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22D-069 (2) 90 FLORENCE RD BP-2019-0334 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block:22D-069 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-2019-0334 Proiect# JS-2019-000541 Est.Cost: $8400.00 Fee: $40.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: RCI ROOFING 0624741 Lot Size(sa.ft.): 11891.88 Owner. FRANKEL NORA Zonine:URA(100)/WSP(100)/ Applicant: RCI ROOFING AT. 90 FLORENCE RD Applicant Address: Phone: Insurance: 6 LINE ST (413) 527-4775 SOUTHAMPTONMA01073 ISSUED ON:9/16/2018 0:00:00 TO PERFORM THE FOLLOWING WORK.-REMOVE AND REPLACE EXISTING ROOF INCLUDING FLASHINGS AND ICE &WATER BARRIERS 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 Sienature: FeeType: Date Paid: Amount: Building 9/16/2018 0:00:00 $40.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner - - IVE INo y 0 Northampton Ildl g D`epartment 21 MSS�P a n treetd ��iu"4~��rroorp 100han pton, MA 01060 :ryo ;�:tsrbtSl�rurotiw.nal iIa,r,s; DEPT.OF BUIL 87- 1240 Fax 413.587.1272 NORTHAMPTON,MA 01080 ' APPLICATION TO GONSTR'UCT, ALTER, REPAIR, RENOVATE OR 0EM01.181-1 A ONE OR TWO FAMILY DWELLING ,.EGTI0N 1 -8.1-T-P INFO.R-MA:TI:O:N i.1 Proper—N gddj)ss_; 1161rifr+s;echl.Ui� t'o:b:e oo:m:p:Cetie`.d:i ya.6fihce 90 �lormce M°aip',._ � ho,t. Unit Florenee� Mjq p/D(v� �;'on.e _— _• !Ehn B.t•,�Is.t6hot;:_—_ �� C;8•�D:Is.trl`at'-^,T., "ECTION 2 -PROPERTY OWN:ER:arNIP7.AUT•H'O:R.IZED'.AG•ENT ?.1 Uwiier of R009tq:; — 1!lYl��rQ_ren Iqotg . 17t2�.�l�icf7on AVg,. Rl :arae(Print) Curren�tylalilr) Address; � _._��.._ A�. _— GUQ�in��-vn Telephone ignaiure — ;? Authorized Ager, 4811 neLCA -• carne(Print) .�� Curre�t'M'allln�g Address; ;ignalWe Telephone ; CTIO_N 3 [ IMATED_C.O.NSTFtUp.-T-1 N 0-- l rem Estimated Cost(Dollars) to be �^ .Official Use-Only completed by Permit a Iloanl• I Building Q� (a)B.,ull.ding Rorml:t:Poe _ r ' Electrical (:p):Bsllmat(W Total Coal o.f C.o:nstruir.,ll©tr.from.(6) s Plumbing ::eulldln_g Pe:rirn-I.t:Fee- I Mechanical(HVAC) •^ �� (J i Fire Protection i-TOIL (I(I + 2 + '3 + 4 + 51 QQ, •Ch-uk Vurrib:4r _ __ _ •T:ha.a 8'f~.�.tfon�F�or`p.ffl:ca.a•I:Use�Onl!L_ __ _____ __. )uilding Permit N:urnbev- Dale• BuIlding.C'ornml,rslonar/l'nspeotor•of•B.ulldinas: Dafe., 4 9 r__- SECTION 6 DFS:CL�1�T�1'0,( 'F P:R:r�.P'O}S D"Vi!ORI I'oh'e :k:asll U42C..ahla:); New Mouse Addition' Replacement Windows Alte.ration(s) 7Roofing�– Or Doors ❑ i Accessory Bldg, ❑ Demolition ❑ New Signs (oj Decka (Q Siding (©) Other(CD) Brief Description of Proposed — Y Alieralion of existing bedroom ,_Yes, No Adding new bedroom Yes No Attached Narrative Renovating unfinished basomel•It Yes No Plans Attached Roll • Sheet �— sa.. I;f:M.ew.,hc0:W ,'-a.hi tj,r, �tli ,tlfti: 'i�>XfYs4tlin ;.tu' ; , . :?�1. a,;.f,o'_ Unra,a A;�,lt�aeim �e a. Use of building : One Family _ Two Family Other b. Number of rooms in each family unit: Number of Balhroom:I,___ r c. Is there a garage attached? _ ci. Proposed Square footage of new-construction, Dlmenslon;I e. Number of stories? I. Method of healing? — Fireplaces or Woodstoves Number of each_ g. Energy Conservation Compliance, Masscheck Energy Compliance form attached? 1 i h 'type of construction �. is construction within 100 fl. of wetiands? Yes ,•_•__No. Is construction within 100 yr. floodplain Yes No I. Deplh of basement or collar floor below finished grade 1<. Will building conform to the Building and Zoning regulations? Yes _No , i. Septic Tank City Sewer Private well City water Supply SECT10N'7.a ••OWN S:RAU:T.M.—OZA•T1C.N.-70-- :E.C.QMRUTE,*p° WI{'SN OWNERS AGE:N>TR-R- IT I, _ aim► kL.__ , as Owner of the subject property hereby authorize ._Jck-�,Yj_ (��C l�._ ( , �� , �1(0[ •L[1;� __ i to act on my behalf, in all matters relative to work authorized by this building permit as liclatlon- jSignalure of Owner �( Date s ���141(11i2 pj n t !wt _ _, as Owner/Authorized Agent hereby declare that tho statements and information omthe foregoing application are true and accurate, to the best of my knowledge and belief, Signed under the pains..and•penalties of perjury. Print Name Signature of Owner/Agonl __ Date rloN 8 license d Construction Sugeryl W: Not Applioable 0 ie of UcenspjjQLd_U:--M' "V 11')''��, 11 a—H "��-N-. License Number 0 Lite,, Sir'-, 0 5 ':52'x. 'R - ess EXPIrstlon Date Lj 11 1� ialure Telephone Not Appiloable 0 nR Registration Number �-�� iliess Expiration Dalle Y —Tolophone CTION 10-WOR.-}(-.E-.R-a'.CCIMP.E.-NS.-ATI'O.N INSURANCE A-F-FIDAVIT(M G.L. o, 162, § 26C;W).) ,rk.ers Compensation Insurance affidavit must be completed and submitted with this application, Fallure to provide this affidavil will result he denial of the Issuance of the building permit, ,)ed Affidavit Atta(,hed Yes....... 52 No...... 0 The current exemption for"homeowners"was extended to Include Owgar occupied welfflnas of one(1) or two(2)families and to allow such homeowner to engage an Individual for hire who does not po!isess n license, provided_that.the owner-mcjt AUMI=Isor. V.11?80—Sixth Rdition—Section 108,3.5j, Def1LiLtI91i of Homeownei;; Person(a) who own a parcel of land on which he/she resides or Intends to reside, on which there is, or is Intended to be, a one or two family dwelling, attached or detached ittruc.tures accessory to such use and/or farm SOWtUrOS.A,=LAwho constructs more than one home In ytv-O—Y-Oa odo-d-shgll jiot be considered &hoineowner. Such "homeowner"shall stibmit to the Building Official,on a form aecoptable to the Building Offiolal,that jje to shall e =)pjjjbLefor AI1 such ypvk performed under the building permIL As acting Constriuctlon.St' erylso your presence on the job site will be required from time to time, during and upon completion of the work for-which this permit Is Issued, Also be advised that with reference to Chapter 152(Workers' Compensation) find Chapter 153 (Liability of Employers to Employees for Injuries not resulting In Death)of the Massachusetts General Laws Annotated, You maybe ltfiilg for person(s) you hire to perform work for you under this permit, The undersigned "homeowner" certifies and assumes responsibility for compliance with the State Building Code,City of Northampton Ordinances, State and Local Zoning Laws and State of Massachwietts 0-eneral. Laws Annotated, Homeowner Signature The Commonwealth of Massachusetts t Department of Industrial Accidents x -- 1 Congress Street, Suite 100 Boston, MA 02114-2017 www.mass.gov/dia l ovkers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Annlicant Information f) Please Print Legibly Name (Business/Organization/Individual): 9 C• 1 /PpU•�rnct . ,L.L-Q Address: City/State/Zip: Sou#1, - Im 04 0/073 Phone#:_ Are you an employer?Check the appropriate box; Type of project(required): 1.71 1 am a employer with c>� O employees(full and/or part-time).* 7, 0 New construction 2.Q 1 am a sole proprietor or partnership and have no employees working for me in $, E]Remodeling any capacity.(No workers'comp.insurance required,] 3.0 I am a homeowner doing all work myself.[No workers'comp.insurance required.]t 1 ❑BuildDemoing 10 ❑Building addition 4.0 1 am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers'compensation insurance or are sole 1 I.0 Electrical repairs or additions proprietors with no employees. 12,E]Plumbing repairs or additions S.Q I am a general contractor and I have hired the subcontractors listed on the attached sheet. 13. 'Roof repairs These sub-contractors have employees and have workers'comp.insurance.► 6.0 We are a corporation and its officers have exercised their right of exemption per MGL c. 14.Q Other 152,G 1(4),and we have no employees.[No workers'comp.insurance required.] *Any applicant that checks box 91 must also fill out the section below showing their workers'compensation policy information. I Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. 1Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation Insurance for my employees. Below Is the policy and job site information. Insurance Company Name: A41�f'Yj_ /�i��ZC��>' 1 Su✓Qd1�� CcJ. Policy#ot•Self-ins, Lic, #; (,f�(f1G-_//1 d'(�Q 2loy'7 'o20/7Fr! Expiration Date:got-mel, � /e/ Job Site Address: 90 Gl or-&,P, r ( City/State/Zip: got- el,1'i9A 0/06.2 Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by a fine up to$1,500,00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification, I do hereby certlfer thgpains d penalties of perjury that the Information provided above is true and correct. Signature: i r- Date; 9-/3 —/d Phone#; k ) 3 7 q'7 7S' Official use only. Do not write in this area, to be completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): I, Board of Health 2, Building Department 3, City/Town Cleric 4, Electrical Inspector 5, Plumbing Inspector 6, Other Contact Person: Phone#: RC-1- Roofing Date 6 Line St. Estimate Southampton, Ma. 01073 8/16/2018 Phone(413)527-4775 Fax(413)527-8469 Name/Address Job Location Nora Frankel 90 Florence Rd. 1406 Constitution Ave. NE Florence, MA Washington, DC 20002 Terms Rep Estimate valid for 30 days Chris Description Total Remove existing roofs. 8,400.00 Furnish& install 1/2" plywood over existing decking. Furnish& install aluminum drip edge,pipe flashings, chimney flashings(if needed)and step flashings. Furnish& install CertainTeed Winterguard ice&water barrier along eaves. Furnish and install synthetic underlayment. Furnish and install Lifetime CertainTeed Landmark Series shingle. Furnish and install CertainTeed approved ridge vent. All exterior roofing related debris to be removed by R.C.I. Roofing. All work will be performed according to manufacturers'specifications. Lifetime CertainTeed material warranty included. All related permits will be obtained by R.C.I. Roofing. WE LOOK FORWARD TO DOING BUSINESS WITH YOU. Total $8,400,00 TERMS OF PAYMENT 5%Deposit Customer Signature:/ Balance upon completion Registration# 126235 Date: Construction License#074334 Zc� Insured by Banas&Fickert Ins. (413)527-2700 [Shingle Color Selection: 11J60$J City of Northampton 212 Main Street, Northampton, MA 01060 Solid Waste 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. Address of the work: 9e W1L/or1h1°& �'1A The debris will be transported by: 121A r���' /�2 c'cr�i�c9 The debris will be received by: Gt�es&rn Recwe-111"7 %rdlISAr Building permit number: Name of Permit App I'cant Date Signature of Permit Applicant .�% 2 �t SCA 1 n5 20M•06/17 d0 Wanlmeooawealt!�CQ/jt�aaauc/u�aek� Office of Consumer Affair &Business Regulation HOME IMPROVEMENT CONTRACTOR TYPE:Partnership Expiration 1 .._ 05/05/2020 RCI ROOFING, Commonwealth of Massachusetts ' Division of Professional Licensure g zt_ MARKT,DELISL 6 LINE STS XM./ C� Board of Building Regulations and Slandards `' '�'4 SOUTHAMPTON,Ml 'L5:4:Q7fl' Undersecretary Conskrtl.ct'id lth�rvIa0r CS•074334 #•'l:. VXplres: 05/03/2020 Registration valid for Individual use only % t7� w A before the expiration date. If found return to: MARK THOM S Dg UR''.'; : f 69 BRIGGS ST EES'". . I f' Office of Consumer Affairs and Business Regulation 1000 Washington Street•Suite 710 EASTHAMPTO ki:.CG Boston,MA 02118 Commissloner ' .l Not valid without signature " --- 0 M M: A` TH::.p A...y A yH lJ S E - c , ON:1NE HOME IMPRQVMN7,'•'C�ONTRACTOR e ° ° ° ° ' R•�C••f•;ROCSFI�I:G�I,LP � 1 ..,p<��3`� , :�. SHE ET Tf . . K R-Bt, :'6, INS T•' � s:� �>�,:s;�>,�.. ,.:: <..:�. IS.$U6S.,•HE FQLLO, x . ; SOU�• �?.Tt�fi1;iYt 01073 mfr¢" �K �. T�..... 1N1W:G ,1' 'EN$E .;'.,; v .,MAST R-U.N A,RK T.,p LIC./RE6 N ... TI' EXPIRES _ ; . '-SRIG'G.S:S;T,A,>,; HIC,0G2474-I- 12./01/ 017. 11/30/2018 EA-STI K'.!"• t IVIA T ` Q .02 W. >• .s3>.> ><« s486498 1'327 'tj;.6'/28'/2020 C� a.�a:�•ss _ o�dr ;i'iii• ' (l.' I,,,,�5�4:,Y+''2e,iM•1" kS�iaYtit+i`tq�a,�. ,,. ........... I, .il..�:'•a+•>:>.:?'*;i;Yi , k.".0� MMONIIV I ifklst.O:EI # :: '.,_*' ::;:.• #'t>s . IZ&U.ES ;lay Vis• �.::1 M111A ., r, •Niy IsF��',O:FING'�11.1.P E°A a1 :1P�fi;QN; �!?AngA p;3. :i IR,,.>,,3J, 8.01 X109/0'91201.9 34'2236 s akx: I i o .Jim I r l ` i. ,.. 0 •" '•"'"',.+^Iv""""x•31•"i':tll'.f,if Ali 51YIfl'.SftYMY.':1W ...• •• ... 1tliae'� I �� - . t„�, t _. .; _ } .:� ,� . M,: ��� --- ' Ap r, 4. 2018 10 ; 50AM No, 2462 P. 1/1 ACOR�J��® DATE(MM/DD/YYYY) ��. CERTIFICATE OF LIABILITY INSURANCE 04/0-4118 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 THC POLICIES BELOW, THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZEC, REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER, IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed, If SUBROGATION I$WAIVED,subject to the terms and conditions of the polioy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER NAME: Michael R.Sanas Sanas&Fickart PHO(AJC.No 413-$27-2700 FAX c No; 413.527-0649 Insurance Agency MAIL 63 Main Street ADDRESS: mb@banasinsuranee.com Easthampton,MA 01027 INSURER(S)AFFORDING COVERAGE NAIC A INSURERA: Admiral Insurance Co, 24856 INSURED INSURERa: Safaty Insurance Co. 39454 RCI Roofing,LLP INSURER C: Admiral Insurance Co. 24856 6 Line Street INSURER D: Southampton,MA 01073 INSURER E t INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THATTHS POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INURED 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 MAYBE ISSUED OR MAY PERTAIN,THE INSURANCEAFFOROEO 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. INSPE TYPE OF INSURANCE IN D POLICY NUMBER MM DD EFF MM/Db1YYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S 1,000,000 CLAIMSLMOE Ea OCCUR PREMISESIC' eno3 $ 50,000 MED EXP(Amy aner-w S 10,000 A CA000020963-04 03/04/16 03/04/19 PER$ONALBADV INJurY $ 1,000,000 GEMLAGGREGATE LIMITAPPUES PER: GENERALAGGREGATE S 2,000,000 POLICY X PRO• JECT LOC PRODUCTS-COMP/OPAGG $ 2,000,000 OTHER: S AUTOMOBILE LIAOIUTY COEeMBIN IN LE LIMIT $ 1,000,000 accident ANYAUTO BODILYINJURY(Perperson) $ OWNEDSCHEDULED B AUTOS ONLY x AUTOS X 6207761 09/30/17 09/30/18 BODILY INJURY(Per accident) S HIRED x NON-OWNED PROPERTY AMAOE $ AUTOS ONLY AUTOS ONLY Per accident S UMBRELLA LIAR OCCUR EACH OCCURRENCE S 5,000,000 C EXCESS LIAe CLAIMS-MADE X GX000000385 02 03/04/18 03/04/19 AGGREGATE $ 5,000,000 DED I X I RETENTION S 10,000 S WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANY PROP RIETOR/PARTNER/EXECUTIVBE NIA E.L.EACHACC:DENT S OFFICERIMEMBER EXCLUDED? (MandAtory In NH) E.L.DISEASE•EA EMPLOYEE S If yes,describe under DESCRIPTION OF OPERATIONS below R,L.DISEASE-POLICY LIMIT S DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (ACORD 101,Additlonsl Remarks Schoduie,may be ahaehed If mora space Is rKuired) ROOFING CONTRACTOR. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN RZrF=NCE COPY. ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REP S NTrE ---------------------------- — — – --- 15AC RD CORPORATION. All rights reserved. ACORD 26(2016/03) The ACORD name and logo are registered marks of ACORD .. • . �� ,.;:., •, _. .,..��. . : � � --: _ .: f .. ., ., -. . . . , _ ,� t R AC RUQ CERTIFICATE OF LIABILITY INSURANCE 71T 01 5/201YYYYI �,. 012 512 0 1 7 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(ies) must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). CC PRODUCER 01978-001 NAME : Branch 1978-1 M R Banas Insurance Agency Inc IMC I. Ext): (913)527-0288 ��AIC.No.: (q13)527-0899 63 Main Street j EMAIL Easthampton,MA 01027 ....... .. ....... ! INSURE.R.(5)J�EEQRPtN4G.QVERAG�._ _.—___ ---� Aan: A.I.M.Mutual Insurance Comp _ !INSURER y INSURED C INSURER B. RCI ROOFING LLP INSURER C: 6 LINE STREET ! SOUTHAMPTON, MA 01073 INSURER D.: _ ,..INSURER E: ... _. 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 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.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. gR ---'—-------— —'----- ------'t ppb—Cy Epp —L'Cy FSP --...._... TYPE OF INSURANCEPOLICY NUMBER i(MMIDDIYYYY),;(MM/DDIYYW) _ _ LIMITS __.. ._ GENERAL LIABILITYEACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITYDAMArETiSREt�`I`ED $ 1 CLAIMS-MADE I OCCUR MED EXP(Any one person) $ L..... _ _.. - ... PERSONAL 8 ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ POLICYRO- i �IECT.....1. IOC AUTOMOBILE LIABILITYCtSMBINEDSINDLLiM1T" $ .._... Stiuden,. — .._..._....._... .. ANY AUTO BODILY INJURY(Per person) S ALL OWNED r—I SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident):$ HIRED AUTOS NON-OWNED i PROt�6ttT!bA?vWBE i AUTOS (Por accident) $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS MADE AGGREGATE g DED I RETENTION $ :$ ..... _.._.. ...... 1/�g Tq7U O Wo P�,PSo� tS�C A�Tl4f� x TORY LIMITS _.. ' PVt IP �p � lP t��� ECUTIVEY�N E.L.EACH ACCIDENT $ 1,000,000.00 A I� [ Y N/A VWC-100-6022647-2017A 10/6/2017 10/5/2018 - - - -(Mandatory In(n NH) ! E.L.DISEASE-EA EMPLOYEE!$ d�t yy ��dd --'---------.............-._..._....__...:.._.._...._......... ..1.000,000.00 U&MINION 6MERATIONS below E.L.DISEASE-POLICY LIMIT $ QQQ,Q00,00 1_...............__.... DESCRIPTION OF OPERATIONS!LOCATIONS]VEHICLES(Attach ACORD 101,Additional Remarks Schedule,If more space Is requlrod) "Proof of Coverage" Worker's Compensation Coverage Applies to Massachusetts Employees Only No Partner is covered by the workers compensation policy, CERTIFICATE HOLDER CANCELLATION RCI Roofing LLP 6 Line Street SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Southampton,MA 01073 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE n 1986-2010 ACORD CORPORATION.All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD s