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18C-067 (2) BP-2022-0703 203 PROSPECT AVE COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 18C-067-001 CTTY OF NORTHAMPTON Permit: Alts Renovations Repair PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) BUILDING PERMIT Permit # BP-2022-0703 PERMISSIONIS HEREBY GRANTED TO: Project# INSULATION Contractor: License: Est. Cost: 7631 102169 Const.Class: Exp. Date: 12/10/2022 Use Group: Owner: M I KIC BORJANA Lot Size (sq.ft.) Zoning: URB Applicant: COZY HOME PERFORMANCE Applicant Address Phone: Insurance: 180 PLEASANT ST#200 4135290200 46-845373-01 EASTHAMPTON, MA 01027 ISSUED ON:06/14/2022 TO PERFORM THE FOLLOWING WORK: INSULATION/WEATHER I ZATI ON 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: Final: Final: Final: Rough Frame: Gas: Fire Department Driveway Final: Fireplace/Chimney: Rough: Oil: Insulation: Smoke: Final: THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Signature: , A -2 ' �'� • Fees Paid: $65.00 212 Main Street, Phone(413)587-1240,Fax:(413)587-1272 Office of the Building Commissioner s , �� !jam_ The Commonwealth of Massachusetts ✓ /V �` J Y, Board of Building Regulations and Standards �N r Massachusetts State Building Cod,i, 789 CMR 4 'IP I SE ALITY Building Permit Application To Construct, Repair Rend emolish a Revis d Mar 2011 One-or Two-Family Dwelling ,,q,,I;'n r ,, This Section For Official Use Only `'?;�o'oNc Buildin Permit Number: 6a- A - 70.. D e Applied: Cv10 / 13 ZOzZ Building Official(Print Name) Signature Date SECTION 1: SITE INFORMATION 1.1 Property Address: 1.2 Ass ors Map&Parcel Numbers �- A ao3 Prose ccve ( YC 00 7 1.1 a Is this 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 yes❑ SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of Record: Boc- )r.°+ 1^n'k K t L N o Cam(-r,,Arr�Ottrn , m A- 0 (0 GO Name(Print) City,State,ZIP Z03 PCO5(:)ec-- c UL '-03 -320 - 3222, bo(-)�rci, cr tlLic 123 43rrw.0• ccw, No.and Street Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply) New Construction 0 Existing Building 0 Owner-Occupied 0 Repairs(s) 0 Alteration(s) 0 Addition 0 Demolition 0 Accessory Bldg. 0 Number of Units Other IrrSpecify: In Sa(cckcry, Brief Description of Proposed Work2: 'IAc-ss a+ue ihs(,,, c.Jar ) wet41-0- ,7 . e , rl\-4..05( .r-e-4 - 1 A*rc 0 Cr2-4 ©rc NA—V c ecL SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1. Building $ 9 ,1g 3 t . q 1. Building Permit Fee: $ Indicate how fee is determined: 2.Electrical $ ❑Standard City/Town Application Fee ❑Total Project Cost (Item 6)x multiplier x 3. Plumbing $ 2. Other Fees: $ 4. Mechanical (HVAC) $ List: 5. Mechanical (Fire $ Suppression) Total All Fees: $ QQ r Check No. 2.(JatCheck Amount: 0� Cash Amount: 6.Total Project Cost: $ , b J l , 8`l 0 Paid in Full 0 Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) c:55L..Inai6 q 1 1aA1o\' rn ft R K L!.Q/�k r Z. License Number Expiration Date Name of CSL Holder L 1 a o P-ea s An. s ¢01 O 0 List CSL Type(see below) t No.and Street Type Description { - /y U Unrestricted(Buildings up to 35,000 Cu.ft.) C HA i1f1 PhM) MTt '31Oc).') R Restricted l&2 Family Dwelling City/Town,State,ZIP M Masonry RC Roofing Covering WS Window and Siding p SF Solid Fuel Burning Appliances 111 3"Sri-nt 0 MN ItA5e rQ My co Zy iviiC'.Co)►1 I Insulation Telephone Email address D Demolition 5.2 Registered Home Improvement Contractor(HIC) ic.a. -i O . 5 I d3 Co z Nome V ( O'm SQ C. HIC Registration Number Expiration Date I'dI Co pan Name or HIC Registrant Name 4 P)e 4. A n St o(� �'Ytai+�v.�eir Q my�a2I\ONA..(ate No.and Str et Email address c.as �� kc u ri\P O'Ua.^) H13-5ila- c* City/Town,Statt,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. SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN CONTRACTOR OR OWNER'S AGENT APPLIES FOR BUILDING PERMIT 1,as Owner of the subject property.hereby authorize CO 2 t tV rn't. Q,e r 4V(iv\AA(t to act on my behalf.in all matters relative to work authorized by this building permit application. * Nt- 1\ - Rtn�l�ot't2o.- `- z m •InditAc1 u c Lo i /a - Owner's Signature Date I SECTION 7b: APPLICANT DECLARATION • By entering my name below.I hereby attest under the pains and penalties of perjury that all of the information contained/in this application islItrue and accurate to the best of my knowledge and understanding. Contractor//Owner s Agent/Owner ignature Date 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 Improvement Contractor(HIC)Program),will 11Q1 have access to the arbitration program or guaranty fund under M.G.L.c. I 42A.Other important information on the HIC Program can be found at www.mass.gov/oca Information on the Construction Supervisor License can be found at www.mass.gov/dps 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" The Commonwealth of Massachusetts Department of Industrial Accidents i Office of Investigations i Lafayette City Center -J 2 Avenue de Lafayette, Boston,MA 02111-1750 1f �/ www.mass.gov/dia Workers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): C 2 kome, Per AI.rmanCe Address: I Ito PIpaS(wy+ -r , Stet 200 City/State/Zip: ecl.Si-Lar • r rt m r - '7 Phone#: i-\\3 - 527 -0 2n v Are you an employer?Check the appropriate box: Type of project(required): 1.® I am a employer with 7 4. ❑ I am a general contractor and I employees (full and/or part-time).* have hired the sub-contractors 6. CI New construction 2.❑ I 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. employees and have workers' 9. ❑ Building addition [No workers' comp. insurance comp. insurance.: required.] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑ Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL I2.0 Roof repairs insurance required.]t' c. 152, §1(4),and we have no employees. [No workers' 13.[ Other /vise.(et1ttn-1 comp. insurance required.] • *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. 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. 1 am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. /�� Insurance Company Name: COvI4AYNee llcetmnii-y CO Policy#or Self-ins. Lic. #: L,to — $c{5 3'i,3 -01 -1'7 Expiration Date: i i IO2 12c22. Job Site Address: 203 Pr'"sP4-c-r five_ City/State/Zip: Cs.“4 ctrr-P m ,714 0/0(00 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 certi under the pains an penalties of perjury that the information provided above is true and correct. Signature: 14,11 Date: (0171a, 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(check one): 10Board of Health 20 Building Department 31:City/Town Clerk 4.1:Electrical Inspector 50Plumbing Inspector 6.0Other Contact Person: Phone#: sue?' City of Northampton r• 1:A i )1. Massachusetts ��S` �f'� ,�` DEPARTMENT OF BUILDING INSPECTIONS F212 Main Street ••Municipal Building J�3 `tea :: Northampton, MA 01060 sph, "3,")� 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: L 03 PrcsPecr Acre , k)n r--kt— n-10 -Y, (Please print house number and street name) Is to be disposed of at: Q r a Dn ,A-c ",10 - 'e \go PIS &r\r SP ahA.'oR X01 4C I 3.3L �t \v',.1L Q"CI W0rl kiv (Pleas print na e and location of facility) v P Or will be disposed of in a dumpster onsite rented or leased from: (Company Name and Address) Signature 4.-24 -'6rg ermit Applic nt 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. mass say..4 a 1 - 0 her za to • Based on your Energy Specialist's recommendations.your home can benefit from program-eligible insulation and/or air sealing improvements.Before moving forward,please see the steps below to remediate your weatherization barrier(s). CUSTOMER INSTRUCTIONS 1.A qualified,licensed contractor will be assigned to evaluate your weatherization barriers)at no cost to you and will call to schedule. 2.The contractor will complete and submit a copy of this form.If the contractor is unable to clear the barrier,the contractor will provide you a quote for additional services and/or parts. it is recommended to get multiple quotes for work needed beyond the evaluation visit.You are not required to use the assigned contractor for remediation. CU.,Tnt1ER INFORMATION-:7 ,..,t ,b; rr ;r zir,' owner Name: Borlana Mikic _ Project ID(s?: 4485557 Owner Occupied:0 Number of truit,:1 Phone Number: 4133203222 —Email: borjana.mikic123@gmaLcom (Site Address:zoa Prospect Ave City:.Northampton _ State: MA ZIP:01060 V crcmnaceutobepen u ornd Owner Signature: Bo_r' Jifa Mom Date: 04/26/2022 KNOB nNi.) 1 UbE WlR;NG OR RECEi;rU LIGhi.I?NGLVALUATION To determine If there is any active knob and tube(K&T)wiring,a MA licensed electrician will evaluate the following areas where eligible Mass Save weatherization recommendations have been made: Energy Specialist Evaluation:K&T evaluation is needed in the following areas Attic now Exterior Wall Basement Live . Live ` Live 'Live Live ; Live 'Live Live .toot Live .- Clot Live --' ,--"Not-'Not Live Not Live Not Live Not Live _..Not Live Not Live Notes: /V0. a(hY°' _,,..7 If you decide to have any lighting fixtures covered or made in contact with insulating materials,a MA licensed electrician must certify that all fixtures located in the areas indicated below arc insulated contact(IC)rated. Energy Specialist Evaluation:IC rated recessed light verification is needed in the following areas Open Attic Enclosed Floor Cavity Enclosed Interior Slope Ali Recessed Lights Qty._ Qty. ._, Qty._ . .Qty.- — IC Rated IC Rated IC Rated IC Rated Not IC Rated ,... Not IC Rated Not IC Rated Not IC Rated le have read and agree� to the Terms and Conditions on the back of this form. Contractor Name: I)a y iiio (7rei le(ft/ I /� P4//� Address: i /A i•� u :A City: f:.j� Sate //!�ZIP: °s°�CQ� Company Name: Jl i. ;i,. 1 G'k4'I J tie 'liC,.Lice:,se Nufl ber. 90..rj 9 q Contractor Signature: I,_ ----- --- -- Date: t /li/ e.5 a .1 RCE Co.,Inc. Invoice dba Ray Croteau Electric 244 Burlingame Rd. Date Invoice# Palmer,MA 01069 5/18/2022 1077 Masters License#20529A Ph/Fax 413-284-0507 raycroteauelectric@comcast.net Bill To Project Location CLEAResult 4487 50 Washington St. Borjana Mikic Westborough,MA 01581 203 Prospect Ave. Northampton.MA 01060 Description Quantity Amount Knob and tube inspection 250.00 Total $250.00 of : CLEAResule CONTRACTOR WORK ORDER Mass Save® Home Energy Services 50 Washington St.Suite 3000 Westborough,MA 01581 Customer Name:BORJANA MIKIC Cozy Home Performance LLC Email:borjana.mikic123@gmail.com 180 Pleasant St,Suite 200 Phone:413-320-3222 Easthampton,MA,01027 Premise Address:203 Prospect Ave,Northampton,MA 01060 413-529-0200 Project ID:4485558 Applicable Customer Required Actions: Notes: • Storage Removal Homeowner is responsible for removal of top layer of • Platform Buildup fiberglass insulation from attic. Homeowner is • Flooring Removal responsible for arranging removal of attic flooring,if you would like your IIC to remove the flooring as an add-on to your weatherization project,see WBI form. Homeowner is responsible for 10"platform buildup,if desired. Location Measure Description Quantity Unit Unit Cost Total Cost Rim Joist-2"Thermal Barrier Polyiso 70 SF $4.78 $334.60 Door-2"Thermal Barrier Polyiso 1 each $90.44 $90.44 Exterior Door Weather Stripping(with AS hrs) 3 each $30.07 $90.21 Door Sweep(with AS hrs) 3 each $25.31 $75.93 Walls-Vinyl-4"Dense Pack Cellulose 1728 SF $2.65 $4,579.20 Attic Stair Cover w/Carpentry(with AS hrs) 1 each $289.31 $289.31 Damming 32 each $2.39 $76.48 Air Sealing at Estimated 62.5 CFM50 Per Hour 6 hr $92.58 $555.48 Attic Floor- 11"Open Blow Cellulose 720 SF $1.98 $1,425.60 Gable Vent(12"x18")Aluminum 1 each $114.64 $114.64 Installed Measures Total $7,631.89 WorkOrder Notes Utility Incentive and Customer Share Information Utility Incentive Weatherization incentive $4,965.72 Air sealing incentive $1,010.93 Page 1 of 2 Permit Authorization mass save Form Site ID: 4485558 Customer: BORJANA MIKIC Borjana Mikic , owner of the property located at: (Owner's Name,printed) 203 Prospect Ave Northampton, MA 01060 (Property Street Address) (City) hereby authorize the Mass Save Home Energy Services Program assigned Participating Contractor listed below to act on my behalf and obtain a building permit to perform insulation and/or weatherization work on my property. Owner's Signature: 8mjaua*kit Date: 05/ 24 / 2022 FOR OFFICE USE ONLY We have assigned the following Mass Save Home Energy Services Participating Contractor to the above referenced project: nz rrt•� (� ) Pe r-cCL- vtck.v1C� ,j 7/:2- articipating Contractor Date Name: CLEAResult Phone: 800-480-7472 Email: Page 1 of 1 For Office Use Only Document Ref:NR2YX-RIST7-SQ4AS-22VTL Page 7 of 18 AC-CPR!? CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 11/11/2021 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: Berkshire Insurance Group Inc PHONE FAX 43 East St (A/C,No, ); (877)234-4420 IWC,No): (877)234-4421 Pittsfield, MA 01201 E-MAIL ADDRESS: PRODUCER (413)447-7376 CUSTOMER ID/ INSURER(S)AFFORDING COVERAGE MAC# INSURED INSURER& Continental Indemnity Co. 28258 INSURER B: Cozy Home Performance, LLC 180 Pleasant St INSURERS: Easthampton, MA 01027-1287 INSURERD: CTL 1273 1679258 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 ADDL SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE MISR WVD POLICY NUMBER (MMIDD/YYYY1 (MMIDD/YYYY) LIMITS GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY DAM DACA OCCURRENCE S AGE TO RENTED CLAIMS MADE OCCUR PREMISES(Ea occurrence) $ MED EXP(any one person) $ PERSONAL&ADV INJURY $ GENERAL AGGREGATE $ GEML AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ i POLICY JEST LOC $ AUTOMOBILE LIABILITY (Ea and n SINGLE LIMIT ANY AUTO S ALL OWNED AUTOS BODILY INJURY(Per person) $ SCHEDULED AUTOS BODILY INJURY(Per accident) $ HIRED AUTOS PROPERTY DAMAGE (Per accident) S NON-OWNED AUTOS $ f UMBRELLA UAB OCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS MADE AGGREGATE >i DEDUCTIBLE $ RETENTION S >i WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS'LIABILITY Y/N X TORY 1 IMITR ER AANY PROPRIETOR/PARTNER/EXECUTIVE N/A 4 6-8 4 5 3 7 3-01-17 11/02/2021 11/02/2022 E.L.EACH ACCIDENT $ 1 r 000,000 OFFICER/MEMBER EXCLUDED? N (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,00 0 If yes,describe under SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT $ 1 r 000 r 000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach Acord 101,Additional Remarks Schedule,if more space Is required) CERTIFICATE HOLDER CANCELLATION Cozy Herne Performance SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED Mill 180 180 Pleasant Street BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED Easthampton, MA 01027 IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATN�� _ / 178 3 ACORD 25 (2009/09) ©1988-2009 ACORD CORPORATION. All rights reserved ACORO CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 5/12/2022 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 The Dowd Agencies, LLC NAME: Diane LaFleche 14 Bobala Road (A/cc, o.Est):413-437-1062 ONE FAX Nor 413-437-1462 Hol oke MA 01040 EMAIL y ADDRESS: dlafleche@dowd.Com INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Selective Insurance of South Carolina 19259 INSURED COZYHOM•01 INSURER B Cozy Home Performance LLC 180 Pleasant St. INSURERC: Easthampton MA 01027 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:2049028382 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 INSD WVO POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) LIMITS A X COMMERCIAL GENERAL LIABILITY S 2206979 I 4/17/2022 4/17/2023 EACH OCCURRENCE $1,000,000 ' DAMAGE TO RENTED CLAIMS-MADE OCCUR PREMISES(Ea occurrence) $500,000 MED EXP(My one person) $15,000 PERSONAL S ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $3,000,000 POLICY X JECo-T I ^ I LOC PRODUCTS-COMP/OP AGG $3,000,000 OTHER: AUTOMOBILE LIABILITY I I CObility Deductible MBINED SINGLE LIMIT S0 $(Ee accident) ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY(Per accident) $ HIRED NON-OWNED PROPERTY DAMAGE AUTOS ONLY ,_-_ AUTOS ONLY • (Per accident) $ A X UMBRELLA LAB X OCCUR S 2206979 i 4/17/2022 4/17/2023 EACH OCCURRENCE $2,000,000 EXCESS LIAB CLAIMS-MADE i AGGREGATE $2,000,000 DED X RETENTION$D I, $ WORKERS COMPENSATION PER GTH- AND EMPLOYERS'LIABILITY Y/N -STATUTE ER ANYPROPRIETOR/PARTNER,EXBCUTIVE E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED, N/A I (Mandatory in NH) ' E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below 'E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES I LES (ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) CERTIFICATE HOLDER CANCELLATION 30 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. To Whom It May Concern AUTHORIZED REPRESENTATIVE -'fir , —. ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD Office of Consumer Affairs and Business Regulation 1000 Washington Street - Suite 710 Boston, Massachusetts 02118 Home Improvement Contractor Registration Type: LLC COZY HOME PERFORMANCE, LLC. Registration: 162770 180 PLEASANT STREET Expiration: 04/05/2023 EASTHAMPTON, MA 01027 Update Address and Return Card. Office of Consumer Affairs&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 162770 04/05/2023 1000 Washin ton Street -Suit 10 COZY HOME PERFORMANCE, LLC. Boston, MA 2118 4 MARK LANTZ 180 PLEASANT STREET ,444wal .�w EASTHAMPTON, MA 01027 Undersecretary Not valid without signature Commonwealth of M*ssllcnuastta Division or Praha&lona! Liconsure Rand of Swiiding Rsgulstians and SUMO/WOO �°�rteii:�'urficxr8tl�i�rvi�ti�NellPr'ItiiE 1;::I64".1621Si . oolr.s:12110f2022 MARK M LANTZ • 180 PLEASANT STREET EASTHAMPTON MA 0102T ' y commissioner ::'i."1164 construction Supervisor Specialty Restriniad tea: CSSLdE-Insulation Cuntracue Failure to possess a current edition of the,Massachusetts State Building Code Is cause for revocation of this license. For information about this license Cali(817)T27.3200 or visit w►vw.mase.govidpl