Nebraska Legislature - Lobbyist Reporting Application

FORM
A

NEBRASKA LEGISLATURE
APPLICATION FOR REGISTRATION AS A LOBBYIST

Jan 29, 2024

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

Foxx, Kelley

Office Address (Street, Box, or Route)

28 Liberty Ship Way, Suite 2815

Permanent Residence (Street, Box, or Route)

City

Sausalito

State

Zip

94965

City

State

Zip

Office Phone

(415) 903-2800

Home Phone

Email Address

instacart@politicomlaw.com

PRINCIPAL {49-1480(2)}

Name

Maplebear Inc. d/b/a Instacart

Office Phone

(415) 903-2800

Office Address (Street, Box, or Route)

28 Liberty Ship Way, Suite 2815

Official to Whom Lobbyist is Accountable

City

Sausalito

State

Zip

94965

Nature of Business {49-1480(3)}

App based delivery service

AMOUNTS GIVEN or to be given to lobbyist as compensation or reimbursement of lobbying: {49-1480(3)}. Please state the basis for your compensation.
1,000.00 Per Month

IDENTIFICATION of MATTERS on which principal or lobbyist expects to lobby: {49-1480(5)} Matters regarding app based delivery services

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

Names and addresses of principal's officers:

Fidji Simo/Asha Sharma/Nick Giovanni

50 Beale St #600
San Francisco, CA 94105

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)}

N/A

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

Kelley Foxx

Lobbyist Name

Jan 29, 2024

Date