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31A-106 (2) BP-2024-0851 22 FEDERAL ST COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 31A-106-001 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-2024-0851 PERMISSION IS HEREBY GRANTED TO: Project# TEMP MOBILE HOME Contractor: License: Est. Cost: 75 AMERICAN MOBILE HOMES INC 081119 Const.Class: Exp.Date: 06/18/2025 Use Group: Owner: M MOLITORIS JOHN V & SUSAN Lot Size (sq.ft.) Zoning: URA Applicant: AMERICAN MOBILE HOMES INC Applicant Address Phone: Insurance: 51 MOORE RD (781)331-0333 WCC-500-5022645 EAST WEYMOUTH, MA 02189 ISSUED ON: 07/05/2024 TO PERFORM THE FOLLOWING WORK: TEMP MOBILE HOME 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. j%� Signature: li� Fees Paid: $75.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Office of the Building Commissioner RECEIVED JUL � 3 2024 The Commonwealth of Massachu etts .'- Board of Building Regulations and S nddiftigr.OF Gun DIN(;INSPF,C-1 R Massachusetts State Building Code, 7 6-CMlo'T"Ati�P'i0N''�^A010; I IPALITY _ SE Building Permit Application To Construct, Repair, Renovate Or Demolish a Revised Mar 2011 One-or Two-Family Dwelling This Section For Official Use Only Building Permit Number:6P--AV- ^J Date Ap lied: 11� &;05S /7� -7• 3-20 Building Official(Print Name) Signature Date SECTION 1: SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map& Parcel Numbers 21 frilerc -I ree-- Flomncr � i . - 1.1 a Is this an accepted street? es .. 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 6( Private CI Zonc: Outside Flood Zone? Munici Check ifycs❑ Pal liOn site disposal system Cl SECTION 2: PROPERTY OWNERSHIP' 2.1 gager"of Record:in Mot tton S notencr C Ind,? Name(Print) City,State,ZIP 22 F''c\ern,I atfet 113.2'10.0611 No.and Street Telephone Email Address SECTION 3: DESCRIPTION OF PROPOSED WORD(check all that apply) New Construction 0 Existing Building 0 Owner-Occupied 0 Repairs(s) 0 Alteration(s) 0 Addition 0 Demolition 0 Accessory Bldg. 0 Number of Units Other (Specify: iri'1 Ie, berry' Brief Description of Proposed Work2: InS4' Q 1.7 x 49' 2- rccm rr- e R -c T, �P Ilvinr soar-kis ale the Ecmt tYb)ikr1S/rr nir;S oleic fire wily-. �nme . J Rte. cd`corc� 6•14.7g } SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1. Building $ �1 — 1. Building Permit Fee: $ Indicate how fee is determined: 0 Standard City/Town Application Fee 2. Electrical $ 3,0 ' ❑Total Project Cost'(Item 6)x multiplier x 3. Plumbing $ 3,CCU, — 2. Other Fees: $_ 4. Mechanical (HVAC) $ — List: 5. Mechanical (Fire $ — Suppression) Total All Fees: Check Ncili 81 IClteck Amount: Cash Amount: 6. Total Project Cost: $ �3, �. 0 Paid in Full 0 Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) II C'S�A- ( 11 l9 William a- 60,1"1"141) License Number E pirati n Date Name of CSL Holder 25 p Imbet 1 I Pra r�h Re rl List CSL Type(see below) '\ !gy No.and Street Type Description Hham I n `3 U Unrestricted(Buildings up to 35,000 cu.ft.) nc '� R Restricted 1&2 Family Dwelling City/Town,State,ILIP M Masonry RC Roofing Covering WS Window and Siding -___ SF Solid Fuel Burning Appliances 7E 1.331•(�333 alum e bil .r1 crin rcrhi le harts can I Insulation Telephone Email address D Demolition 5.2 Registered Home Improvement Contractor(HIC) Arne I1C e(\r). Mobile N 1 IUb38l, l �� l� - HIC Registration Number E pi on Date HISCompany Nam or HIC Registrant Name Prof Head Vilm e.nmencGnr hl(e hrmrs .(Din No.and Street Email address lob t nrrksfh I-1r . 071En '181.33I .0533 City/T , State,2'IP 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 Issua of the building permit. Signed Affidavit Attached? Yes IS 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 fY Tle nu) hfChlle HciirS t r to act on my behalf,in all matters relative to work authorized by this building permit application. (Rer -fit S neri mil Gitached 1/1 Date Print Owner's Name(Ionic Signature) SECTION 7b: OWNER' OR AUTHORIZED AGENT DECLARATION By entering my name below,I hereby attest under the pains and penalties of perjury that all of the information contained in this applich n is true accurate to the best of my knowledge and understanding. 1 ik VI /24 Print wner's or Authorizc9Agent's Name(Electr nic Signature) Date NOTES: 1. An Owner who obtains a building permit to do his/her own work,or an owner who hires an unregistered contractor (not registered in the Home Improvement Contractor(HIC)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 www.mass.gov/oca Information on the Construction Supervisor License can be found at www.mass.gov/dpk 2. When substantial work is planned, provide the information below: Total floor area(sq.ft.) 52 (including garage,finished basement/attics,decks or porch) Gross living area(sq. ft.) Habitable room count Number of fireplaces — Number of bedrooms Z Number of bathrooms l Number of half/baths — Type of heating system F IPc nc Number of decks/porches — Type of cooling system E lectrne_ Enclosed Open 3. "Total Project Square Footage"may be substituted for"Total Project Cost" The Commonwealth of Massachusetts Department of Industrial Accidents k4_. Office of Investigations �; Lafayette City Center .�-`" 2 Avenue de Lafayette, Boston, MA 02111-1750 t�>= www.mass.gov/dia Workers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): American Mobile Homes, Inc Address:51 Moore Rd City/State/Zip: Weymouth, Ma 02189 _ Phone#:781-331-0333 Are you an employer? Check the appropriate box: Type of project(required): 1.❑■ 12 4.I am a employer with ❑ I am a general contractor and I 6. ❑New construction employees (full and/or part-time).* have hired the sub-contractors 2.0 I am a sole proprietor or partner- listed on the attached sheet. 7. 0 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. 0 We are a corporation and its 10.0 Electrical repairs or additions 3.❑ [am a homeowner doing all work officers have exercised their 11.❑ Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12 ❑Roof repairs insurance required.] ' c. 152, §1(4),and we have no l3.®Other temp mobile home employees. [No workers' comp. insurance required.] *Any applicant that checks box#I must also fill out the section below showing their workers'compensation policy information. t I lomeowners 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. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: A.I.M. Ins. Co. Policy II or Self-ins. Lic. #:We 500-5022645-2020 Expiration Date:8/12/24 Job Site Address: 22 Federal Street City/State/Zip:Florence, MA 01062 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 certify under the p . s and pen �ti�ess,of perjury that the information provided above is true and correct Signature: Gt/ /�f3JJ�, irk /L� Date: 07.01.24 Phone#: 781-331-0333 / Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License# Issuing Authority(check one): 1❑Board of Health 20 Building Department 30City/Town Clerk 4.0 Electrical Inspector 5Elumbing Inspector 6.0Other Contact Person: Phone#: CITY OF NORTHAMPTON SETBACK PLAN MAP: LOT: LOT SIZE: REAR LOT DIMENSION: *R'CCr a-4r1,r]hed sI iv v1-w REAR YARD _ SIDE YARD SIDE YARD FRONT SE II3ACK FRONTAGE City of Northampton '4r1JAli .. •.. j✓t-"r )ssachusetts tr ;'� ( ,,,o 7 DEPARTMENT OF BUILDING INSPECTIONS w „r 212 Main Street • Municipal Building WSJ, ' ,..' Northampton, MA 01060 sll,,, '3' °'s 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: I V//6\ — AXIS The debris will be transported by: Name of Hauler: N A S • Signature of Applicant: y Date: —lit 121. AMERICAN MOBILE HOMES INC. 51 Road Weymouth,,MA MA 02189 (781)331-0333 1-800-232-9991 PROPOSAL Fax(781)335-0707 Date ( /TI/21 • Name Jchn m(�I{-{gin S Est.delivery date Address �-P(iP1?�� r± /Rrrc'nce , �:IC American Mobile Homes,Inc.hereby propose to furnish the materials and perform the labor necessary for the completion of installing I„L''-!("( leased mobile home containing: Refrigerator,stove,dining set,living room set,curtains,bedding 1st fJ 1l ,2nd Idcrt',3rd ,washer and dryer,air conditioning. 1v�l t ' emporary Plumbing installation to mobile home i Applying for building permit for mobile home li/emporary Electric installation to mobile home ❑ Remove necessary trees,tree limbs or shrubbery ❑ Remove any necessary fencing 0 Other: Any resulting damage to said property as a result of the installation,removal and existence,of mobile home and its its utility connections shall not be the responsibility of American Mobile Homes,Inc.,specifically driveway,fence, stonewall,septic system,trees,lawn or any other type of landscape items and/or: -- -_ American Mobile Homes,Inc.,is not responsible for the re-installation of any of these items. Costs: _ The monthly rental of the mobile home' '2,5; , mos. The delivery and pick up charge of Air conditioning',TC,.J Pet fees ' 5(`(-\„ other There will be additional charges for utility connections,permits,fees,site preparation. There will be a profit and overhead charge of 10& 10 for all sub contractors and fees paid out Any applicable sales tax.A 5%carrying cost will be billed and payable on all invoices not paid within 45days of billing. A$1,000.00 security deposit is due on delivery of mobile home.I/we agree to sign a lease for the mobile home rental at delivery. Projected job cost: - `{ • 1IY to t'd1 1' C'kf6 Payment Method: Billed directly to insurance company with a signed assignment of payment 0 Other: _ Any alteration or deviation from above specifications involving extra costs, /��'/ wil:become an extra charge over and above the estimate All agreements Respectfully submitted - gio.-- contingent upon strikes,accidents or delays beyond our control ACCEPTANCE OF PROPOSAL The above prices,specifications and conditions are satisfactory and are hereby accepted. You arc authorized to do the work as specified. Payment will be made as outlined above. If insurance company is not willing to honor assignment of payment,Uwe understand Uwe will be responsible for full payment of all services. NOTICE OF RIGHTS TO CANCELLATION You may cancel this agreement if it has been signed by a party thereto at a place other than an address of the Seller,which may be his main office or branch thereof,provided you notify the Seller in writing at his main office or branch by ordinary mail posted,by telegram sent or by delivery,not later than midnight of the third business day following the signing agreement Sec attached notice of cancellation form for an explanation of this right. Signature y71/ = - Date 0 Z/,2 Signature _✓ _ — - _ ,y .i r am, - ., a r R. .ax�;,4 •_ % F y7r' r `3i' rid -•/ •"• • `� �j io.• - • y_ r . 4. - 64. • !_ 'w '►. Ir, - .. « R•t1l-r -46'41 f 4' g • f #Tl .� •. t ft Federal ®,�'R • .. w �, 44411 • yll01V-- „, , 1111,1111111 .? , ', 41( . 4ff ' - 11. �. . �`i ✓"r ` 1," liersicc. I Y 1.....:sdp, -.. :• f it „ r•.itt-'40L^^ "j. I l6 r ...i„ :.. , 41-.. 0,: . , ',„:,1' , . .4, ".1, i , i 1 r •;uft . .� 4 1. j.trjoalai. f s . e- . --- .4 miler.litt.- ....,...,k ' 4, * ifilit* if /, yr40„, • te ,iirr • 3 • �(, f Y • . ;, . .� ��` _. r . .i t t • 4r^ A ;.• •' '' 4 -4, L., ''' ofC P-',- • f- ',me%.:, ti- • .., , ,, .44.4is - A t �;. f cur ' IA _ '�'. .•A \ n I# 0� 'tie f ! • P. •" \ C JV OC +`� 411011.•o lir Client Name Client Email Client Phone Client Signature Copyright Statement Generated by Phou Sheet arms,. Lie na. tr _ ■ l Plan always remains the oopynpk of deopner a seal not be used sth N Omer an for prg0 nr n d w wnano, ',thou wnsae awravy.No Kim Wilson 31s Plan iCe Pen may be produced by any oMer orduehn right be aser0sad without pannlnaan k0al enforcement wit be taken on oopytgln lrllfangenrtenl km®anarrxnadlehdroa.00rn Oscllmtnr Property Daubs Daatgn Saes Tills Is not en oak*document end may not comply WO current laws or Industry standard..You should make your own npukks end seek 22 Feder*SL Florence.MA 01062.USA III..2 Badroeen t:a17 independent edvkv horn relevant hau.y professionals before corny or relying on trio contorts of the documentA"GRICANLE INC. APN:314.1080O1 On,. �__--� Men Ad 012OM a MO as ALL DIMENSIONS ARE IN FEET.DO NOT SCALE FROM PLANS. Commonwealth of Massachusetts \ V : Division of Occupational Licensure Board of Building Re ulations and Standards ConstructioQ ii c a_1 & 2 Family ;� -=s CSFA-081119 z, Ekyires: 0i6/18/2025 WILLIAM J G IRRITY ;, i 25 KIMBALL'BEACH RD HINGHAM Mit02043 ?t, 10 i /'- i 1t Commissioner i7 c4.0 rvi .,,.s.1..r_ THE COMMONWEALTH OF MASSACHUSETTS Office of Consumer Affairs and Business Regulation 1000 Washington Street- Suite 710 Boston, Massachusetts 02118 Home Improvement Contractor Registration it., ....__ ..=___ . . ._. 64 4 - . Type: Supplement Card AMERICAN MOBILE HOMES INC. 15) Registration: 7/22 2 51 MOORE RD ` _-- Expiration: 07/22/2024 E.WEYMOUTH,MA 02189 M am oemanimeaMot 7f 0*) "4--.. ....,,,,,./ ._ --- Update Address and Return Card. THE COMMONWEALTH OF MASSACHUSETTS Office of Consumer Affairs&Business Regulation Registration valid for individual use only before the HOME IMPROVEMENT CONTRACTOR expiration date. If found return to: TYPE:Supplement Card Office of Consumer Affairs and Business Regulation Registration Expiratlgn 1000 Washington Street -Suite 710 106386 07/22/2024 Boston,MA 02118 AMERICAN MOBILE HOMES INC. WILLIAM GARRITY 51 MOORE RD . � .k. E.WEYMOUTH,MA 02189 Undersecretary Not valid without signature Client#:23090 AMEMO ACORD,. CERTIFICATE OF LIABILITY INSURANCE DATE(MM/OD/YYYY) 3/22/2024 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 pollcy(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 any rights to the certificate holder in lieu of such endorsement(s). PRODUCER C01.TACY Matthew M.Bryan Sullivan Insurance Group,Inc. PHONE FAX 1 Mercantile Street (A/C,No,Ext):508 791-2241 J( N,I; 508 797-3689 Suite 710 _ADDRESS: mbryan@sullivangroup.com INSURER(S)AFFORDING COVERAGE NAIC S Worcester,MA 01608 - INSURER A:Westchester Surplus Lines Ins.Co. 10172 INSURED INSURERB: American Mobile Homes,Inc. I NSJRERC: 51 Moore Road East Weymouth,MA 02189 INSURER : INSURER E: INSURER F: 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 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 ADDL SUB POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSR NfVD POLICY NUMBER MM/DO LIMITS ( fYYYY) (MMIODlYYYY) A X COMMERCIAL GENERALLIABILrrY X X G74451482001 03/15/2024 03/15/2025 EACH OCCURRENCE '$1,000,000 CLAIMS-V.ADE XI OCCUR PREMISEStEaocsurzence) $100,000 MED EXP(Any one person) $Excluded PERSONAL&ADV INJURY $1,000,000 GEWL AGGREGATE UMIT APPLIES PER GENERAL AGGREGATE $2,000,000 _ POLICY JECT LOC PRODUCTS-COMP/OPAGG S2,000,000 J_ OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT I Ma accident) S ANY AUTO BODILY INJURY(Per person) S OVV_AUrOSONLY AUTOSULED BODILY INJURY(Pe accident) $ HIRED NON-OWNED PROPERTY DAMAGE AUTOS ONLY —AUTOS ONLY (Per accident] A UMBRELLA LIAR X OCCUR X G74451524001 03/15/2024103/15/2025 EACH OCCURRENCE s5,000,000 X EXCESS UAB CLAIMS-MADE AGGREGATE s5,000,000 DED RETENTION$ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANY PROPR ETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT S OFFICER/MEMBEREXCLUDED? n NIA (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE S If yes descrIbe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACCRD f et AddIConal Remoras Schedula,may LIe attached If more space I.squired) General Liability receives Additional Insured status if required by written contract. 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. AUTHORIZED REPRESENTATIVE .': e< ©1988-2015 ACORD CORPORATION.All rights reserved. ACORD 25(2016/03) 1 of 1 The ACORD name and logo are registered marks of ACORD #S523325/M523302 MBM 08/28/2023 15:41 7813316507 DUNCAN_MACKELLAR INSURANCE T #3629 P. 001/001 A G CERTIFICATE OF LIABILITY INSURANCE DATE IMEVGR'WWi O6/28/2023 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(tes)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(sl. PRODUCER -Z3>7Ylc"r Rob MacElhin eyP1Duncan & Mac&ellar Insurance Agency "E „w. 781-335-117 0 C 781-331-6507 835 Broad Street ApcFN robeA duneanmackellar.coat APDRE3 _ , INSURER(3I AFFORDING COVERAGE NAiC Y E. Weymouth, MA 02189 _ INauRERA Burlington Ins.CO - WSUREo IN URF F:Arbella Protection American Mobile somas, Inc. INSURER C Associated limployers Ina. Co. 51 Moore Road INSURER O: Weymouth, MA. 02189 INSURER E INSURER F: 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 CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POUCIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS. EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSRR: TYPE OF INSURANCE ADDLIER owe U D POLICY NUMBER M OPOUCY EFF/YYYYI'J POLICY ExP , Ll4NT5 ow�Mvn 1 IX 1 COMMERCIAL GENERAL LIABILITY (10713G06814-01 02/04/23 02/04/24 EACH OCCURRENCE $ 1,000,000 A CLAIUS�vWE X,OCCUR 7R is so�p 103( $ 100I000 -- I WED EX=(Any one oaso1 $ tweluded I PERSONAL&ADV INJURY $ 1,000,000 GEN..AGGREGATE LIMIT APPLIES PER• GENERAL AGGREGATE $ 2,000,000 POLICY 7 JECT E LOC PRODUCTS-COMP/OP AGG $ 2,000,000 i OTHER: _ $ AUTOMoeI LELIABLLRY 1020014697 02/26/23 02/26/24 COMBINT-DSING_r`JAW $ 1,000 000 fEa acc,denti r ANY AUTO BODILY INJURY(Per ow son) $ 8 —r OWNED v BGHEDU.ED AUTOS ONLY :I^AUTOS BODILY INJURY(Pee accident) $ I HIRED NON-OWNED P4OPERTv'OAMAGIt Is i AUTOS ONLY —AUTOS ONLY i(Per enanentl $ UM0RELLALIAR _OCCUR 1 EACH OCCURRENCE f EXCESS LIAO CIAIMEHANiE AGGREGATE $ _ UEJ I RETENTION$ I $ WORKERS COMPENSATION WCC-500-5022645-2023 0e/12/23 08/12/24 pok p7�. I ANP EMPLOYERS'UABILI Y YIN sTA ER I C ANYPROPPJETOR/PARTNER CUTIVE n E.L EACH ACCIDENT $ 1,000,000 OFFICER EMBEREXCLUDED? J NIA IMuwatay if NH1 a L.DISEASE-EA EMPLOYEE 1 1,000,000 ItOeS JPTION.OF C 1 000 DESCRIPTION OF OPERATIONS Mow •E.L.DISEASE•POLICY miff $ , ,OQO , PFSCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES(ACORD 11I,AmM INWI l etnuw Schedule,may be attached If more space is raq..0•041 Rental of Mobile Homes CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DEUVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE cl(*-or..e.c l- �� / Cs 1$ -2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD