Nebraska Legislature - Lobbyist Reporting Application

FORM
A-R

NEBRASKA LEGISLATURE
APPLICATION FOR REGISTRATION AS A LOBBYIST

Dec 27, 2023

(This report is required to be filed on or before December 31 of each calendar year.)
49-1480.01(3)

Clerk of the Legislature
Room 2014, State Capitol
PO Box 94604
Lincoln, NE 68509-4604
Phone: (402) 471-2608

For Calendar Year of:

Amended Registration

Lobbyist Registration Fee:
{49-1480.01}

Compensated

$200.00

(If you are a salaried employee of your principal, you are a compensated lobbyist.)

Not Compensated

$15.00

(File a Form E for quarterly report exemption. You are not exempt from the Form D Activity Report.)

PLEASE FILL IN ALL BLANKS

LOBBYIST {49-1480(1)}

Name

Mueller Robak

Office Address (Street, Box, or Route)

530 S. 13th Street, Suite 110

Permanent Residence (Street, Box, or Route)

City

Lincoln

State

Zip

68508

City

State

Zip

Office Phone

(402) 434-3399

Home Phone

Email Address

amber@muellerrobak.com

PRINCIPAL {49-1480(2)}

Name

COPIC Insurance Company

Office Phone

(720) 858-6081

Office Address (Street, Box, or Route)

7351 E. Lowry Blvd., Suite 400

Official to Whom Lobbyist is Accountable

Beverly Razon

City

Denver

State

Zip

80230

Nature of Business {49-1480(3)}

INSURANCE

AMOUNTS GIVEN or to be given to lobbyist as compensation or reimbursement of lobbying: {49-1480(3)}. Please state the basis for your compensation.
10,000.00 Per Quarter

IDENTIFICATION of MATTERS on which principal or lobbyist expects to lobby: {49-1480(5)} Any and all matters relating to professional liability insurance

Description of industry, trade, profession, or interests and groups represented by the principal:
Insurance

Names and addresses of principal's officers:

Ted Clarke - 7351 Lowry Blvd. Denver, CO 80217
Steve Rubin - 7351 Lowry Blvd. Denver, CO 80217

GIVE NAME and ADDRESS of any OFFICIAL in the Legislative or Executive Branch and of any members of any such official's staff or immediate family who is employed by you or by anyone acting on your behalf: {49-1480(8)}

I certify that all information presented in this form is accurate to the best of my knowledge.

Mueller Robak LLC

Lobbyist Name

Dec 27, 2023

Date