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04-006 (6) BP-2023-0728 588 KENNEDY RD COMMONWEALTH OF M SSACHUSETTS Map:Block:Lot: 04-006-001 CITY OF NORTHA PTON Permit: Exterior Res PERSONS CONTRACTING WITH UNREGIS ERED CONTRACTORS DO NOT HAVE ACCESS TO THE GUARA FUND (MGL c.142A) BUILDING PERMIT Permit# BP-2023-0728 PERMISSION S HEREBY GRANTED TO: Project# WINDOWS 2023 Contractor: License: Est. Cost: 37370 RENEWAL BY AND RSEN 090125 Const.Class: Exp.Date: 10/06/202 Use Group: Owner: C ROBI SON DAVID G& LINDA Lot Size (sq.ft.) Zoning: WSP Applicant: RENEW BY ANDERSEN Applicant Address Phone: Insurance: 30 FORBES RD 508-351-227 MWC31415822 NORTHBOROUGH, MA 01532 ISSUED ON: 06/06/2023 TO PERFORM THE FOLLOWING WORK: 13 REPLACEMENT WINDOWS 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: i s2 Tiis I II Fees Paid: $40.00 212 Main Street Phone 413 587-1240,Fa (413)587-1272 Office of the Building Commis oner it., The Commonwealth of Massachusetts ;`T° c-204z, FObt" ' ViBoard of Building Regulations and Standard , / Massachusetts State Building Code, 780 CMR 4„1,,f)°'4/(3 C ALITY ,P itiSA SE ti Building Permit Application To Construct, Repair,Renovate Or Deli, rva,: Revi ed Mar 2011 One-or Two-Family Dwelling This Section For Official Use Only Building Pe t Number: i) 3 - �.Z Date Applied: �zJ,,.l 4Z5s ,' Z G- 5-z23 Building Official(Print Name) Signature Date SECTION 1: SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map&Parcel Numbers 5-88 kenneelj Rd L' ec s MAp,os3 1.la 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: (..ina Rohi'AS on 1„cedS fit dJ loS3 Name(Print) City,State,ZIP ¶ k-Cnntd• R.:1 1,03-519- L/SY No.and Street Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORK(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: Brief Description of Proposed Work2: /17Li+IU`t.t� a,,, 7/4 cC. /,? GI' /14.G , A it( w ii4 /)e Su c 7S i4 r i f ,/t.�•- o . t,_� , 30 . SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1. Building $ 3 7. 3,0,0v 1. Building Permit Fee: $ Indicate how fee is determined: / ❑ Standard City/Town Application Fee 2.Electrical $ ❑Total Project Cost3(Item 6)x multiplier x 3.Plumbing $ 2. Other Fees: $ 4.Mechanical (HVAC) $ List: 5.Mechanical (Fire $ Suppression) Total All Fees: $ 1/0.do I/M Check No. !7%3Check Amount: "I.v Cash Amount: 6. Total Project Cost: $ 3 7 3 9o,v„ pi Paid in Full 0 Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) CS-090125 10/06/24 Jaime Morin License Number Expiration Date Name of CSL Holder List CSL Type(see below) U 30 Forbes Rd No.and Street Type Description NorthboroughMA 01532 U Unrestricted(Buildings up to 35,000 Cu.ft.) R Restricted 1&2 Family Dwelling City/Town,State,ZIP M Masonry RC Roofing Covering WS Window and Siding SF Solid Fuel Burning Appliances 860-952-4112 renewalbyandersen@gopermits.org I Insulation Telephone Email address D Demolition 5.2 Registered Home Improvement Contractor(HIC) 170810 12/22/2023 Renewal by Andersen LLC HIC Registration Number Expiration Date HIC Company Name or HIC Registrant Name 30 Forbes Rd renewalbyandersen@gopermits.org No.and Street Email address Northborough MA 01532 860-952-4112 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 Issuancepermit of the building Signed Affidavit Attached? Yes Cif nc 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 to act on my behalf,in all matters relative to work authorized by this building permit application. 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. G- 2 - ti9z3 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 be substituted for"Total Project Cost" City of Northampton - AM,. \ Massachusetts �„, .io_ '<• A. l DEPARTMENT OF BUILDING INSPECTIONS a', 4' .- ' 212 Main Street • Municipal Building v,`� oc• a_, Northampton, MA 01060 sHy,,,.30‘^ 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. 1 h/ ,..is/cc5 . The debris will be disposed of in: f4/0,s/� AAA?ime-t Location of Facility: 30 PoiIxs a d /110, hor°V' L M 4 0 /f3 2 The debris will be transported by: Tot: nt-t- wt.., Name of Hauler: W asEe Ma A-a Signature of Applicant: 4 --A-8Date: ‘,- 2 - 2 3 The Commonwealth of Massachusetts Department of Industrial Accidents t = Office of Investigations e Lafayette City Center -• 2 Avenue de Lafayette, Boston,MA 02111-1750 <. - www.atass.goWin Workers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Lefibly Name(BusinesssOrganization.Indnidual): Home Depot USA Address: 2455 Paces Ferry Road City/State/Zip: Atlanta,GA 30339 Phone#: 860-952-4112 Are you an employer?Check the appropriate box: Type of project(required): 1.0 1 am a employer with 4. I am a general contractor and I employees (full andror part-time).* have hired the sub-contractors 6. Neve construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have g. ❑ Demolition working for me in any capacity. employees and have workers' 9. 0 Building addition [No workers' comp. insurance comp. insurance.: required.] 5. [J We arc a corporation and its 10.0 Electrical repairs or additions 3.0 I am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions myself p.[No workers' coin right of exemption per MGL 12.3 Roof repairs insurance required] ' c. 152.*1(4).and we have no employees. [No workers' 13.gg Other window replacement comp. insurance required.] `Any applicant that checks box 41 must also till out the section below showing their workers'compensation policy information. Homeowners who submit this aft'idavn indicating they arc dotng all work and then hire outside contractors must submit a new afutdavtt indicating such. :Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and slate whether or not those entities have employees. If the sub-contractors have empksyecs_they must provide their workers'comp.policy number I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Ace American Insurance Policy#or Sclf=ins. Lic. *: Policy WLRC50668150 (MT) Expiration Date: 3/1/24 588 Kennedy Rd rthampton, MA 01053 lob Site Address: XX City�Statc/Zip: Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a tine up to S1,500.00 and or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a tine of up to S250.00 a day against the violator. Bc advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA ter insurance coverage verification. I do hereby certifj•under they pains and penalties of perjury that the information provided above is true and correct. Signature`- Date: X - Z 3 Phone =': 860-952-4112 Official use only. Do not write in this area,to be completed by city or town official. ('ith or hos n: Permit/License # Issuing Authority(check one): 1 QBoard of Health 20 Building Department 3,('ih./Town Clerk 4.0 Electrical Inspector 51:3Plumhing Inspector 6.DOther Contact Person: Phone#: RENEWAL BY ANDERSEN SPECIFICATION&TECHNICAL MANUAL TECHNICAL INFORMATION PERFORMANCE RATINGS A:ND TEST DATA NFRC Total Unit Performance (continued) Renewal by Anders U-Factor Product a High PerformanceMato iiiii, (BTUI(hr ft2 oF)) . M Air HP Gas ..t 'HP GaMir Without Grilles 0.46 0.44 0.57 0.57 .82 Giear Full Divided Light Grilles 0.46 0.44 0.51 0.51 Without Grilles 0.33 0.30 0.31 0.31 .72 Low-E4e Full Divided Light Grilles 0.34 0.31 0.28 0.28 Double-Hung DB Without Grilles 0.33 0.30 0.19 0.19 .40 (Full Frame) Low-Ee Sun Full Divided Light Grilles 0.35 0.31 0.18 0.17 Without Grilles 0.33 0.29 0.21 0.21 .65 Low-E4'SmartSunTM Full Divided Light Grilles 0.34 0.30 0.19 0.19 Low-E4'SmartSun Without Grilles 0.28 0.25 0.20 0.20 .63 with Heatlock'" Full Divided light Grilles 0.28 0.25 0.18 0.18 Without Grilles 0.46 0.44 0.57 0.57 .82 Clear Full Divided Light Grilles 0.46 0.44 0.51 0.51 Without Grilles 0.33 0.30 0.31 0.31 .72 low-E4' Full Divided Light Grilles 0.35 0.31 0.28 0.28 Double-Hung DB Without Grilles 0.34 0.30 0.20 0.19 .40 Low-E4'Sun (Insert Frame) Full Divided Light Grilles 0.35 0.31 0.18 0.18 Without Grilles 0.33 0.29 0.21 0.21 .65 rt----.ow-Eiir SmartSunTM (FullDivided Light Grilles 0.34 0.30 0.19 0.19 Low-E4'SmartSun Without Grilles 0.27 r... 0.20 0.20 .63 with Heatlock" Full Divided Light Grilles 0.27 0.25 0.18 0.18 Without Grilles 0.47 0.45 0.59 0.59 .82 Clear Full Divided Light Grilles 0.47 0.45 0.53 0.53 Without Grilles 0.34 0.30 0.31 0.31 .72 Low-E4' Full Divided Light Grilles 0.35 0.32 0.29 0.28 Without Grilles 0.34 0.30 0.20 0.19 .40 Gilding Low-E4'Sun Full Divided Light Grilles 0.35 0.32 0.18 0.18 Low-E4 SmartSun TM (*Without Grilles ) 0.33 1 0.29 0.21 0.21 .65 Full Divided Light Grilles 0.34 0.31 0.19 0.19 Low-E4'SmartSun Without Grilles 0.27 0.25 0.20 0.20 .63 with HeatLockTM Full Divided Light Grilles 0.27 0.27 0.18 0.18 nq-in COMPANY Cf1NFIflFNTIAI - RFVISION AA-f11 RENEWAL , 444 byANDERSEN f�/ 7 FDEI SERVICE WINDOW&DOOR REPEAaMENT •e . Re: Massachusetts Solid Waste Affidavit Good day, Please find attached location where the installers will bring their debris from the jobs.These are all Renewal by Andersen location. • WASTE MANAGEMENT—30 FORBES RD,NORTHBOROUGH,MA 01532 When filling out any solid waste affidavit, it's the installer whom will be removing the garbage and dumping the trash at the Renewal by Andersen dumpster locations closest to that job. Thank you, Go Permits �C Itemized Order Receipt As,�x DBA:RENEWAL BY ANDERSEN OF BOSTON LINDA ROBINSON&DAVID ROBINSON RENEWAL Legal Name:Renewal by Andersen LLC 588 KENNEDY RD RENAEWAL HIC#170810 LEEDS ,MA 01053 by 4DER WAY maSEN 30 Forbes Road I Northborough,MA 01532 H:(413)519-2154 Phone:(508)351-2200 I Fax:(508)986-7072 I rbaboston@gmail.com ID#: ROOM: SIZE: DETAILS: PRICE: 205 Bedroom 3 Window Double-Hung 1:1 Slope Sill Insert, Traditional Checkrail, Exterior White, Interior White, Performance Calculator PG Rating: 25 I DP Rating: + 35 / - 35 Glass, All Sash: High Performance SmartSun Glass, No Pattern, Tempered Glass, Hardware, White, Screen, Fiberglass, Full Screen, Grille Style, No Grille, Mlsc, Standard Maintenance Free, Replacement of exterior casing from standard options (insert application)., Sill Body Replacement, Sill body replacement. Includes maintenance free sill nose (insert application). WINDOWS: 13 PATIO DOORS: 0 ENTRY DOORS: 0 SPECIALTY: 0 MISC: 0 TOTAL $37,370 Renewal by Andersen is committed to our customers'safety by complying with the rules and lead-safe work practices specified by the EPA. 05/31/23 Page 7/ 38 If Using a Builder 41 DBA:RENEWAL BY ANDERSEN OF BOSTON LINDA ROBINSON&DAVID ROBINSON RENEWAL Legal Name:Renewal by Andersen LLC 588 KENNEDY RD HIC#170810 LEEDS ,MA 01053 byANDERSEN 30 Forbes Road I Northborough,MA 01532 H:(413)519-2154 WOW MONt 0001 R11KINDA Phone:(508)351-2200 I Fax:(508)986-7072 I rbaboston@gmail.com Property Owner Must Complete & Sign This Section If Using A Builder I, as Owner of the said property, hereby authorize Renewal by Andersen LLC to act on my behalf, in all matters relative to building permit application for the property/address indicated on this agreement. j( (-At, +IMPr. db,lN N^ SIGNATURE OF SALES PERSON SIGNATURE SIGNATURE Samuel Nasrah LINDA ROBINSON DAVID ROBINSON PRINT NAME OF SALES PERSON PRINT NAME PRINT NAME 05/31/23 Page 31/ 38 Go Permits, LLC 0041111 105 Buttonball Lane Glastonbury, CT 06033 PERMITS 1 Scott Doughman Phone: 860-952-4112 Fax: 860-430-6719 scottdoughman@gopermits.org Re: Building Permit Application - Licenses Good day, Please find attached permit application, licenses and supporting documents. Renewal by Andersen sold the job and is the G.C. and CSL - CSL #CS-090125 — Exp. 10/06/24 - HIC #170810 -- Exp 12/22/23 - Workers Comp -#MWC 3145822 — Exp. 10/01/23 Old Republic Insurance Co All licenses and insurances are attached. Once the permit is ready: • Please fax or e-mail a copy of the permit and receipt to the below address and mail the original to the homeowner: Fax: 860-430-6719 Email: renewalbyandersenCa�gopermits.org' • If you unable to mail the permit to the homeowner please send to the below address and we will ensure the permit is at the home posted at the time of installation: Go Permits, LLC 105 Buttonball Lane Glastonbury, CT 06033 If we are required to pick up the permit in at the building department, please call 860-952- 4112 once it's ready and we will come to get it. Thank you, Go Permits Page 1 of 1 ACORKI CERTIFICATE OF LIABILITY INSURANCE DATE IMU0O'YYYY} kiiiir-' 09/21/2022 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 poNey(ies)must have ADDITIONAL INSURED provisions or be endorsed_ If SUBROGATION IS WAIVED.subject to the terms and conditions of the poNcy, certain policies may require an endorsement A stalwnerd on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER I C E"t'CT Ulilts Tamura Nataoe Cart/floats Canter Wallis ToNesa Nausea Widow t, Ilse. PHONE cfo 26 Oratory Nlwd it 66,p.n. 1-677-Li65-73711 I _ 1-BOB-6 67-2 3 7 11 P.O. box 305191 EN air. mar tltlastas#W11lie.iris NaalawilLs. fit 372305191 USA tinliEtaiimi AFFORDING COVERAGE NA/CA N_,-� SUNERA. 01d IIsppsblic Ieaveancr Ceapany 24147 INSURED NSMEA 0 Nserval by Andarsre Luc 30 rasLaa !bad I4R RC Nos Wafts eagb, NA 01532 NSURER°: NSUIER E. _INSURER F COVERAGES CERTIFICATE NUMBER:R24007651 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 WREN IS SUBJECT TO ALL THE TERMS EXCLUSIONS AND CONDITIONS OF SUCH PIGMIES LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS LIR TYPE OF INSURANCEWED POLCY RUNNERp PDI rCr EJ s X DOSINIERCIAl GENERAL LIABILITY EACH OCCURRENCE f 2.000.000 CWNASIMDE EjOC '_P - FPREMISESOl CIN I S00,000 A MEIN EA.Oat ma mum I 10,000 RIM 311161 22 10/01/2022 10/01/2023 pERsc$$$t.iscve&NRY I 2,000.000 GEM.ACIDREGATE UNIT APPLES PER OEf1EA4i AGGREGATE I 4,000.000 POLICY Q gCT LGC PRODUCTS-coo/Rea.AUG I 1.000,000 I OTHER f AUTOMOBILE UABIITY D E SINGLE LT $ 5,000,000 X ANY AUTO JII BODILY INJURY iP1r 9ma0M I A —'OWNED ^SCHEDULED OWN 314159 22 10/e1/2022 70/01/2023 SCDILY INJURY Mr acC fit I ,-..„„,,AUTOS ONLY AUTOSS HARE!)ED it NCK¢NNED PtsamhTV WAAEIE / .....,AUTOS ONLY .� AUTOS 011.Y ,iPar amAsetf ,I ` UMIIELIANLIB H OCCUR EACHOCCLSRENCE $ ~EICCESSLent CLJ4JSMADE AGGREGATE $ L'EO I 'RETENTION I I WOIKERSCOf1PEN6ARON 7 ,XTsUT►rTE I I AND EMPLOYERS'L1IASTINY Y,II1.000.000 M A Y3'R_%PR/ETOR.PARTNEREXECUTNE EACH ACCIDENT I OFF':L:ERAAEh REXCLLOED' Q Si.i N!A ten_ 314150 22 10/01/2022 10/01/2023 1,000.000 OI(Nndterr leNq r E L DISEASE-EA EMPLOYEE,I it�a Ot9.:ldlt YMIN DESCRIPTION OF OPERATIONS Daum j EL DISEASE-POLICY LOAD I 1,000,000 DEBCRDe10N OF OPERATIONS,'LOCATIONS 0 9911CLES IACDIO Met-AAdUbee Armalas SOANAAN,me,4a MNaelre doom apeea as Nq irel) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF. NOTICE WEL BE DELNERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Iv ldre oe of InA.camels It Q '/r t/— E 198E-2016 ACORD CORPORATION. All nghts reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD Commonwealth of Massachusetts COf SllperViaOr �` Division of Occupational Licensure of 10111 use group Which contain Board of Building Regulations and Standards less �s� c p1 cubic meters)of enclosed Constl x 511ps/visor Woof tit- ,1 CS 090125 ,il'. `" epires: 10l06/2024 JAIME L MOOIN f 54 NOTTINGNAM RD E; Aso RAYMOND MN 030 >`. •OIlv Failure to pow sos a conuot edition of the btaasachuaatta Cc rrirlii84110FACF deffia X.X Idle is Came for r vocation of this licanaa. v,.�7 .�. For mformaton about this*censc Cali 017)TT1-30e or viol www.anass.govfdpl THE COMMONWEALTH OF MASSACHUSETTS Office of Consumer Affairs and Business Regulation 1000 Washington Street-Suite 710 Boston, Massachusetts 02118 Home impro .• . tractor a istration poi may=Type: Supplement Card ' Regrsu . 170810 RENEWAL BY ANDERSEN LLC Eighratan 12/ 212023 30 FORBES RD us*, NORTHBOROUGH,MA 01532 " «: ire' Update Address and Rehm Card. THE COMMONWEALTH OF MASSACHUSETTS Office of Consumer Affairs a Business Regulation Registration valid for individual use only be4ort.Ina .w p,r ap.�r6 Aar.. it round return to HOME IMPROVEMENT CONTRACTOR Off ce of Consumer Affairs and B'ainesa Regulation TYPE'Su( ni Card 1000 Washington Street -Sune 710 EnirlIttl20 Bo ton,MA 02118 170410 12221202Y Rt'YFWAL H'Y ANDERSEN Lit JAiMk►ORIN :f)FOitF3kS RD u.r../.i ...:G.«. - °1(R'HBORo/J(44,AAA OIS . IJnaersecrslary I Not lid without signature R. , RENEWAL ; byANDE RSEN 41/4wSFIVG MX* To Wtiom It May Concern: This letter will authorize the following pe sonls) to act as agent(s)on behalf of Renewal by Andersen LI.C. 9900 Jamaica Ave South,Cottage Grove MN 55016 to pull for permits and Inspections with respect to the installation, maintenance and repair of windows and entry dnnrc Unripr Macs.ichtrcetti State Home improvement Contractor license ritifr ber 170810 and Construction Supervisor License number CS-090125. If you have any questions, please call me at 508.351.2277 eit6. Authorized personts): Go Permits LL,C Sarah Hammad David Anderson Maureen Kivel Scott Do►,aghman Ryan Biondo Sovannara Kuy Mark.Fester cilynn trargan Jennifer Witnke wrendy Holden Gerald Cramer Nick Raga Dane'VVckerrnan Stephen Wilder Katie Grocott Bonnie Myers Carrie Fol,gno Michael Rogers Rachel Orloff ''amie Morin Renewal by Andersen tut: HIC 170810 CSL—CS090125 Local District Office Address 30 Forbes Rd Northborough, MA 01532 lrrrcwai by Ander:.on 1.0 9900 tarnai AYr.Scat.Conti Grave MN S 016 Page 1 of 1 AC RO CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) o9/z1/zozz 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 Willis Towers Watson Certificate Center NAME: Willis Towers Watson Midwest, Inc. FAX wC.PHONEI .Ext); C.Not 1-877-945-7378 1-888-467-2378 c/o 26 Century Blvd IL P.O. Box 305191 ADDARE S: certificates@willis.cam Nashville, TN 372305191 USA INSURER(S)AFFORDING COVERAGE NAICB INSURER A: Old Republic Insurance Company 24147 INSURED INSURER B Renewal by Andersen LLC ---- - � _ - -- - 30 Forbes Road INSURER C: Northborough, bQQ 01532 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:W26008011 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.UMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL'SUBR POLICY EFF POLICY EXP LIMITS LTR INSO WVD POLICY NUMBER (MM/DD/YYYY) (MMIDD/YYYY) X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 2,000,000 CLAIMS-MADE X OCCUR DAMAGE PREMISES(Ea occurrence) $ 500,000 A NED EXP(Any one person) $ 10,000 MWZY 314161 22 10/01/2022 10/01/2023 2,000,000 PERSONAL 8 ADV INJURY $ GEM.AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 4,000,000 X POLICY JPECOT LOC PRODUCTS-COMP/OP AGG $ 4,000,000 OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 5,000,000 (Ea accident X ANY AUTO BODILY INJURY(Per person) S A OWNED SCHEDULED MWTB 314159 22 10/01/20/22 10/01/2023 BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE AUTOS ONLY AUTOS ONLY (Per accident) UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION )( AND EMPLOYERS'LIABILITY STATUTE ER Y!N A ANYPROPRIETOR/PARTNER/EXECUTIVE EL EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? No NIA MSC 314158 22 10/01/2022 10/01/2023 (Mandatory in NH) EL.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under 1,000,000 DESCRIPTION OF OPERATIONS below EL.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Town of Westford is included as an Additional Insured as respects to General Liability as required by written contract. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Town of Westford 55 Main St. Westford, MA 01886 ( �. ©1988-2016 ACORD CORPORATION. All rights reserved.