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31A-285
3 JAMES AVE BP-2016-1110 GIS #: COMMONWEALTH OF MASSACHUSETTS Map:Block: 31A-285 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: renovation BUILDING PERMIT Permit# BP-2016-1110 Project# JS-2016-001894 Est. Cost: $94520.00 Fee: $647.00 PERMISSION IS HEREBY GRANTED TO: Const. Cass: Contractor: License: Use Group: THOMAS DADMUN 107919 Lot Size sq. 1): 8929.80 Owner: ROSENBURG HENRY&KATHERINE HICKS Zoning: URB(100) Applicant: THOMAS DADMUN AT. 3 JAMES AVE Applicant Address: Phone: Insurance: 60 SCHOOL ST (413) 387-7381 HATFIELDMA01038 ISSUED ON:3/22/2016 0:00:00 TO PERFORM THE FOLLOWING WORK.REMODEL KITCHEN MUDROOM & REPLACE FLOORING 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 3/22/2016 0:00:00 $647.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner File#BP-2016-1110 APPLICANT/CONTACT PERSON THOMAS DADMUN ADDRESS/PHONE 60 SCHOOL ST HATFIELD01038(413)387-7381 PROPERTY LOCATION 3 JAMES AVE MAP 31A PARCEL 285 001 ZONE URB(100)/ THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT 0 04C oe 00 Fee Paid Buildin Pg ermit Filled out Fee Paid Typeof Construction: REMODEL KITCHEN MUDROOM&REPLACE FLOORING New Construction Non Structural interior renovations Addition to Existiniz Accessory Structure Building Plans Included: Owner/Statement or License 107919 3 sets of Plans/Plot Plan THE FOLL NG ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFO TION PRESENTED: 6olApproved 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 _Permit DPW Storm Water Management liti 3 Si of&1ding Official 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. C y of Northampton Bu ding Department �oNs 2 2 Main Street CpO�PMON MpO��'c Room 100 oNo Northampton, MA 01060 phone 413-587-1240 Fax 413-587-1272 APPLICATION TO CONSTRUCT,ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION 1.1 Property Address: Tom: c.J ► I. t Unit `�oIZPio�� � o(o�c7XI cd;, t4 13i etgt s, Gni SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: Name(print) p � Current Mailing Address: Telephone Signature 3 � " 7`�gg V 2.2 Authorized Agent: Name(Pr n) (� Current Mailing Address: Signature Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building ov (a)Building Permit Fee I ' 2. Electrical f p 0-0 (b)Estimated Total Cost of " 1 0�' Construction from 6 3. Plumbing / p0 . i9 Building Permit Fee 1 �0 4. Mechanical (HVAC) 500 =b 5. Fire Protection 6. Total= (1 +2+3+4+5) 15Z0. ' Check Number This Section For Official Use Only Building Permit Number: pate Issued: Signature: Building Commissioner/Inspector of Buildings 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 ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,...,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,............................. £,,._,w,,,..,,,,,,............,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,..,,,,.,,,,,,........ .,,,,,,,,,,,,,,,,,,,_,,,_..._,,,,..........,,,,,,.....d........ s € s LotSize 1,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,�,,,,,�.�_,_,_,,,,,,,_,,,__.................... ,,,,,,,,,,,,..............,,,,,,,.,,�w-....,,,,,,,,,,,,......,,,,,,,,,,,,,,,,,,,,,,, 1,,¢,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,..................,,___.... i Frontage ........_............................w.w.._,............_.................,...... L........._,,,,.......................,.._wwm, a ......,..,,,,,,,,,,,,,,,,.................... i Setbacks Front �.,,,,,_.__,_,_,,,,,,. �......................., Side L:lee_,_.w, R:= L:iµ.------ , 1 Rear Building Height Bldg. Square Footage __,._i z % E.�.�..., ,.� Open Space Footage % (Lot area minus bldg&paved parking) #of Parking Spaces 1.........................1 w,w Fill: (volume&Location) A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO ® DONT KNOW ® YES IF YES, date issued:; IF YES: Was the permit recorded at the Registry of Deeds? NO ® DONT KNOW ® YES IF YES: enter Book Pae and/or Document # B. Does the site contain a brook, body of water or wetlands? NO G DONT KNOW ® YES IF YES, has a permit been or need to be obtained from the Conservation Commission? ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,w„ Needs to be obtained Obtained ® , Date Issued: E C. Do any signs exist on the property? YES NO IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property? YES ® NO _.............. .„m.................................,.... ......... .._,...,,,,,,,,,,,,,,,,,..,..,,,,...,..._,,..m.,..,_....,_.._.w.,..� m,,,,,.n,,,,r..................................... ......... ; 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 ® NO IF YES, then a Northampton Storm Water Management Permit from the DPW is required. SECTION 5-DESCRIPTION OF PROPOSED WORK(check all ap4cable) New House ❑ Addition ❑ Replacement Windows Alterations) Roofing ❑ Or Doors 7 Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [[Z] Siding [0] Other[a Brief Description of Proposed Work: Mw f�-ov y& kyvtoct. " kQwt hooe , Alteration of existing bedroom Yes_2 No Adding new bedroom Yes X No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll -Sheet i r c; /; 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 COMPLETEDHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT 1, � [� Cfl as Owner of the subject property hereby authorize �A�Nti df to act on my behalf, in all matters relative to work authorized by this building permit application. 7. Signature of Owner Date I, t 6' M k5 Y n v1ytvlj 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. Signed under the pains and penalties of perjury. _TJ6lhAk2 N1400 Print Name / Signature of Owner/Agent Date SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder: —t&lMA-S Ny m o,) C >- i 0'7 11 7 License Number W savvti sT . 14MUD, MA olu38 Add e s Expiration Date Signature Telephone Not Applicable ❑ -TJ C"IF, CHOP �L6 Company Name Registration Number Address 'I Expiration Date Telephone `t 13-JbHUA 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 building permit. Signed Affidavit Attached Yes....... No...... ❑ Nr 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.$.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 builjding 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 The Commonwealth of Massachusetts Department of Industrial Accidents W Office of Investigations a I Congress Street, Suite 100 t Boston, MA 02114-2017 www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information (� Please Print Legibly Name (Business/Organization/Individual): �>�DIWtU►J y 1 Esj�i l` �souxnuyJ Address: �0 s(;ML sr, City/State/Zip: �*H" MAr Q[0 w p Phone #: 413- 383-7361 Are you an employer? Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. X] I am a general contractor and I employees (full and/or part-time).* have hired the sub-contractors 6. New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. 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. ❑ We are a corporation and its 10.❑ Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions myself No workers' com right of exemption per MGL y [ p� 12.❑ Roof repairs insurance required.] t c. 152, §1(4),and we have no employees. [No workers' 13.0 Other comp. insurance required.] Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners 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: Policy#or Self-ins. Lic. #: Expiration Date: Job Site Address: 7J Ah+ t6 kk . N 0-ILN40 TY0 City/State/Zip: MA O (¢'D 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$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. Ido hereby certify under thepa* and penalties of perjury that the information provided above is(true and correct. Signa re: , a.,,, Date: Phone#: Official use only. Do not write in this area, to be completed by city or town official. City or Town: Permit/License # Issuing Authority(circle one): 1.Board of Health 2. Building Department 3. City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6. Other Contact Person: Phone#: City of Northampton 212 Main Street, Northampton, MA 01060 Solid Waste Disposal Affidavit In accordance of the provisions of MGL c 40, S54, I acknowledge that as a condition of the building permit all debris resulting from the construction activity governed by this Building Permit shall be disposed of in a properly licensed solid waste disposal facility, as defined by MGL c 111 , S 150A. Address of the work: 5 te, AE The debris will be transported by: &W-WAfl& PC6tWau The debris will be received by: Building permit number: Name of Permit Applicant 16-K ft-t, DAV14,0 � (i � ni, Date Signature of Permit Applicant AC40RD® CERTIFICATE 4F LIABILITY INSURANCE DATE(MM/DDNYYY) `"�� F 1/6/2016 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER($), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must 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(s). PRODUCERNAME T Susan Fleury, CIC, CISR King & Cushman Inc. PAH�ONE t: (413)584-5610 FAX Nod(413)564-9322 P.O. Box 447 E-MAILSFleur SFleury@K±ngCushman.com y@Kin Cushman.com 176 King Street INSURER(S)AFFORDING COVERAGE NAIC 9 Northampton MA 01061 INSURERA Main Street America Assurance Co. 29939 INSURED INSURER B: DADMUN DESIGN & CONSTRUCTION INSURER C 60 SCHOOL ST INSURER D INSURER E: HATFIELD MA 01038-9747 INSURER F: COVERAGES CERTIFICATE NUMBER:CL161601268 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. POLICY NUMBER POLICY EFF POLICY EXP INTR TYPE OF INSURANCE L SUER M ! C YELIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A CLAIMS-MADE Fil OCCUR DAMAGE TO RENTED — 500 PREMISES Ea occurrence 0$ 00 MPT4694Q 11/13/2015 11/13/2016 MED EXP(Anyone person) $ 10,000 PERSONAL&ADV INJURY $ 1,000,000 GENL AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 XIPOLICY PRO- JECT LOC PRODUCTS-COMP/OPAGG $ -2,000,000 I OTHER: Identity Recovery $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ £a accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) $ HIRED AUTOS NON-OWNED PROPERTY DAMAGE AUTOS Per accident $ $ UMBRELLA LAB OCCUR EACH OCCURRENCE $ EXCESS LIAB _ CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION I PER OTH- AND EMPLOYERS'LIABILITY Y/N FAT TE ER ANY PROPRIETOR/PARTNERIEXECUTIVE OFFICERlMEMBER EXCLUDED? NIA E.L.EACH ACCIDENT $ (Mandatory in NH) If yes,describe under E.L.DISEASE-EA EMPLOY£ $ DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS 1 LOCATIONS VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached irmore space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Sample THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POL VISI AUTHORIZED REPRESENTATIVE IL fl/ ©1 sa . ed. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD INS025(201401) AC<? CERTIFICATE OF LIABILITY INSURANCEDATE(�2�11Y)_ _ F16 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(ies) must 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(s). PRODUCER CONTACT NAME: Dale Frank Insurance Agency PHONE 413 665-8324 FAX Np; (413) 665-1280 2 Amherst Road ADDRESS: wendy@dalefrankinsurance.com P.O. BOX INSURERS)AFFORDING COVERAGE NAIC# Sunderlandd,, MA 01375 INSURERA:Connecticut Underwriters INSURED '..INSURER B Paul Ayotte '.I NSU RER C 92 Laurel Park INSURER D PO Box 1063 INSURER E: Northampton, MA 01061-0331 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. INSRADDL SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE I R WVD POLICY NUMBER MM/DONMM/DDIYYYY LIMITS A GENERAL LIABILITY NN432953 2/8/16 2/8/17 EACH OCCURRENCE I $ 500,000 X COMMERCIAL GENERAL LIABILITY DAMAGETo RENTED 000 Is 100 PR E CLAIMS-MADE 1:1OCCUR MED EXP(Arty oneoccuperresonc n) $ 5,000 PERSONAL&ADVINJURY $ 500,000 GENERAL AGGREGATE $ 1,000,000 GEN'LAGGREGATELIMITAPPLIESPER PRODUCTS-COMP/OPAGG $ 500,000 POLICY 7, PRO LOC $ AUTOMOBILE LIABILITY EOaBINEEDSINGLELIMIT $ ANYAUTO BODILY INJURY(Per person) $ ALLOWNED SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) $ NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS Per accident UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-N1ADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS'LIABILITY Y/NLIM ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICE RVEMBER EXCLUDED? NIA E.LEACHACODENT $ (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under SCRIPTION n OPERATIOE.L.DISEASE-POLICY LIMIT $ DENSbelow DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is requi red) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Tom Dadmun ACCORDANCE WITH THE POLICY PROVISIONS. 60 School Street Hatfield, MA 01038 AUTHORIZED REPRESENTATIVE Wendy Leahy ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The AC ORD name and logo are registered marks of ACORD Phone: Fax: E-Mail: Client#:41601 CORTI1 ACORDT. CERTIFICATE OF LIABILITY INSURANCE F DATE(MM/DD/YYYY) 1/13/2016 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 pblicy(ies)must be endorsed.If SUBROGATION IS WAIVED,subject-Co- the ubjecttothe 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(s). PRODUCER NAME:CONTACT Mary Hoth People's United Ins.Agency MA PHONE FAX A/C No Ext):413 781-6871 A/C,No): 1391 Main Street,3rd Floor ADDRESS:PO Box 4950 ss: mary.hoth@peoples.com INSURER(S)AFFORDING COVERAGE NAIC# Springfield,MA 01101 INSURER A:Merchants Preferred Ins.Co. INSURED INSURER B: Cortina Tile of West Springfield INSURER C 1645 Riverdale ST W.Springfield, MA 01089 INSURER D: 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 SUBR. POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER MMIDD/YYYY MM/DD/YYYY LIMITS A GENERAL LIABILITY BOPI071849 3/30/2015 03/30/201 DDEACH��OEECCCURRENCE $1,000,000 X COMMERCIAL GENERAL LIABILITY PREMISES a occur°nce $500 000 CLAIMS-MADE � OCCUR MED EXP(Any one person) $5,000 Blanket per prior X PERSONAL&ADV INJURY $ written contract GENERAL AGGREGATE $2,000,000 GEN'LAGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OPAGG $2,000,000 POLICY X JERCOT- LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED ._ AUTOS AUTOS BODILY INJURY(Per accident) $ NON OWNED PROPERTY DAMAGE HIRED AUTOS AUTOS Per accident $ _ A X UMBRELLA LIAB X OCCUR CUP9146566 3/30/2015 03/30/201 EACH OCCURRENCE $1 OOO 000 EXCESS LIAB CLAIMS-MADE AGGREGATE $1,000,000 DED X RETENTION$1 O OOO $ A WORKERS COMPENSATION WCA1033448 3/30/2015 03/30/201 X WC STATU- OTH- AND EMPLOYERS'LIABILITY Y/N ANY PROPRIETOR/PARTNER/EXECUTIVEE.L.EACH ACCIDENT $500 OOO OFFICER/MEMBER EXCLUDED? FN N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $500,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $500,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) Blanket additional insured per Merchants form MU8277(1111); Blanket Additional Insured Completed Operations per Merchants form 8530(1111) Proof of Insurance CERTIFICATE HOLDER CANCELLATION DADMUN Design+Construction SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Attn: Tom Dadmun ACCORDANCE WITH THE POLICY PROVISIONS. 60 School Street Hatfield, MA 01038 AUTHORIZED REPRESENTATIVE ©1988-2010 ACORD CORPORATION.All rights reserved. ACORD 25(2010/05) 1 of 1 The ACORD name and logo are registered marks of ACORD #S658594/M581699 DLJ ACC)R" CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) �hl1/14/2016 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(ies) must 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(s). PRODUCER CONTACT NAME: Barbara Grynkiewicz Webber & Grinnell PHONE (413)586-0111 FAX No, AIC No), (413)586-6481 8 North King Street E-MAIL b r kiewicz@webberand rinnell.com ADDRESS: g g INSURERS AFFORDING COVERAGE NAIC# Northampton MA 01060 INSURERA:Patrons Mutual Ins. Co. of CT INSURED INSURERB:State Auto Property & Casualt Ins. A. Dion & Son Floor Contractors, LLC INSURER C: Attn: Donald & Daren Dion INSURER D: 74 Russell Street INSURER E: Hadley MA 01035 INSURER F: COVERAGES CERTIFICATE NUMBER:Exp 2016 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 SUBR LTR TYPE OF IN WVDPOLICY NUMBER MM/DD�Y POLICY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 2,000,000 A _�CLAIMS-MADE X OCCUR DAMAGE TO RENTED PREMISES Ea occurrence $ 300,000 BOP2806463 7/1/2015 7/1/2016 MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 4,000,000 POLICY DX ECT LOC PRODUCTS-COM P/OPAGG $ 4,000,000 OTHER. $ AUTOMOBILE LIABILITY CO LE.aBINdEED-91NGLE LIMIT eno $ 1,000,000 A ANY AUTO BODILY INJURY(Per person) $ ATOX SCHEDULED BAP2406132 7/1/2015 7/1/2016 BODILYINJURY(Peraccident AUUTOSS AUTOS ) $ X X NON-OWNED PROPERTY DAMAGE HIRED AUTOS AUTOS Per accident $ X 19 PIP-Basic $ 8,000 X UMBRELLA LIAB OCCUR EACH OCCURRENCE $ 2_000,000 A EXCESS LAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ CXS2125771 7/1/2015 7/1/2016 $ WORKERS COMPENSATION _ AND EMPLOYERS'LIABILITY Y/N X STATUTE OERH ANY PROPRIETOR/PARTNER/EXECUTIVEE.L.EACH ACCIDENT $ 1,000,000 � OFFICER/MEMBER EXCLUDED? N/A B (Mandatory in NH) WCP2227689 7/1/2015 7/1/2016 E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1 000 000 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,maybe attached if more space is required) CERTIFICATE HOLDER CANCELLATION tomd@dadmundc.com SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Tom Dadmun THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 60 School Street ACCORDANCE WITH THE POLICY PROVISIONS. Hatfield, MA 01038 AUTHORIZED REPRESENTATIVE M Horan, CISR/BARBG ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD INS025(201401) INGRAMJ001 MMILLS .4�o,RL7 CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDIYYYY) 1//18/2016 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(ies)must 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(s). PRODUCER CONTACT NAME: Melissa L Mills The Jarrett Agency PHONE 657 Enfield Street A/c No. o Ext:(g60)745-4222 FAA/C,No),(860)741-6901 Enfield,CT 06082 EMAIL h nick tg y. ADDRESS: ejarretta enc com INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Main Street America Assurance Company 29939 INSURED INSURER B: Executive Painting and Wall Covering LLC INSURER C: 10 South Road INSURER D: Enfield,CT 06082 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 ADDLSUUR LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER POLICY EFF POLICY EXP MMIDDIYYYY MM/DD/YYYY LIMITS A COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE [X]OCCUR MPT7137P 08/22/2015 08/22/2016 PREMISES Ea occurrence $ 500,000 X BOP MED EXP(Any one person) $ 10,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY❑JPRO- XX E LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) $ HIRED AUTOS NO pgWNED PROPERTY DAMAGE $ Per accident UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE I I ER ANY PROPRIETOR/PARTNER/EXECUTIVE N/A E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? ❑ (Mandatory in If yes,describe under E.L.DISEASE-EA EMPLOYEE $ DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT 1$ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Dadmun DC THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 60 School St ACCORDANCE WITH THE POLICY PROVISIONS. Hatfield,MA 01038 AUTHORIZED REPRESENTATIVE ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD 7 0 DATE(MMIDDYYYY) AC40RV CERTIFICATE OF LIABILITY INSURANCE 1/20/16 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 CONST11 UTE 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 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(s). PRODUCER CONTACT NAME: .___ ........... ...___..... Bresnahan Insurance Agency, In PHONE 4133 536-0536 FAx No; t413H 534-4291 100 Whiting Farms Road EdNAIL ADDRESS: Holyoke, MA 01040 INSURE S AFFORDING COVERAGE _ NAtc INSURER A:Commercle Insurance Co. INSURED I hLSl/RER B: James Elkins INSURERC: _ 2 Williams Street INSU RERD; Holyoke, MA 01040 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICES 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, 1NSR TYPE OF INSURANCE__...._ _ ADOa S RI �� POLICY NUMBER MOLJMlyCY EFF MOUC YY UMTS LTR INS ' GENERAL LIABILITY YM0750 5/5!1511 5/5f16EACHOCCURRENCE $ 1,000,00p__ TO ){� COMMERCIAL GENERAL Lnce)�IABILITY DAMAGEff.a_=ED ur[e $ 100 OOQ CLAIMS-MADE ! 1 OCC UR MED EXP(Anyone parson) $ _55.0-00 PERSONALAL&ADV INJURY $ QQO 000 * — GENERAL AGGREGATE_ ; $ 2.000,000 GEN`LAGGREGATE L€MITAPPLIES PER PRODUCiS•COMP10PAGG $ ,0i}0�(} 0 _... POLICY PRO- , LOC I $ AUTOMOBILE LIABILITY Eaaccidern N L LIM€ $ ANYAUTO BODILY INJURY(Per person) I$ ALLOWED SCHEDULED 3 BODILY INJURY(Per accident)� $ AUTOS AUTOS I--------- PROPERTY DAMAGE HIREDAUTOS AUTOS Per accident) UMBRELLAt" OCCUR ! EACH OCCURRENCE is _ EXCESS UABCLAIMS-MADE ! AGGREGATE � s I DED RETENTION$ $ I WORKER$COMPENSATION WC STATU- OTH- AND EMPLOYERS'LIABILITY YIN .....i.._EL3.___. .. ANY PROPRIETOR/PARTNER/EXECUTIVE �.NiA EL EACHAOCIDENi $ EXC OFFICERIMEMBER LUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYEEl It yyes,describe under _DESCRIPT€ON OF OPERATIONS below E.L.DISEASE-POLICY LIM T $ DESCRIPTION OF OPERATIONS 1 LOCATIONS 7 VEHICLES (Attach ACORD 101,Additional Rerrs rks Schedule,it more space Is requi red) Electrician f� i CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED M Dadmun Design & Construction ACCORDANCE WITH THE POLICY PROVISIONS. 60 School St. Hatfield, MA 01038 AUTHORIZEDWP"NTATIVE 19884010-ACORD CORPORATION, All rights reserved. ACORD 25(2414105) The AC ORD name and logo are registered marks of ACORD Phone: Fax: E-Mail: tomd@ dadmundc.com A�® CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDIYYYY)F 1/20/2016 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(ies) must 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(s). PRODUCER CONTACT NAME: Lynne Methot Extension 102 Foley Insurance Group Inc. H NAIC,N (413)214-7474 ac No:(413)214-7447 37 Elm Street EMAIL lmethot@foie insurance rou corn ADDRESS: y g p INSURER S AFFORDING COVERAGE NAIC# West Springfield MA 01089-2703 INSURERA:Patrons Mutual Insurance Co of CT 20028 INSURED INSURERB:Travelers Indemnit CO of CT 25682 New England Granite LLC INSURER C: ATTN: Andrey Korchevskiy INSURER D: 75 West School Street INSURER E: West Springfield MA 01089 INSURER F: COVERAGES CERTIFICATE NUMBER:CL15102608707 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 I ADDL SUBR LTR TYPE OF INSURANCE POLICY NUMBER MMIDDY� MWDDY� LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED 300,000 A _ .CLAIMS-MADE OCCUR PREMISES Ea occurrence $ BOP2741752 5/23/2015 5/23/2016 MED EXP(Any one person) $ 5,000 _. PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 PRO- ' X ' POLICYEl JECT 'II LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ _ ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY Per accident $ AUTOS AUTOS ( ) NON-OWNED PROPERTY DAMAGE HIRED AUTOS AUTOS Per accident $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED T—TRETENTION$ $ WORKERS COMPENSATION _ AND EMPLOYERS'LIABILITY Y/N X STATUTE EERH ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? � NIA E.L.EACH ACCIDENT $ 100,000 B (Mandatory in NH) IEUB219MB76715 10/22/2015 10/22/2016 E.L.DISEASE-EA EMPLOYEE $ 100,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Proprietor/Partner/Executive Officer/Member exclusion applies on Workers Compensation. CERTIFICATE HOLDER CANCELLATION tomd@dadmundc.com SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THOMAS DADMUN THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 60 SCHOOL STREET ACCORDANCE WITH THE POLICY PROVISIONS. HATFIELD, MA 01038-9747 AUTHORIZED REPRESENTATIVE Brian Foley/JOANN ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD INS025r?m4mt ACOR�� CERTIFICATE OF LIABILITY INSURANCE DATE(MWDDNM) 1/19/2016 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 pollcyVes)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain poCcies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsements). PRODUCER C.00ME� T Barbara Van MAurik Finck & Perras Insurance Agency Inc. PHONE (413)527-5'520 FAX go, NII:(413)527-5970 6 Campus Lane E' esB:bvanmourik@finckandperras.com INSURER(S)AFFORDING COVERAGE NAIL A Easthampton MA 01027 INSURER Travelers 19046 INSURED INSURER B John Piepul INSURERC: 47 Williams Street INSURER 0: INSURER E: Shelburne Falls MA 01370-1017 INSURER F: COVERAGES CERTIFICATE NUMBER:CL1611902026 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 CONDITIONOF 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. INSIR TYPE OF INSURANCE L SUER POLICY EFF POLICY EXP LTR POLICYNUMBER D /D "Y LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURREE $ 1,1?00 ObU A CLAIMS-MADE ❑X OCCUR PAMAGE TO NC PREMISES-9 Ea o $ 300,000 6809BO36329 6/7/2015 6/7/207.6 MED EXP(Any one person) $ 5,000 PERSONAL&AOV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY❑j� LOC PRODUCTS-COMPIOPAGG $ 2,000,000 _ OTHER: POLEE $ AUTOMOBILE LIABILITY C21191N INGL IMIT $ ANYAUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS -BODILY INJURY(Par accident) $ NON-OWNED PROPERTY DAMAGE HIRED AUTOS AUTOS Per :(dent $ $ UMBRELLA LIAROCCUR EACH OCCURRENCE $ EXCESS LIAR HCLAIMS-MADE AGGREGATE $ DED. 1 RETENTION$ $ WORKERS COMPENSATION PER H• AND EMPLOYERS'LIABILITY YIN STATUTE ER ANY PROPRIETORIPARTNEWEXECUTIVE E.L.EACH ACCIDENT OFFICERIMEMBER EXCLUDED? NIA $ (Mandatory in NH) E.L.DISEASE.EA EMPLOYE $ If yes,describe under PERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF O DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space is required) Proof of coverage RE: Behrens/Rolocut Kitchen Remodel, 699 -Park Hill Road, Northampton, MA 01060 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE DADMUN Design & Construction THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Attn: Tom Dadmun ACCORDANCE WITH THE POLICY PROVISIONS. 60 School Street Hatfield, I4P6 01038 . A7.T11ZE REPRESENTATIVE ©1986-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD INS025(2owi) Ac Ro V CERTIFICATE OF LIABILITY INSURANCEDATE(MMM0YYYY) 1/20/16 THIS CER7IFICATE 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. TM 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(es) must 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 endorsemenXIS). PRODUCER C-00—ACT Dale Frank Insurance AgencyNE --- - X (A( (413) 665-6324 N , (413) 665-1280 2 Amherst Road P.O. Box 455 ADDRESS: @dalefrankinsurance.com ADDRESS, Wen Sunderland, MA 01375 INSUSRE AFFORDING COVERAGE NAIC N .INSURER,A:Providence.,,Mutual Fire Insuran INSURED 1NSURER8: _ _.. .. . Brian Johnson - - ------ ------- 1 NSU RER C: Rig tway Drywall INsuR13RD: 06 Coles Neadow Rd - -- INSURER E: Northampton, MA 01060 INSURER.F COVERAGES CERTIFICATE N UMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICES 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 AMLSUBR `� POLJCYEFF. - .P OUCYEXP -- ----- -----.___...__. _. LTR TYPE OF INSURANCE POLICY NUMBER MJDDfYYYY MMlDLYYYYY UMTS A GENERAL LIABILITY BOP 0093210 00 1/15/161 1/15/17 EACH OCCURRENCE $ 1,000,000 X COILWIFRCIAL GENERAL LIABILITY PA MGETo ERENT-ED ce} $ 50,000 CLAIMS-MAOE OCCUR MED EXP(Anyone person) $ 5 000 PERSONAL&ADV INJURY_. $ 1 000 000 —J LGENERAL AGGREGATE $ 2,000.000 GEN'L AGGREGATE LIMITAPPLIES PER PRODUCTS-COwIOPAGG $ 2,QQQ,t000. POLICY F PRO-JECT r7 LOC -- - $---AUTOMOBILE LIABILITY CO INED IN LELIMff --(Eaaopidert)_ $ ANYAUTO BODILYtNJURY(Perperson) $ ALL OWNED SCHEDULED ----..-----_---.__..___.. AUTOS AUTOS BODILY INJURY(Per accident) $ NON-OWNED PROPERfYDAMAGE HIRED AUTOS AUTOS Per.CCidefd)_,- - S UMBRELLA LIAR OOCUR EACH OCCURRENCE $ _LEXCESS LIAB CLAIMS-AAADES— AGGREGATE DED RETENTION$ - - - IAgRKERS COMPENSATION !EAC STATU- DTH- AND EMPLOYERS'LIABILITY YIN ANY PROPRIETOR/PARTNERIEXFCUTTVE E,LHACaLIENf $OFFICERMIEM13ER EXCLUDED? N/AIftes bryinNH) E.L. ASE-EA Iryes,describe under DESCRIPTION OF OPERATIONS below E.LASE-POLICY LIMIT' $ i DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (Attach ACORD 101,Additional Rema rla Schedule,if nwre space is regUFaM CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WfLL BE DELIVERED N Tom Dadmun ACCORDANCE WITH THE POLICY PROVISIONS. 60 School Street Hatfield, MA 01038 AUTHORIISD REPRESENTATIVE — Wendy Leahy ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD Phone: Fax: E-Mail: ACC)RO CERTIFICATE OF LIABILITY INSURANCE DATE(MM1DWYYYY) 1/19/2016 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(les)must 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 endorsefne S. PRODUCER CONT NACT Elizabeth Carballo Finok & Perras Insurance Agency Inc. PHONE (413)527-5'520 PAX (d13)b27-8970 A! No 6 Campus Lane E*MAIADDRLS..bcarballo@finckandperras.com INSURER(S)AFFORDING COVERAGE NAIC Easthampton MA 01027 INSURER AArbella Insurance Group 17000 INSURED INSURERBArbella Protection 41360 S M G Plumbing & Heating INSURERC: 133 Wyben Road INSURER D INSURER f Westfield MA 01085 INSURER F: COVERAGES CERTIFICATE NUMBER:CL1591801795 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. IN8RR ADDL TYPE OF INSURANCE BR POLICY NUMBER POLICY EFF POLICY EXP DD D LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A CLAIMS-MADE ❑X OCCUR PR=(Any s $ 50,000 13500031965 9/4/2015 9/4/2016 MErson) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: XPRO- GENERAL AGGREGATE $ 2,000,000 POLICY[_]JECT F1 LOC PRODUCTS-COMPlOPAGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMB S1N U rr $ Ea.. nt B ANY AUTO BODILY INJURY(Par person) $ ALL OWNED SCHEDULED 102001,6724 AUTOS AUTOS4/2/2015 4/2/2016 BODILY INJURY(Per accident) $ NON-OWNED PROPERTY DAMAGE HIRED AUTOS AUTOS Peraccident) $ UMBRELLA LIAR HOCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ WORKERS COMPENSATION STA ERH - AND EMPLOYERS'LIABIUTY Y I N ANY PROPRIETORJPARTNER/EXECUTIVE NTA E.L.EACH ACCIDENT $ OFFICERIMEMBEREXCLUDED? (Mandatory in NH) If E.L.DISEASE-EA EMPLOYEE $ E;6 describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT 1$ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Addi fonal Remarks Schedule,maybe attached If more space Is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Tom Dadmun / D+C THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 60 School St. ACCORDANCE WITH THE POLICY PROVISIONS. Hatfield, MA 01038 AUTHORIZED REPRESENTATIVE ffi Carballo/B:ETH ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD INS025(zataar) Hicks/Rosenberg Project, 3 James Ave., Northampton, MA Sole Proprietor Does Sub have Insured Sub-Contractor Name Type of Work Performed employees Yes No Yes No Paul Ayotte X Carpentry X John Piepul X Carpentry X Cortina Tile X Flooring&Walls X New England Granite X Countertops X Rightway Drywall X Drywall X SMG Plumbing& Heating X Plumbing& Heat X James Elkins Electric X Electrician X Dion &Son Flooring X Flooring X Executive Painting X I Painting X Massachusetts -13epartment of Public Safety Board of Building kegulations and Standards C`+ nrtrar ti+,ra��l��t-ris, r License: C&107919 THOMAS DADMUN„ 60 SCHOOL STREE' Hatfield MA 01038 .lJ.e'3f+ Expiration Commissioner 09!2472017 411 Office cif"Consumer Affairs ;and Business Regulation ..r s 10 Dark. Plaza - Suite 5170 Boston, Massachusetts 021. 16 Home Improvement Coptractor Registration Registration 179682 Type: LLC Expiration: 8/28/2016 Tr# 257334 THE TUCKER CROUP LLC. THOMAS DADMUN 60 SCH©OL ST HATFIELD, MA 01038 I'pdate Address and return card.Mark reason for change. Address Renewal Employment 1.ost Card Office of Consumer Affairs&Business Regulation I,irense or registration valid for iudividul use only �€3ME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: fegistration: 1796$2 Type: Office of Consumer Affairs and Nosiness Regulation Expiration: 8t28I2016 LLC IU Park Plaza-Suite i17b Boston,:MA 02116 THE TUCKER GROUP LLC. I i THOMAS DADMUN HATFIELD,MA 01038 t,nderseeretart° Not valid without signature