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29-614 (3) 55 STONE RIDGE DR COMMONWEALTH OF MASSACHUSETTS BP-2021-1774 MapPermit: Exterior 2es614 001 CITY OF NORTHAMPTON Permit: Exterior Res PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) BUILDING PERMIT Permit# BP-2021-1774 PERMISSIONIS HEREBY GRANTED TO: Project# Contractor: License: Est.Cost: $14500 SEXTON ROOFING CO Const.Class: Exp.Date: Use Group: Owner: KROSOCZKA JARRETT J and GINA Lot Size (sq.ft.) Zoning: WSP Applicant: SEXTON ROOFING AND SIDING INC Applicant Address Phone: Insurance: P O BOX 6327 (413)534-1234 HOLYOKE, MA 01041 TO PERFORM THE FOLLOWING WORK: ISSUED ON:08/24/2021 STRIP&SHINGLE 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. Signature: QQ 19 'kg1�A Fees Paid: $40.00 212 Main Street, Phone(413)587-1240,Fax:(413)587-1272 Office of the Building Commissioner - IL, . The Commonwealth of Massachusetts ,Iwt. ' Board of Building Regulations and Standards FOR Massachusetts State Building Code,-780 CMR,7th edition MtJ2. R TY Building Permit Application To Construct,Repair,Renovate Or Demolish a Revised Janvary -----.. One-or Two-Family Dwelling 1,2008 a This Section For Official Use Only z o Bull ermit Num er: Date Applied: o =c Sign o iN� rn Building Commissioner/Inspector of Buildings Date ' `� SECTION 1:SITE INFORMATION 0 1.I'F r y Aoid]ress: / 1.2 Assessors Map&Parcel Numbers i ni — r` 1-�.( Y'z-.. kri ct K- l-` - o z 1.1a s an accepted street?yes no Map Number Parcel Number 1.3 Zon ng 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 Cheek ifyes❑ - SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of Record: /� IA i g, -- k(1.0 s cc 2 <<4 - Cs—c5-k4-.'- R 4 fit 2 - W' (1( . 1' V h-L-"' - Name(Print) i - Address for Service: . .0I.. /z4,-A-4h-1V, C., (7-236 - 41(5-1- . - • 1 Signature Telephone - - SECTION 3: DESCRIPTION OF PROPOSED W'ORK2(check all that apply) _New Construction 0 Existing Building Q•-Owner-Occupied Illy—Repairs(s) ❑ Alteration(s).0 Addition 0 Demolition 0 Accessory Bldg.❑ Number of Units I , Other ❑ Specify: Brief DeKription of Proposed Wor 2 f / e Pt 6 a4 k,l . Ir et ,L c C/ ,,' %i v,/�..c' e'2-.eel c_ - 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 $ El 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 No3( 7 Check Amount:_ Cash Amount: 6. Total Project Cost: $ 4 j( ,Z,b.— El Paid in Full 0 Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES(� Si. Construction Supervisor License(CST) 97 I ?Q Frer?/ / . e t ion Licenserhnnber "bi{;cratio'n Date Naammee}ofCJS�L�Holder/ �J ) /1 1-13 / CJ 4B0( (�/ t List CSL Type(see below _ No.and Street Type Description / o Ye ,77j� /}i/).�f/ U Unrestricted(Buildings np to 35,000 Cu.ft) j d J f // �J tl I j R Restricted I&2 Family Dwelling CityfT State,Lll' Mnry RC _ Rooting Covering WS Window and Siding SF Solid Fuel Burning Appliances I Insulation - - Telephone Email address D Demolition Si Registered Home Improvement Contractor CHIC) 0tfi C 1 9,3 \_� X-i-6 �`3 o(r'//1and3/Wild Jun HIC Registration Nnunber £apiration Date HIC CompanyName or ,Registrant Name No.and Street •�ex oar )7/z1�'p/ Q(/,(.i1"'/ PEJ d/41-5(/ '//3-53!{-/�. address Cityn14wn,State,Lill Telephone SECTION.6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(NLG.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 ' 'irk' No ❑ SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WREN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I,as Owner of the subject property,hereby authorize y. ek(vf) (,ld(,t c_ii(,f!?q 2 e to act on my behalf,in all matters relative to work authorized by this building demur application. CZ/7/TO, /7/TO,r ( ehpr s /1t/7 l Print Owner's Name(Electronic Signature) 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: 1.. 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 Improvr,u4cr t Contractor(HIC)Program),will and have access to the arbitration program or guaranty fund under M.G.L..c.142A_Other important information on the H1C Program can be found at www.mass.gov!nca Inforrrattion on the Construction Supervisor License can be found at}«iv_tnass.i-tov_-( s 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 systcur Enclosed Open 3. "Total Project Square Footage may be substituted for"Total Project Cost' City of Northampton 00. ♦MPt; <5...�...SI Massachusetts tA � ( t. DEPARTMENT OF BUILDING INSPECTIONS 212 Main Street • Municipal Building C� Northampton, MA 01060 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 6-0 r ( G � -t/UU The debris will be transported by: Name of Hauler: ss c I /J &/ l S u, f t.Ae( e (A4 Signature of Applicant: Date: �' / i /e— / • MNI p".; p/A o ,u: • Yee, qc- ;- /,.; fp' ••,!er TT 120v. • ;419f sli q6pt.!2 u,-er)fpul.? 1.1..oti MUSK 7.1O R1 '• JCF fl16 1:;.0Ar:c.3.1?Owor Io` 22-4' q oqo 04 11103: /V.!' Ell::: ,./../.1101,1 Mit • CO1iLnCiIO4 DF. IP iEEThY,LL kw . ? • : 1;k.. Vrbs111.1 ALVA, t..? 1'5":1 •••; Mt, • rev.-•-•,5•,•:..)..n•-•,•,, rrrA oz. .jecT..4,:psur.b4:01., • ropolSar SEXTON ROOFING AND SIDING INC www.sextonroofing.com 'NO - P.O. Box 6327 tux- Setting the Standard f J` 4-• Holyoke, MA 01041 ww■ iRl araw mmAns p. 413.534.1234 f. 413.539.9906 MA HIC# 118239 sextonroofing@hotmail.com SUBMITTED TO Jarrett Krosoczka PHONE 617-230-4198 DATE 6/24/21 STREET 55 Stone Ridge Dr jarrett@studiojjk.com CITY,STATE,ZIP Florence,Ma. roofr SEXTON ROOFING HEREBY SUBMITS SPECIFICATIONS AND ESTIMATES FOR: 1) Strip and remove existing shingles and dispose of in proper landfill. 2) Inspect roofing deck and replace as needed @$105.00 per sheet. 3) Install new metal edging to rakes and eaves of roof. (white) 4) Install ice and water shield on eaves(6'), vent stacks, in valleys, chimney, and at intersecting roofs. 5) Install synthetic roofing underlayment 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 manufacturers' specifications. 9) Install new cap over ridge vent. 10) Replace existing skylight @ $300.00 labor plus cost of skylight. 11) Supply manufactures Lifetime warranty and SRC 5 yr. workmanship warranty. ATTENTION HOMEOWNERS:PLEASE COVER ALL PERSONAL BELONGINGS IN THE ATTIC,GARAGE,OR STORAGE AREAS DUE TO POSSIBLE ROOFING DEBRIS OR DUST COMING THROUGH CRACKS OF WOOD DECKING. We Propose hereby to furnish material and labor-complete in accordance with the above specifications,for the sum of Fourteen Thousand Five Hundred DOLLARS (�14,500.00J PAYMENTS TO BE M� FOLOWS: due in full upon completio All Material is guaranteed to be as specified. All work to be completed in a Authorized / workmanlike manner 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 PIMP estimate.DAMAGES TO BUSHES AND OTHER VEGETATION'MARKS ON HOUSE MAY Note: ' is proposa . ' fie withdrawn by us if not accepted BE UNAVOIDABLE AND WE ARE HELD HARMLESS. Not iesponsible for water within(14)days. damage during construction. Owner to pay responsible legal fees for non- payment,and applicable interest. tteptante of Fropo%al The above prices,specifications and conditions are satisfactory and are hereby accepted. You Signature are authorized to the work as specified. Payment will be made as outlined above. Signature Date of Acceptance. • • • • • • • • • 'I" I frfs't/ ' • • ' t: F ;. :1- : — • - • fit.000'gt • " ! pr , • • - ' • ° ;44 - 7: • War" ono !a nbot: casAshr•tte);, \ • --• k.%N4,‘Arnmkumt+13qVf-Nril.".e. a-e vpiP5t. ccwt a:K-0 mat\%urn: e it‘% :. _ „ • • • • e.f ffirm"-41 ,:"r,fetfitr- e • !if •••:1; •,•1;•i, ; ••••; ' ' ' • Jonca 214-c */ • Now*3/!1.,; "ti4lut1fljJ 'ts infu-74 .14Cfrt r.rt.I.+0 .0 ;. tr• Ty° yur 'e ,IGP. lc!br ; (14I...-91L 744* ",-"Ot...1 tA„,1: ”r.f) -)tra irnf•J • pfivil„..i Es>oi:11 ,31.) L‘1014:!iic-C,I i; LOOI, ti",c, crt;jc; ?U:ILF7.1' 'itfri .46111 6401!iii! 1..nrc.L'rug (re sic,ttscr.; qtri: ".. e /1.-•c-qc1 ;1,1Cli.11(1 • •-• 'Lc) Itmlop..4 r,fp.4.1tit quiet btokr.! • . ID •,z' • • , • _ . I. • :,;:Air•• . _ • : • (• 0.- • • • • irrlifxtrt•wt.ipeciVaVer,461.4, ljFT , — • - • • • EX.10114 001141Itle 2ID-1101.43 IT/IC • • bLotoRqt 4 a Dqp.-rtrninir-of Industri4Accidei 47 . . , • ., . • -tg ,71, - • of Offi ce investigcraons . . . . • . . -Lafayette.City Center • ft: ' Pl....,. 1,.7 - 2.A7enzrs deLcrfayett a, Boston,M.A.021Lt-.1750 . • - -- :.,_•-•—",•t-ci Tom. .inass-govicli-a . • Worker S' Compensation InsuranciA±filiv..ii.Bclers/ContTaaars/ElectticiansItlunibers ••• Applicant Information • -' ' Please Print LezailY• . - . • . . • Nameo3u#essiCergadiFtitsmilIndividnaly.SeYton Railing&Siding, Inc . , • • • • • . . . . • • - . , : . •• 1/4 • . Addiess:P.O. Eqx 637 , ; • . .' : . , . . . • . Cityistate/ip:Holyoke,.MA 01041. ' * phone Ai;41Z-564-1234 • _ . . Are you an employer? Check the appropriate box . - Type ofproje4.(1?-•11°-tredY: I.0 I aca a eniployer viith ' 4. IN I am a general Contractor•and-I , II„,„.._ __ '''''____,.., .,• • have lur''ed the sul- coldr:actons 1---1'c' '''a en1PloYees:(Thu aorl/orparr4olej.*. 2-0 I am a sale pop zietor or Farther- ' lifted on.the atta'rhed Sheet. : 7. D R.qmorlel- T$ . . •. • .. amp and.haFe.no trap,loyees , l'he,se-scb-cOntractrha-ve ' g_ Dbetiacion ... walking for me in atiy capacity. - , - ';i'FPloi'iail and hate woncers' 9. 1=1,-Bri'lriing.adiii1-ion, - [No worker? comp..aim-mice -. • ca]Iip_instranciJ I:palm:4.mi] , • • . . 5. We#e a corporaliaa and ifs ' 10E1. EleCi EldCal repairs or addhicHas • 3.t:I.ma a homeowner dp-inz all work . . ' a-5cfirslave ercised.. 11.0.Phin-144-tepairs or sectitioris rayself [No wickets' 4114. . ' MgaL." .a.6ILL-Lj Lion 1:1!TIfiGi.' : . 121:g izaf repairs , ihsorarrp regalia:1j t ' , •-O.152 0(4),aralwe have no '• employees. [I••To worker s-'• . ;lip Other • ., ,, comp.ir-Sttrap.±requir. ede] . • . . *Any ao-Ti.eamt-that alaeelm lax--#13:caask-al.sia n cc-sea ul telori shaving-131ex wox3= caens-ad=Polic7 igr:C=.LICEL ' . t Ircanermmeri who sulioidt-Us afEdavitindisiiiogthey-are dthing all vork auatlaen..13he outside contractra-sraust-pbrthlamew affidaaolinclicarting-sera. - ,1•Confractorsthat check-this' laarzanst a±taeled an additimaal sheet slao:wingthememocof the sab-contractors and.State-whether or ntitthoie=titles ham einployezz.Ithie s:ab-ereatrasetdielakve employeit;theY raitatInovide Their 9/17/.1*e ceinp-poli#y=ben . : . I Pi/S tat=play&th4t frprtrviding-workers'cOrupensothiniusztrour.iforaity ebayeex .Below is the paiLy cadjob • infmarlatio.riZ - ' . - . , • . . . - - ,L:=1,c,,,,Lavary liame:Travelers proprty CAS CO OF AM • • „ • . . . , • , . • . •,, • Polic4 orelf-ins,.11 .,i;:7PJUBOG0789822f . • • - .. 'EsiorrationDate:6-141.21) ' - ,,',are'•- lob Site.:Address: _)...1 - S-1eiti--.. '114 dep2... ' . .City/State/TT: )1/1 4.41 . . Attach a copy of the workers'compenp-t4m.policy deciaratio-n page(shcrwing the policy rronl:•er and eilOration date). .agrre to secure coverage as:retiOirecl.tradefSection 2.54 ci-01iE;i1,c.152 carileadto the inlposition of iciniin' al:pt.:n*1e.ea - 'foe up to$1,500.01 arEd/or one-year impdsonmbrt,as well as civil penalties in the foimi.of&STOP VOt.E.twdDIEFLand a fine ;.-•• of rip to r..-,56.00A day against-41e.iigla:toi. Be .4:tv.-Isedtat:a Copy of thxsitaterne4 maybe forgacraeclia it le 0- ce of jiaresligafiarmoithe DIA for#itirance coverage verificition. • . . . . . . - . , . , . I do:hei-eby cerii-As unrici thp -- ccrul Fel'arties•ofpednaY thrrt the ii;formsclthaprovidect ahoy is tate acid con7ect • • , . . . •. • Date:• • ' ..* sP I ' -I . Sima6re: • , • - ' ' 4-1•1-5.3+1.23.4 . ,. . , . - • . • . . Phone if: • • • - • , . ,• . . . , . . Off...ciccl use oily. Do TICIPirritehl tkis area,ip be completed by city or lawn official . • • . • • , - .. . .. • • • • ' •City al-town: - • •. • . . .. •iermitd4cen.le# • • . . - . , ' Issuing Authority(check one): • • • • . . • .... ,. • . if3Board of Health 2.11BrildingDepartmeat 3.C1Cityfrown Clerk 4.031ectrical Inspector 417eIn:mling • • Inspector 6.0.0Ther •, . . .. . .• . . . Contact Person:. • .• . . • Phone ; • - • , ' — - . . . .• • - • • . .. •. . • . - - ' . I • • ACC)REI® CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DONYYY) 06/14/2021 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; Eric Dembinske ORMSBY INSURANCE AGENCY (A/CN EMI: (413)737-0300 FAX (A/C.No): E-MAIL • ADDRESS: edembinske@ormSbyins.Com P 0 BOX 718 • INSURER(S)AFFORDING COVERAGE NAIC# WEST SPRINGFIELD MA 01090 INSURER A: TRAVELERS PROPERTY CAS CO OF AM 25674 INSURED INSURER B SEXTON ROOFING & SIDING INC INSURERC: INSURER D: PO BOX 6327 INSURER E: HOLYOKE MA 01 041 INSURER F: COVERAGES CERTIFICATE NUMBER: 665015 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 SUER POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD, POLICY NUMBER (MM/DD/YYYY) (MMIDO/YYYY) LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS-MADE OCCUR DAMAGE TO RENTED PREMISES(Ea occurrence) .$ MED EXP(Any one person) $ N/A PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER • GENERAL AGGREGATE $ POLICY PRO- ' JECT • LOC PRODUCTS-COMP/OP AGG $ OTHER • $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO BODILY INJURY(Per person) $ - ALL OWNED SCHEDULED AUTOS AUTOS N/A BODILY INJURY(Per accident) $ HIRED AUTOS NON-OWNED PROPERTY DAMAGE _ AUTOS (Per accident) UMBRELLA L1Aa OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE N/A AGGREGATE $ DED - RETENTION$ $ WORKERS COMPENSATION H � STATUTE ER • / AND EMPLOYERS'LIABILITY Y!N ANYPROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 1,000,000 A OFFICER/MEMBEREXCLUDED7 N/A N/A N/A 7PJUBOG07898221 06/04/2021 06/04/2022 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below EL DISEASE-POLICY LIMIT $ 1,000,000 N/A DESCRIPTION.OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached 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 atwww.mass.gov/Iwd/workers-compensation/investigations/. 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 Daniel M.Crckhy,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 --''—"" SEXTO-2 OP ID:KH A��� CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDrCfYY) 07/07/2021 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 413-737-0300 NAME CT Eric Dembinske Ormsby Insurance Agency,Inc. PHONE 413-737-0300 I FAX 413-737-0617 698 Westfield St PO Box 718 (A/C,No,Ext): (A/C,No): West Springfield,MA 01090 E-MA1Lss:edembinske@ormsbyins.com Eric DembinskeADDRE INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Northfield Insurance Company INSURED INSURER 8:Quincy Mutual Fire Insurance 15067 Sexton Roofing&Siding,Inc. PO Box 6327 INSURER C: Holyoke,MA 01041 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO 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 ADOL SUER - POLICY EFF POLICY EXP I TR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MM(DD/YYYYI (MM/•D/YYYY) LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE X I OCCUR WS45073 06/25/2021 06/25/2022_PREMISES(Ea occTurrDence) $ 100,000 MED EXP(Any one person) $ 5,000 PERSONAL&ADVINJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POUCY JECT LOC PRODUCTS-COMP/OP AGG $ 2,000'000 OTHER: B COMBINED SINGLE LIMB $ AUTOMOBILE LIABILITY 1,000,000 (Ea accident) $ ANY AUTO AFV206561 05/15/2021 05/15/2022 BODILY INJURY(Per person) $ OWNED SCHEDULED AUTOS ONLY X AUTOS BODILY INJURY(Per accident) $ X AUTOS ONLY X AUUTOS ONELY (Pen ccident)p AMAGE $ $ UMBRELLA UAB OCCUR EACH OCCURRENCE $ EXCESS UAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y/N TO BE ISSUED SEPARATELY STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE EL EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? N/A (Mandatory in NH) EL DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below EL DISEASE-POLICY LIMIT $ DESCRIPTOR OF OPERATIONS/LOCATIONS/VEHICLES (ACORO 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 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. • AUTHORIZED REPRESENTATIVE ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD J4 tILO aacELar.rliaul=aa MALOI..rD S4F3 = / 911 a( Wcalcolic"maqawq,/xlihogiw- 4°!frQdfiis;432v1PcrPiio- Up! itrP si 1 11A1 3_Y=+ °=110 zicil01P -1°3_l.Elam SY_LUW V -I":- 4 QD)Q L1bo 7L t`011U°c ) 4 #1-‘ T cu cfq joikpufi wo_e_okk\=:relifacduito gg -nFsot m ,mmpsix-r..ea tramoc - _ C am„"= odo°rzl ort Tiar§ r s00.71jP°20 c . 0 T'L�T'LIIIZI na or Ir°1 b.CI $ act - "tea`FT'rrissl z tragraISILCO III . _r L3'- Ek —qfL— =gam .afr .D A(1 v'' C 7ARENcLEWntilLIIIVIMUHELL Bala an:mace 96I spa I =N ACQR D CERTIFICATE OF LIABILITY INSURANCE 11/13/2020 THIS CERI IHCATE IS ISSUED AS A MATTER OF INFORMAiiON ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS OERT1FICATE 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 PRODU(,i:714..,AND THE CEkIIFICATE 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 right;to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT N E Edson DeSoitza MAYFLOWER INSURANCE GROUP INC „o Esti_ (774)773--9702 FAX E-MAILEdson m w erinsulance.com AnoR>=ss: @ �10 299 Court Street msuRER(5)AFFORDING COVERAGE NA/Cr 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 mrsuRER.F: COVERAGES CERTIFICATE NUMBER: 595621 REVISION NUMBER THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE US)Ell BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICAItU_ NOTWITHSTANDING ANY RECIUIREMENT,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_ IN-SR I ADOLSUBR POLICY EFF . POLICY EXP LTR TYPEOFINSURANCE -INSZ WI/D POLICY NUMBER I rmurnoTYYYY) (YMIDDi-ecru LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE - S DAMAGE TO RENTED CLAIMS-MADE OCCUR PREMISES(Ea oaamence) S MED EXP(Anyone pion) $ N/A PERSONAL&ADV INJURY $ GFNLAGGREGATEUMrTAPPL)ESPER: GENERAL AGGREGATE 5 POLICYI SCOT- LOC PRODUCTS-COMPtOP AGO S OTHER _ 7 AUTOMOBILE LIABILITY • COMBINED 5iNGLF LIMIT $ {Ea aoadenn ANY-AUTO - BODILY INJURY(Pet pace) S ALL OWNED —SCHEDULED N/A BODILY INJURY(Per acdenI) s _AUTOS AUTOS " NON-OWNED PROVEKTYDAMAGE $ HIRED AUTOS AUTOS {Per acvdent) $ UMBRA I Al rGR OCCUR EACH OCCURRENCE S DCCESSLAB CLAIM-SMADE N/A AGGREGATE S DED RETENTIONS - S WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY x I STA7lITE I ER Y!N ANYPROPRIETORJPARTNER/DCEGVnvE EL EACH ACCIDENT S 1,000,000 A OFR1csrumeEBERECLUOE0? WA WA WA 6S60UB1K70970620 11/16/21320 11/16/2021 (Marsdainry in NH) ELDISEAZE-EA etIPLOYEE S 1,00.0,000 If yes,de-s=ibe under DESCRJFTON OF OPERXOONS blow EL DISEASE-POLICY LIMIT $ 1,000,000 NIA OFcr'RIFITON OF OPERATIONS)LOCATIONS IVHHICLES(ACORD 101,Addi6mai Reme,i,e J.cletdute,may be.,Lte...,ed rfmoresyere is required) • Workers'Compensation benefits will be paid to Massachusetts employees only_Pursuant to Endorsement WC 20D3 06 B,no authouiLation 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 Maacachusetts. This certificate of insurance shows the policy in force on the dale that this certificate was issued(unle the expilatam date on the above policy precedes the issue dots of this certificate of insurance)_ The status of this coverage can be monitored daily by arsocsing the Proof of Coverage-Coverage Verification Search tool at wwlv.mass_govllwd/workers-compensattor/irrvestigations/_ • CERTIFICATE HOLDER • CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES SE CANCFI I Fr)BEFORE THE EXIIRATiON DATE THEREOF, NOTICE WILL SE DELIVERED IN ACCORDANCE WITH THE POLICYPROVISiONS_ Sexton Roofing & Siding Inc 102 Pine St AUTHORIZED REPRESCNrAITYE Holyoke MA 01041 Daniel M_Cr v y,CPCU,Vice President—Residual Market—WCRIBMA 019B3-2014ACORD CORPORATION, All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD ACQRICY CERTIFICATE OF LIABILITY INSURANCE f I 1124/20 • THIS CERTIFICATE IS ISSUED AS A MAI I ER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER THIS "CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALl tK 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 ceriihGate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or he endorsed_ If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement Astatement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s)- PRODUCER CCM ALT pume Art Calvillo One Family Insurance I PHONE4 , i, 978-402'542 (A c, No): 978-402-5943 1 Main SL Suite 15 E-MAIL ADOREs: art 1 nsarance_co @ familyi m Lunenburg,MA 01462 INSURER(5)AFFORBT G COVERAGE NAIC* INSURER A: Evanston Insurance Company INSUILu INSURER B: INNP CONSTRUCTION,INC. INSURER C: 45 EXCHANGE ST APT 3 E INSURER D: MILFORD,MA 01757 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CEFZIIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, I t-!M OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY EE ISSUED OR MAY PEK RAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALLTHE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS_ INER ADOLoUBR POLICY EFF POLICY RE' r LTR I SYt OF INSURANCE INSD YND POLICY NULdEER IMLd1DolYYYY) (141.11IOD/YYYY1_ LIMITS j< cosfis RCIALeefeetd_uAeILIrT EACH oCCURRENCE S 1,000,000 DAMAGE TO RENTED 100,000 CLAIMS-MADE X OCCUR FREMISto(Ea occurrence) S MED EXP(Any one person) S 5,000 A Y Y 3bI9385 11120120 11/213f21 PERSONAL&ADV INJURY S 1,000,000 GEN'LAGGREGATEUMTAPPUESPEZ GENERAL AGGREGATE S 2,000,000 POLICY JE LOC PRODUCTS-COMP/OP AGO S 2,000,000 5 OTHER: _ NED AUTOMOBILE LIABILITY - CO(EaWi t)SINGLE LIMITS ANY AUTO BODILY INJURY(Per person) S OWNED ^AUTOS LIED BODILYINJURY(Per aralent).S AUTOS AUTOS ONLY HIRED NON-OWNED PROPERTY DAMAC- S AU I CA ONLY AUTOS ONLY (Peracaderd1 S UMBRELLA LLAB OCCUR EACH OCCURRENCE S Err:-tiff L1AB CLAIMS MADE AGGREGATE S CEO RETENTION S - S WORKERS COMPENSATION PER DTH- , STATUTE ER AND EMPLOYE LIABILITY Y/N ANYPROPRIETOR/PARTNER/EOCUTPIE NIA FL EACH ACCIDENT - S OFFICER/MEMBER ECCLUO ED? (M.untaI,yln NH) EL DISEASE-EANPLOTtt 5 If yes,describe under . DESCRIPTION OF OPERATIONS below ,El._DISEASE-POLICY LIMIT S O ESCRIFTION OF OPERATIONS!LOCATIONS!VEHICLES (ACORD 1111,AddiIvrol Rna,ak Schedule,may he.rr Ja,d if more space is required) CERTIFICATE HOLDER - CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCF1 I FT-)BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS- SEXTON ROOFING&SIDING INC " 102 PINE ST P.O_BOX 6327 AUTHORIZED RiPRt=seiTA �� HOLYOKE,MA 01040 - �el{+` ©1983-2015 ACORD CORPORATION_ All rights reserved_ ACORD 25(2016/03) The ACORD name and Togo are registered marks of ACORD