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32A-166-012
BP-2023-1034 12 BIXBY CT COMMONWEALTH OF M SSACHUSETTS Map:Block:Lot: 32A-166-012 CITY OF NORTHA PTON Permit: Exterior Res PERSONS CONTRACTING WITH UNREGI TERED CONTRACTORS DO NOT HAVE ACCESS TO THE GUARA TY FUND (MGL c.142A) BUILDING PERMIT Permit# BP-2023-1034 PERMISSION IS HEREBY GRANTED TO: Project# ROOF 2023 Contractor: License: WILDE HSE LLC DB SEXTON Est. Cost: 13800 ROOFING 106265 Const.Class: Exp.Date: 03/08/202 Use Group: Owner: KILBO ' BERG,WENDY &JONATHAN Lot Size (sq.ft.) Zoning: URC Applicant: WILDE! SE LLC DBA SEXTON ROOFING Applicant Address Phone: Insurance: 45 OLANDER DR 315-569-7761 6HUBOW55113923 NORTHAMPTON, MA 01060 ISSUED ON: 08/03/2023 TO PERFORM THE FOLLOWING WORK: STRIP AND REROOF 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: 1 )2 i Fees Paid: $40.00 • 212 Main Street,Phone(413)58'7-1240,Fax (413)587-1272 Office of the Building Commis& ner RECEIVED The Commonwealth of Massa huse is AU5 i 2 zoo 1► Board of Building Regulations an Stanidards R --�(tJNTFOPALITY Massachusetts State Building Code, 78g,/1 pm/DING INgPECTIONS NCB;1 AA PTON MA 01060 SE Building Permit Application To Construct,Repair, a evised Mar 2011 One-or Two-Family Dwelling This Section For Official Use Only Building Permit Number:OD-d 3 -10 b y Date Applied: Lb &O5 IG� 8 -2OZ3 Building Official(Print Name) Signature Date SECTION 1: SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map& Parcel Numbers 12 6 i�� cam- Ni6rti minokAn M4 btwo 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.t.c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Zone: _ Outside Flood Zone? Public 0 Private 0 Check if yes❑ Municipal 0 On site disposal system ❑ SECTION 2: PROPERTY OWNERSHIP[ 2.1 Owner'of Record: t{end,,rcu. '{orbp. Manrgcnekit IVGTNutm1 t ivl t DUXAa Name(Print) City,State,Z 12- $iy C y 13-o15'S-6g�s Su �oFt P kriutiru, C me •car') 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) yl Alteration(s) 0 Addition ❑ Demolition 0 Accessory Bldg. 0 Number of Units Other 0 Specify: Brief Description of Proposed Work': ( rc \wremectk ' INstyrG SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1. Building $ 13 goo 1. Building Permit Fee: $ Indicate how fee is determined: 0 Standard City/Town Application Fee 2. Electrical $ 0 Total Project Costa(Item 6)x multiplier x 3. Plumbing $ 2. Other Fees: $ 4. Mechanical (HVAC) $ List: 5. Mechanical (Fire $ Total All Fees: $ Suppression) ,l71 Check No.1O1 b Check Amount: "l v Cash Amount: 6.Total Project Cost: S /31 $00 0 Paid in Full 0 Outstanding Balance Due: • SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) t0(e211/S Sq , w ltle ( License Number Expiration Date Name of CSL List CSL Type(see below) RL- y S Otemer No.and Street ll! Type f Description -r I. i Unrestricted IBuildings up to 35.000 cu.ft.)iV6(`*Aorrt' en ( MA QtOL9 ? 4 R Restricted t&2 Family Dwelling State.ZiP I M Masonry RC Roofing Covering WS / Window and Siding SF Solid Fuel Burning Appliances 315—Stoa -5ciay. 1 Insulation Telephone Email addr ss B Demolition 5.2 Registered Home Improvement Contractor(HIC) 2oatii0 y 13012425 _ --- (iron_Roorr‘s_.4_6►dA,15 HIC Registration Number Fbtration Date tit( t.or,,ri; \an;. j1t Aame No.and Street Email addre`3 tOrA to o 36-spci--tug C y/Town,State.ZIP Telephone SECTION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.152.g 25C(6)) Workers Compensation Insurance affidavit must be completed and submitted wit this application. Failure to provide this affidavit will result in the denial of the Issuance of the building permit. Signed Affidavit Attached? Yes No ❑ SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR B:ILDLNG PERMIT 1,as Owner of the subject property.hereby authorize *Me. k-kS 'DQA Stakert l to act on my behalf,in all matters relative to work authorized by this building permit application. keene - 'Pnv- Iskuv ra ai& $l i/2423- Print Owner's Name(Electronic Signature) SECTION 7b:OWNER'OR AUTHORIZED AGENT DECLARATION 8t entering my name below.I hereby attest under the pains and penalties of perjsry that all of the information contained in this application is true and accurate to the best of my knowledge and understanding. Print Owner's or Authorized Agent's Name(Electronic Signature) Date NOTES: I. An Owner who obtains a building permit to do hisher own work,or an owner who hires an unregistered contractor (not registered in the Home Improvement Contractor(HiC)Program),will tit 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 c .mass. \ oua information on the Construction Supervisor License can be found at cr.nrt! .,t,1'des 2. When substantial work is planned,provide the intbrmatio n below: Total floor area(sq. R.) (including garage,finished basement:attics,decks or porch) Gross living area(sq. ff.) 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. "TotaI Project Square Footage"may be substituted for"Total Project Cost" City of Northamp on Massachusetts • DEPARTMENT OF BUILDING INSPECTIONS 212 Main Street • Municipal Building �. C 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 csicitlo The debris will be transported by: Name of Hauler: faA.P c r.25 u:Vc4,6.4(s Signature of Applicant: Date: ° The Commonwealth of Massac usetis (' Department of Industrial Ace",ents —i j,t-- 1 Congress Street, Suite 101 t Boston,MA 02114 201 7 '� , ' www. ass.gov/dia VSIters'Compensation Insurance Affidavit:Builders/Con actors/Electricians/Plumbers. TO BE FREI)WITH TII£ PERMITTING' t 'THORITV. . ,,,a 1 t - t1 / i • ' 'i V•1 Name(Business Organisation Individual): \Nt�q, IaSE ii,j.(c1 -Deloi 41A.,„„, ai. C'.t.q k Stacd�c, Address: y n S 3tc .x br J J C ityStategip:_atiemomvp64 MA oiptoo Phone#: 31$-6toci--nu i Are you an employer?Chet*the appropriate box: t Type ofi project(requiredj: I.01 am a employer with employees(full andiorpart-time).` 7. [New construction _piama sole pre prier& or partnership and have no cr oyeesworMng for me in 8 0 Remodeling any capacity.[No workers'comp insurance required.) 9. ❑Demolition 3.01am a homeownerdoingali work myself[No workers'comp.insurance required.)' 4,01ama homeowner and will tie#airirtgcoelil esws to conduct all-work on property. t wilt 10❑Building addition ensure that all cc.tan rs cubes-hat c wititt-rs%aitavrisatiK it sarsa c e r arc side i I.0 Electrical repairs or additions proprietors with no employees. 12.0 Plumbing repairs or additions i am a general contractor and i have hired the sub-contractors listed on the attached sheet. 13. ti Roof repairs These sub-contractors have employees and have workers'comp. insurance.- 6.0 We are a corporation and its officers have exercised their right of exemption per MGL c. 14.Q Other 152.§I(4),rod we havenoemployces.[No workers'comp.insurance required.) in;app:cant that checks box I must also till out `:e soon below al*n:rrc ingtheir wonkcr, 71V 5 r t policy information }Hier who submitthis affidavit indicatingthey are doing all work and then hire outside eonsactors must submit a,.cw affidavit indicating such. !Contractors that check this box must attached an additionalsheet showing the name of the sab-conxacutrs and state whether or not those entities have employees. if the sub-contractors have employees.they must provide their workers'comp.policy number. _ t . I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information_ Insurance Company Name: `rinsmlt>a 'rs ai s rj ,LC.e, t► A.A... Policy #or Self-ins. Lie. #f:_l0 Expiration Date: Olo(a11ZDat{ _ Job Site Address:.._„ t3.i 2,14 Q- City/State'Zip:NptWtarrtct 1 Mi4 c1Ote0 Attach a copy of the isorkerc' 'ompensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGt.c. 152,§25A is a crim ina l violation punishable by a fine up to S 1,500.00 and'orone-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER anda rme of up to S250.00 a day against the violator.A copy of this statement may be fotwarded to the Office of investigations of the DIA for insurance coverage verification. I do hereby ee tifi•under the pains and penalties of perjury that the information provided above is true and correct. Signature: —4n IJt__ pate; $121 2021 Phone . 3i5-d;:eaq tvg Official use only. Do not write in this area,to be completed by city or town official. City or Town: PermitlLicense# Issuing Authority (circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5. Plumbing inspector 6.Other Contact Person: Phone#: i AC p DATE(MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 06/09/2023 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: Eric Dembinske ORMSBY INSURANCE AGENCY PHONE No.EXt) (413)737-0300 FAX `.No1: E-MAIL n edembihk ormsb S com ADDRESS: eG Y� P O BOX 718 INSORER(S)AFFORDING COVERAGE _ NAIC WEST SPRINGFIELD MA 01090 INSURER A: TRAVE_ERS INDEMNITY CO OF AMERICA 25666 _ INSURED MSURER B: WILDE HSE LLC INSURER C: DBA SEXTON ROOFING& SIDING INSURERD: 45OLANDER DRIVE INSURERE: NORTHAMPTON MA 01060 INSURERF: COVERAGES CERTIFICATE NUMBER: 901203 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TC)•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. ILNSR TR TYPE OF INSURANCE TADDLISUBRT- "---_ --- ----- POLICY EFF POUCY EXP*IS yyyD POLICY NUMBER namioo/YYYY),1(MMIDDlrern LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ DAMAGE TO RENTED CLAIMS-MADE 'L�OCCUR PREMISES(Ea occurrence) $ MED EXP(My one person) $ N/A PERSONAL&ADV INJURY $ -- 1 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ _ POLICY Li JjEE T 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 1 I RETENTION$ I • $ WORKERS COMPENSATION X PER 0TH- PERTUTE_ ER AND EMPLOYERS'LIABILITY ANYPROPRIETOR/PARTNER/EXECUTIVE V/N E.L.EACH ACCIDENT $ 1,000,000 A OFFICER/MEMBER EXCLUDED? N/A WA N/A 6HUB0W55113923 06/01/2023 06/01/2024 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 N/A DESCRIPTION OF OPERATIONS 1 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/. 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. Sexton Roofing and Siding Inc PO Box 6327 AUTHORIZED REPRESENTATIVE n C 4k Holyoke MA 01040 Daniel M.CroQ y,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 ACORD Client# DATE M CERTIFICATE OF LIABILITY INSURANCE 07/25/2023 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHT 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 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 Gullherme Camossato NGMF PHONE 978 726-9830 I-INSURANCE GROUP INC (A/C.N°.Ext) EMAIL gcamossatoei-insurancegroup.net 799 GORHAM ST ADDRESS' LOWELL, MA 01852 INSURERIS)AFFORDING COVERAGE NAIC INSURED INSURER A:GENERAL STAR INDEMNITY COM INSURER B:ARBELLA PROTECTION INSURANCE LDG HOME IMPROVEMENT INC INSURER C. 18 SPRING ST FL1 INSURER D:TRAVELERS PRISPERTY CAS CO OF AM MILFORD, MA 01757 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:000015 REVISION NUMBER: 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 TALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, INSRL AOOLI SUER POLICY EFF POLICY EXP TR TYPE OF INSURANCE NSR WVD POLICY NUMBER (MM/DO/YYYY) (MM/DO/YYYY) LIMITS A GENERAL LIABIUTY EACH OCCURRENCE $ 1,000,000.00 DAMAGE TO RENTED X COMMERCIAL GENERAL LIABILITY PREMISES(Ea acurrenceI $ 100,000.00 CLAIMS-MADE IX I OCCUR MED EXP(Any one person! $ 5,000.00 IMA395923A 8/25.'2022 8/25/2023 PERSONAL S ADV INJURY $ 1,000,000.00 GENERAL AGGREGATE $ 2,000,000.00 GEN'L AGGREGATE LIMIT APPLIES PER Products Completed Ops Aggregate $ 2,000,000.00 POUCY l l ^PROJECT I 'LOC B COMBINED AUTOMOBILE LIABILITY EeeSINGLE LIMIT,t $ 100,000.00 ANY AUTO BODILY INJURY(Per person) $ 20,000.00 A OWNED SCHEDULED 1020096012 4/13/2023 4/13/2024 BODILY INJURY(Per accident! AUTOS '-'SCHEDULED AUTOS $ 40,000.00 NON-OWNED PROPERTY DAMAGE HIRED AUTOS AUTOS (Per acndent) $ 100,000.00 C' UMBRELLA LIAR OCCUR EACH OCCURRENCE EXCESS LIAR CLAIMS-MADE AGATE DEO I RETENTION _ D WO R%ERSCOMPENSAt1ON WC STATUTORY OTH AND EMPLOYERS'U Ln ABIY VM LIMITS ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L EACH ACCIDENT OFFICER/MEMBER EXCLUDED? n/a 1,000,000.00 6HUB4N86974323 3/26/2023 3/26/2024 • $ IManOaaxy In Nli) E L DISEASE-EA EMPLOYEE $ 1,000,000.00 If yes,desalbe under DESCRIPTION OF OPERATIONS below EL.DISEASE-POLICY LIMIT $ 1,000,000.00 GENERAL LIABILITY for regular and usual jobs and the certificate holder is an additional insured Workers'Compensation benefits will be paid to Massachusetts employees only.Pursuant to Endorsement WC 20 03 06 B,no authonzation 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 Venfication Search tool at www mass gov/lwd/workerscompensatioivtnvestigations/ CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE IT IS THE CUSTOMER'S RESPONSABILITY TO INFORME ANY SEXTON ROOFING CHANGES OR CANCELATIONS 45 Olander Dr., Northampton, MA GUILHERME CAMOSSATO 1/1 ©1988-2010 ACORD CORPORATION.All rights reserved. ACC) DATE(Mi6DDITYYY) �/ CERTIFICATE OF LIABILITY INSURANCE 05/31/2023 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 at the policy,certain p4Mcies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder In lieu of such endorsements). PRODUCERAml& BRUNO ROZEMBAROUE POINT INSURANCE INC IPSICINE } (817)7r831160 Mak Ems- bruno p° 'resent - 1103 COMMONWEALTH AVE IIRSUREIVS)AFFORDING COVERAGE NAACO BOSTON MA 022151111 0110111tet A: AIM MUTUAL INS CO 33758 MIMED MRIRER 0: E C A GENERAL CONSTRUCTION INC mac: MAMtERD: 8 OTIS ST APT 1 INDUIRERE: MILFORD MA 01757 asueERr:: COVERAGES CERTIFICATE NUMBER: 897535 REVISION NUMBER: THIS IS TO CERTIFY TEAT 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 NAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, OCCLUSIONS AND CONDITIONS OF Si1CH POLICES.pp{ LIATS SH(MW MAY HAVE BEEN REDUCED BY PAID CLAIMS k TYPE OF INSURANCE t� ykp POLICY NI ER 2(Vr7Lr�p f 7 POLICY S CII t ktEWALIrA!'JlirrY EAS'A+'D r,.ii iRE,Ar S DAMAGE rORENrED "CLAI1 � j OCCUR .PREMISES LEE occisrenae} S EIW(Anyone person) s NIA ., PERSONALSAraniuURY $ °EML AGGREGATE MDT APPUESPER 'GENERAL Au GATE $ 1 POLICYE I JEcT I LOG PRODUCTS-COIPATPAGG S 11 OTHFR S j AUTONOBILEUABUTY (CFL NGLEL►MR $ VW ALCM, BOOktf IMARY(Per person) $ TAMED SC EDULBO NIA BODILY INJURY(Per accident) $ *woe ow,' AUTOS 6 HIVED i. NOMOAMED PRCPERIN WAAGE f 'ALMS AUWBONLY Per=DOR i f Ra1A:Uas OGCUR EACH 0 $ EXCESS UAB CLANS—MAW NIA AGGREGATE s t D� RFTEV1Ic N; $ WO COMPENSATION XI STATUTE I ER *no eeruaveier UAdIJTY MiT T£tRTART1ET+A7EC S1af RJM ELEAC*4ACCIDENT $ 1,000.000 A El Met WA VWC10060260282023A 02/11/2023 02/11/2024 IMendamyInNH) ELDIFesF-EAEMPLOYEE $ 1,000,000 I�OF OVERATICSSS Won i EL o sEAsE-POLICY t*Bt $ 1.000,000 I N/A I I DESCRIPTION OF OPERA*ONS:LOCATIONS rw}ec rs tACORD 101,AAdY•oeai Remarks Sckmdrda,sear two attached it wart apses is nisaired1 Workers'Compensation benefits wit 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;n states other than Massachusetts if the insured hires,of has hiredi 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 the certificate of insurance)_ The status of this coverage can be monitored daffy by accessing the Proof of Coverage-Coverage Verification Search foci at vriverunass.govhwdlirborke-s-corrruerisatiortiirwestigationsi. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE AB(YilE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN It HSE PLC ACCORDANCE WITH THE POLICY PROVISIONS_ Wi45 Olander Dr A1101 1101ED dE Northampton MA 01060 Danid It C CPCU,Vice President—Residual Market—WORIBMA ®il 8 2015 ACORD CORPORATION. Aft rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD Licensee Details Demographic Information Full Name: SASHA MARIE WILDE Owner Name: License Address information City: NORTHAMPTON State: MA 'Zipcode: 01060 Country: United States License Information License No: CSSL-106265 License Type: Construction Supervisor Specialty Profession: Building Licenses Date of Last Renewal: Issue Date: 7/6/2023 Expiration Date: 3/8/2027 License Status: Active Today's Date: 7/7/2023 Secondary License Type: • Doing Business As: Status Change Reason: License Issuance Prerequisite Information ^_ No Prerequisite Information No Available Documents THE COMMONWEALTH Of MASSA,CHUSETTS Office of Consumer Affairs and Business Regulation WOO Washington Street-Suites 719 Boston,Massachusetts 0211 B Home Impravement Contractor Registration Typo tt.0 d AE HIM t tC Poapstratan 2SIl441G DIVA SEXTON RDOFIt O 611404{i entreat ObO G23 IVDRTOIAMPTDK uA G3104 {lvd5U Addttts Ana Return C P Q ThhE COMMONWEAL 11 Of MA 5ACMUIETTS O01s4 et Cansumrr POMP'6 Pusinrsr Rtputanan R;splo noton oaf for uss only Wore t». IlOdE IMPROVEMENT Cc TRACTOR .rPlratbn date. INImerdmean N TYPE.:L C 0.6es at Cormut V ARrkI a d Hrmnrss Rog woof, Enala:tnn U I•I Wit f gtan Street •iulta 714 J".&111 !M.10443 eottan•1t&02414 WWI weig.uC Q3`A SEATON ROCi Il+ti 4 SONG SA.Seuk Wel,* 45 ODU4DER DIR ,,,s.� •� •'I ,e1 - — 4011.TURAPTO4i.MA a?tG+ Une ucx.iary Not v#Nd ;$qI tur W I LDE USE,LLC SEXTON ROOFING jeiN. D SIDING www.sextonroofing lcom p.413.534.1234 1 �_ info@sextonroofing.com WO Mirmor OM 45 ()kinder Dr. Northampton, MA 01060 Scurne the Standard MA HIC # 208470 SUBMTTTEDTO Kendrick Property Management I PHONE 4i3-253-0N25 DATE 17/2S/202"3 SiRt.ti 12 Bixby Court EMAIL f scott@ kendrickrnanagement.com C1TY STATE,ZIP Northampton MA 01060 riwfr SEXTON ROOFING HEREBY SUBMITS SPECIFICATIONS AND ESTIMATES FOR I) Strip and remove existing shingles and dispose of in proper landfill. 2) inspect roofing deck and replace as needed @$105.00 per sheet. 3) Install new metal edging to rakes and eaves of roof.(white) 4) Install ice and water shield on eaves(6'),vent stacks,in valleys,chimnty,at intersecting roofs. 5) Install synthetic roofing.underl ayrnent on remainder of roof. b) Install new flanges over existing vent stacks. 7) Install starter shingles on eaves and rakes of roof. 8) install IKO Architectural style roofing shingles as per manufacturers'specifications.Color:Charcoal saran 9) Supply manufactures Lifetime warranty and SRC ID yr.workmanship warranty. ATTENTION HOMEOWNERS Please cover all personal belongings in the attie,.garage,or storage areas due to possible roo f i n debris or dust coming through cracks of wood decking. Sexton Roofing shall apply fur all permits. We propose hereby to furnish material and labor-complete in accordance with the above specifications.for the sum of Thirteen thousand eight hundred dollars($13,800) Payment due in full upon completion All Matenal is guaranteed'to be as specified. All work to he completed in a workutanhke manner according to standard practices. Any alteration or deviation from above specifications Authorized /�)_!4 i rwolving extra costs will be executed only upon written orders. Signature and will beconne an extra charge over and above the estimate. DAMAGES TO RUSHES ANT)OTHER H£6t VEGETATION MARKS ON Note:This pi op)sal may be withdrawn by us if not accepted within FHOUSE MAY At:UNAVOIDABLE AND WE ARV:HELD HARMLESS. Not responsible for water damage during construction, Owner to (14)days. pay responsible legal fees tor non-payment.and applicable interest. i Acceptance of Proposal The above prices, . siseccticancxms and conditions are satisfactory and are Signa*tirc -. - ' #L` 1 ,J ( L'P S hereby accepted. You are authorized to do the work as Pie,C" T t=-t.. t '.-A v /:-sa S u C specified. Payment will be made as.outlined above. Date cli _y