An application was received from Heather Dudko representing Citizens Bank, requesting permission for a projecting blade sign at the premises numbered 616 Main Street approval has been received from Inspectional Services, Department of Public Works, Community Development Department and abutters proof of mailing had been provided

Primary Location Applicant Sign/Awning Permit 616 Main St & HEATHER DUDKO 198904 Cambridge, MA 02139 6 [phone removed] ext. @[email removed] Submitted On: Oct 17, 2022 General Information What option best describes this application? Sign(s) Description of Proposed Work FOR CITIZENS: INSTALL 4 SQ FT NON ILLUMINATED PROJECTING/BLADE SIGN. Estimated Cost of Sign(s) in dollars 1400 Describe any existing signs or awnings that will remain (including the size of the remaining signs/awnings). 2 WALL SIGNS -- 15 SQ FT EACH - FRONT/SIDE OF BUILDING. SEPARATE PERMIT APPLICATION #198476. Cambridge City Council approval may be required. Will one or more of the proposed signs extend six (6) inches You must submit a Projected Sign Application and into the public sidewalk? Abutter's Form Yes (https://viewpointcloud.blob.core.windows.net/profile- pictures/City_Clerk_Sign_Awning_Application_Wed_Jan_o 2_2019_15:28:46_GMT+0000_(Coordinated_Universal_Time )-pdf) to the City Clerk's Office. Sign Information Sign Text NO3 - "DAISY LOGO" Illumination Type of Sign Natural Projecting Width of Sign (feet) Height of Sign (feet) 2 2 Height from the ground to the top of the sign (feet) Area of Sign (square feet) 11.8 4 Sign Material Height from the ground to bottom of the sign (feet) ALUM/ACRYLIC 9.8 Projection from the Building (inches) Weight of the sign (Ibs) 28 30 Is the sign an accessory to a first floor store? Width of Building Facade for Associated Use (feet) Yes 47

Contractor Contractor Name KEVIN M OCONNELL Address 145 CANTERBURY DR Telephone E-mail [phone removed] [email removed] License Expiration Date License Number CS-081706 10/23/2023 Contractor's Signature Date Signature of Licensed Contractor KEVIN O'CONNELL 10/17/2022

OFFICE OF THE CITY CLERK CAMBRIDGE CITY HALL, 795 MASSACHUSETTS AVENUE CAMBRIDGE, MASSACHUSETTS 02139 PHONE [phone removed] FAX [phone removed] PAULA M. CRANE DONNA P. LOPEZ DEPUTY CITY CLERK CITY CLERK Cambridge, Остовыч 17,20 22 To the Honorable, the City Council of the City of Cambridge: EACH PETITION MUST BE ACCOMPANIED BY A DRAWING OF PROPOSED SIGN, INDICATING DESIGN AND DIMENSIONS AND LOCATION ON PREMISES. CITIZENS The undersigned respectfully prays that. (NAME OF BUSINESS) be granted permit to erect a sign of the following specifications in front of premises located al Gl6 MAIn StREET PROJECTING SIGN ROSSILLIMINATED): 45Q IT: 28" PRORATION (state whether electric or otherwise and material ased in construction) INTO DUBLS Reading matter to go on Sign: WAy. CITIZENS LOGO Weight: 30 (bs. Size: 24"× 24" Public Way 9'8" 2g" Obstruction: (Also exact distance from bottom of sign to sidewalk) (Give exact distance sign is to extend over sidewalk) 11'8" Top: 9'8" Height Above Grade: Bottom: NOTICE - REGULATIONS Section 12/2.0 State Building Code - Projecting Signs) (Section 12.08.010 Municipal Code - Encroachments onto Streets] • A projecting sign shall be constructed wholly of incombustible matenals. • All signs must meet requirements of Zoning Ordinances and Building Code. structure in or over a street... shall do so only on • Note: Section 12.12.220 provides in part "every owner who maintains a... the condition that such maintenance shall be considered as an agreement on his part to keep the same and the covers thereof in good repair and condition, at all times during his ownership, and to indemnify and save harmless the City against any and all damages, cost or expenses which it may sustain, or be required to pay by reason of such. structure" PROPERTY OWNER OR AUTHORIZED AGENT HEREBY STATES THAT INFORMATION IS TRUE TO THE BEST OF HIS/HER 444W. LAKESt. CHICAGO, 1L 60606 312) 36601 ROLAND AN ERSTANDING DE 4W. CAE ST EEIN. (505)612-6954. (Business owner) (Address) AMBURN, MA. 01501.

• •. U.S. Postal Service™ U.S. Postal Service™ CERTIFIED MAIL® RECEIPT CERTIFIED MAIL® RECEIPT Domestic Mail Only sps.Com Domestic Mail Only For delivery information, visit ou! For delivery information, visit our wiebsite at, www. 6743 Cambri de frAte 1 Combri de ,AB 02389 0501 Certified Mail Feo $4.00 07 _0501 Sertified Mail Fee $4.00 22 05 4611 Postmark •Retur Receipt (hardcopy) EX Peum Rce retopheck bar, ad le r g plate) 40.00.- •Return Receipt (hardcopy) Here • Return Receipt (electronic) _$0,00— $0,00 •Retum Receipt (electronic) •Certified Mail Restricted Delivery $_ $0.00 •Certified Mail Restricted Defivery Here 40,06- •Adult Signature Required •Adult Signature Required 0002 $0.00~ 00 000₴ • Adult Signature Restricted Delivery $. •Adult Signature Rostricted Dellvery $ . ZZNC 6 1 100 Postage $0.60 : 10/19/2022 $0.60 10219/2022 0410 0410 fotal Postage and fe9 85 RG 150 MAIN MIT GAMBRID6E REAL 25 SON TO MASS NST. O laHt street and Api. Ng, or PO Box N 04.200 Sstiei and Api. No, or aBaia. MASS 7022 AVE 7022 Tiy Siare ZU BRADGK everse for Instructions. 0213 MA Sec Reverse for Inst PS Form 3800, April 2015 PSN 7530-02-000-9047 PS Form 3800, April 2015 PSN 7530-02-000-g5872.5 U.S. Postal Service™ U.S. Postal Service"* CERTIFIED MAIL® RECE PT CERTIFIED MAIL® RECEIPT Domestic Mail Only Domestic Mail Only rebsite at www.usps.com For delivery information, visit our website at www.usps.com For delivery information, visit ou 6729 6767 Cambri dpe tAp02? USE 0501 Certified Mail Fee Certified Mail Fee $4.00 $4.00 ,07 090% 4611 4611 EXtra Services & Fees (check box, add fe l, Tel •Return Receipt (hardcopy) kelum Kecerot narecooy! Postmark $0.00 • Return Receipt (electronic) •Retum Receipt (electronio) $ $0.00 Here $0,00- Cortified Mail Restricted Delivery $0,00 •Certifed Mail Restricted Delivery 7202 6 1 $0.00~ • Adult Signature Required • Adult Signature Required 0002 100 ·0,00 0002 [] Adult Signature Restricted Dellvery $ Adult Signature Restricted Dellvery S Postage Postage $0.60 $0,60 10/19/2022 10/19/202 0410 Total Postage and Fe9. 85 0410 _ MeT lAvestr PS Form 3800, April 2015 PSN 7530 See Reverse tor Ins ..

August 18, 2022 City of Cambridge 637 Mẫm 4. 2 72A- 1 Main St 156 MALH St, 616 MALIN 70-96 600-604 CITIZENS. MAcn st. 41-57 Portland St State St 181 MAsS AvE 11-55. Albany Osborn St Vassar st Massachusetts Ave Kall MEDFORD ARLINGTON • Building Footprints • Parcels Paved Surfaces • Paved Roads GIS SOMERVILLE • Bridges • Unpaved Roads • Unpaved Parking Sidewalks City of Cambridge Massachusetts Driveways Alleys Other Paved Surface 1" = 139 ft • Public Footpath All data is provided for graphic representation only. The City of Cambridge expressly disclaims all warranties of any type, expressed or implied, including, but not limited to, any BOSTON varranty as to the accuracy of the data, merchantability, o fitness for a particular purpose. www.cambridgema.gov/gis

DATE MALID TO ABUTTER: 10/13/2022. OFFICE OF THE CITY CLERK CAMBRIDGE CITY HALL, 795 MASSACHUSETTS AVENUE CAMBRIDGE, MASSACHUSETTS 02139 PHONE [phone removed] FAX [phone removed] TTY/TDD [phone removed] DONNA P. LOPEZ PAULA M. CRANE Ф. CITY CLERK DEPUTY CITY CLERK COLATION OF MORE: U16 MAIn St. ABUTTERS FORM FOR SIGN/AWNING PERMIT To Whom It May Concer: Date 10/18/2022 Massachusetts, I do hereby declare my disapproval of the approval installment of: Canopy over the sidewalk entrance: Awnings over the windows: _ Projecting sign: 45Q11 (Sle"Attached photo) of said property. Sighed: Date ABUTTERS RetUrn to: HEATHER DUDIO 27 DUS MEETIOCOHOUSE RA. AUBURN, MI PLEASE COMPLETE FORM WHETHER OR NOT YOU APPROVE OF THE REQUESTED 01501. SIGN/AWNING AND RETURN IT TO THE APPLICAN?" WITHIN SEVEN (7) DAYS FOR INCLUSION IN THE APPLICATION. SIGN/AWNING APPLICANT: V PLEASE FILL IN DATE THAT FORM WAS DELIVERED TO ABUTTER (TOP RIGHT OF THIS FORM)

FATE MALLS TO ABUTTER: 10/18/2022. OFFICE OF THE CITY CLERK CAMBRIDGE CITY HALL, 795 MASSACHUSETTS AVENUE CAMBRIDGE, MASSACHUSETTS 02139 PHONE [phone removed] FAX [phone removed] TTY/TDD (617, 349-4242 DONNA P. LOPEZ PAULA M. CRANE CITY CLERK DEPUTY CITY CLERK LOLATION OF WORK: G11 MAUn St. ABUTTERS FORM FOR SIGN/AWNING PERMIT 10/18/2022 To Whom It May Concern: Date As Owner of Agent of Cambridge, MIT 150 MAN ST ME CAMBerOCIE of the Massachusetts, I do hereby declare my disapproval approval installment of: Canopy over the sidewalk entrance: Awnings over the windows: Projecting sign: 4 sQ it (sta Attached photo) of said property. Sighied: Date Address: _ ABUTTERS: Return to: HEATHER DuSKo: 27OUs METISGHOUSE RA. ALBURAN, MA PLEASE COMPLETE FORM WHETHER OR NOT YOU APPROVE OF THE REQUESTED 01501. SIGN/AWNING AND RETURN IT TO THE APPLICANE WITHIN SEVEN (7) DAYS FOR INCLUSION IN THE APPLICATION. SIGN/AWNING APPLICANT: PLEASE FILL IN DATE THAT FORM WAS DELIVERED TO ABUTTER (TOP RICHT OF THIS FORM)

DATE MALD TO ABUTTCR: 10/19/2022. OFFICE OF THE CITY CLERK CAMBRIDGE CITY HALL, 795 MASSACHUSETTS AVENUE CAMBRIDGE, MASSACHUSETTS 02139 PHONE [phone removed] FAX [phone removed] TTY/TDD [phone removed] DONNA P. LOPEZ PAULA M. CRANE CITY CLERK DEPUTY CITY CLERK LOLATION OF WORK: G16 MAIN St. ABUTTERS FORM FOR SIGN/AWNING PERMIT To Whom It May Concem: : Date 10/18/2022 . As OmnerorAgentor MCT 18L MAss MiE INNESTMUNTS, Cambridge. Massachusetts, I do hereby declare my disapproval of the approval installment of: Canopy over the sidewalk entrance: Awnings over the windows: Projecting sign: 4 sait (sta Attached photo) of said property. Signed: Date ) ABUTTERS Return to: HEATHER DUSKO: 21 OUs MaTACOHOUSE RA. AMBIRAN, MA PLEASE COMPLETE FORM WHETHER OR NOT YOU APPROVE OF THE REQUESTED 01501. SIGN/AWNING AND RETURN IT TO THE APPLICANT WITHIN SEVEN (7) DAYS FOR INCLUSION IN THE APPLICATION. SIGN/AWNING APPLICANT: PLEASE FILL IN DATE THAT FORM WAS DELIVERED TO ABUTTER (TOP RIGHT OF THIS FORM)

• DATE MAND TO ABUITER: 10/18/2022. OFFICE OF THE CITY CLERK CAMBRIDGE CITY HALL, 795 MASSACHUSETTS AVENUE CAMBRIDGE, NASSACHUSETTS 02139 PHONE [phone removed] .• FAX (617 349-426 [TY/TDD (617) 349-424 DONNA P. LOPEZ PAULA M. CRANE CITY CLERK DEPUTY CITY CLERK LOLATION O LORK: GIl MAIn St. ABUTTERS, FORM FOR SIGN/AWNING PERMIT To Whom It May Concern: 14/18/2022 | Date As Owner of Agent of MASS INSTITUE ON TECH Cambridge, Massachusetts, I do hereby declare my disapproval of the approval installment of: Canopy over the sidewalk entrance Awnings over the windows: Projecting sign: (Sac Attached photo) of said property. Sigfied: _Date ABUTTERS: Return to: HEATHiN •DUsKo. 21 OUs MUTINGHAnSE RA. AUBLIEN, ML PLEASE COMPLETE FORM WHETHER OR NOT YOU APPROVE OF THE REQUESTED 01501. SIGN/AWNING AND RETURN IT TO THE APPLICANI WITHIN SEVEN (7) DAYS FOR INCLUSION IN THE APPLICATION. SIGN/AWNING APPLICANT: PLEASE FILL IN DATE THAT FORM WAS DELIVERED TO ABUTTER (TOP RICHT OF THIS FORM) 'e

PHILADELPHIASIGN Philadelphia Sign Company • 50 Porter Rd • Littleton, MA 01460 5006585 Kendall Square 616 Main Street Cambridge, MA 02139 AUTHORIZATION AND CONSENT FORM By my signature below, 1 hereby represent that I am the owner of the property indicated above or otherwise duly authorized by the Lease to grant authorization for Philadelphia Sign Company and/or their sub contractor to apply for permits and install new signage at the above referenced location as per the attached brand book. LANDLORD APPROVAL Print Name Date Ronald miles 6/13/22 Signature 419 email Title [email removed] Authorized Sgmentory [phone removed] Address 444 W. Lake, Ste Z100 chicago, l2 6060- Return Form to: Philadelphia Sign Company 50 Porter Rd Littleton, MA 01460 email (Preferred): [email removed] or FAX to: [phone removed] attn: Tiphanie Gelinas

(Colle MAIN St.) (N03) Proposed PROJECTING Sign (including signs on awnings) 24" 24" Dimensions: Area in Square feet: External lumination: Natural. Internal Height (from ground to the top of the sigu): |(' g" Fear (leration) . Area of signs allowed accessory to store: Length in fect of store front facing street: (a) 41 Area of all existing signs on , behind windows (0.5 x a). outside (1 x a) _ Area of additional signs the store front to remain (including any freestanding sign): Q 15 permitted:_ 2. COMPLETE FOR ANY OTHER SIGN Area of signs allowed accessory to Length in feet of building facade facing street: (a). , behind windows (0.5 x a), - Area of the building facade: outside (1 xa). all existing signs on the building facade to remain (including any freestanding sign):_ Area of additional signs permitted:_ SUMMARY OF LIMITATIONS FOR PROJECTING SIGNS (see reverse side for more general summary of the sign regulations; review Article 7.000 of the Zoning Ordinance for all zoning requirements.) AREA: 13 square feet maximum. HEIGHT ABOVE THE GROUND: 20 feet but below the sills of second foo vindows. ILLUMINATION: Natural or external only. NUMBER: one per store plus one per entry to the remainde of the building. COMMUNITY DEVELOPMENT DEPARTMENT CERTIFICATION NO Sign conforms to requirements of Article 7.000: YES Sign requires a variance from the Board of Zoning Appeal: YES Relevant sections: 7.16.22.B Proposed projecting sign meets the dimensional and COMMENTS: _ illumination requirements of Article 7. Any sign that projects more than 6" into the public right-of-way will require approval by City Council. Date: 09/01/22 CDD Representative Daniel Messel

N01 NO3 N02 NO1A NOT NO1A Proposed N04 9 4-1/2 ** Citizens BRIGING THE WORLD'S BRANDS TO LIFE PHILADELPHIASIGN (N02 FLB-2-CUST Green Fascia with Ecru Lightbar - Dimensions TBD FLB-2-CUST Green Fascia with Ecru Lightbar - Dimensions TBD i TITLE ADDRESS DSF-1-24 24'h Non-illuminated Green Flag Mount Daisy - 24"h x 24'h (4 SF) -N03 ONL- Citizens 616 Main Street Cambridge, MA 02139 CLL-2-18 18"h iluminated White Horiztonal Channel Letters - 1' 7-5/16"h x 9' 4-1/2"w (15.1 SF)) DWG BY 5006585 - Kendall Square ZAS BUILDING FRONTAGE = 47 4t (NO3) DATE SHEET DWG NUM A36731 08.18.21 PERMOTTEDS SEPARATELY. DATE 12.13.21 09.28.21 12.28.21 03.23.22 09.09.21 08.27.21 Signs Rendered Proportional to the Photo REVISION Revised N04....... Revised as Noted.... RevIsed 101..•••••..•..• 707 WEST SPRING GARDEN ST • PALMYRA. NJ • 08065 • P: [phone removed] • F: [phone removed] • WEB: http://www.philadclphiasign.com Revised as Noted...... Existing Revised 101, Removed N07 RESTAURANT Revised NO3, 101 & Floor Plar SPACE Scale: NTS BLADE SILAN BOW LEASING DHR-1-QR PEM ZAS ZAS ZAS ZAS ZAS Scale: NTS DSF-1-24 CLEARANCE: 9'8" CATERGADRARFETO. CO [phone removed] OR EXHEITED SI ANY FASHIOR. DUTSIDE TOUR URGANCA ROR NOR www rentet oi tabed. lE IESI AN ORGINAL UN/LBLISHED I5 SUISETTED FOR YOUR PERSONAL. T IS HOI TO BE SHOWH TO ANYONE BEING PLANNED FOR YGU EY P.S.CO. I5 IF TO BE USED, COPED, REPROUILCED.

LAG BOLT HAROWARE •241 12ft TOS from Grade or Less -4"- 454ft Entire Support Structure Painted With a Satin Clear Coat #281 228 SP MP #78600 Citizens Green (Satin Finish) Scale: 3" = 1'0° MOUNTING PLATE ELEVATION WALL CONSTRUCTION Scale: 11/2" = 1'0" nty enterent intales pentac-guide for wat centracion tyce. BENSOLASS For Cover Mounting. Peter star sang tee war sute pest.se 3/8" Alum Mounting Plate 125 nta 15 sue or OVERMETAL STUD PAINTE 1/4 × 2 x 2 1/2" Alum Gusset Plates 1/4* Routed Alum Main Support Plate 1/8" × 1/2° x 1" Alum Angle Welded to Plate (4) 7/16" Dia Holes for 3/8" Mounting Hardware to Sult Wall Conditions. Thru-Bolt is Prefered Method. • Denotes Location of #6 Hardware. Engineers Connection Note: Offset .063" Backer Support. - NON ILLUMINATED - #15 Drill (.18 max) 13mm White Sintra Backs McMaster #93738A160 or Equal. 1/4" Routed Alum Main Support Piate With a Gloss Clear Coat #282 208 SP Phillips Machine Screws. 1/4*-20 Thru Bolt Sintra panels to Alum Painted MP #20060 Ecru (Satin Finish) #6-32 Threaded Barb Insert in Faces. - a Matthews #281 228 SP Satin Clear Coat 063" Alum Retums Welded to Face Panel 090" Alum Faces Welded to Returns Painted MP #78600 Citzens Green (Satin Finish) With #6-32 x 3/8" Flat Undercut Head McMaster #91099A215 or Equal With a Matthews #281 228 SP Satin Clear Coat Painted MP #78600 Citizens Green (Satin Finish) Wind xposure SECTION - 215/16*1 Grnd. Snow Pes Scale: 3" = 1'0° 1/4° 3. Sign Shall Be U.L. Listed. -11/4° ruit=115 mph STANDARD WALL SIGN NOTES: DESIGN LOADS Where Allowed By Local Codes. 4. Mounting Hardware By Sign Installer. 2. Final Primary Hook-up By Sign Installer, sumicient Primary Circur in viciniy i sigh DATE: SHEET: DRAWN BY: SIGN TYPE: 4 OF 4 CUSTOMER: No. 49706 Citizens JOB NUMBER: B101508 S108597 DWG NUMBER: 7127/2022 EGISTER IS 616 Main Street DRAWING Por yes a gray on gret Cambridge, MA 02139 RINGING THE WORLD'S ARANOS TO LIFE ENG DEPT PHILADELPHIASIGN CONSTRUCTION

Inspector Plumbing Excavation Date Date Date Depth Inspector Fdn Drain the final inspection had been made. Gas Footings No Dumpster Required Permit Number: BLDC-185597-2023 Date Date Date Rough Inspector Rough Frame Buildings shall not be occupied until a final HVAC Equipment Date Dale Date Final Rough Inspector Sprinkler 610 Main St inspectors approve various stages below. Code violations are subject to Violation Penalties, 780 CMR 114.4. HVAC Duct Work BRIAN LAVERTY Cambridge, MA 02139 Final Date Rough INSPECTIONAL SERVICES DEPARTMENT Electrical CITY OF CAMBRIDGE Above Ceiling has permission to: Ground Floor: New bank (Citizen's), interior fitout BUILDING PERMIT Date Rough Inspector Sanitary Insulation Ranjit Singanayagam, Commissioner Date: February 2, 2023 Date Inspector inspection has been made and a Certificate of Use and Occupancy has been issued. Work shall not proceed until provided that the person accepting this permit adhere to regulations governing the Inspectional Services Department. Approved plans must be retained on the job site and this permit kept posted until Final Inspection Fire Department

PHILSIG Client#: 122011 DATE (MM/DD/YYYY) ACORD. CERTIFICATE OF LIABILITY INSURANCE 5/23/2022 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURERS), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFIGATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer any rights to the certificate holder in lieu of such endorsements). PRODUCER Diane Pavilonis, CIC, CISR Huntington Insurance, Inc. FAC. No): [phone removed] 0, Ext): [phone removed] 310 Grant Street, 2nd floor [email removed] Pittsburgh, PA 15219 NAIC # INSURER(S) AFFORDING COVERAGE [phone removed] 25623 INSURERA: Phoenix Insurance Co INSURED 25674 INSURER B: Travelers Property Casualty Co of Am Philadelphia Sign Company 25658 INSURER C: Travelers Indemnity Co 707 W Spring Garden St (13056 INSURER D: RL Insurance Company Palmyra, NJ 08065 20281 INSURERE: Federal Insurance Company INSURER F: COVERAGES REVISION NUMBER: CERTIFICATE NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, CERTIFICATE MAY BE ISSUED OR MAY PERTAIN. EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ABLOUD TYPE OF INSURANCE SR IWMI POLICY NUMBER X COMMERCIAL GENERAL LIABILITY 12/31/2021 12/31/2022 EACH OCCURRENCE P6604B139679PHX21 $1,000,000 $300,000 | CLAIMS MADE X OCCUR $10,00D MED EXP (Ary one person) $1,000,000 PERSONAL & ADV INJURY $2,000,000 GENL AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 PRODUCTS - COMP/OP AGG LOC POLY XPEC OTHER: AUTOMOBILE LIABILITY 8101L6995682143G 12/31/2021 12/31/2022 GODENDINGLE LMIT $1,000,000 BODILY INJURY (Per person) X ANY AUTO BODILY INJURY (Per accident)s (EDULED ON-OWNED AUTOS ONLY X AUTOS ONLY $15,000,000 12/31/2021 12/31/2022 EACH OCCURRENCE CUP2P9316602143 X B X UMBRELLA LAB AGGREGATE $15,000,000 EXCESS LIAB CLAIMS-MADE DED X RETENTIONSO WORKERS COHPANSATTON UB6K78752522 706/01/2022 06/01/2023 PERTUTE C AND EMPLOYERS LIABILITY $1,000,000 EL EACH ACCIDENT OFFICER MEMBER CURECUE IN NIA EL DISEASE - EA EMPLOYEE $1,000,000 EL DISEASE -POLICY LIMIT $1,000,000 DESCRIPTON OF OPERATIONS beave ILM0301919 D Install Floater 12/31/2021 12/31/2022 $100,000 82626749 12/31/2021 12/31/2022$1,000,000 E Crime/3rd Party P6604B139679PHX2 12/31/2021 12131/2022 $150,000 A [Lease/Rent Equip DESCRIPTION OF OPERATIONS / LOGATIONS/ VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE ORANUASE SHeKeur. WILL BE DELIVERED IN NOTICE ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE © 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD - PADI1 #51938761/M119372380f1

The Commonwealth of Massachusetts Department of Indusirial Accidents Office of Investigations Lafayette City Center 2 Avenue de Lafayette, Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Busines/Organization/Individual):_ PHILADELPLIA SLUN COMPANY Address: STREET 707 WEST SPRING GARDEN Phone#: City/State/Zip: PALMyRA, NT 08065 (' [phone removed] Are you an employer? Check the appropriate boz: Type of project (required): 4. I am a general contractor and I 6. L New construction A I am a employer with 100 have hired the sub-contractors employees (full and/or part-time).* listed on the attached sheet 7. • Remodeling 2. • I am a sole proprietor or partner- These sub-contractors have 8. • Demolition ship and have no employees employees and have workers' working for me in any capacity. 9. • Building addition comp. insurance. [No workers' comp. insurance 10. Electrical repairs or additions 5. • We are a corporation and its required.] officers have exercised their 11.D Plumbing repairs or additions 3. • I am a homeowner doing all work right of exemption per MGL myself. [No workers' comp. 12. Roof repairs c. 152, §1(4), and we have no insurance required.] + 13.IX| Other SIGN INSTALL employees. [No workers' comp. insurance required] *Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information. * Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. *Contractors that check this box must atiached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees, they must provide their workers' comp. policy number. I am an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site information. TRAVELERS INDEMNLTY CO. insurance Company Name: : UB6K787525 Policy # or Self-ins. Lie. #: _ Expiration Date: 6/1/2023 Lotte MAIN Street teNs Job Site Address: Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 and/or one-year imprisonment, as well as civil penaities in the form of a STOP WORK ORDER and a fine of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. that the information provided above is true and correct 10 12 2022 Date: Signature: Phone#: 918) 486. 0137 Official use only. Do not write in this area, to be completed by city or town official City or Towa: Permit/License # Issuing Authority (check one): 1D Board of Health 2 Building Department 3L_|City/Town Clerk 4. Electrical Inspector 5_ Plumbing Inspector 6.Other