KANSAS GOVERNMENTAL ETHICS COMMISSION ECEIPTS AND EXPENDITURES REPORT A POLITICAL OR PARTY COMMITTEE \ October 27, 2008 ILE WITH SECRETARY OF STATE REVERSE SIDE FOR INSTRUCTIONS A. Name of Committee: Kansas Insurance Agents Political Action Committee Address: 815 SW Topeka Blvd City and Zip Code: Topeka 66612 ---------------------------- This is a (check one): __ Party Committee '" Political Committee B. Check only if appropriate: __ Amended Filing __ Tennination Report C. Summary (covering the period from July 25, 2008 through October 23, 2008) 1. Cash on hand at begiIU1ing of period . 35494.77 2. Total Contributions and Other Receipts (Use Schedule A) . 25120.20 3. Cash available this period (Add Lines I and 2) . 60614.97 4. Total Expenditures and Other Disbursements (Use Schedule C) . 38276.16 5. Cash on hand at close of period (Subtract Line 4 from 3) .. 22338.81 6. In-Kind Contributions (Use Schedule B) ......... o 7. Other Transactions (Use Schedule D) .. o 10/23/08 Date GEe Form Rev, 2001 SCHEDULE A CONTRIBUTIONS AND OTHER RECEIPTS Kansas Insurance Agents Political Action Committee (Name of Party Committee or Political Committee) Occupation & Industry of Cbeck Amount of Name and Address Individual Giving More Appropriate Box Cash, Check, Date of Contributor Tban $150 Loan or Cash Check Loan Other Other Receipt 1st Choice Insurance Agency 8/12/08 105 W Main .f $75.00 Norton,KS 67654 1st Choice Insurance, LLC 9/5/08 118 W Greeley Ave .f $75.00 Tribune, KS 67879 AASI Insurance, Inc. 9/10/08 2820 SE 29th .f $75.00 Topeka, KS 66605-2263 ABK Insurance Agency, Inc. Insurance 9/5/08 3339 SE Adams St. .f $225.00 Topeka, KS 66605 Accident Fund Ins Co. of America 8/25/08 232 S Captiol Ave .f $75.00 Lansing, MI 48933 Acuity 8/20/08 1202 Old Hawthorne Drive E .f $75.00 Columbia, MO 65201 Agency, Inc, The 8/20/08 122 N Main $75.00 Lakin, KS 67860 v' Agency in Montezuma, Inc., The 8/12/08 101 Zaldivar $75.00 Montezuma, KS 67867 .f Agency Services Corp of Kansas 9/30/08 815 S Topeka Blvd .f $75.00 Topeka, KS 66612 Agri-Risks Services, Inc. 9/10/08 7540 W 160th St. $75.00 Stillwell, KS 66085 .f AIG Speciality Auto 10/17/08 1310 Morris Road, Ste 600 .f $75.00 Alpharetta, GA 30004 _. - . $975.00 SubtotalThis Page "'"' Page _1_ ofKl_ SCHEDULE A CONTRIBUTIONS Al\'D OTHER RECEIPTS Kansas Insurance Agents Political Action Committee (Name ofPany Committee or Political Committee) Occupation & Industry of Check Amount of Name and Address Individual Giving More Appropriate Box Cash, Check, Date of Contributor Than $150 LoaD or Cash Check Loall Olbe, Other Receipt Air Capital Insurance, LLC 9/3/08 125 East 2nd St. $75.00 ~ Wichita, KS 67202 All Insurance Access, LLC 8/14/08 3706 SW Topeka Blvd, Ste 411 .; $75.00 Topeka, KS 66609 Allied Ins.-A Mbr of Nationwide Ins 8/20/08 PO Box 80758 $75.00 ~ Lincoln, NE 68501 Almena State Bank 8/6/08 500 Main $75.00 ' ~ Almena, KS 67622-0127 AOPA Insurance Agency, Inc. 8/14/08 1995 Midfield Rd $75.00 ~ Wichita, KS 67209 Applied Systems, Inc. 10/17/08 200 Applied Parkway $75.00 ~ University Park, IL 60456 ARMtech Insurance Services 9/10/08 1310 S Sherman Ave .; $75.00 Liberal, KS 67901 AutoSure, Inc. 8/6/08 900 S Second $75.00 ~ Dodge City, KS 67801 Avery Agency, W.E. 8/14/08 201 N Walnut. $75.00 ~ Peabody, KS 66866-0131 Ayres Insurance Agency, LLC 8/6/08 201 Starr Ave $75.00 ~ Miltonvale, KS 67486 Backman-Bishop Agency 8/6/08 2632 Tumbleweed Road $75.00 ~ Vermillion, KS 68544 $825.00 Subtotal Th,is Page Page __~ ofZ-L SCHEDULE A CONTRIBUTIONS AND OTHER RECEIPTS Kansas Insurance Agents Political Action Committee (Name of Party Committee or Political Committee) Occupation & Industry of Check Amount of Name and Address Individual Giving More Appropriate Box Cash, Check, Date of Contributor Than $150 Loan or Casb Check Loan Other Other Receipt Baldwin Insurance Services 8/6/08 802 Ames Street ..; $75.00 Baldwin City, KS Banco Insurance Agency 8/20/08 201 N Main ..; $75.00 Haviland, KS 67059 Berkley & Berkley Agency 9/3/08 104 S Main ..; $75.00 Tescott, KS 67484 Berkshire Hathaway 9/3/08 9290 W Dodge Rd ..; $75.00 Omaha, NE 68114 Beverly Insurance Agency 8/6/08 101 S Main ..; $75.00 Beverly, KS 67423 Billiups, Snyder & Associates 8/6/08 905Walnut ..; $75.00 Blue Springs, MO 64015 Braden Insurance & Real Estate 9/5/08 105 W 3rd St. $75.00 Eureka, KS 67045-1444 ..; Brethren Mutual Aid Agency 8/20/08 3094 Jeep Road ..; $75.00 Abilene, KS 67410 Bridges Group, Inc. 9/5/08 117 N Kansas ..; $75.00 Norton, KS 67654-2050 Brooke Agency Services Co, LLC 8/14/08 103 W Parallel ..; $75.00 Clifton, KS 66937 Brooke Agency Services Co, LLC 8/6/08 104 N Douglas Ave ..; $75.00 Ellsworth, KS 67439 $825.00 Subtotal This l'·ag·e . " -~- Paoe'" ---3 of2-1--­ SCHEDULE A CONTRIBUTIONS AND OTHER RECEIPTS Kansas Insurance Agents Political Action Committee (Name of Party Committee or Political Committee) Occupation & Industry of Check Amount of Name and Address Individual Giving More Appropriate Box Cash, Check, Date of Contributor Than $150 Loan or Ca~h Check Loan Olher Other Receipt Brooke Agency Services CO,LLC 8/14/08 412 W Commercial $75.00 ~ Fairview, KS 66425 Brooke Agency Services Co, LLC 8/6/08 124 N Kansas $75.00 ~ Frankfort, KS 66427 Brooke Agency Services Co, LLC 8/6/08 610 Oregon $75.00 ~ Hiawatha, KS 66434 Brooke Agency Services Co, LLC 9/19/08 600 S Main St. $75.00 ~ Hugoton, KS 67951 Brooke Agency Services Co, LLC 8/14/08 PO Box 250 $75.00 ~ Maple Hill, KS 66507-0250 Brooke Agency Services Co, LLC 8/27/08 119B S Pennsylvania $75.00 ~ Ness City, KS 67560-0547 Brooke Agency Services Co, LLC 8/6/08 133 S Main $75.00 Smith Center, KS 66967 .f Brown Insurance 8/27/08 105 N 8th $143.75 ~ Hiawatha, KS 66434 Bohrer, Croxdale & McAdoo, Inc. 8/20/08 601 SAve $75.00 ~ Springfield, MO 65801 Bolinger Agency 8/25/08 120 N Main $75.00 ~ Bucklin, KS 67834 Bolz Insurance, Inc. 9/5/08 PO Box 486 $75.00 ~ Lyndon, KS 66451-0486 .­ ~ $893.75 Subtotal TillIs Pa.g!f , .~~ 'Z­ Page _4_ of2d­ SCHEDULE A CONTRIBUTIONS AND OTHER RECEIPTS Kansas Insurance Agents Political Action Committee (Name of Pan)' Committee or Political Committee) Occupation & Industry of Check Amount of Name and Address Individual Giving More Appropriate Box Cash, Check, Date of Contributor Than $150 Loan or Cash Cbeck Loan Otber Other Receipt Builders' Ins Consultants, Inc. 8/14/08 1100 Walnut, Ste 3010 .; $75.00 Kansas City, MO 64106 Cananwill Premium Funding 10/17/08 8331 Oakview Circle .; $75.00 Lenexa, KS 66215 Capitol Agency 8/6/08 9500 Nail Ave, #305 .; $75.00 Overland Park, KS 66207 Capital Resources, LLC 9/3/08 7960 W 135th St. .; $75.00 Overland Park, KS 66223 "­ Cardinal Insurance Co., Inc, 9/19/08 332 W 7th .; $75.00 Junction City, KS 66441 Carpenter & Co. 8/6/08 8301 State Line Rd, Ste G-A .; $75.00 Kansas City, MO 64114 Case & Son Insurance, Inc. 8/12/08 220 E Main $75.00 Marion, KS 66861-0217 .; Central Insurance Agency Insurance 8/14/08 101SMiliSt. .; $375.00 Glen Elder, KS 67446-0008 Century 21 Miller & Midyett 9/5/08 1045 E 23rd St. .; $75.00 Lawrence, KS 66046 Charlson-Wilson Ins Agency 8/12/08 55 Poyntz Ave, Ste 205 .; $75.00 Manhattan, KS 66502-0023 Chris-Leef General Agency, Inc. 8/12/08 11503 W 75th St. .; $75.00 Shawnee, KS 66203-0747 .. .~. $1,125.00 ·Sub-total This Page "" Page _~_ ofE­ SCHEDULE A CONTRIBUTIONS AND OTHER RECEIPTS Kansas Insurance Agents Political Action Committee (Name of Party Committee or Political Committee) Occupation & Industry of Check Amount of Name and Address Individual Giving More Appropriate Box Cash, Check, Date of Contributor Than $150 Loan or Cash Cbeck Loan Otber Other Receipt Christian & Associates, Inc. 8/6/08 One Ward Parkway, Ste 106 .; $75.00 Kansas City, MO 64112 Citizens Insurance Agency 8/6/08 124 E Commercial .; $75.00 Waterville, KS 66548 Cline-Wood Agency, Inc. 8/27/08 11250 Tomahawk Creek Pkwy .; $75.00 Leawood, KS 66211 Cockrum Insurance Agency 8/6/08 202 S Main .; $75.00 Johnson, KS 67855-0130 Colonial Life 8/27/08 6710 W 121st St. .; $75.00 Overland Park, KS 66209 Commercial Risk Management 8/14/08 4121 W 83rd St., Ste 156 .; $75.00 Prairie Village, KS 66208-5323 Commercial Ins Associates, Inc. 8/27/08 6155 Oak St., Ste B .; $75.00 Kansas City, MO 64113 Commercial Ins Group, Inc. 8/6/08 400 N Woodlawn, Ste 100 .; $75.00 Wichita, KS 67208 Commercial Ins Underwriters Inc. 8/12/08 305 W Walnut Lawn .; $75.00 Springfield, MO 65808-9005 Community Ins Service, Inc. 8/25/08 309 Maple .; $75.00 Overbrook, KS 66524 Concannon Co., Inc. Michael F. 8/20/08 930 Kehrs Mill Road, #319 .; $75.00 Ballwin, MO 63022 $825.00 Subtotal This Page -' Paae 6 of2--'7 '" --- --­ SCHEDULE A CONTRIBUTIONS A.l\:"'D OTHER RECEIPTS Kansas Insurance Agents Political Action Committee (Narne of Party Committee or Political Committee) Occupation & Industry of Check Amount of Name and Address Individual Giving More Appropriate Box Cash, Check, Date of Contributor Than $150 Loan or Cast! Cbeck Loa.n Otber Other Receipt Conrad Insurance Agency 8/12/08 10701 Barkley St.