Common use of Stockholder Disclosure Certification Clause in Contracts

Stockholder Disclosure Certification. Name of Business: ☐ I certify that the list below contains the names and home addresses of all stockholders holding 10% or more of the issued and outstanding stock of the undersigned. OR ☐ I certify that no one stockholder owns 10% or more of the issued and outstanding stock of the undersigned. Check the box that represents the type of business organization: ☐ Partnership ☐ Corporation ☐ Sole Proprietorship ☐ Limited Partnership ☐ Limited Liability Corporation ☐ Limited Liability Partnership ☐ Subchapter S Corporation Sign and notarize the form below, and, if necessary, complete the stockholder list below. Stockholders: Name: Stockholder Name Name: Stockholder Name Home Address: Home Address Home Address: Home Address Name: Stockholder Name Name: Stockholder Name Home Address: Home Address Home Address: Home Address Name: Stockholder Name Name: Stockholder Name Home Address: Home Address Home Address: Home Address Subscribed and sworn before me this day of , 2 . (Notary Public) My Commission expires: (Affiant) (Print name & title of affiant) (Corporate Seal) PROPOSAL FORM 18: GENERAL TERMS AND CONDITIONS ACCEPTANCE FORM‌ Check one of the following responses to the General Terms and Conditions in this solicitation, including the Master Agreement: ☒ We take no exceptions/deviations to the general terms and conditions. (Note: If none are listed below, it is understood that no exceptions/deviations are taken.) ☐ We take the following exceptions/deviations to the general terms and conditions. All exceptions/deviations must be clearly explained. Reference the corresponding general terms and conditions that you are taking exceptions/deviations to. Clearly state if you are adding additions terms and conditions to the general terms and conditions. Provide details on your exceptions/deviations below: Click or tap here to enter text. (Note: Unacceptable exceptions shall remove your proposal from consideration for award. CCOG shall be the sole judge on the acceptance of exceptions/deviations and the decision shall be final.) PROPOSAL FORM 19: EQUALIS GROUP ADMINISTRATION AGREEMENT DECLARATION‌

Stockholder Disclosure Certification. Name of Business: ☐ I certify that the list below contains the names and home addresses of all stockholders holding 10% or more of the issued and outstanding stock of the undersigned. OR ☐ I certify that no one stockholder owns 10% or more of the issued and outstanding stock of the undersigned. Check the box that represents the type of business organization: ☐ Partnership ☐ Corporation ☐ Sole Proprietorship ☐ Limited Partnership ☐ Limited Liability Corporation ☐ Limited Liability Partnership ☐ Subchapter S Corporation Sign and notarize the form below, and, if necessary, complete the stockholder list below. Stockholders: Name: Stockholder Name Name: Stockholder Name Home Address: Home Address Home Address: Home Address Name: Stockholder Name Name: Stockholder Name Home Address: Home Address Home Address: Home Address Name: Stockholder Name Name: Stockholder Name Home Address: Home Address Home Address: Home Address Subscribed and sworn before me this day of , 2 . (Notary Public) My Commission expires: (Affiant) (Print name & title of affiant) (Corporate Seal) PROPOSAL FORM 1817: GENERAL TERMS AND CONDITIONS ACCEPTANCE FORM‌ FORM Check one of the following responses to the General Terms and Conditions in this solicitation, including the Master Agreement: ☒ We take no exceptions/deviations to the general terms and conditions. conditions (Note: If none are listed below, it is understood that no exceptions/deviations are taken.) ☐ We take the following exceptions/deviations to the general terms and conditions. All exceptions/deviations must be clearly explained. Reference the corresponding general terms and conditions that you are taking exceptions/deviations to. Clearly state if you are adding additions terms and conditions to the general terms and conditions. Provide details on your exceptions/deviations below: Click or tap here to enter text. (Note: Unacceptable exceptions shall remove your proposal from consideration for award. CCOG shall be the sole judge on the acceptance of exceptions/deviations and the decision shall be final.) PROPOSAL FORM 1918: EQUALIS GROUP ADMINISTRATION AGREEMENT DECLARATION‌DECLARATION

Stockholder Disclosure Certification. Name of Business: ☐ I certify that the list below contains the names and home addresses of all stockholders holding 10% or more of the issued and outstanding stock of the undersigned. OR ☐ I certify that no one stockholder owns 10% or more of the issued and outstanding stock of the undersigned. Check the box that represents the type of business organization: ☐ Partnership ☐ Corporation ☐ Sole Proprietorship ☐ Limited Partnership ☐ Limited Liability Corporation ☐ Limited Liability Partnership ☐ Subchapter S Corporation Sign and notarize the form below, and, if necessary, complete the stockholder list below. Stockholders: Name: Stockholder Name Name: Stockholder Name Home Address: Home Address Home Address: Home Address Name: Stockholder Name Name: Stockholder Name Home Address: Home Address Home Address: Home Address Name: Stockholder Name Name: Stockholder Name Home Address: Home Address Home Address: Home Address Subscribed and sworn before me this day of _, 2 . (Notary Public) My Commission expires: _ (Affiant) (Print name & title of affiant) (Corporate Seal) PROPOSAL FORM 18: GENERAL TERMS AND CONDITIONS ACCEPTANCE FORM‌ Check one of the following responses to the General Terms and Conditions in this solicitation, including the Master Agreement: ☒ We take no exceptions/deviations to the general terms and conditions. (Note: If none are listed below, it is understood that no exceptions/deviations are taken.) ☐ We take the following exceptions/deviations to the general terms and conditions. All exceptions/deviations must be clearly explained. Reference the corresponding general terms and conditions that you are taking exceptions/deviations to. Clearly state if you are adding additions terms and conditions to the general terms and conditions. Provide details on your exceptions/deviations below: Click or tap here to enter text. (Note: Unacceptable exceptions shall remove your proposal from consideration for award. CCOG shall be the sole judge on the acceptance of exceptions/deviations and the decision shall be final.) PROPOSAL FORM 19: EQUALIS GROUP ADMINISTRATION AGREEMENT DECLARATION‌

Stockholder Disclosure Certification. Name of Business: ☐ ☒ I certify that the list below contains the names and home addresses of all stockholders holding 10% or more of the issued and outstanding stock of the undersigned. OR ☐ I certify that no one stockholder owns 10% or more of the issued and outstanding stock of the undersigned. Check the box that represents the type of business organization: ☐ Partnership ☐ ☒ Corporation ☐ Sole Proprietorship ☐ Limited Partnership ☐ Limited Liability Corporation ☐ Limited Liability Partnership ☐ Subchapter S Corporation Sign and notarize the form below, and, if necessary, complete the stockholder list below. Stockholders: Name: Stockholder Name Name: Stockholder Name Xxxx X Xxxx Home Address: 0000 Xxxxxx Xxxxxxx Xxxxx Home Address: Mississauga,ON Canada Home Address Name: Stockholder Name Home Address: Home Address Name: Stockholder Name Home Address: Home Address Name: Stockholder Name Home Address: Home Address Home Address: Home Address Name: Stockholder Name Name: Stockholder Name Home Address: Home Address Home Address: Home Address Subscribed and sworn before me this day of , 2 . (Affiant) (Notary Public) My Commission expires: (Affiant) (Print name & title of affiant) My Commission expires: (Corporate Seal) PROPOSAL FORM Proposal Form 18: GENERAL TERMS AND CONDITIONS ACCEPTANCE FORM‌ General Terms and Conditions Acceptance Form Check one of the following responses to the General Terms and Conditions in this solicitation, including the Master Agreement: ☒ We take no exceptions/deviations to the general terms and conditions. (Note: If none are listed below, it is understood that no exceptions/deviations are taken.) ☐ We take the following exceptions/deviations to the general terms and conditions. All exceptions/deviations must be clearly explained. Reference the corresponding general terms and conditions that you are taking exceptions/deviations to. Clearly state if you are adding additions terms and conditions to the general terms and conditions. Provide details on your exceptions/deviations below: Click or tap here to enter text. (Note: Unacceptable exceptions shall remove your proposal from consideration for award. CCOG shall be the sole judge on the acceptance of exceptions/deviations and the decision shall be final.) PROPOSAL FORM Proposal Form 19: EQUALIS GROUP ADMINISTRATION AGREEMENT DECLARATION‌Equalis Group Administration Agreement Declaration

Stockholder Disclosure Certification. Name of Business: ☐ ☒ I certify that the list below contains the names and home addresses of all stockholders holding 10% or more of the issued and outstanding stock of the undersigned. OR ☐ I certify that no one stockholder owns 10% or more of the issued and outstanding stock of the undersigned. Check the box that represents the type of business organization: ☐ Partnership ☐ ☒ Corporation ☐ Sole Proprietorship ☐ Limited Partnership ☐ Limited Liability Corporation ☐ Limited Liability Partnership ☐ Subchapter S Corporation Sign and notarize the form below, and, if necessary, complete the stockholder list below. Stockholders: Name: Stockholder Name Xxxxx Xxxxxx Name: Stockholder Name Home Address: 00 Xxxxxxxxx Xxxx, Xxxxxx Xxxxx, XX 00000 Home Address Home Address: Home Address Name: Stockholder Name Name: Stockholder Name Home Address: Home Address Home Address: Home Address Name: Stockholder Name Name: Stockholder Name Home Address: Home Address Home Address: Home Address Subscribed and sworn before me this day of , 2 . (Notary Public) My Commission expires: _________________________________ (Affiant) ________________________________ (Print name & title of affiant) (Corporate Seal) PROPOSAL FORM 1817: GENERAL TERMS AND CONDITIONS ACCEPTANCE FORM‌ FORM Check one of the following responses to the General Terms and Conditions in this solicitation, including the Master Agreement: ☒ We take no exceptions/deviations to the general terms and conditions. conditions (Note: If none are listed below, it is understood that no exceptions/deviations are taken.) ☐ We take the following exceptions/deviations to the general terms and conditions. All exceptions/deviations must be clearly explained. Reference the corresponding general terms and conditions that you are taking exceptions/deviations to. Clearly state if you are adding additions terms and conditions to the general terms and conditions. Provide details on your exceptions/deviations below: Click or tap here to enter text. (Note: Unacceptable exceptions shall remove your proposal from consideration for award. CCOG shall be the sole judge on the acceptance of exceptions/deviations and the decision shall be final.) PROPOSAL FORM 1918: EQUALIS GROUP ADMINISTRATION AGREEMENT DECLARATION‌DECLARATION

Stockholder Disclosure Certification. Name of Business: ☐ I certify that the list below contains the names and home addresses of all stockholders holding 10% or more of the issued and outstanding stock of the undersigned. OR ☐ I certify that no one stockholder owns 10% or more of the issued and outstanding stock of the undersigned. Check the box that represents the type of business organization: ☐ Partnership ☐ Corporation ☐ Sole Proprietorship ☐ Limited Partnership ☐ Limited Liability Corporation ☐ Limited Liability Partnership ☐ Subchapter S Corporation Sign and notarize the form below, and, if necessary, complete the stockholder list below. Stockholders: Name: Stockholder Name Name: Stockholder Name Home Address: Home Address Home Address: Home Address Name: Stockholder Name Name: Stockholder Name Home Address: Home Address Home Address: Home Address Name: Stockholder Name Name: Stockholder Name Home Address: Home Address Home Address: Home Address Subscribed and sworn before me this day of , 2 . (Notary Public) My Commission expires: (Affiant) (Print name & title of affiant) (Corporate Seal) PROPOSAL FORM 18*Please note that if awarded and requested EC America, Inc. and relevant partners will complete the New Jersey forms/requirement. Proposal Form 17: GENERAL TERMS AND CONDITIONS ACCEPTANCE FORM‌ General Terms and Conditions Acceptance Form Check one of the following responses to the General Terms and Conditions in this solicitation, including the Master Agreement: ☒ ☐ We take no exceptions/deviations to the general terms and conditions. conditions (Note: If none are listed below, it is understood that no exceptions/deviations are taken.) ☐ ☒ We take the following exceptions/deviations to the general terms and conditions. All exceptions/deviations must be clearly explained. Reference the corresponding general terms and conditions that you are taking exceptions/deviations to. Clearly state if you are adding additions terms and conditions to the general terms and conditions. Provide details on your exceptions/deviations below: Click or tap here to enter text. (Note: Unacceptable exceptions shall remove your proposal from consideration for award. CCOG shall be the sole judge on the acceptance of exceptions/deviations and the decision shall be final.) PROPOSAL FORM 19: EQUALIS GROUP ADMINISTRATION AGREEMENT DECLARATION‌:

Stockholder Disclosure Certification. Name of Business: ☐ ☒ I certify that the list below contains the names and home addresses of all stockholders holding 10% or more of the issued and outstanding stock of the undersigned. OR ☐ I certify that no one stockholder owns 10% or more of the issued and outstanding stock of the undersigned. Check the box that represents the type of business organization: ☐ Partnership ☐ ☒ Corporation ☐ Sole Proprietorship ☐ Limited Partnership ☐ Limited Liability Corporation ☐ Limited Liability Partnership ☐ Subchapter S Corporation Sign and notarize the form below, and, if necessary, complete the stockholder list below. Stockholders: Name: Stockholder Name Xxxxx Xxxxxxx Name: Stockholder Name Home Address: 0000 Xxxxxxxx Xx. Sandusky, OH 44870 Home Address Home Address: Home Address Name: Stockholder Name Name: Stockholder Name Home Address: Home Address Home Address: Home Address Name: Stockholder Name Name: Stockholder Name Home Address: Home Address Home Address: Home Address Subscribed and sworn before me this day of , 2 . (Notary Public) My Commission expires: _________________________________ (Affiant) ________________________________ (Print name & title of affiant) (Corporate Seal) PROPOSAL FORM 1817: GENERAL TERMS AND CONDITIONS ACCEPTANCE FORM‌ FORM Check one of the following responses to the General Terms and Conditions in this solicitation, including the Master Agreement: ☒ We take no exceptions/deviations to the general terms and conditions. conditions (Note: If none are listed below, it is understood that no exceptions/deviations are taken.) ☐ We take the following exceptions/deviations to the general terms and conditions. All exceptions/deviations must be clearly explained. Reference the corresponding general terms and conditions that you are taking exceptions/deviations to. Clearly state if you are adding additions terms and conditions to the general terms and conditions. Provide details on your exceptions/deviations below: Click or tap here to enter text. (Note: Unacceptable exceptions shall remove your proposal from consideration for award. CCOG shall be the sole judge on the acceptance of exceptions/deviations and the decision shall be final.) PROPOSAL FORM 1918: EQUALIS GROUP ADMINISTRATION AGREEMENT DECLARATION‌DECLARATION

Stockholder Disclosure Certification. Name of Business: ☐ ☒ I certify that the list below contains the names and home addresses of all stockholders holding 10% or more of the issued and outstanding stock of the undersigned. OR ☐ I certify that no one stockholder owns 10% or more of the issued and outstanding stock of the undersigned. Check the box that represents the type of business organization: ☐ Partnership ☐ Corporation ☐ Sole Proprietorship ☐ Limited Partnership ☐ ☒ Limited Liability Corporation ☐ Limited Liability Partnership ☐ Subchapter S Corporation Sign and notarize the form below, and, if necessary, complete the stockholder list below. Stockholders: Name: Stockholder Name TAKKT AG Name: Stockholder Name Home Address: 00 Xxxxxxxxxxxxxx 00000 Stuttgart Home Address Home Address: Home Address Name: Stockholder Name Name: Stockholder Name Home Address: Home Address Home Address: Home Address Name: Stockholder Name Name: Stockholder Name Home Address: Home Address Home Address: Home Address Subscribed and sworn before me this day of , 2 . (Notary Public) My Commission expires: (Affiant) (Print name & title of affiant) (Corporate Seal) PROPOSAL FORM 18: GENERAL TERMS AND CONDITIONS ACCEPTANCE FORM‌ FORM Check one of the following responses to the General Terms and Conditions in this solicitation, including the Master Agreement: ☒ We take no exceptions/deviations to the general terms and conditions. (Note: If none are listed below, it is understood that no exceptions/deviations are taken.) ☐ We take the following exceptions/deviations to the general terms and conditions. All exceptions/deviations must be clearly explained. Reference the corresponding general terms and conditions that you are taking exceptions/deviations to. Clearly state if you are adding additions terms and conditions to the general terms and conditions. Provide details on your exceptions/deviations below: Click or tap here to enter text. (Note: Unacceptable exceptions shall remove your proposal from consideration for award. CCOG shall be the sole judge on the acceptance of exceptions/deviations and the decision shall be final.) PROPOSAL FORM 19: EQUALIS GROUP ADMINISTRATION AGREEMENT DECLARATION‌DECLARATION

Stockholder Disclosure Certification. Name of Business: ☐ ☒ I certify that the list below contains the names and home addresses of all stockholders holding 10% or more of the issued and outstanding stock of the undersigned. OR ☐ I certify that no one stockholder owns 10% or more of the issued and outstanding stock of the undersigned. Check the box that represents the type of business organization: ☐ Partnership ☐ Corporation ☐ Sole Proprietorship ☐ Limited Partnership ☐ Limited Liability Corporation ☐ ☒ Limited Liability Partnership ☐ Subchapter S Corporation Sign and notarize the form below, and, if necessary, complete the stockholder list below. Stockholders: Name: Stockholder Name Series A of Public Pension Capital LLC Name: Stockholder Name Xxxxx Xxxxxxxx Home Address: Home Address 000 Xxxx Xxx., 0xx Xxxxx Xxx Xxxx, XX 00000 Home Address: Home Address 0000 Xxxxxxxx Xxxxxxxx Dr., Caledonia MI 49316 Name: Stockholder Name Name: Stockholder Name Home Address: Home Address Home Address: Home Address Name: Stockholder Name Name: Stockholder Name Home Address: Home Address Home Address: Home Address Subscribed and sworn before me this 29th day of June, 2 2023. (Notary Public) Kent County, Michigan My Commission expires: July 19, 2027 _ (Affiant) Xxxx Xxxxxx, Executive Director of Sales (Print name & title of affiant) (Corporate Seal) PROPOSAL FORM 1817: GENERAL TERMS AND CONDITIONS ACCEPTANCE FORM‌ Check one of the following responses to the General Terms and Conditions in this solicitation, including the Master Agreement: ☒ We take no exceptions/deviations to the general terms and conditions. conditions (Note: If none are listed below, it is understood that no exceptions/deviations are taken.) ☐ We take the following exceptions/deviations to the general terms and conditions. All exceptions/deviations must be clearly explained. Reference the corresponding general terms and conditions that you are taking exceptions/deviations to. Clearly state if you are adding additions terms and conditions to the general terms and conditions. Provide details on your exceptions/deviations below: Click or tap here to enter text. (Note: Unacceptable exceptions shall remove your proposal from consideration for award. CCOG shall be the sole judge on the acceptance of exceptions/deviations and the decision shall be final.) PROPOSAL FORM 1918: EQUALIS GROUP ADMINISTRATION AGREEMENT DECLARATION‌

Stockholder Disclosure Certification. Name of Business: ☐ I certify that the list below contains the names and home addresses of all stockholders holding 10% or more of the issued and outstanding stock of the undersigned. OR ☐ ☒ I certify that no one stockholder owns 10% or more of the issued and outstanding stock of the undersigned. Check the box that represents the type of business organization: ☐ Partnership ☐ ☒ Corporation ☐ Sole Proprietorship ☐ Limited Partnership ☐ Limited Liability Corporation ☐ Limited Liability Partnership ☐ Subchapter S Corporation Sign and notarize the form below, and, if necessary, complete the stockholder list below. Stockholders: Name: Stockholder Name Name: Stockholder Name Home Address: Home Address Home Address: Home Address Name: Stockholder Name Name: Stockholder Name Home Address: Home Address Home Address: Home Address Name: Stockholder Name Name: Stockholder Name Home Address: Home Address Home Address: Home Address Subscribed and sworn before me this day of , 2 . (Notary Public) My Commission expires: (Affiant) (Print name & title of affiant) (Corporate Seal) PROPOSAL FORM 1817: GENERAL TERMS AND CONDITIONS ACCEPTANCE FORM‌ Check one of the following responses to the General Terms and Conditions in this solicitation, including the Master Agreement: ☒ ☐ We take no exceptions/deviations to the general terms and conditions. conditions (Note: If none are listed below, it is understood that no exceptions/deviations are taken.) ☐ ☒ We take the following exceptions/deviations to the general terms and conditions. All exceptions/deviations must be clearly explained. Reference the corresponding general terms and conditions that you are taking exceptions/deviations to. Clearly state if you are adding additions terms and conditions to the general terms and conditions. Provide details on your exceptions/deviations below: Click or tap here We would like to enter textbe considered at a contract. as we establish this (Note: Unacceptable exceptions shall remove your proposal from consideration for award. CCOG shall be the sole judge on the acceptance of exceptions/deviations and the decision shall be final.) PROPOSAL FORM 1918: EQUALIS GROUP ADMINISTRATION AGREEMENT DECLARATION‌

Stockholder Disclosure Certification. Name of Business: ☐ I certify that the list below contains the names and home addresses of all stockholders holding 10% or more of the issued and outstanding stock of the undersigned. OR ☐ ☒ I certify that no one stockholder owns 10% or more of the issued and outstanding stock of the undersigned. Check the box that represents the type of business organization: ☐ Partnership ☐ Corporation ☐ Sole Proprietorship ☐ Limited Partnership ☐ ☒ Limited Liability Corporation ☐ Limited Liability Partnership ☐ Subchapter S Corporation Sign and notarize the form below, and, if necessary, complete the stockholder list below. Stockholders: Name: Stockholder Name Name: Stockholder Name Home Address: Home Address Home Address: Home Address Name: Stockholder Name Name: Stockholder Name Home Address: Home Address Home Address: Home Address Name: Stockholder Name Name: Stockholder Name Home Address: Home Address Home Address: Home Address Subscribed and sworn before me this day of , 2 . (Notary Public) My Commission expires: (Affiant) (Print name & title of affiant) (Corporate Seal) PROPOSAL FORM 1817: GENERAL TERMS AND CONDITIONS ACCEPTANCE FORM‌ FORM Check one of the following responses to the General Terms and Conditions in this solicitation, including the Master Agreement: ☒ We take no exceptions/deviations to the general terms and conditions. conditions (Note: If none are listed below, it is understood that no exceptions/deviations are taken.) ☐ We take the following exceptions/deviations to the general terms and conditions. All exceptions/deviations must be clearly explained. Reference the corresponding general terms and conditions that you are taking exceptions/deviations to. Clearly state if you are adding additions terms and conditions to the general terms and conditions. Provide details on your exceptions/deviations below: Click or tap here to enter text. (Note: Unacceptable exceptions shall remove your proposal from consideration for award. CCOG shall be the sole judge on the acceptance of exceptions/deviations and the decision shall be final.) PROPOSAL FORM 1918: EQUALIS GROUP ADMINISTRATION AGREEMENT DECLARATION‌DECLARATION

Stockholder Disclosure Certification. Name of Business: ☐ ☒ I certify that the list below contains the names and home addresses of all stockholders holding 10% or more of the issued and outstanding stock of the undersigned. OR ☐ I certify that no one stockholder owns 10% or more of the issued and outstanding stock of the undersigned. Check the box that represents the type of business organization: ☐ Partnership ☐ ☒ Corporation ☐ Sole Proprietorship ☐ Limited Partnership ☐ Limited Liability Corporation ☐ Limited Liability Partnership ☐ Subchapter S Corporation Sign and notarize the form below, and, if necessary, complete the stockholder list below. Stockholders: Name: Stockholder Name Xxxxx XxXxxx Name: Xxx Xxxxxxxxx Home Address: 000 Xxxxxx Xxxxx Home Address Coppell, Texas 75918 Home Address: 0000 Xxxxxxxxx Xxxxx Home Address Irving, Texas 75019 Name: Stockholder Name Home Address: Home Address Name: Stockholder Name Home Address: Home Address Name: Stockholder Name Name: Stockholder Name Home Address: Home Address Home Address: Home Address Name: Stockholder Name Name: Stockholder Name Home Address: Home Address Home Address: Home Address Subscribed and sworn before me this day of Xxxxx Xxxxxxxx (Nov 16, 2023 21:54 CST) , 2 . Nov 16, 2023 (Affiant) (Notary Public) My Commission expires: (Affiant) Xxxxx Xxxxxxxx Xxx (Print name & title of affiant) My Commission expires: (Corporate Seal) PROPOSAL FORM Proposal Form 18: GENERAL TERMS AND CONDITIONS ACCEPTANCE FORM‌ General Terms and Conditions Acceptance Form Check one of the following responses to the General Terms and Conditions in this solicitation, including the Master Agreement: ☒ ☐ We take no exceptions/deviations to the general terms and conditions. (Note: If none are listed below, it is understood that no exceptions/deviations are taken.) ☐ ☒ We take the following exceptions/deviations to the general terms and conditions. All exceptions/deviations must be clearly explained. Reference the corresponding general terms and conditions that you are taking exceptions/deviations to. Clearly state if you are adding additions terms and conditions to the general terms and conditions. Provide details on your exceptions/deviations below: Click or tap here to enter text. (Note: Unacceptable exceptions shall remove your proposal from consideration for award. CCOG shall be the sole judge on the acceptance of exceptions/deviations and the decision shall be final.) PROPOSAL FORM 19: EQUALIS GROUP ADMINISTRATION AGREEMENT DECLARATION‌:

Stockholder Disclosure Certification. Name of Business: ☐ I certify that the list below contains the names and home addresses of all stockholders holding 10% or more of the issued and outstanding stock of the undersigned. OR ☐ I certify that no one stockholder owns 10% or more of the issued and outstanding stock of the undersigned. Check the box that represents the type of business organization: ☐ Partnership ☐ Corporation ☐ Sole Proprietorship ☐ Limited Partnership ☐ Limited Liability Corporation ☐ Limited Liability Partnership ☐ Subchapter S Corporation Sign and notarize the form below, and, if necessary, complete the stockholder list below. Stockholders: Name: Stockholder Name Name: Stockholder Name Stockholders: Home Address: Home Address Home Address: Home Address Name: Stockholder Name Home Address: Home Address Name: Stockholder Name Home Address: Home Address Name: Stockholder Name Home Address: Home Address Name: Stockholder Name Name: Stockholder Name Home Address: Home Address Home Address: Home Address Subscribed and sworn before me this day of , 2 . (Affiant) (Notary Public) My Commission expires: (Affiant) (Print name & title of affiant) My Commission expires: (Corporate Seal) PROPOSAL FORM 18: GENERAL TERMS AND CONDITIONS ACCEPTANCE FORM‌ Check one of the following responses to the General Terms and Conditions in this solicitation, including the Master Agreement: ☒ We take no exceptions/deviations to the general terms and conditions. conditions (Note: If none are listed below, it is understood that no exceptions/deviations are taken.) ☐ We take the following exceptions/deviations to the general terms and conditions. All exceptions/deviations must be clearly explained. Reference the corresponding general terms and conditions that you are taking exceptions/deviations to. Clearly state if you are adding additions terms and conditions to the general terms and conditions. Provide details on your exceptions/deviations below: Click or tap here to enter text. (Note: Unacceptable exceptions shall remove your proposal from consideration for award. CCOG shall be the sole judge on the acceptance of exceptions/deviations and the decision shall be final.) PROPOSAL FORM 19: EQUALIS GROUP ADMINISTRATION AGREEMENT DECLARATION‌)

Stockholder Disclosure Certification. Name of Business: ☐ I certify that the list below contains the names and home addresses of all stockholders holding 10% or more of the issued and outstanding stock of the undersigned. OR ☐ I certify that no one stockholder owns 10% or more of the issued and outstanding stock of the undersigned. Check the box that represents the type of business organization: ☐ Partnership ☐ Corporation ☐ Sole Proprietorship ☐ Limited Partnership ☐ Limited Liability Corporation ☐ Limited Liability Partnership ☐ Subchapter S Corporation Sign and notarize the form below, and, if necessary, complete the stockholder list below. Stockholders: Name: Stockholder Name Name: Stockholder Name Home Address: Home Address Home Address: Home Address Name: Stockholder Name Name: Stockholder Name Home Address: Home Address Home Address: Home Address Name: Stockholder Name Name: Stockholder Name Home Address: Home Address Home Address: Home Address Subscribed and sworn before me this day of , 2 . (Notary Public) My Commission expires: (Affiant) (Print name & title of affiant) (Corporate Seal) PROPOSAL FORM 18: GENERAL TERMS AND CONDITIONS ACCEPTANCE FORM‌ Check one of the following responses to the General Terms and Conditions in this solicitation, including the Master Agreement: ☒ We take no exceptions/deviations to the general terms and conditions. conditions (Note: If none are listed below, it is understood that no exceptions/deviations are taken.) ☐ We take the following exceptions/deviations to the general terms and conditions. All exceptions/deviations must be clearly explained. Reference the corresponding general terms and conditions that you are taking exceptions/deviations to. Clearly state if you are adding additions terms and conditions to the general terms and conditions. Provide details on your exceptions/deviations below: Click or tap here to enter text. (Note: Unacceptable exceptions shall remove your proposal from consideration for award. CCOG shall be the sole judge on the acceptance of exceptions/deviations and the decision shall be final.) PROPOSAL FORM 19: EQUALIS GROUP ADMINISTRATION AGREEMENT DECLARATION‌

Stockholder Disclosure Certification. Name of Business: ☐ ☒ I certify that the list below contains the names and home addresses of all stockholders holding 10% or more of the issued and outstanding stock of the undersigned. OR ☐ I certify that no one stockholder owns 10% or more of the issued and outstanding stock of the undersigned. Check the box that represents the type of business organization: ☐ Partnership ☐ ☒ Corporation ☐ Sole Proprietorship ☐ Limited Partnership ☐ Limited Liability Corporation ☐ Limited Liability Partnership ☐ Subchapter S Corporation Sign and notarize the form below, and, if necessary, complete the stockholder list below. Stockholders: Name: Stockholder Name Sika Corporation Name: N/A Home Address: 200 Xxxxxx Xxx, Lyndhurst, NJ 07071 Home Address Home Address: Home Address Name: N/A Name: Stockholder Name Home Address: Home Address Home Address: Home Address Name: Stockholder Name N/A Name: Stockholder Name Home Address: Home Address Home Address: Home Address Name: Stockholder Name Name: Stockholder Name N/A Home Address: Home Address Home Address: Home Address Subscribed and sworn before me this 29th day of _June , 2 023. (Notary Public) My Commission expires: (Affiant) Xxxxxxxxx Xxxxxx, President - Sarnafil Services, Inc. (Print name & title of affiant) (Corporate Seal) PROPOSAL FORM 18O personally known to me -OR- @ XXXXXXX🡳H X. XXXXXX D proved to me on the basis of satisfactory evid � Notary Public my hand and offic· Commonwealth of Ma11achusetts My Commission Expire1 September 13, 2024 to be the person(s) whose name(s) is/are subscribed to the within instrument, and acknowledged to me that he/she/they executed the same for the purposes therein Proposal Form 17: GENERAL TERMS AND CONDITIONS ACCEPTANCE FORM‌ General Terms and Conditions Acceptance Form Check one of the following responses to the General Terms and Conditions in this solicitation, including the Master Agreement: ☒ We take no exceptions/deviations to the general terms and conditions. conditions (Note: If none are listed below, it is understood that no exceptions/deviations are taken.) ☐ We take the following exceptions/deviations to the general terms and conditions. All exceptions/deviations must be clearly explained. Reference the corresponding general terms and conditions that you are taking exceptions/deviations to. Clearly state if you are adding additions terms and conditions to the general terms and conditions. Provide details on your exceptions/deviations below: Click or tap here to enter text. (Note: Unacceptable exceptions shall remove your proposal from consideration for award. CCOG shall be the sole judge on the acceptance of exceptions/deviations and the decision shall be final.) PROPOSAL FORM 19Proposal Form 18: EQUALIS GROUP ADMINISTRATION AGREEMENT DECLARATION‌Equalis Group Administration Agreement Declaration

Stockholder Disclosure Certification. Name of Business: ☐ ☒ I certify that the list below contains the names and home addresses of all stockholders holding 10% or more of the issued and outstanding stock of the undersigned. OR ☐ I certify that no one stockholder owns 10% or more of the issued and outstanding stock of the undersigned. Check the box that represents the type of business organization: ☐ Partnership ☐ ☒ Corporation ☐ Sole Proprietorship ☐ Limited Partnership ☐ Limited Liability Corporation ☐ Limited Liability Partnership ☐ Subchapter S Corporation Sign and notarize the form below, and, if necessary, complete the stockholder list below. Stockholders: Name: Stockholder Name James E. Fellowes Name: Stockholder Name Deborah D. Fellowes Home Address: Home Address 1789 Norwood Ave, Itasca, IL 60143 Home Address: Home Address 1789 Norwood Ave, Itasca, IL 60143 Name: Stockholder Name Name: Stockholder Name Stockholders: Home Address: John E. Fellowes Home Address 1789 Norwood Ave, Itasca, IL 60143 Home Address: Jeanne C. Fellowes Home Address 1789 Norwood Ave, Itasca, IL 60143 Name: Stockholder Name Home Address: Home Address Home Address: Home Address Name: Stockholder Name Name: Stockholder Name Home Address: Home Address Home Address: Home Address Name: Stockholder Name Name: Stockholder Name Home Address: Home Address Home Address: Home Address Subscribed and sworn before me this 31st day of October _, 2 2023 . (Notary Public) My Commission expires: 08/08/2029 of _ (Affiant) Erin Kellar (Print name & title of affiant) (Corporate Seal) PROPOSAL FORM Notarized remotely via Notarize, Inc. Proposal Form 18: GENERAL TERMS AND CONDITIONS ACCEPTANCE FORM‌ General Terms and Conditions Acceptance Form Check one of the following responses to the General Terms and Conditions in this solicitation, including the Master Agreement: ☒ We take no exceptions/deviations to the general terms and conditions. (Note: If none are listed below, it is understood that no exceptions/deviations are taken.) ☐ We take the following exceptions/deviations to the general terms and conditions. All exceptions/deviations must be clearly explained. Reference the corresponding general terms and conditions that you are taking exceptions/deviations to. Clearly state if you are adding additions terms and conditions to the general terms and conditions. Provide details on your exceptions/deviations below: Click or tap here to enter text. n/a (Note: Unacceptable exceptions shall remove your proposal from consideration for award. CCOG shall be the sole judge on the acceptance of exceptions/deviations and the decision shall be final.) PROPOSAL FORM Proposal Form 19: EQUALIS GROUP ADMINISTRATION AGREEMENT DECLARATION‌Equalis Group Administration Agreement Declaration

Stockholder Disclosure Certification. Name of Business: ☐ ☒ I certify that the list below contains the names and home addresses of all stockholders holding 10% or more of the issued and outstanding stock of the undersigned. OR ☐ I certify that no one stockholder owns 10% or more of the issued and outstanding stock of the undersigned. Check the box that represents the type of business organization: ☐ Partnership ☐ ☒ Corporation ☐ Sole Proprietorship ☐ Limited Partnership ☐ Limited Liability Corporation ☐ Limited Liability Partnership ☐ Subchapter S Corporation Sign and notarize the form below, and, if necessary, complete the stockholder list below. Stockholders: Name: Stockholder Name Board of Trustees Name: Stockholder Name Xxxxx Xxxxxxx Home Address: 00 Xxxxx 00, Xxxxxxxx, XX 00000 Home Address Home Address: 00 Xxxxx 00, Xxxxxxxx, XX 00000 Home Address Name: Stockholder Name Name: Stockholder Name Home Address: Home Address Home Address: Home Address Name: Stockholder Name Name: Stockholder Name Home Address: Home Address Home Address: Home Address Subscribed and sworn before me this day of _, 2 . (Notary Public) My Commission expires: _ (Affiant) (Print name & title of affiant) (Corporate Seal) PROPOSAL FORM 1817: GENERAL TERMS AND CONDITIONS ACCEPTANCE FORM‌ Check one of the following responses to the General Terms and Conditions in this solicitation, including the Master Agreement: ☒ We take no exceptions/deviations to the general terms and conditions. conditions (Note: If none are listed below, it is understood that no exceptions/deviations are taken.) ☐ We take the following exceptions/deviations to the general terms and conditions. All exceptions/deviations must be clearly explained. Reference the corresponding general terms and conditions that you are taking exceptions/deviations to. Clearly state if you are adding additions terms and conditions to the general terms and conditions. Provide details on your exceptions/deviations below: Click or tap here to enter text. (Note: Unacceptable exceptions shall remove your proposal from consideration for award. CCOG shall be the sole judge on the acceptance of exceptions/deviations and the decision shall be final.) PROPOSAL FORM 1918: EQUALIS GROUP ADMINISTRATION AGREEMENT DECLARATION‌

Stockholder Disclosure Certification. Name of Business: ☐ I certify that the list below contains the names and home addresses of all stockholders holding 10% or more of the issued and outstanding stock of the undersigned. OR ☐ I certify that no one stockholder owns 10% or more of the issued and outstanding stock of the undersigned. Check the box that represents the type of business organization: ☐ Partnership ☐ Corporation ☐ Sole Proprietorship ☐ Limited Partnership ☐ Limited Liability Corporation ☐ Limited Liability Partnership ☐ Subchapter S Corporation Sign and notarize the form below, and, if necessary, complete the stockholder list below. Stockholders: Name: Stockholder Name Name: Stockholder Name Home Address: Home Address Home Address: Home Address Name: Stockholder Name Name: Stockholder Name Home Address: Home Address Home Address: Home Address Name: Stockholder Name Name: Stockholder Name Home Address: Home Address Home Address: Home Address Subscribed and sworn before me this day of , 2 . (Notary Public) My Commission expires: (Affiant) (Print name & title of affiant) (Corporate Seal) PROPOSAL FORM 18Proposal Form 17: GENERAL TERMS AND CONDITIONS ACCEPTANCE FORM‌ General Terms and Conditions Acceptance Form Check one of the following responses to the General Terms and Conditions in this solicitation, including the Master Agreement: ☒ We take no exceptions/deviations to the general terms and conditions. conditions (Note: If none are listed below, it is understood that no exceptions/deviations are taken.) ☐ We take the following exceptions/deviations to the general terms and conditions. All exceptions/deviations must be clearly explained. Reference the corresponding general terms and conditions that you are taking exceptions/deviations to. Clearly state if you are adding additions terms and conditions to the general terms and conditions. Provide details on your exceptions/deviations below: Click or tap here to enter text. (Note: Unacceptable exceptions shall remove your proposal from consideration for award. CCOG shall be the sole judge on the acceptance of exceptions/deviations and the decision shall be final.) PROPOSAL FORM 19: EQUALIS GROUP ADMINISTRATION AGREEMENT DECLARATION‌

Stockholder Disclosure Certification. Name of Business: ☐ I certify that the list below contains the names and home addresses of all stockholders holding 10% or more of the issued and outstanding stock of the undersigned. OR ☐ I certify that no one stockholder owns 10% or more of the issued and outstanding stock of the undersigned. Check the box that represents the type of business organization: ☐ Partnership ☐ Corporation ☐ Sole Proprietorship ☐ Limited Partnership ☐ ☒ Limited Liability Corporation ☐ Limited Liability Partnership ☐ Subchapter S Corporation Sign and notarize the form below, and, if necessary, complete the stockholder list below. Stockholders: Name: Stockholder Name SSI Parent LLC Name: Stockholder Name Home Address: Home Address X0000 Xxxxxx Xxxxx Xxxxxxxxxx, XX 00000 Home Address: Home Address Name: Stockholder Name Name: Stockholder Name Home Address: Home Address Home Address: Home Address Name: Stockholder Name Name: Stockholder Name Home Address: Home Address Home Address: Home Address Subscribed and sworn before me this _7 day of November , 2 2023 . (Notary Public) My Commission expires: January 21st, 2026 _ (Affiant) Xxxxxxx Xxxxxx, Assistant Secretary (Print name & title of affiant) (Corporate Seal) PROPOSAL FORM 18: GENERAL TERMS AND CONDITIONS ACCEPTANCE FORM‌ FORM Check one of the following responses to the General Terms and Conditions in this solicitation, including the Master Agreement: ☒ We take no exceptions/deviations to the general terms and conditions. (Note: If none are listed below, it is understood that no exceptions/deviations are taken.) ☐ We take the following exceptions/deviations to the general terms and conditions. All exceptions/deviations must be clearly explained. Reference the corresponding general terms and conditions that you are taking exceptions/deviations to. Clearly state if you are adding additions terms and conditions to the general terms and conditions. Provide details on your exceptions/deviations below: Click or tap here to enter text. (Note: Unacceptable exceptions shall remove your proposal from consideration for award. CCOG shall be the sole judge on the acceptance of exceptions/deviations and the decision shall be final.) PROPOSAL FORM 19: EQUALIS GROUP ADMINISTRATION AGREEMENT DECLARATION‌DECLARATION