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23D-012 (8) 41141411116MCK ST BP-2006-0914 Ai GIS#: COMMONWEALTH OF MASSACHUSETTS :23D-012 t CITY OF NORTHAMPTON Lot: -001 Permit: Building Category: BUILDING PERMIT Permit# BP-2006-0914 Project# JS-2006-1395 Est. Cost: $6722.00 Fee: $25.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: HOME DEPOT AT HOME SERVICES 126893 Lot Size(sq.ft.): 12588.84 Owner: FREEMAN OTIS STANTON Zoning:URB Applicant: HOME DEPOT AT HOME SERVICES AT: 8 NONOTUCK ST Applicant Address: Phone: Insurance: 345 GREENWOOD ST UNIT 1 (508) 341-9401 Workers Compensation WORCESTERMA01607 ISSUED ON:3/15/2006 0:00:00 TO PERFORM THE FOLLOWING WORK:INSTALL REPLACEMENT WINDOWS 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: Driveway Final: Final: Final: Rough Frame: Gas: Fire Department Fireplace/Chimney: Rough: Oil: Insulation: Final: Smoke: Final: THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Certificate of Occupancy Signature: FeeType: Date Paid: Amount: Building 3/15/2006 0:00:00 $25.0011734 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo • a City of Northampton 1.' Building Department :l: 1q , x* ; S 212 Main Street t-lnr ` s tl i -'-.7;.,:'e.'-'-: ' ' n Room 100 ti er eir � � s 2 � :"i ` Northampton; MA 01060 ,w® Sefs o 5 r ?i pk" - .5 phone 413-587-1240 Fax 413-587-1272 � � r rfotISttfaos 4 a ,,,,,,„r.-. ....1.., qu , fi Ns , A Qthec pec ; , . r" t APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION 1.1 Property Address: This section to be completed by office ©�� .� Nfap- Lot Unit ::`Zone .r Overlay District . b-0FElm St District , CBistnct SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: ` �} -V i V\ c rri,i t.- q7 Imp Vf5 tulip V)Drett ..e rt et 0 I©Gig... Name(Print) Current Mailing Add_rg$s 2 � Telephone f f Signature 2.2 uthorized Agent: ,.) %(,r- 'S y Nam- -nnt) / Current Mailing ` ailinng Add)drrresss::ry(////33 ature Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item - Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building (a)Building Permit Fee (i3 7 2. Electrical ' (b)Estimated Total Cost of Construction from(6) 3. Plumbing Building Permit.Fee 4. Mechanical(HVAC) 5. Fire Protection 6. Total=(1 +2+3+4+5) (07 --- Check Number //79y t S- This Section For Official Use Only Date Building Permit Number. Issued: Signature: r Building Commissioner/Inspector of Buildings Date Y Section 4. ZONING All Informatibtt Must Be Completed.Permit Can Be Denied Due To Incomplete Information Existing Proposed Required by Zoning This column to be filled in by Building Department Lot Size —.__._. —-. - —_ iy :- i Frontage — Setbacks Front j Side L R:' . ' L:' 1 R:€ } Rear ` Building Height a • t----- Bldg.Square Footage s ( % € i i Open Space Footage 77 (Lot area minus bldg&paved . parking) #of Parking Spaces , Fill: (volume&Location) A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO 0 DON'T KNOW 0 YES 0 IF YES, date issued:` i IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DONT KNOW 0 YES 0 IF YES: enter Book _._....,wr..a.. Pagel ' and/or Document# B. Does the site contain a brook, body of water or wetlands? NO 0 DON'T KNOW (,) YES Q IF YES, has a permit been or need to be obtained from the Conservation Commission? ` • Needs to be obtained Obtained 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 0 IF YES, describe size, type and location: 'r E. Will the construction activity disturb(clearing,grading,excavation,or filling)over 1 acre or is it part of a common plan that will disturb over 1 acre? YES 0 r NO 0 IF YES,then a Northampton Storm Water Management Permit from the DPW is required. • SECTION 5-DESCRIPTION OF PROPOSED WORK(checkcaltapplicable) New House ❑ Addition ❑. Replacement 15 i ows Alteration(s) IT Roofing ❑ Or Doors Accessory Bldg. ❑ Demolition ❑ New Signs [D] Decks [p Siding[D] Other[D] Brief Description of Proposed,',�,�} ��) wP6 �( , t 1D 9434 et Work: -�-�►`?w VII NNN Alteration of existing bedroom Yes No Adding new bedroom Yes No . Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll -Sheet 6''''i If Netnr hoaseyarid it ctdr>iQ to iusfi c>t'tlioc sinct.=},corttaefe fhe oifQU inq: a. Use of building:One Family Two Family Other b. Number of rooms in each family unit: Number of Bathrooms c. Is there a garage attached? d. Proposed Square footage of new construction. Dimensions e. Number of stories? f. Method of heating? Fireplaces or Woodstoves Number of each g. Energy Conservation Compliance. Masscheck Energy Compliance form attached? h. Type of construction i. Is construction within 100 ft.of wetlands? Yes No. Is construction within 100 yr. floodplain ' Yes No j. Depth of basement or cellar floor below finished grade k. Will building conform to the Building and Zoning regulations? Yes No. I. Septic Tank City Sewer Private well City water Supply SECTION 7a-OWNER AUTHORIZATION-TO BE COMPLETED,WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING_PERMIT- CO Arn ,as Owner of the subject property hereby authorize to act on my behalf,in all matters relative to work authorized by this building permit a licati n. 0 dc9 Ct., Signature of Owner Date -- — -- }% ((I �16' ( I61�,{,� as Owner/Authorized Agent hereby declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge and belief: Si•ned under the pains aid penalties of perjury. L /. rte_ Ilia. I /(:)ia Pri Name /I ignature of Owner/Agent Date r1/4-3/1.5/0G SECTION 8-CONSTRUCTION SERVICES t.. 8.1 Licensed Construction Supervisor: Not Applicable ❑ ` Name of License Holder: License Number Address Expiration Date Signature Telephone 9Re ifd "` e1m/7; ete;7667a616'.6.1. 4::7:41�aa « . ' .t r Z�g, ,�. :• Not Applicable ❑ r Com•an Name Registration Number - . c • bud a - �Ser ��� °/ 31 ty Addr-ss /�/ i'� Expiration Date A IL(.1_A f.1.11 Telephone 1Ul(MU'4433 / SECTION 10-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 issuance of the build ing permit. Signed Affidavit Attached Yes No No ❑ The current exemption for"homeowners"was extended to include Owner-occupied Dwellings of one(1) or two(2)families and to allow such homeowner to engage an individual for hire who does not possess a license,provided that the owner acts - as supervisor.CMR 780, Sixth Edition Section 108.3.5.1. Definition of Homeowner:Person(s)who own a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be,a one or two family dwelling,attached or detached structures accessory to such use and/or farm structures.A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such"homeowner"shall submit to the Building Official,on a form acceptable to the Building Official,that he/she shall be . responsible for all such work performed under the building permit. As acting Construction Supervisor your presence on the job site will be required from time to time,during and upon completion of the work for which this permit is issued. Also be advised that with reference to Chapter 152(Workers'Compensation) and Chapter 153(Liability of Employers to Employees for injuries not resulting in Death)of the Massachusetts General Laws Annotated,you may be liable for person(s) you hire to perform work for you under this permit. The undersigned"homeowner"certifies and assumes responsibility for compliance with the State Building Code,City of Northampton Ordinances,State and Local Zoning Laws and State of Massachusetts General Laws Annotated. Homeowner Signature 7 I • ¢�ltn1-f ADO +O a yE (rift of �arthamiton 1 g �+ � E 3� � �z� n • DEPARTMENT OP IIUILDIJG 1NSPPCTiONS •212 Main Street Municipal Building P G Northampton, Mass_ 01060 WORKER'S COMTENSATIO.N ENSURANCE AFFIDAVIT R.ICVACkUi(1311-e._ (Iiccas perm;ttee) v:ith a principal place of businessfresidence at: NO !(11 P. _111-44 (phone:') ?CO 6a57 572 (scr�.Uci ty/statt/E p) do hereby certify, under the.pains and penalties of perjury, h'i • (/l am an employer providing the followine!worker's compensation coverage for lily • employees w orldng on ti jo iire X95 .3• 807 " (I:sums Con A (Polio;Nu=mber) -- (Expiration Dar`) • ( ) I am a sole proprietor, general contractor or homeowner (circie one) and have hired the contractors listed below wbo have the follow nQ worker's c000ensation pe!icies: (Name of Contractor) (Insurance Company/PoUc, Numh=r) (r ipiracion Date) (Name of Conuncior) (insurance Comoanti-iPolic Numccr) (Ex-pirtion Date) • • Mae of Conr;aetor) (Lass anca Compan}•/Potic} Namkr) (E_cpirr don Dale) • (Dame of Contractor) (Laurance Comczny/Poticy Num ar) (Expiration Date). (Lt:a[3 ad'ttt:ocil t�c�,tlaooca.._-ti•to snout tnforraa.ioa pc-1.1=L to an ( ) I am a sole proprietor and have no one wort rig for me. ( ) I am.a home owner performing all the work myself. NOTE:plese be aw lrC t ai w e b000cow-ocza who cttploy pc.-aaa to do r. mss oa a roar wvri oa a d..elL^z of nrat more tbno t. 0 tit in t. ieh the bozo oowoc-raids or oa tbe ground;z9 = r,',o arc oa cc -id.--0.1 to be eitploy=uoC—the x r Act(GUI 52 1(5)).o.pplir,,ion by a botns000.acr fc c ti==er pomit zs_y c-vidm«the 1c o J moosc of an apioyx tuoder ciao Wocicda C.omp.oaa.tioa Act I uadcszaad tba a copy of thi.CLCmca may be for"nrded to the Dcputmcce oflo.daYiial Acad a&OfSoo of Irru-.00e for tb. cove-ao^c vair=ioa aad the Eilta-c to secure`coverase t,nA ts,aion 25A of MQL 15/coo led to the imposition of c-ia iaal prn,It;c oocc.Lni:xii of a fine of up to S 1,SOO.00 aradfor iax pz4 oczoor!of up to*cc yr_r end coil pmaltio io tSc form or.Stop Worl Ord=.Lad t ft�of 5100.00 a day agyan ow. For door^1.1 u.c oat _[-- Permit Num1x ` - L. . . .. (Via IA)t: I � I1turc of Lica.r-s ./Pcrm itt,— C-ce I l ! 3 ¢(t1AMp2 �0 ,1$ (xt of Northampton ^ =*_�• $ : ti" t Ai a55KCl7U5ttt3 -_11_^ ��" � DEPARTMENT OF BUILDIJ�G INSPECTIONS — /. INSPECTOR 212 Main Street • Municipal Building -d Northampton,MA 01060 e HOME OWNER EXEMPTION ACKNOWLEDGEMENT The State of Massachusetts allows the homeowner the right under 780CMR 108.3.4 to act as his/her construction sups:.- czar. The state defines "Homeowner" as, "Person(s) who owns a parcel on which he/she resides or intends to be, a one or two family dwelling, attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a home owner." The building department fa the City of Northampton wants-any persons)-who-seek-to use the,home owner exemption, to act as their own construction supervisor, to be aware that by doing so you become responsible for compliance with state building codes and fegulations. The inspection process requires that the building department be called to inspect work at various stages, which include foundation/footings(before backfill), sonotube holes(before pour), a rough building inspection (before work is concealed). insulation inspection(if required) and a final building inspection.;The building department requires these inspections before the work is concealed, failure to secure these inspections can result in failure to obtain a certificate of occupancy until the work can be inspected. If the homeowner hires other trades to perform work(electrical, plumbing& gas) the homeowner will be responsible to make sure that the trades hired secure their proper permits in conjunction to the building permit issued, and that they get their required inspections. Failure of the individual trades to secure the permits and inspections as required can DELAY the project until such time as the proper permits and inspections are made I, understand the above. (Home owner/resident's signature requesting exemption) I will call to schedule all required building inspections necessary for the building permit issued to me Date Address of work location r HOME IMPROVEMENT CONTRACT Sold,Furnished and Installed by: . Branch Name: y���'v 4) Date: l ` !/`,f THD At-Home Services,Inc. d/b/a The Home Depot At-Home Services 345A Greenwood Street,Worcester,MA 0I607 Branch Number: g Job#: Z2(19°1 C Toll Free(800)657-5182; Fax:508-756-2859 Federal ID#75-2698460 ME Lie if C 02439 RI Cont.Lit#16427 CT Lic#565522: MA Home Improvement Contractor Reg.5126593 • o PC. \P--(4- Z._ z Installation Address: No eR .,C4 City State Zip Putrhnscr(s): Last 4 Digits of Driver's Lin#1&Exp.;Moryr: Work Phone: Home Phone: ( ) ( ) I Home Address: (If different from Installation Address) City State Zip E-mail Address(to receive updates and promotions from The Home Depot): Project Information: I/We/You("Purchaser"),the owners of the property located at the above installation address,offer to contract with Home Depot U.S.A.,Inc.("Home Depot")to furnish,deliver and arrange for the installation of all materials as described on the attached Spec Sheet#: L.i Z`I6"3' ,incorporated herein by reference and made a part hereof. Home Depot reserves the right to cancel this contract if,upon re-inspection of the job,Home Depot determines that it cannot perform its obligations due to a structural problem with the home,pricing errors or because work required to complete the job was not included in the Spec Sheet or Contract. DEPOSIT PAYMENT OPTIONS (Subject to fund verification and/or credit approval.) --r L 1. Cfieek,Cashiers Check or CS Postal Service Money Omer CONTRACT AMOUNT S y epavallo to The Huron Dcot). 2--_E S 2. Credit Carle and/or other payment options-C:role One Below *LESS DEPOSIT S Visa MasterCard Discover American Express BALANCE DUE The Home Improve:neut Loan The Home Depot Credit Card ON COMPLETION S. t'(5 0 J New Account C Existing Account (HIL&HDCC ONLY) 'Minimum 25%of Contract Amount due upon execution Available C'rn,lit:5 (HIL&HDCC ONLY) of this contract. Accts: Exp.Date; Indicate Payment Method.For Name as a appears on card: BALANCE DUE ON COMPLETION; "By my/our signature below,i/W'c agree to allow Home Depot to charge the above referenced credit card for the deposit indicated. Cardholder'%Signature Date HIL or ADCC Authorization Codes Deposit Final Payment # Purchaser agrees that,immediately upon satisfactory completion of the work,Purchaser will execute a Completion Certificate and pay any balance due. Purchaser also agrees to be jointly and severally obligated and liable hereunder. Entire Agreement:This agreement and its attachments,including any financing agreement,contain the complete agreement between the parties and can not be amended or modified unless in writing in a separate agreement signed by both parties. ,. . ,. .,.. • • NOTICE TO PURCHASER Do not sign this cone-act before you read it You are entitled to a completely tilled-in copy of the contract at the time you gign. Keep. it to protect your rights. Do not sign a Completion Certificate before this project is complete. Law prohibits home repair contractors from requesting or accepting a Completion Certificate signed by the owner prior to the actual completion of rite work to be performed under the contract. You may cancel this transaction at any time prior to midnight of the third business day after the date of this contract. See Notice of Cancellation for an explanation of this right. There will be a service charge equal to 25%of the contract amount if the job is cancelled by Purchaser AFTER the third business day. BY MY/OUR SIGNATURE BELOW,IMF,AGREE TO BE BOUND BY THE TERMS OF TillS CONTRACT. I/Wit ACKNOWLEDGE. RECEIPT OF A COPY OF'fi-us CONTRACT AND TWO COMPLETED COPIES OF THE NOTICE OF CANCELLATION. BY MY/OUR SIGNATURE BELOW, I/WE UNDERSTAND THAT THE AGREEMENT IS SUBJECT TO REV 11.:W OF MY/OUR CREDIT HISTORY AND I/WF.AUTHOR,iiF..HOITr'.DEPOT TO VERIFY AND REVIEW MY/OUR CREDIT RECORD WITH AN INDEPENDENT CREDIT RE•PORTiNCi•AGENCY AND RELEASE THEM FROM ALL LIABILITY INCURRED FROM INAI)VERTF.NT OMISSIlON/SSS `RClRS. DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES. SUBMITTED BY: t��` • 1 � k `- Date:_G ( • 1.„=.-1 Sales Con"Rant ACCEPTED BY: 1A u.4'Y�--f�... Date: 7 r) I. Homiovvner - __ Date: Ilomeowner - - :"OI1CR:ADDITIONAL TRRMS,CONDITIONS AND WAN KAL'TIES ART.STATED ON T iti kEVERSP.SIDE.'Cv:)ARE t OcI'OF THIS CuN're sm W nit^-r:aueh!'ilr 1Vlow Ca;toire' it-Snlex CCnavlleni 12-5-QS (:-.SC bd NHS17:80 900E ZE 'sad OSSE—ST£—EIt' : 'ON XHd MPbO 1-1IE : l4Obd . Feb 28 06 11 :.02a• Michael Bedard 1-401-246-2868 p. 1 MARSH CERTIFICATE OF INSURANCE ATLCERTIFICATE NUMBER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS PRODUCER NO RIGHTS UPON THE CERTIFICATE HOLDER OTHER THAN THOSE PROVIDED IN THE ATTN. USA.AIB MARSH POLICY.TiliS CERTIFICATE DOES NOT AMEND,EXTEND OR ALTER THE COVERAGE ATTh:BRENDA BOOKER (404)095-2594 MAYA MCCLURE(404)995-3206 OR AFFORDED SY THE POLICIES DESCRIBED HEREIN. TAMI ROUSE(404)995-3430 FAX(404)760-5663 COMPANIES AFFORDING COVERAGE__ _.- _ _ __ 3475 PIEDMGNTROAD,SUITE 1200 _— ATLANTA,GA 30305 CCMPAIY 1100492-IPUS A-GWA-03/04 A STEADFAST INSURANCE COMPANY -- - —----- — —.--j— _ '— _ — -1 INSURED COMPANY I THD AT-HOME SERVICES INC. 8_ ZURICH AMERICAN INSURANCE COMPANY DBA THE HOME DEPOT AT-HOME SERVICES,INC. COMPANY DEPOT USA.INC. 2455 PACES FERRY ROAD NW C NEW HAMPSHIRE INS COMPANY _ ATLANTA,GA 30339 — BUILDING C-8 COMPANY ATLANTA, D AMERICAN HOME ASSURANCE COMPANY , COVERAGES This certificate supersedes and replaces any previously issued certificate for the policy period noted below. 3 THIS IS TO CERTIFY THAT POLICIES OF INSURANCE DESCRIBED HEREIN HAVE BEEN ISSUED TO THE INSURED NAMED HEREIN FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT.TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THE CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,CONDITIONS AND EXCLUSIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS CD TYPE OFINSU INSURANCE �'POLICY NUMBER POLICY EFFECTIVE 1 POLICY EXPIRATION LIMITS LTA l ` DATE(MMIDDIYY) DATE(MMIDDIYY) A GENERAL LIABILITY IPR 3757 608-01 ,03101106 103/01/07 ,GENERAL AGGREGATE $ 4,000.000 LX 1 COMMERCIAL GENERAL LIABILITY 'LIMITS OF POLICY ARE EXCESS' PRODUCTS-COMP/OR AGG I$__ 4,000,000 — CLAIMS MADE LX J OCCUR 'OF SIR:$1,000,000 PER OCC' PERSONAL&ADV INJURY T$ _ 4,000,000 ^__ OWNER'S&CONTRACTOR'S PROT - EACH OCCURRENCE — $ _ 4.000,000 —_—__ rF-IF!F_DAMAGE/Any one tire) $ _ 1,000,000 JED EXP(Any one person) $ EXCLUDED AUTOMOBILE LIABILITY 2938863-03 AOS 03/01/06 03/01/07 B BAP 93 COMBINED SINGLE LIMIT $ 1,000,000 FX— 1 ANY AUTO ALL OWNED AUTOS •BODILY INJURY T$ SCHEDULED AUTOS (Per person) _ — — _ — _I HIRED AUTOS BODILY INJURY $ 1 NON-OWNED AUTOS (Per accident) — — _ — X SELF-INSURED AUTO PROPERTY DAMAGE $ �'HYSICAL DAMAGE ^' fL 1 '� GARAGE LIABILITY 1 I AUTO ONLY- _ EA ACCIDENT $ _ ANY AUTO I OTHER THAN AUTO ONLY; _-- _ L_ _ -_ __. I. EACH ACCIDENT $ -- . I..� _...—. _— I I AGGREGATE $ EXCESS LIABILITY EACH OCCURRENCE $ .— .— _ UMBRELLA FORM AGGREGATE I$ _ OTHER THAN UMBRELLA FORM LAIC STATU- 1 OT 'G WORKERS COMPENSATION AND .. 0••: • K MD,VA) •03/01/06 03/01/07 X I TORY LIMITS T . _ EMPLOYERS'LIABILITY C ..10995(AOS) 03/01/06 03/01/07 EL EACH ACCIDENT _ rS _ 1,000,000 G THE PROPRIETOR/ 1 X I INCA. .6611326(0- 03/01/06 03/01/07 EL DISEASE-POLICY LIMIT I$ 1,000,000 PARTNERS(EXECUTIVE E OFFICERS ARE: I EXCL 6610999 NY,WI) 03/01/06 03/01/07 EL DISEASE-EACH EMPLOYEE $ 1.000,000 • OTHER WORKERS I E COMPENSATION CONTINUED 6610997(FL) 03/01/06 03/01/07 l D I 16610996(CA) 03/01/06 103/01/07 DESCRIPTION OF OPERATIONSILOCATIONSNEHICLESISPECIAL ITEMS CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE POLICIES DESCRIBED HEREIN BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE INSURER AFFORDING COVERAGE WILL ENDEAVOR TO MAY,.—3Q DAYS WRITTEN NOTICE TO THE FOR INSURANCE PURPOSES ONLY CERTIFICATE HOLDER NAMED HEREIN,BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY CF ANY XIND UPON THE INSURER AFFORDING COVERAGE,ITS AGENTS OR REPRESENTATIVES,OR THE ISSUER OF THIS CERTIRCATE. MARSH USA INC. BY: Walter Gilstrap `tA 4 MM1(3/02) VALID AS OF: 02/27/06