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29-401 (2) 68 SANDY HILL RD BP-2020-0330 GIs#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 29-401 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: Door Replacement BUILDING PERMIT Permit# BP-2020-0330 Project# JS-2020-000557 Est. Cost: $1200.00 Fee: $40.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: LOWES HOME CENTERS INC 103003 Lot Size(sq. ft.): 11891.88 Owner: MOQUIN BRIAN Zoning: Applicant. LOWES HOME CENTERS INC AT. 68 SANDY HILL RD Applicant Address: Phone: Insurance: 22 GRANVILLE RD 413 272-8931 WC SOUTHWICKMA01077 ISSUED ON.9/12/2019 0:00:00 TO PERFORM THE FOLLOWING WORK:NEW ENTRY DOOR 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 9/12/2019 0:00:00 $40.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner • A i City of Northampton n Building Department { 212 Main Street {a Room 100 Northampton, MA 01060 phone 413-587-1240 Fax 413-587-1272 ' APPLICATION TO CONSTRUCT,ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION b� oZ� �30 1/ Q .1_Property Address: This section to be completed by office V O SANbY R(C.-c- e, Map 07 q Lot_ 4161,21 Unit (OR ENC6, /I/1 A 0(d CO Z Zone Overlay District Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: (Al- O QGf(/t/ Name(Print) Current Mailing Address: I 7Z Telephone Signature 2.2 Authorized Agent: /1111N(6- jX0 lywa5 gl.-A) /�id°'lesfi.((�,✓V I( Name(Print) Current Mailingddress: Signature Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building •� U (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 6. Total = (1 +2 + 3+4+5) I Z v U Check Number Q This Section For Official Use Only Date Building Permit Num r: Issued: Signature: 'T')2- Z61 q Building Commissioner/Inspector of Buildings Date EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR) Hca r✓ ��h 1 a4v Section 4. ZONING All Information Must Be Completed. Permit Can Be Denied Due To Incomplete Information Existing Proposed Required by Zoning This column to be filled in by Building Department Lot Size _ -- _ Frontage �--- Setbacks Front Side L:= R:= L:= R: Rear Building Height r— r------' Bldg. Square Footage -� % - 1 Open Space Footage _. _ % ----, Lot area minus bldg&paved parking) #of Parking Spaces +• Fill: (volume&Location) A. Has a Special Permit/Variance/Finding ever been issued f r/on the site? NO O DONT KNOW © YES IF YES, date issued:4 IF YES: Was the permit recorded at the Registry of Deeds? NO O DONT KNOW O YES IF YES: enter BookPa i geF and/or Document #' - B. Does the site contain a brook, body of water or wetlands? TN (0 DONT KNOW Q YES 0 IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained 0 Obtained Q Date Issued: C -� C. Do any signs exist on the property? YES © NO IF YES, describe size, type and location: AI D. Are there any proposed changes to or additions of signs inten ed for the property ? YES 0 NO IF YES, describe size, type and location: ! E. Will the construction activity disturb(clearing,grading,excavation,orfiling)over 1 acre or is it part of a common plan that will disturb over 1 acre? YES Q NO IF YES,then a Northampton Storm Water Management Permit from the DPW is required. i i SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable) New House F-1Addition ❑ Replacement Windows �lIteration(s) Roofing F Or Doors El Accessory Bldg. ❑ Demolition ❑ New Signs [0] De ks [Q Siding [E3] Other[C7] Brief Description of Pro ose Work: Al Pro os �NT(�1( ��• /(/J 5-4v-�G�y a I �C�1,,5 e I 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 existins� sing;cc»pte he°f©N 1 : a. Use of building : One Family ___ Two Family Other b. Number of rooms in each family unit: Number of Bathrooms 2-- 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 upply SECTION 7a -OWNER AUTHORIZATION-TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, RR 14ju M OaLi(A) as Owner of the subject property hereby authorize �' �'`e 4&1)t/C to act ri"1ty behalf, i 11 matters relative to work authorized by this building permit a plication. S' aturefeftWer Date C' IAt A )tai (e as Owner/Authorized Agent hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and belief. Signed under the pains and penalties of perjury. CSS Myc� Print Name �'"`NJL � ` Signature of Owner/Agent Date SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder: License Number 1&0 iia ..��rc, *e,, of 07 VSg,,a Expiration Date uc —zzZ—63 z`i Telephone 9.Registered Home Improvement Contractor: Not Applicable ❑ C,cw-t 5 RN 6 T� Company Name Registration Number Addre 97W Expiration Date Telephone 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....... No...... ❑ The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers. Applicant Information Please Print Legibly Name (Business/Organization/Individual): j� r7 �W;IG L.pNTep�; Address: _L Q�a &AAI&7 6&V7 City/State/Zip: dhDy fL/�,u �`�l Q t /VCr ?A((1 Phone #: 41 Are you an employer? Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. [ am a general contractor and 1 6. ❑ New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ 1 am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. workers' comp. insurance. 9. ❑ Building addition [No workers' comp. insurance 5. ❑ We are a corporation and its required.] officers have exercised their ]0.❑ Electrical repairs or additions 3.❑ 1 am a homeowner doing all work right of exemption per MGL I l.❑ Plumbing repairs or additions myself. [No workers' comp. c. 152, §1(4), and we have no 12.❑ Roof repairs insurance required.] t employees. [No workers' 13.❑ Other comp. insurance required.] *Any applicant that checks box#I must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. *Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. !�, Insurance Company Name: /Qnoti N4 iC Stgy l C 4P5 �QctA, 1 /t/ C Policy # or Self-ins. Lic. #: WC d (1-7 W Expiration Date: Y'�' v Job Site Address: v �A vT 1 t(CL () City/State/Zip: pomnce, 4, D(bGZ Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of 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. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify uunnder th ins and penalties of perjury that the information provided above is true and correct. Signature: C-w`�a Date: Phone#: 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): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone#: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Persuant to this statute, an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual, partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer, or the receiver or trustee of an individual, partnership,association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally, MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and, if necessary,supply sub-contractor(s)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers' compensation insurance. If an LLC or LLP does have employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy, please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year, need only submit one affidavit indicating current policy information (if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)." A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address, telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel. # 617-7274900 ext 406 or 1-877-MASSAFE Revised 5-26-05 Fax # 617-727-7749 www.mass.gov/dia CERTIFICATE OF LIABILITY INSURANCE 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 CrONTRACT 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 have ADDITIONAL INSURED provisions or be endorsed.It 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 conter rights to the certificate holder in lieu of such endorsemeni(s). CONTr!NOQVCER MEA a A:,,,i �islC Scrvicc% south, Inc. _� —...------------ Ch.triotte 4C Office tA� NaExe, ;Sb6'. iS3 %121 BGlI ?53 C. 5 1:.11 �•et.,opoli tan Avenue, Suite 4011 E.MNL p %h;irlotte N(: :8204 U:A ADDRESS _ INSURER(S)AFFORDING COVERAGE NAIL• INSURCC iNSURERA. Great American A%%urarKe CURlpany 2G 1.44 t.<•nr Companies, Inc. INSURER B- National union Fire iris Co of Pittsburgh 19441, its subsidiaries 1000 tohe's Fwulevir:l INSURER C: New Hampshire insnrdrKe Company 21941 vonresvilic NC 2811' USA *SURER D 'N3URER I- 'NSURER F: __ COVERAGES CERTIFICATE NUMBER:570075483114 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 NOICATED,NOTWITHSTANDING ANY REOUtREMENT,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 CViMS. Limits shown are as requested INSR iR tYPEOFINSURANCE I POUCYNUMBER UMTS •. COMMERCIAL G ENERAL LL#alUTY Y Y Self•lnSU(ed 04101/20190410112020 EAC)'QCC`.RREr;C` :f:CUR t :;t ASMS.KAt?•� • cN Mr_ 5!Er.x•xardicc MED t%P IMy one perm+, PERSONAL 6 AJY Ih.1VNY 'r FC.GAF^.,aTE tlrt!t AP{':'t.g PER GENERA:AGGREGATE ':.t.,CV .1C S•COM- ' i C P Ar r'ROC* !! H ❑ I D e CA 4993101 04/011201.9 04/0112020 COMB14f.O S1W'1'.f t"Ir n AUTOMOBILE LIABILITY S S,00!1,0tp? AOS .. D r At:Y AUTO CA 4993103 04!011201904/01/2021) R%ODILV IWJRv I Pt.pmw-i Y::!t[0 'E'piJLEO MA ROD(LY gOJORY tour arWOr Z, Qr n autn„C IAv Autos CA 4993102 04/0112019 04/01/2020 rycrENrY y we t ° :rC,=.Ulor: !:c>wenvra:';1 _v _..r AtaCM ONLY VA IP«�aMtrnt 7 � d r UNIRELLAUAA x rx;�t:R UMW276205 41 1 - !0112 EACHOCCURRENZIz SIC/.000.00+1 tJ SIR applies per pulicy terms & condi ions AGGREGAtE SIU,000,00(1 £AC£SS UAB :lAl/,l$64d- C WORKERS COMPENSATION AND WC01 1 16 041 1, 1 04/70172772 X PERSIATUTt a•. EMPLOYERS'LIAHiUTY aorRttuarrxR*!;Lr+,cxccvt:rt VON AOS E_ EACHACCI`EN1 s2.000,000 �rr.EReaE#'MLRLxctUaea' r N:A SIR applies per policy terms & conditions n4nd+tory in HH) EL O5EASt:+ALWKQv E:. S2,00U,000 ''yrs CI'•.Cntle wlew VI;'T;0N OF!?Pr.RAT IONS,bekir. Ei MEASE-POoCY LIMIT 12,000,000..-- 6 ilxcrs5 ;,+c x4rc55.65603 04/01/20190410112020 EL Each Accident 13,000,000 AOS EL Disease - Polic:y SI.Ot10,U00 SIR applies per policy terms & 4ondi ion% EL Disease Ea Emp 53,000,000... Or SCRIPTION OF OPERATIONS I LOCATigHS f VENCLES tACORO 1Qt,AddYgrwt Rgnarlu lcMduM,mn tr spKIW A mon np�cr ft rpu!«rl 'o nercial General Liability policy is Self-resured, 56, .-F.i CERTIFICATE HOLDER CANCELLATION `T SHOULD ANY OF THE ABOVE DESCF46EO POLICIES BE CANCELLED (KFORE THE ExPIRAnoN DATE THEREOF. NOncr V14Lt BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS I.r.mm(: % com)art i es, Inc. AUTHORIZED REPRESENTATIVE and its du1esidiaries Ic!oo I errs stud. vooresville rpt 26.111-8520 USA 1`1988-2016 ACORD CORPORATION.All rights reserved. ACORD 26(2016103) The ACORD name and logo are registered marks of ACORD © Berkley N et Massachusetts Workers' Compensation Insurance Plan Acadia Insurance Co I NCC/Carrier Code 33391 a Berkley C—pany Administered by BerkleyNet Assigned Risk Policy Number MAARP300120 Risk ID: 000840622 Tax ID#: 01-6624639 BURGERS HOME IMPROVEMENT Policy Period: From: 10/06/2018 22 Granville Road To: 10/06/2019 Southwick, MA 01077 Date of Mailing: 05/17/2019 BURGERS HOME IMPROVEMENT 22 Granville Road Southwick, MA 01077 Insured Address Page P.O.Box 59143 1 Minneapolis,Minnesota 55459-01431 Toll Free(888)548-7431 1 Fax(866)215-8118 www.berkleyassignedrisk.com I assigned risk@berkleynet.com l 0 DATE(MMIDD/YYYY) ACORV CERTIFICATE OF LIABILITY INSURANCE 06/06/19 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 have ADDITIONAL INSURED provisions or 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). PRODUCER NAME: Mike Pelletier Rejean J.Remillard Ins Agency PION o Ext), 413-789-3070 Fes,No): 413-786-0193 1040 Springfield Street Feeding Hills,MA 01030 ADDRESS: mikep@rejeanremillard.com INSURER(S)AFFORDING COVERAGE NAIC 0 INSURER A: Main Street American Assurance INSURED INSURER B: National Grange Mutual Burgers Home Improvements INSURER C: Acadia Ins Co 119 High St. 1st Floor INSURER D; Agawam,MA 01001 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 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. INSR TR TYPE OF INSURANCE IN D XD POLICY NUMBER MMIDD/YYYY MMIDDNYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENT1:ff__ CLAIMS-MADE OCCUR PREMISES Ea occurrence $ 500,000 MED EXP(Any oneperson) $ 10,000 A Y Y MPK6213N 06/08/19 06/08120 PERSONAL s ADV INJURY $ 1,000,000 GEN'LAGGREGATE LIMIT APPLIES PER. GENERAL AGGREGATE $ 2,000,000 X POLICY❑JECO T TLOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANY AUTO BODILY INJURY(Per person) $ 100,000 B OWNED X SCHEDULED MIT338SE 06/10/19 06110/20 BODILY INJURY(Per accident) $ 300,000 AUTOS ONLY AUTOS X HIRED X NON-OWNED PR PERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per accident UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE E .EACH ACCIDENT $ C OFFICER/MEMBEREXCLUDED'� N/A Forwarded by Co. (Mandatory in NH) E DISEASE-EA EMPLOYEE $ IIyes,describe under DESCRIPTION OF OPERATIONS below E .DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Lowe's Companies,Inc.and Lowe's Home Centers LLC are named as Additional Insured with respect to General Liability and Automobile Liability Coverage. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN Lowe's Companies,Inc. ACCORDANCE WITH THE POLICY PROVISIONS. and any and all Subsidiaries Mail Code:A3ESS / 100 Lowe's BLVD AUTHORIZED REPRESENT Mooresville,NC 28117 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD ACCW?"' CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD 05/17/201919 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 and endorsement.A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsements. PRODUCER CONTACT Remillard Rejean J Ins Agency NAME: Berkley Assigned Risk Services St PHONE FAX 1040 Springfield (ac.No.Ext.): (888)548-7431 (ac.No) (866) 215-8118 Feeding Hills, MA01030 EMAIL ADDRESS: ass ignedrisk@berkleynet.com INSURER(S)AFFORDING COVERAGE NAIC# suers INSURER A:Acadia Insurance Co 31325 Michael Burgamaster INSURER B: dba: BURGERS HOME IMPROVEMENT 22 Granville Road INSURER C: Southwick. MA 01077 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN INSSUED 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. INSR LTR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS INSR VVVD (MM/DDIYYYY) (MM/DD/YYYY) WORKERS COMPENSATION AND WC STATU- EMPLOYERS'LIABILITY ®TORY LIMITS C]OTHER ANY PROPRIETOR/PARTNER/ E.L.EACH ACCIDENT $100,000 EXECUTIVE OFFICE/MEMBER Y E.L.DISEASE-EA EMPLOYEE $100,000 A EXCLUDED?(Y/N) N/A El MAARP300120 10/06/2018 10/06/2019 (Mandatory in NH) E.L.DISEASE-POLICY LIMIT $500,000 If yes,describe under DESCRIPTION OF OPERATIONS below. ❑ ❑ DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) Election Category Election Status Name Effective Expiration All Insured Entity Sole Proprietor Excluded MichaelBurgamaster Michael Burgamaster Risk Location 119 High ST tat Floor,Agawam MA 01001 COMMENTS CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE Lowe's Companies, Inc. &any and all subsidiaries EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE Mail Code: A3ESS POLICY PROVISIONS. 1000 Lowe's Blvd AUTHORIZED REPRESENTATIVE Mooresville, NC 28117 Signature: ACORD 25 (2010/05) BRAC 3139 _...n �,.[ IN pm x k Commonwealth of Massachusetts Mir Division of Professional Licensure Board of Building Regulations and Standards ns r ' 0 ! S -103403 Expires - 09108/2020 r MICHAEL W BUR A ASTE jj\ (�/.'''�'�,�, {(f\jam 22 RANVILL.E �211I � t SOUTHWICK NIA 01077 Commissioner ♦ ''.' d - �a'Y/U�' t}�+�.y4 '��' ✓ �#� ! 3� � ��,.If!l•.�'Y�.s..»,>�.,"` t i-' .r�i... .r a a^a+�i.+�" � �� /".. ,Iy s ,...ttwy i�ri..{71't..�r�#'{.p�� '.. ,y ar • '� r ��' y �'� - ° ri,t -Wt�i'R.r} sf:�r,«{'I' rr•'r,� 7R{� #„r.{ f',!`I f 'd' f .e r office of Consumerr����Atfalrs Bad HOME IMPROVEMENTT ness Regulation CONTRACTOR TYPE:SUDDlemerlt Card Ir 14868 r LOWES HOME CENT 10l � ERS..LLC [ CHRISTOPHER MINIE MOOREESVILLE,NC 228117 C, £ Undersecretary STORE COPY INSTALLATION SERVICES CUSTOMER CONTRACT- MWORK - INT/EXT/PATIO DOOR LOWE'S OF HADLEY, MA, STORE# 1916 STORE PHONE: (413)588-0270 282 RUSSELL STREET SALESPERSON: BRUCE HUNTER HADLEY, MA 01035-0000 SALESPERSON ID: 1508948 Document Print Date : 09/02/2019 This is only a Quote for the merchandise and services printed below. This becomes an agreement upon payment and issuance of a Lowe's receipt, upon which the entire agree- ment, including the specifically completed pages of this document, the Terms and Conditions included with this document, the applicable portion(s) of Lowe's receipt, and any other addenda or attachments hereto, shall be referred to herein as this "Contract." PLEASE READ THIS ENTIRE DOCUMENT INCLUDING THE "TERMS AND CONDITIONS." BEFORE SIGNING Lowe's Registration or Contractor License Number/Lowe's Contractor Name Lowe's Home Centers, LLC's MA HIC NO.: 148688 Lowe's Home Centers, LLC's FEIN: 56-0748358 Customer Name Home Phone S BRIAN MOQUIN 413-313-5212 O Customer Address Other Phone 68 SANDYHILL RD. L City State/ Province Zip/Postal Code D FLORENCE MA 01062 Installation Address T 68 SANDYHILL RD. O Installation City Installation State/Province Installation Zip/Postal Code FLORENCE MA 01062 MERCHANDISE AND INSTALLATION SUMMARY MERCHANDISE SUMMARY 15634 : 230612 : STK : 120Z DOOR AND WINDOW FOAM : GREAT STUFF Window and Door 12-oz Spray Foam Insulation : DDP SPECIALTY ELECTRON- IC - QTY 1 145691 : 145691 : STK : 1-5-8 TOP CHOICE EWP PREM S4S : 1-5-8 TOP CHOICE EWP PREM S4S : IRVING FOREST PRODUCTS (MAINE) - QTY 1 238348 : 2828-8 : STK : 1-8-8 ROYAL PVC BOARD : 1-8-8 ROYAL PVC BOARD : ROYAL MOULDINGS LIMITED -QTY 1 287055 : 883351070614 : STK : KW SN COMBO SGL CAMERON SMT : KW SN COMBO SGL CAMERON SMT : KWIKSET - QTY 1 353937 : 37098032 : STK : CB 36 WEST POINT WHT MV : CB 36 WEST POINT WHT MV : LARSON MANUFACTURING COMPANY - QTY 1 379723 : 126 8 OAKGO : STK : OAKGLDNSHOE126 1/2-INX3/4-INX8-FT : OAKGLDNSHOE126 1/2-INX3/4-INX8-FT : EMPIRE COMPANY, THE - QTY 1 741037 : 741037.0 : STK : MAS 36 CRFTSMN MORELITE PTNA LH : MAS 36 CRFTSMN MORELITE PTNA LH : DOOR FABRICATION SERVICES INC - Store 1916 Project No. 593727908 for BRIAN MOQUIN Page 1 of 8 STORE COPY QTY 1 • Materials Price $ 493.33 INSTALLATION DESCRIPTION Door type : Exterior Location of new door(s) : Front Door Select new door : Single Pre-Hung Hardwood door : No Sidelights or transoms : No Number of additional holes bored for accessories : None Install specialized mortise hardware : No Install storm door : Install new storm, screen or security door Select storm door : Storm Door Lead safe practices : No Total linear feet of custom trim to be Installed : 0 Deliver door : Yes Customer understands scope of the project : Yes Who will obtain permit : Lowe's Permit fee : Yes Additional miles traveled over 20 : 0 Access fee : None Dump entry Fee : Yes Describe other work needed : None Comments : Craftsman moorlite and a westpoint screen door Labor Charges $ 723.0 Detail Deduction -$ 35.0 Additional Specifications: Notation: Lowe's will not make structural modifications, paint or stain or remove/reinstall security system equipment. Customer is responsible to advise if prop- erty is governed by Historic District Regulations. LEAD SAFE INFORMATION: Federal and applicable state laws require that You be provided with a lead hazard information pamphlet such as the Renovate Right: Important Lead Hazard Information for Families, Child Care Providers and Schools. By signing this Contract, You acknowledge having received a copy of this information pamphlet before work began informing You of the potential risk of the lead hazard exposure from renovation activity performed in Your dwelling unit or facility. A copy of the pamphlet is also available at the following website: ht- tp://www2.eoa.00v/sites/production/files/documents/renovate rip htbookletwsept2011 pdf. PHOTO RELEASE: Customer grants to Lowe's and Lowe's employees and independent contractors the right to take photographs of the Premises where In- stallation Services will be performed and all work performed at the Premises related to this Contract, and irrevocably grants to Lowe's all right, title, interest in and to the photographs for use in all markets and media, worldwide, in perpetuity. Customer authorizes Lowe's to copyright, use and publish the photographs in print and/or electronically, and agrees that Lowe's may use such photographs for any lawful purpose, inclu i g, but not limited to, marketing, advertising, publi- city, illustration, training and Web content. By initialing here, Customer agrees to the foregoing. /� [Customer to initial to the left]. NOTICE TO CUSTOMER-PRICE CALCULATIONS: If this Contract includes Goods and related Installation Services sold by unit of measurement, such as per Store 1916 Project No. 593727908 for BRIAN MOQUIN Page 2 of 8 STORE COPY square foot, the Price may include more Goods than the actual measurements of Your project area. The Price includes the total amount of Goods required by Lowe's to fulfill the Contract (including surplus materials and overages) (together the "Estimated Product") and the Installation Services required based upon this total amount of Goods. For instance, a 120 square foot room may require 140 square feet of carpet to properly match the carpet seams, pattern, or unique room characteristics, and the Price would include Installation Services based on the 140 square feet of carpet. The total amount of Estimated Product is based upon the total Goods recommended by the Installer, based on industry practice and the Installer's assessment of the unique characteristics of Your project. If any useable Goods are left over, Lowe's may, at its discretion, initiate a Price adjustment. Lowe's will not adjust the Contract Price for the related Installation Services. By signing this Contract You acknowledge You are aware of Your project area measurements and the amount of Estimated Product, and that the Es- timated Product may exceed Your actual project area. TOTAL CHARGES OF ALL MERCHANDISE AND SERVICES where applicable SUB-TOTAL $ 1181.3 *TAX $ 0.0 DELIVERY $ 0.0 ORDER TOTAL $ 1181.3 BALANCE DUE Work is to commence upon reasonable�avvailablity of0ontractor which is anticipated to be 2 OC f �/ [fill in date]. Estimated completion date is � /V 4 ✓ / [fill in date]. NOTICE TO CUSTOMER All items listed in this contract and specification sheet(s) are to be installed under conditions agreed upon at time of purchase and at the price appearing on this contract form. This assumes sound existing substructures, superstructure and points of attachments. Extra labor or material incident to installation necessitated by defective substructures, superstructure, points of attachment, or the moving of fixtures or appliances to be billed at extra cost to custom- er. IF THE CONTRACT TOTAL IS $1,000.00 OR LESS Customer must pay in full COMPLETE THIS SECTION ONLY WHEN THE CONTRACT TOTAL EXCEEDS $1 000 00: [XCustomer to use the following payment schedule: Store 1916 Project No. 593727908 for BRIAN MOOUIN Page 3 of 8 y STORE COPY (1) Deposit of $ to be paid upon signing contract. Any deposit collected at the time this Contract is signed will not exceed one-third (1/3) of the contract price; and/ (2) Payment of $ !� to be collected upon or after the commencement of work. I/We authorize Lowe's to do one of the following (check ap- propriate box below): [-Charge my/our credit card for the amount of the payment indicated above upon or after the commencement of work; or [_] Deposit my/our check for the amount of the payment indicated above anytime upon or after the commencement of work; and (3) Final payment of$100.00, to be paid upon completion of the installation to both parties' satisfaction. DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES AND UNTIL YOU HAVE READ THE TERMS AND CONDITIONS CON- TAINED IN THIS CONTRACT AND WHICH FOLLOW THE SIGNATURE PAGE(s). BY SIGNING BELOW, YOU ARE ACKNOWLEDGING THAT YOU HAVE READ, UNDERSTAND AND AGREE TO THE TERMS AND CONDITIONS SET FORTH IN THIS CONTRACT. YOU ARE ENTITLED TO A COPY OF THIS CONTRACT AT THE TIME OF SIGNATURE. NOTICE REGARDING ARBITRATION AGREEMENT FOR CLAIMS COVERED BY M.G.L. c 142A LOWE'S AND OWNER HEREBY MUTUALLY AGREE IN ADVANCE THAT IN THE EVENT LOWE'S HAS A DISPUTE CONCERNING THIS CON- TRACT, THAT LOWE'S MAY SUBMIT SUCH DISPUTE TO A PRIVATE ARBITRATION SERVICE WHICH HAS BEEN APPROVED BY THE SECRET- ARY OF THE EXECUTIVE OFFICE OF CONSUMER AFFAIRS AND BUSINESS REGULATIONS AND THE OWNER SHALL BE REQUIRED TO SUB- MIT TO Sg�,'y ARBITRATION AS PROVIPFzffTN M.G.L. c.142A. J By: .,"_` Date: Lowe's Ho ters LL 9 yDate: r By: Date: Co-owner or Witness THE SIGNATURES OF THE PARTIES ABOVE APPLY ONLY TO THE AGREEMENT OF THE PARTIES TO ALTERNATIVE DISPUTE RESOLUTION INITIATED BY LOWE'S PURSUANT TO M.G.L. c 142A THE OWNER MAY BE PERMITTED TO INITIATE ALTERNATIVE DISPUTE RESOLUTION EVEN WHERE THE SECTION ABOVE IS NOT SEPERATELY SIGNED BY THE PARTIES g WITNESS OUR HAND(S) AND SEAL(S) BELOW THIS 2 DAY OF SeP / Lowe's Home Centers, LLC BY: (Seal) Store 1916 Project No. 593727908 for BRIAN MOQUIN Page 4 of 8 STORE COPY Print Name: (Seal) Address Ow -,<,- C ity ,<,-City State/Province Zip/Postal Code Print Name (Seal) Co-Owner or Witness Print Name Customer acknowledges receipt of a true copy which was completely filled in prior to Customer's execution hereof. You the customer may cancel this transaction at any time prior to midnight on the third business day after the date of this transaction. See the attached Notice of Right to Cancel for an explanation of this right. Store 1916 Project No. 593727908 for BRIAN MOQUIN Page 5 of 8 STORE COPY TERMS AND CONDITIONS 1.'%OWE'S"DEFINED.Within this Contract(as defined on the front page of this Contract),the term"Lowe's"shall refer to Lowe's Home Centers,LLC,a North Carolina limited liabity company. 2.GENERAL DESCRIPTION. By executing this Contract,Customer and Lowe's agree that 1) Lowe's shall provide Customer the goods and/or materials (the "Goods"),2) Lowe's shall procure on Customer's behalf,the services to install the Goods(the"Installation Services") in or on the premises identified on the face of this Contract(the"Premises")and 3)Customer shall pay Lowe's the lump-sum Contract Total stated on the face of this Contract(the"Price")and according to the provisions of the"Contract Documents".The Installation Services shall be perfomed in the specific rooms or areas of the Premises identified on the face of this Contract("Project Area").The"Contract Documents"shall consist of(1)the face of this Contract, (2)these Terms and Conditions, (3)the applicable portion(s)of Lowe's receipt and(4)any attached sketches,materials lists,floor plans,and/or specification sheets and other addenda or attachments hereto.The Contract Documents do not include any correspondence,advertisements,estimates or other documents that are not attached. 3. INSTALLATION SERVICES.Customer authorizes Lowe's on Customer's behalf to(a)arrange for the Installation Services to be performed by an independent contractor(the"Installer")(licensed when leg- ally required), (b) issue a work order to the Installer to perform the Installation Services, (c) have the Installer's work inspected,should Lowe's in its discretion choose to do so(it being agreed that Lowe's has no obligation to do so),and(d)pay the Installer after completion of the work and after receipt of a certificate,signed and dated by Customer,that the work has been satisfactorily completed(the"Certificate of Completion").Customer understands that Lowe's will rely upon the Certificate of Completion in paying the Installer for the Installation Services.Customer agrees that the Installation Services do not include ar- chitectural/engineering services or structural changes to the Premises or any other services beyond the ordinary and routine installation of the Goods as specifically provided in this Contract. Customer is re- sponsible,at Customer's cost,for providing any necessary architectural/engineering services or structural changes to the Premises or any other services not specifically identified in this Contract. 4. GOODS. Lowe's will arrange for delivery of the Goods to the Premises. Customer agrees that title to goods does not pass to Customer until installed in Customer's home,building,or on Customer's prop- erty. Customer agrees Contract is being offered for the total Price(per below).Customer further agrees any surplus materials upon completion of the Installation Services are not the property of customer and, if instructed by Lowe's,such surplus materials shall be returned to Lowe's by the Installer. Upon request from Customer at the time of job completion,Lowe's,in its discretion,will allow all or part of the unused, receipted surplus materials to be retained by the Customer. 5. PRICE.The Price covers the Goods, Installation Services,and applicable taxes.The Price assumes sound existing substructures,superstructure and points of attachments.The Price shall be increased by the cost and reasonable profit to Lowe's of having to provide additional Goods and/or Installation Services as a result of defective substructures,superstructures, or points of attachments or the existence of any other Undisclosed Condition(per below). In the event of an Undisclosed Condition or the foregoing,Customer will execute a change order or a new replacement contract upon Lowe's request. 6. DISCOUNTS and PROMOTIONS. From time to time, Lowe's provides various promotions,offers and discounts that may apply to Goods and/or Installation Services.See specific promotion,offer and dis- count for terms and conditions that may apply.All discounts are taken at the time of Customer's purchase.Applicable discounts or discounted Prices will appear on the Lowe's receipt and/or on the Contract. 7. PAYMENT.If the Price is$1,000.00 or less,payment of the Price by Customer to Lowe's is due in full uopon execution of this Contract.If the Price is over$1,000.00,Customer agrees to pay Lowe's accord- ing to the payment schedule set forth in this Contract. 8. LICENSES, PERMITS,SAFETY RULES, BUILDING CODES,ZONING ORDINANCES,AND OTHER LAWS.The Installer shall be solely responsible to Customer for obtaining any and all licenses,regis- trations and certifications which are legally required to perform the Installation Services.The Installer shall also be solely responsible to Customer for the Installation Services being performed in compliance with all applicable safety rules and all existing buidling codes,zoning ordinances and other laws.Lowe's shall be responsible to Customer for obtaining building permits which are legally required to perform the Installation Services where Lowe's is legally required to obtain such permits.Where Installer is required to obtain such permits then Installer will be responsible to Customer for obtaining such permits.Custom- ers who secure their own building permits will be precluded from claiming against certain state guaranty funds relating to home improvements.Neither the Installer nor Lowe's shall be responsible for any pre- existing violations of safety rules, building codes,zoning ordinanaces or other laws and shall not be required to address or correct same. If prior to the completion of work a change occurs to any applicable safety rule,building code,zoning ordinance or other law which requires additonal Goods and/or Installation Services to perform this Contract,Customer agrees to pay Lowe's the cost and reasonable profit for such additional Goods and Installation Services and to execute a resulting change order or new replacement contract as requested by Lowe's. No additional work will be performed under this Contract due to any change to any applicable safety rule,building code,zoning ordinance or other law that occurs after the completion of work. 9.CUSTOMER'S WARRANTY AGAINST VIOLATIONS OF EASEMENTS,COVENANTS,AND THIRD PARTY RIGHTS.Customer warrants that performance of Installation Services will not violate any exist- ing real property easements,covenants,homeowner's association rules or rights of third parties holding an interest in the real property being improved. 10. UNDISCLOSED CONDITIONS IN PREMISES. If any defect,weakness or dangerous condition including,but in no way limited to,mold,mildew,rot,asbestos or infestation("Undisclosed Condition")is dis- covered or identified in the Premises'structure,substructure, superstructure or points of attachment at any time prior to commencement or completion of the Installation Services,Customer must remedy the Undisclosed Condition at Customer's sole cost and expense and to Lowe's sole satisfaction. If Customer refuses to permit inspection of the Premises as set forth below, Lowe's may terminate or rescind this Contract without remedy or recourse by,or further obligation to,Customer,except as expressly provided below. If Customer and Lowe's disagree as to whether an Undisclosed Condition exists,Lowe's may in its sole discretion obtain the services of an inspector to inspect the Premises at Lowe's sole cost and expense,and if Lowe's chooses to do so,such inspector's report shall be final and conclusive as to wheth- er an Undisclosed Condition exists. In the event of any Undisclosed Condition that Customer does not remedy to Lowe's sole satisfaction,or any failure by Customer to perform any other obligation of Custom- er under this Contract,then at Lowe's option (i) Lowe's may rescind this Contract and return the Price to Customer without further cost or obligation by either Customer or Lowe's if Lowe's notifies Customer of its election to rescind this Contract prior to the earlier of delivery of the Goods and the Installer beginning performance of the Installation Services,or(ii) Lowe's may terminate this Contract without remedy or recourse by,or further obligation to Customer,except as expressly provided below if Lowe's notifies Customer of its election to terminate this Contract after the earlier of delivery of the Goods and the installer beginning performance of the Installation Services. In the event that Lowe's terminates the Contract as provided in this Section,then Customer may return the Goods(other than Goods that have been"custom- made") in their original,unopened condition,to Lowe's for a refund or credit.Any such return must be made within 30 days after Lowe's terminates this Contract.Customer will be charged a 15%restocking fee on any such returns. Goods not in their original, unopened condition, and custom-made goods, may not be returned. "Custom-made" goods include goods that have been uniquely altered, color-matched, shaped,sized,cut or otherwise designed or fitted to accomodate the requirements of a particular space or environment. Examples of custom-made goods include,but are not limited to,cabinets,countertops, floor and wall coverings,and window treatments. If Lowe's terminates this Contract as provided herein, Lowe's shall have no obligation to refund any portion of the Price(except as expressly provided herein) and shall have no obligation to restore the Premises to their original condition. Notwithstanding the foregoing,and alternative to rescinding or terminating this Contract as described above, upon discovery or identification of any Undisclosed Condition in the Premises, Lowe's may in limited circumstances and markets, and in Lowe's sole discretion, authorize the commencement or continuation of Installation Ser- vices upon Lowe's receipt of Customer's written agreement(to be furnished to Customer by Lowe's)to release and hold harmless Lowe's and installer from any and all liability arising out of or related to the Un- disclosed Condition and Customer's remedy of Undisclosed Condition. 11.CUSTOMER'S RESPONSIBILITIES:Customer agrees to pay Lowe's according to these Terms and Conditions. Customer agrees to facilitate the location of utility lines.Customer is responsible for identi- fying property lines. Customer agrees to ensure that work areas are free of vermin and pre-existing physical or environmental hazards,and building/zoning code violations. Customer agrees to provide the In- staller with access to work areas during working hours and to provide access to sanitary facilities or to pay the rental costs for such facilities. Customer agrees to ensure that any security system at the Premises will not interfere with performance of the Installation Services.Customer agrees to provide power to,as applicable,climate control in,the work areas.Customer agrees not to allow unattended minors at the Premises while the Installer is present. Customer agrees to control and keep pets away from work areas. Customer agrees to keep posted permits on display at all times.Customer agrees that if Cus- tomer or anyone Customer controls interferes with or delays performance of the Installation Services,Customer may be subject to transportation/storage charges or other resulting charges.Customer agrees not to assign or transfer this Contract. Customer agrees that any claim against Lowe's or the Installer under this Contract should be made to Lowe's within thirty(30)calendar days of the date Customer first Store 1916 Project No. 593727908 for BRIAN MOQUIN Page 6 of 8 STORE COPY becomes aware of a problem. (Lowe's will attempt resolution of any claim(s)within sixty(60) calendar days of receiving Customer's notice.)CUSTOMER ASSUMES THE RISK AND THE FULL LIABILITY OF PHYSICALLY ASSISTING WITH DELIVERY OF THE GOODS OR WITH PERFOMANCE OF THE INSTALLATION SERVICES.To Ensure Compliance with Smoke Alarm and Carbon Monoxide Detector Requirements. Prior to the start of the Installation Services, You will ensure the Premises have all necessary carbon monoxide detectors and smoke alarms ("Detectors") needed for the Installer to obtain the necessary pern'its and complete the Installation Services. You are solely responsible for the proper number, placement, type, functioning, operation, installation, testing, as per the manufacturers'specifica- tions,and maintenance of any Detectors required by Local Regulations. Failure to meet Federal,State or Local Detector requirements, if any,will be considered an Undisclosed Condition. 12. MANUFACTURER WARRANTY FOR GOODS.Customer is entitled to any warranty provided by a manufacturer of the Goods sold under this Contract.The Installer will provide Customer with any manu- facturer consumer warranty information accompanying the Goods, and Customer may also obtain such information by contacting Lowe's. LOWE'S DOES NOT WARRANT THE GOODS AND EXPRESSLY DISCLAIMS ALL WARRANTIES.EXPRESSED OR IMPLIED.TO THE FULLEST EXTENT PERMITTED BY LAW. 13. LOWE'S WARRANTY FOR INSTALLATION SERVICES/ LIMITATIONS OF LIABILITY. Lowe's does warrant that the Installtion Services will be performed by the installer in a good and workmanlike manner. Lowe's warranty for Installation services shall extend for a period of one year from the earlier of(1)the date the Certificate of Completion is signed by Customer or(2)the date that Lowe's determines that the Installation Services have been completed, or for such greater period as may be required by applicable law governing consumer warranties for workmanship(the "Warranty Period"). LOWE'S WAR- RANTY THAT THE INSTALLATION SERVICES WILL BE PERFORMED BY THE INSTALLER IN A GOOD AND WORKMANLIKE MANNER DOES NOT COVER, AND LOWE'S WILL NOT BE RESPONS- IBLE FOR,ANY DEFECT IN SUCH INSTALLATION SERVICES DUE TO(1)ANY DEFECT,WEAKNESS OR DANGEROUS CONDITION, INCLUDING BUT NOT LIMITED TO, MOLD, ROT,ASBESTOS OR INFESTATION IN THE PREMISES' STRUCTURE, SUBSTRUCTURE, SUPERSTRUCTURE OR POINTS OF ATTACHMENT, OR OTHER PRE-EXISTING PHYSICAL OR ENVIRONMENTAL HAZARD, OR (2) ABUSE, MISUSE, NEGLECT, OR IMPROPER CLEANING. LOWE'S WARRANTY FOR INSTALLATION SERVICES SHALL BE IN LIEU OF ANY OTHER WARRANTY, EXPRESSED OR IMPLIED,TO THE FULLEST EXTENT PERMITTED BY LAW. Customer acknowledges and agrees that Customer shall be limited to seeking recourse or remedy exclusively from Lowe's or the Installer(as applicable)and that no affiliate of Lowe's shall have any liability under this Contract. Customer must give Lowe's written notice within the Warranty Period of any warranty claim relating to Installation Services. Customer agrees that its sole and exclusive remedy against Lowe's for a warranty claim is reinstallation in a good an workmanlike manner,including the repair or replacement of any Goods if and to the extent resonably necessary to correct the defective Installation Ser- vices. CUSTOMER SHALL HAVE NO OTHER REMEDY FOR A WARRANTY CLAIM, INCLUDING WITHOUT LIMITATION REMEDY FOR LOSS OR DAMAGE CAUSED BY NORMAL WEAR AND TEAR, LOSS OR DAMAGE WHICH HAS NOT BEEN REASONABLY MITIGATED, OR LOSS OR DAMAGE CAUSED BY ACTS OF GOD. IN NO EVENT SHALL LOWE'S BE LIABLE FOR INDIRECT, PUNITIVE, CONSEQUENTIAL OR INCIDENTAL DAMAGES(SUCH AS,WITHOUT LIMITATION, LOST PROFITS, LOST SALES, AND INJURIES TO PERSONS OR PROPERTY), EVEN WHERE LOWE'S HAS BEEN ADVISED OF THE POSSIBILITY OF SUCH DAMAGES. WHERE, DUE TO OPERATION OF LAW, SUCH DAMAGES CANNOT BE EXCLUDED, THEY ARE EXPRESSLY LIMITED IN AMOUNT TO THE PURCHASE PRICE. In connection with any warranty claim,Customer agrees,at no cost to Lowe's or the Installer,to prepare the Premises and the reinstallation area in the manner described in Section 11 of these Terms and Conditions. 14. DISPUTE RESOLUTION FOR CLAIMS COVERED BY M.G.L. c.142A. Most questions or complaints are resolved informally. If Customer has a question or complaint, Customer agrees to contact the Lowe's salesperson whose name appears on this Contract and the manager of the Lowe's store at the address and/or phone number on the front page of this Contract. If Customer has a complaint which can- not be resolved informally,The Home Improvement Contractor Law(M.G.L. c.142A) may provide Customer with the right to request arbitration through a private arbitration program approved by the Director of the Office of Consumer Affairs and Business Regulation,as an alternative to court action. The same right is not afforded to Lowe's unless the"Notice Regarding Arbitration Agreement for Claims Covered by M.G.L. c.142A"on the front page of this Contract is signed and dated by Lowe's and the owner. If allowed by statute or applicable law, the arbitrator may awared statutory damages and/or reasonable attor- neys'fees and expenses. If Customer fails to pay Lowe's in accordance with this Contract, Lowe's shall be entitled to recover its reasonable attorneys'fees as provided by N.C. Gen. Stat.Section 6-21.2 or other controlling law. To the fullest extent permitted by law, Lowe's and Customer agree that no class action lawsuit or class action artibration of any type may be pursued by or on behalf of the Customer or ordered by a Court or arbitrator(s)under this Contract and, in addition,that there shall be no joinder of parties,except for joinder of parties to the transaction covered by this Contract. 15.ARBITRATION AGREEMENT,WAIVER OF JURY TRIAL AND WAIVER OF CLASS ACTION ADJUDICATION FOR CLAIMS NOT COVERED BY M.G.L.c.142A:All claims by Customer or Lowe's con- cerning this Contract which cannot be resolved informally,and which are not covered by M.G.L.c142A or subject to the jurisdiction of a small claims court,shall be resolved by binding arbitration conducted by a single arbitrator under the current applicable rules, procedures and protocols of JAMS, Inc. (JAMS) (www.jamsadr.com) (as amended) or the American Arbitration Association (AAA) (www.adr.org) (as amended).The parties agree that if JAMS or AAA are unable or unwilling to arbitrate the matter,the parties will agree upon a single arbitrator with a nationally recognized arbitration firm to arbitrate the matter. Claims to be resolved by binding arbitration include, but are not limited to(1)all claims directly or indirectly related to the signing of this arbitration agreement,the validity or scope of this arbitration agreement, or any attempt to set aside this arbitration agreement, (2)all federal or state law claims relating directly or indirectly to this Contract(including this arbitration agreement),the information Customer gave Lowe's before entering into this Contract and/or any past agreement or agreements between Customer and Lowe's, (3)all counterclaims,cross-claims and third-party claims,(4)all common law claims of any kind in- cluding claims based upon alleged product defect, contract,tort,fraud, or other intentional torts, (5) all claims based upon a violation of any state or federal constitution, statute or regulation, (6) all claims as- serted by Lowe's against Customer,including claims for money damages to collect any sum Lowe's claims Customer owes Lowe's, (7)all claims asserted by Customer individually against Lowe's and/or any of Lowe's employees,agents, directors, officers, shareholders, managers, members, parent company or affiliated entities(herein collectively referred to as"related third parties")or the Installer, including claims for money damages and/or equitable or injunctive relief, (8) all claims asserted on Customer's behalf by another person, (9) all claims asserted by or on behalf of a Customer as a private attorney general against Lowe's, related third parties and/or the Installer, (10)all claims arising from or relating directly or indirectly to the disclosure by Lowe's, related third parties or the Installer of any non-public personal in- formation about Customer, and/or(11)all other claims arising under or related to this Contract whether or not set forth above. If the dispute falls within the jurisdiction of a small claims court the claimant may. at its option,choose to arbitrate or file a small claims action.Any appeal of a judgment from a small claims court shall be resolved by arbitration as provided herein. Binding arbitration means that Customer waives: (1)any right to a jury trial; (2)any right to bring a lawsuit in a court(other than a small claims court as described above); and(3)any right to seek relief in any other forum or from any other agency.Any claim not decided by a small claims court will be decided by an arbitrator selected as set forth immediately above.Lowe's and Cus- tomer agree that binding arbitration provides a simple, cost efficient method to resolve disputes quickly. Lowe's and Customer agree that no class action lawsuit or class action arbitration of any type may be pursued by or on behalf of the Customer or ordered by a Court or arbitrator(s)under this Contract and, in addition,that there shall be no joinder of parties,except for joinder of parties to the transaction covered by this Contract.By agreeing to binding arbitration Customer and Lowe's waive any right to bring or participate in a class action lawsuit or class action arbitra- tion regarding any claim. How Arbitration Works: Lowe's may demand arbitration by sending written notice to Customer at the address listed in this Contract. Customer may demand arbitration by sending written notice to Lowe's at the following address: Mail code NB6LG, P.O. Box 1000, Mooresville, NC 28115. The arbitration shall be held in the city or county where the Premises are located or in such other convenient location as the Customer and Lowe's may mutually agree. Lowe's shall pay the filing, administrative, hearing and arbitrator's fees associated with the arbitration. Customer shall not be required to reimburse Lowe's for these expenses even if Lowe's wins the arbitration. Unless the arbitrator's award or controlling law specifically provides otherwise, Lowe's and Customer will each be responsible for its own attorneys'fees and other expenses, such as wit- ness and expert witness fees.At the timely request of Customer or Lowe's,the arbitrator will provide a written explanation of the award so long as such requirement is consisent with the then current rules,pro- cedures and protocols of the arbitration entity selected by the parties as set forth above.The arbitrator's award may be filed with and enforced by any court having jurisdiction. If allowed by statute or applicable law,the arbitrator may award statutory damages and/or resonable attorneys'fees and expenses. If Customer fails to pay Lowe's in accordance with this Contract, Customer agrees that Lowe's shall be entitled to recover its reasonable attorneys' fees and expenses as provided by N.C. Gen. Stat. Section 6-21.2 or other controlling law. The parties agree that this arbitration agreement is made in connection with a Store 1916 Project No. 593727908 for BRIAN MOQUIN Page 7 of 8 STORE COPY transacticm involving interstate commerce and shall be governed by the Federal Arbitration Act, 9 U.S.C. Sections 1-16 (as may be amended) (FAA), but if for any reason the Federal Arbitration Act does not apply,then this arbitration agreement shall be goverened by the laws of the State of North Carolina, 16-GOVEROING LAW AND SEVERABILITY.This Contract shall be interpreted under and governed by the law of North Carolina,without regard to the choice of law rules of any state,except that the ARBIT- RATION AGREEMENT, WAIVER OF JURY TRIAL AND WAIVER OF CLASS ACTION ADJUDICATION is governed by the FAA, if any provision of the Contract is contrary to any law to which it is subject, such unlawful provision shall be ineffective without invalidating the other provisions,which shall remain in full force and effect. 17. CREDIT CARD/FINANCED TRANSACTIONS. If Customer uses a credit card or obtains financing to pay some or all of the Price, then Customer acknowledges that the terms of his or her cardholder agreement or financing documents may change the total amount of money Customer must pay to the credit card provider or lender, including any interest charges and fees. Customer acknowledges that his or her cardholder agreement or financing documents may have other terms and conditions to which Customer will be subject. Customer also acknowledges that Lowe's is not a party to any such cardholder or fin- ancing agreement. 18.WAIVER OF LIENS.Because responsibility for paying the Installer on Customer's behalf belongs to Lowe's, Lowe's will require the Installer,on behalf of itself and any of the Installer's subcontractors,ma- terialmen or suppliers,as a condition precedent to payment by Lowe's on Customer's behalf,to fully and unconditionally relinquish,waive and release any and all mechanic's liens, materialman's liens and oth- er liens in the Premises which the Installer or its subcontractors, materialmen or suppliers might have or acquire in the future,by operation of law or otherwise,as a result of this Contract. 19. UNAVOIDABLE DELAY OR FAILURE IN PERFORMANCE EXCUSED. Any delay or failure by Lowe's or the Installer in performing this Contract because of strike,fire, flood, epidemic,acts of terrorism, acts of God, inability to obtain Goods in a timely or commercially feasible manner, or any other causes beyond the reasonable control of Lowe's or the Installer shall be excused and shall not be breaches of this Contract. 20. ENTIRE AGREEMENT/CHANGES IN WRITING.Customer and Lowe's agree that this Contract accurately states the entire agreement between Customer and Lowe's concerning the Goods and Installa- tion Services and replaces and supersedes all prior agreements and understandings relating thereto, both oral and written, and all oral agreements and understandings entered into at the same time as this Contract.Any additions or changes to this Contract,or any waiver of rights under this Contract,must be in writing signed by Customer and Lowe's. 21.CAPTIONS.Titles or captions of sections contained in this Contract have been inserted only as a matter of convenience and in no way define.limit, extend,describe or otherwise affect the scope or mean- ing of this Contract or the intent of any provisions hereof. 22.ADDITIONAL INFORMATION.All contractors and subcontractors must be registered by the Administrator of the Board of Building Regulations and Standards.Inquiries about a contractor or subcontractor relating to a registration should be directed to the Administrator of the Board at One Ashburton Place,Room 1301,Boston,MA 02108,(617)727-8598. 23.QUESTIONS OR CONCERNS. Customer should speak to the Lowe's salesperson whose name appears on this Contract and the manager of the Lowe's store at the address and/or phone number on the front page of this Contract, regarding routine matters such as scheduling, any requested changes to Customer's order,or any concerns Customer may have about this Contract,the Goods or the Installation Services. Store 1916 Project No. 593727908 for BRIAN MOOUIN Page 8 of 8 NOTICE OF RIGHT TO CANCEL Your Right to Cancel You are entering into LOWE'S Installed Sales Contract Number 5J 3?2 ? /5he "Contract") that may result in a lien or security interest on your home in which property (the "Property" ) is to'be in- stalled pursuant to the Contract. You have a right to cancel the Contract, without cost, penalty or ob- ligation, at any time prior to midnight of the third business day after the latest of (i) the date of the Contract, which is -2 .S eta rt- /q (year), (ii) the date you received this Notice of Right to Cancel, and (iii) if you have paid or will be paying for the Contract by using your LOWE'S private label credit card, the date you received your Truth-In-Lending disclosures in connection with such credit card. Effects of Cancellation If you cancel the Contract, the lien or security interest on your home is also canceled. Within 20 cal- endar days (except in Connecticut where the period is 10 business days) of receiving your notice of cancellation, we must take any necessary steps to reflect the fact that the lien or security interest on your home has been canceled, and we must return to you any money or property you have given us or anyone else in connection with the Contract. How to Cancel If you decide to cancel the Contract,you may do so by notifying us in wri g, mail,telegram, or personal delivery,at: LOWE'S O� S"z �iy S� e�/ 4 =ILIL i d1D ,3.3 You may use any written statement that is signed and dated by you and states your intention to can- cel, or you may use this notice by dating and signing below. Keep one copy of this notice no matter how you notify us because it contains important information about your rights. To be effective, you must drop your cancellation notice in the mailbox, file it for telegraphic transmission, or deliver it to us by other means at the above address no later than midnight of .G_ S-e P /_ / 19 , (year) (or midnight of the third business day after the latest of the three events listed above). I WISH TO CANCEL. (Customer's/Resident Owner's Signature) (date) Print Name ACKNOWLEDGEMENT OF RECEIPT OF DISCLOSURES AND CERTIFICATION On this 2nd day of September, 2019 (year), each of you hereby acknowledges receipt of two (2) cop- ies of the foregoing Notice of Right to Cancel; each of you who is a party to the Contract hereby ac- knowledges receipt of one (1) copy of the fully executed and dated Contract; if any of you has paid or will pay for the Contract by using your LOWE'S private label credit card, you hereby acknowledge having received the Truth-In-Lending disclosures in connection with such credit card; and you certify, represent and warrant to LOWE'S that you are all of the customers who signed the Contract and all of the persons who own and reside in the home in which the Property is to be installed pursuant to the Con (SEAL) (SEAL) Print Name Print Name Witnes Print Name NOTE : Each Customer who is a party to the Contract and each Resident Owner of the home must sign above.