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18C-158 (3)
BP-2023-1072 36 WARBURTON WAY COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 18C-158-001 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-2023-1072 PERMISSION IS HEREBY GRANTED TO: Project# ROOF 2023 Contractor: License: WILDE HSE LLC DBA SEXTON Est. Cost: 7350 ROOFING 106265 Const.Class: Exp.Date: 03/08/2027 Use Group: Owner: AMIR PAKNYA, Lot Size(sq.ft.) Zoning: URB Applicant: WILDE HSE LLC DBA SEXTON ROOFING Applicant Address Phone: Insurance: 45 OLANDER DR 315-569-7761 6HUBOW55113923 NORTHAMPTON, MA 01060 ISSUED ON: 08/10/2023 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: ' '. a; or , >2 . I Fees Paid: S40.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Office of the Building Commissioner RECE/ The Commonwealth of Massachusetts Board of Building Regulations and Standards ` FOR f. ''y� Massachusetts State Building Code, 780 CM' WOE PA TY o ,r USE Building Permit Application To Construct,Repair,Renovat 0 DeglVapt ,! •d Ma 2011 One-or Two-Family Dwelling R�,�pT N, NSP crioN This Section For Official Use Only Building Permit Number: ✓f'"-13" �07,2-- Date Applied: 4,,,,a, ,2 8-!o-zozf Building Official(Print Name) Signature Date SECTION 1: SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map& Parcel Numbers 3431 Vs10.41 ti ►S Mplat MA bot o 1.1a 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: Zone: _ Outside Flood Zone? Public 0 Private El Checkif yes❑ Municipal 0 On site disposal system 0 SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of Record: June, \ rnar njoCiOCAa+pkon % l'AX OVA.o Name(Print) City,State,ZIP No.and Street Telephone Emai hAddress SECTION 3: DESCRIPTION OF PROPOSED WORK2(check all that apply) New Construction 0 Existing Building 0 Owner-Occupied 0 Repairs(s)i Alteration(s) 0 Addition 0 Demolition 0 Accessory Bldg. 0 Number of Units Other 0 Specify: Brief Description of Proposed Work: (la re.Ocradr e1*A A fr o' e ►ry YnprAed SECTION 4:ESTIMATED CONSTRUCTION COSTS Item ! t5mated Costs: Official Use Only (Labor and Materials) I. Building $ -1 3s) I. Building Permit Fee: $ Indicate how fee is determined: ❑ Standard City/Town Application Fee 2. Electrical $ ❑Total Project Costa(Item 6)x multiplier x 3. Plumbing $ 2. Other Fees: $ 4. Mechanical (HVAC) $ List: 5. Mechanical (Fire $ Suppression) Total All Fees: $ �,fj) Check No. (D((1O Check Amount: i"Cash Amount: 6. Total Project Cost: $ -350 0 Paid in Full 0 Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES C i Construction Supervisor License(CSL) tOto �} Q1vS Si llti SasWA w k4e, 1 License Number Expiration Date List c Sl_ i spc(see below( k. No.and Street Type Description i' r:: t eted(Buitdinps up to 35.000 cu.ft.) tNieseilnotivOion 1 KA (It ot-e et I R Re rricted I&2 ramify Dwelling City Town,State,ZIP M Mason ry RC Rooting Covering _ 4i'S Window anti Siding SF - Solid Fuel Burning Appliances 315-7.912a_-114-- SGS1 ,Z,se .k-a vran •CAM j I 1 Insulation Teephone t:r,uil addr ss + D 1 Demolition 5.2 Registered Home Improvement Contractor(HIC) 2ogy�a 4inae L 4 knn 'RrepCU 4 64 MC RstrationNumber MC Company Name or MC Rego rant Name 44S OingVi r l� : schtv.OSeicion b t •c rs No.and Street \ Email addre.1 O CO its- t-"I->(ol ` City'Toe.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 At 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 • 'S� to act on my behalf,in all mailers relative to work authorized by this building permit application. t6t.t1e. VALY x IVO-oa3 Print Owner's Name(Electronic Signature) SECTION 7b:OWNER'OR AUTHORIZED AGENT DECLARATION i 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. Sc;, . \/ OAL 8191 v061.3 Print Owner's or Authorised Agent's Name(Electronic Signature) Date NOTES: I. An Owner who obtains a building permit to do hisrher own work,or an owner who hires an unregistered contractor (not registered in die Home Improvement Contractor(HIC)Program),will not have access to the arbitration program or guaranty fund under M.G.L.c. I42A.Other important information on the HIC Program can be found at \v ewe m its, ie oca information on the Construction Supervisor License can be found at v,w 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 Massachusetts _ '••'cam t a. DEPARTMENT OF BUILDING INSPECTIONS €jb' 212 Main Street • Municipal Building ti AZ, Northampton, MA 01060 7140 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: ugh R S1 \,Se, A d\Olo The debris will be transported by: Name of Hauler: Rss(5-z-iaAce\ "23k}- Signature of Applicant: A --04.j- Date: a(9b.om ` The Commonwealth ofMfassachusetr' ""'— - Department of Industrial Accidents = 1i 14 _ iiii- 1 Congress Street, Suite 100 �"�� Boston,MA 02114-2017 Vwww mass gov/din %.iw ers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TORE FILED 111TH THE PERMITTING Applicant Information Please Print Legibly Name ti itsin.,,()rganiiationTndividuall:\INtAN, IaSE, ._l- cemIctrn liZaslc.,1 k Slav Address: yS OtcatQL.r br City/State/Zip: islooktnamelty, MA =too Phone*: 3i5-%Lo9--3-RA Are you an empioyer?OW*the appropriate box: Type of project(required): 1 1.Q1 am a employer with employees(full andiorpart-tune).` 7. :New construction 2.01 am a sole proprietor or partnership and have no err luyees working far me in l. Remodeling any capacity.[No workers`comp. insurance required.] 9. ❑Demolition 301am a homeowner doing all work myself:[No workers'comp.insurance required.)' 10❑Building addition -in I am a homeownerand will be haringwaraes,is to conduct all work on my pioperty. I will cttct:re that all c:aeaaetr either have workers-roorpmsicsor+t'.t.ra,t: or arc sole r I I 0 Electrical repairs or additions proprietors with no employees. 12.1:1 Plumbing repairs or additions 5E11 am a general contractor and I have hired the sub-contractors listed nn the attached sheet. 13.®Roof repairs These sub-conrac,or have employees and have workers-comp. insurance.: 60 We arc a corporation and its off-wets have exercised their right of exemption per MGL c. 1 4.❑Other I52.EI(4),and we have no employees.[No wcwkers'comp.insurance required.] *any applicant that checks box must also till out the section hel:nv showingtheir workers';ir?-,:mini policy information. 'Homeowners who submit this affidavit indicating they are doingall work and then hire outside contractors must submit a new affidavit indieatingsueh. Contactors that check thistles must attached an additional sheet showing the name ofthe sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. l am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job.site information. Insurance Company Name i(lees/a.kz -TraaM14.5 .a edk 64 AftlitAr.o. Policy #or Self-ins. Lie. #: l0 Nl,t[QW 6tSkt3510 Expiration Date: Olo tilt(2.Oa4 Job Site Address: al/ \NI84-4citufkon Vsp. City/State;Zip:Acet 4w,tthadp_AAL6g100 Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL c. 152,*25A is a criminal violation punishable by a fine up to S 1,500.00 andi`orone-year imprisonment,as well as civil penalties in the Corm of a STOP WORK ORDER and a tine of up to S250.00 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 certi ji•under the pains and penalties of perjury that the information provided above is true and correct. Si .e: t1Q/t��►— Date: ��g12b1.3 1'h:>ne rr 315— 6(LQ—71tpi Official use only. Do not write in this area,to be completed by city or town official. (_it) nt Toss,,: Permit/License# 1 Issuing Authority (circle one): I. I.Board of Health 2. Building Department 3.City/Town Clerk 4.Electrical inspector 5. Plumbing inspector ' 6.Other Contact Person: Phone#: ACORD Client#: DATE TM 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 Guilherme Camossato fICME PHONE 978 726-9830 I-INSURANCE GROUP INC (A/C,No.Ext): EMAIL gcamossato@i-insurancegroup.net 799 GORHAM ST ADDRESS: LOWELL, MA 01852 INSURER(S)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 PROPERTY 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 ADOLI SUBR POLICY EFF POLICY EXP TR TYPE OF INSURANCE NSR N1VD POLICY NUMBER (MM/ODIYYYY) (MMIOOJYYYY) LIMITS A GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000.00 DAMAGE TO RENTED X COMMERCIAL GENERAL LIABILITY PREMISES(Ea eminence) $ 100,000.00 CLAIMS-MADE IX I OCCUR MED EXP(Any one person) $ 5,000.00 IMA395923A 8/25/2022 8/25/2023 PERSONAL&ADV INJURY $ 1,000,000.00 GENERAL AGGREGATE $ 2,000,000.00 GENII_AGGREGATE LIMIT APPLIES PER Products Completed OF'Aggregate $ 2,000,000.00 POLICY {PROJECT Floc B 111 COMBINED SINGLE UMIT AUTOMOBILE LIABIUTY (Ea accident) $ 100,000.00 —•ANY AUTO BODILY INJURY(Per person) $ 20,000.00 ALL OWNED SCHEDULED 1020096012 4/13/2023 4/13/2024 BODILY INJURY(Per accident)AUTOS AUTOS $ 40,000.00 NON-OWNED PROPERTY DAMAGE HIRED AUTOS AUTOS IPer accident) $ 100,000.00 C UMBRELLA LIAR OCCUR EACH OCCURRENCE EXCESS UAB CLAIMS-MADE AGGREGATE CEO I RETENTION S D WORKERS COMPENSATION WC STATUTORY I OTH ANO EMPLOYERS'LIABILITY YIN LIMITS ER ANY PROPRIETOR/PARTNER/EXECUTIVE EL.EACH ACCIDENT OFFICER/MEMBER EXCLUDED' n/a $ 1,000,000.00 6HUB4N86974323 3/26/2023 3/26/2024 (Mandatory In NH) E L DISEASE-EA EMPLOYEE $ I,000,000.00 H yes,describe under E L.DISEASE-POLICY LIMIT DESCRIPTION OF OPERATIONS below $ 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 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.massgov/wd/workers-compensationlinvestigabons/ 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 El 1988-2010 ACORD CORPORATION.All rights reserved. -----"'N , Acc,RI! CERTF1CATE OF WielLITY WSURANCE GATE(relli=11.711- i THel CERTIFTCATEM ISSUED AS 4 MATTER OF INFORMATITIN ONLY At=C MO MITTS UPON THE CERTIFICATIE HOLDER.THIS CERTIFICATE DC es NOT AFFIRMATIVELY OR *EGA:MELT AMEND EXTEND OR ALTER TIE COVERAGE AFFORDED BY TIE POLICES BELOW. MS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER-51,AUTHORIZED REPRESENTAITVE OR PRODUCER,ANC THE CERTIFICATE HOLDER. IMPORTANT: It the certificate holder is an ADDITIONAL INSURED,the polficriles)must have ADDITIONAL INSURED provisions or be enclorsed. II SUBROGATION IS WAIVED suistect to the terms and canditiceris af des penny,certain patties my restutre-an annorsernent.. A sennireent on this cerntleate does net corner maids as the neettilicinensider in Mn of such endoesetneelt* Hammen CONXACT ,low; BRUNO ROZEIM3AROUE PONT INSURANCE 1,NC -pwailir elast,,si,ti* .„,,:602a,___Ortritteociinfinstraccis 1102.COMMONIATEACTH,AVE 1 nomiwitementAgs CSONIENCIE 'i min* 80SON TM SIZISIttri Ininamen::WITIMIRFILIAL MECO 33758 INSOREC, 1 SMONSAir E C A GENERAL CCWSTRUCMN fir4C wavormez:, ormiwour: ,, s OTIS ST APT 1 IMPRONLEr MILFORD UK MST 1 INIPWINIF: : COVERAGES ATE NiallBER.: 097535 REVISION NUMBER: 'MG IS V .MRTIFY 1,4,7 THE POUCES a if4a. CE LISTEC 'BELOW,iikkili SEat Estain Mr viie INSUREla NAMED AEOVE FOR THE POLICY PERM' IRMA-TM ROTRITHSTAREiNG leitir REZOSTEMEWV, TEMA OR COROCTIOR C MO CONTRACT OR OTHER EXXIMEAT tifili RESPECT TO vittiCH THIS CER111,11WE OW EE ISStiaa OR MP'PENTAD% DIE figSLICE AFFOROE15 K",'THE MIMES:-ERCRIVED HEREIN IS SUB-IF,`:' TO ALL THE YEWS, EXCUISIONS ief4D CONEITIMS OF SUCK POLICIES.LOFTS SHCPAIN,IWO&ME e.EEICREMC,E1 ilY PASO MANS. WWI krzintsawri Patera, i 110LINCIFW-1 -- 1.111. PAPEOFMAISURANCE MEM INK MUM MUNGER fivismormyrit'apasiserem Watt 1 1 COMSERCIAL 5101561KLAWASUTT . ,. , EACtla.TInAliiege.E VAY,f$444/:"F. 'errs? market Toeisermt 'it PRERISIES.RivIcairrenos$ t d . MEE•EXPrAny lute milsomp /St WA PERSONAL SJOYV MAW $ 11 p '41110RIARRINERIMERIVAWINEORIE I! GENERAL staaVEGAME It ' VIM iiiiaxy.FM nuac. mnoupostevniurr g g i ii ) 1 'I cam49EssagRE oar $ ,.ifevenvirste ' ii atin AWTO) i r.noctur-maw Low warn .S OWNED 504E-731--IN, - i ' !, 440606AILY /WEIS ,( RA !HOMY*maw 0,*vriiinnot TV maw nehertnei$ il .i INI$PIffiriVW$MIE 'i 1 U AVMSESIC. Titsrarciners ti i i ii ,1 i useVen.A.4,Jkla xmlis i ' li ' ' sycomizzatRistaseE g I:7CM*40d5 , ¢CSAWAS4WASE i PIM 1 GTE rs- wl tit , 4 MalinlillaMPSINIEStie Ai 14 ligitUrE i ERr m••• Nment taismeire i'l 1 AO,,NLAINROWNSWITSFSIBSFr.......0RIE Igi , :EL.ffectAccosrar 1 T filelLODU A ,z.44,traTINOWRITErroaccio- Inn INII 'ANICIIMINOMMIROM e.L.ISSEASE-EA ESIPLOYEE S i AMMO i meveassyStIMIT l'i "o 'es'd.„="11.CaltNgtorharra nee* 1, 1 21 Ea,.DISEASE--PULICY LAMS'tr T,DDITORD i 1 i i TM sEscaersoncrOWINITIONIA Localiests-ANNIMEa JA OM-MK ANAlladAktrorkwlidloikelx msylke-VIOnenrsiAtwatatusoanar rinirestivrq, Atcricers.C.nnperreallinattemeirs Ad!inemint my Men.a- OsennenmeiployeesatIN:Ft to Endorsement At Ze Da OE Et,no authorization tg guten to pay ded for fri...mrD4i fasimnployees rrstabssother thee ileseadredelis de frtStked Nres,or ha hired V4ose eirplayeak artside of Massachusetts_ This certidcare ads:imam storm are polity in force on ass TIMITInintlisamillieste was trisrsect turilesa the expiration Oen orrthe amis policy precedes the issm date i;Itis ioficare of itwealtli. Tice*WIZ.of thiettevence carr he'inwittrad daffy Nit aramserm!fie Rod of Coverage-Coierar;eVenfication Seaut,i mai at ativaurtass..grmvorttworiters-rarmertsettourinvesingottam, CERWICATE MOLDER CMCIELLATION inaLILD me oF THe macaw BE scsom PoLIC3Es RE c*Air vi-LEO BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELNERED IN ACCORDAACEMITH TIRE POLL=PM:MESON& Wide HSE L.I..0 45 gander Or ' iniensWWWWWErtninuE 'D,--( C--A-,'BC,•54iw Northampton MA 01060 . Dorsidit. CPCLI,VOW Resident—Resiettliat titariqt.t.-lir-PEMA tOillillhOWESACORDCOMPORNISDIL All rights reserved. ACOND is WNW% Me AODRC nuraraadhossiaresseatinedemertikev of ACORD �p d^•/�-7vEy� CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDIYYYY)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). CONT PRODUCER NAMEACT Eric Dembinske ORMSBYINSURANCEAGENCY i,;/CNo,Ey (413)737-0300 FAX ( ,Nat: E-MAIL ADDRESS: _edembinsketaOrmsbyins.cOm P O BOX 718 INSURER(S)AFFORDING COVERAGE NAIC t WEST SPRINGFIELD MA 01090 INSURER A: TRAVELERS INDEMNITY CO OF AMERICA 25666 INSURED _INSURER B: WILDE HSE LLC ISURERC DBA SEXTON ROOFING & SIDING INSURERD: 45 OLANDER DRIVE INSURER E: NORTHAMPTON MA 01060 INSURER F: COVERAGES CERTIFICATE NUMBER: 901203 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. I R ADDL SUER POLICY EFF POLICY EXP LT TYPE OF INSURANCE LIMITS LTR IN4D AND POLICY NUMBER (M MI MDDD/YYYY) (MDDIYYYY) COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S DAMAGE TO RENTED I CLAIMS-MADE OCCUR PREMISES(Ea occurrence) , $ MED EXP(Any one person) $ N/A PERSONAL 8 ADV INJURY $ GENT AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $ POLICY jE I- _ LOC PRODUCTS-COMPIOP AGG S OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE UNIT $ (Ea accident) ANY AUTO BODILY INJURY(Per person) S OWNED SCHEDULED AUTOS ONLY AUTOS NIA BODILY INJURY(Per accident) $ HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY (Per accident) S UMBRELLA UAB OCCUR EACH OCCURRENCE S EXCESS UAB CLAIMS-MADE_ N/A AGGREGATE S DFA I TRETENTIONS $ WORKERS COMPENSATION X PER$EAitJTE ER OT AND EMPLOYERS'LIABILITY Y/N ANYPROPRIETOR/PARTNER/EXECUTIVE EL.EACH ACCIDENT $ 1,000,000 A OFFICER/MEMBER EXCLUDED? N/A N/A WA 6HUBOW55113923 06/01/2023 06/0112024 (Mandatory in NH) EL.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 I LOCATIONS/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 Holyoke MA 01040 Daniel M.Cly,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 Licensee Details Demographic Information Full Name: SASHA MARIE WILDS 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 Prere uisite Information No Prerequisite Information No Available Documents THE COMMONWEALTH OF MASSACHUSETTS Moe of Consumer Affairs and Business Regulation WOO Washington Street-Suite 110 Boston, Massachusetts 02118 Horns Improvement Contractor Registration TYPO' U.0 RegislratiOro 236+17G 0 B-A _+TC ROOFING&510lltia Eftdrtbpll Wa r7rl25 4$0;.A 0ER Dis t,l'JRTM k%PTOt+ MA 03104 lrpn:o A:11mo%ono Ra1L.rn. set! THE CCVN4a.vtALTs Of ptASM0HuIlETT11 CNSu v!C yurnt•A010Yo 6 P oinol$6iptiutatscm IOW atrodon.•yMd br k dM duet two ontr before OWI HOVE IMPROVEMENT CC TRACTOR •tre,rxan data. Ir 0.01+rt,rm rp TYPE-iLC Q+fltar Ot COMMON'Mlap't Intl AaIinole IbpulatIorr tta[6lttlaim balsam t'UY waeol mail Om*•Sully 710 464711 4r3C! $ ®orlon.10A 02t1* C'3A SEXTON WTCiiO4O6Qt>A1G 1 akCATHAMPTON,MA 031CA f"l 0 i.oem acht.nry Kid valid wtth+9ut tiIgnature WILE IISE, LLC, SEXTON ROOFING AND SIDING www.sextonroofing.com Vane -`- iat klil 45 fl�cier Dr Stscrtt cb4 ,ra II No MA 01060 41111,MO OM ISM Illi. MA MC It 208470 p. 413.534.1234 info@sextonroofing.corn STREET Prospect Ave&Wazlnaton Way. DAM. davidhersti224trgtnallsont art SOMA! riorthampoon.I MMO, , *mod I) Strip and remove existing shingles and dispose of in properproper landfill. 3) Iona new metal edging to rakes and eaves(frock(white) 4) install s aides _r itaiari emus(fA.wsinstadim,into ,chromes:at aonfs. 5) install sritheic roofing inideslaroost inemaiodoralfaust 6) inuaR new flanges asere>mikrg sent stacks, 7) kinallsuraershingles a®eo►rs and oaks stmt. g) insult MO Architecturalstjler°°fing shingles pqStanufacower Match am per 9) testi wigop®rerisider 10) Rehash abutting chimneys difeE6®r etaircaurc wad SAC 5yrt ATTENTION HOMEOWNERS:Please cover all personal belongings.int a ate,g or storage areas due to possible roofing debris or dust coming through cracks of wood decking. Sexton Roofing shall apply for all permits. We propose hereby to furnish material and labor-complete in accordance with tt►eatbove belowspecifications,brokenouton the page i■einiv oo►iont eow All Material if guaranteed to bras specified Alworktobecompieted Agliiiimed ./` in a u nivaniir acoas 0aalaadasdpv s.*rig Sillialle WI ammo acme gals ab veapimiirusees` ealraaostr will be executed Ditty k9?"‘glitke""tdevs`264dwabect"fte an tall./ ' Note: charge over and above the estimate.n .ecesA satstaseanoz tutThi Pal j maybe withdrawnby us if not accepted within I Not responsible for water damage dkiring constructionOwner to pay responsible legal fees fur non-payment,and applicable interest ACOrpftwarefiltoposall floeabase p , and conditions are satisfactory and are hereby accepted, You -_.___. are authorized to do the work as specified. Payment will be made as outlined above. .? Signatrzi naer� � � l , 3 late 9 *I ) 39 b b Lkitui uvi t I 36 .3e..,tuitt•e@ts"it ,,at+-N Ck.t PA