Loading...
17D-012 (60) 491 BRIDGE RD#1301-1302 BP-2017-0804 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block: I7D-012 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-2017-0804 Project# JS-2017-001341 Est.Cost: 55775.00 Fee: $100.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: ADAM QUENNEVILLE 070626 Lot siae(so. ft.): 1169150.40 Owner: MEADOWBROOK PRESERVATION ASSOCIATES LTD PARTNERSHIP Zoning: URB(100)/WP(28)/ Applicant: ADAM QUENNEVILLE AT: 491 BRIDGE RD #1301-1302 Applicant Address: Phone: Insurance: 160 OLD LYMAN RD (413) 536-5955 () Workers Compensation SOUTH HADLEYMA01075 ISSUED ON:12/29/2016 0:00:00 TO PERFORM THE FOLLOWING WORK:STRIP EXISTING ROOF ON BACK SIDE ONLY & INSTALL NEW ASPHALT ROOF SYSTEM ON BACK SIDE ONLY 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 Occu.anc Si•nature: FeeTYpe: Date Paid: Amount: Building 12/29/2016 0:00:00 $100.00 212 Main Street, Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck- Building Commissioner Versionl.7 Commercial Building Permit May 15,2000 _ a Department use only 2. -- Cityof Northampton stabs of Perron: Building Department Curb Cut/DrivewayPermit '^� _ 212 Main Street Sewer/Septic Availability c--- Room 100 Water/Well Availability -- _ -iis Northampton, MA 01060 Two Sets of Structural Plans 413-587-1240 Fax 413-587-1272 Plot/Site Plans Other Specify APPLICATION TO CONSTRUCT,REPAIR,RENOVATE,CHANGE THE USE OR OCCUPANCY OF,OR DEMOLISH ANY BUILDING OTHER THAN A ONE OR TWO FAMILY DWELLINGC SECTION 1 -SITE INFORMATION £p_ (7- go LL 1.1 Property Address: This section to be completed by office 491 Bridge Rd. Units#1301-1302 Map Lot Unit Florence MA 01062 Zone Overlay District Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: POAH Communities, LLC 3100 Broadway Suite 1234,Kansas City,MO64111 Name(Print) Current Mailing Address: 413-777-1506 Signature Telephone 2.2 Authorized Agent: Adam Quenneville Roofing &Siding Inc. 160 Old Lyman Rd South Hadley MA 01075 Name(Print) Current Mailing Address: 413-536-5955 Signature Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building 5775.00 (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) 5775.00 Check Number /01./49 111/CP This Section For Official Use Only Building Permit Number Date Issued Signatu � /9 — 29/K Building Commissioner/Inspector of Buildings Date Versionl.7 Commercial Building Permit May 15,2000 SECTION 4-CONSTRUCTION SERVICES FOR PROJECTS LESS THAN 35,000 CUBIC FEET OF ENCLOSED SPACE Interior Alterations ❑ Existing Wall Signs 0 Demolition Repairs Additions ❑ Accessory Building 0 Exterior Alteration ❑ Existing Ground Sign❑ New Signs❑ Roofing® Change of Use❑ Other❑ Brief Description Enter a brief description here. Of Proposed Work: Strip existing roofing on back side only and install new asphalt roof system on back side only. SECTION 5-USE GROUP AND CONSTRUCTION TYPE USE GROUP(Check as applicable) CONSTRUCTION TYPE A Assembly A-1 ❑ A-2 0 A-3 ❑ IA I 0 A-4 ❑ A-5 0 1B ❑ B Business ❑ 2A ❑ E Educational ❑ 2B I ❑ F Factory 0 F-1 0 F-2 ❑ 2C ❑ H High Hazard ❑ 3A 0 I Institutional 0 I-1 ❑ 1-2 0 1-3 ❑ 3B ❑ M Mercantile 0 4 ❑ R Residential ❑ R-1 0 R-2 ❑ R-3 0 5A ❑ S Storage ❑ S-1 ❑ S-2 0 5B I ❑ U Utility ❑ Specify: M Mixed Use ❑ Specify: S Special Use ❑ Specify: COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATIONS,ADDITIONS AND/OR CHANGE IN USE Existing Use Group: Proposed Use Group: Existing Hazard Index 780 CMR 34): Proposed Hazard Index 780 CMR 34): SECTION 6 BUILDING HEIGHT AND AREA BUILDING AREA EXISTING PROPOSED NEW CONSTRUCTION OFFICE USE ONLY Floor Area per Floor(sf) 1't 2nd 2nd 3m 3 4th 4a Total Area(sf) Total Proposed New Construction(sf) Total Height(ft) Total Height ft 7.Water Supply(M.G.L.c.40,§54) 7.1 Flood Zone Information: 7.3 Sewage Disposal System: Public 0 Private 0 Zone Outside Flood Zone❑ Municipal 0 On site disposal system Versionl.7 Commercial Building Permit May 15,2000 8. NORTHAMPTON ZONING Existing Proposed Required by Zoning This column to be filled in by Building Depamnent Lot Size Frontage Setbacks Front Side L: R: L: R: Rear Building Height Bldg.Square Footage Open Space Footage (Lot area minus bldg&paved parking) #of Parking Spaces Fill: (volume&Location) A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO O DONT KNOW O YES O IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO O DONT KNOW O YES O IF YES: enter Book Page and/or Document# B. Does the site contain a brook, body of water or wetlands? NO O DONT KNOW O YES O IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained O Obtained O , Date Issued: C. Do any signs exist on the property? YES O NO O IF YES, describe size, type and location: At entrance D. Are there any proposed changes to or additions of signs intended for the property? YES O NO Qi 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 O NO Q IF YES,then a Northampton Storm Water Management Permit from the DPW is required. Version1.7 Commercial Building Permit May 15,2000 SECTION 9-PROFESSIONAL DESIGN AND CONSTRUCTION SERVICES-FOR BUILDINGS AND STRUCTURES SUBJECT TO CONSTRUCTION CONTROL PURSUANT TO 780 CMR 116(CONTAINING MORE THAN 35,000 C.F.OF ENCLOSED SPACE) 9.1 Registered Architect: Not Applicable 0 Name(Registrant): Registration Number Address Expiration Date Signature Telephone , 9.2 Registered Professional Engineer(s): Name Area of Responsibility Address Registration Number Signature Telephone Expiration Date Name Area of Responsibility Address Registration Number Signature Telephone Expiration Date Name Area of Responsibility Address Registration Number Signature Telephone Expiration Date Name Area of Responsibility Address Registration Number Signature Telephone Expiration Date 9.3 General Contractor Adam Quenneville Not Applicable ❑ Company Name: Adam Quenneville Roofing 8 Siding Inc. Responsible In Charge of Construction Adam Quenneville Address 413-536-5955 Signature Telephone Versionl.7 Commercial Building Permit May 15,2000 SECTION 10-STRUCTURAL PEER REVIEW(780 CMR 110.11) Independent Structural Engineering Structural Peer Review Required Yes O No O SECTION 11 -OWNER AUTHORIZATION-TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT POAH Communities, LLC ,as Owner of the subject property hereby authorize Adam Quenneville Roofing 8 Siding Inc. to act on my behalf,in all matters relative to work authorized by this building permit application. See Contract i> a'1 I to Signature of Owner Date Adam Quenneville ,as Owner/Authorized Agent hereby declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge and belief. Signed under the pains and penalties of perjury. Adam Quenneville Print Name Signature of Owne/Agent Date SECTION 12-CONSTRUCTION SERVICES 10.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Hpltler. Adam Quenneville CS070626 U License Number 160 Old Lyman Rd South Hadley MA 01075 8/21/17 Address Expiration Date 413-536-5955 Signature Telephone SECTION 13-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.152,§25C(6)) Workers Compensation Insurance affidavit must be completed and submitted with this application.Failure to provide this affidavit will result in the denial of the issuance of the building permit. Signed Affidavit Attached Yes ® No 0 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: 491 Bridge Rd. Units#1301-1302 Florence MA 01062 The debris will be transported by: USA Hauling &Recycling Inc. 15 Mullen Rd Enfield, CT The debris will be received by: USA Hauling &Recycling Inc. 15 Mullen Rd Enfield, CT Building permit number: Name of Permit Applicant Adam Quenneville Roofing & Siding Inc. Date Signature of Permit Applicant ACORO oe CERTIFICATE OF LIABILITY INSURANCE DATE IMWDDYYYY3 6/24/2016 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 poficy(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). CONTACT PRODUCER Melinda Karakuls _BANS_—. _... Gass A McLain inavzanco Agency PRONE (413)539-7355 I, „o,,9131536.12es 1767 Northampton Street kgss;mkarakulaNgaasowlain.nom P 0 Box 1128 INSURER{S)AFFORDING COVERAGE_ Nan a Holyoke MA 01091-1128 INSURER A Nautilus Ins Company 1 INSURED IN$URERB AIM Mutual In_a,Co I Adam Ouennevilie Roofing & Siding Inc INSURER C: 160 Old Lyman Road INSURER°: INSURER I South Hadley MA 01075 INSURERE COVERAGES CERTIFICATE NUMBER:CL1662403220 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. NOTWTHSTANDING ANY REQUIREMENT,TERM CR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT HATH 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. WHAT TYPE OFINSUMNCE 1.0511§B .S , EDUCT POLICY UP — -� LIMITS - — r ICY NUMBER MM!DD e M X I COMMERCIAL GENERAL LIABILITY 1,000,000 EACH OCCURRENCE_ f 5 °TAT 6EiD REMf1b A 1 I CLAMS,MADE ( X <>Ca2 1 % CREiMISEStE achEr xM IS 100,990_ 1 NN6e5342 6/23/2016 1/23/2017 MED E PIA y one person) 'S 15.000 i I PERSONAL a ADv wJunr a 1,000.909 GENT AGGREGATE LIMIT APPLIES PER 1GENERAL AGGREGATE $ 2,000,000 x POL CY '�O III 1 [PRODUCTS COMP/OP AGO IS 2,000,000 I IOTHER. I IEryWfEE Benefits oT 1,000,000 I AUTOMOBILE LABILITY ICOMBINEDSINGLE VMIT $ IlEa accident) 1ANY AUTO i I BODILY INJURY(Po person) IS — ALL OWNED I SCHEDULED - - --- AUTOS AUTOS "HOOILV INJURY{P rncdtl n 5 INOMOWNE_D PROPERTY DAMAGE �e !HIRED AUTOS __ I AUTOS ! .UndennsureorroEnst El split IS .UMBRELLA OA3 OCCUR 1 EACH OCCURRENCE 15 1.000,000 o X_ESCESS LIAR X1 CLAIMS-MADE . i AGGREGATE 5 •CED I X I RETENTIONS 10,000 ! I AN03062] 5/13/2016 8/13/2019 $ ABILITY AND EMPLOYERS' RTNERI .NIA. ANC900991dBdl-2016A I EL.EACH;A °R I WORM ERS COMPENSAnDN ANY RRIMEMMORIPXCLUDEIXWOTIVc Y/XI I �EI.EACH ACCIDENT 5 3,000,000 OFm/bieMEMNH)ER EXCLUDED'+ y 14/29/3016 4/29/2017 IEL DISEASE-EA EMPLOYE $ 1,000,000 I) I(fy 56tloryIn NN) 'G 'II POuMe, DESCRIPTIONr OF OPERATIONS LNOw GI DISEASE-POLICY LIMIT IS 1,000,000 DESCRIPTON De OPERATIONS/LOCATIONS/VEHICLES (ACORD101,Additional Remarks Schedule,may be attached If Mete space le relit/Wed) Certificate holders are additonal insured on the above captioned GL policy; subject to policy forme, conditions, and exclusions. Adam Quenneville, as an officer, is excluded from the Workers Comp policy. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS, AUTHORIZED REPRESENTATIVE !�j// � M Karakula/MINDY /"�/ / -< rA.1? —ZAA___. 01988-2014 AGGRO CORPORATION. All rights reserved. AGGRO 25(2014/0t) The ACORD name and logo are registered marks of ACORD INSO2S xmRl. The Commonwealth of Massachusetts ; . f Department ofIndustrial Accidents Eta t1 4 1 Congress Street,Suite 100 vat Boston,MA 02114-2017 www.ntass.gov/dia Workers' Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legiblq Name (BusmessrorganizationRndividual): Adam Quenneville Roofing &Siding Inc. Address: 160 Old Lyman Rd. City/State/Zip: South Hadley, MA 01075 Phone#: 413.536.5955 • Are you an employer?Check the appropriate box; Type of project(required): L®I am a employer with 15 employees(Poll and/or pan-time)' 7. Q New construction 2,0 I am a sok propnctor or partnership and have no employees svoddmig Pam nit in 8. O Remodeling any capacity.[No workers'camp.insurance required] 3.0 I am a homeowner doing all work myself[No workers'comp.insurance required.] 9. ❑DemOhtiOn 4 D am a homeowner and will be hinng contractors to conduct all work on my property. I will 10© Building addition ensure that all contractors either have workers'compensation insurance or are sole II.i Electrical repairs or additions proprietors with no employees. 12EPlumbing repairs or additions 5.fl I am a general contractor and I have hired the sub-contractors listed on the attached sheet, 13.®Roof repairs These sub-contractors have employees and have workers'comp.insurance) 6.0We arc o corporation and its officers have cimmised their right of exemption per MGL c 4.0Other 152.§i(4},and we have no employees.INC workers'compinsurance required] 'Any applicant that checks box#1 must also till out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. (Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities hate employees. If the sub-contracmrs have employees,they must provide their workers comp.pokey 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: AIM Mutual Insurance Policy N or Self-ins.Lic.#: AWC4007012861-2016A Expiration Date: 4129/2017 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 NIOL e. 152,§25A is a criminal violation punishable by 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 fine of up to$250.00 a day against the violator. 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 5 aides of perjury that the information provided ab.ye is true and correct Sienature; J Date: phone#; 413.536.5955 Official use only. Do not write in this area,to be completed by city or town official. City or Town:J. Permit/License# Issuing Authority(circle one): I.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other • Contact Person: Phone#: Massachusetts Department of Public Safety V Board of Building Regulations and Standards License: CS-010626 Construction Supervisor ADAM A QUENNEYILLE 189 OLD LYMANRD / r C. }} SOUTH HADLEY MA, I j CC— 4l M-%r k . Expiration: �G Commissioner 081212017 Is'- 1_ r �Jt�� (r-fir li7 J71Ot/114rrZflJ't. F ��t f[.;JF(!'li ieoe B J, Office of Consumer Affairs and Business Regulation 11 .1 10 Park Plaza- Suite 5170 . i'l- <r .r, Boston, Massachusetts 02116 I Improvement Contractor Registration Registration: 120962 Type: DBA Expiration'. 3/25(2018 Tre 419291 ADAM QUENNEVILLE ROOFING ADAM QUENNEYILLE 160 OLD LYMAN RD --- -- - ----- - SO. HADLEY, MA 01075 __..__ _.. _ Update Address and return card.Mark reason for change. �� Address �, Renewal Employment (� Lost Card SCA I 0 20M nil f- � -� x s r r a t! }� b QT gt.'K . ttC' yr;1t *.6`=_'..d�1p' 't' `.C' '!. .'1 1C .t' :+,1: .SLI._ g_11� 1+' 'i' t +.er' , C_':�C T . 1 STATE OF CONNECTICUT + DEPARTMENT OF CONSUMER PROTECTION ` y� a Beit known that tati ADAM QUENNEVILLE : 'i 160 OLD LYMAN ROAD SOUTH HADLEY, MA 01075-2632 ,` 1 sel ' 1s certified by the Department of Consumer Protection as a registered iii HOME IMPROVEMENT CONTRACTOR + - Registration # HIC.0575920 a ADAM QUFNNEVILLE ROOFING a 7 .�, Effective: 12/01/2015 Expiration: 21/3012016 k -. s' .10 ratan.A.I latris,Cnaunaninuet R �v.eh/.4J.:✓✓\.,i�t''/\,../ via✓`..,''14 l „ .L' lw .. !., :11. e s , . Exhibk O Contract Not t21._., Cotaamityt aueao.eiert}p n+rw AGREEMENT BETWEEN OWNER AND CONTRACTOR—FORM B THS AGREEMENT Is made and entered into between a awrew.w.e.Paeaa ( "Contractor") and wwmnrmarr ewnna,wwr p'Owner"). Owner Owns the Property known as n..eran.esveew.ew loured at am Mtge Reed Fkneu,eat MOW (dm'Property", Owner shall act through in agent,POA14 Communities,LLC(the"Agan[. Owner and Contractor agree as follows I. SCOPE OF WORK(See Exhibit_) 2. PAYMENT. To receive any payment,Contractor must submit to Owner an invoice detailing the labor,sondem or materials *cagy provided for Work perfomlad Owner may withhold any payment If there Is tldective Work that has not been remedied;if third parries have Fled or have threatened to file chinas or NMI If the Contractor has failed to pay subcontractors for labor minerals or equpment Y damage has been caused to the Owner or another contractor:If Conoaaar his to submit an involve as required by the terms of this Agreement. (See Exhibit ) 3, TERM. This Agreement will be eflealve from 12043'a through 003112017 .The Term of this Agreement will not be longer than 12 smmadu. 4, CONTRACTOR O%IGATIONS A. Contractor shall require each subcontractor to be bound by this Agreement to the extent of the Work performed by such subcontractor,and shall obtain from every subcontractor or other hired party an executed contract materially mid subsandegy similar to this Agreement E. Contractor shall obtain,at its own expense,all permits end licenses and agrees to pay all royalties that may be necessary. Contractor dull ere notices and comply with ail building codes,lout ordinances,lawd rules,regiatoa and orders olany public authority. The Work shall not be accepted until Owner.Agent and all pubflc authorities have inspected and approved the Work and any certificates of occupancy amflor fuel inspection certificates are Issued. C. Contractor guarantees Si materials and equipment incorporated in the Work will be new and of good quality and free from faults or defects,and that all the work shall be hoe from defects in workmanship and materials for period of at least one year from the date Owner accepts the Work and promptly upon Owner's request,Contractor will correct by repair or rephctmma,without dage,any such defects and damage to other property. Addldoaiy,rroterWslequipnent warranty provided by the manufacturer of said mate,IaWequlp ant Is to be for at least one year from de due Owner accepts the Work Where any governmental bodies or agendas reguhtgg Owner's operations require beyond said periods. Contractor's obligations shall remain In effect through such extended period of time D. All changes in the Work shall be authorized only by writing stied by the Owner. In the absence of such spaded change order, such work shaft be considered to have been performed as part of the original Agreement without adddond compensation. E. All Work wig be completed during the hours of 840 a.m.and Sade p.m,Monday through Friday. F. By signing this agreement.Contractor warrants that none of Contactors employees or owners are related whether by marriage or blood to Owner or Agent employees.or who otherwise have a personal or business relationship with an Owner or Agent. My exceptions must be dhdaed to Owner In writing and executed via an addendum to this agreement by Contractor and Owner. G. By signing rids contract the Contractor we;enure that any employee,sub-contractor or person under their direction as an employee or paid Individual who does business and or provides services to our companies and prapmtlea I. That each person under the Vendors direction has a clear criminal record that the Criminal record Is not mere than 12 months old.that there are no felony convictionsfor the past7 years.and ROAN Communities,t1C January 201 S �(�///�,,,.yF; Page I of 3 Initials: Contractor, AgendfMner(vi 2 That each person under the Vendor's direction has a dear record relative to the national registry of ser offenders by a third parry verification company,that the rations(frigidly of sea offenders record Bleck Is not more than 13 months old,and H. Kickbacks and inappropriate Errors to POAHC/POAH members are not permitted If a POAHC/PORN member asks for money.gifts,favors,those requests wlfi not be honored.The Vendor wifi report such activity co Lauri Brown at 816-886 4119 or gsroy6®ooahccommunmesetlm. 5. INSURANCE Contactor shall submit an Acord Insurance Cerdiate demonstrating the below coverages. The cmd4aa holder shall be Owner's name and address and shall provide 30 days'written analbdon node to Owner. All policies shall waive subrogation in favor of the Additional Insured. Owner reserves the right to modify the insurance requirements as Owner reasonably sees fit. A. General Lability. Contractor shall maintain an occurrence-based Commercial General Ebbing coverage Such coverage Mai be prnary and ,and than include but not be gndod to.freasa/Opeadoa,ProducanComAated Operations.Personal and Advertising Injury, Independent/Subcontractor Liability.Mabee Equipment Liability and Blanker Contractual LiabIky. The Additional Insureds as described in the ndenmmadon section shall be named as additional insureds /or ongoing and completed operations. Products Wbiky coverage shall be maintained for six years akar completion of this Agreement with mins indicated below.which Mai survive this Agreement. Coverage Mai be in form no less broad than the most recent version of ISO CG 00 01. I Unlit= $1,000.000 Each Occurrence ilk $1000.000 General Aggregate(shall apply on a per protea bels) XL lNlaaiOperanons 0s B. Automobile liability. Contractor shall $1.000.00 of Commorcbl Automobile Liability Insurance covering ail owned nomowned and aired automobiles. C Workers Compensation and Employers Liability. Conrncor shall maintain Workers Compensation coverage cwnplant with the jurisdiction In with the work will be performed and the following!knits of Employers Walk I. $100.000 Each Acddant i. $100.000 Disease-Policy Umit Ill. $100400 Disease-Each Employee Worker Compensation and Sole Proprietor.Contractor agrees that by entering Into this Agreement.Contractor has represented to Purchasers that Contractor Is a sole proprietor, does not have employees and is not an employer. Contractor represents that under the sate laws in which services will be performed Contractor has verified Contractor Is not subject to workers compensation or employers liability laws. Should a court of competent jurisdiction astir from Purchasers to Contractor benefits Including but not limited to workers compensation.unemployment nwnna,'odd security or other benefits.Contractor will Indemnify Purchases for such benefits. D. Property or Inland Marne Contractor shag purchase and maintain"sped]ferns causes of loss'Insurance coverage for its own equipment and property at repbmrnent cmc Coverage Mag Include loss to equipment and materials to be Installed or used h the Work whore title has=passed to the Owner. 4. PREVENTION OF UENS. Contractor agreed to pay when due all claims of subcontramn and others for tabor.materiab, services or equipment for the performance of Work and to prevent the filing of any las by mechanic or materi]men or amdnoms.pruishosents or amts,dam,security Interests or encumbrances affecting tide to the Property upon which the Work Is performed. Contractor agrees within fifteen(15)days after notice Is mailed to Contractor to cause any such suit or lien to be dismissed or remand from the Property and to pay all expenses for,and on Staff ofOwner,including asoney fees and expenses to be dismissed or removed from the Property. Contractor further agrees that no Hens or judgments shall attach to the Pmpety owned by Owner by virtue of Work done by Contractor or by any supplier.employees.material men or sub- subcontncor employed by him,and Contractor warrants that all suds parties shall be advised of these tram and bound by the provisions of this section. Contractor area to provide waivers and releases of Bea from Contractor and a macomaactars and suppliers of Work under this Agreement and any other evidence In a form satisfactory to Owner demonstrating that all labor,ll ata8.bis,invoices.pairai axe of any kind and any other indebtedness beamed by Contractor up to and%dulling the date of Invoking have been pad In rap prior to or in exchange for final payment to Comrractor. S. INDEMNIFICATION, To the fullest extent permitted by law,Contractor shall indemnify.defend and hold harmless Owner,its partners,the Agent.parent companies.subslday companies and other alta%directors,csntromag persons.and ahtdars. partners,employees and affiliates(collectively,tre Additional bitted)f om and against any and al claims.damages.losses.costs FOAM Camrm W des.ac January 3015 Pagel of3 mitalr, ContractorjvQr.— AgenrtOwnerKN and expenses whenever incurred including but nos lwnited to,reasonable atmmeyh fees.arising directly or indirectly out of any kind and natura whatsoever.including without limitation claims,damages costs and expenses attributable to injury.loss of use or destruction to tangible property.bodily injury.Within,disease or Oath or resulting in whole or in part from the Work or incurred by reason of a breach by Contractor.its subcontractors.their agena or anyone directly or Indirectly employed by any of them,or by anyone for whom acts of them nay be gable This indemnification shall survive this Agreement. 6. OWNER GARRI Y. Contractor shah not bring claps or iawwlts under or related to this Agreement against any principals. employeek agents,officers.directors,stockholders,controlling person,partner or affiliates of Owner or Agent Contractor further agrees Nat the sole and exclusive remedy of Contractor fa payment anther performance of this Agreement shall be against the assaa of Owner. In no event dug the Owner be gable to Contractor for en amount greater than the Contract Sum. 7. OWNER'S RIGHT TO TERMINATE. Owner,at its sole discretion may trmirete this Agreeement at any rime. Upon any termination of this Agreement,Contractor shall be entided to payment for all accepted Work finished or awaited. B. MItrFELANEOUS A, Nothing contained In this Agreement shall he construed to create the relationship of employer and employed,principal and agent.partnership or blest venture between the parties,it being understood that the 04 relations between the parties Is that Contractor is an Independent contractor of Owner, Nothing contained In this Agreement shall create any contractual or other relationship between Owner and any wbcontractar or suppler. Should a court of competent jurisdiction assign such bendRts from Owner or Agent to Contractor or sub-contractors.Contractor will Indemnify Owner or Agent for such bent B, This Agreement shall be construed in accordance wkh the laws of the State where the Work is to be petit.m.d C. This Agreement and as the representations warranties and conditions shall be binding upon and inure to the benefit of the parties and their respective heirs,executors,administrators,assignees and other successors In Interest IN WITNESS WHEREOF,the parties have executed this Agreement as of the__day of OWNER: CONTRAlit By. POAH Communities,LLC By. LiG_.... 3100 Broadway,State 1331 Kansas Cies,MO 64111 as'o.,'.a'MA*saemt"„"'cs"."'.s•'. As Agent for Owner 4.1; It r By / u.enlwwaesy- Semi Rigiawr°) nnn RwgionW3wrv4v aanawe.rnw.r (Print Name and Tide) (Print Name and Tide) Check Applicable Attachments to this Contact Q Scope of work M ProjectspedkaSons ® Otter Cost Is not to exceed$5775.00 O Other O Other POAH Communities,ttC jamary 2015 J` Page 3 of 3 halals Contractor AgentOwnoX -'"—''"510$1143/450012041r0 'aaavufga4.1."I ISII anTAIWP ayapnwaw. N WO rynWIIOW eupunan0 WOW WOOmoppa meet glNMtit ByWa MP 40 num,Swoons Amapa an tin Nip azuv Whams.YC.bhow Mal Artrillsieltponnad IraaafnwaW<9pNMOMd1 N011N3UT >,s«nawmm_.gc_._umwna (slum slppuuutOOnlagy lau.N lNI ..1"" aIOwVA" 'n0. -�":aawWq .0.a W11I4 WRutln M w9N paWAPwO"OP de N Mw1u { OTCOV953 zit/W.491461p v0.=WWI 'PONS/n wan maw.va'agt— •.evv Mown. W'SlL'{ tIawaked uw➢ va9aImP L4m*I'-ne sq4.t141bY Ia.MgRTT' 0074125 a:aa owl r••+Nnwnnm*•w•ww+w.y.•0.-Wvwlaww.bwu.me+x —:N6AlwuuaW swttne w;N%00 0DOEIPtionC tOppnhII 0 wucM nota Irma MINN S 40•41,grOrwa9 1ww19 C1 kaA•N1'w•Rou,w#iM100161ftaWOg10 driMo.sOImaW 0 MOO rinP96nn0 w16Egn18R31111eM O ONgntlmWMppea)c tapepuquwmaa urn NuweMGRIMM W14o9sv AwweM V46 104,05 ern (apAfllIleJJt*ma WI)Dem MYO1 gtlptale*JAlOMmoµamt.)am X :rvnpaOAWn+nM a$4.4sautam ous -OM num 05 0 'tang X meds[ 0 t uNS yagywa0 IalaRialaflRup wrrotas Sapnq! in6/MISS 4/PIIw[gn]/ANuno nwS-110^apptlgwl X MWvaAewaAJ Sullies low aga,Nn Mut X sopa aim Pm roma Oil w tali*alas SAThrIerocu4 Mut X (menti ry e; Nyq put Mee*ap Qlp II2WV OM X tam&map9gwamgaawwAgppm Caat*3*SO Mal X A4pPAmputSala•s wwito 1ailW9/.01ittea Be Ie awNN10M,I Mull —OpWpawtm* ap'wNulllnl aye ts ad WESapwgaalN lb,SuIn uptpapomn11a1b ] (0.a amaroma,>l.uldvartpjlwaP Aapaa®NN WKgwm ROwei/X tad ION 00 wpaaty p4 g!PluN'apS4u!Iw maw=Son adIM X POP Mid N oi pulaxxMl Pun lol*da MUON X VO*OP W muaaggK6laa Nln4a anis am X oupya91.01Pwoix .• 531VIGIV31Y15102es1 r ON 40saA YWnPuI POWAAla P E 7joAI1 'pays Jed 00'BGSNW,W€la eel i+* vaunt)µ3N Y3MAO3x �n }09.4111109Np 4W'tey am pooaka$0940 M3. NaHI 92904Y9 E[i.Ti77 p 17571 ala kyWaW 1900. mow YW'anemlA :a.aapnwYmaes :aaaga'am-Aso uwsegimmu00yp9akllawegm (MAO VWtI d aO 060.43 lot ORO awn quaugnanOrugMopOOyp :.aanuae 91071I7/110WO :O1 DN1wa3R1aWa Nsua wnnmNnn woman pwvn4"Pei (Bans 1140444a11gr s:a<NI tll a.leaa5Ulf a JWI pNg1 Aicuu wrist•. r....MOI+µ Icw161WMCCOt/alalMEM WARM Mai SSW4LS£it• • 30OTM1M1OO4'i peuWNale ped 4OWWY.Amon gno5•geyllaWtNWMI Ott gu n USIA / 2SSAO }|i | ||| | !| ` | |f | | �( | | |` | | | | |||SSW | f| | | |I11: | !dr | | | .| ! !f . 1 1 ! , 1111 . | 10 . | . , �|| ` i|( |I i t! . •, ! I ! ! 111!1 1.11 1 | | | || pi .| ! 1 | III |, . ! ,| | a |` . - t! : , F!`• ; II I. ! !| lug I` | |• • | I |' !| 1| ||! ill | | 1111 - | !! a 1 I|| 1 ,4 l 1 11 • I! | i | I 'll ,l| . :! t i.! , 1. , ! | |. | | .! |, | |- | itt | !•§ | ! / & b ! §| ! 1 ! � ! ' • i • , !, . | . 0° Ili - . ||| | |I �! |� |l s| |! || | | || |!| `d It ii it �� li ! .| 11 [Ilii ti I till |c| ill ; I • I : § ! 1 14 § , les § = i of ` | | | it !i | , | |! f'!. ! !!| | | |il ��! | 1 ft | | 11 ! |! i , | 01 I 1111 !1 ' |! ! I'| It | ! � l���' §| It R ! § r h n! §| | f§ ' It!! | | .. || ! ! 1 |t ||| | . l , I | | !|! I. . i | ,�|! •| . I |!'� | | .| |i| I . i! I | i| | |l |.s! III I|!! 1| 111 - HI 11 || I ! 11 1 ' 1 i II 1 ip i 1 11i it ;I t|| !! ! . |. i | l, ., . | ,|! � . �|