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31A-239 (3)
49 KENSINGTON AVE BP-2021-1127 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 31A-239 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-2021-1127 Project# JS-2021-001892 Est.Cost: $13700.00 Fee: $40.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: SEXTON ROOFING CO 99689 Lot Size(sq.ft.): 5140.08 Owner: LARKIN DIANA Zoning: URB(100)/ Applicant: SEXTON ROOFING CO AT: 49 KENSINGTON AVE Applicant Address: Phone: Insurance: P O BOX 6327 (413) 534-1234 WC HOLYOKEMA01041 ISSUED ON:4/6/2021 0:00:00 TO PERFORM THE FOLLOWING WORK:STRIP & SHINGLE ROOF POST THIS CARD SO IT IS VISIBLE FROM THE STREET Inspector of Plumbing Inspector of Wiring D.P.W. Building Inspector Underground: Service: Meter: Footings: Rough: Rough: House# Foundation: Driveway Final: Final: Final: Rough Frame: Gas: Fire Department Fireplace/Chimney: Rough: Oil: Insulation: Final: Smoke: Final: THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. 7- it ' • • mr . ' 1 Certificate of Occupancy Signature:l FeeType: Date Paid: Amount: Building 4/6/20210:00:00 $40.00 212 Main Street, Phone(413)587-1240, Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner • sZa4, _ The Commonwealth of Massachusetts . Board of Building Regulations and Standards FOR1. Massachusetts State Building Code,760 CMR,7t edition MUNI USE CIPALITY Building Permit Application To Construct,Repair,Renovate Or Demolish a Revised January One-or Two-FcmrilyDwelling 1,2008 a p. This Section For Official Use Only › B�fJ'drjg Permit Num er: b�'•pp //� Date Applied: 3 0 t t ,/�� • •• ' Li- �- •20Z) En Sere: • s- r%.) <i Buil ing Commissioner/Inspector of Buildings Date ' Dv O g m M. SECCTION 1:SITE INFORMATION 0 1 r¢perty Add Bess: 1.2 Assess rs Map&Parcel Numbers u' .�7 !�'�'�s;' : C 4 mil .4'i"�- ,_3(j1 .� _ . • 1.1aIsThis an accepted street?yes no Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use ___ Lot Area(sq ft) Frontage(ft) 1.5 Building Setbacks(ft) Front Yard Side Yards Rear•Yard Required - Provided Required Provided Required Provided . 1.6 Water Supply: (M.G.L c.40.§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Public 0 Private❑ Zone: Outside Flood Zone? Municipal 0 On site disposal system 0 Check;if yes0 SECTION 2: PROPERTY OWNERSHIP' Ownerl of Record: ) !c �j �J/e.,".. L/1,2.LC /'v - 7 g f`C-r.5.-11;a o'' Alf,-Y ,e_J2d1 I2L Name(Print) Address for Service: ())et / �;Y� — 9 'fs • Signature Telephone • SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply) New Construction 0 Existing Building 17, owner-Occupiedepairs(s) 0 Alteration(s)'0 _ Addition 0 Demolition 0 Accessory Bldg.0 Number of Units / Other 0 specify: • Brief Descrii don of Proposed \Vork2:• c- [�.�7! .�P�L„Joe �..a /C•�7la - C��S�.-/i . IX JZ--e erg . . . • SECTION 4:ESTIMATED CONSTRUCTION COSTS. • _ Item • Estimated Costs: ' Official Use Only (Labor and Materials) 1.Building $ 1. Building Permit Fee:$ Indicate how fee is determined: 0 Standard City/Town Application Fee 2.Electrical $ - ❑Total Project Costa(Item 6)x multiplier_ x 3.Plumbing $ 2. Other Fees: $ 4.Mechanical (HVAC) $ List: 5. Mechanical (Fire $Suppression) /�Total All Fees: • • Check No. �v Cheek Amount: " Cash Amount: 6. Total Project Cost: $ /3 76Z ❑Paid in Full 0 Outstanding Balance Due: r SECTIONS: CONSTRUCTION SERVICES 5.1 Construction l�ySupervisor License� (CSL) fi S i, , e re JJ-�J e, !V) License Number kpss-atia`ri Date Name of CSL Holder ) �/L j�, ?D /BOK J 3/7 List CSL Type(see below ! t.�} <LJ (�J f No_and Street Type Description 1761 U i �y�/p l 11 I ).rjI U Unrestricted(Buildings 7 to 35,000 cu ft) U t— (AIL/ f R Restricted l&2 Family Dwelling Cty/ ,Stag ZIP M Masonry RC _Roofing Covering WS Window and Siding SF Solid Fuel Burning Appliances I Insulation --- - Telephone Email address D Demolition . 5.2 Registered Home Improvement Contractor(HIC) allyI ,3�xfnr. got-Ana and sJ r _LrJf,_ T l pad u HIC Registrationumber -N £cpiratian Datc HIC Co arty Name or Hl�egistrant Name ; ,- -- .nx 423.�2_7 ,)t°rf017ra n an marl,W No.and Street Fil address 41444) m19 61itfyi qi3-53i- 3. City,State,ZIP Telephone SECTION 6: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 ' '[if' No ❑ SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT '1 `1 I,as Owner of the subject property,hereby authorize Sex_ on _u G 'L.J1 /fig I-/)- to act on my behalf in all matters relative to work authorized by this burldidgermit application.] en/Tar ii/iriehed 3/2 /ter Print Owner's Name(Electronic Sig tanm) Date SECTION 7b:OWNER'OR AUTHORIZED AGENT DECLARATION By entering my name below,I hereby attest under the pains and penalties of perjury that all of the information contained in this plication is true and accurate to the best of my knowledge and understanding_ MUST BE SIGNED by Owner or Authorized Agent Date NOTES: I_ An Owner who obtains a building permit to do his/her own work,or an owner who hires an unregistered contractor (not registered in the Home Improvement Contractor(HIC)Program),will zut have access to the arbitration program or guaranty fond under M.G.L.c.I42A.Other important information on the HIC Program can be found at www_mass.gov!nca Information on the Construction Supervisor License can be found at�r.�Y,,,v_rnass_gay.rdns 2. When substantial work is planned,provide the information below: Total floor area(sq.ft) (including garage,finished basement/attics,decks or porch) Gross living area(sq.ft) Habitable room count Number of fireplaces Number of bedrooms Number of bathrooms Number of half/baths Type of heating system Number of decks/porches Type of cooling system • Enclosed_ Open 3. "Total Project Square Footage"may be substituted for"Total Project Cost" City of Northampton SAS Massachusetts �2 .L !��c h, a ( tt 4 DEPARTMENT OF BUILDING INSPECTIONS r r, 212 Main Street • Municipal Building 4 yi' Ps ��a-1•� Northampton, MA 01060 'r''-- `1� CONSTRUCTION DEBRIS AFFIDAVIT (FOR ALL DEMOLITION AND RENOVATION PROJECTS) In accordance of the provisions of MGL c 40, S54, a condition of Building Permit Number is that all debris resulting from this work shall be disposed of in a properly licensed waste disposal facility, as defined by MGL c 111, S 150A. The debris will be disposed of in: Location of Facility: 7� y� /4 5 r l 6, 4 G - The debris will be transported by: Name of Hauler: 1<"5 , /e�i -� Z(ivice Signature of Applicant: Date: / t d �� f iDropottai sE y XTON ROOFING AISTI) SIDING INC "A',,,. W W W.Sextonroof ng.tom k't.,#, Virg, .. .__ _ ,._ • lill ` -- •_' r1r:_.. 1tif 1 E!.T0j� 1 Setting the Standard r �+ : A•11101":11111MIIMMI41111111011.6. p. 413.5„'". , f 413,5 '. MA HJC# 118239 sextonroofingiiihotmail.com SUBMITTED TO Diane Larkin PHONE 586- 9 7 $s j DATE 3/25/21 j STREET 49 Kensington Ave. dw(arkin6ara gnail.com CITY STATE,ZIP No ton. Ma. roofr SEXTON ROOFING HEREBY SUBMITS SPECIFICATIONS AND ESTIMATES FOR: HOUSE ROOF , 1) Strip and remove existing shingles and dispose of in proper landfill. 2) Inspect roofing deck and replace as needed a 575.00 per sheet. 3) Install new metal edging to rakes and eaves of roof. (8") 4) Install ice and water shield on eaves ( 6'), vent stacks, in valleys, chimney, and at intersecting roofs. 5) Install #15 synthetic roofing felt on remainder of roof. 6) Install new flanges over existing vent stacks. 7) Install starter shingles on eaves and rakes of roof. 8) Install IKO Architectural style roofing shingles as per anuftcturers' specifications. 9) Install new cap over ridge vent. Ott��e t KO ' !-du trN n vd S loxe 10) Reflash chimney as needed (a $350.00 11) Supply manufactures Lifetime warranty and SRC 5 yr. workmanship warranty. urzyK -.113 6, Ce,fr..i 64ed bn c ( t-5 (a 1 We Propose hereby to furnish material and labor-complete in accordance with the above specifications,for the amount of, t Thirteen Thousand Seven Hundred DOLLARS ($13,700.00) PAYMENTS TO BE MADE AS FOLOWS: due in full upon completion All Material is guaranteed to be as specified All work to be completed in a Authorized workmanlike mariner according to standard practices Any alteration or Signature deviation from above specifications involving extra costs will be executed only ) upon written orders,and will become an extra charge over and above the estimate.DAMAGES TO BUSHES AND OTHER vEGErAnoN'MARKS S ON HOUSE MAY Note: This proposal may be withdrawn by us if not accepted BE UNAVOIDABLE ANT)WE ARE HELD HARMLESS. Not responsible for water within(14)days. damage during construction. Owner to pay responsible legal fees for non- paYmatt.and applicable interest Cott pt*Ate of lfropo%al The above prices,specifications - and conditions are satisfactory and are hereby accepted. You Signature Q.y�l�, W are authorized to the work as specified. Payment will be made as outlined above. Signature Date of Acceptance. 3 l 3 i !a f x r" ; Department of Industrial Accidents . �+ Office of Investigations • rl Lafayette City Center / g 2Avenue de Lafayette, Boston,MA 02111-1750 'ems www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual):Sexton Roofing & Siding, Inc _ Address:P.O. Box 6327 City/State/Zip:Holyoke, MA 01041 Phone#:413-534-1234 Are you an employer? Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. 0 I am a general contractor and I 6. New construction employees (full and/or part-time).* have hired the sub-contractors listed on the attached sheet. 7. ❑Remodeling 2.❑ I am a sole proprietor or partner- ship and have no employees These sub-contractors have g. ❑ Demolition workingfor me in anycapacity. employees and have workers' p tY 9. ❑Building addition [No workers' comp.insurance comp. insurance.t required.] 5. ❑ We are a corporation and its ' 10.111 Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions myself [No workers' comp. right of exemption per MGL 12.©Roof repairs insurance required.] t c. 152, §1(4), and we have no employees. [No workers' 13.111 Other comp. insurance required.] *Any applicant that checks box#1 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 anew 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:Travelers Property CAS CO OF AM Policy#or Self-ins.Lic.#:7P,JUB0007898220 Expiration Date:6/4121 Job Site Address: 9 /...4-77/1../ /o4) f A City/State/Zip: ii/A4P-01ti7L4/4"( 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"France coverage verification. I do hereby certify under t ins and penalties of perjury that the information provided above is true and correct Signature: — Date: ' ii 3/2 ci 1.2/ Phone#: 413-534-1234 • Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority(check one): 1❑Board of Health 2❑Building Department 30City/Town Clerk 4.0 Electrical Inspector 5Iumbing Inspector 6.0 Other Contact Person: Phone#: ` E D YYY R ® 'CERTIFICATE OF LIABILITY INSURANCE DATE 06/09/2020 THIS CERTIFICATE IS ISSUED AS A MA i i tH 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 Kathi Hutchinson ORMSBY INSURANCE AGENCY (A/c T.1 .EA. (413)737-0300 {AX No): ADDDRFss: khutchinson@omubyins.com P 0 BOX 718 ; INSURERS)AFF IL ORDING COVERAGE NA # WEST SPRINGFIELD MA 01090 INSURER A: TRAVELERS PROPERTY CAS CO OF AM 25674 INSURED • INSURER B: SEXTON ROOFING &SIDING INC INSURER C: • INSURERD: PO BOX 6327 INSURER E: • HOLYOKE MA 01041 INSURERF: • COVERAGES CERTIFICATE NUMBER: 541733 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 POUCIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS: ILTR TYPE OF INSURANCE wvo POUCY NUMBER POLICY EFF- POLICY DQ' LIMITS (MWDOYYYYY) (NM/DCUYYYY) COMMERCIALGENERALLIABILITY ' - EACH OCCURRENCE $ DAMAGE TO RENTED CLAIMS-MADE OCCUR- PREMISES(Eaecaarence) $ MED EXP(Any one person) S NIA PERSONAL&ADV INJURY S GEN'LAGGREGATE LIMIT APPLIES PER: _ S • - GENERAL AGGREGATE $ • POLICY[ JET LOC PRODUCTS-COMP/OP AGG S ' OTHER S AUTOMOBILELIPelLrlY COMBINED SINGLE LIMIT S (Ea accident) ANY AUTO -• . .BODILY INJURY(Per person) $_ • ALL OWNED SCHEDULED AUTOS AUTOS N/A - BODILY INJURY Per accident) S • _ NON-OWNED. ' PROPbxI Y DAMAGE $ HIRED AUTOS AUTOS (Per accident) • _ S • UMBRELLA LAB i OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE N/A _ . AGGREGATE $ • DED RETENTIONS S WORKERS COMPENSATION - . - X EAIUTE I(i)RTH- • AND EMPLOYERS LIABILITY Y/N ' ANYPROPRIETORFARTNERJECECISTIVE EL EACH ACCIDENT S 1,000,000 A OFFICER/MEMBEREXCWnErr? NIA NIA NIA 7PJUBOG07898220 06/042020 06/04/2021 (Mandatory in NH) EL DISEASE-EA EMPLOYEE 3 1,000,000 If yes,desoibe under DESCRIPTION OF OPERATIONS below EL DISEASE-POLICYUMT S 1,000,000 N/A • • DESCRIPTION OF OPERATIONS I LOCATIONS r VEHICLES(ACORD'KM Addtion+I Remarks Schedule,may be attached RMore space Is required) Workers'Compensation benefits will be paid to Massachusetts employees only_Pursuant to Endorsement WC 20 03 06 B,no authorization is given.to pay claims for benefits to employees in states other_than Massachusetts if the insured hires,or has hired those employees outside of Massachusetts. This certificate of insurance shows the policy in force on the date that this certificate was issued(unless the expiration date on the above policy precedes the issue date of this certificate of insurance). The status of this coverage can be monitored daily by accessing the Proof of Coverage-Coverage Verification Search tool at w w JTIass.goviwd/workers-compensationfinvestigations/. - • CERTIFICATE HOLDER CANCELLATION k SHOULD ANY OF THE ABOVE DESCRIBED POLIChES BE CANCELLED BEFORE • ' THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. • AUTNORizEDREPRESENTATIVE • 1 (. Amherst MA 01002 _,:i Daniel M.Cr ey,CPCU,Vice President—Residual Market—WCRIBMA ©1988-2014 ACORD CORPORATION. Al!rights reserved. ACORD 25(2014(01) The ACORD name and logo are registered marks Of ACORD ' AC ® DATE(MM,DD,YYY10 . CERTIFICATE OF LIABILITY INSURANCE 626/2020 th 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 Ormsby Insurance Agency,Inc. PHONE FAX IA/C.No.Ertl: (413)737-0300 (ac NO)_ (413)737-0617 698 Westfield Street E-MAIL ADDRESS: West Springfield,MA 01089 INSURER(S)AFFORDING COVERAGE NAIC# INSURER A_ Colony Insurance Company 39993 INSURED INSURER B: Sedan Roofing and Siding Inc INSURER C:102 Pine Street INSURER D: Holyoke,MA 01040 INSURER E: INSURER F: I COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE US I I L)BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POUCY 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 �SUBR POLICY EFF POLICY EXP L7R TYPE OF INSURANCE 1N50 I WVD POUCY NUMBER (MM/DD/YYYY) (MMIDD/YYYY) LIMITS A X COMMERCIAL GENERAL UABILTTY 101PK0002159905 6/25/2020 6/25/2021 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED CLAIMS-MADE X OCCUR PREMISES(Ea occurrence) S 100,000 ' MED EXP(My one person) $ 5,000 PERSONAL 8ADV INJURY I$ 30,000 GEN'L AGGREGATE UMIT APPLIES PER: GENERAL AGGREGATE S 2,000,000 X POLICY jEo- LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER S AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT S (Ea accident) _ANY AUTO BODILY INJURY(Per person) S ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS HIRED AUTOS NON-OWNED PROPtx I Y DAMAGE S AUTOS _ (Peracdde t) _ S UMBRELLAIIAB _ OCCUR EACH OCCURRENCE S EXCESS UAB CLAIMS-MADE AGGREGATE S DID 1 RETENTIONS S WORKERS COMPENSATION PER OTH- AND PLOYERS LIABILITY YIN I STATUTE ER EM ANY PROPRIETORIPARTNER/E ECUTIVE EL EACH ACCIDENT S OFFICER/MEMBEREXCLUDED? j 1 N/A (Mandatory in NH) EL DISEASE-EA EMPLOYEE$ Eye desrn�e DESCRIPTION OunderF OPERATIONS below - EL DISEASE-POLICY UNIT S DESCRIPTION OF OPERATIONS!LOCATIONS I VEHICLES(ACORD 101,AddIona]Remarks Schedule,may be attached It more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS_ AUTHORIZED REPRESENTATIVE i (T.:ma C 3.LLQ.,,,a_.--- !III 111 ©1988-2014 ACORD CORPORATION_ All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD 1 , l' v' py �" .I III� �• . lj ffI t i Kit il r5 6 66 6 '" , z 1 1 f � �� 0 r. ti pi M M M l ' o'I At311111, ' ' .; .i ' ‘' -:11 Ati t ih :I 0 41 14 I I ' it I 2 . ,. :!,J, IP t " i' lid 1 r frill 1 fil: i '4, \ . ''.. 1 ... ...'' I ; 1. 4 lill , r7eir ' 0 I lip ii ! Jr' r , , . ] i 1 . 1 ' I NI : 5 1141 all 011 : If. I , g i 'j 1 frlo , • , thOpli 11 hp ' sr- :.' r if ' .ifi' i I ; [ it 1 siP t, puliti 01. 0 0 ;I; I . til ' i 1 I ki ..ttltiti --= - . pito [fot 0 1 i 0 grow ot t 4, r 1 as i .1 pl, 1 , isi• ' ,dip i I q 1 : 1 o%•, 1.-,.. Plitts 1 All 14 wi HI 41 a , :: ,,it• r , . 1,,,,. 4 $4,, G., till 1 ' 11 it , ' :“ p - cp3 ,4 . 1. I!! ! w I I rfll iiil , J1 ' EI i r r. 'I'' AW Rom® CERTIFICATE OF LIABILITY INSURANCE DATE(Y WDD/YYYY) 11/13/2020 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_ tf SUBROGATION IS WANED,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 CONTAputbm, Edson DeSouza MAYFLOWER INSURANCE GROUP INC No ,, (774)773 s7o2 FAX N)_ EMAIL @ �ADDREss: Edson@mayflowerinsurance.com 299 Court Street INSURER(s)AFFORDING COVERAGE NAIL# Plymouth MA 02360 INSURER A: HARTFORD UNDERWRITERS INS CO 30104 INSURED INSURER B: MNP CONSTRUCTION INC INSURER C: INSURER D: 45 EXCHANGE ST APT 3E INSURER E: MILFORD MA 01757 INSURERF: COVERAGES CERTIFICATE NUMBER: 595621 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 INDICAILU_ 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 TYPE OF INSURANCE ADM_SUER POLICY NUMBER POLICY EFF POLICY DDI YY LIMITS LTR INSDJ+wD _(MruUDDIYI'YYt MMRJOlYYY'() COMMERCIAL GENERALLUI,BILIY • EACH OCCURRENCE S DAMAGE TO RENTED CLAIMS-MADE OCCUR PREMISES(Ea occurrence) $ MED EXP(Any one person) $ N/A PERSONAL&ADV INJURY $ GENT AGGREGATE LIMIT APPUESPER GENERAL AGGREGATE $ PRO- POLICY • a LOC PRODUCTS-COMP/OP AGO $ OTHER _ S AUTOMOBILE LIABILITY COMBINED SINGLEUMrr $ (Ea accident) ANY-AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS N/A BODILY INJURY(Per accident) $ NON-O HIRED AUTOS AUTOS WNED (Per accident)ROPE AGE $ dent) $ UMBRELLA LIAB OCCUR EACH OCCURRENCE S DICESS LIAB CLAIMS-MADE N/A AGGREGATE $ DED RETENTION$ _ OTH- ER S WORKERS COMPENSATION X STATUTE AND EMPLOYERS'LIABILITY YIN ANYPROPRIETORIPARTNER/EXECUTIVE EL EACH ACCIDENT $ 1,000,000 A OFFICER/MEMBEREXCLUDED? N/A N/A NIA 6S60UB1K70970620 11/16/2020 11/16/2021 (Mandatory in NH) EL DISEASE-EA EMPLOYEE $ 1,000,000 It yes.desaibe under DESCRIPTION OF OPERATIONS below EL DISEASE-POLICY OMIT $ 1,000,000 N/A DFSr'RIPTION OF OPERATIONS/LOCATIONS I VEHICLES(ACORD 101,Adthlional Remarks Schedule,may be 411e.hed if more space is required) Workers'Compensation benefits will be paid to Massachusetts employees only_Pursuant to Endorsement WC 20 03 06 B,no authorization is given to pay claims for benefits to employees in states other than Massachusetts if the insured hires,or has hired those employees outside of Massachusetts. This certificate of insurance shows the policy in force on the date that this certificate was issued(unless the expiration date on the above policy precedes the issue date of this certificate of insurance). The status of this coverage can be monitored daily by accessing the Proof of Coverage-Coverage Verification Search tool at www.mass.govllwd/workers-compensationlinvestigations/. CERTIFICATE HOLDER - CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Sexton Roofing & Siding Inc ACCORDANCE WITH THE POLICY PROVISIONS_ 102 Pine St AUTHORIZED REPRESENTATIVE Holyoke MA 01041 Daniel M.C y,CPCU,Vice President—Residual Market—WCRIBMA ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD ACC-IRE) CERTIFICATE OF LIABILITY INSURANCE DATE("'"°DN'"Y) Ib.....------ 11/24/20 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 CONTACT NAME: Art Cali/810 One Family Insurance (Am.No, ). 978-403-5942 ( ,r,i0): 978-403-5943 1 Main St.Suite 15 AIL DAD : anglfamrlyinsurance.com Lunenburg,MA 01462 I NSURER(S)AFFORDING COVERAGE NAIC :SURER SURER A:6: Evanston Insurance Company INSURED MNP CONSTRUCTION,INC. INSURER C: 45 EXCHANGE ST APT 3E MILFORD,MA 01757 INSURER D INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE US I t11 BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POUCY 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.OMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR AUULSUUR POLICY OFF POLICY EXP LTR TYPE OF INSURANCE WNUMBER D VD POLICY (N{AIDDIYYYY),(MMIDDIYYYY) LIMITS r X COMMERCIAL GENERALLIABILn7 EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE x OCCUR DAMAGE TO RENTED pREMIaEb(Ea occurrence) $ 100,000 MED E P(Any one perms) $ 5,000 A Y Y 3ET9385 11/20/20 11/20/21 PERSONAL&ADVINJURY $ 1,000,000 G' GENT AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $ Z,000,000 RO- POLICY JE LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER $ AUTOMOBILE LIABILITY COMBINED SINGLE OMIT $ (Ea accident) ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILYINJURY(Peraccident $ AUTOS ONLY AUTOS ) HIRED NON-OWNED PROPERTY DAMAGE $ AU ILA ONLY _ AUTOS ONLY (Per accident) $ l UMBRELLA LIAB OCCUR EACH OCCURRENCE $ — EXCESS LIAR CLAIMS-MADE AGGREGATE $ Dm RETENTION$ $ WORKERS COMPENSATION I STATUTE AND EMPLOYERS'LIABILITY YIN ' OTH- ANY PROPRIETOR/PARTNER/EXECUTIVE I N/A EL EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? (Masedatory in NH) EL DISEASE-EA EMPLOYEE $ If yes,describe Icx r DESCRIPTION OF OPERATIONS below EL DISEASE-POUCY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (ACORD 1D1,Additional Remarks ScItedufe,may be attached if more space is required) CERTIFICATE HOLDER • CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN SEXTON ROOFING SIDING INC ACCORDANCE WITH THE POLICY PROVISIONS_ 102 PINE ST P.O.BOX 6327 AUTHOR®REPRESENT A HOLYOKE,MA 01040 4 +, f. I 0 i988 2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD