Nebraska Legislature - Lobbyist Reporting Application

FORM
A

NEBRASKA LEGISLATURE
APPLICATION FOR REGISTRATION AS A LOBBYIST

Jan 18, 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

Sepich, Craig

Office Address (Street, Box, or Route)

1515 W. 22nd St., Suite 1300W

Permanent Residence (Street, Box, or Route)

1515 W. 22nd St. Suite 1300W

City

Oak Brook

State

Zip

60523

City

Oak Brook

State

Zip

60523

Office Phone

(847) 772-7667

Home Phone

(847) 772-7667

Email Address

csepich@nicb.org

PRINCIPAL {49-1480(2)}

Name

National Insurance Crime Bureau

Office Phone

(847) 772-7667

Office Address (Street, Box, or Route)

1515 W. 22nd St., Suite 1300W

Official to Whom Lobbyist is Accountable

Richard DiZinno, Senior VP & General Counsel

City

Oak Brook

State

Zip

60523

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.
400.00 Per Month

IDENTIFICATION of MATTERS on which principal or lobbyist expects to lobby: {49-1480(5)} Insurance and Public Safety

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

Names and addresses of principal's officers:

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.

Craig Sepich

Lobbyist Name

Jan 18, 2024

Date