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17D-069 HOME IMPROVEMENT CONTRACT PLEASE READ THIS Sold, Furnished and Installed by: lantBostan Date: THID At -Home Services, Iao. d/bfa The Home Depot At -Horne Services 908 Boston Turiq kn, Unit 1, Shtawsbtuy, MA 01545 - Toll Free (800) 657 -5182; Fax (508) 845 -601 Branch Number: 31 Federal ID # 75- 2698460; ME Lie it C 02439; RI Cott Lid/ 16427 CT Uv # 11IC.0505522; MA He mprovement Contractor R. # 126893 r \ Installation Address: ; i i. 0 11 'L r l tiLs ock_. � A {) ( c* )_ Qty State Zip Parotsaser(s): • Work }hone: Home Phone. Call Phone: • Ark Olt .1 C-i oS5 [ i NO] s at ei ] eR(10 Li 0 s3 [ 1 , [ 1 [ 1 Home Address: (If different from Installation Address) City State - Zip E-ii ail Address (to receive project commtmioationt and Home Depot updates); o 1 170 NOT wish to rehired any marketing cmaila from The Home Depot Proiett Information: Undersigned ( "Customer"), the owners of the property located at the above installation oddness, agrees to buy, and THD At -Home Services, Inc. ("The Home Depot") agrees to furnish, deliver and arrange for the installation (Installation") Of all materials described on the below and on the referenced Spec Sheet(s), all of which are incorporated into this Contract by this reference, along with any applicable State Supplement and Payment Summary attached hereto and any Change Orders (collectively, "Contract"): Job #: 0uw•sra.nn.w) ere: Spec Sheet(s) #: Project Amount D fing 0 iding endows ( a f Roo S' Insulation 4 (7 DOUt 1 Covets paltry Doom Q ci7 X37 $ 1 1]Roofing ['Siding D Windows ❑ insulation /4 I ( DGuttea / Covers Entry Doors n $ - DRootm ❑5idiOB D Windows 1:1 Insulation - 3 0,914,0075 DOunel / Covers paltry Doo n S - 1 QRoofing (Siding ❑ Windows U losuleton - — OuttwS 1 Covers (Entry Doors n 5 D • W. Minimum 25% Deposit of Ceuhad Amount doe upon execution of this conbnet.. Total Contract Amount 5 ( (1 4 L1 IIIL�� Afetut Pat hasarr may eat deposit more than node* ot tDe Contrite Amount. Cuaiomer agrees that immediately upon completion of the work for each Product, Customer will execute a Cotnpktion Certificate 'one for each Product as defined by an individual Spec Sheet) and pay any balance due. As applicable, each Customer under this Contract agrees to be jointly and severally obligated and Liable hereunder. The Home Depot reserves the right to issue a Change Order or terminate this Contract or any individual Product(s) included herein, at its discretion, if The Home Depot or its authorized service provider determines that it cannot perform its obligations due to a structural problem with the home, environmental hazards such as mold, asbestos or lead paint, other safety concerns, pricing errors or because work required to complete the job was not included in the Contract. Payment Summary: The Payment Summary # '1' ( 4 5 included as part of this Contract, sets forth the total Contract amount and payments required for the deposits and final payments by Product (as applicable). NOTICE TO CUSTONMEN You are entitled to a compiebrly filled -in copy of the Contract at the time you sign. Do not sign a Completion Certificate (note: there is one Completion Certificate for each listed Product as defined by individual Spec Sheets) before work on that Product is complete. In the event of termination of this Contract, Customer agrees to pay The Monte Depot the costs of materials, labor, expenses and services provided by The Horne Depot or Authorized Service Provider through the date of termination, pins any other amounts set forth In this Agreement or allowed under apOcable law. THE HOME DEPOT MAY WJTImOLD AMOUNTS OWED TO THE DEPOT FROM THE DEPOSIT PAYMENT OR OTHER PAYMENTS MADE, WITHOUT LIMITING THE HOME DEPOT'S OTHER REMEDIES FOR RECOVERY OF SUCH AMOUNTS. Act r1 lho rLmtion: Customer agrees and undcrHands that this Agreement is the entire agreement between Customer and The ome with regard to the Products and Installation services and supersedes all prior discussions and agreements, either oral or written, relating to said Products and Installation, This Agreement cannot be assigned or amended except by a writing signed by Customer and The Home Depot. Customer acknowledges and agrees that u , r has read, understands, voluntarily accepts the terms of and has received a copy of this Agreement. red by. - Sub , I —�- is S- titre m Date _ ` /� Sales e!S' . ' t s S re rate X �, , Telephone N0. 3 4 7/ , Sac, Customer's Sign Date f /1f CANCELLATION: CUS OMBR MAX CANCEL THIS Sales Consultant License No. (se imoSenble) AGREEMENT WITHOUT PENALTY OR OBLIGATION BY DELIVERING WRITTEN NOTICE TO THE HOME DEPOT BY MIDNIGHT ON THE THIRD BUSINESS DAY AFTER SIGNING TIES AGREEMENT. THE STATE SUPPLEMENT ATTACHED HERETO CONTAINS A FORM TO USE IF ONE IS • SPECIFICALLY PRESCRIBED BY LAW IN CUSTOMER'S STATE. NOTICE: ADDITIO1IAL TERMS AND CONDITIONS APE STATED ON THE REVERSE SIDE AND ARE PART OF THIS CONTRACT 0540.12 mate - Brant} File Yellow - customer ?> r> (aL R I. F is -' A f' . , OF 1,J L J ,' , .4 \4 ' _ 1\4'l- r r ?3 DE2 (.r Imo. 1 i _ 1:0 2 D AS A MATTER OF I FORMA,T 1 O'L , AND C 1 ]; E RC NO r RI am r IJIDOv' I ,. rn i ./1 .) _ I;ERTIFiCATE OCES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED DED 8 THE , vI.iCI'c OELOW. TI-HS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE CONTRACT EET,'VEEN THE ISSUING' INSURER(S), A'J IHO'Frf REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. • IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the pclicy(ies) r'Lisl b - e,ldorSeci I; SUBROGATIG•1 IS WANED. b e , T he terrns and conditions of the policy, certain policies may require can enciorsernen A staterae s.; c..illficat dqe ,. •r con far r 'r ."o .1.; certificate holder in lieu of such endorsernent(s). ,0 .00UCER .L- Soa -9auu ?hn ICONTAC: .... - Sa.r3h USA Inc. NAME. -- — PHONE ;, ] -...,/ - (A/C. No : ?:L 1 l:uC, Nia'I: ---- ------ .._._ -. -� E -MAIL iomedepOt.cectrequest@marsh.cam ADDRESS:__ - -_ ____ _ Cwo Alliance Center, 3560 Lenox Road, Suite. 2400 INSURER {S}AFFORDINGCOVE2AGE i NA1C# kt l anta , GA 30326 ---- .------ - -.. -- ?ax (212) 948 -0902 INSURER A: Steadfast Ins Co 26387 NSURED ' INSURER 8: Zurich American In Cc 16535 Che Home Depot, Inc. come Depot U.S.A., Inc. INSURER C: New Hampshire Ins Co 23841 2455 Paces Ferry Road NW INSURER D: Illinois Nati Ins Co 23817 3uilding C -20 INSURERS: NATIONAL UNION FIRE INS CO OF PITTS 19445 ktlanta, GA 30339 - — — INSURERF: Illinois Union Ins Co 27960 COVERAGES CERTIFICATE NUMBER: 25776028 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 I 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. VSR ADDL SUBR POLICY EFF POLICY EXP -TR TYPE OF INSURANCE INSR WVD _ POLICY NUMBER (MM /DD/YYYY) (MM /DDIYYYY) LIMITS A GENERAL LIABILITY GL04887714 - 02 03/01/12 03/01/13 EACH OCCURRENCE $ 9,000,000 X DAMAGE TO RENTED 1,000,000 COMMERCIAL GENERAL LIABILITY PREMISES (Ea occurrence) $ CLAIMS -MADE X OCCUR MED EXP (Any one person) $ EXCLUDED X LIMITS OF POLICY XS PERSONAL &ADVINJURY $ 9,000,000 X OF SIR: $1M PER OCC GENERAL AGGREGATE $ 9,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP /OP AGG $ 9,000,000 � POLICY JFCT -LOC $ B AUTOMOBILE LIABILITY BAP 2938863 -09 03 • 2 13 0 COMBINED SINGLE LIMIT 1, 000, 000 (Ea accident) $ . _.. X ANY AUTO BODILY INJURY (Per person) $ ALL OWNED — SCHEDULED BODILY INJURY (Per accident) $ AUTOS ALTOS _. _HIRED AUTOS NON -OWNED PROPERTY DAMAGE $ _ AUTOS (Per accident) X SELF INSURED PHY DMG $ UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS -MADE AGGREGATE $ DED RETENTION $ _ _ $ C WORKERS COMPENSATION WC019736915 (AOS) 03/01/12 03/01/13 X TOR ORY LIMITYLrMU- II 1l TH AND EMPLOYERS' LIABILITY SL� - Y/N D ANY PROPRIETOR/PARTNER/EXECUTIVE WC019736917 (FL) 03/01/12 03/01/13 EL. EACH ACCIDENT $ 1,000,000 OFFICER /MEMBER EXCLUDED? N N 1 A E (Mandatory lnNH) WC019736916 (CA) 03/01/12 03/01/13 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 _ If ESCRIPTs, describe N OF OPERATIONS below under DESCRIPTION E.L. DISEASE - POLICY LIMIT $ 1,000,000 D _ E Workers Compensation WC1192494 (QSI) 03/01/12 03/01/13 SIR (AOS) /SIR (GA) 1M /750,000 C Workers Compensation WC019736918 (WI) 03 /01 /12 03/01/13 F TX Employers XS Indemnity TNSC46566397 (TX) 03/01/12 03/01/13 Occurrence /SIR 30M/1M )ESCRIPTION OF OPERATIONS / LOCATIONS/ VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) tE: EVIDENCE OF COVERAGE • 7.ERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 'HE HOME DEPOT, INC. THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN COME DEPOT U. S .A. , INC. ACCORDANCE WITH THE POLICY PROVISIONS. 455 PACES FERRY ROAD NW AUTHORIZED REPRESENTATIVE IUILDING C -20 / �, .TLANTA, GA 30339 r-,61,_____ l 62,-,---c 1 USA ©198`-2010 AC,QRD CORPORATION. All rights reserved. i t