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38D-020 (2) 36 HAMPDEN ST BP-2020-0802 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 38D-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: INSULATION BUILDING PERMIT Permit# BP-2020-0802 Proiect# JS-2020-001388 Est.Cost: $3328.00 Fee: $65.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: AMERICAN INSTALLATIONS LLC 106178 Lot Size(sg. ft.): 56628.0_0 Owner: MCKAHN DANIELLE Zoning: SC(96)/URB(4)/ Applicant. AMERICAN INSTALLATIONS LLC AT. 36 HAMPDEN ST Applicant Address: Phone: Insurance: 130 COLLEGE ST (413) 552-0200 WC SOUTH HADLEYMA01075 ISSUED ON:1/14/2020 0:00:00 TO PERFORM THE FOLLOWING WORK.-ATTIC AND BASEMENT INSULATION AND AIR SEALING THROUGHOUT I 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 1/14/2020 0:00:00 $65.00 212 Main Street, Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner Hlb 4fir� City of Northam tong'.•, Dep 1ION 07 Building Departme J�41p 212 Main Street-,r � �. HULA TlC3N Room 100 4,60ke, Northampton, MA 010 q��i�:n phone 413-587-1240 Fax 413-58 ONLY APPLICATION FOR INSULATION FOR A ONE OR TWO FAMILY DWELLING ONLY SECTION 1 -SITE INFORMATION INS ULA TION PERMIT 1.1 Property Address. This section to be completecL by office Map� Lot Unit 37 Hampden Street(left&right) Zone Overlay District Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: Danielle Mckahn 37 Hampden Street (left &right) Name(Print) Cugggt(vjailir�q Adtt[�s : See attached Telephone Signature 2.2 Authorized Agent: American Installations 130 College Street Ste. 100, South Hadley, MA 01075 Name(Print) Current Mailing Address: -w j2UII&VAM V . (413) 552-0200 Signature ITelephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building 3328.00 (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=0 +2 + 3+4+5) 3328.00 Check Number This Section For Official Use Only Building Permit Number: -�0 Date Issued: Signature: I N Building Commissioner/Inspector of Buildings Date production @ americaninstallations.com EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR) SECTION 4-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder: Wesley R. Couture 106178 License Number 130 College Street Ste. 100, South Hadley MA 01075 912912021 Address Expiration Date bk�," K CMA tAIJA (413) 552-0200 Signature Telephone 9.Registered Home Improvement Contractor: Not Applicable ❑ American Installations 175982 Company Name Registration Number 130 College Street Ste. 100, South Hadley MA 01075 612612021 Address Expiration Date Telephone (413) 552-0200 SECTION 5-WORKERS' COMPENSATION INSURANCE AFFIDAVIT(M.G.L. c. 152,§25C(t)7) 7 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....... .L� No...... ❑ l D f Brief Description of Proposed Work ;M O TE; INS ULA y TIy ON ONL Y Attic and basement insulation and air sealing throughout. 1, American Installations - Wesley Couture 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. Wesley K. Couture Print Name It, C&IJAI 1 1/10/20 Signature of Own /Agent Date I, , as Owner of the subject property hereby authorize American Installatums to act on my behalf, in all matters relative to work authorized by this building permit application. See attached 1/10/20 Signature of Owner Date City of Northampton Massachusetts DEPARTMENT OF BUILDING INSPECTIONS ?' z 212 Main Street • Municipal Building c„. Northampton, MA 01060 ssb j��J AFFIDAVIT Home Improvement Contractor Law Supplement to Permit Application The Office of Consumer Affairs and Business Regulation("OCABR")regulates the registration of contractors and subcontractors performing improvements or renovations on detached one to four family homes. Prior to performing work on such homes,a contractor must be registered as a Home Improvement Contractor("HIC"). M.G.L. Chapter 142A requires that the"reconstruction, alteration, renovation, repair, modernization, conversion, improvement, removal, demolition, or construction of an addition to any pre-existing owner-occupied building containing at least one but not more than four dwelling units....or to structures which are adjacent to such residence or building"be done by rey_istered contractors. Note:If the homeowner has contracted with a corporation or LLC,that entity must be registered Type of Work: Insulation Est. Cost: 3328.00 Address of Work: 37 Hampden Street (left &right) Date of Permit Application: 1/10/20 I hereby certify that: Registration is not required for the following reason(s): _Work excluded by law(explain): _Job under$1,000.00 _Owner obtaining own permit(explain): Building not owner-occupied x Other(specify): Contractor pulling permit for homeowner OWNERS OBTAINING THEIR OWN PERMIT OR ENTERING INTO CONTRACTS WITH UNREGISTERED CONTRACTORS OR SUBCONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK ARE NOT ELIGIBLE FOR AND DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER M.G.L.Chapter 142A.SUCH OWNERS ALSO ASSUME THE RESPONSIBILITES FOR ALL WORK PERFORMED UNDER THE BUILDING PERMIT.SEE NEXT PAGE FOR MORE INFORMATION. Signed under the penalties of perjury: I hereby apply for a building permit as the agent of the owner: 1/10/20 American Installations 175982 Date Contractor Name HIC Registration No. OR: Notwithstanding the above notice, I hereby apply for a building permit as the owner of the above property: 1/10/20 1A )PdW V� CGUt" Date Owner Name-And Signature City of Northampton ?•'' `' Massachusetts G DEPARTMENT OF BUILDING INSPECTIONS t 212 Main Street •Municipal Building Northampton, MA 01060 jsN�y `tiJ 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: 37 Hampden Street (left &right) (Please print house number and street name) Is to be disposed of at: Waste Management of New England, Chicopee, MA 01020 (Please print name and location of facility) Or will be disposed of in a dumpster onsite rented or leased from: American Installations (Company Name and Address) JA)� � rMA& Signature of P rmit 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. City of Northampton %r• fi Massachusetts ��?� 5" DEPARTMENT OF BUILDING INSPECTIONS oe� 212 Main Street • Municipal Building � Northampton, MA 01060 MANDATORY FOR HOUSES BUILT BEFORE 1945 Property Address: 37 Hampden Street (left &right) Contractor Name: American Installations Address: 130 College Street Ste. 100 City, State: South Hadley MA Phone: (413) 552-0200 Property Owner Danielle McKahn Name: Address: 37 Hampden Street (left &right) City, State: Northampton, MA 01060 1, Wesley K. Couture (contractor) attest and affirm that the building I intend to insulate does not have any open air (knob and tube) wiring in the spaces to be insulated and that I have provided the property owner with a copy of this affidavit. Contractor signature �> IL, Date 1/10/20 7 yio- www.Americaninstaliations.com BBB ��z ppp i PA IcIVAnNG l CON Licensed&Insured - MA CSL#:106178 American Installations MA Registration#175981 130 College Street Suite 100,South Hadley,MA 01075 • Office:(413)552-0200 Fax:(413)552-0202 Email:support@Americanlnstallations.com McHenry,Corey&Bethany 6/19/2019 hall iF�..II n>alel 37 Hampden Street(right) Northampton MA 01060 laee.n,l Iced nve, .i�� 413 320 7208 danimckahn@gmail.com (H-0 1 11) IEmaiA 485 143 19-18078 Isne 101 i Iib e1 Quantity Unit Unit Cost Total Air Sealing AIR SEALING 4 man hour $ 85.00 $ 340.00 Air Sealing $ 340.00 Air Sealing Incentive $ (340.00) Air Selaing WX Balance $ - Weatherization ATTIC DAMMING-R-38 FIBERGLASS 60 sqft $ 2.05 $ 123.00 ATTIC FLAT-10"OPEN R-37 CELLULOSE 520 sqft $ 1.56 $ 811.20 ATTIC HATCH-SEAL&INSULATE 1 each $ 60.00 $ 60.00 VENT BATH FAN THRU ROOF 1 each $ 118.75 $ 118.75 VENTILATION CHUTES 32 each $ 2.50 $ 80.00 BASEMENT SILLS-R19 FG BATT 66 sqft $ 1.95 $ 128.70 Total Weatherization $ 1,321.65 Weatherization Incentive $ 1,189.49 Total Project $ 1,661.65 Total Utility Contribution $ 1,529.49 Total Customer Contribution $ 132.17 WARRANTY.American Installations,LLC will provide the above stated homeowner with a t year workmanship warranty. American Installations,LLC hereby proposes to furnish all material and labor to complete the above scope of work in accordance with the above specifications and all focal and state building regulations for the Total Contract Value as stated herein. ACCEPTANCE OF PROPOSAL:The above prices,specifications and TOTAL CONTRACT VALUE= $ 132.17 conditions are satisfactory and are hereby accepted. You are authorized to do work as specified.Payment will be 1/3 down prior to Down Payment= $ 44.00 ❑ start of work,and balance due upon Completion. PAID Balance Due Upon Completion= $ 88.17 G to as t gna�u�e a an Danielle McKahn, Pioneer Development (6" 25/19 P�oPenY Caner lPr+,t P,aper.�..nn siE�l nate PepnminNe IPnnll RepnentaNne(S�En Uate THIS AGREEMENTS COMPOSED OF THIS PAGE AND THE REVERSE NDE OF THIS PAGE AND SHALL BE CONSIDERED THE[WIRE AGREEMENT BY THE PARTIES INVOLVED THIS AGREEMENT IS BETWEEN AMERICAN INSTALLATIONS,LLC HEREINAFTER REFERRED TO AS'COMPANY",AND THE CUSTOMER(S)NAMED ABOVE.HEREINA ER REFERRED TOM-WENT-,ANDWILL BE SVBIECT TO ALL APPROPRIATE LAWS.REGULATIONS AND ORDINANCES OF THE STATE OF MASSACHUSETTS OR CONNECTICIFT RESPECTIVELY,AS WELL AS ALL LOCAL IIIRISOICTIONS 1 ` www.America ninstallations.com ♦ BIBB TIN4 °tINIRaI TVH Licensed&Insured � MA CSL#:106178 American Installations MA Registration#175982 130 College Street Suite 100,South Hadley,MA 01075 • Office:(413)552-0200 Fax:(413)552-0102 Email:support@Americaninstallations.com McHenry,Corey&Bethany 6/19/2019 naaal II"a ioala 37 Hampden Street(left) Northampton MA 01060 IA�rsal IOLI IsoW J ri 413 320 7208 danimckahn@gmail.com (—.I ¢�In (1-1) 485 144 19-1807A ILL NI Ilu�F Quantity Unit Unit Cost Total Air Sealing AIR SEALING 4 man hour $ 85.00 $ 340.00 Air Sealing $ 340.00 Air Sealing Incentive $ (340.00) Air Selaing WX Balance $ Weatherization ATTIC DAMMING-R-38 FIBERGLASS 60 sqft $ 2.CS $ 123.00 ATTIC FLAT-10"OPEN R-37 CELLULOSE S20 sqft $ 1.56 $ 811.20 ATTIC HATCH-SEAL&INSULATE 1 each $ 60.00 $ 60.00 VENT BATH FAN THRU ROOF 1 each $ 118.75 $ 118.75 VENTILATION CHUTES 32 each $ 2.50 $ 80.00 BASEMENT SILLS-R19 FG BATT 66 sqft $ 1.95 $ 128.70 Total Weatherization $ 1,321.65 Weatherization Incentive $ 1,189.49 Total Project $ 1,661.65 Total Utility Contribution $ 1,529.49 Total Customer Contribution $ 132.17 WARRANTY:American Installations,LLC will provide the above stated homeowner with a 1 year workmanship warranty. American Installations,LLC hereby proposes to furnish all material and labor to complete the above scope of work in accordance with the above specificatiors and all local and state building regulations for the Total Contract Value as stated herein. ACCEPTANCE OF PROPOSAL:The above prices,specifications and TOTAL CONTRACT VALUE= $ 132.17 conditions are satisfactory and are hereby accepted. You are authorized to do work as specified.Payment will be 1/3 down prior to Down Payment= S 44.00 start of work,and balance due upon Completion. PAID Balance Due Upon Completion= S 88.17 Danielle McKahn, Pioneer Development / / " / L--- 6/25/2019 P,oP.nv o.n..IPrnU Property o.M.(sNnl oat. eprnmtalire IPr ntI Pepesenlatrve IBllnj Dale THIS AGREEMENT IS COMPOSED OF THIS PAGE AND THE REVERSE SIDE OF THIS PAGE AND SHALL BE CONSIDERED THE ENTIRE AGREEMENT BY THE PARTIES INVOLVED.THIS AGREEMENT Is BETWEEN AMERICAN INSTALLATIONS,LLC HEREINAFTER REFERRED TO AS'COMPANY AND THE CUSTOMER(SI NAMED ABOVE,HEREINAFTER REFERRED TO AS'WENT'.AND WILL BE SU51ECT TO ALL APPROPRIATE LAWS,REGULATIONS AND ORDINANCES OF THE STATE OF MASSACHUSETTS OF,CONNECTICUT RESPECTIVELY,AS WELL AS ALL LOCAL IINIISDICTIONS. The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street,Suite 100 Boston,MA 02114-2017 " www mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legibly Name (Business/Organization/Individual): American Installations, LLC Address: 130 College Street, Suite 100 City./State/Zip: South Hadley, MA 01075 Phone#: 413-552-0200 Are you an employer?Check the appropriate box: Type of project(required): l.®tam a employer with 70 employees(full and/or part-time).* 7. ❑New construction 2.[J i am a sole proprietor or partnership and have no employees working for me in $. E]Remodeling any capacity.[No workers'comp.insurance required.] 3 El am a homeowner doing all work myself.[Noworkers'comp.insurance required.]t 9. El Demolition 10[]Building addition 4.❑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 I LF-1 Electrical repairs or additions proprietors with no employees. 12.F1 Plumbing repairs or additions 5.a I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.❑Roof repairs These sub-contractors have employees and have workers'comp.insurance.t 6.Q we are a corporation and its officers have exercised their right of exemption per MGL a 14.QX Other Insulation 152,§1(4),and we have no employees.[No workers'comp.insurance required.I 'Any applicant that checks box ill 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 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: Berkshire Hathaway GUARD Policy#or Self-ins.Lic.#: AMWC049875 Expiration Date: 09/04/2020 ff 7 Job Site Address: �-4 ity/State/Zip: I tK^ Attach a copy of the workers'compensation policy declare on page41mg, the policy number and expirat on date . Failure to secure coverage as required under MGL c. I52,§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 certify under the pains and penalties of perjury that the information provi ab ve is true and correct I Si nature: Date: Phone#: 413 52-000 - 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#: Commonwealth of Massachusetts Construction Supervisor Division of Professional Licensure Unrestricted -Buildings of any use group which contain Board of Building Regiiiatinns and Standards less than 35,000 cubic feet (991 cubic meters) of enclosed Construction Supervisor space. CS-1061 76 Expires: 09,29,202' WESLEY COUTURE 139 PACKARDVILLE ROAD PELHAM MA 01002 Failure to possess a current edition of the Massachusetts State Building Code is cause for revocation of this license. Commissioner �,/�,�� For information about this license Call (617) 7273200 or visit www.mass.gov/dpi Office of Consumer Affairs and Business Regulation 1000 Washington Street - Suite 710 Boston, Massachusetts 02118 Home Improvement Contractor Registration Type: LLC AMERICAN INSTALLATIONS,LLC. Registration: 175982 130 COLLEGE STREET SUITE 100 Expiration: 06/26/2021 SOUTH HADLEY,MA 01075 Update Address and Return Card_ SGA 1 O 2eM-Ml7 Office of Consumer Affairs 3 Business Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only TYPE:LLC before the expiration date. If found return to: Registration Expiration Office of Consumer Affairs and Business Regulation 175982 06/26/2021 1000 Washington Street -Suite 710 AMERICAN INSTALLATIONS.LLC. Boston,MA 02118 WESLEY COUTURE 130 COLLEGE STREET SUITE 100 SOUTH HADLEY,MA 01075Undersecretary `pt valid without signature ACs" CERTIFICATE OF LIABILITY INSURANCED.—T,( 2019) 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). PRODUCER CONTACT NAME: Linda Powers Webber & Grinnell AX PHONE t)t (413)586-0111 A/C,NO; (413)586-6481 8 North King Street E-MAIL ADDRESS: /powers@webberandgrinnell.com INSURERS AFFORDING COVERAGE NAIC# Northampton MA 01060 INSURERA:Employers Mutual Casualty INSURED INSURER B:Berkshire Hathaway GUARD IRs. Co. American Installations, LLC INSURER C: Attn: Wes & Suzanne Couture INSURER D: 130 College Street, Suite 100 INSURER E: South Hadley MA 01075 INSURERF: COVERAGES CERTIFICATE NUMBER:Master Exp 9-2020 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 ADDL SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSID WVD POLICY NUMBER MM DD/YYYY MM/DD/YYYY LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 ❑ A X CLAIMS-MADE OCCUR PREMISES DAMAGE TO RENTED 500,000 Ea occurrence $ 5D3535217 9/4/2019 9/4/2020 MED EXP(Any one person) $ 10,000 PERSONAL&ADV INJURY $ 1,000,000 GENIAGGREGATE LIMIT APPLIES PER. GENERAL AGGREGATE $ 2,000,000 X POLICY ❑ PRO ❑ LOC 2,000,000 JECT PRODUCTS $ OTHER $ AUTOMOBILE LIABILITY Ea aBINEDtSINGLE LIMIT $ 1,000,000 A ANYAUTO BODILY INJURY(Per person) $ ALL OWNED X SCHEDULED 523535217 9/4/2019 9/4/2020 BODILY INJURY Per accident $ AUTOS AUTOS ( ) X X NON-OWNED PROPERTY DAMAGE HIRAUTOS Per accident $ X Coll$2,000 X comp$2,000 PIP-Basic $ 8,000 X UMBRELLA LAB OCCUR EACH OCCURRENCE $ 1,000,000 A EXCESS LAB HCLAIMS-MADE AGGREGATE $ 1,000,000 DED I X I RETENTION $ 10,000 5J3535217 9/4/2019 9/4/2020 $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY YIN X STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 500,000 B OFFICER/MEMBER EXCLUDED? ElNIA (Mandatory in NH) AMWC994153 9/4/2019 9/4/2020 E.L.DISEASE-EA EMPLOYEE $ 500,000 If yes,describe under DESCRIPTION OF OPERATIONS below E .DISEASE-POLICY LIMIT 1 $ 500,000 A Business Personal Property 5A3535217 9/4/2019 9/4/2020 deductible$1 000 500,000 DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Evidence of Insurance THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE q }I W Grinnell, CPCU, CIC ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD INS025(201401)