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23A-040 BPi2022-1388 52 MAPLE ST COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 23A-040-001 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-2022-1388 PERMISSION IS HEREBY GRANTED TO: Project# ROOF Contractor: License: Est. Cost: 9200 SEXTON ROOFING CO 99689 Const.Class: Exp.Date: 10/05/2023 Use Group: Owner: 52 MAPLE STREET PLACE LLC Lot Size (sq.ft.) Zoning: GB Applicant: SEXTON ROOFING CO Applicant Address Phone: Insurance: P 0 BOX 6327 (413)534-1234 7pjubog07898222 HOLYOKE, MA 01041 ISSUED ON: 11/02/2022 TO PERFORM THE FOLLOWING WORK: STRIP AND RE-ROOF NORTH SIDE ONLY 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: • • )2 •- � 1915, Fees Paid: $80.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Office of the Building Commissioner i , _ The Commonwealth of Massachusetts FOR ' Board of Building Regulations and Standard Ve `/, F.OR TY 131 Massachusetts State Building Code,-780 CMR.,71yedition ` /USE BuildingPermit Application To Construct,Repair,Renovate Qem lisbaised.1armary Pp p One-or 7wo-Fami41Dwelling 1008 ,-�c2 . This Section For Official Use 0��!?�,, Building Permit Number: 4,1' .i-•3 "/ J Date Applied: - gt1n 11ir, ''Ill' 'c,), Signature: - ' 1(7%[Z .1 i--Z-?Q1 °'oe00/vs Building Commissioner/Inspector of Buildings Date ' - SECTION 1:SITE INFORMATION 3.1 Property Address: 1.2 A4es^o �Map&._Parcel Numbers S i,t( vi ( �U• '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 V Side Yards Rear-Yard Required Provided Required Provided Required Provided 1.6 Water Supply: (M.O.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Public 17 Private❑ Zone: _ Outside Flood Zone? Municipal 0 On site disposal system Ch eck,if yes0 • SECTION 2: PROPERTY QWN1RSHIPI 2. Owner'of Record: A Pa Q )( 3 ?7 0 A' kw. it , 0)4_ • Name(Print) ,/ a - Address for Service: • .Cow -fie,c 44t - V a 3T c F` - , Signature Telephone SECTION 3:DESCRIPTION OF PROPOSED WORK'(check ail that apply) New Construction❑ Existing Building[D' Owner-Occupied 0 Repairs(s) ❑ Alteration(s)"0 Addition 0 Demolition ❑ Accessory Bldg. Number of Units - Other 0 Specify: Briefpescription ofProposed Work': . se.2-c Owly , - • SECTION 4:ESTIMATED eQNSTRUCTION COSTS • . Item Estimated Costs: ' Official Use Only (Labor and Materials) . • 1.Building S 1. Building Permit Fee:5 Indicate how fee is determined: ❑Standard City/Town Application Fee • 2.Electrical $ ❑Total Project Costs(Item 6)x multiplier . x 3.Plumbing : . S ' • 2. Other Fees: 1< - ' 4.Mechanical (HVAC) $ List: _ , 5.Mechanical (Fire $ Total All Fees:S Suppression) ' ' Check No.�j 5(,l(7Areck Amount Cash Amount: 6, Total Project Cost: S :-� 7&0 0 Paid in Full 0 Outstanding Balance Due: • (Ci �1100 C • it ( 61) • SECTION 5: CONSTRUCTION SERVICES 5.1 Construction so (�Supervi r License(CSL) l . //!I Frere 1 J / i',k 1 on License Number rraava Dot Name �ofCSLHolder 1 1� 1 \ �CJ (667 ( -I 7 List rSi Type(seebetow) ! u..3 No. +and Street Type Description I 1 t 0 Cp I( 4" 0 'Vf U Unrestricted(Bthdinga no to 35,000 el.1L) R Restricted 1&2 Family Dwcfing City?T State,1:11' M Masonry RC Roofing Covering DVS _ Window and Siding SF Solid Fad Burning Appliances I Insulation Telephone Email address D Demolition _ 7 7 � Registered HOIIlf/��ImptilYPmeitt Contractor{$)C) ������. (��I� 7 C�L�7- p and 0/Wily e r Hlc Re on_Z3nmber t = r..._.. ffiC Co asry Name or egis[rant Name �s�dp!rton,k tc. No.and Street addmss Vh� 7)7,9 G}/ 1-4(/ 4/3-531-1. 3 City State,LLt' Telephone SECTION.fi:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L c 152.§25C(6)) Workers Compensation Insurance affidavit rnnct be completed and submitted with this application. Failure to provide this affidavit will result in the drtial of the Issuance of the building permit. Signed Affidavit Attached? Yes ' 'fail`' No ❑ 1 SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT '1 I,as Owner of the subject property.hereby authorize y i v i r 1f lti Q i c_i/ /)C ` to act on my behalf,in all matters relative to work authorized by this buildirtu jertnit application.' ea rc r /6/2-v/2Z Prue Owner's Name(Electronic Signanue) 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 placation is true and accurate to the best of my knowledge and understanding_ In /7 e 'L 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 Improv-uuak Contractor(HIC)Program),will nitt have access to the arbitration program or guaranty fund under M.G.L.to 142A Other important information on the HIC Program can be found it w w.rc ss_gov/oca Information on the Construction Supervisor License can be found at www-_rnass_ttovidns 2_ When substantial work is planned,provide the information below Total floor area(sq_fr.) (including garage,finished basement/attics,decks or porch) Gross living area(sq.ft.) Habitable morn 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 • Fnrlosed Open 3. "Total Project Square Footage"may be substituted for"Total Project Cost" City of Northampton •' Massachusetts `e NM DEPARTMENT OF BUILDING INSPECTIONS y " 212 Main Street • Municipal Building Northampton, MA 01060 sty 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( �!'/� /T S/ //1 ( 'c 4 The debris will be transported by: Name of Hauler: 5GCi g,, 7,e i 4 Signature of Applicant: Date: 16(72--G'/z Propofiat SEXTON ROOFING AND SIDING INC • www.sextonroofing.com 1K0 - aTrre Setting the Standard I, r #tr�w 11 ,"ram P.O. Box 6327 M p. 413.534.1234 Holyoke, A101041 f. 413.539.9906 MA HIC# 118239 sextonroofing@hotmail.com SUBMITTED TO Kendrick Property PHONE 253-0825 DATE 10/18/22 Management STREET 2 Bay Rd.Hadley,Ma./P.O.Box 3220 JOB NAME Managed Rental Property CITY,STATE,ZIP Amherst,Ma. JOB LOCATION 52 Maple St.Florence,Ma. SEXTON ROOFING HEREBY SUBMITSSPECIFICATIONS AND ESTIMATES FOR:NORTH SIDE UPPER ROOF ONLY 1) Strip and remove existing shingles and dispose of in proper landfill. 2) Inspect decking and replace as needed(a $105.00 per sheet 3) Install new metal edging to rakes and eaves of roof. (white) 4) Install 15' ice and water shield on 6' on eaves, around chimney, vent stacks, and at intersecting roofs. 5) Install #15 synthetic roofing felt on remainder of roof. 6) Install new flanges over existing vent stack. 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) Reflash chimney as needed (a' $400.00 11) Supply manufactures lifetime warranty and SRC 5 yr. workmanship warranty. /19e Fropoot hereby to furnish material and labor-complete in accordance with the above specifications,for the amount of Nine Thousand Six Hundred($9,600.00)Payment to be made as follows: Due in full upon completion 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 g upon written orders,and will become an extra charge over and above the estimate. All agreements contingent upon strikes,accidents or delays beyond Note:This proposal may be withdrawn by us if not accepted our control. Not responsible for water damage during construction. Owner within(14)day • to pay responsible legal fees for non-payment,and applicable interest. acceptance of Proposal The above prices,specifications and conditions are satisfactory and are hereby accepted. You Signature are authorized to the work as specified. Payment will be / Pi>-1 91 made as outlined above. / - A Date of Acceptance. A/IG IiVI/nIIIVII IYGM.III EA/VIA uaaa./saJCi/a Department of Industrial Accidents 1° Office of Investigations L\x 1F Lafayette City Center 2 Avenue de Lafayette,Boston,MA 02111-1750 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. 1.1 I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. New construction ?.❑ 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 workingfor me in anycapacity. employees and have workers' P ty $ 9. ❑Building addition [No workers' comp.insurance comp. inctttance. required.] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions ❑ 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.B Roof repairs insurance required.]t c. 152,§1(4),and we have no • employees. [No workers' 13.❑Other 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. ontractorn that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have nployees. If the sub-contractors have employees,they must provide their workers'comp.policy number. am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site 'formation. • isurance Company Name:Travelers Property Cas Co Of Am olicy#or Self-ins.,,Lic.#:7PJUB0G07898277 Expiration Date:06/4/23 ill Site Address: 74/ -t S City/State/Zip: ((n ttach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). allure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a tie 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 [up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of tvestigations of the DIA for insurance coverage verification. do hereby certify under the ins and penalties of perjury that the information provided above is true and correct ignature: Date: /CJ�7 0/2-4-__ • hone#: / z 3 y Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority(check one): 1❑Board of Health 20 Building Department 30City/Town Clerk 4.0 Electrical Inspector 50Plumbing Inspector 6.0Other Contact Person: Phone 4: A 1 CERTIFICATE OF LIABILITY INSURANCE DATE peeelDorrrYvl 44.—.---- 06/07/2022 THIS CERTIFICATE IS ISSUED AS A MAi itti OF INFORMATION ONLY AHD CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER-THiS CERTIFICATE DOES NOT AFFIRMATiVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the pzthcy{ies)most be endorsed. if SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement A statement on this certificate does' confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CWITACT Kaita Hum • ORMSBY INSURANCE AGENCY r (413)737-0300 INC.** ANAIL Miti hinson ns.c um - aDox�s: �onnstrn P 0 BOX 718 NAICit- WEST SPRiNGRELD MA 010IXt INSI BIA: TRAVELERS PROPERTY CAS CO OFAM 25674 INSUFfED INSURERS SEXTON ROOFING&SIDING INC MISUrt$i C: PO BOX 6327 INSURER E_ HOLYOKE MA 01041 INSURER F: 1 COVERAGES CERTIFICATE NUMBER: 7132111 REVISiON NUMBED THIS IS TO Girt E IFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUE TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICAIHi. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY Pttt.AiN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT 70 ALL THE TERMS, . EXCLUSIONS AND CONDITIONS OF SUCH POLICIES_LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. txsR ,�p�,��R POLICYs� POLICY MorsLTR 1 TYPEOFI m RANCE 'peSplyryp POLICY MINDER r+ rr i 1 i COMMERCIAL GENERAL LLArarrr EACH OCCURRENCE CE S DAMAGE O Rat TED CLAIMS-MADE ,OCCUR aa:maea). $ MEI MCP Om one dam) I S NIA PERSONAL&ADV INJURY 5 GE4LAGGREGATE LIMIT APPUES PErt GENERALAGGREGATE $ { l PC1LiCY JECT 1 f C f LOC PROMICTS-COMRDPA4G $ 7 OTHER: S AUTCMO I F LIABILITY 'COMBINE)SINGLE LIMiT $ (Ea accident) ANY AUTO BODILY ICY(Pn pne) S 'Ail Orin 1 SGFH%9� WA BO:MYIN.JURY(Per addled) S AUTOS PROPERTY DAMAGE HIRED AUTOS AUTOSAUTOS A . (Per accident, • S S UMBRELLA s LI occuEAQ-f ICE -S EXCESS LIAR iaalMs-MADE. - WA AGGREGATE S DED RETENTION$ - $ WORKERS COMP86SAYKIII (`' ' X 1 STATUTE BR 1 AND EMPLOYERSAIABILITY Y I It A ANYPROARrEfORJPARTNERISCEOITIVE of euAf MIA WA 7P.A]HOG0789B222 0610412022 06I04f2023 EL EACH veer • s 100O000 Mandatory in NH) EL DISEASE-EABaPLOYEF s 1,000,000 Eyes,describe under DESCRIPTION OF OPERAnceiS beer ei.DISEASE.-POLICY UNIT s 1,000,000 i I WA DESCRIPRONOFOPERATIONSIL(HATIONS3VBDt7S(ACCRIIletAtedifiamarr2erearks Schedule,may teaifaasaiNm:3paraarequire' d) Workers'Compensation benefits wit be paid to Massachusetts employees only_Pursuant to Cndursisrnst WC 20 03 06 B,no authorization is given to pay claims for benefits to employees in states other than Mascachusetts lithe insured hires,or has hired those employees outside of Massachusetts. This certificate of insurance shows the policy in farce on the date that this certificate was issued(urdess the expiration dale on the above policy precedes the issue date of this ate of insurance)_ The status of this coverage can be un.iiiikoi ed daily by accessing the Proof of C -Coverage Verification Search tool at www_nlass.gw rs/. CERTIFICATE HOLDER CATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN AC€ARDAANCE Viral THE POLICY PROVISIONS. 1 AUTHORIZED REPRESENTATIVE MA 01040 DateM. ,CPCLI, President-Residual Market-WCRIBMA ( ®tom-2014 ACORD CORPORATION. All rights reserved. ernon'TE einiAiail Th.Aural..-s..b n.t I. .., ..ran:r3a.ari remzim.,f Arrsnn SEXTO-2 OP ID: KH acoRO' CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 06/30/2022 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 413-737-0300 NONE CT Eric Dembinske Ormsby Insurance Agency Inc. PHONE 493-737-0300 II FAX 413-7374517 698 Westfield St PO Box 718 (Arc,No,Exq: ((NC,No): West Springfield,MA 01090 E-MAIL edembinske@ormsbyins.com Eric Dembinske INSURER(S)AFFORDING COVERAGE NAIL# INSURER A:Northfield Insurance Company SURED INSURER B:Progressive 24260 sNexton 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 TYPE OF INSURANCE ADDL SUER POUCYNUMBER IY EFF POUCY EXP UMITS LTR INSD WVD IMMIDDYYYI IMM/DD/YYYYI A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE T,000,000 CLAIMS-MADE X OCCUR W545073 06/2512022 06/25/2023 PR MISES(Ea occcu°nce) $ - 100,000 • MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY PRO- JECT LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: !$ B AUTOMOBILE LIABILITY Ea accideOMBINEntSINGLE LIMIT 1,000,000 ANY AUTO 04434955-0 05/1512022 05/15/2023 BODILY INJURY(Per person) $ OWNED X SCHEDULED AUTOS ONLY AUTOS • BODILY INJURY(Per accident) S X HIRED X NON-OWNED PROPERTY PcEcRTY DAMAGE AUTOS ONLY _ AUTOS ONLY ) S UMBRELLA LIAB OCCUR EACH OCCURRENCE 'S EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTIONS WORKERS COMPENSATION STATUTE I ER AND EMPLOYERS'LIABILITY YIN ANY PROPRIETOR/PARTNER/EXECUTIVE TO BE ISSUED SEPARATELY E.L EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? N/A (Mandatory In NH) EL DISEASE-EA EMPLOYEE S If yes,describe under DESCRIPTION OF OPERATIONS below E.L DISEASE-POLICY LIMIT $ J DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may he attached if more space is required) roofing&siding contractor CERTIFICATE HOLDER CANCELLATION NONE-01 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POUCY PROVISIONS. AUTHORIZED REPRESENTATIVE ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. ACGREP CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYY1) 06/17/2022 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 NAME: Karina Silva MAYFLOWER INSURANCE GROUP INC PHONE 774 773 9702 FAX oc.No Ertl: ( ) IAIG Nok E-MAIL ADDRESS: karina@mayllowerinsurance.com 2 Court St Unit B INSURER(S)AFFORDING COVERAGE NAIC# Plymouth MA 02360 INSURER A: HARTFORD UNDERWRITERS INS CO 30104 INSURED INSURER B: MNP CONSTRUCTION INC INSURERC: INSURER D: 76 GROVE ST APT 1 INSURERE: MILFORD MA 01757 INSURER F: COVERAGES CERTIFICATE NUMBER: 785876 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. I EFF POLICY EXP NSR ADDLTYPE OF INSURANCE INSD WVDSUBR POLICY NUMBER (MMIDDPOUC%YYYY) (MMIDD/YYYY) UMITS LTR INSD WVD COMMERCIAL GENERAL IJAB UTY EACH OCCURRENCE $ 1 DAMAGE TO RENTED CLAIMS-MADE OCCUR PREMISES(Ea occurrence) $ MED EXP(Any one person) $ N/A PERSONAL&AOV INJURY $ GEN'LAGGREGATE LIMIT APPUES PER: GENERAL AGGREGATE $ POLICY PRO JECT LOC PRODUCTS-COMP(OP AGG $ OTHER: AUTOMOBILELIABILfTY criuMNED SNr"-[F LIMIT (Ea accident) ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED -AUTOS ONLY AUTOS N/A .BODILY INJURY(Per accident) $ _ HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY (Per accident) UMBRELLA LIAB _ OCCUR EACH OCCURRENCE $ EXCESS[JAB CLAIMS-MADE N/A AGGREGATE f$ DED RETENTION$ $ WORKERS COMPENSATION X STATUTE • ER AND EMPLOYERS LABILITY Y/N ANYPROPRIETOF/PARTNER/EXECUTNE EL EACH ACCIDENT $ 1,000,000 A OFFICER/MEMBEREXCLUDED7 NIA WA N/a 6S60UB6R43531322 06/08/2022 06/08/2023 (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 he attached it 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.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 SEXTON ROOFING & SIDING INC ACCORDANCE WITH THE POLICY PROVISIONS. 102 PINE ST AUTHOROF[)REPRESENTATIVE Holyoke MA 01040 Daniel M.Croy,CPCU,Vice President—Residual Market—WCRIBMA ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD C6enllk_ • ATE it CERTIFICATE OF LIABILITY INSURANCE 03/21/2022 THIS CERTIFICATE 1S ISSUED AS A MATTER:OF INFORMATION ONLYAND.CONFERS NO'RIGHY UPON.THE CERTIFICATE HOLDER.THIS • CERTIFICATE DOES NOT AFRRMATIVE LY Oliii IElMIW9.TAlI ItD,EIQEIE ORALTER TIE COVERAGE AFFORDED BYTHE'POUCES BELOW-THIS CERTTFICATEOF INSURANCE DOES NOTCONSTITUTEAcOIFFRACTBE I EENTHEISSUWG WSURER(S),AUTHOR® REPRESENTATIVER 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 cif thecertain policy, PmitY+ ae endnrsanentA staimme*tvrr this cerbricate does not confer rights to the certificate holder in Ben of such endorsement(s). PRODUCER CONTACT Gib Camos:vale leiiiiiF PHONE 97a•72&+91330: I-INSURANCE GROUP INC fAc.14Q6dk . EMAIL acatzmalolliiesemmagarawint 799 GORHAM ST LOWELL,MA 01852 .reS0RERPFAFFORDNGEXIVE7LLGE NeIC INSURED INSURERA GENERAL STAR.JNDEMNITY COM INSURER EI:ARBELLAPROTEC7TON INSURANCE LDG HOME IMPROVEMENT INC INSURER C:.: 18 SPRING ST FL1 INSURER D:.TRAVELERS PROPERTY CAS CO OF AM MILFORD, MA 01757 WSURE2.E, INSURER F' COVERAGES CERTIFICATE.NUMBER:000015 REVISION NUMBER: INDICATED_NOTWITHSTANDING ANY REQUIREMENT TERM OR CONDITION OF ANY.CONTRACT OROTHE7;<DOCI.I dTWffHRESPECT TO WHICH THIS CEl 1 IFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES.DESCRIBED HEREIN IS SUBJECT TO TALL THE TERMS,EXCLUSIONS AND CONDMONB OF SUCH POUCIES:UMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSRL Amu SUER Pou ram PCLCYE7P • TR TYPE OF DISUFAra=E 162 vein POLICY NUMER (reMXVYVYY)- (Iae00KYYY) MARS A CMERAL.LU1dnY EAOrOmaORI� $ 1,naknm re °WAGE TORENTED X allraSSL4LGE?ER.L IL.SItY - PiedaeMES(bm .) '$ 100000.03 S n®�u"�ae=.r a-�r+mE x J ocae $ saaano 923A 3/s_rxr_»_ 3(5/2023 PERSONAL SAovmurr 5 1,D00000.00 mt3rAk.AGG2EGA1E $ 2A00,000.00 carp AGGRE-.�n=isrr APPLIES PEW Radva c.c=i si OPA�De'pre $ 2,00nrairi 00 —1 � n p310.1ECTntOC B AIlrO.O13o.E1IA8ULTY $ ,mom 130011.7 VARY pier roes* y' 7RoplUo fart Aura I ^— MS'F" 1020096012 4/13/2021 4/13202 m.Y w2 eare Ter�AUTOS AV . a.0 $ 40,000A0 -- — rnoisrrf0....GE —l AUTOS ___1 p�»n S 100,00pk➢0 C UMBRELLA GAB OCNA , EACH OC ME —DOSS WO —QM6,.11<F AGGREGATE O® fE7ENron5 D NWirERIcco PBfAnne ATIADRY OTN As O BPLOT6C L.AMM/ ON WITS E3e ANY PROPRIETORE Eta EL EACf3AQ731011- OFFICERNBEERECCILOGM mTr_ mi_m • MA) 6HU64Nt16974.322 3/7SJ2�1» 326rL023 $ 1 'ELDISEASE-EAijFLf7YlF 5 1000p10.00 IPrion of OPflrAnaas baler EL.seer POLICY UAW" $ 1,000p00.00 OF OPERATIONS l LOCATIONS/VEHICLES(Attach AOORD 101,A06621'0l Remarks Schemtle,if mon spice is iaqui60)• . GSVERALLLABBJTY'for regrdarard tare!j1:ars and the certthcate tildes'is an addiionta insured. lie m*Comperratiorc benedCtribe pa*Ito Massachusetts employees anyPursuatto --Kat 1SC 20 03 06 8,no authorgOlOian ii given topay darns for forbenefits to employees it states other-than Mmaacle s d the isued hies,o-hras hied those employees outside Of hitessachusetts. This oerafcate of insurance shows the policy a,force on the date t attha Tie eras issued(unless the espiation dads on the above - . P�YPm'�the issue date°fifes certificate of insurance):Manner orate-.coverage can be moralised:daily by accessing the Proefaf Coverage-Coverage Verifaation Search tad atriwaass. - - - • CERTIFICATE HOLDER CANCELLATION SHOULDAANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE D<PIRATION DATE IT IS THE CUSTOMER"RESPONSABIUTY TO[NFORME ANY SEXTON ROOFING&SIDING INC CHANGES OR CANcaATICNS, 102 PINE ST.,HOLYOKE MA GUIILHERME CAMOSSATO 1/1 019SI-201O ACDRD CORPORATION.AN rights rese.ed. STATE OF CONNECTICUT DERART_irEX7—OF CONS(.rER FROTECTfO.V C o aci re ands ts HOME IMPR,QVEMBdYT:c•BTRAcroR limit Oman of pro Wan -ons and Stand EVER .Tr J Sf X`�• ,_SR .1.v, geacd of Building Ret3 r... r specialty. I Pm_S't consul l ,j Jpires:101051Za23 HOEYOI E,A&. '1.• # 2411 �. " n,;; - SEXTON ROO y CSSL^fl89689 , .` ay k§ i5 p, FIlV &. Di CO �X �o�oa 4" � HIC.0605383 . •f f �41/2 's;;i L • :_. 'n"� YOKE 4 03/31/2023 f��r;,ois .4 cy SIGNED �"'L:S; .-. . Commissioner `(j ,%5,g'x.5t:1_s iqariLe S ri_ S ,Bl_E 'S'L:..- iSL`AT1WN s=;:.i .G-5-'S .�k''Ps:. N S1,.7... . - r r _ SEXTON ROOFING&a SOON,EVERETT 113239 P.O..BOX 6327 1r .+y.c Curient Siang Inc HOLYOKE.MA 01041