The URL can be used to link to this page

35-029 (17)1010 RYAN RD BP-2019-1513 ar=: COMMONWEALTH OF MASSACHUSETTS Map i310 6 35 - 029 CITY OF NORTHAMPTON' L911-A&L PERSONS CON 1 RA( IING W t I'll IJNRt.G S I I:RFL'1 CON I'RAC1`ORS I errno BuitdlfK DO NOT HAVE ACCESS TO�THE TGUARANTY irFUND (MGL C.142A�) C'at�n demolition {.l - LJ V 1 i'ef(ttj7 i BP-2019-1513$ JS-2019-002448 Us{:;Cost A64000.00 e_ 700.00 PERMISSION IS HEREBY GRANTED TO: Const,A`PAts' Confeacror: =License: Use G!Rpp CHARLIE ARMENT TRUCKING INC 017764 t oistruTsa tt r' 172-Q�62(7 0O awmepr-3,t,[s MA,i ,ciil157 1•ni'+%7xN[k t i (" lonrjg, :AyhtPcxint: CHARLIEARMENTTRUGKING.ING AT: 1010 RYAN RD Atiptica el Address: Plr. atte; Insuranrer 77:WAILI.Iit}tiSl ti7;.---.;_,_,._....?398431_.._. w �. ;:� t.iatsility SPPRINGFIELDMA01118 ISSUED 0, :711120190.00:00 TO PERFORM THE FOLLOWING WORK. DEMO AND REMOVE ALL STRUCTURES POST THIS CARD SO IT IS VISIRLE FROVI IHESTREET Impeder of plumbing Inspector of Wiring: €1.P,.W. Running Inspector Underground: Service: Meter: Footings: Rough: Rougi: Noose# Foundation: Ornewas Float: Final: Final: Rough. Frame: Dace �:Fire Dcuartutent F[ro(ilanefChimrzep.` Rough: Oil: Insulation: Final: Smoke: Final:. THIS PERMIT MAY ICE REVOKED I V TTIE (TTY OF NORTHAMPTON UPON VIOLATION Of' ANY OF ITS RULES AND: REGULATIONS, Certificate of Occupancy FeeT'v c: Dote Paid: Amnlint: Building 7 i`20140'00:00 S700.00 `212 Main Street, Phone (413) 587 1240, Fax:: (413) 587-1272 lmuislJasbrmwl, - Building Commissioner .:File,"liP-2019-1513 -APPI l(iAN'i CON ILA(' l PLRSON CIIARLIF; ARM6iN f MUCKING INC 'ADDRESS 1,10N), Al WAREHOUSE ST "SPRINO IELF) 140)739-$431 PROPF,RI Y LOC A71ON I00 RYAN RD -MAP 2C YARC:I [P_(117_i„-QN1: I L174 Sk.C`k:UN OR t)FFICIAI 1,1S ONLY: PC,ij�il7 API I ICA FION C I i,lt� ht; IS 7 LNCIA)S], O RFQUIRLD DAFE ZONINt IT{lvf [ILIIjjOCt1 ]rre Pn�d _ Ralig,7)snrft�lgd otrt,..,w,„,;�,,,,,,, ._.,. Foul#<u{LRytp t_I?I,MOANDRI-MOVE ALL S I R]ICTUR(S Neu t'oncfrgction .:��._.. �._.._,.,.....:_..............._�__.... '01}. ortterunaripecrior renovirrom Building Plans Included:_._:�.. ....._.�_. .._.__w...„.„,...„. -� t?uner_;C,tltemenk �l�cetue 0l'1 t6n 3 seN of Plans pkXPlott) THE FOLLOWING ACTION "AS RUN TAKEN ON THIS APPLICATION BASED ON INMArION PRESENTED: Approved. Additlonnipcnrutstcquired(soobtloo)� PLANNING BOARD PERMIT RLQUIRED UNDER.6 Intermediate Pro lect _ Sne 1'Ioti AM?/C)it _ Special Permit With Site Plan bl -ajot Project. Site: Plan ANIXOR Special Permit With .Site Platt ZONING BOARD PERMIT REQUIRED UNDER: § Finding- Special PetinII Variance* ..Received R Recrorded ut Ruesny txf Dacds :ProoCEncloo-ui Ocher Fenoite Required: -Curb Cut front UPW Waiet Availability ,S`kovei Availabddv ,Septic Approval Board of I leulth WrIl 4'atat Pofandit} #Roardri ilealdt Pernnt from Conservation Coinnussion Permit book (D Architecture Committee �.Pvxmn from l;hn Street C'nrmiusvun Perrah DPW Strom Water Maraigoncm Demolition Delay J f fj y Sty+nature of Building CNYS<ral Date :Notc� Issuance of a Zoning Permit does not relieve a applicant's burden to comply with all zoning requirements and obtain all required permits from Board of Reath, Conservation Commission, Department r'of public works and other applicable permit granting authorities. °Variances tiregranted Pak to thoseapplicants oho meet the smct vtandaidt of MG I,, SOA Contact Office of Planning Rc Development far mot e information. RECEIVED # D1 Versron l.7 Commercial Building• Permit May 15, 2000 R CEI V Ci I of Northampton t"oliParmt" �e r B ilding De partment t`t1dX Utt#D ,yPeratd JuN 2 B 2019 12 Main Street sewarsepbcAsellabinty Room 100 WaVii roll Av011oblity art ampton MA01060 Two iies"a# eft t+r= w aiNr rN e2f 13-5 7-1240 Fax 413-567.1272 P]oUSite Plans . S711DW"I n- ...._.:..._........_ DtherlSpaciiy APPLICATION TO CONSTRUCT, REPAIR, RENOVATE, CHANGE THE USE OR OCCUPANCY OF, OR DEMOLISH ANY BUILDING ':OTHER THAN NE OR TWO FAMILY DWELLING SECTION I- SITE INFORMATION i 1A &ggi tv Address. This section to be completed by.Rice Ivry y1 �r&Pl tiG7 Map Cot Unit :wane overlay District are St. Ondriat. Ca plain" SECTION 2 - PROPERTY OWNERSHiPtAUTHORVFD AGENT 2.tOwy/n��erJno�ft�Rspo�oM: [ g r ` p� foune(Pnnp "Current Malting Address 6/1 Signature Telephone Authorized Aaenti f 1 . -T t� ft° �% cc rice k 71 1Tl Name(Pnnh 'j 'Cuu ts Matimg Addresrys `f YI �pldG ZU' �i�l�i Signature G Telephone SEC ON3• ESTIMATED CONSTA14TION Estimated Cast (Dollars) to as Official Use Only I. Item - 'com fetedb errand ling 1 ::Building (a) Building: Permit Fee 2:: Electrical (b) Estimated Total Cast ofJ ConstructiliaA m 6 3 Plumbing Building Permit Fee 4 Mechanical(HVAC) 5, Fire Protection 6 Total -(1+2+314+5) q dd'V Check Number p"p This Section For Official Use Onl Building Permit Number Nate issued Signature 0uikiing Comm aaionemnspact" of au"Ings Date Vorsiugt? Commercial Buildings Permit May IS 2000 SECTION 4- CONSTRUCTION SERVICES FOR PROJECTS LESS THAN 36,000 CUBIC FEET OF ENCLOSED SPACE Interior Alterations ❑ Existing Wall Signs 93 Demolition❑ .Repairs Additions ❑ Accessory Building Exterior Alteration ❑ Existing Ground Sign ❑ New Signs ❑ Roofing :Change of Use Other Brief Description iEnter a brief description here. Of Proposed Work j ( t SECTION S - USE GROUP AND CONSTRUCTION TYPE USE�GROUP (Chackas applicable) CONSTRUCTION TYPE A Assembly �.. A-1 ❑ A„2 ❑ A-3: ❑ IA ❑. A-4 ❑ : A S ❑ : 18 ❑: B Business ❑ F1 '.❑ -. F.2 ❑ :. 2A 2B 2C ❑ ❑. ❑; E Educational ❑ F: Factory ;.❑ "H High Hazard ❑ 3A - 1-1 :❑ '. 12 ❑ 1-3 ❑ 3B - ❑ . ❑.: 1 Institutional -❑ M Mercantile :❑ 4 ❑. R Residential ❑ R-1 ❑ R-2 ❑ R-3 : ❑ SA :: ❑. S "Storage ':. ❑ S 1 :0 ": S-2 ❑ `:. 56 - "❑:. U Utility :© Specify Specify M Mixed Use 0 S Special Use E Specify COMPLETE THIS SECTION IF: EXISTING BUILDING UNDERGOING RENOVATIONS ADDITIONS ANDACR CHANGE IN USE Existing Use Group ::�E1'.p1d1d sed Use Group Existing Hazard intlez 780 CMR 34j Hoiertl Index 760 CMR 34} SECTION S BUILDING HEIGHT AND AREA BUILDING AREA EXISTING PROPOSED NEW CONSTRUCTION OFFICE USE ONLY Floor Area per Floor (sb i' faf 2m 2r' V 3m 4 e Total Area (sp Total: Proposed New Construction ch (. Total Height (ft) Total Height 8 7, Water Supply(NLG.L. c. 40, § 54) 7A Flood Zone Information: 7.3 Sewage Disposal bear Puhiic o "Private ❑ Zone Outside Flood Zone[ Municipal ❑ On site disposal system[ Versionl 7 Comnrereial Building Permit May 15, 2000 S, NORTHAIULPTON ZONING GXixNng Prtrpttsed ... R quired by 7aning no, to bo bike r, or', ♦eotnma fdullalot Vvi."iem, LDS Snie kranta c Setbacks :Front ..:Side L R. < L.., R. Rear Budding Height Bldg. Square Footage Open Space Footage 'Sr u,t.w. nms bid, M,ioi,I " ..0. n n � DC PaYkiliU S aC<i Fill .tumuC Cxaavnr A. Has a Special Permit/Wriance/Finding ever: been issued forfon the site? NO'. Q DONT KNOW 0 YES 0 IF YES, date issued: IF YES: Was the permit recorded at the Regis" of Deeds? NO 0 DONT.KNOW 0 YES 0 IF YES: enter Book Page and/or Document if B. Does the site contain a brook, body of water or wetlands? NO 0 DON'T KNOW 0 YES 0 IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained 0 Obtained 0 , Date Issued: C. Do any signs exist on the property? YES 0 NO 0 IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property? YES 0 NO U IF YES, describe size, type and location: E Wit the construction activity disturb icle^"anng, grading excavation orfiff n d over t acre or is it pan of a common plan that will disturb over 1 acre? YES 0 NO 0 IF YES then a Northampton Storm Water Management Permit from the DPW is required Version 1.7 Cuatmemial Budding Permit May 15, 2000, SECTION 9- PROFESSIONAL DESIGN AND CONSTRUCTION SERVICES • FOR BUILDINGS AND. STRUCTURES SUBJECT TO CONSTRUCTION CONTROL PURSUANT TO 700 CMR 116 (CONTAINING MORE THAN 35,000 C.F. OF ENCLOSED SPACE) 9.1.Ragietered Aeafittectx Nof Applicable C7 Name Ayegistranp Registration Number Addi Signature Telephone EAu a ire, Dale 9.2". Registered Professional Engkfoer(s): Name Address Signature Neme�� Aaat8e6 felephpne Area of Responsibility Registratipn Number —Date Area of Responsibility Registration Number Expiration Pate Simanee Telephone - Name Area of Responsibility RCgl9flaf19n N4m68f Atldt240 Sgualem Telephone Expotboii flare Name Area of Responsibility Address Regetramn Number Expiration bate Signature Telephone 9.3 General Contractor Not Applicable ❑ Company Name Resperumbir, In Charge of Cnnstmction Address Signature Telephone - Venuonl 7 Commercial Building Permit May 15, 2000 SECTION TO- STRUCTURAL PEER REVIEW 980 CMR 110,11y Independent Structural Engineering Structural Peer Review Required - Yes 0 No I J 'SECTION IT -:OWNER AUTHORIZATION - TO BE COMPLETED; WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT 1 - as Owner of the subject propery, hereby authonza - to act on my behalf, in all matters relative to work authorized by this building permit application SIQnalura of Once, Date as OwnebAuthonxed Agent hereby declare that the statements and information on the foregoing application are true and accurate to the best of my knowledge and belief Signed under the pains and penalties of perjury Print Narre Signature of OwraclAgent Date SECTION 12 - CONSTRUCTION SERVICES 1Q.1 LISUggig Gonstruct an8 did on Nort A(pplica"I ^❑}J { _ f JIPt tL of GG0R88Hbld¢i Hui�S.L„ZJ(`�'M1L9 Load. Nanbbbe, �"' Adtlre - Expvatiun Date Sign a uis Telephone SECTION 13 -WORKERS' COMPENSATION INSURANCE AFFIDAVIT {M.G.L. m 152, § mm,6 ) Workers Compensation Insurance affidavit must be completed and submitted with thie application Failure to provide this affidavit will result In the denial of the issuance of the building permit. Signed Affidavit Attached Yes er No 0 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: IdId XOw" fJC r r The debris will be transported by. The debris will be received by: Scx Building permit number: Name of Permit Applicant } Date Signature of 4mit Applicant jr The Commonwealth ofMassachusetts '> Department ofintlustrlatAceidents ! Congress Street, Suite 100 Boston, At(A.02114-2017 qw x ttnuw.masa.gonfdla Workers' Compensation Insurance Affidavit; Buildm,slContractorslNllwtricianslPiumbers, TO BE FILED WITH THE PERMITTING AUTBDRTI Y. Applicapt Informadon Please Print I e ilth Name lBusmcesi(Jrgan¢atroniludiviasl): (.tyyG r "Address: ,r T� _ CttyStatefZip _ ',% Phone#. ?3s l.f .5�. .Are ,on an employer' Check the oppiopriate lox: Type ofiaralect(required) l i i am n e�+glloyar rv:rh ,we nplaye4w tXWI awVw k tumF ` i E]Slew coname on :t fmm� i pnryaxem pea slnpa don amnpl gss uoduup flumes $ []:Remodeling d, r p: ... ""ticd I 9 nto E2 6crnoln 3 Ix I I rl eownt dons,.11wt kra If [`.o oekv lwal 10 DBuildrngaddrnon d�t n ha ri e d ilt bet rtg�th nrf "msdex[ II ko 3 an+ar�dwsuit ram inn ulite¢kn e.vmku. uenprn t ssr:nanrawnc,,rCe ll []Flectrical repairs or additions Moreton salt., m,rpmyee. 12Plumbing repairs or additions 3 [n "ever co tram rn [ nue h hh tb nrra t ',L ixl<all an,hed ahuo ll.E]Rooflepru s ❑xx sob. covmlators Wi euinlJayc[w and hn ewceki asp imnsoirG..« 4�4tcsva,uryti. xc nnM itv ri2mu to ul eettliv pot auxcmbHm purhiflc 14 QOtlYer 12,oit4ksmi h,e nn utSrttYccs Ck. wtirAirsc P aaani,vngnmall `Any appl mot dardcotka bee Wl mtutalro ftlom thx waiovb to h< me ihzr worRu e,,.meation W le,pinal fiI ser, wbc'abset thn waiddtit waWatmg hay a,,, ding all wun, and tha her oats'de wancern, acun sabmk a avw afl Ann 111,1c,abse svuh $Cucu,us,fla, dook on, iron Husk uYN46it ca addnrumaahest aemasihv aaca„cf ilosebseacenwacdoare "hicl ieo notflux" o,ftam hwv " empiuy es It A(eAr.M, miuxunn M5 v+;ntpinxav, thv5`inuvt rw th rhuu ubike 'comp troixw'mnntsr Iam an employer thates proniding workers' counteeswtton hiisusance for my emphereec Salon, is the poticyF i+acif el, site information. Insurance Compam Narne_u,*✓✓i, �A Pohwydor 5elfilns. L,w s-&(„1-��%�} /l-„j..�t"� 21!f.. Exturanon Dale:jlf.,, ion Site Addlessi t e"( [ .� Clt State'7ap oaf{/ Attach a copy of the W orkera' tD�ensadon po6cry deriaration page (showing the policy number and expiration date), reduce to secure coverage as required under s4GL e 152, C25A is a criminal violation punishable by d fine tip to $ i,500 o "anchor one-year finprismrmem, as well as civil penalties in the Sam of a STOP WORK ORDER and a fine ofupto $250 t00 a -day against the violator. A Copy of this statement may be Actwarded to the Office of investigations of the DIA for insurance :coverage terific n. t da hereby c . + under t .. seed pe sale., ofpehany that the intormafinn provided above o man and correct Signature: ! Dates Phone 4. , f� Official use axle. Do not write in this area. to he completed by one or town officiuG City or Town: ( Permit/license issuing .tuthorny (eirele ova+). _.. I. Board of Health 1.. Building Department:3. Cityl'Posn Clerk d. Electrical Inspector. 5. Plumbing Inspector 6. Other Contact Person:— Information and Instructions Massachusetts(weend Lank chapter 152 requires all employers to movideworkirti compensation hatheirempioyeea. Retention to this statute, an employee is orbital as ` "eveiyperson in the service of another under any contract of hire, express, or implied„ oral or Under," „Ate employer5s def rrd as „"an individual, partnership, association„ corporation Air other kpad enity.. or any two ar wrote of the foregoing cugaged in a;Ionrt leo p risc. and including the legal representatives of a deceased employer, or the receiver or trustee ^ofair individual, parrionship, association or other legal entity, employing employees. Iloweverthe owner of a dwelling house having not more than three apattrhenh and who resides therem,:(it the oucupantof the duelling house of an rger who employs persons to du ratentenanue, constructed or repair work on such dwelling house court the grounds or building appurtenant drereto steal l nor because of such employment be deemed to bean employer.'* AWL chapter 15-„ §25ntbo alstntates thin "every state or local licensing agency shall withhold the issuance or r curved of license or permit to operate abusiness or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required" Additionally; MCrL chapter 152, g25C(7) states "Neither the commonwealth nor any of its puhfted subdivisions shall enter into any contract for tire performance of public work until acceptable evidence of compliance wah the roam once ' requirements of this chapter have been tokeiction to the contracting authority'." Applicants Please fill out the workers' Compensation affidavit completely. by checking tire boxes that apply to your sinkintion and, if necessary, , supply sub contra6ior(s) namkeid, askinve (es) andpeace number(s)along with their even provers) of insurance.: Limited liability Commands (LLC) or Limited Liability Partmer ships iL LP) with no employees other than the members, or: partners, are not required or carry workers' compensation insurance It an L C or LLP does have employees; a policy is regafred, Be me card that this aifidwal may be submitted to the hard, art of Industrial Accidents for confirmation ofireanowe coverage Also be sure to sign and date the affidavit. Theaffirzimahould be returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents should you have tiny questions regarding the law orifyou are required to obtain a workers' compensation pope} please cull the Department at the minter listed below. Self -insured companies should enter their self-msur4hEe ftaomc nanymer on the appropriate tam City or Town Officials :. Please be sere that the affidavit is complete and printed tembly. The Department but procumd a tussock the Ireland of the affidavit for you to fill rout in the event the Office of Investigations had to Contact you regarding the applicant Please be sure to fill in the petvnbhcease number which will be used as a reference number: In addition, an applicant that rural submit mulhple pernnbhoense applications in any green year, need only submit one aChdaoit indicating utrri nt policy information (if necessary) and under "Job Site Address" the applicant should write "ail iocka one an - furry or z ore.- A.copy of the affidavit that his been officially +tamped or marked by the city or Latin may be provided to the applicant os proor that a valid affidavit is on file for future permits of licenses. A new affidavit must be blooper each year. Where a home owner (it urtuen is obtaining a license or perms not related to any business or commercial venture de. a dog license or permit it, burn leaves eic.l seal person isNOT required to complete this affidavit The Department's address, telephone and fax number The C7otninonweztGh of Ma datchusude Department of Industrial Accidents I Congress Street, Suite 100 Boston. MA 02114-2017 Tel,# 617-727-4900 ext.'7406 or 1-877-MASSAFE Fax n 617-727-7749 Revised 02-21-15 www mass.gov,dia Clients: 17303 CHAARY °A29 ACARD,. - CERTIFICATE OF LIABILITY INSURANCE 3/29/2019 019 THIS CERTIFICATE IS ISSUED AS A MATTE OF INFORMATION ONLY AND CONFERS NO RIGHTS DRENTHE 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 INSUREIRS), AUTHORIZED REPRESENTATIVE OR PRODUCER; AND THE CERTIFICATE HOLDER IMPORTANT: It [he certdlcate holtlDr is an ADDITIONAL INSURED, the palleyties) must be endorsed. if SUBROGATION IS WAIVED sumandio - thaterms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate deed not confer rights to the certificate header in If.. of such emlomonamf(s). pRODUCER ..NAME T Kathy T.P. Daley insurance Agcy, Inc �Mx"— ]394895 w_ 138,:WBsttieidSt. - EAMu41S788-04]7913 -II A,,,as, kathieendaley@tpdaleyinsurance.com West Springfield, MA 01090 _ INSUREflISf AFFOflDING COVERPGE_ J NAICA ". _ _ _ _ INSIIflER A: smnven:e nwame .... NSUREO ,INSURERS N Charlie Armeni Trucking; Ina 47 Warehouse Street"wsueEnc. - SPringield,MA01118 I I INSOPEflF >COVERAGES CERTIFICATE NUMBER 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 CONTRACTOR OTHER DOCUMENT WITH RESPECT: fO 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. INSfl '� pDOL�@aPI LTq_ T'PE pE1N5URANCF INSR WVDJ POLICY SMORMS POLICYEF POLIC"EXP jMM'OOrYYYY1 QOARIV YY : tYMIT9 A GENERALUAPLITY. CPS3191687 �1 1131/201901/31/2021i EA CH OCOUPRENCE It BOB BOB X COMMENTAL GENER�ALLIARILTY _ S�E^�RSYtRE 7E0 Kd) s7000� CLAWSMADE L,n1OPOUR _XI@I&PDDed.$5090 Pe@aoN LhAOV INJURY 87 OOQL000 ,TFRAIAGOR-GATE__ 12000000 CFNLAOGRCGATFIs, APopFC1PN PMIOVCTE COMP)OPAGOI 62jpp0J000 r 1PR0 1 X POLI YL LOBS I S . C. AUT(INO@ILE LIADIWTY spssooi _ _ 1/31/2019 01/31n021�EAM 91NED81nGLE UMir ig1 p000Q0. _ ANYAUTO -�A4LO DOPILY INJURY tPerparean) ,5 �..._._. . ._.. _-_ AUTOS ix A TOS LCP 'I @o01LY INJURY IP ualo j E X HPYD AUTOS X 4UOOWNEO ( IPQ II AM CE J 1L 5 T1 A "X U.S.. unB X DccuR I Xt$0108992 .� Y/37/267901/31(202Q EOLH nccuRRENCE jsS WU OOp EMMACCUas ` I CIAI. MADE_ 6E° i,x S TION 70000 : rtW0@KEPS COMPEN@ATION _ Ar40HEGATC S5,900 000 & WC T TU OYI ® SHUI34951P33A1g 1i31 /2p7901/31/2020 X_(TpVATlisr k5 AIR EMPLOYERSUAa1Lm ANY PgOPg1ETOBMAPTNERCXECUTNEVIX _ E,L FACkI ACC10ENT §1000 Q0p OF%OERIMEMEER EXCH-AL, Ni N/A 'pp tlAoryln NN) E__L_019EA$E EALOTOYEE $1090,000 1 i .n19EAAE-POLICY LIMP ($1,000_000 ' .DESCRIPTION OFOPEPPTIOMSI LOCAPONSI VEHECUO (ARrFR ADDED t0, A9NIlonal R¢ aft 9 hedUl3 It Ym Arai lS I.W.) General Certificate -CERTIFICATE HOLDER : CANCELLATION SHOULD ANY OF THE PROVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS -. ANTNORISEn.RpEP�fl�E9ENTATIVE/ 01988.2010 ACORD CORPORATION. All rights resarvetl ACORD 26(201045)7 1 of, The ACOBDnamaaad logo mahegabood marks of ABSORB #9150748/10750247 KJD