (aka Safelite PAC)

    NOTE:Commmittee Name is different than previously reported

    2400 Farmers Drive
    Columbus, OH 43235
    Email: doug.herron@safelite.com,brian.dimasi@safelite.com

    NOTE: Email address is different than previously reported

2. Date: 10/03/2012

3. FEC Committee ID #: C00526509 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

Safelite Group Inc.
2400 Farmers Drive
Columbus, Ohio 43235
Affiliated Relationship Code: Connected Organization

Custodian of Records:


Treasurer:

Mr. Douglas A Herron
2400 Farmers Drive
Columbus, Ohio 43235
Title: Treasurer
Phone # (614) 210-9199

Designated Agent(s):

Mr. Brian Dimasi
2400 Farmers Drive
Columbus, Ohio 43235
Title: Assistant Treasurer
Phone # (614) 210-9249

Banks or Depositories

Bank of America
100 North Tryon Street
Charlotte, North Carolina 28255

Signed: Mr. Douglas A Herron
Date Signed: 10/03/2012

(End FEC FORM 1)


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