38B-002 (14) VE BP-2006-0973
GIS# COMMONWEALTH OF MASSACHUSETTS
I � CITY OF NORTHAMPTON
Lot: -001
Permit: Buildinq
Category: Sidine BUILDING PERMIT
Permit# BP-2006-0973
Project# JS-2006-1451
Est. Cost:
Fee: $25.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: HOME DEPOT AT HOME SERVICES
Lot Size(sq. ft.): 106722.00 Owner: Robert Haberstaat
Zoning:URB Applicant: HOME DEPOT AT HOME SERVICES
AT. 22-24 PAQUETTE AVE
Applicant Address: Phone: Insurance:
345 GREENWOOD ST UNIT 1 (508) 41-9401
WORCESTERMA01607 ISSUED ON.
TO PERFORM THE FOLLOWING WORK.InstaII Vinyl 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:
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 $25.0011797
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo
File#BP-2006-0973
APPLICANT/CONTACT PERSON HOME DEPOT AT HOME SERVICES
ADDRESS/PHONE 345 GREENWOOD ST UNIT I WORCESTER (508)341-9401
PROPERTY LOCATION 22-24 PAQUETTE AVE
MAP 38B PARCEL 002 001 ZONE URB
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled I out 7- S'Co
,,.-Fee Paid
Typeof Construction: Install Vinyl Siding
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/Statement or License
3 sets of Plans/Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFORMATION PRESENTED:
'Approved Additional permits required(see below)
PLANNING BOARD PERMIT REQUIRED UNDER:§
Intermediate Project: Site Plan AND/OR Special Permit With Site Plan
Major Project: Site Plan AND/OR Special Permit With Site Plan
ZONING BOARD PERMIT REQUIRED UNDER: §
Finding_ Special Permit Variance*
Received&Recorded at Registry of Deeds Proof Enclosed
Other Permits Required:
Curb Cut from DPW Water Availability Sewer Availability
Septic Approval Board of Health Well Water Potability Board of Health
Permit from Conservation Commission Permit from CB Architecture Committee
—Permit from Elm Street Commission
0
J I 10�
Signature of BuildQVOfficial Date
Note: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 Health,Conservation Commission,Department
of public works and other applicable permit granting authorities.
*Variances are granted only to those applicants who meet the strict standards of MGL 40A. Contact Office of
Planning&Development for more information.
Departiraent ttse only'
City of Northampton
Building Department
212 Main Street
Room 100
Northampton; MA 01060 F`
phone 413-587-1240 Fax 413-587-1272r ,
APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION
1.1 Property Address: Thts section to be completed by oft%ce
4 EIdit3I$trlCt .',K oCB�IStFICt _
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner f Record:
it
Name(Print) Current Mailing Address:
Telephone
Signature LqI'
2.2 Authorized ent:
Name(Prin Current Mailing Address:
Signatur �b— I ! ` —
Telephone
SECTIONESTIMATED'CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by permit applicant
1. Building (a)Building Permit Fee
2. Electrical ,(b)Estimated Total Cost of
Construction from 6
3. Plumbing Building;Permit Fee
4. Mechanical(HVAC) � ��eo
5. Fire Protection
6. Total=(1 +2+3+4+5) _ Check Number 17 > CI
This Section For ficial'Use Only
Building Permit Number' aate.
Jsksued:
Signature:
Building Commissioner/Inspector of"Bindings Date
Section 4. ZONING All Information 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
Frontage l
Setbacks Front
Side L:I ; R:! L: R:= i
Rear
Building Height
Bldg.Square Footage
Open Space Footage % r-—
(Lot area minus bldg&paved
arkin
#of Parking Spaces
Fill:
(volume,&Location)
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
N0 0 DONT KNOW 0 YES 0
IF YES, date issued::
IF YES: Was the permit recorded at the Registry of Deeds?
NO 0 DONT KNOW 0 YES
IF YES: enter Book j Page; and/or Document#
B. Does the site contain a brook, body of water or wetlands? NO DONT KNOW YES
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtainedObtained Date Issued:
C. Do any signs exist on the property? YES 0 NO 0
IF YES, describe size, type and location:
a
D. Are there any proposed changes to or additions of signs intended for the property? YES e"N NO N
IF YES, describe size, type and location: _ }
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 - NO 0
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
SECTION 5-DESCRIPTION OF PROPOSED'WORK(check all apolicable)
New House ❑ Addition ❑; Replacement Windows Alteration(s) ❑ Roofing ❑
Or Doors D
Accessory Bldg. ❑ Demolition ❑ New Signs [O] Decks [p Siding Other[ol
Brief Description of Proposed""
Work:
Alteration of existing bedroom Yes o Adding new b edremYes No .
Attached Narrative Renovating unfinished basement Yes No
Plans Attached Roll -Sheet
saa=�f T�evu{�ouse�.aric�>r�ad �n::ta.Daus#Ana.�a�sincicorrxn�et�Pf���fiIowlrrg:
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 EN
OWNERS AGENT OR CONTRACTOR APPLIES fOR BUILDING:PRMIT
as Owner of the subject
property
hereby authorize
to act on my behalf,in all matters relative to work authorized by this building permit applicatio r
6
Signature of Owner Date
I, 1 ,as Owner/Authorized
Agent hereby decl re that the s ate ent and information on the foregoing application are true and accurate,to the best of my knowledge
and belief.
Signed der the pains n2ena ties of perjury.
Print a
Sign at re of wn Age Date
SECTION 8-CONSTRUCTION SERVICES r
8.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Halder
License Number
Address Expiration Date
Signature Telephone
Re'"isEere '{`time.m caerienoiarcto14Not Applicable ❑
c
If
.. 0y-�
Camgany Name Regisfi`aflon�r/k --'-"- �--
K--
Add r s Expiration Date ^�
Telephone
SECTION 10-WORKERS'COMPENSATION INSURANCE AFFl[AVIT`(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 buildin ermit.
Signed Affidavit Attached Yes....... No...... ❑
The current exemption for"homeowners"was extended to include Owner-occupied Dwellinlls 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 1.08.3.5.1.
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-vear 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 buildine 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
Einployees for injuries not-resulting-iwDeath)of the Massachusetts General Laws Annotated,you may be liable for persons)
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
'i
C! iffcrl� �li? fotl -
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w DEFARi MElJ? OF BUILDD\10 INSPECTION'S
212 j Afain Street ' Nfunicipal Building •e
j NorLhampton. A1ass. 01060
1
{ WORK— i'S CONCENSAnO.N "GNSLTR.ANCI- Al I"LT)r ti I'J'
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�>nLh a principal plat-- of businesslre idence at: -
1 � 1 (pllonc-') L401 .T35-DQE
,1 (str�.t/a ry/sta.itlzip)
do hereby cerzif% under Ll)e.p?-i.ns azd penalties of penury, haI
I -
j I a�,n an ernplo}ger providing die folloWin worl:crs cornocasaaon cove Lac for my
i tmployc;es %vorlang on this job:
k7to
{ ) I am a sole proprietor, ngeaeral coma-actor or homeow-Ier (c c:e one) aid have hired
t_he coauaCors lisa..d below wbo have the folloivinp, worker's comoersa;ion po►;cies:
I (N am� Of Contncior) (lri ur-3nt-. Compa,'iyt�obci }`�ttSSIlYt:) (t '--oiiduon II-11c) .
(Nanic of Concraaor) Rnsnraac-- CozupanrrPolicr Numinr) (.,mira-6on Dace)
(Name of Coturaetdr) (Imsuram� Compare}1PoE;c} Number) {Sipir [ioa Dalc)
(N�amc of Conaacior) Rlisuran= Comcasry/PoLicy Numb:.r) (Expilm6oa Datc).
<ncs%s:�i:ccxl�.itacc�-s�_^r ca ir>dvc5;;afornLioo .ids to..I.1 or,�-_co:�)
� ) I am_a -sale pr-oprietor and have no one working for me.
( } I am,a home o-,vDcr performirig all Lhe word myself.
NOTI:ploy:be"-ut th,•utzjc hcm= •=--a�ao CMPIvy pc-nO=to d'�c+ •^^,c�sada rc;�u-OM a d••cl of
not—ter ` _tetra-i-t icb Ube bamcowr�c rfvsdo�ar cc tb,P-Mm. s zppatica:.w the-o zr vac C=C--ity�-cS ai to t c
QjplQy"`7 Lh-NVJi-===pc=Lc-n All GU4Sly 1!5111 �.,I
L \ l�'•t�il13:JOII V J a bomco4^t>c fc c GC�IX r='IOfi t✓7 cvKt�CC IrC
icp�I e_..,,of ati¢7toyar wader tiro Wor?:tilc a1-+ar her_ '
. I uadc�a•ad tb,d x Dopy of tby mtcxacca m.y be foc�.ard.d to too 73cQutrama of Ia�.cssict ncadcori'offiw oi-1,�rr+.000 for t�
oovcs.Ee vt"'iFc4ioa:�thct L-.iltat us smut taverr,�ttadrx soi�ion 2SA of I.SGIL 152 exn Ic:d to the t�rsstiaoa of cizaias!pcasttics
most axg of a fort orup ta S 1304.OQ azor of up to Doc),=Lod ci,il p¢nt'uo in tSc form of.Slop Ws tkd dad=
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D£PASTMENT of BumDDdG INSPECTioNS /
INSPECTOR 212 Main Street i Municipal Building 'o
Northampton, MA 01060
HOME OWNER EXEMPTION ACKNOWLEDGEMENT
The State of Massachusetts allows the homeowner the right under 780CMR 108.3.4 to
act as i.isllter construction sup�u .> ar. The state defines "Homeowner" as, "P erson(s)
who owns a parcel on which he/she resides or intends to be, a one ar"fwo gnu y ____-
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 B—u—il ing department for the City of Northampton wants any person(s)-who-seek-tai
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/footinErs (before backfill),
sonotube holes (before pour). a rough buildinLy'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 occupancv
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 pertttii
issued-to rue
Date
Address of work
location
r
i
0.3713-2006 13:33 FROM-THD AT HOME SERVICES +j508 756 8823 T-756 P.007/007 F-189
• Sold,Furnished and Installed by:
Branch Name: `� Date: " THD At-Home Services,Inc.
d/b/a The Horne Depot At-Home Services
345A Greenwood Street,Worcester,MA 01607
Branch Number. Job M �-� - Toll Free(800)657-5182; Fax:508-756-2859
, Federal ID#75-2698460 ME Lie#C 02439 RI Cont.Lie#16427
U3 o _ L � rp�- �—,LC.—GT Lie#565522; MA Home Lnprovement Contracror Rcg.A126893
Installation Addresin t o AJQ— k cA m i ti� MA
City 5ta a Zip
Purchase e a Last 4 DI is of Driver's Lie.#&Lip.Mo/Yr: Work Phone: Home Phone:
oaj2�f 14P,sZ2STar+4 aq 1 -7 4 ( () 531-&Z:67 ( ~30
( ) ( )
Home Address:
(If different from installation Address) City State Zip
E-mail Address(to receive updates and promotions from The Home Depot):
Pro•e t information: I/We/You("Purchaser"),the owners of the property located at the above insrallation address,otter ro
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#: n la4 D ,incorporated herein by reference and mads 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 structunAl 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
(Subjmt to food verification and/or criKhl appfoval.)
CONTRACT AMOUNT S I �� 1• (;heck,CashiersChockorUSPaatatServiceMoneyOttley
(Made ixtyable to The Rome Depot).
"LESS DEPOSIT $ 6 t� 2. Cm1ir Card-and/or other gryrneia options-Circle One Below
Visa MasterCard Discover American Express
BALANCE DUE (� The Horne Improvamant Loan The Home Depot Credit Card
ON COMPLETION S 119U_
❑ New Acvvuat ❑Existing Account (HIL&HDCC ONLY)
'Minimuin 251/o of Contract Amount due uptin execution Available Create: OCO (HIL&HDCC ONLY)
f this contract. g-7
Acag; 77 Exp.Datcc!--!
Indicate Payment Method For N.1ine as it appears on card; Q wd flAiwk c/t Aq-4
BALANCE.DUE ON COMPLETION: •By mw/our sigoanife balow,I/Wc agree to allow Home Depot to charge the above
taferenecd credit card for the deposit indicated.
X 03 5 3 a° 0073 53-? � ate
atdholder's Signatu )ate
re D
HIL or HDCC Authorization Colles
{a Ma,, K NO Deposit Final Pa ment
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.
EOA reement: This agreement and its attachments,including any financing agreement,contain the complete agreement
n the parties and cannot be amended or modified unless in writing to a separate agreement signed by both parties.
NOTICE TO PURCHASER
Do not sign this contract before you read it. You are entitled to a completely Cdled-in copy of the contract at the time you siga. Keep
it to protect your rights. Do not sign n Completion Certificate before this project is complete. Law prohibits home repute
contractors from requesting or accepting a Completion Certificate signed by the owner prior to the actual completion of the work to
be performed under the contract.
You may cancel this transaction at any time prior to inidnip t of the third(business day atter the date of this contract. See Notice of
Cancellation for an explanation at'this right There will r 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,l/WL-'AGREE TO DE BOUND BY TIIE TERMS OF TIIIS CONTRACT. I/WE ACKNOWLEDGE
RECEIPT OF A COPY OF THIS CONTRACT AND TWO COMPLETED COPIES OF'fHE NOTICE OF CANCELLATION,
BY MY/OUR SIGNATURE BELOW, UWE UNDERSTAND THAT THE AGREEMENT IS SUBJECT TO REVIEW OF MY/OUR
CREDIT HISTORY AND I/WE AUTHORIZE HOME DEPOT TO VERIFY AND REVIEW MYIOUR CREDIT RECORD WITI-I AN
INDEPENDPNT CRF..Drr REPORTING; AGENCY AND RELEASE THEM FROM ALL LIABILITY INCURRED FROM
INADVERTENT OMISSIONS O ERRORS. DO NOT SIGN THIS CONTRACT 1 F THEREpAA�RE ANY BLANK SPACES.
SUBMITTED BY: VV kZb 'f Date;_ V
S fes Consultant
ACCEPTED BY: Dater
Homeowner
Date:
Homeowner
NOTICE!ADDITIONAL TERMS,CONDITIONS AND W ARRANTIES ARrt STATED ON TITS RI=VERSE SIDE AND ARE PART OT THIS CONTP-Ac-r
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ENERGY PERFORMANCE RATINGS
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HOME IMPROVEMENT CONTRACT01. y i
Reglstration,, 126893
Expiration# 3/3/2006
Tvpe: Supplement Card j
THE Home Depot At-Homeuervic
RICHARD FALLCNE
r+.L i Aiv l A,GA 30x39 Administrator —�
Feb 28 06 11 :02a Michael Bedard 1-401-246-2868 P. 1
MARSH CERTIFICATE OF INSURANCE CERTIFICATE NUMBER
ATL-000915907-11
PRODUCER THIS CERTIFICATE 15 ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS
MARSH USA.INC. NO RIGHTS UPON THE CERTIFICATE HOLDER OTHER THAN THOSE PROVIDED IN THE
ATTN:BRENDA BOOKER {404}995-2594 POLICY.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR ALTER THE COVERAGE
MAYA MCCLURE(404)995-3206 OR AFFORDED BY THE POLICIES DESCRIBED HEREIN.
TAMI ROUSE(404)995-3430 FAX(404)760-5663 COMPANIES AFFORDING COVERAGE
3475 PIEDMONT ROAD,SUITE 1200
ATLANTA,GA 30305 COMPANY
100492-IPUSA-GWA-03iO4 A STEADFAST INSURANCE COMPANY
INSURED COMPANY
THD AT-HOME SERVICES INC. BURICH AMERICAN INSURANCE COMPANY
DBA THE HOME DEPOT AT-HOME SERVICES,INC.
HOME DEPOT USA.INC, ��CIIPA Y Z
2456 PACES FERRY ROAD NW C NEW HAMPSHIRE INS COMPANY
BUILDING C-8
ATLANTA,GA 30339 COMPANY
0 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 RESPECTIO 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
pp i POLICY EFFECTIVE LIMITS
TYPEOFtNSURANCE POLICY NUMBER POLICY EXPIRATION
LTR DATIJMWDDIYY) OATEjMMIDDJYY)
107
A GENERAL LIABILITY IPR 3757 608-01 GENERAL AGGREGATE 4,000,000
COMMERCIAL GENERAL G
X LIABILITY LIMITS OF POLICY ARE EXCESS'l PRODUCTS-COMP10-AG �,000
_li_
TS
I CLAIMS MADE EX:_j OCCUR 'OF SIR:$1,000,00( _PERSONAL 8 ADV INJURY 4,000.000
gwNER'S&CONTRACTOR'S PROT EACH OCCURRENCE $ 4.000.000
1,000.000
FEOEXP
(Any oneperson) EXCLUDED
B AUTOMOBILE LIABILITY BAP 2938863-03 AOS 103/01105- '03/01/07 -COMaWEDISINGLEANIT $ 1,000,000
X ANY AUTO I I —_
li ALL OWNED AUTOS BODILY INJURY
SCHEIYULEO AUTOS
(Per parson)
HIRED AUTOS DI
(per accident)I'D 'Y'N'URY $
NON-OWNEDAUTOS
X SELF-INSURED AUTO4 PROPERTY DAMAGE
HYSICAL DAMAGE
GARAGE LIABILITY �AUTO ONLY-EA ACCIDENT $
ANY AUTO OTHER
THAN AUTO
1.___ gLAqHACCj2ENTj$
AGGREGATE $
EXCESS LIABILITY EACH OCCURRENCE
-�UMBRELLA FORM AGGREGATE 4!
OTHER THAN UMBRELLA FORM $
G WORKERS COMPENSATION AND �6610998(AZ,ID,MD,VA) WC STATU- 1 107
EMPLOYERS`LIABI 113101/06 03101107 X I TORY DRY LIM-ITS I - ER,
6610995(AOS) 03/01106 03/01107 EL EACH ACCIDENT 1 000,000
G THE PROPRIETOR/ X JINCL 6611326(OR) 0.13/01/06 103/01107 EL DISEASE-P01 ICY I[MIT js
PARTNERSIEXECUTIVE
E OFFICERS ARE: EXCL 16610999(NYWI) 103/01106 103/01107
ELDISEASE-EACH EMPLOYEE I$ 1.000,000
COMPENSATION CONTINUED
E COMPENSATION CONTINUED 6610997(Ft.) 103101106 1 1031 03101107
03/01106 1
D 16610996(CA) 01/07
DESCRIPTION OF OPERATIONSILOCATIONSIVEHICLESISPECIAL 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 fAkr _3(1 GAYS WRITTEly NO-ROE 70 THE
FOR INSURANCE PURPOSES ONLY CERTIFICATE HOLDER N"TED HEREIN,BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO DBUGA71014 OR
LIABILITY OF ANY KIND UPON THE INSURER AFFORDING COVERAGE,ITS AGENTS OR REPRESENTATIVES,OR THE
ISSUER OF THIS CERTIFICATE.
MARSH USA INC.
By., Walter GlIstrap -hIAIX
MMI(3102) VALID AS OF. 02/27106