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31A-023 (4) BP-2024-0613 38 FRANKLIN ST COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 31A-023-001 CITY OF NORTHAMPTON Permit: Alts Renovations Repair PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) BUILDING PERMIT Permit# BP-2024-0613 PERMISSION IS HEREBY GRANTED TO: Project# SIDING 2024 Contractor: License: ADAM QUENNEVILLE ROOFING & Est. Cost: 97999 SIDING 070626 Const.Class: Exp.Date: 08/21/2025 BIENKOWSKI, PETER TRUSTEE THE BV Use Group: Owner: HAMPSHIRE HOUSE TRUST Lot Size(sq.ft.) Zoning: URB Applicant: ADAM QUENNEVILLE ROOFING &SIDING Applicant Address Phone: Insurance: 160 OLD LYMAN RD (413)536-5955 AWC4007012861 SOUTH HADLEY, MA 01075 ISSUED ON: 05/16/2024 TO PERFORM THE FOLLOWING WORK: SIDING 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(?(A/Z Fees Paid: $686.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Office of the Building Commissioner - • '/ -�Thle Commonwealth of Massachusetts �rf �AY Office of Public Safety and Inspections • `5 2024 Massachusetts State Building Code(780 CMR) non= Building Perim' Ap lication for any Building other than a One-or Two-Family Dwelling �—�NOR ik /N�IN (This Section For Official Use Only) Building Permit N~mtZsr ' to Applied: Building Official. SECTION 1:LOCATION 38 Franklin St Northampton Ma 01060 _ No.and Street City/Town Zip Code Name of Building(if applicable) Assessors Map# Block#and/or Lot # SECTION 2:PROPOSED WORK Edition of MA State Code used If New Construction check here 0 or check all that apply in the two rows below Existing Building D Repair'I Alteration 0 Addition 0 Demolition 0 (Please fill out and submit Appendix 2) Change of Use 0 Change of Occupancy 0 Other 0 Specify: Are building plans and/or construction documents being supplied as part of this permit application? Yes 0 No 4 Is an Independent Structural Engineering Peer Review required? Yes 0 No l� Brief Description of Proposed Work:New siding,remove existing,new wall shealthing replacement,new henry blue skin on top of sheathing,new siding new trim around wmdos doors and fascia,isntall new soffit i I SECTION 3:COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATION,ADDITION,OR CHANGE IN USE OR OCCUPANCY Check here if an Existing Building Investigation and Evaluation is enclosed(See 780 CMR 34) 0 Existing Use Group(s): R-2 �._ Proposed Use Group(s): SECTION 4:BUILDING HEIGHT AND AREA Existing Proposed No.of Floors/Stories(include basement levels)&Area Per Floor(sq.ft.) Total Area(sq.ft.)and Total Height(ft.) SECTION 5:USE GROUP(Check as applicable) A: Assembly A-1 0 A-2 0 Nightclub 0 A-3 0 A-4 0 A-5 0 B: Business 0 1 E: Educational 0 F: Factory F-1 ❑ F2 0 H: High Hazard H-1 0 H-2 0 H-3 0_I�--4 0 H-5 0 I: Institutional 1-1 0 I-2 0 1-3❑ 1-4❑ M: Mercantile 0 R: Residential R-10 R-2 R-3 0 R-4 0 S: Storage S-1 0 S-2 0 U: Utility 0 Special Use 0 and please describe below: Special Use Description: SECTION 6:CONSTRUCTION TYPE(Check as applicable) IA ❑ IB O IIA 0 IIB ❑ IIIA 0 IIIB ❑ IV 0 VA 0 SECTION 7:SITE INFORMATION(refer to 780 CMR 105.3 for details on each item) Trench Permit: Debris Removal: Water Supply: Flood Zone Information: Sewage Disposal: Licensed Dis osal Sit Public 0 Check if outside Flood Zone 0 Indicate municipal 0 A trench will not be P required 0 or trench or specify:_.... _ Private 0 or indentify Zone: or on site system Cl Adamis enclosed❑ Adam Quenneville Roofing 8 Sidling la .160.OW.Lyman.RdsouthHadtey._ Railroad right-of-w y: Hazards to Air Navigation: MA Historic Commission Review Process: Not Applicablet Is Structure within airport ap roach area? Is their review competed? or Consent to Build enclosed 0 Yes 0 or No Yes 0 No SECTION 8:CONTENT OF CERTIFICATE OF OCCUPANCY Edition of Code: Use Group(s): Type of Construction: Does the building contain an Sprinkler System?: Special Stipulations: Design Occupant Load per Floor and Assembly space: SECTION 9: PROPERTY OWNER AUTRORIZATION Name and Address of Property Owner Peter Bienkowski Name(Print) No.and Street City/Town Zip Property Owner Contact information: 413-575-2845 petebeinkowski@gmail.com Title Telephone No.(business) Telephone No. (cell) e-mail address If applicable,the property owner hereby authorizes: Adam Quenneville 160 Old Lyman Rd South Hadley Ma 01075 Name Street Address City/Town State Zip to apply for and act on the property owner's behalf,in all matters relative to work authorized by this building permit application. SECTION 10:CONSTRUCTION CONTROL(Please fill out Appendix 1) it a building is less than 35,000 cu.tt of enclosed space and,or not under Construction Control then check here❑. Odtet wlse provide consttruction control tort (see section l07 in the code)as required. 10.1 Registered Professional Responsible for Construction Control(the professional coordinating document submittals) Adam Quennevile 413-536.5955 kaylee.agrs@gmail.com Cs 070626 Name(Registrant) Telephone No. e-mail address Registration Number 160 Old Lyman Rd South Hadley Ma 01075 u 8/21/25 Street Address City/Town State Zip Discipline Expiration Date 10.2 General Contractor Adam Quenneville Roofing&Siding Company Name Adam Quenneville HIC 191093 expiration 3/22/26 Name of Person Responsible for Construction License No. and Type if Applicable 160 Old Lyman Rd South Hadley MA Street Address City/Town State Zip 413-536-5955 kaylee.agrs@gmall.com Telephone No.(business) Telephone No.(cell) e-mail address SECTION 11:WORKERS COMPENSATION INSURANCE AFFiD.AVIT(M.G.L.c.152.§25C(6)) __ A Workers'Compensation Insurance Affidavit from the MA Department of Industrial Accidents 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. Is a signed Affidavit submitted with this application? Yes O No 0 SECTION 12:CONSTRUCTION COSTS AND PERMIT FEE Item Estimated Costs:(Labor and Materials) Total Construction Cost(from Item 6)_$ 1.Building $ 97,999•00 Building Permit Fee=Total Construction ost x (Insert here 2.Electrical $ appropriate municipal factor) 3.Plumbing $ 4.Mechanical (HVAC) $ Note:Minimum fee=$ (contact municipality) 5.Mechanical (Other) $ Enclose check payable to h 6.Total Cost $ 97.999.00 (contact municipality)and write check number here_16-V (Y SECTION 13:SIGNATURE OF BUILDING PERMIT APPLICANT 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. 413-536-5955 Adam Quenneville Buisness Owner 05/11/2024 Please print and sign name Title Telephone No. Date 160 Old Lyman Rd South HadleyMA Y kaylee.agrstllgmail.com Street Address City/Town State Zip Email Address Municipal Inspectot to fill out this section upon application approval: � 5A•2,0Z7 y Name Date - ... a, Septic As Built submitted 0 YES 0 NO • N/A. Number of bedrooms at start of job • Number of bedrooms at completion • Are there any DEED RESTRICTION by the.Board of Health: 0 YES 0 NO (if yes please explain) CONSERVATION 1.:Does"Work Involve: WETLANDS, WATER SHED, WELLHEAD, CONSERVATION • AREAS or 310 CMR 10.00(circle all that applies &initial) D YES 0 NO Initials: • SIGNATURES Approved/Disapproved by Zoning Authority: Date Approval/Disapproval by Board of Health: Date Approval/Disapproval by Conservation: Date Approved/Disapproved by Planning Board: Date Approved/Disapproved by DPW: Date Driveway Water Sewer DEBRIS. Adam Quenneville Roofing&Siding Disposed by At Facility 160 Old Lyman Rd South Hadley MA As a condition of issuing a permit for the demolition, renovation, rehabilitation or other alteration of a building or structure, MGL c40,§54 requires that the debris resulting there from shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL c111 §150A. 1 certify that I will notif'the Building Official by (two months maximum) of the location of the solid waste facility where the debris resulting from the said construction activity shall be disposed of, and I shall submit the appropriate form for attachment to the B uilding Permit. City of Northampton 212 Main Street, Northampton, MA 01060 Solid Waste Disposal Affidavit In accordance of the provisions of MGL c 40, S54, I acknowledge that as a condition of the building permit all debris resulting from the construction activity governed by this Building Permit shall be disposed of in a properly licensed solid waste disposal facility, as defined by MGL c 111 , S 150A. Address of the work: 38 Franklin St Northampton Ma 01060 The debris will be transported by: Adam Quenneville Roofing&Siding The debris will be received by: Adam Quenneville Roofing&Siding @160 Old Lyman Rd South Hadley Building permit number: Name of Permit Applicant Adam Quenneville 05/11/2024 Date Signature of Permit Applicant � 25. YEARS .. gii QUENNEVILLE JamesHardie ' • ' " . , • tom: • .4 • wn., ... VJ yr. '.ski v I_ ,,.—.A., • JAMES HARDIE SIDING PROPOSAL PETER BIENKOWSKI 38 Franklin Street Northampton, MA Adam Quenneville Roofing & Siding Inc. 01060 Residential - Commercial - Industrial i Prir INTRODUCTION Hi Peter, We extend our sincere gratitude for affording us the opportunity to present a bid for your esteemed project. With nearly three decades of dedicated service in the industry,our firm has proudly executed 1000s of projects, showcasing our commitment to excellence and reliability. Among our extensive portfolio are projects encompassing roofing,siding,windows, doors,and decks,demonstrating our versatile expertise across various construction domains. Over the years,we've diligently cultivated our skills and invested in state-of-the-art equipment, positioning ourselves as leaders in the field. Our unwavering dedication to quality craftsmanship ensures that each project is executed to perfection,earning us the trust and satisfaction of countless clients. One of our paramount priorities is ensuring the safety and well-being of all individuals involved in our projects.To this end,we provide a dedicated non-working job site supervisor who oversees every aspect of safety protocol, meticulously adhering to OSHA standards and regulations.This proactive approach not only safeguards the welfare of our team members but also extends to the occupants, fostering a secure environment for everyone involved. Our commitment to maintaining clean and safe work sites underscores our professionalism and dedication to excellence. By entrusting us with your project,you can rest assured that every aspect will be handled with the utmost care and precision. Thank you once again for considering us for this opportunity.We eagerly anticipate the prospect of collaborating with you and delivering exceptional results that exceed your expectations. If you have any questions, please feel free to reach out anytime! Warm regards, Steven Minkler I Vice President stevenm.minkler@gmail.com 4139773985 a4 DAMES HARDIE SIDING INSTALLATION Description James Hardie Siding Details We will pull all associated building permits Rip all exisiting siding to the original wood Wall Sheathing replacment will be on a as needed basis @ 5.99 sq ft Properly dispose of all construction related debris Install 1x wood nailer around perimeter of all windows and doors Install Henry Blue skin on top of all sheathing Install 5" Reveal James Hardie Siding-statement collection-color Mountain Sage-SMOOTH! All window/door/fascia/rake trim to be Kaycan match coat linen All soffit to be Kaycan match coat linen Provide 10 year labor warranty direct through AQRS --All lead-safe precautions will be taken due to potential for lead paint on old/existing wood siding. --Existing shutters and gutters to be reinstalled. Quote subtotal $75,000.00 --Trim around doors/windows to be 1"x4".exterior corner trim to be 1'x6 --Installation will he scheduled as soon as possible once all materials are available,in good-faith Total $75,000.00 consultation between Adam Quenneville Rooting&Siding Inc.and Peter Bienkowski,scheduling subject to Peter Bienkowski's approval.Adam Quenneville Roofing&Siding Inc.has estimated as 12-14 week lead time for materials to arrive. --Notwithstanding anything to the contrary contained herein,if Adam Quenneville Rooting&Siding Inc.is unable to schedule and complete the install prior to December 31,2024(excluding owner/Peter Bienkowski-caused delays), Peter Bienkowski shall have the right to terminate this Agreement and receive a full refund of all deposits/payments made. AUTHORIZATION James Hardie Siding Installation $75,000.00 Name: Peter Bienkowski Address: 38 Franklin Street, MA Estimates valid for 30 days from date of estimate/A 1/3 deposit is required before any project begins,1/3 due upon material delivery and commencement of project,final 1/3 upon completion. Optional Upgrades Description Line total Q Install Rockwool 1" Comfortboard on entire prior to siding install $22,999.00 ❑ 42,125.00 wood ones - NO -old gutters will all he replaced. Customer Comments / Notes Availability and proper install of the ROCKWOOL Comfortboard'SO (https://www.rockwool.com/north-america/products-and-applications/ products/comfortboard-80/)on entire house,on top of sheathing underneath the Hardie with strapping no greater than 16"apart,is of the essence to this contract,and a requirement for the project moving forward. No alternate selections for this product or any selections outlined herein will be accepted. Peter Bienkowski: /4624., U54v..ktien G Date: 5/7/2024 By signing this form I agree to and confirm the following:I certify that I am the registered owner of the above project property,or have the legal permission to authorize the work as stated.I agree to pay the total project price and understand that this work will be completed in accordance with industry best practices. The Commonwealth of Massachusetts 41 I Department of Industrial Accidents Office of Investigations z 1 600 Washington Street Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information /� Please Print Legibly 1 Name (Business/Organization/Individual): �Cir\ uer1 U n k 1 � ` 0 l nX �1�I✓1 y �j i'](, Address: (G0 0 A L..,tn..G,., L L City/State/Zip: 5ou1 I4e,lk4). Cf'1 z 01015— Phone#: L(13 —53C`5g55 ___ - Are you an employer?Check the appropriate box: Type of project(required): I.•K I am a employer with 15 4. ❑ I am a general contractor and I 6. El New construction employees(full and/or part-time).* have hired the sub-contractors 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 ❑ Building addition [No workers' comp. insurance comp.insurance.. required.] 5. [] We are a corporation and its l0.❑ Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their IL.❑ Plumbing repairs or additions myself'. [No workers' comp. right of exemption per MGL I2. Roof repairs insurance required.] t c. 152,§1(4),and we have no employees.[No workers' 13.0 Other comp.insurance required.] `Any applicant that checks box#I must also fill out the section below showing their workers'compensation policy information. Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. 'Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. lithe 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. Q Insurance Company Name: n l•'fr\ u l uc \ /ls tI r'c rat c. Policy#or Self-ins. Lic.#: A W c c(OO10 l age-( Expiration Date: 04/29/2025 I 7 Job Site Address: 38 Franklin St City/State/Zip: Northampton Ma 01060 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 fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby rertifvruinder+the pains and nenalties ofoeriu^• - rtlon provided above is true and correct. �cte auen►�et/a o»1„2��,��,. 05/11/2024 Signature: Date: Phone#: i- " 53L — 59 55- Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): E. Board of Health 2. Building Department 3.City/Town Clerk 4. Electrical Inspector S. Plumbing Inspector 6.Other Contact Person: Phone#: 1., Commonwealth of Massachusetts ill Division of Occupational Licensure Board of Building Regulations and Standards t�d Cons lr• ` a` Supervisor ,f• CS-070626 ,x * a.iss,pires 08/21/2025 ADAM A QU4NN i 1. 1 r 160 OLD LYMAN - , : jt SOUTH HADe.Y l: F ,404.001 Commissioner _. tee' THE COMMONWEALTH OF MASSACHUSETTS Office of Consumer Affairs and Business Regulation 1000 Washington Street - Suite 710 Boston, Massachusetts 02118 Home Improvement Contractor Registration t .. Type: Corporation ' w^ --:' -_Registration: 191093 ADAM QUENNEVILLE ROOFING AND SIDING, INC.W „ ' —._,' Expiration: 03/22/2026 160 OLD LYMAN RD. - —"" SO. HADLEY,MA 01075 'w's'� "'' ___ ti.fn,' ► i.. ; -.. r -.1t-. Update Address and Return Card. -�. -. ? �C..���� i��r' \$. .A‘,.:'*, �j. /fc �\� rG. .�� y' 1r /�! \�:7 '+�:.f 4% \ X r1b 'E' y r \ ', i STATE OF CONNECTICUT + DEPARTMENT OF CONSUMER PROTECTION 1 < ;,..1...... E Be it known that . - 1 ar f I ADAM QUENNEVILLE " ` i 160 OLD LYMAN ROAD f `` Al 1 SOUTH HADLEY, MA 01075-2632 '< 4,# L: w:: I 100 = ! has satisfied the qualifications required bar law and is hereby registered as a '' '` '-'' HOME IMPROVEMENT CONTRACTOR tt .A. ADAM QUENNEVILLE ROOFING s'' . Registration #: HIC.0575920 Effective: 04/01/2024 =`` tJ •L,, Expiration:p 03/31/2025 Bryan T.C.ifferelli,Conimi<aiuncr AC RL CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) 4/1/2024 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If 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 Lauren Eckhardt NAME: Clayton Insurance Agency, Inc. INC.No.ExO: (413)536-0804 FAX No): (413)534-7974 1649 Northampton Street E.MAILss: leckhardt@claytoninsurance.net ADDRE P. O. Box 989 INSURER(S) AFFORDING COVERAGE NAIC#_ Holyoke MA 01041-0989 INSURERA:NaUti1US Insurance Company INSURED INSURER B:Green Mountain Insurance Company Adam Quenneville Roofing & Siding Inc. INsuRERc:Gray Surplus Lines Insurance Company 15889 160 Old Lyman Road INSURER D:AIM Mutual Insurance Company South Hadley, MA 01075 INSURERE: INSURER F: COVERAGES CERTIFICATE NUMBER:2023 MASTER REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP UMITS LTR INSD WVD POLICY NUMBER (MMIDD/YYYY) (MM/DDIYYYY) X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED 100,000 A CLAIMS-MADE X OCCUR PREMISES (Ea occurrence) $ X BI & PD DED $2,500 BN965983 6/23/2023 6/23/2024 MED EXP(Any one person) $ 5,000 PERSONAL &ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER. GENERAL AGGREGATE $ 2,000,000 POLICY X PECOT- LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 (Ea accident) ANY AUTO BODILY INJURY(Per person) $ B ALL OWNED SCHEDULED AUTOS X AUTOS 20047429 6/23/2023 6/23/2024 BODILY INJURY(Per accident) $ NON-OWNED PROPERTY DAMAGE $ X HIRED AUTOS X AUTOS (Per accident) UNINS;UNOERINS MOTORISTS $ 100,000/300,000 X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 5,000,000 C EXCESS LIAB CLAIMS-MADE AGGREGATE S 5,000,000 DED RETENTION$ GSL101401 6/23/2023 6/23/2024 $ WORKERS COMPENSATION X PER OTH- AND EMPLOYERS'LIABILITY STATUTE ER YIN ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 1,000,000 OFFICERIMEMBER EXCLUDED° y N I A D (Mandatory in NH) AWC4007012861 4/29/2024 4/29/2025 E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes.describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) For Informational Purposes Only. 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/lwd/workers-compensation/investigations/. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Adam Quenneville Roofing & Siding Inc THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 160 Old Lyman Rd South Hadley, MA 01075 AUTHORIZED REPRESENTATIVE "ichael Regan/FMT �� 1 ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD INS025 t201401)