Flam Form Energy 30 Dane — File 211525

CITY OF SOMERVILLE Commonwealth of Massachusetts 93 Highland Avenue Somerville, MA 02143 [phone removed] BUSINESS LICENSE APPLICATION - Flammables File #: 21-001090 License #: BL21-000013 Address: 30 DANE ST Licensee: Morgan Armstrong Form Energy DBA Name: Form Energy, Inc Business Ownership Type: Corporation Legal Name of Entity: Form Energy, Inc. Owners/Officers: Ted Wiley, Mateo Jaramillo, Marco Ferrara, License Information: # of Gallons of Flammables to be Stored: 300 Hours of Operation: Monday- Friday, 9 am- 5 pm Approval Conditions: Approved By: City Treasurer, Approved Dennis Sullivan, Approved Hans Jensen, Approved John J. Long, Approved