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29-228 (7) 168 ACREBROOK DR BP-2017-0042 GIS#: COMMONWEALTH OF MASSACHUSETTS Mao:Block:29-228 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: REPLACEMENT DOOR BUILDING PERMIT Permit# BP-2017-0042 Project ft JS-2017-000066 Est. Cost: 52756.00 Fee: $40.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Grouo: HOME DEPOT AT HOME SERVICES 92937 Lot Size(sq. ft.): 10018.80 Owner: WELLMAN JOANNA S&JOANNE M GANGI zoning Applicant: HOME DEPOT AT HOME SERVICES AT: 168 ACREBROOK DR Applicant Address: Phone: Insurance: 5 RIVERVIEW DR (401)935-2633 0 Workers Compensation NORTH PROVIDENCERI02904 ISSUED ON:7/12/2016 0:00:00 TO PERFORM THE FOLLOWING WORK:INSTALL REPLACEMENT DOOR 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: OI: 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 Sienature: FeeTvoe: Date Paid: Amount: Building 7/12/2016 0:00:00 $40.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner 1 \J Department use only \***- rte'.% City of Northampton Status of Permit: O rLo6 Building Department Curb Cut/DrivewayPermit p 212 Main Street Sewer/Septic Availability 6C Room 100 Watermell Availability e'oo - Northampton, MA 01060 Two Sets of Structural Plans 01 7ltphone 413-587-1240 Fax 413-587-1272 Plot/Site Plans Other Specify 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 �{�}y� (J�,.�, / n Map Lot Unit )�y Pi12L bizoi,!` Pa_ Zone Overlay District Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: 1 �9rYr✓NA- JAM"!'l Ai l6� C K Name(Prot) / y�-�� ///� Current Mallin Address. r1 v is Ai oft CtriTizA / Telephone P ( /VL Signature 2.2 Authorized A.-nt: ' / X11 i ri2C?; 04131(77s 7- Nam%'•,ty / Current Mailing Address: 4 r O / Sig•S tore Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building 22a (a)Building Permit Fee 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) -2--7a -07) Check Number /0 qq7 'IY (79770 This Section For Official Use Only Date Building Permit Number: 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 Lot Size _.. ..... _. . . Frontage _.. .-.� Setbacks Front Side L: R:_.. L:. R Rear _.. Building Height Bldg Square Footage Open Space Footage (Lotareaminusbldg&paved parking) k of Parking Spaces - - —' (volume&Location) A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO Q DONT KNOW 0 YES 0 IF YES, date issued:.. IF YES: Was the permit recorded at the Registry of Deeds? NO Q DONT KNOW Q YES Q IF YES: enter Book Page and/or Document A'' B. Does the site contain a brook, body of water or wetlands? NO Q DONT KNOW Q YES Q IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained Q Obtained Q , Date Issued: ,. C. Do any signs exist on the property? YES Q NO Q IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property? YES Q NO Q 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 Q IF YES,then a Northampton Storm Water Management Permit from the DPW is required. SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable) New House ❑ Addition ❑ Replacemen • dews Alteration(s) n Roofing n Or Doors Accessory Bldg. ❑ Demolitionolit ❑ New Signs [Di Decks [= Siding[CI Other[CO BriefDescrigtifof P�On /,f 0'-1 J1�� & £ ep 7T /l/ 24,,4 Work'. / �y.KL,LI/// / [/ /�'(� K^"' zinnilic Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll -Sheet 6a. If New house and or addition to existing housing, complete the following: 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 J :eWA-1 L' -ln,/l ✓ as Owner of the subject property T/�� hereby authorize 1 I11/2/2P"Facie ie to act on my behalf, in al afters relat v work authorized by this building permit application. (>1/P e ig Signature of Owner Date I, ayt) Ti" d /1 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 and e phi s and penalties of.- ' y. vilh..... alit Print Name4 i 2.1.---' ���7g Signat,>of Owner/Agent - Date 9 A SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: 1y_/,,1 Not Applicable'lipicleE Name of License Holder'. 14 /-A/' / "o / � ~✓ /v ` 7 License Number 19 alii3tgnvi agoa /Al• 61-r17 Address Expirat nn Date Date W &T� -) . oi'4C Signature Telephone 4tV)-T23---/35-2- 9. --}&5'29.Re.istered Home Im• •rment Co tractor: ,._.— Not Applicable £ Company Name 1'M Pe �^ �'-/It1--I— Registration Number Address ///�I `��/{{��� ,/� P� y^ �,/ rExpiration Date / -2/t W� 'v kA• Telephone Y/"lZ3/ 4-- 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 . uilding permit. Signed Affidavit Alla S No E 11. - Home Owner Exemption The current exemption for"homeowners"was extended to include Owner-occupied Dwellings of one(I) 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,von 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 1 Irl Office of Investigations {�. gat -" 600 Washington Street Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): Address: City/State/Zip: Phone #: Are you an employer? Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. ❑ I am a genera] contractor and I employees (full and/or part-time).* have hired the sub-contractors 6. ❑ New construction listed on the attached sheet. 7. ❑ Remodeling 2.CI I am a sole proprietor or partner- ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. employees and have workers' comp. insumnce.I 9. ❑ Building addition [No workers' comp.insurance required.] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑ Plumbing repairs or additions myself [No workers' comp. right of exemption per MGL 12.0 Roof repairs insurance required.] * 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. 7Ho meowners 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. Lie. #: - Expiration Date: Job Site Address: City/State/Zip: 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 51,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a foe of up to S250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct. Signature: 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 prit& Massachusetts < DEPARTMENT OF BETIDINGINSPECTIONS s 212 Main Street • Municipal Building Northampton, MA 010606:haraP INSPECTOR Louis Hasbrouck Chuck Miller Building Commissioner Assistant Commissioner HOME OWNER EXEMPTION ACKNOWLEDGEMENT The State of Massachusetts allows the homeowner the right under 780CMR 108.3.4 to act as his/her construction supervisor. 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 for the City of Northampton wants any person(s)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 regulations. The inspection process requires that the building department be called to inspect work at various stages, which include foundation/footinqs (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 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 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: The debris will be transported by: The debris will be received by: Building permit number: Name of Permit Applicant Date Signature of Permit Applicant Jun 21 16 08:35a T''2 HOME IMPROVESIENT CONTRACT PLEASE READ THIS // tt Scid.F-rtdslnd and Installed by: Branch Name:New Enehmd Date:b! IL THD.At-Home Senkes.Inc. d,'b/a The Hume Uopot.At-Hunte Service: Branch Number:33 903 Boden Turnpike,Loil I,Shrewsbury,MA 01535 Tall Free 977-433-3768 Fedex ID a 75-2698466.ME Lk IC 02439:RI Cont.Lee 16427 CT Lic 411110.0565504:AIA Homme Inamencment Cort-xtor Rca.it 126893 'Installation Address: kb PeLQ-rj i1iX_f� Q& Flow.) m;' Ery State Zip Purekrser(s): workPhone: Home Phone: Cell Pboue `37:394aNJA-WO 1 lIN1A-5-J [ ] I [ 1 Home Address: /if different -o:n InSia Inion Address) City Sp 0 Zip E-mail Address;lo ree ivc project anumuni aliens and Home Depot updates I: ❑I DC NOT wish to receint any marketing.-r us!role The Home Depot Prosect Information: Undersigned("Costomer").the owners ofthe property located at rho above installer ion address auvsz to buy. and THD A H ScCl tdl a[ n") s( all materials described nn the below nn or thea Depot' Spm Shculsl all of which h 9 incorporated into this Conner by this reference,along will any applicable State Supplement and Payment Summary attached hereto and any Change Orders(collecsr,dy, "C'ontrar): Johk .....i Prodacn Spec Shenk)ft: Project Amulet � R ❑9Mne %%m ❑l r 3005Donors r D - ❑ ax ❑windowsInsulation ion TIrion :Carers❑EthC 7b�7 $ Z75!S Al�cti, J1oon € oss s w'a In- Lula• De Atom iCuver: :Tarry Doors] ' • DRDoEng 's'd e U Windows ❑I dation • COutterztevez❑Enh,poors C 9 � Minn hRl+ / en vv rC ct Am [dueep execution NOemmraet Total Contract Amount Si cliT7C✓ /' \ i Mane Purchasers may nut dtpmn tM1noaonnN lheC utl known. l'� Castanet a gees rhe'..:.mmcdiate v upon completion of the work fur each Product,CUSmaer will execute a Completion Cer.ificate lone far each Prcdoct as defined Man net viival Spec Shea)and pay nn limCushman:v balance dun. Ac appblti each .,dc! :Ons Contract.agrees to bed aims are severallyseverallyobligated and Gable licreander. Me Homo Depot rexetvis Me«gut lo Issue a Change Order or tern nate this Conran or any individual Producr(5)included herein.al its discretion,if the Home Depot or Ls autimri,ed srerVee provider determines Nal it casnotperlbnn its obligaticns due to a structural problem with the home,eneircnmenml hazards such as mold,asbestos or lead pant,other safety masons.pricing errors(Jr became work r,quiecd ro complete the job was net included n the Com:acl. Payment Summary: The Payment Snmr:n.:y p '3(] y tt 1'] 7 mchjded as parr of this Contract res rah the total Contract amount and payments required for the depos Is mai nal payments by Product(as appli,ble). NOTICE TO CUSTOMER Yon ore entitled to a completely filled-in copy ofthc Contract at the time yxt zip. Do not sign a Completion Certificate(note: there Is one Completion Certificate for each listed Product as defined by individual Spee Sheet,)before work on(hat Product is complete. In the evens of termination of this Contract,Customer agrees en pay The Hone Depot the costs of materials,labor,eapener and semicec provided by The Home Depot or Authorized Service Provider through the dam of termination,plus any other amounts set forth ha this Agreement or allowed wader applicable law. THE HOME DEPOT MAY WITHHOLD AMOUNTS OWED TO THE HOME DEPOT FROM THE DEPOSIT PAYMENT OR OTHER PAYMENTS MADE. WITHOUT LIMITING IDE HOME DEPOT'S 01'11 ER REMEDIES FOR RECOVERY OFSUCH AMOUNTS. ACMpm nee and Author-iattiun t Customer:gran mid urethan is that this Agreement is the untie avec-,c,t between Customer and Mc Home Depot rvi[retard io lie Products am( Intl/laden Serneaen and monse:las all Niordiscus-ons'ad agreements.either oral or wri wen,relating to sod Pr:ducts mid Installation.This Agmemar:cannot be asss'ened or amended exoea by a online sinned by 0151e111C and Cie Hone Depot Crammer acknothhDes and oyrus nut Costumer las tad,understands_rah warily materna dm terms of and l'.m received a copy or lltis Agreenem A a 3✓ Submmed by: — / Cos 'S Signature ale ales ConsulprCsslgnnu¢ Dna X Td:piw.ro No, Customer's Signature Dam Sales Consultant icense NO. _ CANCELLATION. CUSTOMER MAY CANCEL THIS ts.pphu=bla �l AGREEMENT WITHOUT PENALTY OR OBLIGATION hh L 3 /P :36_5) .2 - BY DELIVERING W'RITTES NOTICE TO THE HOME " t ('� ✓/J II DEPOT BY MIDNIGHT ON THE THIRD BUSINESS f I �✓ JJJ DAY AFTER SIGN/NG THIS AGREEMENT. THE . 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( L;v of as S3 s141 IT•51 0r_ fi£'$-- � [4 0000. 00..«.x0.. . ::.c.::_m_.yi s::fAG 8000 lJ _ %tae E0 YR, z '1, S'.tite.ta)-.M01 ./ as r0 ciarT t i-^� � . .;fv>oyaayr:7777E F ,fp a �a cns_i3a*,i.S,rm.5T_@ igvVeralg4&.it13,�7 a Hegira SerVlees '-/ 4U1 Z40 ZObb p2 • \ /���/ l // E ? Office of Consumer Affairs'and Business Regulation 10 Park PInna - Suite 5170 • Boston, Massachusetts 02116 Home Improvement Contractor Registration ' Registration: 125E93 _ Type: Supplement Card THD AT HOME SERVICES, INC. Expiration: 813/2018 RICHARD TRDIA 2690 CUMBERLAND PARKWAY SUITE 300 -- ATLANTA. GA30339 • Update Address and return cord.Mark reason for change SCA, a aww„f _ Address Renewal ..:ploy_z.1 f Lal Cn;o Tier ,..,..,:red%.�'-2,_...<,..<... -=OlLee of Consumer affairs&BusinessRegu1 tion License or registration valid for individul use only Tie -(5t1iOME IMPROVEMENT CONTRACTOR before the erpiratien date. If found return to Office of Consumer Affairs and Business Regulation - _ Reg"strabor.: 12e50 Type: io Park Plaza-Suite 5170 Ex:kronen:.&3I2016 " Suppiemenl Card Bonen,MA I12116 T HO AT HOME SERVICES.INC. / THE HOME DEPOT AT HOME SERVICES G'�'v 2E90 CUMBERLAND 2E4J CUPABERLANDdBortenS � '—�.--� lev 1YrA GA30339 Undersecretary Not valid WiI out signaatre .Y.:411-41 1i v $ r �S�Ysdm`2�f 7� 4J4J aiii r er I r. el .p'! „US: !�� V te'9.11 n 11 I� 'I�S1I t9 .1 „A, i 'n R 2, F • •y b\l soyaX53' �il�V 1 it if M , !> .. 4 'S WI d KriY9 d,�� !2 v `` lti, t IJ I, ,r a % _ i•nt i t+ fil ,6•. / ," �: 1 q t�Tll is! l,UJ1 ' qy ti 1 s1 ., sv.i. f r tra d?! l Fr "I Y S, ,f' r t i t d ss B i �� !d 4 4 ti itx Xt � u s 41 . � o, x sz r� , YI t l I ' I G7, � ';, In ' 11 aitli a: s',-,8?1 �, E '� tl?ir., i - is op ,4 I y `c4. ,P, in m ' .m . , t M1� ! R I O a:5s s.� s. p { '1�,1 'Y r II r �n t Out al ,1 ! �l } 1r � 1 0„, }4 � Ij 11 51 T1 F., -i t ,? r• a kYi � W yy P,. x�� I'� 'P f! c I f �, 'q PSI ll .� r. [/ A( �' J t",;*'i ;n v�, it li' .u, 1kl4 0a ''O'er; apg4 "4 .,, � i�G 4:6%1, f rA� R-2, t `J,n r l .1,.,i' b g ifl , I 31 ,, "aril tl k1 4 vim' H -N7k prey la.4 4 • ,`,iii0 6Of m 3iil h. .g. o,utA�� 0w 'g r- oR '� t7os UVIP a t fy( max n i f a U x n rel I,. r,t., G�- p' ,N4 ^r ,'y F ,xy p CV ti g•�: �F 16 iI jj (F51 amin au m i s ifl p; 0 Is 0 IJf , 5 5y,� $ Y.' 1'�',' t a�i tl� f3 y' F Ir . �Y,t!{k •4 ,, CI r�V�l s7 ACORD CERTIFICATE OF LIABILITY INSURANCE DATE ' �� _ 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 CONNECT MARSH USn.''.NC. PHONE FAX AHD ALLIANCE CENT IAIr NO Fat wC Not 33E0 LSIOX ROTS.SUIT:NCO E IL ADDRESS: ATLANTA CA 6S32E INSURER(S)AFFORDING COVERAGE I NAM a 1133492-HomeD-GAW-3il7 __. _ INSURER A:Reaelfast Insurance CcmpaiY '126287 INSUREDD A .l1E BEP•/ICE31HC. INSURER B:7011American Assam Co '.i 16535 DOA THE HOME'uEFOT ATACdE SERVICES INSURER c:New Hampslire Ins CO !23 4l 2650 CUMBERLAND PARKWAY.SUITE 300 INSURER O:IpmSO Nalbnal Insurance Company 123817 ATLANTA.GA 30332 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: AT.N374554614 REVISION NUMBER:8 THIS IS TO CERTIFY THA: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 Lffi TYPE OF INSURANCE ATSSD MILD POLICY PODGY EFF I FOUNT SIP ! WAIT (PODGrVEFF IIMWJCY WYll A S COMMERCIAL GENERAL LIABILITY . :DL04887714 Cp I03/0112016 IO3Q112017 I EACH OCCURRENCE I S 9.0000100 . m DAMADE10REtU X0.1S.Md0E _OCCUR PREMISESIEa occurrence) I5 1.000.000 LIMITS OF POLICY X$ MED EXP!My ,eoanoPl '.S EXCLUDED _ OF SIR:SIM PER DCG PERSONAL 6 ADV INJURY I5 9,000000 SEN Aoup APF'JI:IC i?P:_E$o`3. GENERAL AGGREGATE 1 3 9000.000 5 OL - .Iv _ too ' "'I PRODUcTS-COMPIOP AGG I S 9.000.000 OTHER. 15 3 AUTOMOBILE LIABILITY SAP 293886313 .0301,2016 :010112017 COMMNED SINGLE LIMIT Is 1000000 XANy I GODLY INJURY Men perms) S — au on'nEJ 5CEGULED SELF INSURED AUTO PH?Dk:GI smut INJURY(Per acdderO'''S _AUTOS nurOS • ]AUTn$ _NONMIAMED PROPERTY DAMAGE I S HIRE __ AUKS ,(Per accident, • I UMBRELLA LIAe OCCUR EACH OCCURRENCE 'I$ EXCESS LIAR CLAIMS-MADE (AGGREGATE 1 S ]W RETENTION 3I I• S C WORKERS COMPENSATION I`NC015519215(AOS) '030112016 .010112017 I 'Y I PERTIf(E I 'ER I LIABILITYD EMPLOYERS'LIABILITY U •ANY PROPR1ETcmPARTNeaiCELUTME YPINIx1A ''WC01551921I(AK,M/,P1H,NJ.VT) 10310112016 '0310112017 I EL EACH ACCIDENT IS 1,W0,000 U Mandatory in NH)OFFICERIMMSEP B.cLuoaw �9100155102166(FL) 10110112016 10/0112017 I EL OISASE.EA EMPLOYS S 1,000,080 If dasmoaunder ICOnimued on AddWmal Pane I 1,000000 'DESCRIPTION OF OPERATIONS below a DISEASE.PIXJCY LIMA S I I OESCRIPION OF OPERATIONS I LOCATIONS I VEHICLES IACORD 101.AddI1baaJ Rema.s Schedule.may be attached if more space Is requlnd) EJIDE_NCE OF INSURANCE CERTIFICATE HOLDER CANCELLATION THD AT-HOME SERVICES.INC. SHOULD ANY OF THE ABOVE DESCRIBEDPM rr'1FC BE CANCELLED BEFORE DBA THE HOME DEPOT AT-HOME SERVICES THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 2455 PACES FERRY ROAD ACCORDANCE WITH THE POLICY PROVISIONS. &ILEUM.GA 30339 AUTRORZED REPRESENTATIVE of Marsh USA Inc. Manashi Muktler)ee ..S tnseLew a- -.Tb..4_a.a s-S-e+ ©1908..2014 ACORD CORPORATION. All rights reserved. ACORD 25(20141011 The ACORD name and logo are registered marks of ACORD , Massachusetts - Department of Public Safety 1/4`,. Board of Building Regulations and Standards License: CS-092937 _r t, SLAV MOKAN -- c 43 SABRfNA ORM) - P :. V1+PSIFIELD Meir 91 33, !sk — P 40, Commissioner O42W 017