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30 CHURCH STREET- (EAST REGIMENT BEER COMPANY) 30 Church Street(East Resiment Beer Company) J -. „�5 Salem ® Redevelopment Authority Salem Redevelopment Authority Proposal September 13, 2017 30 Church Street (East Regiment Beer Company): Discussion and vote (to refer to design review) on proposed signage and outdoor seating area (cafe permit) scheme. Proposal The owners of 30 Church Street are seeking to establish a brewery with a tasting (tap) room; a use for which they will need to obtain a special permit from the Zoning Board of Appeals. The basement level of the building is not ADA accessible and the owners do not have plans at this time to invest in making necessary upgrades to have it become ADA accessible. The basement will house the production facility. An outdoor deck/patio will serve as the tasting/tap room element of the project. The SRA owns the property on which it is proposed to sit; therefore the applicant will require an easement or some other mechanism to legally allow it to occupy the space (no such instrument has been drawn up or decided upon). A 12' wide by 69' long area directly adjacent to the building will be decked over with wood and host nine aluminum square top tables (seating for 36), and a five seat bar. It will be roped off and have an ADA accessible ramp. Right now, the proposal shows the deck as being open air with tables that have accompanying umbrellas. The applicants informed me that they may propose a larger awning system that can cover the extent of the patio, with sides that fold down in inclement weather(allowing the deck to be used all seasons). The installation of this patio will require the removal of what looks to be two existing planters that contain one tree each, and one light pole. A 54"x54" (20.25 sf) wooden blade sign is proposed to be mounted toward the rear of the building, above the entrance to the brewery's space. An awning with signage is shown in the drawing but not called out with dimensions. Staff Comments: This is an ambitious project that we felt needed to be reviewed by the SRA prior to the applicant seeking design review. The Building Department has reviewed these initial drawings and feels they lack detailed enough information to acquire a permit to build the proposed structure. For instance, we do not know the dimensions of the aisles between seats/tables (at least 36” is required) and the width of the remaining pedestrian way (at least 4' is required; although it appears to be compliant). The proposed signage appears to be compliant with the City's sign ordinance and design guidelines; we will need dimensions for awning signage if that is proposed. e � Design Review Board 120 Washington Street, 3-Floor Salem, MA 01970 Scott Perry and Joshua Engdahl Owner/Managers East Regiment Beer Company 30 Church St. Salem, MA 01970 Dear Sir or Mam, The East Regiment Beer Company Respectfully requests permission to erect a sign on our proposed brewery at 30 Church st.Salem, MA.The sign will be mounted at a right angle as to be two sided and will be visible along the side of the building adjacent to Salem Green.The existing signs are located on the Church st. Side of the building save for the 10sgft. Sign which will be removed.The sign will be made of wood, paint, metal,and chains and will have solar powered lights on the mounting arm that will light the sign at night.The font we are using is called Old Style and will be roughly 8" in height and will run SO"along the bottom of the sign.The mounting arm is square steel tubing and will be bolted to the brick wall by a series of steel mounting brackets that are welded to the mounting arm.The sign will be hung by a professional sign company. Thank you for your time and consideration Very Respectfully Scott Perry i Joshua En hl ) Permit Number �— APPLICATION FOR PERMIT TO ERECT A SIGN NOTE:BUILDING PERMIT MUST BE OBTAINED BEFORE SIGN Is ERECTED Location, Ownership and Detail Must Be Correct, Complete, and Legible yr r Salem, Massachusetts Date To the Building Inspector. The undersigned hereby applies for a permit to D Erect, u Alter, ❑Repair a sign on the following described buildings: DistrictStreet Address Zoning 30 Chufch St. Central Development o Urban Renewal Area D Entrance Corridor B5 o Historic Distr ct None • Mass Bay Colony Properties Use of Building Telephone 508-932-1275 1 floor Restaurant/Design Studio • - East Regiment Beer Co. 2m floor office sP ace Address q Cleveland Rd.Salem MA 01970 3 floor Telephone 508-932-1275 4 floor E-mail mbcbrewem@gmail.com How many businesses are in the building? 8 lfa corporate body, name Frontage of responsible officer Scott Perry Building ae x 98 linear feet Construction Sup's License No Applicant's Space(if multi-tenant) 98 linear feet Address Property 48,98 linear feet Telephone Mail Sign Permit to x Sign Owner ❑Sign Erector o Other: posed Signs (if more than three signs are proposed. attach additional sheets) Sign 1 7 5-i-an Sign 3 ❑Surface ❑Surface XRight Angle to Building ngle to Building o Right Angle to Building o Free Standing anding o Free Standing ❑Awning ❑Awning ❑ Portable(A-Frame) e(A-Frame) ❑ Portable(A-Frame) o Other(specify) specify) n Other(specify) Sign Materials gerials Sign Materials Wood Metal Chain Lights,Oil Paint Sign Dimensions 54"x 54"x 3.5" Sign Dimensions Sign Dimensions Sign Area Sign Area Sign Area 20.25 s ft s ft sq ft Sign Height(if free standing) Sign Height(if free standing) Sign Height(if free standing) Estimated Cost of Net Work $ 800 Existing Signs Type Sign Area To Be Removed? Sign Owner� XSurface 1_sq ft D yes Xno 1()g(Right Angle to Building � _sq ft Xyes o no ❑ Free Standing sq ft �yes o no g Owner's Authorized Representative Li Awning sq it D yes o no Se Other(specify) Window 3§_sq ft ❑yes Xno P1 pe r Internal Review Planning&Community Development Department Historical Commission Building Inspector OW24Me re Design Review Board 120 Washington Street, 3• Floor Salem, MA 01970 Scott Perry and Joshua Engdahl Owner/Managers East Regiment Beer Company 30 Church St. Salem, MA 01970 Dear Sir or Mam, We respectfully request permission to be added to the agenda for the Salem Redevelopment Authorities Design Review Board taking place on September 27th, 2017. Thank you for your time and consideration Very Respectfully Scott Perry Joshua Engdahl i i�� DESIGN THAT MATTERS EXISTING / BUILDING NICK'S FIREHOUSE COFFEE SHOPPE F- LU w w ~ IXSTM MENS O EXISTING y � iOILEf ROOM LOBBY EXIST STAIR IXSTM6 WOMENS / = TOLLET ROOM ^O 1? up El ------------------- U 1 _ EXISTING FIRST FLOOR PLAN SCALE:IIS'=I'-0' ` CHURCH STREET PARKING LOT J � CxYRCM OTPEfiT M 9 � L 1 � 4 3b e f G i ILI r ------------ PROPOSED _.PROPOSED MICRO BREWERY 3D CHURCH$TflEET EXISTING CONDITIONS FLOOR PLANS 1 j SALEM,MASSACHUSETTS PREPARED FOR MSC BREWERS _„"� T Q PROPOSED MICRO BREWERY MASSACHUSETTS BAY COLONY BREWERS ossa u*M FPs ,I 30 Church Street,Salem,Massachusetts �Of Ra}mmJ T. n n A' l LEAP 9RHf rvicns FlFPM se corrse suoppp ®. A9I 10' R J to 207 ±Ot Tel 076-3%T aaJ ReARTGNhke u.cem ui i b 771. 4Y - - ,oEL- F_ ' 1 ¢� PROPOSED FIRSTI O FR 2LAd 08 ATEMEM DF PP 9 g fsY. i S _ W uaaux4a y mno a e artummaa[u O U p OEM n ro ure. exmn p < i OUTDOOR TASTING ARTA PPSSPFGTIV4 Al » .. EMUPEx BLPEEi Q II 6 5 Y E - o - E p ® 0 } a o� i o� � @ 12 t ` PROPOSED MICRO BREWERY 8585 i niom�� y MASWHUSMS BAY Ca BPEWMS PROPOSED LOWER LEVEL FLOOR PLAN N M Gnome street S .MensecfiUs aISTINO FIRST FLOOR PLAN HLJ Prep lar MSC S.. 37 30 Church Street,Salem, MA 01970 SITE PIAN l w SALEM REDEWLQhKW. I{ � AUTHMITT MM CW7Y 9J7 � M AREA•SEAT S.F. O � poem 6 wow v MAcunc �e CHURCH STREET PLAN OF LAND �+ w- CHURCH ST. SALEM,MASS, SCALE 1%IC DCT. 6, IS70 onp m Mt�1 C,So" FAiM91Y1C 0111 SHUKA ASSOCIATES.INC.,8 ENON STREET.SUITE IB.BEVERLY,MA 01915(978)911-1700 38 30 Church Street,Salem,MA 01970 DESCRIPTION OF THE SITE Utilities : Public Underground Electric : Yes Street Access: Site access via Church Street Frontage: 48 .14 feet on Church Street Maintained By: City of Salem Ingress and Egress: Pedestrian and vehicle access via a right of way only Land Area: 4, 537 square feet Topography: Mostly level Configuration: Trapezoid Easements/Encroachments: As reflected within the deed on page 19 and site plan on page 37, the property has a right of way on the easterly side of the property which is reportedly utilized for deliveries. There may be normal utility easements assumed to be in place and are assumed to have no detrimental effect on value. There are no known adverse easements or encroachments noted. This appraiser cannot guarantee that none exist. Drainage• Appears and assumed adequate Flood Zone: According to InterFlood, the subject property is not located in a "FEMA Special Flood Hazard Area" and appears to be in Zone X; Areas determined to be outside 500-year floodplain determined to be outside the 1% and 0.2% annual chance floodplains. ; Community Panel #25009C0419G. The effective date is July 16, 2014. SHUKA ASSOCIATES,INC.8 ENON STREET.SUITE IB,BEVERLY.MA 01915(978)911-1700 .._, , --� r��.. ' - c�i, �.. . ,�- `� ps` #�, .may Y H4 •, �+u � t •, • � .r.- J n 1 - �.. ' +..w- � �� -�..Tom. �., ��, ,� 1 --.._ . - '1L � ` , ��� _ .. r— r : �,- , . it J'(F±�4' . ' r�`�'ry Imo ^{. ,�� .,j�I;N,V•el�'� r../ 41. ilk N i 'N ! t �'' � 'ice- �'�•• x :p Design Review Board 120 Washington Street, 3-=Floor Salem, MA 01970 Scott Perry and Joshua Engdahl Owner/Managers Massachusetts Bay Colony Brewers DBA: East Regiment Beer Company 30 Church St. Salem, MA 01970 Statement of Proposal: We intend to build a three barrel microbrewery and tasting room at 30 Church St. Salem, MA.The brewery will be located within the 1442 Square foot basement and the 915 Square foot exterior tasting room/area will be located on the exterior east side of the building.The brewery will utilize the existing bathrooms within Nicks Fire House restaurant after modifications have been completed to make them both ADA compliant and accessible to patrons via a common hallway. Massachusetts Bay Colony Brewers will seek an easement to construct the outdoor tasting area and install an ADA compliant ramp for patrons both onto the outdoor tasting area and into the ADA compliant bathrooms.A Federal brewery license has already been obtained.The state license is under review pending local authority acceptance for the project.The tasting area will in no way inhibit or block any pedestrian walkways (Salem Green) and will seat 32 patrons around both high and low top tables. Thank you for your time and consideration Very Respectfully Scott Perry Joshua Engdahl Design Review Board 120 Washington Street, 3 Floor Salem, MA 01970 Scott Perry and Joshua Engdahl Owner/Managers Massachusetts Bay Colony Brewers DBA: East Regiment Beer Company 30 Church St. Salem, MA 01970 Proposed Schedule Upon approval of the microbrewery and tasting room we will submit our revised plans for final approval for the October Design Review Board meeting.As soon as we receive approval we will begin construction on both the indoor and outdoor components of the brewery at 30 Church st. We expect to receive approval from the State ABCC board as soon as the Zoning Board of Appeals grants us the ability to build the microbrewery at the 30 Church st. Location. Once we have obtained permission to build and the State Farmer Brewery license we can apply for the local brewery license and pouring permit from the licensing board.We are hoping to have all required licenses in hand by the October meeting. Thank you for your time and consideration Very Respectfully Scott Perry Joshua gdahl d ; �r P 14 q14 'j 14 r'R: III ii��7I II7 dl��l��I ISi .a. �i„1`IIII11 7V �I j1�l4�lnll�l I,II �I('jl'�'li I I �� fi �1 I `2 em.. .:� l ' s ' g y Y� • _ r � r • a 1 �f � �Pi + i - � ' � Ytl .4 1114 49 ol F • F F - _ ■ III i d � �OAW '. , s ' s + a /t . - 4 M . .J 41. X41 .� —Fy a _. a i { . 'fry +�1, `v1 .�'✓•a i\.�\` ��.' - - R � I ,* i T PROPOSED MICRO BREWERY MASSACHUSETTS BAY COLONY BREWERS I' oE;s.�I.T-MkT11.5 i 30 Church Street, Salem, Massachusetts R<9 jlEl na—und r.epcnln.AmMico i LIAR n P OO., ' 'CMS Fi,LnaosE cO«.E Si9�at. NSI naamk.R W,Sinn,. i' 'RM enfv< • ret.mtl 136 ,ea GmaI Ry@HTLA hircieomLL TM. .•v t ow o t..+�l.�^4•. ¢ C3 Ww O¢ 00 PHQPQSEa—FIRST ELQQH. PLAN no o~ ^J_ STAIEFP_54CxBL 3 m 8g • ���� 4r •ee.4ftw uscuex, Q � Yr{ � I m if W` U 2. _ w.muwc a u G¢ O I � QLTAOOH TASTING AREA PEHSPfzQTIVE A'l - L - » . ) \ § ) ( r - ) , ! { \\� ! � 77, i f§ 1 \; \9 \ F, �| N ® ,• ®- . MASSkCHUSETTS BAY COLON'BREWERS ` E_ .PL-AN " �2 _ � _ „, - - - - y � .. r��� i��; j _�, _ - _ _ -- 7 �w. i . d �•. l �' � -- E .F �..-. w,, ,� .,.+.� s - �,. ' _ �` + ,, ��e:� } ��� � .. � " - _ NNW AIL-r i ■ T Y h^i } �r map lip w -tv 4 r a #A �. � Vol t •Q d _ f � y a �JY � itdoor Dining Sets > Patio Dining Sets luare Aluminum Indoor-Outdoor Table with 4 Slat $ 141 60 Was S177.59 Save S35.99 lash Furniture Walmart r: 557086972 Sold &shipped by Walmart Free shipping Arrives within 3-5 days Or get it by Thursday, Sep 7 with faster shipp PAW Free pickup at Salem 450 Highland Ave Pickup options S 7 Protect your purchase with a Care Plan 0 Add 2-Year Protection $14.00 Quantity: 1 - �© Add to List AM w w • BEER COMPANY �-�.•• \\_ter �\ � I � � \ \ `-- ....� f! \� \\ ter- ` ��-�''�\ \\✓ ... �•\ ,.��\ `. � �I- �\`� ' '� i .F` mono -------------- F, S '�: Computer Rendition for Review Only 7 W t Tis_ 16 ,F ate , Scale: Description: Fabric/Color: Construction/installation: NTS Welded Frame Canopy Fabric:tbd; Graphics: tbd Welded Frame; 1"x 1"galvanized sq tube Z-Clips: Steel Posts (781) 665-4040 phone Proposed Awning 30 Church St (781)665-5234 fax CApyrgM 2017 Salem, MA • info@atlantic-awning.Com REVA 09/11/17 �r I LI � 3 O DO CD 3 0 SF C r- ^m .. g'r ... ^ 5fw m 9 MEE I _ { Ce URCa STREET o �2 i i a � AB aim `>$ 8" Fbz A �f it R5 N M RA S 9p .. m €g RA.L G.. PROPOSED MICRO BREWERY I�I ruc MASSACHUSETTS BAY COLONY BREWERS OUTDOOR TASTING AREA PERSPECTIVE °5. F 30 Church Street,Salem,Massachusetts Prepared for MBC Brewers PROPOSED FIRST FLOOR PLAN Date: 09/11/2017 Quote#: Page 1 of 7 Commercial Package Quote Proposal Underwritten By: Scottsdale Insurance Company A.M. Best rated A+ (Superior), FSC XV Quote Summary Commission: 10 % Minimum Earned: 25% Minimum & Deposit: 100% These terms are valid for 60 days from the date on this letter. Our quotation may differ from the terms requested in the submission. Please review the quotation carefully. If the policy is cancelled at the insured's request, including non-payment of premium, there will be a minimum earned premium retained by us. At the close of each audit period, we will compute the earned premium for that period. If the earned premium is greater than the advance premium paid, an audit premium will be due. If a policy or inspection fee is applicable to this policy, the fees are fully earned. No flat cancellations. Applicant: East Regiment Beer Company Address: 30 Church St Salem MA 01970 Policy Type: Commercial Package Quote Policy Period: 09/11/2017 To:09/11/2018(12:01 AM Standard Time on both dates at the address of the Named Insured) Quote#: Premium Summary iabilit : $1,707 Li uor Liability: $6,610 ro ert : $3,498 her: $ ub Total Premium: $11815 u lus Tax: $472.60 Inspection Fee: $150.00 Po Fee: $350.00 rand Total: $12787.60 Terrorism: Terrorism coverage can be purchased for an additional premium of$591 plus applicable taxes and fees. Signed acceptance/rejection required at binding. Date: 09/11/2017 Quote#: Page 2 of 7 Subject to following terms and conditions: • No Known Loss letter signed by the insured. • Favorable inspection. • Completed, signed and dated ACORD application. • Completed, signed and dated supplemental application. • Signed TRIA form at time of binding rejecting or accepting coverage • Annual audit. • Confirm TIPS or equivalent training for all servers at time of binding. • Signed and Dated MA Affidavit Commercial Liability Coverage Limits General Aggregate $2,000,000 Products/Completed Operation Aggregate $2,000,000 Personal and Advertising Injury $1,000.000 Each Occurrence $1,000,000 Dama e to Premises Rented to You $100,000 Medical Payments $5,000 Deductible Applicable to BI /PD / PI /Al None Liability Rating Classifications and Premium Program Code Description Premium Basis Exposure Rate Premium G 16930 Restaurants - with sales of Per 1000/gross 315,000 5.42 $1,707 alcoholic beverages that are 75% sales r more of the total annual receipts of the restaurants - with tables - without dance floor - table ervice Additional Coverage Coverage Limits Notes Premium Additional Insured Included Included Assault and/or Battery Limited Liability GLS-285s is included and Included Coverage Form (Designated Premises) mandatory for risks with bar, tavern $25,000/$50,000 Included r nightclub occupancies. Date: 09/11/2017 Quote#: Page 3 of 7 Liquor Liability Coverage Limits Aggregate $2,000,000 Each Common Cause $1,000,000 Liquor Liability Rating Classifications and Premium Code Description Premium Basis Exposure Rate Premium Program KM 58161Taverns/Bars, Bowling Alleys & Per 1000 315,000 20.98 $6,610 Casinos 58168 liquor/gross sales Liquor Liability Additional Coverages Coverage Notes Premium Assault and/or Battery Limited Liability GLS-285s is included and mandatory for risks Included Coverage Form (Designated Premises) with bar, tavern or nightclub occupancies. ($25.000/$50,000 Included Commercial Property Coverage Loc#/ State/Terr Program Class Code AOP Deduc Wind/Hail Coins Cause of Bldg# Deduc Loss 1 / 1 MA/Remainder of AG 0541 - Bars and $1,000 80% Special Ex State I I Taverns I I I Theft Loc #/ Program Class Code Coverage Valuation Limit Rate Premium Bldg# 1 / 1 AG 0541 - Bars and Building RC $180,000 0.66 $1,188 Taverns 1 / 1 AG 0541 - Bars and BPP RC $50.000 0 66 $330 Taverns 1 / 1 AG 0541 - Bars and Business EVE $300,000 0.66 $1,980 Taverns I Income Date: 09/11/2017 Quote#: Page 4 of 7 Forms and Endorsements Common Policy IL 00 17 11-98 COMMON POLICY CONDITIONS IL 00 21 9-08 NUCLEAR ENERGY LIABILITY EXCLUSION ENDORSEMENT IL 09 53 1-15 EXCLUSION OF CERTIFIED ACTS OF TERRORISM NOTX0178CW 3-16 CLAIM REPORTING NOTX0423CW 2-15 POLICYHOLDER DISCLOSURE NOTICE OF TERRORISM INSURANCE COVERAGE OPS-D-1 1-17 COMMON POLICY DECLARATIONS UTS-119g 6-14 MINIMUM EARNED CANCELLATION PREMIUM UTS-9g 5-96 SERVICE OF SUIT CLAUSE UTS-COVPG 1-16 COVER PAGE UTS-SP-2 12-95 SCHEDULE OF FORMS AND ENDORSEMENTS UTS-SP-3 8-96 SCHEDULE OF LOCATIONS Commercial Liability CG 00 01 4-13 COMMERCIAL GENERAL LIABILITY COVERAGE FORM CG 21 01 11-85 EXCLUSION - ATHLETIC OR SPORTS PARTICIPANTS CG 21 06 5-14 EXCLUSION - ACCESS OR DISCLOSURE OF CONFIDENTIAL OR PERSONAL INFORMATION AND DATA-RELATED LIABILITY - WrrH LIMITED BODILY INJURY EXCEPTION CG 21 44 4-17 LIMITATION OF COVERAGE TO DESIGNATED PREMISES OR PROJECT CG 21 47 12-07 EMPLOYMENT-RELATED PRACTICES EXCLUSION CG 21 67 12-04 FUNGI OR BACTERIA EXCLUSION CG 21 73 1-15 EXCLUSION OF CERTIFIED ACTS OF TERRORISM CG 24 07 1-96 PRODUCTS AND COMPLETED OPERATIONS HAZARD REDEFINED CG 24 26 4-13 AMENDMENT OF INSURED CONTRACT DEFINITION CLS-SD-1 L 8-01 COMMERCIAL GENERAL LIABILITY COVERAGE PART SUPPLEMENTAL DECLARATIONS CLS-SP-1 L 10-93 COMMERCIAL GENERAL LIABILITY COVERAGE PART EXTENSION OF SUPPLEMENTAL DECLARATIONS GLS-152s 8-16 AMENDMENT TO OTHER INSURANCE CONDITIONS GLS-285s 11-15 ASSAULT AND/OR BATTERY LIMITED LIABILITY COVERAGE FORM DESIGNATED PREMISES GLS-289s 11-07 KNOWN INJURY OR DAMAGE EXCLUSION - PERSONAL AND ADVERTISING INJURY Date: 09/11/2017 Quote#: Page 5 of 7 GLS-30s 1-15 CONTRACTORS SPECIAL CONDITIONS GLS-341s 8-12 HYDRAULIC FRACTURING EXCLUSION GLS-455s 8-14 MARIJUANA/CANNABIS PRODUCTS EXCLUSION GLS-457s 10-14 AIRCRAFT EXCLUSION GLS-47s 10-07 MINIMUM AND ADVANCE PREMIUM ENDORSEMENT GLS-74s 9-05 AMENDMENT OF CONDITIONS UTS-266Q 5-98 ASBESTOS EXCLUSION UTS-267g 5-98 LEAD CONTAMINATION EXCLUSION UTS-365s 2-09 AMENDMENT OF NONPAYMENT CANCELLATION CONDITION UTS-428g 11-12 PREMIUM AUDIT ENDORSEMENT UTS-74g 8-95 PUNITIVE OR EXEMPLARY DAMAGE EXCLUSION CG 00 33 4-13 LIQUOR LIABILITY COVERAGE FORM CG 28 06 01 96 LIMITATION OF COVERAGE TO INSURED PREMISES CLS-SD-5 8-01 LIQUOR LIABILITY COVERAGE PART SUPPLEMENTAL DECLARATIONS Commercial Property CP 00 10 10-12 BUILDING AND PERSONAL PROPERTY COVERAGE FORM CP 00 30 10-12 BUSINESS INCOME AND EXTRA EXPENSE COVERAGE FORM CP 00 90 7-88 COMMERCIAL PROPERTY CONDITIONS CP 01 40 7-06 EXCLUSION OF LOSS DUE TO VIRUS OR BACTERIA CP 02 99 6-07 CANCELLATION CHANGES CP 10 30 9-17 CAUSES OF LOSS-SPECIAL FORM CP 10 33 10-12 THEFT EXCLUSION CPS-SD-1 2-16 COMMERCIAL PROPERTY COVERAGE PART SUPPLEMENTAL DECLARATIONS Date: 09/11/2017 Quote#: Page 6 of 7 SCOTTSDALE INSURANCE COMPANY' Scottsdale Indemnity Company SCOTTSDALE SURPLUS L INSUR CE COME Y POLICYHOLDER DISCLOSURE NOTICE OF TERRORISM INSURANCE COVERAGE TERRORISM RISK INSURANCE ACT Under the Terrorism Risk Insurance Act of 2002, as amended pursuant to the Terrorism Risk Insurance Program Reauthorization Act of 2015, effective January 1, 2015(the"Act"), you have a right to purchase insurance coverage for losses arising out of acts of terrorism, as defined in Section 102(1) of the Act:The term "certified acts of terrorism" means any act that is certified by the Secretary of the Treasury-in consultation with the Secretary of Homeland Security-to be an act of terrorism;to be a violent act or an act that is dangerous to human life, property, or infrastructure;to have resulted in damage within the United States, or outside the United States in the case of certain air carriers or vessels or the premises of a United States mission;to have been committed by an individual or individuals as part of an effort to coerce the civilian population of the United States or to influence the policy or affect the conduct of the United States Government by coercion. You should know that where coverage is provided by this policy for losses resulting from "certified acts of terrorism," such losses may be partially reimbursed by the United States Government under a formula established by federal law. However, your policy may contain other exclusions which might affect your coverage, such as an exclusion for nuclear events. Under the formula, the United States Government agrees to reimburse eighty-five percent(85%) of covered terrorism losses in calendar year 2015 that exceed the statutorily established deductible paid by the insurance company providing the coverage. This percentage of United States Government reimbursement decreases by one percent(1%) every calendar year beginning in 2016 until it equals eighty percent (80%) in 2020. The premium charged for this coverage is provided below and does not include any charges for the portion of loss that may be covered by the Federal Government under the Act. You should also know that the Act, as amended, contains a$100 billion cap that limits United States Government reimbursement as well as insurers' liability for losses resulting from "certified acts of terrorism" when the amount of such losses in any one calendar year exceeds$100 billion. If the aggregate insured losses for all insurers exceed $100 billion, your coverage may be reduced. CONDITIONAL TERRORISM COVERAGE The federal Terrorism Risk Insurance Program Reauthorization Act of 2015 is scheduled to terminate at the end of December 31, 2020, unless renewed, extended or otherwise continued by the federal government. Should you select Terrorism Coverage provided under the Act and the Act is terminated December 31, 2020, any terrorism coverage as defined by the Act provided in the policy will also terminate. NOTX0423CW (2-15) 1 of 2 Date: 09/11/2017 Quote#: Page 7 of 7 IN ACCORDANCE WITH THE ACT, YOU MUST CHOOSE TO SELECT OR REJECT COVERAGE FOR "CERTIFIED ACTS OF TERRORISM" BELOW: The Note below applies for risks in these states: California, Connecticut, Georgia, Hawaii, Illinois, Iowa, Maine, Missouri. New Jersey, New York, North Carolina, Oregon, Rhode Island, Virginia, Washington, West Virginia, Wisconsin. NOTE: In these states, a terrorism exclusion makes an exception for(and thereby provides coverage for)fire losses resulting from an act of terrorism. Therefore, if you reject the offer of terrorism coverage, that rejection does not apply to fire losses resulting from an act of terrorism coverage for such fire losses will be provided in your policy. If you do not respond to our offer and do not return this notice to the Company, you will have no Terrorism Coverage under this policy. I hereby elect to purchase certified terrorism coverage for a premium of$591, 1 understand that the federal Terrorism Risk Insurance Program Reauthorization Act of 2015 may terminate on December 31, 2020. Should that occur my coverage for terrorism as defined by the Act will also terminate. I hereby reject the purchase of certified terrorism coverage. Policyholder/Applicant's Signature Named Insured/Firm Print Name Policy Number, if available Date NOTX0423CW (2-15)) 2 of 2 1 Date: 09/11/2017 Quote#: Page 7 of 7 IN ACCORDANCE WITH THE ACT, YOU MUST CHOOSE TO SELECT OR REJECT COVERAGE FOR "CERTIFIED ACTS OF TERRORISM" BELOW: The Note below applies for risks in these states: California, Connecticut, Georgia, Hawaii, Illinois, Iowa, Maine, Missouri, New Jersey, New York, North Carolina, Oregon, Rhode Island, Virginia, Washington, West Virginia, Wisconsin. NOTE: In these states, a terrorism exclusion makes an exception for(and thereby provides coverage for)fire losses resulting from an act of terrorism. Therefore, if you reject the offer of terrorism coverage, that rejection does not apply to fire losses resulting from an act of terrorism coverage for such fire losses will be provided in your policy. If you do not respond to our offer and do not return this notice to the Company, you will have no Terrorism Coverage under this policy. I hereby elect to purchase certified terrorism coverage for a premium of $591. 1 understand that the federal Terrorism Risk Insurance Program Reauthorization Act of 2015 may terminate on December 31, 2020. Should that occur my coverage for terrorism as defined by the Act will also terminate. 1 Ian rnF„�n nnl lF..... .nhnnn ni....Niiin.i 1...�n rinm nn, n.nn..