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18-020
144 COOKE AVE BP-2018-0116 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 18-020 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: ROOF BUILDING PERMIT Permit# BP-2018-0116 Project# JS-2018-000195 Est.Cost: $13800.00 Fee: $40.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: SEXTON ROOFING CO 118239 Lot Size(sq. ft.): 22389.84 Owner: DUBOIS EILEEN Zoning: Applicant: SEXTON ROOFING CO AT: 144 COOKE AVE Applicant Address: Phone: Insurance: P O BOX 6327 (413) 534-1234 WC HOLYOKEMA01041 ISSUED ON:8/2/2017 0:00:00 TO PERFORM THE FOLLOWING WORK:REMOVE AND REPLACE EXISTING SHINGLE ROOF POST THIS CARD SO IT IS VISIBLE FROM THE STREET Inspector of Plumbing Inspector of Wiring D.P.W. Building Inspector Underground: Service: Meter: Footings: Rough: Rough: House# Foundation: Driveway Final: Final: Final: Rough Frame: Gas: Fire Department Fireplace/Chimney: Rough: Oil: Insulation: Final: Smoke: Final: THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Certificate of Occupancy Signature: FeeType: Date Paid: Amount: Building 8/2/2017 0:00:00 $40.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner .'r a f ' \ °\ Department use only ctNAM >A \ Cit�t,of Ntorthampton Status of Permit: tat, Q tlA &iilcting Department Curb Cut/Driveway Permit ,," 212 Main Street Sewer/Septic Availability 09 Room 100 Water/Well Availability r; . $ Northampton, MA 01060 Two Sets of Structural Plans r» k -4' phone 413-587-1240 Fax 413-587-1272 Plot/Site Plans Other Specify APPLICATION TO CONSTRUCT,ALTER, REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING 69 SECTION 1 -SITE INFORMATION v PI l -'1 I, 1.1 Property Address: , 'I c . This section to be completed by office 4 V f / e&bis t),K.-_ Map /p Lot Oa?0 Unit Zone Overlay District Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: Na Print) // Curr t Ma ing A ress: Telephone Signature 2 Authorized Agent: }�,,.; c �i vt�( J /�r _CA c: �-� X -7 /7� //Q 604-ei aV/ Name Print) Current Mailing Address: Signature Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building/Xcc IL / 3/ &•66 (a)Building Permit Fee 2. Electrical (b)Estimated Total Cost of Construction from(6) 3. Plumbing Building Permit Fee 4. Mechanical(HVAC) 5. Fire Protection / /(06. Total=(1 +2+3+4+5) / 3/ $6G '`— Check Number This Section For Official Use Only Building Permit Number: Date Issued: Signature: ,f._"( __- mnizzi-v,e ,R 1, 117 Building Commissioner/Inspector of Buildings Date na EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR) SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable) New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing U Or Doors El Accessory Bldg. ❑ Demolition ❑ New Signs [D] Decks [U Siding[0] Other[0] BriiekDescription of Proposed i2'rno fre 4„ / die,/ t eyi S.,z/ 9 S'k1Lyj ,e_coF Alteration of existing bedroom Yes No Adding new bedroom /Yes No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll -Sheet 6a.If New house and or addition to existing housing, complete the,following: a. Use of building : One Family Two Family Other b. Number of rooms in each family unit: Number of Bathrooms c. Is there a garage attached? d. Proposed Square footage of new construction. Dimensions e. Number of stories? f. Method of heating? Fireplaces or Woodstoves Number of each g. Energy Conservation Compliance. Masscheck Energy Compliance form attached? h. Type of construction i. Is construction within 100 ft.of wetlands? Yes No. Is construction within 100 yr. floodplain Yes No j. Depth of basement or cellar floor below finished grade k. Will building conform to the Building and Zoning regulations? Yes No . I. Septic Tank City Sewer Private well City water Supply SECTION 7a-OWNER AUTHORIZATION-TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, //e r-J u iSC,1 S , as Owner of the subject property hereby authorize yC o v G U c( (,�-c> k' �i l r CGU - to act my behalf, in all matters relative to work authorized by/this building permit pplibation. --)cP 7 Signature of Owner Date I, t�y"•ett 1 a-V Ovv a 1/±0 y✓'CA i v ISN'ei Pzy cf' - ,as Owner/Authorized Agent hereby declare that the statem: is and information on the foregoing application are true and accurate,to the best of my knowledge and belief. Signed under/ the p ins and penalties of perjury. '/ lre LrJr, a y -b.,. y N/� L. Print Name 74-c /17 Signature of Owner/Agent Date • SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not J ,/7 NotAppliiccable 0 Name of License Holder:F/ E, E 7 / 1 S&x ?9'(p 7 License Number PC) -• /SOX (0 S) -7 - tyo k._ wt,-1c,(04 / ,/ -s- i 7 Addres Expiration Date Signature Telephone 9,R alstered Home Improvement Contractors Not Applicable 0 X.400-) 'Rom IC/V ss 3(""P.>7 .— -11- C _ )j Y;31 Com any Name Rdgistration Number Z� - 60% (c)-3 ) "7 l oI ON\ 0iOLI/ /s -- / i A dress Expiration Date Telephone 53V' / 3f SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c. 152,§25C(6)) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. Signed Affidavit Attached Yes Ve- -- No 0 City of Northampton -¢t,JaMP\ 4u A o `S si .'' Massachusetts A. „._ `% w w.. ^_ , DEPARTMENT OF BUILDING INSPECTIONS 2 �,r r, ',d.' 'r $' 212 Main Street •Municipal Building y`)i t 4-. Northampton, MA 01060 -41,, �' Debris Disposal Affidavit In accordance of the provisions of MGL c 40, S54, I acknowledge that as a condition of the building permit all debris resulting from the construction activity governed by this Building Permit shall be disposed of in a properly licensed solid waste disposal facility, as defined by MGL c 111, S 150A. The debris from construction work being performed at: / 7/V dee)X 7--- (Please print house number and street name) Is to be disposed of at: aNple ric or 5,00 sic 766 4-/t.) s1 /6 / o lc al 4. . ease print name location of facility) Or will be disposed of in a dumpster onsite rented or leased from: ,9/4 iv el (Company Name and Address) — -7.' 42' /'/ 1 Signature of Permit Applicant or Owner Date If, for any reason, the debris will not be disposed of as indicated, the Applicant or Owner shall notify the Building Department as to the location where the debris will be disposed. Yci Propo5at SEXTON ,ROOFING AND SIDING INC. (413) 534-1234 0 . Box 6327 MIL . FAX (413) 539-9906 4=11Z1Inalla Oft M Holyoke, MA 01041 . 111011,1111101111 sextonrooting h otmai Loom air aim CT HIC #0605383 MA HIC #118239 xton Since 1985 )UOMOTU .1 PHON 7i-• 2,//./ 7 ;;TREET /1414( ie` 31054,TE 2apucirrE „<„,t74/7/HilC:,fri, ,JC42-Proposal to furnish and install the following r.mA,L J Re-Root or-tear-Off r-Main House 4--narage Stied Complete Roof Preparation --Home exterior to be protected by tarps and plywood CShrubs. landscaping, trees to be protected Entire existino roofing material to be removed to existing decking, Including flashing. etc if-Site to be cleaned everyday With roll magnet debris removed at protect completion 41/4 Deteriorated existing decking replaced at$2.50 per sg tt J Install all new decking type- Ot7T-_ Brown metal drip edge installed at eaves and rakes 4--4r'8 F-5 J Rake Frige flashing will be installed where necessary(see Special Requirecnentsi 4---thstall new pipe boot flashing -.I Bathroom Exhaust Vent Reflash chimney with new lead ---We shall acquire all appropriate permits etc for all rooting work Complete Roofing System 4--teak Barrier installed at all eaves to protect from ice dams iand meet codes in the northt J (itt' 'teak Barrier installed at valleys around penetrations and chimneys to protect critical areas *-k-"Instati Roof Deck Linderiaymont on remainder of roof J 015 Felt 4---"kinthetir Fell Shingles 44.'"IKO J GAF J CertainTeed j Tamko J 0 yearyea a 50 year 4. -rfetirne Color istali Attic ventilation system „4--eap over Ridge Vent a Root Louvers Warranty Options Jelr17;;guaranteed eui workmanship for 25 full years _70 PtoPOstfljby to furnish mt6ertal and labor-complete in accordance with the above specifications. for the sum of ,r2,4! Arry-t-- „,,e7 1dollars(S • Aillhorized Acceptance of Proposal-The:it 4)ec!ficaton!,and conrilt;Ori: . , Are' li,at4AIC-t0r), arta a:e. oe,criy acci-,rted ‘tbd 10 iii AA ti", Paymen' valhe ia',“,if- nit atiove . . . . . . • • . '— ' ' • . . . . . . • . . , . • . : . . • • • . - 1 . . .. . . . ' . . . . - . • . .71.e Con-rnon-i41eaIth of Alas s rachus Et& . , . ------ D g a-rt.-rne-nt of Indv_strial Accidents . . . . n=war===4 . . . . . Ojfic.e of Inv estig atio its . , - i 7."- .11j.LAM 1 • . • . mil= ' 1.Con.gress stTee, Suite .10 Ci . • ' . . "IF—.9' • . € OEM:MEM ., . . - 3 osto-L,?TA_0_2_Z.14--.2 017 . • . .,„, --:/, . . . )494.rw.Trzass.g oiVaia .. . • • Worke-rs' C omp.ens atio-n Ins-tu-a.r(ce AfficlaviL: B-milciers/C ontr a cf_ors/Ele ctrid 2 1-1 /P 1-arib ers , . ADD li cal_rt-T-prfornaafioli : - . • Please Prhit Le zibly . . . . . - . .Na-me (Basi-ness/Organir.aiionaLrvid:u2.1): Sexton Roofing & Siding Inc . .' . . • . . . • . . . . . • . kaaress: P . O . Box 6327 . . • . . . . . . City/State/Zip: H o 1 y o k e , MA 01041 - PID:one 4: 4 1 3-5 3 4-1 2 3 4- ' . . Axe you an employer? Check the appropriate.box: " . Type.of proj ect(r- q-u.X.-ed.): , . 4. Ei-T am a_general.6onii-actor and I . . 1.El'I am a e .plo-yer with. • - . . 6. [1-11-e-w cons-tacfion • have hired.the.sub-contractors -' ' . employees (full and/or put-time).-# 1 . hs' ted on the attached sheet .. 7. ____Remo delin_g 1] I am.a s ole propnetor Or artier-. • .. . . 'These sub:contractors have ' - sitip andhave no employees , ?). 0 Demolition . , . employees and.have workers' . woildtg for me in any capaci'g.• • 9; [1 Bi7i1(Min g addition. , comp:insurance.1 . [No worlrers' comp.insurance , 5. E We are a co-rporafion audits 10.0 Electrical rep a,frs or arldifions, required] . _ . officer§have.exercised their 11.]Plirtbing repairs Or additions . . 3.(11 I ani a homeowner donig all work , right of exemption per MGL, _ myself_ [No workers' comp. • , . 12.0 Roof repa_ s , - • c. 152,:§1(4), and-we have no . . ins-urance required_] t . 13.0 Qther ' _ - employees. [No-workers' ' . comp.insurance required_] - . ' . • _ . - . ' .. *Any applicant-tilat ChC,C1:3 1=41 must also,3U out-the section below showing filen-workers'caul,ens ationpolicy information_ . . . t gozaperwacrs-gale slibmit-Es adz-v-iii-naic7ti-rTftheraTe doing all-woncl.and then hire outide contiaetors roast submit anew,affolaiit indicathag rtiol].. • -1-Contractors that el:Leek:this box m-usi Rftnch.5c1 an additional sheet sliming the name of.-fric sub--contactors and state wfieler CfE notthose mfities have . etqloyces. If.the sub-ceantractors'haye employem,they rourtprcryide their 7 orimrs'comp=policy nrrrnben . . • • . v . I crn-L crri employ e.7-tha:t is pr.ovicling-worker?ccrm__pcasedon.insv_Torzce for 72-Ey ens_ployees, 3 eTow is fie p°Zig :rld job site. . ' informcLO-.71. • ' . . - . • . Insurance Company NaTne: • - . . - P olicy.#or S eH-ins.Lic.#: - . P.-ilLeilion D ate: V . . . ' . . . . / t 7, j ,/-'.„.,,, /,--- c, .Job Site_A ddress: ./. -r- 7 t---‘'u Ps- J i ' City:IS' n1Zip A14-//112.1,/ria, .41; AtEach a copy of the woxkers' comp enrs ation policy dec-1Praton.p age (showing the policy number and empira•b.on date). . F allure to secu_re coverage as re Tinire-d under S ecfion 25.A_of MGL c: 152 can.lead to the imp°Eifion of vcrinainal penalfies of a • -Fr'n ev Up tb$1,5 00,Q0 and/Or one-ye -inipisonsent, as well as civil_pni- alfieS n:i the for_ra'of a STOP-CV-OR_ OR.DER and a•fine . of up to$250.00 a day a...,D-ainst the violator. Be advised_that a copy of-Els statement ina_y be forwarded to the Office of. . . . Invesfigations ofte.DIA for 'N. -Tice coverage ven:fcadon_ . . , . I do heT ebY cLrZify.2..1.n.der ' r,as cold pe?-1.a2tes,of petrzry fizz'the i-nformat on_pr ol;i dad id)oy e is true Lrad coTr e.d_ 0 .. . . . -...,.... . , Siena:i-ure: ---__ . - *De: 7/(;,.)C,//i , - . . . . V . . • • pilmeik 413541Z34 . . . . . .. . . . - . . . . . . . . . .. . . . 0.6cial u.S e only. Do not-write&i.this a-Ito,to be c ompleted by city pr-to)--pn offuzi al • . . . . . . , . . . . . . . . , . . . . " ' ' City or T°vim: . . . ' • • 'Permit/License# * . . . .. , . . . . Issming Authority(circ,le one): - • .. . . . . . . 1.Bo ard of He altli 2.3-ailain g Dep&I'm ent 3. Cityfr own Clerk 4..Electrical Insp ector. 5.Plumbing Inspector. . . . . . 6. Other • . . , . . • . •Contact-Person: . . , . . Phone#: . . . . . . . . \\\ The Commonwealth of illas.vachuyetts rni-7-rr711-- DoPuriment".1‘Imluviri0Lictident8 r7-71- 1 Congress.Street. Suite 100 (12111-2017 www.mas.s•rsvorfilia uvhersC'omp.ms:ttion Instican(t 111idavit; Builders ("outrAdors'LliNtricians 101W IlI ED\Vail lif:PL1011r1INC 111-11012111. Am/lir:int In!'ormation Please Print Name k .p nt jd 0.-hit5 C3- 3o/I ‘Ull Address. 113 Q. upg.sfen Prue, (7ily,/stafic./zirGrockfon 0 -3D I Phone - - it Arr Lni iiijittrr?(lir( the Pt'''PN r)pe of project (required): IA ' 7, n ' o+ c:itr-o..1io..1 U J ;In) ilk reltr .,11111UF.:•.ip eitiplo±c.2.5nrrt IT 17,..!. ti . ZI(cmode'.ric , iv tti iv nt ttitti 1tP 10 )enllitinn _1.0 I aryl 11-nts.:11 [NJ° v.01: .ni:.rarcc id(11U)7i 4 01:111i :1116 0.7111h: I ' riviot !,) _ttittt,. 111 rtr. 1 01,1,7( :.:ottrdo ItLtfatli.0 .3.;11," LEJ ElectrIcal ;cpaits .iddit:ons I 2 PlowlraT 7-1 ! ,t,ni I:72,2 hr,7C;,'the itrulo'c IL-nci 14,.• ii to/IZoi,f repairs 1.1 Ej0,.1.:cr_ *?? 111. •A I el'c'7o)t-11"- 1-10 7. 11 -_ 1.1,01:ir.:CkS tICA=I tan Akioñ uta thC r11107-, a-lit, nit, it thitt a la illtotn-i apd ltcti fittc Ett-ittitio-.;lit ti lull I pa 111ti1i t, lilt ,LUIit 1"..44 This it it.th tilict ow,I Ii v vol >o iRP ciiniat 1: deatittlrtcSdIa tialiu'vv lhti tittust pm:!tic I on,an employer that is providing irorh na uniipt'n fittlit/in sor,ince far nix einptorces Below is the Indio etml 14i We informatioa. Insurinue. Otlirat:t:t• Ntiniut ee American _insurance. 0_0 LoStocl,L1I311-105q3 ri CI/3 "lAtc. 1-4 cp-.1-1112 Iibite aidl Attach :t copy of the A‘orkers' compensation policy declaration line isho‘sing the policy number and expit:ition date). l'ailur.i di i tuiici inlet .!,i1( 1 a I 25/1 is ctinnnal skaI ,Ii p'ratidiAble Fr:. ii Eine t:p In SI,50(11:P.) and:Jr IS Wel .is CIII pe/: ICS :11 Rant of I STOP VOl K ORDER and a fine ot up t S250 0'1 cap iii It ,tittenterit fic Hzis-aided It thz Ofirit.e if it usIn als I the DIA fbr COVtraf!,,eu crll!caIu;I. --I at, rehy Cp/ ef1' he it tpal andn pealties of l'erpti) that m inforunim pH), non find Cr,m-, - SW.n:l1:1 air - D rise daily. Do tiOf write in this area, in be Lomplelcd lit city or WIril (it y Or it: icense Issuing 1titliority(circle one): 1. Bon rd of IleAlth 2. Buildwg Department 3.Cih1l own Clerk 4, 1.111..cti ical inspector 5. Plumbing Inspector it tither (-wit act Pereira: Phone ' 07/10/2017 14:20 15086201202 MICHAEL SONG PAGE 01/03 c©R�'-'�` CERTIFICATE OF LIABILITY INSURANCE DATE (I 'D""'" ../ 07/10/2017 Remise THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Tem Doan Agency ONLY o DERE. THIS CERTIFICATE DOES RIGHTS NOT AMEND TEND OR 941 N.Main St ALTER THE COVERAGE'APFQQED eY THE POLICIES BELOW. Randolph,MA 02388 Phone:781-767-8867 Fax:781-767-9886 ,INSURERS AFFORDING COVERAGE NAIC e INSURED INSURER k, Mount Vernon Fire Insurance Co , A. CHRIS&SON EXTERIOR INC i INSURER SI Ace American Insurance Co 73 N WARREN AVE IMeURE,R C BROCKTON,MA 02301 INSURER D, __._��_ -•...-._. I _ _ _.INSURERS , COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES,AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. • to -- WSRE SIROCE P0LIEVAMMIR Okra— 1 N UNITS int - UASIUTY ! EACH 000URRENCEi Off_ 1,000 g00 ., A ' x OOM146R01AL GENERAL LIABILITY 01.235674 04/27/2017 04/27/2018 PREMISES racesl®ILEM } 100,000 — CLAIMS LODE a occult f MED EXP(Any aro wr.on) s 5000 1$ ,PSR evv..ADV INJURI!_$ ......1.4.92_0000_ ........... _- GENERAL AGGREGATE $ 3...2002.011_ 1.-GE-N'LAGGREGATE LIMITAPPUE6PEI: PRODUCTS-COMPRIPAGG $ 2,000,000 I '}" rrPOLICY I I LOC L 1 I AUTOIlOWRG UAOI ILrTY COMBINED WHOLE LIMIT t ._ ANY AUTO r i(Es°cam fi _ AU,OWNED AUTOS I BODILY INJURY S SCHEDULEDAUTD9 I HIRED BODILY INJURY $ NON OWNED AUTOS Paraogtl (PayicaIdi tDAMAGE a r ) • GARAGE LIABILITY AUTO ONLY• AOCIDETN .1____i_-_ _ ANY AUTO OTT•4ER THAN EJB Ai" $ 4 AUTO ONLY: POO 1 excess ItUMSRILLA UABLITY -EA I4 OCCURRENCE $ OCCUR ED CLAIMS MADE AGGREGATE $ .-- DEDUCTIBLE Iys —r--- I I RETENTION S I I - M $ WORKERS cosereMMYION Ii TORY Y I TU- x OTHU AND EMALOYER$ MIUTYKR , g �I � uTc /E D 6862U08H08437917 04/27/2017 04/27/2018 I E•L•EACH ACCIDENT f s 1,000,00D I MrwNay n NIB - - E.L.DISEASE-EA EMPLavEF s 1,000,000 I IPEGIALROVI�B b#c0 I EL DISEASE•POLgY J.IMrT $ 1,000,000 OTHER f l i I . DEECTIP'TION OM'OPEN ATIONS I LOCATIONS 11tiNICUM 1 EXCLUSIONS ADOBE EY ENDORSEMENT I IIPI IAL PROVISIONS • CERTIFICATE HOLDER. CANCELLATION SNDULDANYOFTHE MOVE DESCRIBED POLICES BB CANCELLED BEFORE THELCPIRATION Sexton Roofing &Siding Inc DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRRTSN PO BOX 6327 NOTICE NOTICE TO TKE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO D0 CO SHALL HOLYOKE, MA 01041 IMPOSE NO OILKIAATION OR WISILRY OF ANY KIND UPON THE INSURER,rrs ASENTn OR aarsgeeta.Anves. AUTNOPIZIDREPRISENTATNE I. Michael Soong ra ISI ACORD 20(2009101) 01065.2009 ACCORD • • • . All rights roo mved, TM AOORO nom sad toga an registered maliks o/ACORD A c, CERTIFICATE OF LIABILITY INSURANCE DATE 6)2812017 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(les)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy, certain policies may require on endorsement.A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME:Kathl Hutchinson Ormsby Insurance Agency,Inc. PHONE(AIC,No,Ext):(413)737.0300 l FAX(AIC,No): PO Box 718 E-MAIL ADDRESS:khutchinson(Qormsbyins.com West Springfield,MA 01089 INSURERS AFFORDING COVERAGE NAIC#) INSURED INSURER A:Colony Insurance Company 39993 Sexton Roofing and SIding Inc INSURER B: PO Box 8327 INSURER C: Holyoke,MA 01041.6327 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHfCH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS POLICY EFF POLICY EXP INST ADD'L SUBR DATE DATE LTR TYPE OF INSURANCE NSRD WVD. POLICY NUMBER (MM!DDIYY) (MM/001YY) LIMITS A X COMMERCIAL GENERAL LIABILITY 101PKG002159902 6/25/2017 6/25/2018 EACH OCCURRENCE 51,000,000 j CLAIMS MADE n OCCUR REMI E TO RENTED $100,000 P PREMISES(Ea Occurrence) MED EXP(Any one person) $5.000 PERSONAL&ADV INJURY 51,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE 52.000,000 Y POLICY DM N� LOC PRODUCTS-COMP/OP AGG $2,000,000 OTHER: —' COMBINED SIGNED LIMIT $ AUTOMOBILE LIABILITY (Ea accident) _ ANY AUTO BODILY INJURY(Per person) S ALL OWNED —SCHEDULED BODILY INJURY(Per 5 _ AUTOS _ AUTOS accident) HIRED AUTOS NON-OWNED PROPERTY DAMAGE AUTOS (Per acadent) S UMBRELLA LIAB OCCUR EACH OCCURRENCE S —7EXCESS LIAB CLAIMS MADE AGGREGATE S DED 'RETENTION S I S WORKERS COMPENSATION AND PER DTH. EMPLOYERS'LIABILITY Y/N STATUTE ER ANYPROPR IETORJPARTNER/EXECUTI V E OFFICER/MEMBER EXCLUDED? N/A EL EACH ACCIDENT S (Mandatory In NH) EL DISEASE-EA IF yes,describe under EMPLOYEE DESCRIPTION OF OPERATIONS below EL DISEASE-POLICY LIMIT S DESCRIPTION OF OPERATIONS!LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,If more space is required) CERTIFICATE HOLDER CANCELLATION Town of Amherst SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE ...- . THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ACORD 25(2014/01) ©1988-2014 ACORD CORPORATION.All rights reserved. The ACORD name and logo are registered marks of ACORD • /nY/ (/ro e JII?>2WiUi)CClaL O J�/ �C�JJC�C C(JGGIJ • ,r" Office of Consumer Affairs and Business Regulation 10 Park Plaza- Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Type: Corporation • • Registration: 118239 SEXTON ROOFING & Siding Inc Expiration: 02/14/2019 P.O. Box 6327 Holyoke, MA 01041 • Update Address and return card. Mark reason for change. SCA n 20M.0511 Ti n��_ n o.ne,..,! El. Fmn!nvm'.+en+ n ! qca C?.-1 Massachusetts Department of Public Safety Board of Building Regulations and Standards License: CSSL-099689 Construction Supervisor Specialty EVERETT J SEXTON : ; PO BOX 6327 " �. ? HOLYOKE MA 01041,x :• - _ ^^^ Expiration: Commissioner 10/05/2017 1