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FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-1315686

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1. Grange Insurance Federal PAC

    NOTE:Commmittee Name is different than previously reported

    671 SOUTH HIGH STREET
    PO BOX 1218
    COLUMBUS, OH 43216
    Email: DickensonW@grangeinsurance.com;npettit@bricker.com

    NOTE: Email address is different than previously reported

2. Date: 02/13/2019

3. FEC Committee ID #: C00302695 This committee is a separate segregated fund. Its connected organization is a Corporation

Affiliated Committees/Organizations

Grange Insurance
671 South High Street
PO Box 1218
Columbus, Ohio 43216
Affiliated Relationship Code: Connected Organization

Custodian of Records:

Treasurer:

Wendy Dickenson
671 South High Street
PO Box 1218
Columbus, Ohio 43216
Title: Executive Legal Asst
Phone # (614) 445-2607

Designated Agent(s):

LaVawn D. Coleman
671 South High Street
PO Box 1218
Columbus, Ohio 43216
Title: Ex. Vice Pres.
Phone # (614) 445-2649

Banks or Depositories

PNC Bank
One Financial Parkway
Kalamazoo, Michigan 49009

Signed: Wendy Dickenson
Date Signed: 02/13/2019

(End FEC FORM 1)

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