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23B-048 • 214 aST BP-2006-1107 GIs u: COMMONWEALTH OF MASSACHUSETTS `°"'-33B-o484 CITY OF NORTHAMPTON Lot: -001 Permit: Building Category: BUILDING PERMIT Permit# BP-2006-1107 Project# JS-2006-1633 Est. Cost: $33000.00 Fee: $25.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: F J B ASSOCIATES LLC_ Lot Size(s9. ft.): 16117.20 Owner: BERNIER JAMES R JR&SYLVIA M Zoning:URB Applicant: F J B ASSOCIATES LLC AT: 216 LOCUST ST Applicant Address: Phone: Insurance: 55 TOWN LINE RD (800) 506-9477 WETHERSFIELDCT06109 ISSUED ON:4/19/2006 0:00:00 TO PERFORM THE FOLLOWING WORK: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 Flim!: 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 4/19/2006 0:00:00 $25.0024663 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo File#BP-2006-1107 APPLICANT/CONTACT PERSON F J B ASSOCIATES LLC ADDRESS/PHONE 55 TOWN LINE RD WETHERSFIELD (800)506-9477 PROPERTY LOCATION 216 LOCUST ST MAP 23B PARCEL 048 001 ZONE URB THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid (Auildina Permit Filled out Paid 1*2 cu.63 fZS,OU TvpeofConstruction: Siding New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/Statement or License 3 sets of Plans/Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INPRESENTED: ( Approved Additional permits required(see below) PLANNING BOARD PERMIT REQUIRED UNDER:§ Intermediate Project: Site Plan AND/OR Special Permit With Site Plan Major Project: Site Plan AND/OR Special Permit With Site Plan ZONING BOARD PERMIT REQUIRED UNDER: § Finding Special Permit Variance* Received&Recorded at Registry of Deeds Proof Enclosed Other Permits Required: Curb Cut from DPW Water Availability Sewer Availability Septic Approval Board of Health Well Water Potability Board of Health Permit from Conservation Commission Permit from CB Architecture Committee Permit from Elm Street Commission Si nature of Buil g Official Date I Note:Issuance of a Zoning permit does not relieve a applicant's burden to comply with all zoning requirements and obtain all required permits from Board of Health,Conservation Commission,Department of public works and other applicable permit granting authorities. *Variances are granted only to those applicants who meet the strict standards of MGL 40A.Contact Office of Planning&Development for more information. - l.ern = City of Northampton , `--'" "" "_ Building Department � .-r�. i . -a.,�_d �2 212 Main Street r�- T>4 n,-€ Room 100 .6314- T; Wt J4 £ P -$-- £ Northampton, MA 01060 r;r ,P. phone 413-587-1240 Fax 413-587-1272 `' j APPLICATION TO CONSTRUCT,fTER,,REPAURl- EYA r � � � OLISHAONE OR TWO FAMILY DWELLING SECTION 1-SITE INFORMATION )✓ 2e0E 1.1 Property Address: A F secttontobe comptetod by.ofgce , 6 �jCu4k St swg swi' �Nr Zone-; OveslayDisirict Erm SGnishict CSOlstIct SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: tom . S l/,' e� X16 )oL�Sfi 5t 0106 Name(Print) Current Mailing Address: Telephone L l 3 ,( Signature [ 2.2 Authorized Agent: Name(Print) Current Mailing Address: Signature Telephone SECTIONS-ESTIMATED CONSTRUCTION.COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building .3 a Lq G (a)Building Permit Fee 2. Electrical L (b)Estimated Total Cost of Construction from.(6) 3. Plumbing Building Permit Fee GCS 4. Mechanical(HVAC) 5. Fire Protection ��55 6. Total=(1 +2+3+4+5) 5)- �`f3 Check Numbera114bC3 tz. .ad. _ This Section For Official Use Only Building Permit Number. - - sse Issued: Signature: Date Building Commissioner/Inspector of Buildings 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:—' It: L:! R:: _ Rear Building Height Bldg. Square Footage —.. Open Space Footage % _, — (rot area minus bldg ffi pavedI parking) N of Parking Spaces Fill: (volume&Location) A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO 0 DONT KNOW 0 YES 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 • Page. and/or Document# B. Does the site contain a brook, body of water or wetlands? NO Q DONT KNOW © YES O IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained © Obtained © , Date Issued: C. Do any signs exist on the property? YES © NO O IF YES, describe size, type and location: 1. D. Are there any proposed changes to or additions of signs intended for the property? YES © NO O IF YES, describe size, type and location: I 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 l 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 applicable) New House ❑ Addition ❑ Replacement Windows Alterations) n Roofing ❑ Or Doors E Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks ED Sidingga7 other[0] Brief Description of Proposed y�,/ p� � qq Work: I YJ&) VtyL S t CIS l\5 Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll -Sheet ra'iPNeWtiousoenf"ot aftioWKtoexisttrw housihe ''completW h'e" o`tiowfnsi: 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 1, ,as Owner of the subject property hereby authorize to ad on my behalf,in all matters relative to work authorized by this building permit application. Signature of Owner Date -- /r� Date 1.1 1 a& M'V I As d *t'!n r.° c Irvq/ J / AMcoc \c .Vc S ,as Owner/Authorized Agent ere ecare that the statements and infon4ation on the foregoing application are true and accurate,to the best of my knowledge and be ef. Signed under the pains and penalties of perjury. V i Nix( S w,%-i,% Print Name,,, / t/ , Bof OwC r A,11'/y'yp1j�o ���S�f7 6 Signature of Own nt Date 111 SECTION 8-CONSTRUCTIONS SERVICES 8.1 Licensed Construction Supervisor Not Applicable 0 Name of License older'. License Number Address Expiration Date Signature Telephone S:Iieq"lata£ed'Noniiilim'piovameBCGoit&actar'VW ,;r, i7 Not Applicable 0 Company Nameq� Registration Number ((/ '(1l 611-‘5Soaa.&5 / 32og3 Address O‘pL.-y t-tf t( (!`-Y Expiration Date /Oci ' c0k-Ecis-C c?V\-e-c bGo67 TelephoneV66 Sy3 o-co S"--- 17/67a 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 QJ� No 0 The current exemption for"homeowners"was extended to include Owner-occupied Dwellings of one(1) or two(2)families and to allow such homeowner to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor.CMR 780, Sixth Edition Section 108.3.5.1. Definition of Homeowner:Person(s)who own a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be,a one or two family dwelling,attached or detached structures accessory to such use and/or farm structures.A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such"homeowner"shall submit to the Building Official,on a form acceptable to the Building Official that he/she shall be responsible for all such work performed under the building permit As acting Construction Supervisor your presence on the job site will be required from time to time,during and upon completion of the work for which this permit is issued. Also be advised that with reference to Chapter 152(Workers'Compensation) and Chapter 153(Liability of Employers to Employees for injuries not resulting in Death)of the Massachusetts General Laws Annotated,you may be liable for person(s) you hire to perform work for you under this permit. The undersigned"homeowner"certifies and assumes responsibility for compliance with the State Building Code,City of Northampton Ordinances,State and Local Zoning Laws and State of Massachusetts General Laws Annotated. Homeowner Signature • F? E (cin" of• �Drfl(altt} iDtt 1 �- gIastatinci Ens- DEPARTMENT OP BUILDING INSPECTIONS • 11� 212 Main Sired. • Municipal Building NorthampLon, Mass. 01060 gni \VOR1¢It S Con-mcr?SA7lON ENSUPANC a. AM:DAM- • iu:r 9r on vc9'417 • Q;crnsrJlA.l uri:uc) suhLL 2 principal place of busioesshesidence at I 0 0 Cod?_,Ccc.tf- Ao6(CyCt Cphonei) 4-C6 C`130cr, S sD, ( ioll ty/nrfaop) oa' < do hereby certify, under the pains and penalties of perjury, War ( ) I zm an employer providing the followine workers compensation coverage for Inv employees wofng on this job. • eeede% ( n5 Co Liu 6- 657a is-o6 (Insunac Cooczn•) (Policy Nunrrr) (_: had n Dat) () I am a sole proprietor, geoeral contractor or homeowter(cite one) and have hired the coon actors listed below wbo have the following worker's coopenszdon• pebcies: (TSemc at Co itncon (Ina-Limn=Company/Pober Nuevei f`2rueoa Oatc) (Name of Cooeaaor) (Irsw-ane CompanyiPoUc: Number) (E pinion Dane) • Mame of Comractor) (Luny-Lao: Company/Policy NNtmF: ) (Ecpir_uon Date) (Name of Contractor) (insuran¢ Compamy/Policy Numbs) (Ewwri i<alioo Dane) t.u,a Lee«eal am J aeay eo irrh.ck bfcvaua u.0 mc--c ) • ) I am a sole propriecor and have no one working for me. ( ) I aura home owner performing all the work myself NOii_plcac lz.war th._ 1,0mco..a-n vbo mplOy pc.ao.uh r-.'r.—.n, c r.r.1LFa( gay w oamxe,ur1St. ' c,. Na Mca ( LI51 1wthepv+a6 arra/year]rat oat 4-`-ally ir- nube Cpl C= Of s tbc cplayy:o _ c,&ta. GLISj�-al(5)}agliatiw by.banm.a-a ry:L¢Knl"-'A^t'—Y"TSN' Icpl u-��o.u glnyx uoM Ca WMNv Cmp... t:oo A¢ _..M tad a copy of Ibi.mam:m o y bf�tE.<t tt<p�yuweyarluL.v:U AmilevigLYOPw at L-a."m tc W. corr.-Act ve-Qeuw Dadltu arc to£ rc'w.mye'n- armor 2M of MOL ISl oa lad le the 'p—co at=all pwrue ^r+':"^yeta rime of tp to S 13OJ00 uric(vrctoowa of up to o¢y-=,c 8 cn1 p-. Yee.o rc focal of.Shp Wmt O:t uL of icoo o0.cuy.pim a3c 16\ Fce yp„��l tt<W y P twit Numbs IIr� 4•0 g-g- t2L) Map: UM (LicnsccfPcln3uc ce _- .1 F 4S %O3 � "e CCifg of Protan tfon a_,..14,.r.._ —---- til,.:. ____ ,...u.mir---;1•_---rFzi{tc ,,,,,.���� �' DEPARTMENT OF BUILDING INSPECTIONS 0. =_E:, -t/ INSPECTOR 212 Main Street • Municipal Building Northampton,MA 01060 I HOME OWNER EXEMPTION ACKNOWLEDGEMENT The State of Massachusetts allows the homeowner the right under 780CMR 108.3.4 to act as iris/her construction sups.: .i sor. 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/footings (before backfill). sonotube holes(before pour). a rough building inspection (before work is concealed), insulation inspection (if required) and a final building inspection. The building department requires these inspections before the work is concealed, failure to secure these inspections can result in failure to obtain a certificate of occupancy until the work can be inspected. If the homeowner hires other trades to perform work(electrical, plumbing& gas) the homeowner will be responsible to make sure that the trades hired secure their proper permits in conjunction to the building permit issued, and that they get their required inspections. Failure of the individual trades to secure the permits and inspections as required can DELAY the project until such time as the proper permits and inspections are made I, understand the above. (Home owner/resident's signature requesting exemption) I will call to schedule all required building inspections necessary for the building permit issued to me. Date Address of work location NY: IAcnu5NC II334N1 Ybtlfine M _ . 4lNew Ramer Rood-Albany Nv 22E6 o m#W(xw3Rrd m arc iv Hms 1-1 O� U/3 / 3 -/> / 5 O (4131? xd s Il/5y e NY 73205 r/ ?i31Rea 55cr W 10011P,xr au aPfRaklka+Xutb ' ]1von le '254.0 MJ swttf /� Am'ImpFlmvN 5770Z69 .ma !Ae. H - x ✓l� >✓ [� J, //- Hornefrrlpamarrt Cr: Guyer100(5 rare s4jrylBmr " ap .Jets' 4' Ik wpartt Pine fla3yNMl D' > / (WOMRNnB NA etgxon .y U LpC-[✓ ./ j <ir Reeky Hill CT 0te 6067 nse1102EJ s¢3N WeRIkIy MAmWs Reeky Hutampav RI: ur<�:.rxwn . ' •• '•• . > -zia*N�",', a , 1.0665430535 OH: 0 I OM(ek,Road•Sra 101.5.furyy OR 4418 2 icrid yl t /I K O/..11E 7 HOME IMPROVEMENT SALE AND INSTALLATION AGREEMENT The Buyer(s)listed above hereby Jointly and severally agree to purchase the goods and/or services listed below,in accordance with the prices and terms described on the front and the reverse of this Agreement,and Buyer(s)have requested that such goods or services be installed or provided at Buyer's address listed above.FiB Associates LLC("Contractor),hereby agrees to install or cause to be installed the products or services listed in this Agreement Buyer(s)agree to sign a completion certificate upon completion of the installation of the goods.The Buyer(s)agree to pay the purchase price as described below, Deescriptionsfor siding and roofing orders are contained in the accompanying addendum to this Agreement.The Buyer(s)may request Contractor to try and obtain financing for the Buyer's purchase. Any financing agreements for the purchase will be contained in separate financing document.THIS IS A NON- NEGOTIABLE CONSUMER NOTE. THIS INSTRUMENT IS BASED UPON A HOME SOLICITATION SALE,AND IN CONNE[R,GGT THIS SALE IS SUBJECT TO THE PROVISIONS OF THE HC"'SOLICITATION SALES ACT THIS INSTRUMENT IS NOT NEGOTIABLE, INSUL•SASH PRIM - 'I REINFORCED VINYL REPLACEMENT WINDOWS All windows will ou Low E with.(deck one) rypton Gas ❑Argon Gas ❑Otfa (see Addendum) 2Tbe �� i/r.� WINDOW MODEL TOTAL wSCREENS WNIDCIW NO MULLS. NEW F1 DECORATIVENUMBER UNITS nwCASES °a REM STOOL DORMobri nuFINISH ',pN61MQDiZr«K SET FINISH 5.p1 ;)Ju )),;) .)C2,< l(1,fLI/ : "L F I tA/ *A/ "'Jot I T 77., (� 5ni "#I ciD , no's„— r — .. `yw )73J�✓f•,? kfz✓ %it./ L7u6QGOkV SI1)) {7 Sr�Ef9y2C)1);✓U7r7^/ TOTmu nnsOON (/ orTOTAL our comwrr 2cemann UNITS ._ ""1: ” 3 a r (56 ,�l / 73'7'm v„zy .Y:'E '' uy Fra .,�s.4.G �?c , tdi spr, z%, rl� .dl's 'G"k.S, It is agreed and understood by and between the parties that this Agreement.front and back,constitutes the enure understanding between the parties,and there are no verbal understandings,changing or modifying any of the terms of this Agreement This contract may not be changed or its erms modified or aried in any way unlessr such changes writing andaigned by both the Contractor.Buyer(s)and the Buyer(s)hereby acknowledged that Buyedsl has read the front and the reverse oft is Agreement and has received a completed,signed and dated copy of this Agreement,including the two attached Notice of Cancellation forms,on the date first written above, Buyer(s)also acknowledged that they were orally informed of their right to cancel this transaction. Nonce to Owner of Deposit:If we receive payment under this contract from you prior to the substantial completion of work,as required by lien law section 71-A(4),we will deposit such payment in an escrow account within five business days,and we will use the deposits for the purposes of this contract and for other purposes permitted by law,You are hereby advised that the name of the depository where the funds will be placed is Bank of America, Notice to Buyer:(I)Do not sign this agreement if any of the spacesintended for the agreed terms to the extent of then available Information are left blank.(2) You are entitled to a copy of this agreement at the time you sign t(3)You may at any time pay off the full unpaid balance due under this agreement and in so doing you may be entitled to receive a partial rebate of the finance and insurance charges,(4)The seller has no right to enter unlawfully your premises or commit any breach of the peace to repossess goods purchased under this agreement.(5)You may cancel this agreement if it has not been signed at the main office or a branch office of the seller,provided you notify the seller at his main office or branch office shown in the agreement by registered or certified mail, which shall be posted not later than midnight of the,third calendar day after the day on which the buyer signs the agreement,excluding Sunday and any holiday on which regular mall Ytldddlvefies arenotylp4E Se the attached notice of cancellation form for an explanation of buyers right. FIB Associates LLC By: ✓ /'/// '^' 04/ '� License No. BUYERISI: T _ I _�� BUYERISIT J yt 1'(14' l SIGNATURES Tr x.g e.,1.44 j> SIGNATOR / ”'/datte"f-�7�-G; Pint Name I If>✓� I� 1JE rc/1I ) Cr T=> ---- PrintName 74C/L �, �, l�iy.y You,the Buyer(s),may cancel this transaction at any time mimic:midnight of the third business day after the date of this transaction.Sae the attached No ice of Cancellation form for an explanatiwn of this right. NOTICE OF CANCELLATION NOTICE OF CANCELLATION Date of Transaction — (5 Date of Transaction 0 i7 You may cancel this transaction, without any penalty or You may cancel this transaction, without any penalty or obligation,within three business days,from the above date.If you obligation,within three business days,from the above date.If you cancel,any property traded in,any payments made by you under cancel,any property traded in,any payments made by you under the Contract or Sale,and any negotiable instrument executed by the Contract or Sale,and any negotiable instrument executed by you will be returned within 10 days following receipt by the Seller you will be returned within 10 days following receipt by the Seller of your cancellation notice,and any security interest arising out of of your cancellation notice,and any security interest arising out of the transaction will be cancelled.N you cancel,you must make the transaction will be cancelled. If you cancel,you must make available to the Seller at your residence,in substantially as good available to the Seller at your residence,in substantially as good ✓tce ioom nozneseah1 o sestemem. Board of Building Regula ons and Standards OCT 18 hJ04 _. - @ lL " One Ashburton Place - Room 1301 Boston. Massachusetts 02108 Home Improvement Contractor Registration • Registration: 132093 Type: Ltd Liability Corporation Expiration: 11/16/2006 F J B ASSOCIATES LLC. FRANK BOCIAN 55 TOWN LINE RD. WETHERSFIELD, CT 06109 --- - -- - --- -- • Update Address and return card.Mark reason for change. DES-CM 0 5eu-04r04-6101216 Address I] Renewal J J Employment E1 Lost Card gge eont,no.ealdo/,gamadue444 Board of Building Regulations and Standards License or registration valid for individul use only Et "• 's HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Registration: 132093 Board of Building Regulations and Standards One Ashburton Place Rm 1301 Expiration: 11/16/2006 Boston,Ma.02108 Type: Ltd Liability Corporation F J B ASSOCIATES LLC. • FRANK BOCIAN • 55 TOWN LINE RD. —474i„i WETHERSFIELD,CT 06109 Administrator Not valid without signature Date. 8112105 12:08 PM Senders Fax ID:Sinclair Insurance G Page 1 of 2 ACORD_ CERTIFICATE OF LIABILITY INSURANCE DP ID RX DATEDJMTDm"Y' FJ13AS-1 00/12/05 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Sinclair Insurance Group, Inc. HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OF 4 Tower Drive ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Wallingford CT 06992 Phone: 203-265-0996 Fax:203-265-5863 INSURERS AFFORDING COVERAGE NAlce INSURED FJB Associates LLC 6 'NSDREPA Peerless Insurance Company 24198 FJB Associates LLC DBA INsoREPe _.--- Clearwater Gutter Protection --- --------._ Attn: Bette Kielb INsUREPD 100 Corporate Place INSURER C. - -Rocky Hill CT 06067 iNsURERE COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED NOIWRHBTANDING REOUSEMENL TtRM CP CONDITION OF NLY CONTRACT OR OTHER DOCJNENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OP L444 PEPLA.N SIPANCE SF FORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERNS EXCLUSIONS AND CONDriON5 O=SJCH C-CRE3ATE LIMITS SHOWNMAY HAVE SEEN REDUCEDBY PAID CLAIMS. BON CUL .— __ POLCrttrol.Irve TL XPIRArOry LTR Ns TYPE OF INSURANCEDATE POLICY NUMBER DATE IMMMONNI DATE IMMIODmI LI GENERAL EACH OCCURRENCE 411,000,000 A X COMMZRCIQG ERx•xur- CBP8055678 08/15/05 08/15/06aRt E E '' 300,000_ ex, 1 miswo- � AI OCCUR L,EDEXP I Essex, 30,000 PERSONAL B/CVIAv,RY I11,000,000 _ - GENZRAL APLOPEGALE 12,000,000 P6,ArLIMIT APPL!ES PER CPO-DUCTS COMPS;-.11 12,000,000 P [ LOC AUTOMOBILEBILE LIABNITY O c .G Lu, 1,000,000 A BA8056178 08/15/05 08/15/06 IEn - - Bt SCREECHED NB OS (Pee ,an) X HRED ALTOS B001LY,N:r.Y (PK...mnO t X Comp Ded 5250 _ RO:EcT'•DIeMGE X Coll Ded $500 (Par acnMnO GARAGE LABILITY AUTO WX.Y-EA..ECIDEct It wvNLTO THAN THA U OON.1 EYCESSIUMBRELLA LIABILITY EACH OCCURRENCEi 1,000,000 A X OCCII> CLAIMS CODE CU8057179 08/15/05 08/15/06 AGOREGAT=_ I 51,000,000 1 7;EDICTS F I IX IRELENrION $10,000 WORRERSCOMPENSATIONAMOX TOORYRYLIAN JIAITS ` EP EMPLOYEAre RS' K-WD%ECUT'VE WC8056578 08/15/05 08/15/06 EL EACHAccDENT I>1,000,000 JF CEEMFEEXCLUDED? E L DISEASE-EA.ECLT 11,000,000 SPECL :Sew D>E PCL,. 000,000 OTHER DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION EVIDEN1 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF.THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS'NRIIIEII NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT.BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY HIND UPON THE INSURER.rrs AGENTS OR Evidence of Insurance REPRESENTATIVES. AUTHORIZED RIfT/E I42 ,Jf [( �� ` ACORD 25 2001/081 ©ACORD CORPORATION 1988