Nebraska Legislature - Lobbyist Reporting Application

FORM
A

NEBRASKA LEGISLATURE
APPLICATION FOR REGISTRATION AS A LOBBYIST

Dec 18, 2018

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

PLEASE FILL IN ALL BLANKS

LOBBYIST {49-1480(1)}

Name

Behrens, Mark A.

Office Address (Street, Box, or Route)

1155 F Street, N.W., Ste 200

Permanent Residence (Street, Box, or Route)

City

Washington

State

Zip

20004

City

State

Zip

Office Phone

(202) 639-5621

Home Phone

Email Address

mbehrens@shb.com

PRINCIPAL {49-1480(2)}

Name

Nationwide Mutual Insurance Company

Office Phone

(515) 508-3400

Office Address (Street, Box, or Route)

1100 Locust Street, D1-7C-0301

Official to Whom Lobbyist is Accountable

Winston Morris

City

Des Moines

State

Zip

50391

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.
630.00 Per Hour

IDENTIFICATION of MATTERS on which principal or lobbyist expects to lobby: {49-1480(5)} All matters related to asbestos trust transparency.

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

Names and addresses of principal's officers:

Anne Saxson, Vice President, State Government Relations, One Nationwide Plaza, Columbus, OH 43215

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.

Behrens, Mark A.

Lobbyist Name

Dec 18, 2018

Date