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18C-125 (3) BP-2023-0383 33 ALLISON ST COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 18C-125-001 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-2023-0383 PERMISSION IS HEREBY GRANTED TO: Project# 2023 DOOR Contractor: License: Est. Cost: LOWES HOME CENTERS INC 117055 Const.Class: Exp.Date: 08/02/2025 Use Group: Owner: H MATHEWS PHILIP J&LORI Lot Size (sq.ft.) Zoning: URB Applicant: LOWES HOME CENTERS INC Applicant Address Phone: Insurance: 1000 LOWES BLVD 860-505-9314 WC035901712AOS MOORESVILLE, NC 28117 ISSUED ON: 04/03/2023 TO PERFORM THE FOLLOWING WORK: REPLACE EXTERIOR ENTRY DOOR WITH NO STRUCTURAL CHANGES 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: P • • ,2 . 9:,617 Fees Paid: $40.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Office of the Building Commissioner n gZ., The Commonwealth of Massachusetts W Board of Building Regulations and Standards FOR Massachusetts State Building Code, 780 CMR MUNICIPALITY USE Building Permit Application To Construct,Repair, Renovate Or Demolish a Revised Mar 2011 One-or Two-Family Dwelling This Section For Official Use Only Building Pe it Number:-ZD2,3—03S 3 Date Applied: K eviti>r I�,S /s 3 1)-ZOZ s � � 3 Building Official(Print Name) Signature Date SECTION 1:SITE INFORMATION 1.1 Proper ddres :�' _ m 1.2 Assessors Map&Parcel Numbers 3 /2' —/25— 0 vt 1.1 a Is this an accepted street?yes no Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: u gis ,257. 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 0 Zone: _ Outside Flood Zone? Municipal 0 On site disposal system 0 Check if yes❑ SECTION 2: PROPERTY� OWNERSHIP' 2.1 Ownpt}pf)R or : A / a2 C `J / /Atf, 11r),4-,t1 P O/e610 Name(Print) M 1y,State,ZIP 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 I epairs(s' Alteration(s) 0 Addition ❑ Demolition 0 Accessory Bldg. 0 Number of Units Other 0 Specify Brief Description of Proposed W orkz: ir'k e Apligt �(We fine_) iv SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) I.Building $ JdW,9.p.) 1. Building Permit Fee:$ Indicate how fee is determined: 0 Standard City/Town Application Fee 2.Electrical $ ❑Total Project Costa(Item 6)x multiplier x 3.Plumbing $ 2. Other Fees: $ 4.Mechanical (HVAC) $ List: 5.Mechanical (Fire $ Total Al'Fees: $ Suppression) y Check ." Check Amount:440.' Cash Amount: 6.Total Project Cost: $ /X-42'9° 0 Paid in Full 0 Outstanding Balance Due: • SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisorg (CSL) 1/�( J /,y/-4/�s-- k1/e , U/a) License Numberr Exxppiration Date Name of CSL H l Q. D/df) �nrd/�, e; List CSL Type(see below) No.and eet /` I (� li�{ Type Description /� �/r y1 /Jl� U Unrestricted(Buildings up to 35,000 cu.ft.) CityLlnwn/,/State,ZIP(•Y C/u` // R Restricted I&2 Family Dwelling M Masonry RC Roofing Covering WS Window and Sidin 6 � J(r'hY`'' /'% SF Solid Fuel Burning Appliances o� �� � I Insulation Telephone Email address I D Demolition 5.2 Registered Home Im i rovement Contractor(HIC) )//����(i /%2),0 - �� + / �� . HIC Reg_sttrationaNutnber Expiration Date HIC Company ame or RegiWant Name Na and S g,C //� /j�1/1 PGJ/7 9'7 -25 '—Mr Email address City/Town,State,ZIP!'/ d� 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 (I No .❑ SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT "� J1rz)i 1,as Owner of the subject property,hereby authorize LIKAA to act on my behal in all matters relative to work authorized by this building permit application. hilLe_A&-kios 3Aii,1 i Print Owner's ame(ElSignature) Date SECTION 7b:OWNER1 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 thi application is true and accurate to the best of my knowledge and understanding. c_A 46/61 &ar° SP1/23 Print Owner's or Authorized Agent's Name(Electronic 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(HIC)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 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 he substituted for"Total Project Cost" City of Northampton oatH�M Massachusetts DEPARTMENT OF BUILDING INSPECTIONS te 5 212 Main Street • Municipal Building Z! aT 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 a �G��"l 1 I/&G�'C— /'2/M/2 (K/-5--C The debris will be transported by: 4 Name of Hauler: /e Signature of Applicant: Date: '��9/ The Commonwealth eahh of Massachusetts �. ,---1;11 Deportment of Industrial.Accidents I Congress Street,Suite 100 Boston. ALA 02114-2017 www.mass.gor/dia ))utkrr.' ('omprnsation Insurance. 1lidasit: BuildersK'ontractoraftktetricians1Plnttbers. 1(1 BE FILET)►1 I III IIIF PERMUTING AIiTHORITY. _tnnlicant Information Please Print Ls-edits Name413usiness;chganizatton.tndi idual►: LOWES HOME CENTERS Address: 1000 LOWES BLVD City/StatetZip: MOORESVILLE, NC 28117 phone#: 860-505-9314 Art lam Y employee Cheri the appropriate Ines: Type Hired :(re9 Y of project 1.0 1 am a employer with emplolkreek iftdl andur pate-eiael.• 7- New construction 20 1 am a sole proprietor or mi tnrishtp and base Ski CraPlawm working far me in B. ®Remodeling Any capacity.[Nu workers'comp.MUMMY requarn.j +,L_.! w I am a homeowner tk'ww all work myself.[No wurkats'comp.icfifuaoace 9_ ❑Demolition a.❑1 am a lrrnreownr and will be turmg wmractrm w ec llci all work tin My property. I will I Budding addtt ion ensure this all contractors tinier base workers'compensation insurance or are sole I I a Electrical repairs or additions prupnc ova w ith no ernptusem. 12.0 Plumbing repairs or additions 5231 aam a yencral cuntraetur and 1 laser hired the tub-euntractots listed on the anached ihret (3.0 Roof repairs These 1'Unrraiaors have employees and lust:w comp.rrL•1uninee.' 6.0 We air a ostpuattitn air!its at ricers haverminised their neat of esempirat pet.M(iL e. I4.®Other ISM f t(4),and we base rs,employees.INN,workers'wraes murrance reyusitd.j 'Amy applicant that ehscls lei&a1 mint.also fill out the sccpon below showing then wurkas•compensation Polk,inferniati m. +Iltnneuwn en.54 he submit lbw.,truia%at indicating they arc donut all w urk and then hue outside contractors must submit a new affrdas it uidreating st.h :Conttacturs that cheat thus but must attached an additional sheet show ing the name tit the sub-contrutors and state w Iathee or riot those entities to.c employees Ii the sub-cuntractuis hate employees.die) Heusi pros ids their workers'eon ".pulley number. I am an employer that is presiding a•orAers'compensation insurance for my employees. Below is the policy and job sire information_ Insurance Company Nana AIU INSURANCE COMPANY Policy#or Self-ins.Luc. WC035901712A�OS Expiration Date: 4/1/2023 Job Site Address: <3L -4/// St���7 City State Z 2/4 Attach a copy of the workers'compensation policy declaration page(showing the policy number and expire date C)/C)W Failure to secure cut crage:ts rimmed under MGL c. 152.§25A is a criminal violation punishtble by a fine up to 51.500.00 and/or one-year imprisonmentt,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to 5250.00 a day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance cos eraseVerification_ I do hereby c of•under the pains a ►era ' . f perjury that the information provided above/is true and correct. Signature: Dale_ �J Phone-. gle _ 2 Official use'only. Do not write In this area.to be completed by city or torn of/icier ur Town: Permit/License Issuing:lullturitt (circle one): I. Board of Ilealth 2.Building.Department 3.( its:Town Clerk 4.Electrical Inspector S.Plumhintl Inspector I,.Other ('ontact Person: Phone 4: STORE COPY INSTALLATION SERVICES CUSTOMER CONTRACT- MWORK - INT/EXT/PATIO DOOR LOWE'S OF HADLEY, MA,STORE tt 1916 STORE PHONE:(413)588-0270 La W E ' 282 RUSSELL STREET SALESPERSON: DANTE SEQUEIRA HADLEY, MA 01035-0000 SALESPERSON ID: 3581961 Document Print Date: 03/24/2023 This is only a Quote for the merchandise and services printed below. This becomes an agreement upon payment and issuance of a Lowe's receipt, upon which the entire agree- ment, including the specifically completed pages of this document, the Terms and Conditions included with this document, the applicable portion(s) of Lowe's receipt, and any other addenda or attachments hereto, shall be referred to herein as this"Contract." PLEASE READ THIS ENTIRE DOCUMENT,INCLUDING THE "TERMS AND CONDITIONS," BEFORE SIGNING, Lowe's Registration or Contractor License Number/Lowe's Contractor Name Lowe's Home Centers, LLC's MA HIC NO.: 148688 Lowe's Home Centers, LLC's FEIN: 56-0748358 Customer Name Home Phone S Philip Mathews 413-923-8502 O Customer Address Other Phone 33 ALLISON ST 413-923-8502 L City State/Province Zip/Postal Code D NORTHAMPTON MA 01060 Installation Address T 33 ALLISON ST O Installation City Installation State/Province Installation Zip/Postal Code NORTHAMPTON MA 01060 MERCHANDISE AND INSTALLATION SUMMARY MERCHANDISE SUMMARY 193584 : EC444 : STK : PFJCASE444 11/16-INX3.1/4-INX8-FT : PFJCASE444 11/16-INX3-1/4-INX8-FT : ECMD DISTRIBUTION-QTY 3 234228 : 7526 : STK : PVC BRK MLD EXT DOOR SET 3-PC : PVC BRK MLD EXT DOOR SET 3-PC : ECMD DISTRIBUTION -QTY 1 833538 : BMTT626364 : STK : 36 TTBM UNF SHKR 6L LH : 36 TTBM UNF SHKR 6L LH : TRU LOGISTICS INCORPORATED -OTY 1 Materials Price S 621.92 INSTALLATION DESCRIPTION Store 1916 Project No. 773052690 for Philip Mathews Page 1 of 8 STORE COPY Install Interior Doors : No Install Exterior Doors : Yes Install Entry Doors : Yes Install Entry Door Up To 36 Inches : 1 Install Entry Door Between 36 and 72 Inches : None Install Entry Doors Between 72 and 96 inches : None Install Field Mulled Sidelite or Transom : None Entry Doors Above 2nd Story : None Install Patio Doors : No Install New Single Storm Screen or Security Door : None Install New Double Storm Screen or Security Door : None Remove and Replace Single Door : None Remove and Replace Double Door : None Threshold Support : None Cutback Flooring : None Cutback Siding : None Cutback Drywall : None Aluminum Wrap Single Door : None Aluminum Wrap Single Door With Sidelites : None Aluminum Wrap Double Door : None Aluminum Wrap Double Door With Sidelights : None Total linear feet of custom trim to be Installed : None Lead safe practices : No Customer understands scope of the project : Yes Permit Fee : Yes Additional Mileage : 0 Access fee : None Additional Work : None Comments : Looking to get 6L RH Fiberglass Entry Door Labor Charges S 1214.00 Detail Deduction -S 35.00 Additional Specifications: Notation:Lowe's wi I not make structural modifications,remove cabinetry to accommodate new appliance,or upgrade electrical service. Additional Specifications: LEAD SAFE INFORMATION: Federal and applicable state laws require that You be provided with a lead hazard information pamphlet such as the Renovate Right:Important Lead Hazard Information for Families, Child Care Providers and Schools.By signing this Contract, You acknowledge having received a copy of this information pamphlet before work began informing You of the potential risk of the lead hazard exposure from renovation activity to be performed in Your dwelling unit or facility.A copy of the pamphlet is also available at the following websile: httns://www.eoa.gov/sitos/oroduction/fifes/documents/renovaterightbrochure,pd(.For more information see:)lttos://www.epa.gov/Iead/lead-renovation-repair•and-oainting.program. PHOTO RELEASE:Customer grants to Lowe's and Lowe's employees and independent contractors the right to take photograghs of the Premises where Installation Services will be performed and all work performed at the Premises re'ated to this Contract, and irrevocably grants to Lowe's all right, title, interest in and to the photographs for use in all markets and media,worldwide, in perpetuity. Customer authorizes Lowe's to copyright, use and publish the photographs in print and/or electronically,and agrees that Lowe's may use syc photographs for any lawful purpose, including,but not limited to,marketing,advertising,publicity,illustration,training and Web content.By initialing here,Customer agrees to the foregoing._ fit /I (Customer to initial to the left). NOTICE TO CUSTOMER-PRICE CALCULATIONS: In order to properly perform the installation of certain Goods,the Contract Price may i lude more Goods than actually will be installed based on the measured square footage of the Project Area.As a result,the parties agree that the lump-sum Price stated in this Contract is calcu'ated upon both the value of the estimated Goods required to ful- fill the Contract(including waste),which may exceed the actual square footage of the Project Area,and the labor which may be estimated based on the amount of Goods required to fulfill the contract (including waste). By signing this Contract below,Customer acknowledges receipt of this notice and agrees and understands that the Price includes these costs which may not be refunded once the Installation Services are performed.. NOTICE OF ARBITRATION AGREEMENT This Contract provides that all claims by Customer or Lowe s will be resolved by BINDING ARBITRATION. Customer and Lowe's GIVE UP THE RIGHT TO GO TO COURT to enforce this Contract (EXCEPT for matters that may be taken to SMALL CLAIMS COURT). Lowe's and Customer's rights will be determined by a NEUTRAL ARBITRATOR and NOT a judge or jury. Lowe's and Customer are entitled to a FAIR HEARING. But the arbitration procedures are SIMPLER AND MORE LIMITED THAN RULES APPLICABLE IN COURT.Arbitrator decisions are as enforceable as any court or- der and aro subject to VERY LIMITED REVIEW BY A COURT. FOR MORE DETAILS: Review the section titled ARBITRATION AGREEMENT,WAIVER OF JURY TRIAL AND WAIVER OF CLASS ACTION ADJUDICATION found in the Terms and Conditions of this Contract. Store 1916 Project No. 773052690 for Philip Mathews Page 2 of 8 ' STORE COPY TOTAL CHARGES OF ALL MERCHANDISE AND SERVICES •,vhereapplicable SUB-TOTAL S 1800.92 *TAX S 0.00 DELIVERY $ 0.00 ORDER TOTAL $ 1800.92 BALANCE DUE Work is to commence upon reasonable availablity of Contractor which is anticipated to be -,/ &r 2 _____[fill in date). Estimated completion date is_-2 V /Po—YZ-[fill in date. NOTICE TO CUSTOMER All items listed in this contract and specification sheet(s) are to be installed under conditions agreed upon at time of purchase and at the price appearing on this contract form. This assumes sound existing substructures, superstructure and points of attachments. Extra labor or material incident to installation necessitated by defective substructures, superstructure, points of attachment, or the moving of fixtures or appliances to be billed at extra cost to custom- er. IF THE CONTRACT TOTAL IS$1,000.00 OR LESS, Customer mustpay in full. COMPLETE THIS SECTION ONLY WHEN THE CONTRACT TOTAL EXCEEDS $1,000.00: [i Customer to use the following payment schedule: / (1) Deposit of $ b 00 f to be paid upon signing contract. Any deposit collected at the time this Contract is signed will not exceed one-third (1/3) of the contract price; and /j-2 6 (2) Payment of $ // to be collected upon or after the commencement of work. i/We authorize Lowe's to do one of the following (check ap- propriate box below): [_] Charge my/our credit card for the amount of the payment indicated above upon or after the commencement of work; or [_] Deposit my/our check for the amount of the payment indicated above anytime upon or after the commencement of work; and (3) Final payment of S100.00, to be paid upon completion of the installation to both parties' satisfaction. DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES AND UNTIL YOU HAVE READ THE TERMS AND CONDITIONS CON- Store 1916 Project No. 773052690 for Philip Mathews Page 3 of 8 STORE COPY TAINED IN THIS CONTRACT AND WHICH FOLLOW THE SIGNATURE PAGE(s). BY SIGNING BELOW, YOU ARE ACKNOWLEDGING THAT YOU HAVE READ, UNDERSTAND AND AGREE TO THE TERMS AND CONDITIONS SET FORTH IN THIS CONTRACT. YOU ARE ENTITLED TO A COPY OF THIS CONTRACT AT THE TIME OF SIGNATURE. NOTICE REGARDING ARBITRATION AGREEMENT FOR CLAIMS COVERED BY M.G.L. c.142A LOWE'S AND OWNER HEREBY MUTUALLY AGREE IN ADVANCE THAT IN THE EVENT LOWE'S HAS A DISPUTE CONCERNING THIS CON- TRACT, THAT LOWE'S MAY SUBMIT SUCH DISPUTE TO A PRIVATE ARBITRATION SERVICE WHICH HAS BEEN APPROVED BY THE SECRET- ARY OF THE EXECUTIVE OFFICE OF CONSUMER AFFAIRS AND BUSINESS REGULATIONS AND THE OWNER SHALL BE REQUIRED TO SUB- MIT TO SUC ARBITRATION A R IN Kai_ c.142A. / �j By: ~`— Date: ,! L/ i�'/�' 6 3 Lowe's Home Center. LLC Date: � i''t4 7 Owner By: Date: Co-owner or Witness THE SIGNATURES OF THE PARTIES ABOVE APPLY ONLY TO THE AGREEMENT OF THE PARTIES TO ALTERNATIVE DISPUTE RESOLUTION INITIATED BY LOWE'S PURSUANT TO M.G.L. c.142A. THE OWNER MAY BE PERMITTED TO INITIATE ALTERNATIVE DISPUTE RESOLUTION EVEN WHERE THE SECTION ABOVE IS NOT SEPERATELY SIGNED BY THE PARTIES. WITNESS OUR HAND(S) AND SEAL(S) BELOW THIS 7 II DAY OF / /c LI 2 3 . Lowe's Home Centers, LLC By: (Seal) Print Name: Address Owner (Seal) o ��s City State/Province Zip/Postal Code Print Name (Seal) Co-Owner or Witness Store 1916 Project No. 773052690 for Philip Mathews Page 4 of 8 grQ 3 - _r' � --iIlRii11VN.�'ii i `Q3.1 _fig} fiIEtel ma 's Norgenftsealtall=aet m at d- -.sue. - -` wk A�I CERTIFICATE OF LIABILITY INSURANCE DATE(MWDD/YYYY) 03/23/2022 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 Marsh USA Inc. NAME: 100 North Tryon Street,Suite 3600 PHONE o.Exit: (A/,Noj Charlotte,NC 28202 E-MAIL ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# CN102776519-Lcwes-SI 22-23 INSURER A:National Union Fire Ins Co.of Pittsburgh PA 19445 INSURED INSURER B:Interstate Fre 8 Casualty Co 22829 Lovre's Companies.Inc. and subsidiaries INSURER C:MU Insurance Co 19399 1300 Lowe's Boctevard INSURER D Mooresville.NC 28117 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: ATL-004976909-11 REVISION NUMBER: 10 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. LIR TYPE OF INSURANCE NSD SUBR WVD POLICY NUMBER (M /Y WDDYYY) (MMIDO ryP N ) LIMITS COMMERCIAL GENERAL UABI.I Y EACH OCCURRENCE $ CW MS MADE Orrt lR Self Insured-See below DAMAGE TO RENTED PREMISES(Ea occurrence) $ MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GEN L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE S POLICY EECOT- LOC PRODUCTS-COMP/OP AGG $ OTHER A AUTOMOBILELweuIIY CA7030892 (AOS) 04/01/2022 54/01/2023 COMBINED SINGLE LIMIT $ 5,000,000 (Ea accident) C X ANY AUTO CA7030891 (MA) 04/01/2022 04/01/2023 BODILY INJURY(Per person) $ A OWNED SCHEDULED CA7030893 (VA) 04/01/2022 04/0112023 BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE S AUTOS ONLY _ AUTOS ONLY tPer accident) $ B X UMBRELLA LIAB X OCCUR USZ00024220 04/01/2022 114/01/20235,000,000 EACH OCCURRENCE $ EXCESS LAB CLAIMS-MADE AGGREGATE $ 5,000,000 DED RETENTIONS $ C WORKERS COMPENSATION WC035901712 (AOS) 04/0112022 04/01/2023 x PER OTH- C AND EMPLOYERS'LABILITY y/N WC035901713 D,WA,WI, 04/01/2022 04/0112023 STATUTE ER ANYPROPRIETOR/PARTNER/EXECUTME EL EACH ACCIDENT S 2,000,000 OFFICERMEMBEREXCLUDED? N N/A (Mandatory in NH) E.L DISEASE-EA EMPLOYEE S 2,000,000 U yes,describe under DESCRIPTION OF OPERATIONS below EL DISEASE-POLICY LIMIT S 2,000,000 A Excess Workers'Compensation XWC1647325 (FL) 04/01/2022 04/01/2023 (WC per statute) 3,000,000 A Excess Workers'Compensation XWC1647324 (AOS) 04/0112022 04/01/2023 (WC per statute) 3,000,000 DESCRP710N OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,AddItional Remarks Schedule.may be attached if more space is required) Commercial General Liability policy is Self-Insured,effective 4/1/2022 to 4/1/2023. CERTIFICATE HOLDER CANCELLATION Lowe's Companies,Inc.and Subsidiaries SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 1000 Lowe's Blvd. THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Mooresvle,NC 28117 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE :ZZ' .,Z4 ZLS' 7,tc. ©1988-2016 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD • AGENCY CUSTOMER ID: CN1 02 77651 9 LOC#: Charlotte ACORD® ADDITIONAL REMARKS SCHEDULE Page 2 of 2 AGENCY NAMED INSURED Marsh USA Inc. Lowe's Companies.Inc —__--- and subsidiaries POLICY NUMBER 1000 Lowe's Boulevard Mooresville,NC 28117 CARRER NAIC CODE EFFECTIVE DATE: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: Certificate of Liability Insurance Workers'Compensation and Excess Workers'Compensation policies induce a self-insured retention of$2.000.000. General Liability:The insured is self insured for$10,000,000 each occurrence for the period of 4/1/2022 l0 4/1 2023. The Automobile Liability poicy evidenced above is subject to additional self-insured retentions excess of limits shown for various perils covered. ACORD 101 (2008/01) ©2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD ACCPREP CERTIFICATE OF LIABILITY INSURANCE DATE B/14/ DN Y) 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 Diane Gendreau,CISR NAME: Nicholson Associates,Inc. PHONE (203)203)877-2741 FAX ((A/C No,Ext): (AMC,No): (203)877-9004 395 New Haven Ave. ADDRESS: d.gendreau@nicholsonassoc.com P.O.Box 5189 INSURER(S)AFFORDING COVERAGE NAIC# Milford CT 06460 INSURER A: Selective Insurance Co of S.C. 19259 INSURED INSURER B: EAST COAST MILLWORK,LLC INSURER C: 14R PEACH ORCHARD RD INSURER D: INSURER E: PROSPECT CT 06712-6001 INSURER F: COVERAGES CERTIFICATE NUMBER: 9/22-23 GL Auto Umb 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 NOTVWTHSTANDING 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 ADOLSUBR POLiCYEFF POLICY DIP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MM/pp/YYYY) (MMIDDIYYYY) LIMITS X COMMERCIAL GENERAL LIABILITY EACHOCISIRRENCE $ 1,000,000 DAMAr.F TO REM ED CLAIMS-MADE I Xl OCCUR PREMISES(Ea occurrence) $ /•000 MED EXP(My one person) $ 15,000 A Y S 2040386 09/22/2022 09/22/2023 PERSONAL&ADV INJURY $ 1.000.000 GEMLAGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 3.0�•�0 POLICY n,zT n LOC PRODUCTS-COMP/OP AGG $ 3,000,000 OTHER $ A LIABILITY COMBINED SINGLE LIMIT AUTOMOBILE $ 1,000 000 (Ea accident) X ANY AUTO BODILY INJURY(Per person) $ A OWNED SCHEDULED Y S 2040386 0922/2022 09/22/2023 BOISLY INJURY(Per aadent) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY _ AUTOS ONLY (Per accident) Medical payments $ 5,000 X UMBRELLA LIAB ticCI.IR EACH OCCURRENCE $ 2,000,000 A EXCESS UAB CLAIMS-MADE S 2040386 09/22/2022 09/22/2023 AGGREGATE $ 2•�•� DED RETENTION$ $ WORKERS COMPENSATION XI STA UTE I I ERA AND EMPLOYERS'LIABILITY Y/N A ANY PROPRIETOR/PARTNER/EXECUTNE Y NIA WC 9084546 06/04/2022 06/04/2023 E.L.EACH ACCIDENT $ r 00'000 OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 500,000 E yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ '� DESCRIPTION Of OPERATIONS/LOCATIONS I VEMCLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Lowe's Companies,Inc.and Lowe's Home Centers,LLC are named as additional insureds as respects general liability and auto liability. This insurance is primary over any other available insurance coverage.10 Day Notice of Cancellation for Non-Payment of Premium. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN Lowe's Companies,Inc.and any and all subsidiaries ACCORDANCE WITH THE POLICY PROVISIONS. 1000 Lowe's Blvd AUTHORIZED REPRESENTATIVE Mooresville NC 28117 I ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD Commonwealth of Massachusetts 10, Division of Occupational Licensure Board of Building Rel lathons and Standards Consta on rAipioxvisor CS-117055 spires: 08/02/2025 KYLE R SEARLES 14R PEACH ORCHARD ROAD PROSPECT C5' 06712 Commissioner lul /'. 1&7