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48-0001
426 LOUDVILLE RD BP-2017-0282 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block:48-001 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-2017-0282 Project# JS-2017-000476 Est. Cost:$8000.00 Fee:$40.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: SEXTON ROOFING CO 99689 Lot Size(sq. ft.): 9191.16 Owner: RASID JESSE zoning: Applicant: SEXTON ROOFING CO AT: 426 LOUDVILLE RD Applicant Address: Phone: Insurance: P O BOX 6327 (413) 534-1234 WC HOLYOKEMA01041 ISSUED ON:9/1/2016 0:00:00 TO PERFORM THE FOLLOWING WORK:REMOVE & REPLACE EXISTING 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 9/1/2016 0:00:00 $40.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner Department use only �Q City of Northampton Status of Permit: ABuilding Department Curb Cut/Driveway Permit cL, o 212 Main Street Sewer/Septic Availability 4 4C. #chN 4`o Room 100 Water/Well Availability �\ Northampton, MA 01060 Two Sets of Structural Plans .24 ': one 413-587-1240 Fax 413-587-1272 Plot/Site Plans 6 � <,$r Other Specify AP'VI ?TION 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 4Qe. L o ve/zi,P% 41 Map Lot Unit AHA ya Zone Overlay District Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: •4?SS A S I b V,2 , 16 u J U;l// � L' iq 1 Na (Print) f� Gwen"fling 75 ' o?‘// t.2.4(cc Ll /r/f"�/0-h(� Telephone Signature 2.2 Authorized Agent: nn Name(Print) Current Mailing Address: 53 / 23 4/ Signature Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building (a)Building Permit Fee 2. Electrical (b)Estimated Total Cost of Construction from (6) 3. Plumbing Building Permit Fee 4. Mechanical(HVAC) 5. Fire Protection 6. Total=(1 +2+3+4+5) 666 • Check Number 153/ 27 This Section For Official Use Only Building Permit Number: Date ssued: Signature: die VeC Building Commissioner/Inspector of Buildings Date SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable) New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing [ h Or Doors 0 Accessory Bldg. El Demolition ❑ New Signs [0] Decks [Q Siding[0] Other[CO Brief Description of Proposed Work: Kewitli e A_Ad . e pale 14 .3-/,...7- Alteration ,a-/,1 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 I, It'S j--e_ 4 S 1 n , as Owner of the subject property hereby authorize S.4.> )6, U eR 6 G C C to act on my behalf,in all matters relative to work authorized I'this building permit application. �nJ f Ag -/ 5 /QC' Signature of Owner Date I, t 4_4-u `l/ SL 18,A) (Anc/ ,as Owner/Authorized Agent hereby declare that th#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. Print Name Signa ure of Owner/Agent Date SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable 0 Name of License Holder: ctEt&# :e License Number Co 3 a 1- l Lio lie , , 4IA i7 Address Expiration Date Signature Telephone 9.Realstered Home Improvement Contractor: Not Applicable 0 41° ti4Vni (86 Cttr1 l/ 39 any Name J Registration Number O . 60x (, 3 )_ 7 a -/s-- /7 Address f / Expiration Date 1-40 I y 6I VV 1 J b t 1/4T I Telephone S3 V/23 V 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 ©r- No 0 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,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: k o v ouil/C id A k'4 / The debris will be transported by: A44/#74 s faj,a- The debris will be received by: o ff1-t /1 SJR Building permit number: Name of Permit Applicant Saj �o ocr/rrt F/251/0 Date Signature of Permit Applicant ill 6 Prred SEXTON ROOFING AND SIDING INC www.sextonroofing.com &IMOMir MASTER 0AFYG 0.�...1rI Ir♦Q�Inty. Setting the Standard wumnF.O. Box 6327 p. 413.534.1234 Holyoke, MA 01041 f. 413.539.9906 MA HIC # 118239 sextonroofin ghotmail.com SUBMITTED TO Jesse Rasid PHONE 617-792-8616 DATE 7-12-16 STREET 421 Loudville Rd Aldi 4I,Q f JOB NAME Purchase Property CITY,STATE,ZIP Northampton,Ma. JOB LOCATION SEXTON ROOFING HEREBY SUBMTTSSPECIFICATIONS AND ESTIMATES FOR:Main House 1) Strip and remove existing shingles and dispose of in proper landfill. 2) Inspect roofing deck and replace as needed. ($2.75 per sq.ft. )Add$2,200.00 for all new 3) Install new metal edging to rakes and eaves of roof. (8") 4) Install ice and water shield on eaves(6'), around chimney, vent stacks, in valleys, and at intersecting roofs. 5) Install#15 synthetic roofing felt on remainder of roof. 6) Install new flanges over existing vent stacks. 7) Install starter shingles on eaves and rakes of roof. 8) Reflash chimney with new lead. 9) Install IKO Architectural style roofing shingles as per manufacturers' specifications. 10)Install new cap over ridge vent. 11) Supply manufactures lifetime warranty and SRC 25 yr. workmanship warranty. ALL CONTRACTS INSURED WITH PROPERTY LIABILITY AND WORKMANS-COMPENSATION. 44 Pr7~hereby to furnish material and labor-complete in accordance with the above specifications,for the amount of Eight Thousand Dollars ($8,000.00) Payment to be made as - tows: Due in full upon completion _ All Material is guaranteed to be as specified. All work to be completed in a i Authorized - workmanlike manner according to standard practices. Any alteration or f Signature deviation from above specifications involving extra costs will be executed only upon written orders,and will become an extra charge over and above the estimate. All agreements contingent upon strikes,accidents or delays beyond Note:This proposal may be withdrawn by us if not accepted our control. Not responsible for water damage during construction. Owner within(14)days. to pay responsible legal fees for non-payment,and applicable interest. The Commonwealth of Massachusetts _ • Department of IndustrialAccidents =1;=.7E=�1 Office of Ircvestigatiohs " i Congress Street, Suite 1OO� it r: Boston, 1102114-1017 • www.mass.g ov/die . . • • • Workers' Comp'ensationlns-aranee A davit:B13alders/Conth-actors/lie ctricians)P1-ambers . A Dlicant Ljlforma-don . • ." Please Priit LeQi11Y • 'Name (Thassesslorganixation/3ndivith al): Sexton Roofing & Siding Inc . . . Address. P .O . Box 6327 City/State/Zip• Holyoke , MA 01041 • Phase#: 413-534-1234- • Are youe employer? Check the appropriate box: ' T}Te•of project(required): 1.❑ I am a ep to er with • 4. N I am a.generalcortractor wadi. employees(full and/or p artiuie).r have hied the.sob-c tractors 6. ❑New constro.Fton 2 I am a soleprop fetor or punier-. listed on-the attached sheet .7. ❑Remodel;-�g = These subcontractors have ' snip andhave no employees 8. ❑Demolition - . workingfor mein anycapacity.... employees and have workers' p 9: 0 Beading addition [No workers' :Drop.its rance comp. insurance# req. ed-] • 5. 0 We are a corporation audits 10.0 Electrical rep s or additions. 3.El :am ahomecwner doing all work officers have.exerciseatheic 11.0 Pluibingrepairs or additions . myself (No wo±a s' comp. . right of exemption per 1' GL • 32.[ Roofrepa;zs • ms mce requirecL]1- - c.152,•§1(4), and we have no - employ -workers'.[No 130 Offer - comp.Msnrance req_utred] - - . TAay apohczitbox r'1 mostalso.fill orat a sectim below showiugtheirwailers'compensatioapolicy information_ - - Homeownerswho si[bmitthis afFdavitindicdig'hey.ardoingall-Feick and tea lire outside contractsmust Omit anew,affidavitindioad -such . Contractors tit check this box-must attached an additional sheet shewMg the name of-the subs and stat whether cc not-hose.endues have i loyees_ if the sub-comae slim employees,they mustproyBetheyr workers'comp,policy number: • 1am an en-Troyer that is providing workers'co7rpersat:on inrL.Tarr.ce for my eir2Zoyees.- Below is the policy wi.d job sae. zrformcdian • . Insurance Company Name: - • Policy#or Self-ms.Lie.#: - . ExpirationDate: • • . • • "Job Site Address: City/StakiZip: a copyof compensation policy declarationage(showingthe olio number and iration date). Attach P P y p gpolicy �P Fare to secure coverage as required under Section 25 A of MGT,c. 152 can leadto the impo steon of criminal penaltes of a • . fine> to$1,500.00 and/or one-yew imprisonment, as well as eiva_pe-ialti es.iQ to f bf a STOP WOR1 ORDER and a•fine ofwp to X1.50.00 a day aga st the violator. Be advised that a copy of this statemen_may be forwarded—to the Office of. - . . Layestigarions offhe DLA.for insurance coverage verification. Ido hereby certify zai.der the pains andpenaldes of pes-joy tkai the i-4 rye ion provided eb oye is tree cid cc-.--.-e,.:1 Simamre: • Dale: . . - P-none#: 4135341234 - . •• . Official use only. 'J)o riot write i�.this awed,to be compteted by city or toivn officiaL ' • . • ' City or Town: . . • - Permit/License# . . Issuing Authority(circle one): . - _ - . 1.Board of Health' 2.BviidingDepartaent 3. City/TownClerk 4:Electrical lnsp.ector.5.Plumbing Inspector . 6. Other . S• - . 'Contact Person: Phone#: •. •• rte\ .b epartne4t.of Industrial Accideras v 0 - '= . t e Office of Inpestigations • . ty` t�bi - 600.Washington gton Street � Fri' , v • Boston,lkfA 02111 - . • �� r a+. : 1••vtl�v,inass.gov/rtia - • . Workers' Compensation Insurance Affidavit: Builders/Contractors/EIectricians/Plumbers A palicant Information . Please Print Legibly . Name(Business/Organization/Individual): i_/ t~ (c,,,i ,(or 4 1 c 1,..) ? C: ,-r . •Addres: //( C t/4 p / s!' • • - ' 6-1G- r! • !1 Ga C City/State/Zip:C br eel./ l£'A LLtf-U.a 14 Phone.#: 6 i 9 - 71 V 3 - i_� 9 . , r r Are you•an,employer? Check the appropriate box: Type of Project-(required): • 1.[ 'I am a employer with . 4. 0 I am a general contractor and I —T— b. ❑New construction+ • • employees(full and/or part-nine) have hired the sub-contractors listed on the attached.sheet. 7. ❑Remodeling 2.❑ I an a sole proprietor or psriner- • ship and have no ernpioyees • These dub-contractors have g, ❑Demolition ' - • worldng forme in n 'capacity.i esnpioyees and have worlkers' - � �' , 9. ❑Building addition [No' workers' co hp.insurance comp. nsurance.t requ±ed] . • . . . 5. 0 We are a corporation and it - 10.0 Electrical repai=s or additions 3..❑ Iam a hor..eowner doing all work • officers have exercised their 11.0 Plumbing repairs or additions - myself. [No workers' comp. . - right Of exemption per 14GL 12.12Roof repairs .insurance required.]t , c. 152, §l(4),and we have no - • employees,[No w ®oriers' 13. Omer 5 id'i i cf • . comp. insurance required.] l 'Any ihat checks box#1 must also fill out the section below showing their workers'compensation policy information. • • 4 Homeowners who submit this affidavit indicating they tare doing all work and then hire outside contractors must submit a.ncw affidavit indicating such. 4Contactors that check this box must attached an additional sheet showing the name of the cob-contractors and state whether or not those entities have employees. E the sub-coaractnrs have eiplcyees,they must piovidethcir worlzrs'comp.policy number. - I am an ent_ployer Chat is providing workers'compensation irsarance for my employees. Below is the policy and job site information. 0• / • . • Insurance Co�anyN e:J/n4 i tM Ad LA'S` , • GO . . Policy#or Self-ins.Lia#: V W 1 1/i Co i GqO b`�o A • apiratioaDate: r j!i Z I/7 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.ofh4GL c. 152 can lead to the i_mpositicn of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment as well as civ-il penalties in the form.of a STOP WORK ORDER and aline • of up to$250.00 a day against the violator. Be advised that a copy-of::-is statement maybe forwarded to the Office of . Investieations of the DIA for insurance cove±ane verification. I do-hereby cerl'ify under the pains and penalties ofperjury that the information provided above.is.true and correct •Simature- Date: . _ Phone 4: IV. 47 - q7.l�. q S 7 • • - J Oficial use only. Do not x-'rite in this area,to be completed by city or town officiaL City or Town: Pertnit/License# Issuing Authority(circle one): . 1.•Board ofRealth 2.Building Department 3.Ci y/Toivn Clerk 4.Electrical Inspector 5.Plumbing Inspector - 6.O.th Other • - 0 ' _ . IContact Person: Phone#: 0 - • AC R @ CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDlYYYY) kiii.--,----- 03,18/2016 THIS CERTIFICATE tS 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 I CONTEACT Leandro Guimaraes NAM UNIVERSAL INSURANCE AGENCY "y; E,Ry: (508)752 9333 -FAX UNIVERSAL "ADDRESS: leandro@universalinsagency.Com 374 BELMONT ST. INSURERS)AFFORDING COVERAGE - NAIC WORCESTER MA 01504 INSURERA: AIM MUTUAL INS CO 33756 INSURED INSURER B: , ALG CONSTRUCTION INC INSURERC: . INSURER D: 116 CHAPEL STREET I INSURER E: CHERRY VALLEY MA 016 I INSURER F: COVERAGES CERTIFICATE 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 0O_ICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OF: MAY PERTAIN,THE INSURANCE AFFORDED BY THE•POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS.AND CONDTIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUER POLICY NUMBER (MMIDOIYYYYl IMMIDD/YYYY)I UNITS UCY EFF POLICY EXP LTR INSO V>`JD' COMMERCIAL GENERAL LIABILITY. EACH OCCURRENCE I $ DAMATO RENTECY CLAIMS-MACE OCCUR „PREMISES(Ea existence' ' S I MED EXF(Any one person) S 1 N/A -PERSONAL&ADV NJURY S GEN AGGREGATE LIMIT APPJES PER _GENERAL AGGREGATE $ CY , POLI � I LOC i PRODUCTS-COMP/OF.AGO $ JECOT ,OTHER: I S AUTOMOBILE LIABILITY , COMBINED SINGLE LIMIT $ .(Ea aazderr;l ANY AUTO BODILY INJURY(Per person) S ALL OWNED SCHEDULED AUTOS .AUTOS N/A BODILY INJURY(Per accident) $ NON-OWNED PROPERTY DAMAGE $ . HIRED AUTOS AUTOS (Per a:ddent•. $ UMBRELLA UAB OCCUR I I EACH OCCURRENCE S EXCESS LIAB I C'_AIMS-MADEN/A AGGREGATE S _ DEC I RETENTION S S WORKERS COMPENSATION X SU-Inc I Eqµ AND EMPLOYERS'LIABILITY A OFCEOR/MEMB=P,EXCLJO D7 CUTIVE WA N/A N/A VWC10060199052016A 03/121201o'.! 03112/20171 E.L.EACHACCOENT $ 1,000,000 - (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE, $ 1,000,000 If yes,aescrlbe under DESORPTION 0-OPERATIONS below I E.L.DISEASE-POJCY LIMT $ 1,000,000 _ N/A I - DESCRIPTION OF OPERATIONS 1 LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if morespate is required) 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 Verification Sear&tool at www.mass.gov/lwd/workers-compensation/investigations/. 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 - AUTHORQED REPRESENTATIVE OLYOKE MA01041 , (- �I Daniel M.Cr vey,CPCU,Vice President-Residual Market-WCRIBMA I ©1988-2014 ACORD CORPORATION. All rights reserved. /r'1rl4 A1r1d1 Tha ACORD name and Togo are registered marks of ACORD �"� SEXTO-2 OP ID: ER ACORO DATE(MM/DO/YYYY) �� CERTIFICATE OF LIABILITY INSURANCE 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 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 NAME:CONTACT Eric Dembinske Ormsby Insurance Agency, Inc. PHONE FAX 698 Westfield St PO Box 71 B (AIC,No,Ext:413-737-0300 (,q/C,No):413-737-0617 West Springfield,MA 01090 E-MAIL Eric Dembinske ADDRESS: INSURERS)AFFORDING COVERAGE NAIL# INSURER A:Atlantic Casualty Ins.Co. INSURED Sexton Roofing&Siding, Inc. INSURER B:Quincy Mutual Fire Insurance 15067 PO Box 6327 Holyoke, MA 01041 INSURER C: INSURER D: INSURER E: c, INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: -HIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE-BEEN ISSUED TO THE INSURED NAMED ABOVE FOR T-IE POLICY PERIOD INDICATED. NO-WITHSTANDING 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 ANC CONDITIONS-OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. . INSRTYPE OF INSURANCE (ADDL SUBR POLICY EFF POLICY EXP LTLIMITS R IINSD IWVD POLICY NUMBER (MM/DD,'YYYY) IMM1DD/YYYY) A X COMMERCIAL GENERAL LIABIUTY EACH OCCURRENCE $ 1,000,000 1 C-A IAS-MADE X OCCUR 101GL002159900 06!2512016 06/25/2017 ii:VIVA af2E cuErrencel $ 100,000 MED EXP(Any one person) $ 5,000 _ PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY JECOT- LOC PRODUCTS-COMP/OP AGG $ 2,000,000 —I OTHER: $ AUTOMOBILE LIABILITY I COMBINED SINGLE LIMIT $ 1,000,000 (Ea accident) B 7 ANY AUTO AFV206561 05/1512016 05/15/2017 BODILY INJURY(Per person) S _ ALL OWNED X SCHEDULED BODILY INJURY(Per accident)' $ AUTOS AUTOS X ' HIREDXNON.OWNED PROPERTY DAMAGE $AU-OS AUTOS (Per acodent) jl $ UMBRELLA LIAB I OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE S DED RETENTION$ I S WORKERS COMPENSATION. PER0TH- AND EMPLOYERS'LIABILITY Y/N STATUTE I ER ANY PROPRIETOR/PARTNER/EXEC'UTIVEN 1 A E.L.EACH ACCIDENT S OFFICER/MEMBER EXCLJDED7 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPT}ON OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS 1 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 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Everett Sexton ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Eric Dembinske 1 ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD • • • • 1 Ca ��it 4 .ce of Gon —„qtr d -as ass Re�_1a on , - • . . l� - • 3os�o :�` r ��s D�11b . - Hone T n rI oT r ; `e.:Re ation -.. , • - - _ 1 • • _-__ --- -- . Regi-ii- oto tia?3s - - `��' r. try 2%15/I7 Tr4 227SS5 • SD�QN ROOFING CO - --- .-_,—.____-7-___-.•-____ • . • EVERL t ! SDCTON - _ P.O. BOjr\.6?,27 H0LYf3Y,E, MA 01 D1 _ ?B-C.ii to> -04)04-81X.216 - - - - — - - -- . i • ;,. Massachusetts Department of Public Safety • ) •:lBoard of Building Regulations and Standards. - License: CSSL-099689 Construction Supevisor Specialty ..-__•1_,--4., """ r'- PO BOX 6327. '., 1.._ — r `= HOLYOKE MA•02104-1-V.-- — -::s • ML""r` Ci Expiration: Commissioner 10105/2017 . • • • • • • \ •