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An application was received from Russell House Tavern, requesting permission for a projecting sign at the premises numbered 14 JFK Street approval has been received from Inspectional Services, Department of Public Works, Community Development Department and abutter
⚠ This document is a scan; its text was recovered by optical character recognition and may contain errors. The original PDF is authoritative.
February 19, 2025
City of Cambridge, MA
Primary Location
Applicant
1146028
14 Jfk St
Sign/Awning Permit
& Stuart Pitchel
Status: Active
Cambridge, MA 02138
2 [phone removed]
Submitted On: 12/13/2024
@ [email removed]
Owner
A 236 Pearl Street
1834 REALTY, INC.
Somerville, MA 02145
FACILITIES DEPARTMENT
WALTHAM, MA 02451
Hide
General Information
What option best describes this application?*
Sign(s)
Description of Proposed Work*
Installation of (1) projecting blade sign to read "RUSSELL HOUSE TAVERN"
Estimated Cost of Sign(s) in dollars *
21906.25
Describe any existing signs or awnings that will remain (including the size of the remaining signs/awnings).*
Two awning signs ("Russel House Tavern") remain on the valence with 1 on each
awning.
Cambridge City Council approval may be required.
Will one or more of the proposed signs extend six (6)
inches into the public sidewalk?*
Yes
You must submit a Projected Sign Application and Abutter's Form to the City
Clerk's Office.
Sign Information
Sign Text*
RUSSELL HOUSE TAVERN
Illumination*
Type of Sign*
Internal
Projecting
Height of Sign (feet)*
Width of Sign (feet)*
4
2.8
Height from the ground to the top of the sign
Area of Sign (square feet)*
(feet)*
10.9
12.8
Height from the ground to bottom of the sign
Sign Material*
(feet)*
Aluminum & Acrylic
10
Projection from the Building (inches)
Weight of the sign (Ibs)*
48
125
Is the sign an accessory to a first floor store?*
Width of Building Facade for Associated Use
(feet)*
Yes
45.75
Contractor
Contractor Name*
STUART R PITCHEL
Address*
30 FREEMAN ST
E-mail*
Telephone*
[phone removed]
[email removed]
License Number*
License Expiration Date*
12/20/2026
CS-091230
Contractor's Signature
Date*
Signature of Licensed Contractor*
Stuart Pitchel
12/11/2024
Community Development Approval
@ Sign conforms to requirements of Article 7.000
• Sign requires a variance from the Board of Zoning
Appeal
-
• Comments
& Exempt under Article 7.000
-
City Clerk Internal
& Bond Number
Attachments
Required
Drawing of Sign(s)
RusselHouse_Blade_v1.pdf
Uploaded by Stuart Pitchel on Dec 11, 2024 at 4:08 PM
Required
Contract with Sign Company
SRP revised estimate signed.pdf
Uploaded by Stuart Pitchel on Jan 9, 2025 at 11:20 AM
= Versions
Required
Proof of Insurance
SRP Sign Corp COl.pdf
Uploaded by Stuart Pitchel on Dec 11, 2024 at 4:08 PM
Required
Signed contract between property owner and applicant
dfraine_11-21-2024_10-48-32.pdf
Uploaded by Stuart Pitchel on Dec 11, 2024 at 4:11 PM
14JFK_ApprovedSignCert_241016.pdf
14JFK_ApprovedSignCert_241016.pdf
Uploaded by Stuart Pitchel on Dec 11, 2024 at 4:11 PM
WorksComp_Signed.pdf
WorksComp_Signed.pdf
Uploaded by Stuart Pitchel on Dec 11, 2024 at 4:13 PM
draine 11-21-2024-10-58-59.00f
dfraine_11-21-2024_10-58-59.pdf
Uploaded by Stuart Pitchel on Dec 11, 2024 at 4:13 PM
signabutterformpdf.pdf
signabutterformpdf.pdf
Uploaded by Stuart Pitchel on Dec 11, 2024 at 4:13 PM
SRP revised estimate signed.pdf
SRP revised estimate signed.pdf
Uploaded by Stuart Pitchel on Jan 9, 2025 at 11:19 AM
14 JFK St COA Russell House Tavern blade sign.pdf
14 JFK St COA Russell House Tavern blade sign.pdf
Uploaded by Sarah Burks on Feb 10, 2025 at 7:15 PM
Record Activity
Timeline
Due
Label
Status
Completed
Activated
Assignee
Date
Branden
12/13/2024,
1/13/2025,
Completed
8:08:54 AM
9:17:49 AM
Vigneault
Review for
Completeness
12/13/2024,
12/13/2024,
Completed
Teal Delys
9:20:53 AM
8:08:54 AM
Community
Development
Plan Review
Due
Label
Status
Activated
Assignee
Completed
Date
Sarah
1/13/2025,
2/10/2025,
Completed
-
9:17:49 AM
7:14:57 PM
Burks
Historical
Commission
Brian
1/23/2025,
1/13/2025,
Completed
9:17:49 AM
McLane
9:47:28 AM
Department of
Public Works
Review
2/10/2025,
Active
Lori Perez
7:14:58 PM
City Clerk
Review
* Inactive
City Council
Approval
Inactive
Bond
Stuart
Inactive
Pitchel
$
Sign Permit Fee
Due
Label
Activated
Status
Completed
Assignee
Date
Inactive
Building
Inspector
Review
Inactive
=
Sign Permit
B0T3
OFFICE OF THE CITY CLERK
CAMBRIDGE CITY HALL, 795 MASSACHUSETTS AVENUE
CAMBRIDGE, MASSACHUSETTS 02139
PHONE [phone removed]
FAX [phone removed]
DIANE P. LEBLANC
PAULA M. CRANE
CITY CLERK
DEPUTY CITY CLERK
10/8
, 2024
Cambridge,
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.
The undersigned respectfully prays that Russell House Tavern
(NAME OF BUSINESS)
be granted permit to erect a sign of the following specifications in front of premises located at
14 JFK Street
(ADDRESS)
Type of Sign: Projecting Blade Sign
(state whether electric or otherwise and material used in construction)
Reading matter to go on Sign:
Russell House Tavern
32.75" × 48" × 10"
Size:
Weight: 125lbs
Public Way
121.5"
Obstruction:
A. 48"
(Give exact distance sign is to extend over sidewalk)
(Also exact distance from bottom of sign to sidewalk)
121.5"
Top: 1695"
Height Above Grade: Bottom:
NOTICE - REGULATIONS
[Section 12.08.010 Municipal Code - Encroachments onto Streets]
Section 1212.0 State Building Code - Projecting Signs]
• A projecting sign shall be constructed wholly of incombustible materials.
• All signs must meet requirements of Zoning Ordinances and Building Code.
• Note: Section 12.12.220 provides in part "every owner who maintains a ... structure in or over a street... shall do so only on
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
KNOWLEDGE AND UNDERSTANDING UNDER PAINS AND PENALTY OF PERJURY.
1374
1617.438•1868
MASS AVE
(Property owner or authorized agent)
(Tel. No.)
(Address)
[phone removed]
14 JFK Street Cambidge, MA. 02136
(Address)
(Business owner)
(Tel. No.)
OFFICE OF THE CITY CLERK
CITY OF CAMBRIDGE
[phone removed]
FAX [phone removed]
ty/TDD [phone removed]
DONNA P. LOPEZ
INTERIM CITY CLERK
ABUTTERS FORM FOR SIGN/AWNING PERMIT
Date 12/07/2024
To Whom It May Concern:
18-28 JFK Street
As Owner of Agent of
Cambridge,
of the
X
Massachusetts, I do hereby declare my disapproval
_approval
installment of:
Canopy over the sidewalk entrance:
Awnings over the windows:
X
Projecting sign: _
of said property.
12/07/2024
Date
Signed:
PO Box 590179, Newton, MA 02459
Address:
ABUTTERS:
PLEASE COMPLETE FORM WHETHER OR NOT YOU APPROVE OF THE REQUESTED
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)
CITY HALL, 795 MASSACHUSETTS AVENUE CAMBRIDGE, MASSACHUSETTS 02139
OFFICE OF THE CITY CLERK
CAMBRIDGE CITY HALL, 795 MASSACHUSETTS AVENUE
CAMBRIDGE, MASSACHUSETTS 02139
PHONE [phone removed]
FAX [phone removed]
TTY/TDD [phone removed]
DIANE P. LEBLANC
PAULA M. CRANE
CITY CLERK
DEPUTY CITY CLERK
ABUTTERS FORM FOR SIGN/AWNING PERMIT
To Whom It May Concern:
Dano 1/2/24
As Owner of Agent of 1374 MASS AVE
Cambridge,
of the
V
Massachusetts, I do hereby declare my disapproval
_approval
installment of:
Canopy over the sidewalk entrance:
Awnings over the windows:
Projecting sign:_
of said property.
Signed:
Dato. 11/2/24
Lamil Train
MASS AVE CAMBRIDGE
Address:
1374
ABUTTERS:
PLEASE COMPLETE FORM WHETHER OR NOT YOU APPROVE OF THE REQUESTED
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)
CAMBRIDGE HISTORICAL COMMISSION
831 Massachusetts Avenue, 2nd Fl., Cambridge, Massachusetts 02139
Telephone: [phone removed] E-mail: histcomm@cambridgema.gov
URL: https://www.cambridgema.gov/historic
LIDGE HISTO
Chandra Harrington, Chair, Susannah Barton Tobin, Vice Chair; Charles M. Sullivan, Executive Director
Joseph V. Ferrara, Elizabeth Lyster, Jo M. Solet, Yuting Zhang, Members
RICAL
Gavin W. Kleespies, Paula A. Paris, Kyle Sheffield, Alternates
OMMISSIO™
CERTIFICATE OF APPROPRIATENESS
14 JFK Street
Property:
1834 Realty Inc.
Applicant:
Attention:
Daniel Fraine
Cambridge Savings Bank
81 Wyman Street
Waltham, Mass. 02451
Patrick Lee
Grafton Group Hospitality
14 JFK Street
Cambridge, Mass. 02138
The Cambridge Historical Commission hereby certifies, pursuant to the
Massachusetts Historic Districts Act (MGL Ch. 40C) and the Cambridge
Historical Buildings and Landmarks Ordinance (Cambridge City Code,
Ch. 2.78), that the work described below is not incongruous to the
historic aspects or architectural character of the building or
district:
Install illuminated blade sign as shown in the sign drawing
by SRP Sign Corp. titled, "Blade Sign 14 JFK St Cambridge
MA 02138," and dated October 8, 2024.
All improvements shall be carried out as shown on the plans and
specifications submitted by the applicant, except as modified above.
Approved plans and specifications are incorporated by reference into
this certificate.
This certificate is granted upon the condition that the work
authorized herein is commenced within six months after the date of
issue. If the work authorized by this certificate is not commenced
within six months after the date of issue, or if such work is
suspended in significant part for a period of one year after the time
the work is commenced, then this certificate shall expire and be of no
further effect; provided that, for cause, one or more extensions of
time, for periods not exceeding six months each, may be allowed in
writing by the Chair.
Case Number: 5252
Date of Certificate: February 10, 2025
Case 5252: 14 JFK Street
Certificate of Appropriateness, page 2
Attest: A true and correct copy of decision filed with the
offices of the City Clerk and the Cambridge Historical Commission
February 10, 2025
on -
By Chandra Harrington/sto, Chair.
***---*----**********************************
Twenty days have elapsed since the filing of this decision.
No appeal has been filed
→ Appeal has been filed
Date
/ City Clerk
CITY OF CAMBRIDGE
Community Development Department
City Hall Annex, 344 Broadway, Cambridge, MA 02139
SIGN CERTIFICATION APPLICATION
Please fill out this application to indicate the number, type, and dimensions of signage for your building. If
you are unsure of the type of sign and/or allowable dimensions, please review the following pages of this
application and Article 7.000 of the Zoning Ordinance. Please note the following additional requirements:
• All signs must receive a permit from the Inspectional Services Department (ISD) before
installation. Community Development Department certification action does NOT constitute issuance
of a permit or certification that all other code requirements have been met. Do not contract for the
fabrication of a sign until all permits have been issued, including City Council approval if necessary,
for signs in the public way.
• Any sign or portion of a sign extending more than six (6) inches into the public way/sidewalk must
receive approval from the Cambridge City Council and a bond must be posted with the City Clerk. For
questions or additional information, please contact cddzoning@cambridgema.gov.
APPLICANT INFORMATION
Applicant Name: SRP Sign Corporation
Phone: [phone removed]
Email: [email removed]
Sign Address: 14 JFK St
CITY OF CAMBRIDGE • CDD • SIGN CERTIFICATION APPLICATION
PROPOSED SIGN
Please fill out the information below and attach a sketch of the proposed sign to the application. Each proposed sign
requires an individual form to be filled out. For further information on sign types, see the below page.
Sign text: Russell House Tavern
Sign type: Projecting Sign (including awnings)
Area in square feet: 10.9
Dimensions: 32.75"
H × 48"
Placement height in feet: 10
Depth from façade: 48"
Illumination: Internal
Sign frontage in feet: 45.75
Area of existing signs to remain: 0
COMMUNITY DEVELOPMENT DEPARTMENT CERTIFICATION
FOR INTERNAL USE ONLY
Sign conforms to requirements of Article 7.000: No
Sign requires a variance from the Board of Zoning Appeals: No
The signage is approved as it conforms to the requirements of the Harvard Square
Overlay, which offers more flexible dimensional allowances than Article 7
Non-conformance with Article 7 includes internal illumination, projection from the
Comments:
facade beyond 6 inches, and height of an illuminated sign greater than 30 inches.
Signature:
Date
CDD Representative
CITY OF CAMBRIDGE • CDD • SIGN CERTIFICATION APPLICATION
NATURAL
AND EXTERNAL
ILLUMINATION
WITH CONDITIONS
INTERNAL ILLUMINATION
MAX 30
SIGN
DING
MAX
GROUND
2 SIGNS PER LOT
FREESTANDING SIGN
A free standing sign is attached to or part of a
self-supporting structure and is not attached to
any other structure.
ONLY 2
NATURAL AND
ILLUMINATION
DE CIGNC DER
UNLIMITED #
SIGN FRONTAGÉ - -
PARALLEL TO STREET-
_LENGTH OF BUILDING
SO FT
MAX 60
ABOVE
GROUND
WALL SIGN
OVERVIEW BY SIGN TYPE
A wall sign is affixed so its exposed face and all
sign area is parallel to the plane of the building.
IF PROJECTION
COUNCIL MUST
EXCEEDS 6*, CITY
SIGN FRONTAGE -
ABOVE
PARALLEL TO STREET
LENGTH OF BUILDING
SQ FT
MAY 12 1
ONE SIGN PER
GROUND FLOOR
ESTABLISHMENT
CITY OF CAMBRIDGE • CDD • SIGN CERTIFICATION APPLICATION
ONLY
•EXTERNAL
NATURAL AND
ILLUMINATION
PROJECTING SIGN
Please note that this guide is intended to provide an overview of requirements by sign type. Sign shall mean and include any permanent or
advertisement, announcement, or direction and which is designed to be seen from the outside of a building. For further information on specific
requirements, consult Article 7.000 of the Zoning Ordinance.
temporary structure, device, letter, words, model, banner, pennant, insignia, trade flag, or representation used as, or which is in the nature of, an
a building face, including marquee, canopy, and
awning mounted signs.
A projecting sign is attached to and projects from
DATE 10-8-2024
JECT: BLADE SIGN
DDRESS: 14 JFK ST CAMBRIDGE MA 02138
ESCRIPTION EXTERIOR SIGNAGE
FLE LOCATION ClimerRishop drawing templates Shop Drawing Tamplate. pot
CUENT: RUSSEL HOUSE TAVERN
DRAWABY: ADAM KNAUER
[phone removed]
236 PEARL STREET
CORPORATION
SRESIGN
48"
TAVERN
HOUSE
RUSSELL
4%"
3½"
41¼"
5%"
14½"
32¾"
Gold Translucent Vinyl
White
Beige Translucent Vinyl
Black
White Cut Vinyl Text Applied Behind Neon to Sign Face
Rule Line, Stars & "Tavern" Push Through Acrylic
Opaque Black Vinyl Applied Over Stars
Aluminum Fabricated Cabinet
Gold & Beige Translucent Vinyl
Blade Sign
Neon Border & "Russell House" Text
32-3/4" × 48"x 10"
Qty. (1)
ing Templatepot
DATE 10-8-2024
1-1/2" x 1-1/2" 2" x 1/8" Wall Thickness Aluminum Square Tube Frame
Removable Top, Bottom & Front Return
Neon Transformers & LED Power Supply
.080 Aluminum Face
2" x 2"x 1/4" Wall Thickness Steel Mounting Arm
White Neon w/ Tube Stand
Building Power Brought to Sign by Others
White Neon w/ Tube Stand
DICT BLADE SIGN
1/2" White 2447 Push Through Acrylic
for Mounting & Service
DRESS 14 JFK ST CAMBRIDGE MA 02138
White LEDs
RAWN BY: ADAM KNAUER
ESCRIPTION EXTERIOR SIGNAGE
FLE LOCATION. CantRPshop drawing terplates Shop Dre
CIENT: RUSSEL HOUSE TAVERN
([phone removed]
236 PEARL STREET
SOMERVILLE, MA 02145
CORPORATION
SRESIGN
3021
Beige Translucent Vinyl
White
Gold Translucent Vinyl
Black
Rule Line, Stars & "Tavern" Push Through Acrylic
Neon Border & "Russell House" Text
Gold & Beige Translucent Vinyl
Opaque Black Vinyl Applied Over Stars
White Cut Vinyl Text Applied Behind Neon to Sign Face
32-3/4" × 48"x 10"
Aluminum Fabricated Cabinet
Blade Sign
Qty. (1)
Fabricated Sign Frame
DATE 10-8-2024
Mounting Bracket
BLADE SIGN
* 14 JFK ST CAMBRIDGE MA 02138
WN BY: ADAM KNAUER
LE LOCATION. ClientsLAPshop drawing
CLENT: RUSSEL HOUSE TAVERN
[phone removed]
236 PEARL STREET
SOMERVILLE, MA 02145
CORPORATION
SRESIGN
Mounting Bracket
Fabricated Sign Frame
Gold Translucent Vinyl
Beige Translucent Vinyl
White
Black
Rule Line, Stars & "Tavern" Push Through Acrylic
Neon Border & "Russell House" Text
Gold & Beige Translucent Vinyl
Opaque Black Vinyl Applied Over Stars
White Cut Vinyl Text Applied Behind Neon to Sign Face
32-3/4" x 48"x 10"
Aluminum Fabricated Cabinet
Blade Sign
Qty. (1)
FDC
TAVERN
HOUSE
RUSSELL
BLADE SIGN
14 JFK ST CAMBRIDGE MA 02138
DENT RUSSEL HOUSE TAVERN
ESCRIPTION, EXTERIOR SIGNAGE
Proposed New Blade Sign
[phone removed]
SOMERVILLE, MA 02145
CORPORATION
SRPSIGN
TAVE N
HOUSE
RUSSELL
Existing Blade Sign
Beige Translucent Vinyl
White
Gold Translucent Vinyl
Black
Rule Line, Stars & "Tavern" Push Through Acrylic
Opaque Black Vinyl Applied Over Stars
White Cut Vinyl Text Applied Behind Neon to Sign Face
Blade Sign
Aluminum Fabricated Cabinet
Gold & Beige Translucent Vinyl
Neon Border & "Russell House" Text
Qty. (1)
32-3/4" × 48"x 10"
estimate
SRPSIGN
Date
Estimate #
CORPORATION
236 pearl street. somerville, ma 02145
t. [phone removed] f. [phone removed]
4847
9/12/2024
Rep
Name / Address
Ship To
Russell House
Harvard Square
Cambridge
Item
Cost
Description
Total
Qty
Double-sided blade sign.
Sign
1
18,500.00
18,500.00T
48" × 32.75" x 10" deep (approximate dimensions: vif)
All aluminum fabrication with exposed white neon letters and Noveil Gold neon
border as per drawing.
Stencil-cut letters, stars, and line with push-through acrylic w/translucent vinyl faces.
Welded bracket.
Installation
1
Open shop installation during normal business hours
2,250.00
2,250.00
power to be brought to the sign by others
permits, police detail, engineering at face value
MA Sales Tax
6.25%
1,156.25
Terms: 50% deposit required to begin.
Delivery: 4 - 6 weeks from receipt of all required approvals.
Total
$21,906.25
Balance due upon completion.
Estimates are valid for 30 days
Police details, municipal license or permit fees and/or aquisition expenses incurred by SRP Sign Corp,, and sales or use taxes where applicable or
required are additional charges which shall be born by the Purchaser.
Sign permit at face value plus $85.00 per hour to obtain with a minimum 1 hour added to final invoice
This contract in accordance with terms stated is hereby accepted. Signed
Dated: 9/25
estimate
SRPSIGN
Date
Estimate #
CORPORATION
236 pearl street. somerville, ma 02145
t. [phone removed] [phone removed]
4847
9/12/2024
Rep
Name / Address
Ship To
Russell House
Harvard Square
Cambridge
Item
Description
Qty
Cost
Total
Sign
Double-sided blade sign.
1
18,500.00 18,500.00T
48" x 32.75" x 10" deep (approximate dimensions: vif)
All aluminum fabrication with exposed white neon letters and Noveil Gold neon
border as per drawing.
Stencil-cut letters, stars, and line with push-through acrylic w/translucent vinyl faces.
Welded bracket.
Installation
Open shop installation during normal business hours
1
2,250.00
2,250.00
power to be brought to the sign by others
permits, police detail, engineering at face value
MA Sales Tax
6.25%
1,156.25
Terms: 50% deposit required to begin.
Delivery: 4 - 6 weeks from receipt of all required approvals.
Total $21,906.25
Balance due upon completion.
Estimates are valid for 30 days
Police details, municipal license or permit fees and/or aquisition expenses incurred by SRP Sign Corp,, and sales or use taxes where applicable or
required are additional charges which shall be born by the Purchaser.
Sign permit at face value plus $85.00 per hour to obtain with a minimum 1 hour added to final invoice
This contract in accordance with terms stated is hereby accepted. Signed
Dated: 19/25
DATE (MM/DD/YYYY)
ACORD®
CERTIFICATE OF LIABILITY INSURANCE
01/24/2024
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 INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE 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 rights to the certificate holder in lieu of such endorsements).
CONTACT Nicole Bobocea
Risman Insurance Agency, Inc.
[phone removed]
[phone removed]
H/C
No. Ext):
FAIC, NO):
E-MAIL
[email removed]
689 Fellsway
ADDRESS:
NAIC #
INSURER(S) AFFORDING COVERAGE
Medford
MA 02155
24082
Ohio Security Insurance Co.
INSURERA:
Norfolk & Dedham Mutual Ins Co
INSURED
23965
INSURER B:
Ohio Casualty Insurance Co.
24074
Srp Sign Corp
INSURER C:
236 Pearl St
INSURER D:
INSURER E:
Somerville
MA 02145
INSURER F:
CL2412360071
COVERAGES
CERTIFICATE NUMBER:
REVISION 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 CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR
ADDL SUBRI
OLICY EX
LIR
LIMITS
TYPE OF INSURANCE
POLICY NUMBER
INSD WVD
X COMMERCIAL GENERAL LIABILITY
EACH OCCURRENCE
$ 1,000,000
DAMAGE TO RENTED
CLAIMS-MADE
OCCUR
PREMISES (Ea occurrence)
$ 300,000
MED EXP (Any one person)
$ 15,000
01/20/2025
A
01/20/2024
BKS60819504
PERSONAL & ADV INJURY
$ 1,000,000
GEN'L AGGREGATE LIMIT APPLIES PER:
GENERAL AGGREGATE
$ 2,000,000
PRO-
LOC
POLICY
PRODUCTS - COMP/OP AGG
$ 2,000,000
$
OTHER:
COMBINED SINGLE LIMIT
AUTOMOBILE LIABILITY
$ 1,000,000
(Ea accident)
$
ANY AUTO
BODILY INJURY (Per person)
OWNED
SCHEDULED
91970387A
BODILY INJURY (Per accident)
$
B
01/20/2025
01/20/2024
AUTOS
AUTOS ONLY
HIRED
NON-OWNED
PROPERTY DAMAGE
$
X
AUTOS ONLY
(Per accident)
AUTOS ONLY
UMBRELLA LIAB
OCCUR
EACH OCCURRENCE
$ 5,000,000
USO60819504
EXCESS LIAB
C
01/20/2025
01/20/2024
CLAIMS-MADE
AGGREGATE
$ 5,000,000
DED
RETENTION $ 10,000
WORKERS COMPENSATION
X PATUTE I
AND EMPLOYERS' LIABILITY
YIN
E.L. EACH ACCIDENT
ANY PROPRIETOR/PARTNER/EXECUTIVE
$ 1,000,000
01/20/2024
B
N/ A
01/20/2025
WE190737A
N
OFFICER/MEMBER EXCLUDED?
(Mandatory in NH)
E.L. DISEASE - EA EMPLOYEE
$ 1,000,000
If yes, describe under
DESCRIPTION OF OPERATIONS below
E.L. DISEASE - POLICY LIMIT
$ 1,000,000
DESCRIPTION OF OPERATIONS / LOCATIONS/ VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
Insurance verification:
Workers' Compensation benefits will be paid to Massachusetts employees only. Pursuant to Endorsement WC 20 03 06 B, no authorization is given to pay
claims for benefits to employees in states other than Massachusetts if the insured hires, or has hired those employees outside of Massachusetts.
With respect to insured's operations and required in written and signed contract, the following are included as additional insureds in regard to General
Liability per forms CG8810 04/13 (ongoing operations) and CG8611 10/16 (completed operations) and Umbrella Liability per form CU6002 04/21.
CERTIFICATE HOLDER
CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS
SRP Sign Corp.
236 Pearl St.
AUTHORIZED REPRESENTATIVE
MA 02145
Somerville
-Vicole Bobocca
© 1988-2015 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
ACORD 25(2016/03)
00033115
AGENCY CUSTOMER ID:
LOC #:
ACORD®
of
Page
ADDITIONAL REMARKS SCHEDULE
AGENCY
NAMED INSURED
Risman Insurance Agency, Inc.
Srp Sign Corp & Goodpitch LLC & 234 Pearl Street Realty Trust
POLICY NUMBER
CARRIER
NAIC CODE
EFFECTIVE DATE:
ADDITIONAL REMARKS
THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM,
25
FORM TITLE: Certificate of Liability Insurance
FORM NUMBER:
Liability per forms CG8810 04/13 (ongoing operations) and CG8611 10/16 (completed operations) and Umbrella Liability per form CU6002 04/21.
Waiver of subrogation applies in favor of the following subject to requirement in written and signed contract in regard to General Liability per form CG8810
04/13, Auto Liability per form AP-2 09/08, and Umbrella Liability per form CU6495 12/07.
Additional insured status is primary and non-contributory subject to requirement in written and signed contract in regard to General Liability per form CG8810
04/13. General Liability aggregate applies per project per form CG8870 12/08.
Please refer to actual policy for all other terms, conditions and exclusions.
ACORD 101(2008/01)
© 2008 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
Lafayette City Center
2 Avenue de Lafayette, Boston, MA 02111
www.mass.gov/dia
ЗагатАнн
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information
Please Print Legibly
Name (Business/Organization/Individual): SRP Sign Corporation
Address: 236 Pearl St
Phone #: [phone removed]
City/State/Zip: Somerville, MA 02145
Are you an employer? Check the appropriate box:
Type of project (required):
4.
• I am a general contractor and I
1. I am a employer with 8
6. • New construction
have hired the sub-contractors
employees (full and/or part-time).*
listed on the attached sheet.
7. • Remodeling
2. L I am a sole proprietor or partner-
These sub-contractors have
ship and have no employees
8. - Demolition
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._ Plumbing repairs or additions
3. L 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.] *
Other Signage
13.0
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 attached 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.
Insurance Company Name: Risman Insurance Agency, Inc.
Policy # or Self-ins. Lic. #: WE190737A
Expiration Date: 1/20/2025
Job Site Address: 14 JFK St
City/State/Zip: Cambridge, MA
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 penalties 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.
I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct.
12/11/2024
Date:
Signature:
[phone removed]
Phone #:
Official use only. Do not write in this area, to be completed by city or town official.
Permit/License #
City or Town:
Issuing Authority (check one):
1 Board of Health 2 Building Department 3_City/Town Clerk 4.
Electrical Inspector 5LPlumbing
Inspector 6.Other
Contact Person:
Phone #:
The Commonwealth of Massachusetts
Department of Industrial 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 (Business/Organization/Individual): SRP Sign Corporation
Address: 236 Pearl St
Phone #: [phone removed]
City/State/Zip: Somerville, MA 02145
Are you an employer? Check the appropriate box:
Type of project (required):
4. 1am a general contractor and I
1. 1am a employer with 8
6. New construction
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
ship and have no employees
8. • Demolition
employees and have workers'
working for me in any capacity.
9. _ Building addition
comp. insurance.‡
[No workers' comp. insurance
5.
10. Electrical repairs or additions
We are a corporation and its
required.]
officers have exercised their
11. Plumbing repairs or additions
3.0
I am a homeowner doing all work
right of exemption per MGL
myself. [No workers' comp.
12. Roof repairs
c. 152, 81(4), and we have no
insurance required.] *
13.M Other Signage
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.
T 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 attached 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.
Insurance Company Name: Risman Insurance Agency, Inc.
Policy # or Self-ins. Lic. #: WE190737A
Expiration Date: 1/20/2025
Job Site Address: 14 JFK St
City/State/Zip: Cambridge, MA
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 penalties 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.
I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct.
12/11/2024
Date:
Signature:
Phone #: [phone removed]
Official use only. Do not write in this area, to be completed by city or town official.
Permit/License #
City or Town:
Issuing Authority (check one):
1D Board of Health 2 Building Department 3_City/Town Clerk 4.l
Electrical Inspector 5Plumbing
Inspector 6. Other
Contact Person:
Phone #:
(usden at)