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18C-160 BP-2023-1077 39 WARBURTON WAY COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 18C-160-001 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-2023-1077 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: MARCELLA PALMISANO DONALD P& 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: if 6 >9 T1 1 6 Fees Paid: $40.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Office of the Building Commissioner .se--Cei VED 4 . The Commonwealth of Ma.;achu ettAUC . Board of Building Regulations.nd S andards I G 20 FOR Massachusetts State Building Iode�F Pr OF MR M MUSE CIPALITY Building Permit Application To Construct, R- . t MervAt3 P(i`�e� R ised Mar 2011 One-or Two-Family Dwelling �`�-`-1 �""��>>oi30 Ns This Section For Official Use Only Building Peit Number:/ ^a'3 • 10 7 7 Date Applied: eu it- Koss //�2 f;-IO-Zaz3 Building Official(Print Name) Signature Date SECTION 1:SITE INFORMATION - 1.1 Property Address: 1.2 Assessors Map&Parcel Numbers SekVicurbkAleisrAnkAi Not •vAp1d, I'dV4 Vca.0 l.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❑ Private❑ Zone: — Outside Flood Zone? Municipal 0 On site disposal system 0 Check if yes❑ SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of Record: Name(Print) City,State,ZIP VIk Wt 41)tmc w \./Jc HIS—Sikh—NW _ath3/4 dope40n; o Qc.schcijl•call 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) J. Alteration(s) 0 Addition 0 Demolition 0 Accessory Bldg. 0 Number of Units Other 0 Specify: Brief Description of Proposed Work': <bac \ Q-bete Hence-►— SECTION 4: ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1. Building $ —1 x6 1. Building Permit Fee: $ Indicate how fee is determined: 2. Electrical $ ❑ Standard City/Town Application Fee ❑Total Project Costa(Item 6)x multiplier x 3. Plumbing $ 2. Other Fees: $ 4. Mechanical (HVAC) $ List: 5. Mechanical (Fire S Suppression) Total All Fees: $ IL Check No.1007/Check Amount: Cash Amount: 6. Total Project Cost: $ i 3s3 ❑Paid in Full 0 Outstanding Balance Due: • 1* A • SECTION 5: CONSTRUCTION SERVICES a v,rai�uctlon supervisor License(LSt.) 10(900 gl21)2} Burrs w Wt License Number Expiration Date 5.. List t sL l ype(seebeiow I LAOtavixr K� No.and Street Type Description Buildines un to 35.000 cu.ft.) ivo"TNortnpkeA ' IA 01 MP O —_ j R Restricted 1&2 Family Duelling City/Town,State,ZiP i M Masonry RC Roofing Covering S Window and Siding , SF , Solid Fuel Burning Appliances 315_77-5 -11(0k 5a.5Yx..Q KkatkCtsakM5•wm I \ Insulation Telephone , D Demolition 5.2 Registered home Improvement Contractor(H1C) V�ItWoz) 4tS � 2n�'t0 4(36(?e25 Iv (RA Sexvon ROOcV9 4 6td tn5 IIIC Registration Number Expiration Date MC Company Name or TUC Reg grant Name No.and Street Email addred N 1 Ap� A►i O 0t o 15- i-1�(pj Cit�To ,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 aft'uia't it will result in the denial of the Issuance of the building permit. Signed Affidavit Attached? Yes ela No 0 SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I,as Owner oldie subject property,hereby authorize \t , k-ME, 'DZA Settiala,r4vs tom, area to act on my behalf,in all masers relative to work authorized by this building permit application IsiewctlIcA Tt e..1rw� -._ $.15112 . Print thu TIC' Date SECTION 7b:OWNER'OR AUTHORIZED AGENT DECLARATION By entenog 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. W ttrk.e) $iq 1s Print(hater's or Authorin:d Agent's Name(Electronic Signature) Date NOTES: 1. An Owner who obtains a building permit to do hisiher own work,or an owner who hires an unregistered contractor (not registered in the Home Improvement Contractor(MC)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 \1/4 \u tt,;,»Foot. oea information on the Construction Supervisor License can be found at „ .lr> 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 ,s .«� s/ Massachusetts � ' 1 c'<< 14 44, t DEPARTMENT OF BUILDING INSPECTIONS a'• \ 41` ,4' 212 Main Street • Municipal Building 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: rl.,.!‘n 461,161e- , Ntit Gi _ The debris will be transported by: Name of Hauler: ,As.snG°Ad, ��N WexAlt.e,LS Signature of Applicant: Date: Skip a,3_ The Commonwealth of Massachusetts cr- Department of Industrial Accidents • 1 Congress Street, Suite 100 . =_>! Boston, MA 02114-2017 yj, www.massgov/dia V,irNters'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILET)WITH THE PERMITTING 1I'>>TIIORITV. Applicant information n Please Print I.egibly Name(Rtt,ino,,Organiratioti;Tnilividtial):VC►ide, ME„ 1.1L '1 4Ytcacv Savt6 Address: t-{S n ax �r City/State`Zip: , tr A . • ,. Phone#: 31S-51o9--1 7(01 Are yea an employer?(he ek the appropriate l:ta ; Type of project(required): 1.01 am a employerwith employees(full and/or part-time).4 7, ❑New construction 2.01 am a sole proprietor or partnership and have no etripiokeesworking for me in 8. El Remodeling any capacity.thin workers'comp. insurance required.] 9. 0 Demolition 3.01am a homeowner doingall work myself[No workers'comp.insurance required.]' 40 r am a homeowner and will be itsringeanaactars to conduct all work on m psopertm. l will I 0 CI Building addition ensure that all cr,atr evcv either have workers'cr»tnpmsatiar r*321^3.nt: or arc sole l In Electrical repairs or additions proprietors with no employees. 12.0 Plumbing repairs or additions 5. 1 am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.5gRoof repairs These sub-contractors have employees and have workers'comp.insurance." 6.OWWe arc a corporation and its office'shave exercised their right of exemption per MGL c. 14.0 Other =,- i(4),and we have no employees.[No workers'comp.insurance rea u ired] A, at checks box must also till out the section below showing their worker's".ea:tcesatrnnpolicy information- tlt-oast, h no submit this affidavit indicating they are doingall work and then hire outside contractors must submit a new affidavit indicatingsuch. tContractors that check this box must attached an additional sheet showingthe name of the 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. 1 am an employer that is providing workers'compensation insurance for my employees Below is the policy and job site information. Insurance Company Name: `rto ,asap � AY lco. Policy #or Self-ins. Lie. #: kp IckURA\AS 661.13W Expiration Date: also(IA 12.0.24 Job Site Address: 3°I Wouinki a-lop \' City/State Zip: tiekkkotelem Mq M610 Attach a copy of the workers'compensation pdflcy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL c. 152,§25A is a crim final violation punishable by a fine up to$1,500.00 and:'or one-year imprisonment.as well as civil penalties in the foam of a STOP WORK ORDER and a fine 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 certify under the pains and penalties of perjury that the information provided above is true and correct. Signature; Steir--1, 0,,kb---- Date: /e/IZ023 Phone#: 3IS--g(7e —lite! Official use only. Do not write in this area,to be completed by city or town official. ' City or Town: Permit/License# i 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#: Accow CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 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 737-0300 FAX (A/C,.No.Ext1: (1413) (A/C,Not E-MAIL --- — ADDRES_s: edembinske@ormsbyins.com P 0 BOX 718 INSURER(S)AFFORDING COVERAGE NAIL It WEST SPRINGFIELD MA 01090 INSURER A: TRAVELERS INDEMNITY CO OF AMERICA 25666 INSURED INSURER B: WILDE HSE LLC INSURERC: DBA SEXTON ROOFING &SIDING INSURERD: 45 OLANDER DRIVE INSURERE: 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. INSR TYPE OF INSURANCE iADDLSUBR w POLICY EFF POLICY EXP LIMITS LTRINSD VD POLICY NUMBER (MM/DD/YYYYI (MMIDD/YYYY) COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ _ DAMAGE TO RENTED CLAIMS-MADE -__-_ OCCUR PREMISES(Ea occurrence) $ MED EXP(Any one person) $ N/A PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY JJEECOT- LOC PRODUCTS-COMP/OP AGG $ OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) 4 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 1 RETENTION$ $ 'WORKERS COMPENSATION X PERTUTE OTH- ER AND EMPLOYERS'LIABILITY A OFFICER/MEMBERE.L.EACH ACCIDENT $ 1,000,000 EXCLUDED?ECUTIVE N/A NIA 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/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 Holyoke MA 01040 M Cr Daniel M.Cry,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 Trx CERTIFICATE OF LIABILITY INSURANCE 07/Z5/2023 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 AtUIF PHONE 978 726-9830 I-INSURANCE GROUP INC (A/C.No,Ext). EMAIL gcamnssatoai-insuran egroup.nel 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 AOOLI SUER POLICY EFF POLICY EXP TR TYPE OF INSURANCE NSR WVD POLICY NUMBER (MMIDD/YYYY) (MM/DD/YYYY) LIMITS A GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000.00 DAMAGE TO RENTED X COMMERCIAL GENERAL LIABILITY PREMISES(Ea oowrercel S 100,000.00 CLAIMS-MADE IX I OCCUR MED EXP(Any one person! $ 5,000.00 IMA395923A 8/25/2022 8/25/2023 PERSONALS ACV INJURY $ 1,000,000.00 GENERAL AGGREGATE $ 2,600,000.00 GENT AGGREGATE LIMIT APPLIES PER ProducB Completed Ops Aggregate $ 2,000,000.00 POLICY [1 PROJECT' ILOC B A COMBINED SINGLE LIMIT AUTOMOBILE LIABILITY (Ea amdardl $ 100,000.00 BODILY INJURY(Par parson) ANv AUTO S 20,000.00 ALL OWNED SCHEDULED 1 020096012 4/13/2023 4/13/2024 BODILY INJURY IPar acadenh AUTOS AUTOS $ 40,000.00 NON-OWNED PROPERTY DAMAGE HIRED AUTOS AUTOS (Per accident) 5 100,000.00 C UMBRELLA LIAR OCCUR EACH OCCURRENCE EXCESS UAB CLAIMS-MADE AGGREGATE DEO f RETENTION D WORKERS COMPENSATION Y/N WC STATUTORY OTH AND EMPLOYERS'UABILITY LIMITS ER ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED' n/a E.L EACH ACCIDENT $ 1,000,000.00 (Mandatory In Nip 6HUB4N86974323 3/26/2023 3/26/2024 E L DISEASE-EA EMPLOYEE $ 1,000,000.00 If yea,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 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 Verification Search tool at www.mass.govAwd/workers-compensationhinvestigations/ 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. ACO [7�R DATE paevorrrYY) CERTIFICATE OF LIABILITY INSURANCE 05I31n023 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 PROM/CM,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 endorses A statement on this cerlificalle does not confer rights to the certificate holder in lieu of such endorsements} PRODUCER N�IIm BRtJNO ROZE BAROUE POINT INSURANCE INC r.E,t (617)783-1160 AX WC.Not paggEs& bnesepcinfins re coo 1103 COMMONWEALTH AVE , AFFOROINC COVERAGE 'WC f BOSTON MA 022151111 UISmoyeA: AIM MUTUAL INS CO 33758 stacatEo IanME B: E C A GENERAL CONSTRUCTION INC rlsr.Enc: WAIRERIT: 8 OTIS ST APT I SWUM E: MILFORD MA 01757 INSURER r: COVERAGES CERTIFICATE NUMBER: 897535 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO TrE 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 AFFOtR7@ BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AA D CONDITIONS OF SUCH POLICIES.LWITS SHOWN MAY HAVE BEEN REDUCED BY PMD CLAIMS MLIRR TYPE OF WV AU F APB EI POLICY NUMBER 8�POLICY fYYYTi0Mt00NYY1lI S cC CUL A&.WWIL rr i EACH OCCURRENCE s I CIAanSiMOE OCCUR I DAMAGE PREMISES an occumatoel S IE'D DO'(Anyone person) 3 WA PERSONAL&AM INJURY $ S fpou Yb ►TcLF6nJWPLa Li Jim II 1 ,PRODUCTS-CGtIPXWAGG $ one 3 AUTOROSILELIABILJIY 1lANNED SINGLE LIMIT $ 1 ANY AiTO RRR BOXY INJURY Ter pe sus) $ OWNED SC EhtrS-D Aricao ow I AUTOS N/A 1 BOCJLY INJURY(Per accident) $ _ PROPERTY DAMAGE _ AUTOS 01141Y AUTOS OrRi1RLY ii 1 Per ar ew4 $ $ immeuat c1A8 occis R EACFHOCC OCCURRENCE s — EXCESS LIAR CUTLET-MADE NIA AGGREGATE $ n d DEC n ;iETEI* 1cm¢ ; 3 wORKEIWCOMPaBATION 6!f X`STATUTE ER AND EfROYERIP'UAMIJTY YIN a EL MC"Air $ 1,000.000 A n NOT Net VWC10060260282023A -D2/11/2023'02/M2024 (Mandatory In NH) ELorcz -EAEMPLOYEE $ 1,000,000 H�w�d�aersonmaw p pi4ROFOPERATIONSodohr i ELADISERSE-POUCYLNOT $ 1,000,000 NIA DEaCIWOONOF OPERATIONS/LOCALTI01 I ICI tAconoisr,AiliWendRaa da'dwdels„.wbearrsr.df.r.aessrwaotnal Workers'Compensakon benefits vwi be paid to Massachusees 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 poky in force on the dale that this cerillcat a was issued(unless the expiration date on the above policy precedes the issue date of this c ertilicate of insurance). The status of this coverage can be monitored daily by accessing the Proof of Coverage-Coverage Verification Search hod at rrracr .. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE smart r ED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Wilde HSE LLC ACCORDANCE WITH THE POLICYPROVISIONS_ 45 Olander Dr AUThran¢ED suracsOrrAAYE Northampton MA 01060 Daniel M.Crowleg CPCU,Vice President—Residual Market—WCRIBMA i CI 19813-2015 ACORD CORPORATION. AS rights reserved. ACORD 25(2016103) 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 _ T No Prerequisite Information No Available Documents THE COMMONWEALTH OF MASSACHUSETTS Office of Consumer Affairs and Business Regulation IMO Washiriglon Street-Suite 710 Boston, Massachusetts 02118 Home Improvement Contractor Registration Type t.LC Ragtsvabon 23847G +*5E..LC EItIPabot#: 04,307.425 f?SA SEXTON ROOFING.&813 Pti{i •C$OLA SDER DR NDRTMsA''dTTOht Ma 031134 lrodsts Addrsrs Pm!1410++Card. THE CGVMrAVEALT*t OP MASIACHVIETT3 Orr'.of Canrur4r AMprs 6 tiusinsss RsquINaon Mgi fr.tto.woad Poe itadvtddet uss*My stators Li• HOVE IMPitOYEMERiT conoltarloo foolfsSan data' *layoffs*"Par TYPE LC One.dir etlfilltiMile Affairs and;dww'Im►*Regulator Basasitallaa Liftltrata TOOL W,Mdtgtan Stryat •Sada 710 2118Ai7a O413C. 5 ElwLan,WA O3TTf 'h` JE+4E.W.. Olt AOEXtONlR C* 4Q6&OW SA..rtk'+h AX 45 T.R.MDER DR 4i,Ir.,"•+ ..tse' ,_ > b nF;Pt'H.t'.1P7171,MA C}ICA Unc.'uc"4nry Not wand v..411 ut signettrs WILDE LIST,LLC ROOFING ExTONjaanwegfingssan AND SIDING2 gig() 3- 45 Ulander Dr 1060 Northampton, MA we.1111111111 OW' k4ttRf the Standard agif III .xr infoC�sextonroofing.com mA to( p.413.534.1234 ATEl 3 ,Ai o 1i �- f, * ,a .. ' 3 r✓r4"'-�►" roc&f field STREET ��,��QlO60 c:STnTrLr5cwT> A�6s and Fait of in p lan dfill deck 13 Pand moo moonyles ci fI!aS1oaOPersheet. ing to rakes and t yes of roar twl ) chimneX at roofs- „Md water 63 vent stacks-in sratbe s� V trawl� �xx��ent remainder of so�mt 57 i Ott `roofing underia.,e r st on 6) lrtst I r over _ ii statl starter shingles on eaves and rakes of r manufacturers'tat as per caucyc.s � ��Architectural style waling s havgks 9) Instal/new cap aVer ridge rent ra) Re$ash abutting chimneys. li) sum}, mom/factures fifetine%v and SRC M yr..weitkmonship ec mnty- the atria.garage,,or storage areas due to posstble ref nA d or dust coming through cracks of wood decking. Sexton Rooting Sha I appify for ail permits. We propose hereby to ftanish material!and labor-complete Mt arreadarice with the above spectfitcations,broken out on the p beinior Payment doe in Material is guaranteed to be as specified Aiwndrito be conwpkited ALthotiived �� Aorkrrtari7re rnweir er accordi"tom''no.itaradkodporgione.Mil 111.11111M ift oat...„,----. anon or deviation from above specificaliallrilleaftedia ,e exerttrd oni, upon written,crrtiiet'S,.>N111ll1121el0/1tI[ealta lisseibit !•��)twithdrawn L'E not CE Ca" e or er and oboe the estimate_taA�►raG+B ,Tiov.MAR.Ks..( Hil'SF J44.11BE(X.41,011.1 LEAlli iponsible for water damage dim:ng slble legal fees for non-payment,and applicable interest 4101 C —) tance of Proposal The above prices,specifications c bans aee sabsfactorG arid webeiebracompted. You S oriied to do the work as specified. Parma t be cceptance: