An application was received from City Paint & Supply - Benjamin Moore, requesting permission for a projecting sign at the premises numbered 1149 Cambridge Street approval has been received from Inspectional Services, Department of Public Works, Community Development Department and abutter

CITY OF CAMBRIDGE - INSPECTIONAL SERVICES DEPARTMENT SIGN PERMIT APPLICATION SUBMISSION Addiess: 1149 Cambridge St General Information Description of Proposed Work Re-face existing double sided projecting sigr ''h x 6"-1/2'w; Remove existing wall sign an install (2) new wall signs, 3'h × 17"w and 4"h x 6'w Estimated Cost of Sign(s) in dollars : 3100 Describe any existing signs that will remain (including: The only sign to remain will be an existing he size of the remaining signs) projecting sign, faces are 4"h x 6"-1/2"w, ~19" Cambridge City Council fli one or more of the proposed signs extend six (6) : Y approval may be required. ches into the public sidewall Sign Text Sign Information : Type of Sign : lilumination • Natural • Natural • Internal Height of Sign (feet) : : Width of Sign (feet) Area of Sign (square feet) : • 51 • 24 • 24.2 Height from the ground to the top of the sign (feet) : Height from the ground to bottom of the sign (feet) :

: Sign Material • Aluminum, Viny • Aluminum, Viny • Polycarbonate : Weight of the sign (Ibs) : Projection from the Building (inches) • 72.5 Width of Building Facade for Associated Use (feet) : : Is the sign an accessory to a first floor store? Contractor Contractor Name : DAVID J RANDA Address : Viewpoint Sign & Awning 35 Lyman St. Northboro, MA 01532 E-mail :[email removed] Telephone : [phone removed] ×21 License Number : CS-076718 License Expiration Date : 03-15-2020 Signature of Licensed Contractor Contractor's Signature : David Randa Date : 01-17-2019

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 _ 20_19 Cambridge, JANUARy 24 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 CITy PAINT & SuppLy - BENAmIN mooRe (NAME OF BUSINESS) be granted permit to erect a sign of the following specifications in front of premises located at 1149 CAMBRIDGE ST. Type of Sign: PRE- EXISTNG DOUBLE SIDED, INTERNITULY ILLUMINATEL (state whether electric or otherwise and material used in constructión) BLADE SIGN Reading matter to go on Sign: (1000) BENJAMIN MOORE CITY PAINT + SUPPLY Size: 4'H× 6'-%½" w Weight: 215 Ibs. Public Way Obstruction: 15' 6-½½" (Give exact distance sign is to extend over sidewalk) (Also exact distance from bottom of sign to sidewalk) 15' Height Above Grade: Bottom: 19' Top: NOTICE - REGULATIONS Section 1212.0 State Building Code - Projecting Signs] [Section 12.08.010 Municipal Code - Encroachments onto Streets] • 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 or 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 35 LymAN ST. VIEWPOINT. Cnin- SIGN - ALINING 1508393 8200 Lauren NORTIBRO, MA x21 (Property owner or authorized agent) 01532 (Tel. No.) 38 VARICK RD SEE AMACItED - PILiP KADETS NEWTON, MA 1 [phone removed] (Address) (Business owner) 02468 (Tel. No.) OWNER. *PHiLIP KADETS IS PROPERTY + BUSINESS

SIGN CERTIFICATION FORM COMMUNITY DEVELOPMENT DEPARTMENT Sign Text: Denjamin More auren Coin De Larda Applicant (name and address) ( Signature Telephone: 61 508-393-8200FAX: 1149 Camb Location of Premises: St Overlay District: BA Zoning District: Date Application Submitted: 11/21|18 V No Yes Sketch of Sign Enclosed: PLEASE NOTE: All signs must receive a permit from the Inspectional Services Department (ISD) before installation. Community Development Department (CDD) 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 approval from the City Council, if necessary (see below)! Historical Com. City Clerk* Copies: ISD V Applicant _ CDD *Any sign or portion of a sign extending more than Six (6) inches into the public posed it the recy erik: Forms or tia aproval are obtained at the free bo the City Clerk. NOTE: PLEASE PROVIDE ALL REQUESTED INFORMATION FOR EACH SIGN PROPOSED. FAILURE TO DO SO WILL ONLY DELAY CERTIFICATION.

Proposed WALL Sign 17' 51 Ф Dimensions: Area in Square feet: Internal Illumination: Natural V External Height (from ground to the top of the sign): below loof line I. COMPLETE WHEN SIGN IS ACCESSORY TO A FIRST FLOOR STORE Length in feet of store front facing street: (a)1(' + 57 • Area of signs allowed accessory to store: 49฿ outside (1 xa) 98₽ • Area of all existing signs on behind windows (0.5 x a)_ the store front to remain (including any freestanding sign): _ Area of additional signs permitted: 400 2. COMPLETEFOR ANY OTHER SIGN • Area of signs allowed accessory to Length in feet of building facade facing street: (a) the building facade: outside (1 x a). behind windows (0.5 x a) _ Area of all existing signs on the building facade to remain (including any freestanding sign): Area of additional signs permitted: SUMMARY OF LIMITATIONS FOR WALL 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: 60 square feet maximum. HEIGHT ABOVE THE GROUND: 20 feet but below the sills of second floor windows. ILLUMINATION: Natural or external, or internal illumination with significant limitations. NUMBER: No 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: COMMENTS:

Proposed WALL Sign 24Đ 6' Dimensions: Area in Square feet: Internal Illumination: Natural V . External Height (from ground to the top of the sign): below roof line 1. COMPLETE WHEN SIGN IS ACCESSORY TO A FIRST FLOOR STORE 980 Length in feet of store front facing street: (a)_ - Area of signs allowed accessory to store: , behind windows (0.5 x a) Area of all existing signs on outside (1 xa) _ Area of additional signs the store front to remain (including any freestanding sign): 51$ H6D permitted: 2. COMPLETE FOR ANY OTHER SIGN Length in feet of building facade facing street: (a) • Area of signs allowed accessory to the building facade: outside (1 x a). → behind windows (0.5 x a). _ Area of all existing signs on the building facade to remain (including any freestanding sign):_ Area of additional signs permitted: SUMMARY OF LIMITATIONS FOR WALL 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: 60 square feet maximum. HEIGHT ABOVE THE GROUND: 20 feet but below the sills of second floor windows. ILLUMINATION: Natural or external, or internal illumination with significant limitations. NUMBER: No limit. 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: COMMENTS: Dato: 1/7/19-coo Represenative LeaM. Piles

Existing Legally Established NONCONFORMING Sign 12/½"W Area in Square foot: 24.2 (Ex Dimensions: 48" H Illumination: Natural _Internal_ External Height (from ground to the top of the sign): 19' 1. TYPE OF SIGN a. wall b. projecting_ c. freestanding... 2. REASON FOR NONCONFORMITY V b. illumination a. dimensions _ _ c. other... 3. NATURE OF ALTERATIONS c. other. i. replacement of plastic face b. repainting of face I certify that the above referenced sign was legally erected and in conformance with the requirements of Article 7.000 at that time and further that the alterations now proposed, and any others made within the last three (3) years, do not exceed fifty (50%) percent of the current replacement value of the sign.). VIEWPOiNT. Date: 1218|18 Applicant signature: Lauen Cronia: SIGN + AUNINE 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: COMMENTS: Sega los ben is plas entires Date: 12 1819 CDD Representative. Egalu Piles

Existing Legally Established NONCONFORMING Sign 72.5" Area in Square feet: Dimensions: × 48" Illumination: Natural Internal \ External Height (from ground to the top of the sign: Same locaton 1. TYPE OF SIGN a. wall b. projecting c. freestanding 2. REASON FOR NONCONFORMITY b. illumination c. other a. dimensions 3. NATURE OF ALTERATIONS _ b. repainting of face a. replacement of plastic face V _ c. other I certify that the above referenced sign was legally erected and in conformance with the equirements of Article 7.000 at that time and further that the alterations now proposed, and ar hers made within the last three (3) years, do not exceed fifty (50%) percent of the curre replacement value of the sign.). Date: Applicant signature: Oneline 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: COMMENTS:

D 71 1370 7173 Sent To Postage City, State, ZIP+4% Total Postage and Fees • Adult Signature Required • Return Receipt (hardcopy) Return Receipt (electronic) $4.05 $0.55 $3.50 Domestic Mail Only • Certified Mail Restricted Delivery Street and Apt. No., or PO Box No. • Adult Signature Restricted Delivery $ CAMBRIDGE: MA 02139 U.S. Postal Service™ 3073 NORFOLK ST PS Form 3800, April 2015 PSN 7530-02-000-9047 $0.00 $0.00 $0.00 $0.00 Extra Services & Fees (check box, add fee albarpüate) 02139 A la CERTIFIED MAIL® RECEIPT Here BRIDG, MA 02139 Postmark USE 0581 For delivery information, visit our website at www.usps.com®. 01/31/2019 09 LEAL, FRANCISCO a GRACINDA LEM See Reverse for Instructions

PM FAXCOM Anywhere 01/24/2019 12:27:20 OFFICE OF THE CITY CLERK CANBRIDGE CITY HALL, 795 MASSACHUSETTS AVENUE CAMBRIDGE, MASSACHUSETTS 021.39 PHONE [phone removed] FAX [phone removed] TTY/TDD [phone removed] PAULA M. CRANE DONNA P. LOPEZ DEPUTY CITY CLERK CITY CLERK ABUTTERS FORM FOR SIGN/AWNING PERMIT To Whom It May Concern: Date / 24-19 As Owner of Agent of 115/-1157 CAmB210w 81. Cambridge, approval of the Massachusetts, I do hereby declare my disapproval _ installment of: Canopy over the sidewalk entrance: Awnings over the windows: FACE REPLACEMENTS FOR () PRE- EXISTiNG Projecting sign: DOUBLE SIDED, INTERNITZLY LUMINATED BLADE SION. of said properly. (REGARDING BENAMIN MOORE CITY PANT @1149 CAMERIDGE S _Date 1-24-19 1151-1157 CAMBRIDGES. 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: FORM) PLEASE FILL IN DATE THAT FORM WAS DELIVERED TO ABUTTER (TOP RIGHT OF THIS Scanned by CamScanner

City Paint Benjamin Moore® & Supply WALLPAPER HARDWARE SalTY@ Supply EXISTING CONDITIONS NTS DISCLAIMER:Renderings are for graphic purposes only and not intended for actual construction dimensions. For windload requirements, actual dimensions and mounting detail, please refer to engineering specifications and install drawings. : Everbrite These drawings and designs are the exclusive property of Everbrite LLC Use of, or duplication in any manner without express written permission of Everbrite LLC is prohibited. Customer: BMCO - CITY PAINT & SUPPLY Description: PROPOSED ELEVATION Customer Approval: Graphics and colors on file will be used unless otherwise specified by customer. Please review drawing carefully. By signing below, you agree to graphics as VIEW Scale: 3/16" = 1' shown above, and to location of sign as shown. Please return signed copy back to Everbrite. Project No: 393570 Drawn By: LC Date: 10.09.18 DATE Revised: Revised: Revised: 10.16.18 CUSTOMER SIGNATURE Location & Site No: 1149 CAMBRIDGE ST. Revised: DATE Revised: 12.19.18 Revised: LANDLORD SIGNATURE CAMBRIDGE, MA

Benjamin Moore City Paint & Supply Benjamin Moore City Paint & Supply 472419 EXISTING CONDITIONS NTS DISCLAIMER:Renderings are for graphic purposes only and not intended for actual construction dimensions. For windload requirements, actual dimensions and mounting detail, please refer to engineering specifications and install drawings. : Everbrite These drawings and designs are the exclusive property of Everbrite LLC Use of, or duplication in any manner without express written permission of Everbrite LLC is prohibited. Customer: BMCO - CITY PAINT & SUPPLY Description: PROPOSED ELEVATION Customer Approval: Graphics and colors on file will be used unless otherwise specified by customer. Please review drawing carefully. By signing below, you agree to graphics as VIEW Scale: 3/16" = 1' shown above, and to location of sign as shown. Please return signed copy back to Everbrite. Project No: 393570 Drawn By: LC Date: 10.09.18 DATE Revised: Revised: Revised: 10.16.18 CUSTOMER SIGNATURE Location & Site No: 1149 CAMBRIDGE ST. Revised: DATE LANDLORD SIGNATURE Revised: 12.19.18 Revised: CAMBRIDGE, MA

2" DEEP 17' - 0" (204") City Paint 3'- 0" (36") Al Benjamin Moore® & Supply SF Non Illuminated Wall Panel Face: 3mm ACM or I/8" Aluminum w first surface graphics Vinyl: 3730-33 Red; Leave | I/2" White border Frame: 2" deep painted BM OC-65 Chantilly Lace Mounting: Flush to wall using clips or best method Notes: Scope of Work: Fabricate and Install One (1) SF Non Illuminated Wall Panel. DISCLAIMER: Renderings are for graphic purposes only and not intended for actual construction dimensions. For windload requirements, actual dimensions and mounting detail, please refer to engineering specifications and install drawings. : Everbrite These drawings and designs are the exclusive property of Everbrite LLC Use of, or duplication in any manner without express written permission of Everbrite LLC is prohibited. Customer Approval: Graphics and colors on file will be used unless otherwise specified by Customer: BMCO - CITY PAINT & SUPPLY Description: SF NON ILLUMINATED customer. Please review drawing carefully. By signing below, you agree to graphics as WALL PANEL Scale: 1/2" = 1' shown above, and to location of sign as shown. Please return signed copy back to Everbrite. Project No: 393570 Drawn By: LC Date: 10.09.18 DATE CUSTOMER SIGNATURE Revised: Revised: Revised: 10.16.18 Location & Site No: 1149 CAMBRIDGE ST. Revised: DATE Revised: Revised: 12.19.18 LANDLORD SIGNATURE CAMBRIDGE, MA

2" DEEP 6'- O" (72") Benjamin Moore 4'- 0" (48") City Paint & Supply SF Non Illuminated Wall Panel Face: 3mm ACM or 1/8" Aluminum w first surface graphics Vinyl: 3730-33 Red; 3730-137L European Blue; Leave I" White border Frame: 2" deep painted BM OC-65 Chantilly Lace Mounting: Flush to wall using clips or best method Notes: Scope of Work: Fabricate and Install One (1) SF Non Illuminated Wall Panel. DISCLAIMER:Renderings are for graphic purposes only and not intended for actual construction dimensions. For windload requirements, actual dimensions and mounting detail, please refer to engineering specifications and install drawings. : Everbrite These drawings and designs are the exclusive property of Everbrite LLC Use of, or duplication in any manner without express written permission of Everbrite LLC is prohibited. Customer Approval: Graphics and colors on file will be used unless otherwise specified by Customer: BMCO - CITY PAINT & SUPPLY Description: SF NON ILLUMINATED customer. Please review drawing carefully. By signing below, you agree to graphics as WALL PANEL Scale: 1/2" = 1' shown above, and to location of sign as shown. Please return signed copy back to Everbrite. Project No: 393570 Drawn By: LC Date: 10.09.18 DATE Revised: Revised: Revised: 10.16.18 CUSTOMER SIGNATURE Location & Site No: 1149 CAMBRIDGE ST. Revised: Revised: DATE LANDLORD SIGNATURE Revised: 12.19.18 CAMBRIDGE, MA

6 - 1/2" (72.5") CABINET Ber amin Moore Benjamin City Paint Moore Paints Benjamin Moore 4'- 0" (48") CABINET City Paint & Supply EXISTING CONDITIONS SCALE: 3/8"= l' DF Illuminated Cabinet - Replacement Faces Faces: 2" Deep formed polycarbonate w first surface translucent vinyl applied Benjamin Vinyl: 3730-33 Red; 3730-137L European Blue Moore Retainers: Existing I" aluminum; Repaint BM OC-65 Chantilly Lace Cabinet: Existing 5" Deep aluminum; Repaint BM OC-65 Chantilly Lace Illumination: Retrofit w White LEDs City Paint & Supply Scope of Work: Fabricate and Install One (1) Replacement Face for Existing SF Illuminated Wall Cabinet. PROPOSED ELEVATION VIEW SCALE: 3/8" = l' DISCLAIMER:Renderings are for graphic purposes only and not intended for actual construction dimensions. For windload requirements, actual dimensions and mounting detail, please refer to engineering specifications and install drawings. Everbrite These drawings and designs are the exclusive property of Everbrite LLC Use of, or duplication in any manner without express written permission of Everbrite LLC is prohibited. Customer Approval: Graphics and colors on file will be used unless otherwise specified by Customer: BMCO - CITY PAINT & SUPPLY Description: DF ILLUMINATED customer. Please review drawing carefully. By signing below, you agree to graphics as CABINET - Scale: 1/2" = 1' shown above, and to location of sign as shown. Please return signed copy back to Everbrite. Project No: 393570 REPLACEMENT FACES Date: 10.09.18 Drawn By: LC DATE Revised: Revised: CUSTOMER SIGNATURE Revised: 10.16.18 Location & Site No: 1149 CAMBRIDGE ST. Revised: DATE LANDLORD SIGNATURE Revised: 12.19.18 Revised: CAMBRIDGE, MA

[phone removed] steven boraks p. 1 Nov 13 18 01:49p Landiord Authorization ViewPoint Date:_ SIGN AND AWNING 41/0/18. To whom it may concern: 35 Lyman Street Nortbore, MA 01532 [phone removed] [phone removed] Fax • Philip Kaclots Owner of the property located at nea Cambridge st. Cabride, MA INTERIOR/EXTERIOR SIGNAGE Electric Do hereby consent to allow Margaret Vosburgh of ViewPoint Sign and Awning to act on Archilectural my behalf perlaining to permitting and installation of signs and/or awnings for the Dimensional property named above. Waylinding Channel Letters LED/Neon Elecironic Message Centers Sincerely, Digital Graphics AWNINGS Commercial Backlit P. Kadets Canvas Retractable Address 30 Varick Rd. Newten 02468 SIGN SERVICE Telephone. [phone removed] ARCHITECTURAL METAL FABRICATION Email: [email removed] VEHICLE GRAPHICS (Please print carefully) MEMBERS Deeded name of property: Massachusetts Sign Associetion Rhode Island Sign Association Philip tactets. Internatione| Sign Association Nortineast Stales Sign Association North East Canvos Products Associction dustrial Fabrics Associalic ternation UL LISTED FABRICATORS 12:52PM (GMT-05: 00) 11/13/2018

DATE (MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE ACORD® 08/29/2018 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). Elizabeth Borlone FM Walley Insurance Agency Inc FAC. No): [phone removed] PANG No. ExI: 781) 326-8383 E-MAIL 475 High Street ADDRESS: [email removed] P. O. Box 469 NAIC # Dedham MA 02026 INSURER A : 25682 TraVe SURER AFROM COVERAGE INSURED Charter Oak Fire Insurance Co 25615 INSURER B: Expansion Opportunities Inc INSURER C : DBA View Point Sign & Awning INSURER D: 35 Lyman Street, Suite 1 INSURER E : Northborough MA 01532 INSURER F: CERTIFICATE NUMBER: 2018 REVISION NUMBER: EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. POLICY NUMBER X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED CLAIMS-MADE OCCUR PREMISES (Ea occurrence) $ 100,000 $ 5,000 MED EXP (Any one person) A Y 630-5609C939-TCT-18 09/14/2019 09/14/2018 $ 1.000,000 PERSONAL & ADV INJURY GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000000 PRO- LOC X POLICY PRODUCTS - COMP/OP AGG $ 200000 OTHER: AUTOMOBILE LIABILITY OMBINED SINGLE LIMI $ 1,000,000 Ea acciden $ X ANY AUTO BODILY INJURY (Per person) OWNED SCHEDULED BODILY INJURY (Per accident) BA-0123T720-1 09/14/2019 AUTOS ONLY AUTOS 09/14/2018 HIRED NON-OWNED PROPERTY DAMAGE co AUTOS ONLY AUTOS ONLY (Per accident) UMBRELLA LIAB X OCCUR $ 10,000,000 EACH OCCURRENCE EXCESS LIAB A 09/14/2019 09/14/2018 CUP-2L457061 CLAIMS-MADE 510,000.000 AGGREGATE DED X RETENTION S 10,000 WORKERS COMPENSATION TOR* XI STATUTE T AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR/PARTNER/EXECUTIVE $ 1,000,000 UB-5J433976-18-14 N/ A )FFICER/MEMBER EXCLUDED E.L. EACH ACCIDENT A 09/14/2019 09/14/2018 (Mandatory in NH) 5100000000 E.L. DISEASE - EA EMPLOYEE E.L. DISEASE - POLICY LIMIT SORT OF OPERATIONS beloN $ 1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) City of Cambridge MA is an Additional Insured, Grantor of Permit, for General Liability. CANCELLATION CERTIFICATE HOLDER SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFOR HE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED I ACCORDANCE WITH THE POLICY PROVISIONS. City of Cambridge Dept of Public Works AUTHORIZED REPRESENTATIVE 147 Hampshire Street MA 02139 Cambridge Trames he Walley IIt © 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD ACORD 25(2016/03)

The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street, Suite 100 Boston, MA 02114 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legibly Name (Business/Organization/Individual):_ Expansion Opportunities dba ViewPoint Sign and Awning Address:_35 Lyman Street Suite 1 Phone #: City/State/Zip: Northborough, MA 01532 [phone removed] Are you an employer? Check the appropriate box: Type of project (required): 1. V lama employer with_ 48 employees (full and/or part-time).* 7. • New construction 2.L 1 am a sole proprietor or partnership and have no employees working for me in 8. • Remodeling any capacity. [No workers' comp. insurance required.] 9. L Demolition 3.1 ] I am a homeowner doing all work myself. [No workers' comp. insurance required.]* 10 • Building addition 4. I am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers' compensation insurance or are sole 11.L Electrical repairs or additions proprietors with no employees. 12. O Plumbing repairs or additions 5. 1 am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.• Roof repairs These sub-contractors have employees and have workers' comp. insurance.* 14. Dother_SIGNS | We are a corporation and its officers have exercised their right of exemption per MGL c. 6.L 152, §1 (4), and we have no employees. (No workers" comp. insurance required.] *Any applicant that checks box #l must also fill out the section below showing their workers' compensation policy infonnation. * 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. It 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: Traveler's Indemnity Co of CT UB-5J433976-18-14 09-14-2019 Policy # or Self-ins. Lic. #: Expiration Date: ST. Job Site Address: 1149 CAMBRIDGE 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 MGL c. 152, $25A is a criminal violation punishable by 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. 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. Date: Signature: ONiO RANDA) 117|19 Phone #: [phone removed] X21 Official use only. Do not write in this area, to be completed by city or town official. City or Town: _ Permit/License # Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone #: