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24C-077 (4) BP-2023-0697 16 MASSASOIT ST COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 24C-077-001 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-2023-0697 PERMISSION IS HEREBY GRANTED TO: Project# DOOR 2023 Contractor: License: Est. Cost: 4064 SETROC LLC 106106 Const.Class: Exp.Date: 09/29/2024 Use Group: Owner: WESTON NARAM, APARAJIT & ERICA Lot Size (sq.ft.) Zoning: URB Applicant: SETROC LLC Applicant Address Phone: Insurance: 1029 NORTH RD PMG 150 (413)433-3777 13WECAJ6EDF WESTFIELD, MA 01085 ISSUED ON: 05/30/2023 TO PERFORM THE FOLLOWING WORK: REPLACE ENTRY DOOR 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: I 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: r . a' • ,52 T't'1 • f I Fees Paid: $40.00 212 Main Street,Phone(413)587-1240,Fax (413)587-1272 Office of the Building Commiss ner FCEI\ aAY 3 0 2023 'The Commonwealth of Massachusetts Board of Building Regulations and Standards FOR Massachusetts State Building Code, 780 CMR MUNICIPALITY - •-BUII_C711`ir Injcrr 'I'JNS. USE j'crmtt Application To Construct,Repair,Renovate Or Demolish a Revised Mar 2011 One-or Two-Family Dwelling This Section For Official Use Only Building Permit Number:.d 0 3-• G{97 Date Applied: //EO, 72-'5 / /l s-X-z6Z3 Building Official(Print Name) Signature Date SECTION 1: SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map&Parcel Numbers 16 Massasoit St Northhampden,MA 01060 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 0 Zone: _ Outside Flood Zone? Municipal 0 On site disposal system 0 Check if yes❑ SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of Record: Aparajit Naram Morfhampton, MA 01060 Name(Print) City,State,ZIP 16 Massasoit St 9$9-714-499A Aparajitnaram@gmal.com 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 0 Specify:Replacing a Entry Door Brief Description of Proposed Work':Replacing a entry door SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1. Building $ 1. Building Permit Fee: $ Indicate how fee is determined: 4.064 0 Standard City/Town Application Fee 2.Electrical $ 0 0 Total Project Costa (Item 6)x multiplier x 3. Plumbing $ 0 2. Other Fees: $ 4. Mechanical (HVAC) $ List: 0 5. Mechanical (Fire $ Total All Fe Suppression) 0 es$ `kit Check No. r Check Amount. 6.Total Project Cost: $ 0 Paid in Full 0 Outstanding Balance Due: 4.064 SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) ( `, 10(0lo(! i(�1� ,� Eugeniu Ciubotaru License Number Expiration ate Name of CSL Holder Zb '60\hc...M 5 List CSL Type(see below) UJ No.and Street Type Description 5 �l s� �`� � ©„� U Unrestricted(Buildings up to 35,000 cu.ft.) , City/Town,State,ZIP R Restricted 1&2 Family Dwelling M Masonry RC Roofing Covering WS✓ Window and Siding SF Solid Fuel Burning Appliances 4N13*1- -610E t1030f(7 Qj 5,, tv 0, 1 _i on. I Insulation Telephone Email address D Demolition 5.2 Registered Home Improvement Contractor(HIC) 50-eoc (AA_ ca tlt -,ice LA).42vo Pao{'t " 'Loo323 1Z�tS(? zy HIC Registration Number Expiration Date HIC Company Name o HIC Registrant Name 1u2a nbrtr. d .5I kCC LL-.(, & rvtcul <<o cv- No.and treet Email address 1nJ tti� Ll� /hA ,p 0$ 4-k13-1-k33-;71-1 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 B ----- No .❑ 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 c L r dt- 1_L C to act on my behalf;in all matters relative to work authorized by this building permit application. f cc (\ al�W\ 5I ` 12023 Print Owner's Name(E ectronic 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 th. application ism:e d ac ate to the best of my knowledge and understanding. 4/"'1 s)Zu 12a23 Print er's or Author�a ame(Electr. gnature) 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 be substituted for"Total Project Cost" go cpi-t The Commonwealth of Massachusetts �� Department of Industrial Accidents =�:j1 Congress Street,Suite 100 � , Boston,MA 02114-2017 t` www.mass.gov/die urkers'Compensation Insurance Affidavit:BuilderslContractorsiEleetricianc/Plumbers. TO BE FILED W iIU THE PERMITTING'Al1THOR1i1'. Applicant Information Please Print Legible; Name(IlusinessUrgantzatton Individual): Set ROC LLC Castle "The window people" Address: 1029 North Road City/Sbtc ip: Westfield, MA 01085 phone#: 413-433-3777 Are lose;;tttt; Y layer?Cheek lie ap repre boa: il��!�/` Type of paled(regnirrd): 1 am a employer with 3 employees lfrrll nadir part-tune).• 7. New construction 2.0I am a sole proprietor or prenerslip and have nu employees wurkitmg for me is 8. a Remodeling any capacity.[No workers'camp.irmiuranci required.] 0 l am a homeowner doing all wo myself.[No% siers�'comp.insurance umpired"t 9. El Demolition Wee 4.01 am a homeowner and will be bins;rvdnceera to cordon all work or my property. 1 will 10 El Building addition MAIM that all contractors either bare wears'amspearatios ioesssee orate sole 11.121 Electrical repairs or additions proprietors with no r rpleysra 12.0 Plumbing repairs or additions 501 am a general contractor and I have hired the sub-contractors hated tat the anadhed sheet. 13 (repairs These subcontractor have employees and baste waken coop.insurance.: 6.0 We are a co op s-Aim mid its officers lave museieed their right of a/x=0 a per!1[tiL c. It pi 1. Entry Door 152.¢1(4).and we have ma employees.[Nu workers'camp.insurance terpired.1 "Any applicant that ebecke boa RI meet also fill out the section below showiag Heir workrmsr conversation policy idormatios. +Hunwuwms who submit Ibis affidavit indicating they arse doing all wait maim het outside east; u tors mom submit a sew affidavit indicating such_ :Co ntractws that clack Ilia bin tots;;anrtlted an additional sheet shawls;the state aloha sub earaches and state whether or rut those entities have c aployees. fibs mecasOytfeshereeml ii pis.they omit provide Ilea swims'coop-policy number. I am an essptoy er that is praavtdbtp workers'compensation insurance for my employers. Below Ls the policy and job site information. Insurtttcc C'oinpany Name: Hartford accident and indemnity company 13 WEC AJ6EDF 01/01/2024 Policy#or Solt=ins.Lilo..#: Expiration Date: Job Site Address: 16 Massasoit St CitylStatel'Zip: Northampton, MA 01060 Attach a copy of the workers"compensation policy declaration page(showing the policy number and expiralioo date). Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by 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.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify an 'er the pains an •no ' _ of perjuiy that t .formation provided above is true and correct Signature: Date: 05-24-2024 phone 3-433-3777 Official use only. Do not write in this area.to be completed by city or town official City or Town: Permit/Licease Issuing Authority(circle one►: 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector S.Plumbing Insltrct„r 6.Other Contact Person: Phone ft: City of Northampton r�r «._ /** Massachusetts �'r ft� {.� ` DEPARTMENT OF BUILDING INSPECTIONS i: 212 Main Street • Municipal Building 4Oar ,y,+! Northampton, MA 01060 `^0Q 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: 200 Leicester St North Oxford MA The debris will be transported by: Name of Hauler: The dumpster guy Signature of Applicant: Date: 05/24/2024 City of Northampton H�MPTo\. •"� ` Massachusetts �?' ._ '<< f.: G �. 1 f . .f DEPARTMENT OF BUILDING INSPECTIONS , 212 Main Street • Municipal. Building r✓h% Northampton, MA 01060 sl%h.. �� HOMEOWNERS'EXEMPTION ELIGIBILITY AFFIDAVIT I, (insert full legal name), born_ (insert month, day, year), hereby depose and state the following: 1. I am seeking a building permit pursuant to the homeowners'exemption to the permit requirements of the Massachusetts State Building Code, codified at 780 CMR 110.R5.1.3.1, in connection with a project or work on a parcel of land to which I hold legal title. 2. I am not engaged in, and the project or work for which I am seeking the aforementioned homeowners' exemption, does not involve the field erection of manufactured buildings constructed in accordance with 780 CMR 110.R3. 3. I qualify under the State Building Code's definition of"homeowner"as defined at 780 CMR 110.R5.1.2: Person(s) who owns a parcel of land on which he/she resides or intends to reside, on which there is, or is intended to be, a one-or two-family dwelling, attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a home owner. 4. I do not hold a valid Massachusetts construction supervision license and, except to the extent that I qualify for and will abide by the Massachusetts State Building Code's requirements for the supervision of the project or work on my parcel, I am not engaged in construction supervision in connection with any project or work involving construction, reconstruction, alteration, repair, removal or demolition involving any activity regulated by any provision of the Massachusetts State Building Code. 5. If I engage any other person or persons for hire in connection with the aforementioned project or work on my parcel, I acknowledge that I am required to and will act as the supervisor for said project or work. Signed under the pains and penalties of perjury on this day of , 20 (Signature) Commonwealth of Massachusetts Division of Occupational Licensure Board of Building Re ulations and Standards Constructice§upkAtilw Specialty 4s.' ,„:N.. .. IP CSSL-106106 , ;3 pires: O9I29I2O24 EUGENIU CI } OTAR IRO I *stl 4 44 23 BENHAM TREET 1 0T SPRINGFIELb MA .01 9 ; g: ?,,,, . , '' ',./ it., ; .;k' ,f 44,„ ' . --" . t 3 # # 7;‘ 0. .LVCtrt' S) t . is Cornrnss0nor L./t , ,. . 17�u��.t ACORLI CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 1/12/2023 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: INSURANCE AGENCY MANAGEMENT INC (A/C. 609-387-0606 FAX INSURANCE PO BOX 158 E-MAIL ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# BURLINGTON NJ 08016-0158 INSURER A: SELECTIVE INS CO OF ANERICA 12572 INSURED INSURER B: SETROC LLC INSURER C: 1029 NORTH RD PMB 150 INSURER D: WESTFIELD MA 01085-9711 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 WTH 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 LIMITS LTR INSR MM/WVD POLICY NUMBER ( DD/YYYY) (MM/DD/YYYY) X COMMERCIAL GENERAL LIABILITY X S 2464098 1/1/2023 1/1/2024 EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE X OCCUR PR RENTED PREEMIMI ESESS IE aaoccurrence) $ 500,000 ( A MED EXP(Any one person) $ 15,000 PERSONAL 8 ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY I jE X LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMB $ (Ea accident) _ ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED AUTOS NON-OWNED PROPERTY DAMAGE $ ONLY — AUTOS ONLY (Per accident) A X UMBRELLALIAB X OCCUR EACH OCCURRENCE $ 1,000,000 S 2464098 1/1/2023 1/1/2024 EXCESS UAB CLAIMS-MADE AGGREGATE $ 1,000,000 DED X RETENTION$ZERO $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER . _ ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) This Certificate of Liability Insurance was created by Selective on behalf of the agent. SETROC is included as additional insured with respect to General Liability as required by written contract or agreement. CERTIFICATE HOLDER CANCELLATION SETROC SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 1029 NORTH ROAD PMB 150 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Westfield MA 01085 AUTHORIZED REPRESENTATIVE ©1988-2016 ACORD CORPORATION. All rights reserved. ACORD 26(2018/03) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: LOC#: D ADDITIONAL REMARKS SCHEDULE Page 2 of 2 AGENCY NAMED INSURED INSURANCE AGENCY MANAGEMENT INC SETROC LLC POLICY NUMBER 1029 NORTH RD PMB 150 S 2464098 CARRIER NAIC CODE WESTFIELD MA 01085-9711 SELECTIVE INS CO OF AMERICA 12572 EFFECTIVE DATE: 1/1/2023 ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: ACORD 25 FORM TITLE:CFRTIFICATF OF LIABILITY TNSIIRANCF. JOB # JOB LOCATION ACORD 101 (2008/01) ©2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD THE COMMONWEALTH OF MASSACHUSETTS Office of Consumer Affairs and Business Regulation 1000 Washington Street - Suite 710 Boston, Massachusetts 02118 Home Impro ement C•ntractor Registration IIIMMINFtf INNEN i Z UMW = L y Type: LLC SETROC LLC re, I. = ---.e'egistration: 200323 ..4, �t :x suinir Expiration: 12/15/2024 DB/A CASTLE "THE WINDOW PEOPLE" -- • ------ 1029 NORTH ROAD PMB 150 OR rinwinammlosaim 0111 � :::= t 111111111111, 44 •. WESTFIELD, MA 01085 --•— -- 111111.11111► `7 mwr' tW 1� ...fit lip ;1 Update Address and Return Card. THE COMMONWEALTH OF MASSACHUSETTS Office of Consumer Affairs & Business Regulation Registration valid for individual use only before the HOME IMPROVEMENT CONTRACTOR expiration date. If found return to: TYPE: LLC Office of Consumer Affairs and Business Regulation Registration Expiration 1000 Washington Street - Suite 710 200323 12/15/2024 Boston, MA 02118 SETROC LLC D/B/A CASTLE "THE WINDOW PEOPLE" Q rR FRANCISCO J. CORTES JR ;'. 1029 NORTH ROAD PMB 150 i; ��u"''',,,tia Est% iNoa(ld TFIEUndersecretary ' ith ut signatu E - ENERGY STARR' Certified in Highlighted Region ( ' ,:::::- i,..tya ‘1 ,,,,,,. ENf:HGYSIAN � `_� :, _ 2L.,li ,{ 1j �' ' .ram - ,,,�"L' a Cell. ea Niiii.0 4 ..r ��� (Cast it NFRC ► "fie Window People" Ajr ,% VINYL DOUBLE HUNG ENERGY SAVER + Double Glazing.Argon Fill.Low E.Grid „anc� 9 9 SLL-A-56 fit; 00001 ENERGY PERFORMANCE RATINGS U-Factor (U.S./I-P) Solar Heat Gain Coefficient O . 27 0 • 27 ADDITIONAL PERFORMANCE RATINGS visible Transmittance Condensation Resistance 0 .49 r4 *jt#LIIM01 Stllydat thdt these ra►tkn%ronftrnt to applk able NI RC proctscttaes for deter minks.AK,k'INMiti I perfamark A NI RC ratting%are determined fora fixed set of envk wine,ttai i ostdItlartt and A VW Ilk p rodtxt size. NI RC ant does not war r ant the 30IGtblltt r of any pi oet n t for a x r spec not t ec ommt�t of an P merahae for am/product perform inre IntormatI9n, t I c ilk ttse.Cat9uAt mau>trfc «M�t www Mc.or • THE HARTFORD BUSINESS SERVICE CENTER THE 3600 WISEMAN BLVD HARTFORD SAN ANTONIO TX 78251 January 12, 2023 For Informational Purposes 1029 NORTH RD PMB 150 WESTFIELD MA 01085-9711 Account Information: Contact Us Policy Holder Details : SetRoc LLC DBA Castle The Need Hel Window People p Chat online or call us at (866)467-8730. We're here Monday - Friday. Enclosed please find a Certificate Of Insurance for the above referenced Policyholder. Please contact us if you have any questions or concerns. Sincerely, Your Hartford Service Team WLTR006 DATE(MM/DD/YYYY) "`;`="r" CERTIFICATE OF LIABILITY INSURANCE 01/12/2023 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 be endorsed. If SUBROGATIONIS 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: INSURANCE AGENCY MANAGEMENT INC 13652859 PHONE (609)387-0606 FAX PO BOX 158 (A/C,No,Ext): (A/C,No): BURLINGTON NJ 08016 E-MAIL ADDRESS: INSURER(S)AFFORDING COVERAGE NAIL# INSURER A: Hartford Accident and Indemnity Company 22357 INSURED INSURER B: SETROC LLC DBA CASTLE THE WINDOW PEOPLE INSURER C: 1029 NORTH RD PMB 150 WESTFIELD MA 01085-9711 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 POLICY NUMBER POLICY EFF POLICY EXP LIMITS LTR INSR WVD IMM/DD/YYYYI (MM/DDIY YYYI COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE CLAIMS-MADE OCCUR DAMAGE TO RENTED PREMISES(Ea occurrencel MED EXP(Any one person) PERSONAL&ADV INJURY GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE POLICY PRO- LOC PRODUCTS-COMP/OP AGG JECT OTHER AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (EaaccidentI ANY AUTO BODILY INJURY(Per person) ALL OWNED SCHEDULED _AUTOS AUTOS BODILY INJURY(Per accident) HIRED NON-OWNED PROPERTY DAMAGE AUTOS AUTOS (Per accident) UMBRELLA LIAB OCCUR EACH OCCURRENCE EXCESS LIAB CLAIMS- AGGREGATE MADE DED RETENTION$ WORKERS COMPENSATION x PER OTH- AND EMPLOYERS'LIABILITY STATUTE ER ANY Y/N E.L.EACH ACCIDENT $500,000 A PROPRIETOR/PARTNER/EXECUTIVE r N/A 13 WEC AJ6EDF 01/01/2023 01/01/2024 OFFICER/MEMBER EXCLUDED? E.L.DISEASE-EA EMPLOYEE $500,000 (Mandatory in NH) If yes,describe under E.L.DISEASE-POLICY LIMIT $500,000 DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Those usual to the Insured's Operations. CERTIFICATE HOLDER CANCELLATION For Informational Purposes SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED 1029 NORTH RD PMB 150 BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED WESTFIELD MA 01085-9711 IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ©1988-2016 ACORD CORPORATION.All rights reserved. ACORD 26(2016/03) The ACORD name and logo are registered marks of ACORD