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29-370 (6) 37 AUSTIN CIR BP-2017-0196 GIs#: COMMONWEALTH OF MASSACHUSETTS Map:Block:29-370 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: ROOF BUILDING PERMIT Permit# BP-2017-0196 Project# JS-2017-000329 Est. Cost: $3400.00 Fee: $40.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: SEXTON ROOFING CO 99689 Lot Size(sq.ft.): 13111.56 Owner: O'DONNELL SARA Zoning: Applicant: SEXTON ROOFING CO AT: 37 AUSTIN CIR Applicant Address: Phone: Insurance: P O BOX 6327 (413) 534-1234 WC HOLYOKEMA01041 ISSUED ON:8/15/2076 0:00:00 TO PERFORM THE FOLLOWING WORK STRIP & SHINGLE ROOF 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 8/15/2016 0:00:00 $40.00 212 Main Street, Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner Department use only City of Northampton Status of Permit: Building Department Curb Cut/Driveway Permit !ES 212 Main Street Sewer/Septic Availability Room 100 WatenWeli Availability Qrthampton, MA 01060 Two Sets of Sul mans 3-587-1240 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 Map Lot Unit f�J5�7y-1 Ci xc'/C Zone Overlay District Elm St.District CS District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT ;<.i Owner of Record: ('/ ,S'/49/.t O raannc/I 3- 9 4,047" C--t- (/-e fro -ce/ /,G Nan(Print) Current Mailing Address: l-1-.1-(/vs. Telephone/7 - /�/9 ^ w 9/ Signature 2. tho A en�t:/'J p to I ✓C-cfc1 �'/ij DGS e 6 3 / 12 rd L/49 d/6c// Name(Print) t.... Current Mailing Address: Signature Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS hem Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building (a)Building Permit Fee 2. Electrical (b)Estimated Total Cost of Construction from(6) 3. Plumbing Building Permit Fee 4. Mechanical(HVAC) 5. Are Protection /54° ��/y 6. Total=(1 +2*3+4+6) 31 r�QO Check Number 1�n? 54° This Section For Official Use Only fid¢-- YYYfff / Budding Permit Number: Date Issued: Signature: Buikting Commissioner/Inspector at Buildings Date SECTION S&DESCRIPTION OF PROPOSED WORK(check all applicable) New House ❑ Addition ❑ Replacement Windows Alteration(s) 0 Roofing G Or Doors 0 r Accessory Bldg. ❑ Demolition ❑ New Signs (❑I Decks [q Siding[0] Other(fl Brief Description of Proposed / / / Work: .GYM-1°M /fancrl F4,7,&Pr r�fii.' /ran/ Alteration of existing bedroom Yes ...----17o Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes No Plans Attached Rolf -Sheet sa,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 a. Number of stories? f. Method of heating? Fireplaces or Woodstoves Number of each g. Energy Conservation Compliance. Massoheck 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 Ts-OWNER AUTHORIZATION-TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT C\J p (j t, C J aUF<7< G1 ,as Owner of the subject P /-,c yyy /) /ff hereby authorize c ...y.-1-a1.4. k..) ped'01.c to act o my behalf,in all matters relative to work authorized y this building permit application. 4flr - 9 #J—rl JJ Si stture of Owner / �J Date P7.- 77 i, ykc, c y„ , ..ezte^4 .as OwnertAuthorized Agent hereby declare that the statements and information on a foregoing application are true and accurate,to the best of my knowledge and belief. Signed under the pains and penalties of perjury. o Print Name O .-:----- ---- a-Ce/r� Signet - of Owner/Agent Date • • SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor t Not Appplicablee❑ Name of License Bolder: UG/CaLd ' }C � _ 1fc £ 'r ) // License Number Le Address 41. Erpiralon Date er d ora 5/ Signature Telephone 8. red HOMO I,PRIVement Contractor Not Applicable 0 A. 4,., line f N 1 // Number e om N e Registration N . Erb (et R-1 -/ `7 AddressExpiration Date µnyogM4" ' Q/dt/ / Telephone 0 I/f Z3 t/ 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 V No 0 i i. — Rome 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 he 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_ 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: g 7 ,4,g-J j/ 6-;iC h- The debris will be transported by:: alAy 4 4 i/ 1c 51-e-- The debris will be received by: at/Cdt viva permit number: (�j Name of Permit Applicant ...)� 1Crl0vi) :Facia C Date Signature of Permit Applicant 13rcpoonl SEXTON ROOFING AND SIDING INC W Ww.sextwgioofOf.cor 0/10 Setting the Standard rh,' Lmm_ par — h a a P.O. Box 6327 p. 413.534.1234 Holyoke, MA 01041 1. 413.539.9906 MA FIIC k 118239 iligaiallala SUBMJIr TD eaao'Dewa,Ed= PHONE 517.tlp1S DATE *.IS-t fTBEET 37 Ands Clyde JOB NAME CITY,BIATB,ZIP Dom Ma JOB LOCATION SEXTON ROOFING HEREBY SUIMTT&SPECIFICATIONS AND ESTIMATES POB: I) Strip and remove existing shingles and dispose of in proper landfill.la belt'send metal roof to In Owe and not roofed. 2) Inspect roofing deck sem replan as needed. (82.75 per sq.&) 3) Install is and water shield 3'on encs and M unsexing mei. 4) Install 015 synthetic roofing telt on remaloder of roof. 5) Install new flanges over existing vent stacks. 6) Install ISA Architectural style roofing shingles se per manSactmm'specifications. 7) Install new cap over ridge vent. 8) Supply nmsfactates lifetime warranty and SRC 25 yr. workmanship warranty. All.CONTRACTS INSURED WITH PROPERTY TIABIIIY AND WOI[MAIS.COMPENGATION. IR groan hereby to furnish material and labor-auntie in accordance with the above specifications,for the amount of Three 7h otwnd Four Hundred Dollars(53,400.00)Payment to be made as follows:Due in an upon completion All Hatpin Is a,anatad m it ea gained M week to be wept ova A_Yut'ea wodamube naw wanly o¢dad paints Asp ahatlu or deviating from above sprdBuamf lawn*tan mer Wen be awned very upon minim orders,reed well become an ems mars mar and above the anima¢. M aeeemmn moms®upon Ws,widen a delap beyond .Nose:This proposal may be withdrawn by us if not accepted out Not rewind*an was Mamas doing conwnerina. Owner within(14)days. to pay enpuesSe Ind Is rbc ampymsa and appdmtle leant. EIIIHMERte SI IrgMal The above prim,specific. /dons and conditions am satisfactory and art hereby accepted. You Signature are authorized to the wort as spelled, Payment will be l/� /J _ n.(v / , made as outlined above. signat're I,nGS�y/ E t/y Dam of Mama= e �� Nioc,.x ice i3e /Vs /44- , w , ,. /r The Elfin of 1107ssach✓aegis Deprzh7,_er.; ci 1r4vs`-ha "cciderrs C, Office ofT ve..a ations tgi iConorssStreet Sute100 /= BOST072, 31(940(2_H4-2 a 7 7 Wior±nrs' Compensa_ionTn snranced !avt Ssriljets:Contraetors/Flectrl ci-no;1 tubers ADtlicsnt Information - Please Prlt Lek-adv Nate (3--,ess/O:gz-nno csa±aaJ). Sexton Roof in: & Sidin: Inc . An.rt<s P . O . Box 6327 Ci':,/Stale/Zap Holyoke , MA 01041 PScneki 413-534-1234 a - -a - r:shyer Check Me a :nate bo : ?pe of p s7 c zeerees u Ian ae p'oyer seats. �I egn.wal co ac rare I have;menthe st. ira 5. ❑New summon employe-es MUll m 'o pat-1 h oe)' rs 1 i 2 7 soleero . . puna - Intea o e arta e sheet �Bon e =g '�:.. sS�Je n envoi _,e Lee e s cc._i ea_s tame Do_ tca w =sig fosnat n am ner:ref employees end hake worms' [Nc n innsmse- 9: Ea_..._., �_ o wo�rers' conn.mmu:zace _ P _ equ.edl U -a a a corporator and Ds I I 10 Ele --i ale a=.3 a mike= 3 L I as a homsowa r d_rn wodx n Lan ex s u then i _ J Pisructs4k MpaDS anIra= myself [nut manner' scrap nett of exernplacu p MG iissumene recfa reel c. ;c 4-:4),men-we haus no - employees. 1-No worriers' li.❑ CaSer comp nsuumce roTce3] Sm'znoncmtia- Eechb .,1 mundse� h.steisIslex.towq her enners conpcsmnl i .li bo Wim_ tHom. .ars who Nass a7=raitdiah, myrc ao ilwoILeaktIskimsv.@ide corcractors METs¢Sytau staJr±adi: .gsuch -Coatastsater:heck'bi 'oomut Era:el radaIlia sliest s.loTam the vane e seb-cont-amsr Ira snts atLecaeo Ins Bose ekLa- e 2ioyas. if'Le sem-onracton bave emleyws"Ley ertrradn tosr wad:enJ..oatpolicy v__ Zm-i-m enplallanar Okr..IS v.. ._.mg we-o ca-771(0e ,=On e..,cc c m e- 3_107N ZS 7777rE nolzq mere job -q1r z Compats=e'a ee Policy$s Self-me Inc.k. Eaoza::onD=te: Toe Sia A32ress. - C;w•5mte'Z_v _Me mockers' c= a erna$anpoh v neulmankust axe (Mowing Me ethce number ne e skarion =-e') ZEalare.ao Stnara :overage as reenter under Serum 25A..sf mat. _. 152 saz lead he=ton=of c---tier penal-Les o_est t = up to 51,500.00 oin one-year mp- mute as welas Bun netartesmie of a Slfale woRK opIDER ri±_fa= flak tc I250 00 a nay skean faemonitor.. Be acnsiMa a copy tf as stenen y bs somusettielkCi?os of luvestisktons aI^e DIA for 3smance cctierans ve-fes^01 matte. Date. - - ?hoar: 4135341234 OfJruel use or1y. 'Do hoY verde -re MU era;to be eetrepieted oy sy m town offici cl City or Town: PermIeLicense Lsstang ku'_hority (circle one): - - 1.Board of Health 2-3u]hngDenar`_ent 3. C'ty/=ennClerk 4.Electrissaishaspector- PL.zu¢Inspector 6. Other _ �� Con<actP arson: _Phone l?_ D amt.'s 1 'qyr 'e :i_ Offi0e o jr1,026,5dgivicns - 500 Wasitingion S rat ? Bc ma MA 027 71 t _ Hw'W.Yass.gcv/dia Workers' COUA2e S2ilOf InsuranceAffidavit: Binders/CoutractorsiEtect cians/ Lumbers Aopllcatt_Tnformrat:ion Please Print LeeiLly Name(purioe siDrgatCstionthidi.ddual): 4 i 1„ (nisi` ,f ne i 1 c e„ t�.. ?r% A_ ecE: /)i. ( >lPC. l S` YL // C:r• date/Zip: C/1r_—ee tea! / Lel/ LSI r Pl : n #. /- /'7 - %'u3 He yc an slayer Check the appropriate box: .... _ 7 7 :fp c ctl e n-e0); 1 i lo; n''rh ' 4. lura _ clot anal •en bye pfial on ^ coo-metra hie d ne s h actor_ [3:i'Qev. ._ 2 1 cl„p:m tt orpater- ship '.r- lined on the nal .. i sheet Fiteno i-g ship a.d have no employees +dose rub-ontraeton hme E. E Lteaolid uoldd gg for ne in my capacity' employees and him c others' 9. �'Lsaildithedition -No xt k ;' comp, alance comp ur ncc q igd] 5. [i We a ampo, tion and in 10.j Electhcal terditho ortddirO e r s.❑ Ta a -.me-,an Lama al 0'a ems Sou SAL e tv:; I 1,1=t-L-gterainso a'�ss my " Miami-kat? cornu. eh t - :,,r i n r. its 12 �•Eo fr eel 14511721:105 requiredi; 1 e §. 4) and w, have no „- employees No 7v Dryer, I 13 b{ Other 5 91 Aga omp assuranv ce e,iecl ....,J 'Anvpocant ttatc.,cts box"Ki musta'.xa 51]dot...c maim mica shgwing heir we k_._ ...rgnnvao n;..vy i.,o.:g4ing. gime-own=who sub e9 d,is affidavit indicab:€Int)"ere doing III work andthen bio:ousidv c onoaciors must suimil a new a tart indir�cing push. arontramr;that tied:Egger must attached an ad th rional sh:_l showing rhe name online svb:untaotrn and route whoCwr Or got those:Hugs gzv: ernisicyans If the ruin-soo vaaors hay empl oyss,they must?maids thci r.wmi-rs'comp policy numbs_ _ !am an emaleybr that ' F v ding werhsrs compensation lasurcarce for my_arp(nvess. Barlow is thepolcy cad jcb rite isfortmarlse. / ]arum e Cone ny Name: l='�qq/ 0 n4,--(-,4,;,-1 L,W S . 6-3 Polity a or Self-ins Lic.p: Vw,UC. 1(j/1 (o hie cc?Clea ,A rx_ ator2Gcc ,2)// / 7 7b Sire Ad9rem: - CrytStatc.'Zip: . . .peach a copy cf the workers' compemshon policy declaration page ( howin the policy number nd ethniratioa date). Taihu-a to secure coverage a, egar ei ruder Seotion iSA of BLOT_c L 2 can lead to the:npe idon of cricadizel pens/ides of a fm-up[o til,503.03-thadhas one-Fear.mu:sommeny as well as civil p=aides t the lc=c.a STOP W' . K ORDER anti a.Puc Pict to $250.30 a day arainst$e violeto,. Be advised :het a cosyo:'this gttcment may 1715 rward tc the Omcec= alovesECatous o:tae.DIA for incur antcoverage venfcador Zdo F" 4r5i nailer:ha alas and ip lues ofir „up rib at She tterarrobartoc.arao vaned abevu is.true and comers. 1� Pjjrcle/use an Do eor'1Hjeff in aLt arm,is be unncnleed by cloy or town offk:ioL City or Town: - Permit/Liceose g Issuing Authority (circle one): t.Board o Ee-elth 2. F',uildino Department 3.Ci iTo- n Clerk 4. :El ectica: Inspector S.Plumbing Taspecter G.Other - Contact Person: Phone a: • ACOD f2 ® CERTIFICATE OF LIABILITY INSURANCE DATEozwoo""m Lim„/ 03/182016 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 endorsemen(s). PRODUCER CONAI F:NTACT Leandro Gu'maraes UNIVERSAL INSURANCE AGENCY (v"c."xn Ertl: (508)752-9333 INC,Nm. E-MAIL Dss. leandro@universalinsagency.corn 374 BELMONT ST. INSURER(SI AFFORDING COVERAGE I NAM% WORCESTER MA 01604 INSURER e AIM MUTUAL INS CO 1 33758 INSURED INSURERS: ALG CONSTRUCTION INC INSURER C. I INSURER D'. 116 CHAPEL STREET INSURER E: CHERRY VALLEY MA 01611 INSURER., COVERAGESCERTIFICATE NUMBER: 38399 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 COND'TIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. 1LTRR TYPE OF INSURANCE IINSDI WVo POLICY NUMBER If MMTDY/YYI^RFS. 91(MMrt flIYY'1� LIMITS I COMMERCIAL GENERAL LIABILITY I EACH OCCURRENCE I $ DAMAGE TO REM 0 I CLAIMS-MADE I I OCCUR PREMISES(Ea ocerenrel I $ MED EYP(Any one tortoni S N/A PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER I GENERAL AGGREGATE IS I POLICY FROJECT ILOC PRODUCTS-GDMPIOP AGO $ I OTHER S AUTOMOBILE LIABILITY i COMBINED SINGLE LIMIT ' $ Eaam 1n A N'YAVTO BODILY INJURY(Per person) lS ALLAOWNED i--SCHEDULED N/A BODILYURc INJ '(PeremerD is I 'Dios 'P' NON-OWNED I PROPERTY DAMAGE I S HIRES'AU CS AUTOS ' Pe-accident S UMBRELLA LIAR I OCCUR I EACH!RECURRENCE '.S 'I EXCESS LIAR CLAAMS-MAC-_, N/A ! AGGREGATE I$ DED RETENTIONS 1 $ WORKERS COMPENSATIONi XsTAT(ITE I ALR AND EMPLOYERS'LIABILITY ANYPROPRIETOR/PARTNJLEXECUTIVE Y N ' EL EACH ACCIDENT ' S 1,000,000 A lO-FIICERmnEMSEREXCLUDED, N/A N/A N/A VWC10060199052016A 103/12/2016' 03/12/2017 (MYandatory in NHe 'E.L.DISEASE-EA EMPLOYEES I.000,000 II ,describe DESCRIPTION OF OPERATIONS belowI EL DISEASE'POLICY LIMn I $ 1000,000 N/A I DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,mat be aaaohed II more space Is repulred) Workers'Compensation benefits will be paid to Massachusetts employees only.Pursuant to Endorsement WC 20 03 06 B.no authorization is given to pay claims for benefits to employees in states other than Massachusetts if the Insured hires,or has hired those employees outside of Massachusetts. This certificate of insurance shows the policy in force on the date that this certificate was issued(unless the expiration date on the above policy precedes the issue date of this certificate of insurance). The status of this coverage can be monitored daily by accessing the Proof of Coverage-Coverage Vehncation Search tool at www.mass.gov/Iwd/workers-compensationhnvestigations/. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN SEXTON ROOFING ACCORDANCE WITH THE POLICY PROVISIONS. 102 PINE ST AUTHORIZED REPRESENTATIVE r1 a r et HOLYOKE MA 01041 "x r C Daniel M.Cr4y,CPCU,Vice President—Residual Market—WCRIBMA ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2D14ID1) The ACORD name and logo are registered marks of ACORD .------ 4.1 SEXTO-2 OP ID:ER ATE(ARMR0010111 CERTIFICATE OF LIABILITY INSURANCE DA 07/0112016 07/01/2016 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 pollcylies) 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 Ormsby Insurance Agency,Inc. NAME. Eric Dembinske 698 Westfield St PO Box B PHONE Ent 413.737-0300 ,uc NoI.413-737-0617 West Springfield,MA 01090 EMAIL Eric Dembinske ADDRESS: INBURERIS)AFFORDING COVERAGE NAJC P INSURER A-Atlantic Casualty Ins.Co. . INSURED Sexton Roofing& iding.Inc. INSURER i Quincy Mutual Fire Insurance 15067 PO Box 6327 - - Holyoke,MA 01041 INSURER C INSURER O'. _ INSURER E r INSURER F: I COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES Or INSURANCE LISTED BELOW HAVE SEEN 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. Mek • ADDL URR POLICY POLICY EX LYE TYPE OF INSURANCE IINg.} MM. POLICY NUMBER IMM 7 ?WWI IMM)DDIYYYYI LIMITS A I X,COMMERCIAL GENERALUABIutt EACH OC.RR NCE 5 1,000.000 CLAIMS-MADE I X coons 1010L002159900 0612512016'0612512017 i 5A55 gyyyrtcente" a 100,000 'MED EXP(Any Ana person) $ 5,000 ' PERSONAL&ADV INJURY . 5 1,000,000 IGENL AGGREGATE LAC!APS PER. I I GENERAL AGGREGATE IC 2,000,000 ! PO Tel= I cT I )IDC PRODUCTS i COMPIOP AGO i $ 2,000,000 II I OTHER.. s II AUTOMOBILE LIABILITY COMBINED dED SINGLE:,LIMIT Is 1,000,000 AU B ANY AUTO IAFV206561 05115120160511512017 BODILY PcdUPY(Per person) 5 a1OWNa XjscFF.IY.R.ED t BORAX INNiv(Pei aa'9at) F AUTOS AUTOS X MTOS X ION-OWNED PROPERTY DAMAGE AUTOS re,accident) ., k AIRED AU ,.. I 5 UMBRELLA LIAR (l':ICWR EACH OCCURRENCE EXCESS LIAR I CLAIMS-ADE' AGGREGATE to Ip{ RETENTIONS I 'S I ANY PROPRIYERS'LI COMPENSATION Pet ! SKIT WORKERS COMP - I 'Lmealry MT..E I,,. wPARTNERIEXEOm'NE Yl x I E EACH ACCIDENT I F OFFICER/MEMBER EXCaUDEDa I N 1 A (Mandatory in NHI EL.DISEASE.EA EMPLOYEE a N yes.desalee under OESCRIPTAN Or OPERATIONS micro- i , I 1 E.L.DSEK£-POLICY LIMIT I S I DESCRIPTION OF OPERATIONS i LOCATIONS I VEHICLES (ACORD ICI,Additional Remarks Scbedol4 may be attached:II more space is Hammell I v CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Everett Sexton ACCORDANCE WITH THE POLICY PROVISIONS AUTHORIZED REPRESENTATIVE Eric Dembinske Ni 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 2512014/01) The ACORD name and logo are registered marks of ACORD -E o_ C � ±L.z ?s tic 3 Vl _inn s ,nss ROGFNG CO 2/15/17 EVEP:ETf :;TOP: • -- HO]_v^ I — _ �if101041 Mq ach sz • �p ••a! a2:j ,3'✓% ng uau,.aans ani a.an:inau ,;,icy vimo pec;ass 3S EVEREL ./SEXiON . =E z."; 1 HOLYOKE MC 030gi: :J• m Plc 5ICR�+4.' Ea-ai:c_'G... 50/05/2017