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38B-181 (3) BP-2023-0361 17 FORT ST COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 38B-181-001 CITY 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-2023-0361 PERMISSION IS HEREBY GRANTED TO: Project# repairs 2023 Contractor: License: WMJ TUROMSHA DESIGN & Est.Cost: 14000 CONSTRUCTION 000515 Const.Class: Exp.Date: 02/15/2024 Use Group: Owner: SCOTIA MACGILLIVRAY, Lot Size (sq.ft.) Zoning: URB Applicant: WMJ TUROMSHA DESIGN &CONSTRUCTION Applicant Address Phone: Insurance: 11 WILLIAMS ST 413-586-4005 7PJUB0653N47922 NORTHAMPTON, MA 01060 ISSUED ON: 03/24/2023 TO PERFORM THE FOLLOWING WORK: REPAIR MASONARY WALLS 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: • !if • y2 . 92015, Fees Paid: $91.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Office of the Building Commissioner s rCh The Commonwealth of Massach setts E a<�'�' W Board of Building Regulations and tand4rds "q9 FOR Massachusetts State Building Cod, , 78C1. R 23 20 I�UNIC1SPEALITY Building Permit Application To Construct,Repair,Ien �El:f olish a 1/RevLd Mar 2011 q w One- or Two-Family Dwelling �"'��,'�qs„F-e,_ This Section For Official Use Only ��-°!-)60'•s- Building P rmit Number: /3O.2 - — ')CC ( Date Applied: / , 3-Z3-zaz u � � /loss ,�� 3 Building Official(Print Name) Signature Date SECTION 1: SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map&Parcel Numbers 13 o leT STeEST MbitTitiunirrbsJ PIA 1.1 a Is this an accepted street?yes k 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 ili' Private El Municipal` Outside Flood Zone? Municipal O' On site disposal system 0 Check if yeses SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of Record: SCe4TiA MAC GIU.tWf NortTI4Am Pro PJ ilia oso0 Name(Print) City,State,ZIP I7. FbRT 3TRffBT 831 31.5" I'•i-42 SCAR&�rrpoc 63® RAMl.• cor, 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) Oa Alteration(s) 0 Addition ❑ Demolition 0 Accessory Bldg. 0 Number of Units Other 0 Specify: Brief Description of Proposed Work': S?ku.eTo•.,.,,< Kapta,'re_ +e, nr,,,vs Wel wp Its CZ) prle I 14 snit1JOTy ciLb a Msuta Lap+ 6daa.re 5MI pTr*J r) VA)pa .r We&k p►{o FLAA.1 S14a4,a6;I LOC^f,e',N es II". Wosek ,4411 Idelek is Ist TKO eeast frke,.T SECTION 4: ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1. Building $ eo 1. Building Permit Fee: $ Indicate how fee is determined: l`l,ova• ❑ 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 -2 4-1 dtheck Amount: Ct-) Cash Amount: 6.Total Project Cost: $ Pi,O°c,• de 0 Paid in Full ❑Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) Ooo5t5 Oz)15/2o2 1 WlihAn —14eomSHA License Number Expiration Date Name of CSL Holder List CSL Type(see below) 11 W,1 i."In s S7+t!H'etct' Type Description No.and Street U Unrestricted(Buildings up to 35,000 Cu.ft.) NORTH A m 'k,rJ I O t o is O Restricted 1&2 Family Dwelling City/Town,State,ZIPS 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) 10q72. e S'IL/0c.Z 4/ Gt(i)bA;n toms IA 'DEVIr.1•+ CAWS TR _eriet1 HIC Registration Number Expiration Date HIC Company Name or HIC Registrant Name Il Wi11Iurn% 3Tr%g5T It/TisiesweHA6. Get. No.and Street Email address Nott•04amprect Mn Otot.o titsS SSb Loos City/Town, 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 No 0 SECTION 7a: OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I,as Owner of the subject property,hereby authorize wtMilan. ? —14 rec,t rxHq to act on my behalf,in all matters relative to work authorized by this building permit application. SCOTA MACGt11,v1C�'f 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 application is true and accurate to the best of my knowledge and understanding. INt�(tatn S w omshp k1 Print Owner's or Authorized Agent's Name(Electr is Signature) 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 Improvement Contractor(H1C)Program),will not have access to the arbitration program or guaranty fund under M.G.L.c. 142A.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 ww,‘‘.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" City of Northampton I- ''' \ Massachusetts S"�k , .91(� :'� '�, l� w:DEPARTMENT OF BUILDING INSPECTIONS 7k. �I�' ' ;I' t� 212 Main Street • Municipal Building yJ: 1. Northampton, MA 01060 s N ., .14C 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: I/p lit 1 `i EcilcLrw1 13'-) EAsTHAo p'ss,a Ropo The debris will be transported by: Name of Hauler: L/di,,,p, ju2oros/4o oK dxj ►-t.4, GAHSsL Signature of Applicant: ia, �r��»s�� Date: THE WORK Structural repair to first floor living room and dining room. Floors and masonry repairs to north elevation and west elevation foundation walls. All specifications listed below reference plans dated 12 October 2022. FOUNDATION North wall; saw cut 20 linial feet of mortar floor. Excavate and remove 8 inches of earth below floor. Pour new steel reinforced 8" thick concrete footing to support concrete block pilasters. Erect concrete block pilasters and block wall to support deflection in stone wall. Fill concrete blocks and area behind block wall with concrete. See FigureA on drawing. Remove approximately 9 linial feet of structurally unsound brick wall from between stone foundation and wood sill. Brick to be replaced with 8" thick concrete block. The work described above will require saw cutting and removal of 18 inch wide by 16 feet long of the exterior concrete pad. Pad will be refilled with concrete upon completion of the work. EAST WALL Saw cut 17-18 linial feet of mortar floor. Excavate and remove 8 inches of earth below floor. Pour new steel reinforced 8 inch thick concrete footing. Footing to support concrete block wall and two steel reinforced concrete block pilasters. Remove approximately 11 linial feet of brick wall from top of stone foundation and wood sill. Replace with 8 inch concrete block. (*Note in order to replace the brick wall with concrete block, the front porch floor deck will have to be removed. This work to be performed by others.) See Figure B on plan. INSTALLATION OF STRUCTURAL SUPPORTS TO FLOORS Saw cut 4 - "-6" x 1'-6" square holes in mortar floor. Excavate 8 inches of earth. Pour 4 -- 1'-6" x 1'-6" x 8" steel reinforced concrete footings. Figure C - Install 2" x 8" x 2 micro laminated girders beneath floor joists with a piece of% inch steel angle in front of chimney. 3'/W" concrete filled steel lally columns to support micro laminated girders with Springfield steel plates at floor level and 1/a" flat steel plated beneath girder. Figure D - Saw cut mortar floor, excavate. Remove earth, pour three 1'x-6" x 1' 6 x 8" steel reinforced concrete footings. Install 18 linial feet of 2" x 8" micro laminated beam supported by 3 - 3% x 3% concrete filled lally columns Springfield base plates with 1/4' flat steel at the top. Figure E- "Sister" existing floor joists with an additional 2" x 8" spruce joist glued and screwed to existing joist. This will flatten the existing floors and eliminate the need for a girder beneath the floor joists. The work includes all demolition, temporary structural supports. Labor and materials for all masonry repairs and carpentry repairs, field measurements plans, permits, clean up, and removal of construction debris from the work site. CITY OF NORTHAMPTON SETBACK PLAN MAP: LOT: LOT SIZE: 991-Gff x 8-a N 1:(. 59 .4 REAR LOT DIMENSION: REAR YARD 23‘-a 13` y Siu6LF 11/tlu� u,.1fsy CAR (BAR E 20._o„ SIDE YARD ZZ 0 SIDE YARD 14 trI D vi _ 7 ra 7oACN FRONT SETBACK !bi- 0" FFrzr s RfET FRONTAGE 5/8t- o" The C urrtnronn.ealth of.11ussuchusetts Department of ludustriuiAccident's I C'urtgress Street, Suite 100 _dice 4 Boston. MA 02114-2017 • rovw.m tss.gotyldia 1l to kers' ('ornliCtISatiun I11%urauct•.\ffidstt it: Buildersi('ttntractar1Ekrtricittns(Plumbers. I t)HI. r lilt)\►I I II I III.. i'r.RM{IFFIlt: At 1110Rrt 1. .\ptrticattt In forma(lint Please Print Lettish Name(Husmcss Organization Individual,: Wirt it&Roai5110. 13@=16ht & Cols TRu.CTtoN Address: 11 kb I I/E.ANS STRt fAT City/State1Zip:N0T<T14i mproaJaya o)o c3 [':uint:' ": 1{l3 S l4 49a5 Are yam allenrpluicr:'I heck the appropriate taw Type at project(required): 1.Q I am a..nyakn cs%t nth etatrtayrvea tfatl and of par t•[ism i 7. ❑New construction 4SIt as a ksle pruprartut L.t partncr:.tup and tune nu earltr)..Y, arkutr• :e.r(OK an g, ©Remodeling any t sp:uu)_(-1st NJ11.t4.•coup.uuurnre rogria at.j 30 I am a ttumtvurter di icw alt wur4 cm.di.tl4.0 nutria's'cutup.cura cr:raywreal.)' 9. [3 Demolition I U 4.Q tam a luracvw mar anti uJI i•e huuc ..viHrr..tur,1i cvexlud all work un uey property. I u iU © Building addition amine that all rontractura citts:r fun c s.utkcr►' uw.tirneY ut arc auk I I a Electrical repairs or additions Kowloon a Ida nu ampler...... }� warted contractor Plumbing repairs or additions 5 ■t am a arted contractor cin)I ire.a hired t)a rub-runrr:Ktors Listed art the attached that 130 Roof repair e_�These,ub-cuntracian hate artployers and ha►c owner,'e-uenp.uu.4tance ".0 We ate a cuipurauun and as officers t.�n ixd their nght et even iiuut per M st_t_ 14� �' ►►r a'o !ram t s.o 152.Ir 1141.and e a have no ariltlu►ces.(:tier wuruers'romp.testaan e:reque nil STC.1.4T1H►t, thz post s *Any apptiamt that..tricks bus.a I stint ale iil tact dt sctitseai thud show ins then*utter.'t.uutpensation policy information. ttwraY warn who Mai-ant tins atlittat ht enthrones der)arc dicing all wink end their hue outside contractual must subniiit a acit stridat it indicating ats:h. =Contrietws dwt check tins box mug attached an adttitionai sh,tct 410V6 my the rune ut the sadreu trac tuna and awe whether it nut those canoes ha...: empty:.ec.+_ If for wt*ctin teretat> errsplu runt pm's al:their .t:,nA am...tnnp.path)number. 1 am on employer that it providing►►'urAer.+'compensation insurance for my employees. Below i.s the policy and Job'Ate infunnutian. Insurance Company'\lute: `Tt4Pu8Lg_tt S Policy#or Self-ins.Lie.#: rue D t.53 N si T I Z l:xpiniliun Datt::o&j 01 ao a 3 tub Stti.Addy ess: (a C ENIER Co uit City'State,Zit.: tZTRAppto&.JI j Ololop Attach a copy of the markers'compensation policy declaration page(showing the polity number and expiration duty). Failure to secure coverage as required under MGL c. 152,*25A is a criminal violation punishable by a fine up to S 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 S250.00 a d.r% against the violator. A copy of this statement may be turn.trded to the Office of Investigations of the DIA for insurance Ne:n1ieatic-n. I do hereby certify under the pains tool penultie.s rrl perjure that the in frtrntulierrt pro►�idrd above i!i true'and correct. St nature: Wm 9, !1>o----r G,-� I;st:. pal 70/Qd d3 Phone a: (Official use oak. Do not write in this nreu.ter he completed/Jl'city or town n official_ ( itti or Unit re: I'i rrnit.'I.icensc? Issuing.1.ulhuritt icircle otter I_ Board of Health 2. flu Win Department 3.city/Town Clerk 4.Electrical Inspector S. Plumbing Inspector 6.Other ( (intact Person: Phone#: ,4co CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYYY) 03/06/2023 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 Kim Pages _ HUB INTERNATIONAL NEW ENGLAND LLC (ANN/Co Exg; (413)750-7110 iac.Ne): E-MAILDDE ADDRESS: kim.pages@hubinternational.com 96 Shaker Road INSURER(S)AFFORDING COVERAGE NAIC East Longmeadow MA 01028 INSURER A: TRAVELERS PROPERTY CAS CO OF AM 25674 INSURED _INSURER B: TUROMSHA WILLIAM INSURERC: . DBA DESIGN & CONSTRUCTION INSURERD: ' _ 11 WILLIAMS ST INSURER E: NORTHAMPTON MA 01060 INSURERF: COVERAGES CERTIFICATE NUMBER: 867710 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 SUBR POLICY EFF POLICY EXP LTR INSD WVD POLICY NUMBER (MM/DD/YYYY) (MMIDD/YYYY) LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ DAMAGE TO RENTED CLAIMS-MADE I OCCUR 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) $ 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 LIAB CLAIMS-MADE N/A AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION PER 0TH X STATUTE AND EMPLOYERS'LIABILITY Y I N ANYPROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 100,000 A OFFICER/MEMBEREXCLUDED? NIA N/A 7PJUB0653N47922 06/20/2022 06/20/2023 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 100,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 N/A DESCRIPTION OF OPERATIONS I LOCATIONS I 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 at www.mass.gov/Iwd/workers-compensation/investigations/. Sole proprietor has not elected coverage. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Scotia Macgillivary ACCORDANCE WITH THE POLICY PROVISIONS. 17 Fort St AUTHORIZED REPRESENTATIVE Northampton MA 01060 Daniel M.Crowley,CPCU,Vice President—Residual Market—WCRIBMA ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD ACOREP CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 03/06/2023 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 Tina Beaulieu NAME: Borawski Insurance PHONE (413)586-5011 FAX (413)586-7973 (A/C,No,Ext): (A/C,No): 88 King Street,Suite B E-MAIL tbeaulieu@borawskiinsurance.com ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# Northampton MA 01060-3257 INSURER A: Atlantic Casualty Insurance Co INSURED INSURER B William J.Turomsha,DBA:William Turomsha Design&Construction INSURER C: 11 Williams Street INSURER D: INSURER E: Northampton MA 01060 INSURER F: COVERAGES CERTIFICATE NUMBER: 22/23 GL 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 AUUL SUHk LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER POLICY EFF POLICY EXP {MMIDD/YYYY) (MMIDDIYYYY) LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1 000,000 DAMAGE TO RENTED CLAIMS-MADE X OCCUR PREMISES(Ea occurrence) $ 100,000 MED EXP(Any one person) $ 5,000 A L2050041010 05/10/2022 05/10/2023 PERSONAL B ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER. 2,000,000 GENERAL AGGREGATE $ POLICY n PRO- LOC2,000,000 JECT PRODUCTS-COMP/OP AGG $ OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ _ AUTOS ONLY - AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY _ AUTOS ONLY (Per accident) UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y I N STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? N/A E.L.EACH ACCIDENT $ (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 (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN Scotia Macgillivray ACCORDANCE WITH THE POLICY PROVISIONS. 17 Fort Street AUTHORIZED REPRESENTATIVE Northampton MA 01060 -> ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD 9“-O" X I=6 " vt= ExlsTluci 'f3R1ck, !.gall To Ise. PAGE 1 FE►'zovEo 79_6•+•TNT SrC1P4E well +. +kt Si1t I13R 1 c k wn it "rci IrE R€PLLAes.: La;+ O®.J" C b1Osia. )\ 1 ® ( 4 Zti ', I I ; Y ______,. 3-O. _ It9='� I I I `— il. , i 1 i I I I � ' 1 - - - --' - - - - --� l III) i46 =- - - -_ 2."-0 Sl- ,E L l' \ET>TOR eta I_ ' _. 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