TEGELER INSURANCE SERVICES OF CT, INC.

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	2016-06-01
Business code	524210
Sponsor’s telephone number	2032649197
Plan sponsor’s address	201 PLAYHOUSE COR, SOUTHBURY, CT, 064882265

Signature of

Role	Plan administrator
Date	2024-07-11
Name of individual signing	WILLIAM TEGELER
Valid signature	Filed with authorized/valid electronic signature
Role	Employer/plan sponsor
Date	2024-07-11
Name of individual signing	WILLIAM TEGELER
Valid signature	Filed with authorized/valid electronic signature

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	2016-06-01
Business code	524210
Sponsor’s telephone number	8602649197
Plan sponsor’s address	201 PLAYHOUSE COR STE 201, SOUTHBURY, CT, 064882265

Signature of

Role	Plan administrator
Date	2023-06-27
Name of individual signing	WILLIAM TEGELER
Valid signature	Filed with authorized/valid electronic signature
Role	Employer/plan sponsor
Date	2023-06-27
Name of individual signing	WILLIAM TEGELER
Valid signature	Filed with authorized/valid electronic signature

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	2016-06-01
Business code	524210
Sponsor’s telephone number	2032649197
Plan sponsor’s address	201 PLAYHOUSE COR STE 201, SOUTHBURY, CT, 064882265

Signature of

Role	Plan administrator
Date	2022-06-22
Name of individual signing	WILLIAM TEGELER
Valid signature	Filed with authorized/valid electronic signature

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	2016-06-01
Business code	524210
Sponsor’s telephone number	2032649197
Plan sponsor’s address	201 PLAYHOUSE COR STE 201, SOUTHBURY, CT, 064882265

Signature of

Role	Plan administrator
Date	2021-06-17
Name of individual signing	WILLIAM TEGELER
Valid signature	Filed with authorized/valid electronic signature
Role	Employer/plan sponsor
Date	2021-06-17
Name of individual signing	WILLIAM TEGELER
Valid signature	Filed with authorized/valid electronic signature

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	2016-06-01
Business code	524210
Sponsor’s telephone number	2032649197
Plan sponsor’s address	201 PLAYHOUSE COR STE 201, SOUTHBURY, CT, 064882265

Signature of

Role	Plan administrator
Date	2020-07-14
Name of individual signing	WILLIAM TEGELER
Valid signature	Filed with authorized/valid electronic signature
Role	Employer/plan sponsor
Date	2020-07-14
Name of individual signing	WILLIAM TEGELER
Valid signature	Filed with authorized/valid electronic signature

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	2016-06-01
Business code	524210
Sponsor’s telephone number	2032649197
Plan sponsor’s address	201 PLAYHOUSE COR STE 201, SOUTHBURY, CT, 064882265

Signature of

Role	Plan administrator
Date	2019-07-11
Name of individual signing	WILLIAM TEGELER
Valid signature	Filed with authorized/valid electronic signature
Role	Employer/plan sponsor
Date	2019-07-11
Name of individual signing	WILLIAM TEGELER
Valid signature	Filed with authorized/valid electronic signature

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	2016-06-01
Business code	524210
Sponsor’s telephone number	2032649197
Plan sponsor’s address	201 PLAYHOUSE COR STE 201, SOUTHBURY, CT, 064882265

Signature of

Role	Plan administrator
Date	2018-05-01
Name of individual signing	WILLIAM TEGELER
Valid signature	Filed with authorized/valid electronic signature
Role	Employer/plan sponsor
Date	2018-05-01
Name of individual signing	WILLIAM TEGELER
Valid signature	Filed with authorized/valid electronic signature

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	2016-06-01
Business code	524210
Sponsor’s telephone number	2032649197
Plan sponsor’s address	201 PLAYHOUSE COR STE 201, SOUTHBURY, CT, 064882265

Signature of

Role	Plan administrator
Date	2017-06-27
Name of individual signing	WILLIAM TEGELER
Valid signature	Filed with authorized/valid electronic signature
Role	Employer/plan sponsor
Date	2017-06-27
Name of individual signing	WILLIAM TEGELER
Valid signature	Filed with authorized/valid electronic signature