17C-114 (5) 50 STILSON AVE BP-2017-1436
GIS#: COMMONWEALTH OF MASSACHUSETTS
Mao:Block: 17C- 114 CITY OF NORTHAMPTON
Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: INSULATION BUILDING PERMIT
Permit# BP-2017-1436
Project# JS-2017-002389
Est. Cost: $2414.00
Fee: $65.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: AMERICAN INSTALLATIONS LLC 106178
Lot Size(sq. ft.): 11979.00 Owner: RICE ROBERT T&SUSAN M RICE
Zoning: URB(lo0)/ Applicant: AMERICAN INSTALLATIONS LLC
AT: 50 STILSON AVE
Applicant Address: Phone: Insurance:
130 COLLEGE ST (413) 552-0200 WC
SOUTH HADLEYMA01075 ISSUED ON:6/9/2017 0:00:00
TO PERFORM THE FOLLOWING WORK:ATTIC AND BASEMENT INSULATION AND AIR
SEALING THROUGHOUT
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: O1: 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 6/9/2017 0:00:00 $65.00
212 Main Street,Phone(413)587-1240, Fax:(413)587-1272
Louis Hasbrouck—Building Commissioner
File#BP-2017-1436
APPLICANT/CONTACT PERSON AMERICAN INSTALLATIONS LLC
ADDRESS/PHONE 130 COLLEGE ST SOUTH HADLEY (413)552-0200
PROPERTY LOCATION 50 STILSON AVE
MAP 17C PARCEL 114 001 ZONE URB(100)/
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
KipENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out
Fee Paid
TYpeof Construction: ATTIC AND BASEMEN l INSULATION AND AIR SEALING THROUGHOUT
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/Statement or License 106178
3 sets of Plans/Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFOIjMATION PRESENTED:
pproved 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 Permit DPW Storm Water Management
De yj, .-delay '
•
� (-7/2
Signature of Iuil•in fficial Date
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.
17-1108
' peparbnent Use only
tit _ 7 City of Northampton Status of Permit:
Building Department Curb gnyDdvawaypamat
212 Main Street Sewartsepr�avanataT�ly
Room 100 WaterNyell Availability
Northampton, MA 01060 sats afsoi)durai Pians
phone 413-587-1240 Fax 413-587-1272 PlotlSge Plans .
btfier6pedty - . .
APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH AONE OR TWO FAMILY DWELUNG
SECTION 1-SITE INFORMATION
1.1 Property Address: This section to be temple dbyoffice
50 Stilson Avenue Florence, MA 01062 Map 1,1C,/. . Lot Unit.
Zone Overlay District
Elm SL District CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
Curtin 4 Robert Rin' 50 Stilton Avenue Florence, MA 01062
Name(Print) Current MaWng Address:
(413) 386-7861
See attached Telephone
Signature
2.2 Authorized Agent
American Installations 130 College St., Ste 100 South Hadley,MA 01075
Name(Pit) Current Mating Addams:
American Installations 413-552-0200
Signature Telephone
SECTION S-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Ral Use Only
completed by permit applicant
1. Building $2,414.14 (a)Building PermitFee
2. Electrical (b)Estimated Total Cost of
Construction front(6)
3. Plumbing Building Permit Fee
4. Mechanical(HVAC)
6.Fire Protection
6. Totalt(1 +2+3+4+5) $2414.14 Check Number 474-/751 4x617
This Section For Official Use Only
Date
Budding Perm&Number. Genet
Signature:
Betiding Commissioner/Inspector of Sulgrave Dye
Section 4. ZONING AR 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 I
Frontage I I �—
Setbacks Front I
Side L: J R:I Led it I
Rear I i I
Building Height
Bldg.Square Footage , LJ
Open Space Footage
(Lot arta Mnesbldg de paved I I I I
Nuking)
#of Parking Spaces I--�
Fill:
(volume&Location)
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO 0 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 I I Pagel I and/or Document#`
B. Does the site contain a brook,body of water or wetlands? NO O DONT KNOW O YES 0
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: I 1
D. Are there any proposed changes to or additions of signs intended for the property? YES O NO (3
IF YES, describe size, type and location: l
E. Will the construction activity disturb(dealing,grading,excavation,orfilling)over acre or Is it part of a common plan
that will disturb over l acre? YES O NO O
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 Alteration(s) Q Rooting ❑
Or Doors 0
Accessory Bldg. ❑ Demolition 0 New Signs IC] Decks tO Siding to) 015
Brief Desafption of Proposed
Work: Attic and ab sement insulation and air sealing throughout
Alteration of existing bedmom Yes No Adding new bedroom Yes No
Attached Nanative Renovating unfinished basement Yes No
Plans Attached Roll -Sheet
sa.If New house and or addition to existing housing.,.complete thefollowing:
a. Use of bmWmg: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 construceran. Dimensions
e. Number of stories?
f. Method of heating? Fireplaces or Woodstoves Number of each
9. Energy Cementation CompRance. Masscherk Energytompliance 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 of cellar floor below relished grade
k. Will building conform to the Building and Zoning regulations? Yes No.
I. Septic Tank_ City SewerPdvate well City water Supply
SECTION?a-OWNER AUTHORIZATION-TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
.Susan&Robert Rice ,as Owner of the subject
properly
herebyeu0erize American Installations
to act on my behalf,in all matters relative to work authorized by this building permit application.
See attached 616117
Signature otWeiner Date
American Installations ,as Owner/Authorized
Agent hereby declare that the statements and bdmnation on the foregoing application are tare and accurate,to the best of my knowledge
and ballet
Signed under the pains and penalties of perjury.
American Installations
Pres Name
American Installations 6/6/17
Signature of Owner/Agent Date
SECTIONS-CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: NetAppitcable C
Name of Cleanse Homer: Wesley K. Couture 106178
Ucense Number
130 College St.,Ste 100 South Hadley,MA 01075 9/29/17
Address / _ Expiration Date
J. !e' . u 13-552-0200
Signa Ire Telephone
9.Registered Houle imProiremetit tiontractor. _ Not Applicable ❑
Wesley Couture 175982
Company Name Registration Number
American Installations 6/27/17
Address Expiration Date
130 College St., Ste 100 South Hadley, MA 01075 Telephone 413-552-0200
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 Pa No ❑
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 Mee who does not possess a license,provided that the owner acts
as saperyiser,CDR 180, h_k:.d'rtlop.. .a 351.
pet-mitten of Homeowner Person(s)who own a parcel of land on which he/she resides or intends to reside,on with 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"shalt submit tothe Building Official,on a form acceptable to the Building Oficial,thathelahe shall he
responsible for all such work performed under the heading permit..
As acting Construction Supervisor your presence onthe job site will be required from lime 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 him to perform work for you under ibis 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
.F.,......77: 4,
.,._. :„0
Massachusetts A ' r`
r.. ',i' '
c
ll212 Main
OF BUILDING INSPECTIONS
212 Nein Street • MniciBel Building \„ 0CD
Northampton, NA 01060 -I51
Property Address: 50 Stilson Avenue Florence, MA 01062
Contractor
Name: American Installations
Address: 130 College Street Ste. 100
City, State: South Hadley, MA
Phone: 43-552-0200
Property Owner
Name: Susan eb Robert Rice
Address: 50 chicon Avenue
City, State: Florence, MA 01062
I, American Installations (contractor)attest and affirm that the building I intend to
insulate does not have any open air(knob and tube)wiring in the spaces to be insulated and that I have
provided the property owner with a copy of this affidavit.
Cortfgktor ign /e // o
Date l
6/6/17
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: 50 Stilson Avenue Florence, MA 01062
The debris will be transported by: American Installations
The debris will be received by: Waste Management of New England - Chicopee Landfill
Building permit number:
Name of Permit Applicant American Installations on behalf of Susan & Robert Rice
6/6/17 W
Date ignature of Permit Applicant
tae&inwae ! www.AmerlonInstallations.rom
892
MA Reytat�tion,
American Installations
-Efficient Nome Services'
130(allege Street Suite 100,South Hadley,MA 01075.Office(4131552-0200 res:(413)552mN•[rax:supp.t NnennMnrommm.wm
AIR SEALING PROPOSAL
Susan M Rice
50 Stilson Ave
Florence.MA III 1162-1348
Site ID:5000503001337
Project ID:P00050343512
Customer ID:C00050302732
Contract ID:2_0I 70601 ASEAL
Dewiptlan Quantity Location
Perform Air Sealing at Estmated 62.5 CFM50 Per Hour 4 Living Space $33728
Exterior Door Weather Strppny 2 NIA 355.18
Door Sweep 2 N/A 34686
__ . . l
Sub Total: $438.82
Custom IncentivenShare E4$0.00
0.82
00
Customer Contribution so eo
WARRANTY:tmanon ltmaterial
C hereby proposes to furnish all above Tn
end labor to complete the above of work l accordance with the above specifications
a
aneInstallations.rican
all bet Iandstastate ummg regulations mane Total Contract Value as seed herein.
e The above pricey.specifications and conditions TOTAL CONTRACT VAlUE=s
are etisr:mnandaroNrmnccepted.you are au<hedaed w do work as , s a O
specified. will be 1/5 down prior to ren of work,and balance due Down Pavmen
5
5nnreepl,ntrn cone Open Completion oar 0
Property Owner(Print) lsanl_ Date
Representawe':lpdnp
het Marta Islgnl_ 01— Dam rt-I-v
•
TRE FOLLOWING TERMS AND CONDITIONS ALSO APPLY
1 THIS AGREEMENT IS SUBJECT TO THE APPROVAL OF A MANAGER OF THE COMPANY FOR THIS AGREEMENT TO BE EFFECTIVE UNDER ANY CONDITION.
1. SHOULD DEFAULT BE MADE IN THE PAYMENT OF THIS AGREEMENT,CHARGES SHALL BE ADDED FROM THE DATE THEREOF AT A RATE OF ONE AND ONE-HALF(11/2)PERCENT PER MONTH.118%PER
ANNUM)WITH MINIMUM CHARGE OF BEM PER MONTH,AND IF PLACED IN THE HANDS OF AN ATTORNEY OR COLLECTION AGENCY FOR COLLECTION,ALL ATTORNEYS'FEES,EXPENSES AND COSTS
COILED-IONOF
SHALL BE PAID BY THE CLIENT.IN ADDITION,CLIENT UNDERSTANDS THAT IN FAILING TO PAY ACCORDING TO THE ABOVE TERMS,COMPANY MAY HAVE THE RIGHT TO A LEIN ON THE
PROPERTY.
3. THE COMPANY THE COMPANY WILL ADVISE THE CLIENT AS SOON AS REASONABLE.
4. Y AGREES TIAT,NOTWITHSTANDINGBECOME ANY AGREEMENT FOR MATERIALS AND/OR LABOR BETWEEN COMPANY AND THIRD PARTY,COMPANY IS RESPONSIBLE TO CLIENT FOR COMPLETION
OF ALL WORK
N A TIMELY AND WORKMANLIKE MANNER.
5. WARRANTIES FOR EQUIPMENT EPMENTAND PRODUCTS SUPPLIED BY THE COMPANY UNDER THIS AGREEMENT SHALL BE THOSE GIVEN BY THE MANUFACTURERS OF SUCH EQUIPMENT AND PRODUCTS.
UNDER SUCH MANUFACTURER'S WARRANTIES,THE CLIENT MAY BE REQUIRED TO REGISTER OR MAIL IN A WARRANTY CARD OR OTHER EVIDENCE OF OWNERSHIP AND USE OF SUCH EQUIPMENT
AND/OR PRODUCTS IN ORDER TO ACTIVATE SUCH WARRANTIES.
6. THE QUOTATION ON THE PAGE HEREOF DOES NOT INCLUDE EXPENSES OR CHARGES FOR BONO OR INSURANCE PREMIUMS OR COSTS BEYOND NORMAL INSURANCE COVERAGE,ANY SUCH
ADDITIONAL EXPENSES,PREMIUMS OR COST SHALL BE ADDED TO THE TOTAL AGREEMENT AMOUNT.
7. THE COMPANY'S LIABILITY FOR CLAIMS ARISING OUT OF THIS AGREEMENT SHALL NOT EXCEED THE TOTAL AG REEMENT PRICE EXCEPT TO THE EXTENT THOSE DAMAGES ARE PROVEN TO BE SOLEY
DUE TO lHECOMPANY'S NEGLIGENCE.E
8. DURINGDURATION OF THE WORK THE CLIENT'S HOMEOWNERS INSURANCE WILL BE RESPONSIBLE FOR ANY AND ALL DAMAGES AS LONG AS THE COMPANY HAS TAKEN THE APPROPRIATE
ACTION TO PROTECT AREAS OF WORK.
9. THECOMPANY IS NOT RESPONSIBLE FOR PREEXISTING DEFICIENCIES OR HAZARDOUS MATERIALS THAT MANIFEST THEMSELVES DURING THE CONSTRUCTION PROCESS.E.G.WOOD ROT,MOLD,
ASBESTOS,NAIL POPS,DUCTWORK AND CONNECTIONS PLUMBING AND VENT PIPES,DECKING DEFLECTION,ETC.IF A PRE-EXISTING DEFICIENCY OR HAZARDOUS MATERIAL IS ENCOUNTERED PRIOR
TO OR DURING CONSTRUCTION,AND COMPANY IS NOTIFIED IN WRITING,COMPANY WILL TRY TO ASSIST CLIENT WITHIN THE COMPANY'S MEANS AND CAPABILITIES TO CORRECT THE PROBLEMS)
ON A TIME AND MATERIAL BASIS.CLIENT AGREES THAT SUCH CONDITIONS ARE UNAVOIDABLE BY THE COMPANY AND SHALL NOT BE CONSIDERED A VIOLATION OF THE AGREEMENT AND THAT DUE
TO THESE CONDITIONS THE DURATION OF THE WORK AND SCHEDULED DATE OF COMPLETION MAY DIFFER FROM THAT AGREED UPON,IF APPLICABLE,UNDER THIS AGREEMENT.
10. REPLACEMENT OF DETERIORATED DECKING,FASCIA BOARDS,ROOF JACKS VENTILATORS,WASHING,RAFTERS,JOISTS,INSULATION OR OTHER MATERIALS ARE NOT INCLUDED UNLESS OTHERWISE
NOTED HEREIN.
11. THE COMPANY WILL NOT BE RESPONSIBLE FOR THE SCRATCHING OR DENTING OF INTERIOR WALLS AND CEILINGS,FLOORS,TRIM.GUrTERS,DOWNSPOUTS,EXISTING SIDING AND WINDOWS,DOORS,
OIL DROPLETS IN DRIVEWAYS,HAIRLINE FRACTURES IN CONCRETE DR BLACKTOP DRIVES AND WALKS,OR DAMAGE TO PLANTS OR SHRUBBERY. IF EXCESSIVE DAMAGE IS CAUSED BY COMPANY.
COMPANY WILL REPAIR OR REPLACE DAMAGED AREA ONLY AT COMPANY'S EXPENSE.
12. THE COMPANY UNDER PROVISIONS OF CHAPTER 14240F THE GENERAL LAWS IS REQUIREDTO APPLY FOR AND OBTAIN ALL CONSTRUCTION-RELATED PERMITS.THE NY SHALL NOT BE DEEMED
RESPONSIBLE FOR DELAYS IN THE WORK DESCRIBED IN THIS AGREEMENT CAUSED BY REGULATORY PERMIT GRANTING OR INSPECTIONAL AGENCIES.AUTHORITIES.ORI INDIVIDUALS.
13. THIS AGREEMENT,INCLUDING THE PROVISIONS RELATING TO PRICE AND PAYMENT SCHEDULE,CANNOT BE CHANGED OR ALTERED EXCEPT BY A WRITTEN STATEMENT SIGNED BY BOTH THECOMPANY
AND THE CLIENT.
14. ANY REPRESENTATIONS,STATEMENTS,OR OTHER COMMUNICATION NOT WRITTEN ON THIS AGREEMENT ARE AGREED TO BE IMMATERIAL AND NOT RELIED ON BY EITHER PARTY,AND DO NOT
SURVIVE THE EXECUTION OF THIS AGREEMENT.
15 THIS AGREEMENT CANNOT BE CANCELLED WITHOUT THE MUTUAL WRITTEN CONSENT OF BOTH PARTIES EXCEPT AS OTHERWISE SET FORTH HEREIN.
15. THIS AGREEMENT,AND ANY NTYISI PROVIDED HEREUNDER SHALL NOT BE ASSIGNED EXCEPT BY OR WITH TYE WRITTEN PERMISSIOV OF THE COMPANY.
17 IF THE GHENT FAILS TO PERFORM ITS OBLIGATIONS HEREUNDER OR TERMINATES THIS AGREEMENT WITHOUT THE PRIOR WRITTEN CONSENT OF THE COMPANY,THE CLIENT SHALL BE LIABLE FOR
DAMAGES
ACTUAL DAMAGES OR 25%OF THE AGREEMENT FOR RESTOCKING FEE.
SB. ANY CHANGES TO MATERIALS BY THECLIENT(BRAND,STYLE,COLOR,ETC.(AFTER SAID MATERIAL HAS BEEN DELIVERED OR IS IN ROUTE TO THE CLIENT COULD RESULT IN A 5%RE-STOCKING FEE
BASED ON THE COST OF SAID MATERIALS.
19. THIS AGREEMENT SHALL BE EFFECTIVE ONLY UPON ITS EXECUTION BY ALL PARTIES HERETO.PRIOR TO WHICH TIME IT SHALL BE DEEMED A PROPOSAL.THE COMPANY RESERVES THE RIGHT TO REVOKE
THIS PROPOSAL 90 DAYS FROM DATE IT IS EXECUTED BY THE COMPANY IF IT IS NOT EARLIER EXECUTED BY THE CLIENT AND THE REQUIRED DOWN PAYMENT RECEIVED PRIOR TO THE EXPIRATION OF
SUCH 90 DAY PERIOD,AFTER 90 DAYS,AND IN THE EVENT COMPANY DOES NOT REVOKE THE PROPOSAL,COMPANY RESERVES THE RIGHT TO REVISE ITS PRICE IN ACCORDANCE WITH ILS COSTS IN
EFFE
AT SUCH TIME
20. NPROVISION OF THIS AGREEMENT SHOULD BE HELD TO BE INVALID OR UNENFORCABLE,THE VALIDITY AND ENFORCEBILITY OF THE REMAINING PROVISIONS OF THIS AGREEMENT SHALL NOT
BE AFFECTED THEREBY.
21 THE EVENT THE CLIENT AND COMPANY HAVE A DISPUTE REGARDING ANY OF THE TERMS,CONDITONS,PROVISIONS,OR PERFORMANCE OF THIS AGREEMENT,THE PARTIES AGREE
TO PLACE THE MATTER INTO ARBITRATION BEFORE AN INDEPENDENT ARBITRATOR ASSIGNED BY THE AMERICAN ARBITRATION ASSOCIATION TO RESOLVE THEIR DISPUTE.
22THAT IS PART OF A STATE SPONSERED UTILITY PROGRAM y.E.m SAVE.)IS SUBJECT TO THE AVAILABILITY OF QUALIFYING
STATE SPONSERED PROGRAM AND WILL BE SUBJECT TO TERMINATION THE STATE SPONSERED UTILITY PROGRAM IS DISCOUNTINUED.FUTHERMORE,THE TERMS AND CONDITIONS OF STATE
SPONSERED UTILITY PROGRAMS MAY BE ALTERED OR UPDATED PERIODICALLY WITH OR WITHOUT NOTICE,
33. UNDER THE MASS SAVE'ENERGY PROGRAM.
24. WESTERN MASSACHUSETTS ELECTRIC COMPANY(THE UTIILITYI IS ENTITLEDTOOTHERW%OFITHETHENERGY BENEFITS ASSOCIATED WITH ALL ENERGY CONSERVATION MEASURES,EXCLUDING THE VALUE
OF ENERGY COST SAVINGS BY THE HENT,BUT INCLUDING ALL RIGHTS TO ALL ASSOCIATED ISO-NE ENERGY,CAPACITY AND RESERVES PRODUCTS.COMPANY AGREES TO PROVIDE THE UTILITY WITH
SUCH FUR-WIER DOCUMENTATION AS THE UTILITY MAY REQUEST TO CONFIRM THE UTILITY'S OWNERSHIP OF SUCH BENEFITS AND PRODUCTS.
25, CLIENT UNDERSTANDS AND ACKNOWLEDGES THAT COMPANY IS NOT AN AGENT,VENDOR OR SUB-VENDOR OF THE UTILITY WITH RESPECT TO THE INSTALLATION OF ANY ENERGY EFFICIENCY
MEASURES.IN THE EVENT OF THE FAILURE OF ANY ENERGY CONSERVATION DEVICE TO PERFORM AS EXPECTED,CLIENT E 5 SOLE RECOURSE IS TO THE COMPANY AND NOT TO
CONSERVATION SERVICES GROUP 1CSG)OR TO THE UTILITY.THE UTILITYUTILITYAND ITS OPERATING COMPANIES SHALL NOT MAINTAIN,REMOVE OR PERFORM ANY WORK WHATSOEVER ON THE ENERGY
CONSERVATION MEASURES INSTALLED.CLIENT UNDERSTANDS AND ACKNOWLEDGES THAT ITS PARTICIPATION IN THE MASS SAVE HOME ENERGY SERVICES PROGRAM IS VOLUNTARY AND THAT IT
HAS CONSENTED FOR COMPANY TO
INSTALL THE CONSERVATION MEASURES.
26. CLIENT AGREES THAT IT SHALL NOT HOLD CSG,THEA PROPOSED
HEIR AFFILIATES OR OPERATING COMPANIES LIABLE FOR COMPANY'S FAILURE TO PERFORM ITS OBLIGATIONS UNDER THIS AGREEMENT,
FOR FAILURE OF THE ENERGY CONSERVATION MEASURES TO FUNCTION,FOR ANY DAMAGE TO CLIENTS PREMISES CAUSED BY COMPANY OR FOR ANY AND ALL DAMAGES TO PROPERTY OR INJURY
TO PERSONS CAUSED BY THE ENERGY CONSERVATION MEASURES.
27. CLIENT IS RESPONSIBLE FOR THE PAYMENT OF ANY AND ALL FEDERAL,STATE,OR LOCAL TAXES THAT ARE APPLICABLE TO THIS AGREEMENT,
UMITED TIME OFFER.THE PRICES AND INCENTIVE OFFERED IN THIS CONTRACT ARE SUBJECT TO CHANGE IN ACCORDANCE WITH THE WESTERN MASSACHUSETTS ELECTRIC COMPANY MASS SAVE HOME
ENERGY SERVICES PROGRAM OFFERS.
MA CLIENTS:You may cancel this agreement if it has been signed by a party thereto at a place other than an address of the seller,which may be his main office or
branch thereof,provided you notify the seller in writing at his main office or branch by ordinary mail posted,by telegram sent or by delivery,not later than midnight
of the third business day following the signing of this agreement. See the attached notice of cancellation form far an explanation of this right.
DATE CLIENT'S SIGNATURE
DATE COMPANY REPRESENTATIVE'S SIGNATURE
•
nensed&Insured • www.Americanlnstallaticns.com
MMA A SI ft Reg �ICE178 American Installations
ratiw ea5aa, -Efficient Home Services-
130 Coreae Street suite]W.booth Hadley,MA 01075•Office:(413)55343300 raw 6113)553-0202•Email:wppa1 AowrkanFatllationeaom
WEATHERIZATION PROPOSAL
Susan M Rice
50 Silicon Ave
Florence,MA 01062-1348
Site ID:S00050300837
Project ID:P00050343512
Customer ID:C00050302732
Contract ID:20120601 WORK
Description Quantity Location
Insulate Rim Joist With 2'Theroid Ramer PolyisO 116 _._INYIgSp%a --,-, $51040
Insulation Removal 200 NIA $10042
AAAA _ ...
Sheathing Arrest 3 NIA $100 42
Install r Fiberglass Bati g In Open K eewell Slope - 150 Lrvkg Space $283.:50
InstYl T Thermal Bernier Polpso en Open KneMYII Slope 150 Limp Space, $860.00
3... _AAAA. _ ._
pibe
ass
Install 2'Thermal
Banter P in_OpenGable
Ga30 Lrvaeg Span 100
Im1a112'Tharmal Berner Polysc On Open Gable Wall 30 O4Tg Space $132.00
Sub Total: 5197532
Utility Incentive Share $1.308.99
Customer Contribution $666.33
WARRANT(.American Installations-LJrwdl provide the abr..at.ted homeowner With e 2 yearworkmanafr,sea.ann.
LLC hereby proposes to furnish all material and labor mmmPiet.the above scope of work in accordance with the above spetlrwations
and all Real and slate building regulations for the Total Contract Value as stated herein.
ACCEPTANCE he L:The above pekes.speci!cadmic and conditions TOTAL CONTRACT VALUE=$ 666.33
are satisfactory and are hereby accepted.You are authorized to do west as _S )))pU K� 6-1-17
will be 1/3 down ono r to start of work,and balancedue Down ayment
upon Com pleton. Oa lance are upon Completion s 5 494.33 PAID
signatureA ALOti l— 'C. ate--621-t7
Property pree„,wrest, (Sign) /q���� Date
n
Represenuve:Printl )cel Martell Deal 416i - `2 `4 mu 6-1-17
THE FOLLOWING TERMS AND CONDITIONS ALSO APPLY
1. THIS AGREEMENT IS SUBJECT TO THE APPROVAL OF A MANAGER OF THE COMPANY FOR THIS AGREEMENT TO BE EFFECTIVE UNDER ANY CONDITION,
3. SHOULD DEFAULT BE MADE IN THE PAYMENT OF THIS AGREEMENT,CHARGES SHALL BE ADDED FROM THE DATE THEREOF AT A RATE OF ONE AND ONE-HALF(1-1/21 PERCENT PER MONTH.(18%PER
ANNUM)WITH A MINIMUM CHARGE OF$2.00 PER MONTH,AND IF PLACED IN THE HANDS OF AN ATTORNEY OR COLLECTION AGENCY FOR COLLECTION,ALL ATTORNEYS'FEES,EXPENSES AND COSTS
OF COLLECTION SHALL BE PAID BY THE CLIENT.IN ADDITION,CLIENT UNDERSTANDS THAT IN FAILING TO PAY ACCORDING TO THE ABOVE TERMS.COMPANY MAY HAVE THE RIGHT TO A LEEN ON THE
PROPERTY.
3 THE COMPANY AGREES THAT WHEN DELAYS BECOME KNOWN TO THE COMPANY,THE COMPANY WILL ADVISE THE CLIENT AS SOON AS REASONABLE.
4. COMPANY AGREES THAT NOTWITHSTANDING ANY AGREEMENT FOR MATERIALS AND/OR LABOR BETWEEN COMPANY AND THIRD PARTY,COMPANY IS RESPONSIBLE TO CLIENT FOR COMPLETION
OF ALT WORK DESCRIBED IN A TIMELY AND WORKMANLIKE MANNER.
5. ALL WARRANTIES FOR EQUIPMENT AND PRO DUBS SUPPLIED BY THE COMPANY UNDER THIS AGREEMENT SHALL BE THOSE GIVEN BY THE MANUFACTURERS OF SUCH EQUIPMENT AND PRODUCTS.
UNDER SUCH MANUFACTURER'S WARRANTIES,THE CLIENT MAY BE REQUIRED TO REGISTER OR MAIL IN A WARRANTY CARD OR OTHER EVIDENCE OF OWNERSHIP AND U5E OF SUCH EQUIPMENT
AND/OR PRODUCTS IN ORDER TO ACTIVATE SUCH WARRANTIES.
6. THE QUOTATION ON THE PAGE HEREOF DOES NOT INCLUDE EXPENSES OR CHARGES FOR BOND OR INSURANCE PREMIUMS OR COSTS BEYOND NORMAL INSURANCE COVERAGE,ANY SUCH
ADDITIONAL EXPENSES,PREMIUMS OR COST SHALL BE ADDED TO THE TOTAL AGREEMENT AMOUNT.
7. THE COMPANY'S LIABILITY FOR CLAIMS ARISING OUT OF THIS AGREEMENT SHALL NOT EXCEED THE TOTAL AGREEMENT PRICE EXCEPT TO THE EXTENT THOSE DAMAGES ARE PROVEN TO BE SOLER
DUE TO THE COMPANY'S NEGLIGENCE.
8. DURING THE DURATION OF THE WORK,THE CLIENT'S HOMEOWNERS INSURANCE WILL BE RESPONSIBLE FOR ANY AND ALL DAMAGES AS LONG AS THE COMPANY HAS TAKEN THE APPROPRIATE
ACFION TO PROTECT AREAS OF WORK.
9 THE COMPANY IS NOT RESPONSIBLE FOR PREEXISTING DEFICIENCIES OR HAZARDOUS MATERIALS THAT MANIFEST THEMSELVES DURING THE CONSTRUCTION PROCESS.E G.W
ASBESTOS,NAIL POPS DUCTWORK AND CONNECTIONS.PLUMBING AND VENT PIPES,DECKING DEFLECTION,ETC. IF A PRE-EXISTING DEFICIENCY OR HAZARDOUS MATERIAL IS ENCOUNTERED PRIOR
TO OR DURING CONSTRUCTION,AND COMPANY IS NOTIFIED IN WRITING.COMPANY WILL TRY TO ASSIST CLIENT WTHIN THE COMPANY'S MEANS AND CAPABILITIES TO CORRECT THE PROBLEM(S)
ON A TIME AND MATERIAL BASIS.CUENTAGREES THAT SUCH CONDITIONS ARE UNAVOIDABLE BY THE COMPANY AND SHALL NOT BE CONSIDERED A VIOLATION OF THE AGREEMENT AND THAT DUE
TO THESE CONDITIONS THE DURATION OF THE WORK AND SCHEDULED DATE OF COMPLETION MAY DIFFER FROM THAT AGREED UPON,IF APPLICABLE,UNDER THIS AGREEMENT.
10. DETERIORATED DECKING,FASCIA BOARDS,ROOF JACKS,VENTILATORS.FLASHING,RAFTERS,JOISTS,INSULATION OR OTHER MATERIALS ARE NOT INCLUDED UNLESS OTHERWISE
NOTED HEREINOF
11. L NOT BE RESPONSIBLE FOE THE SCRATCHING OR DENTING OF INTERIOR WALLS AND CEILINGS,FLOORS,TRIM,GUTTERS,DOWNSPOUTS.EXISTING SIDING AND WINDOWS,DOORS,
OIL DROPLCOMPANY
IN DRIVEWAYS,HAIRLINE FRACTURES IN CONCRETE OR BLACKTOP DRIVES AND WALKS,OR DAMAGE TO PLANTS OR SHRUBBERY. IF EXCESSIVE DAMAGE IS CAUSED BY COMPANY
COMPANY WILL REPAIR OR REPLACE DAMAGED AREA ONLY AT COMPANY'S EXPENSE.
12 VISIONS OF CHAPTER I@AOFTHE GENERAL LAWS IS REQUIRED TO APPLY FOR AND OBTAIN ALL CONSTRUCTION-RELATED PERMITS.THE COMPANY SHALL NOT BE DEEMED
RESPONSIBLE FOR DELAYS IN THE WORK DESCRIBED IN THIS AGREEMENT CAUSED BY REGULATORY PERMIT GRANTING OR INSPECTIONAL AGENCIES,AUTHORITIES,OR INDIVIDUALS.
13. THIS AGREEMENT,INO.UDING THEPROVISIONS RELATING TO PRICE AND PAYMENT SCHEDULE,CANNOT BE CHANG ED OR ALTERED EXCEPT BY A WRITTEN STATEMENTSIGNED BY BOTH THE COMPANY
AND THE CLIENT.
14. ANY REPRESENTATIONS.STATEMENTS,OR OTHER COMMUNICATION NOT WRITTEN ON THIS AGREEMENT ARE AGREED TO BE IMMATERIAL AND NOT RELIED ON BY EITHER PARTY,AND DO NOT
SURVIVE THE EXECUTION OF THIS AGREEMENT.
I5. THIS AGREEMENT CANNOT BE NELLED WITHOUT THE MUTUAL WRITTEN CONSENT OF BOTH PARTIES EXCEPT AS OTHERWISE SET FORTH HEREIN.
15. THIS AGREEMENT,AND ANY WRRANTY(S)PROVIDED HEREUNDER SHALL NOT BE ASSIGNED EXCEPT BY OR WITH THE WRITTEN PERMISSION OF THE COMPANY,
17CUENT
LS TO PERFORM ITS OBLIGATIONS HEREUNDER OR TERMINATES THIS AGREEMENT WITHOUT THE PRIOR WRITTEN CONSENT OF THE COMPANY,THE CLIENT SHALL BE LIABLE FOR
DAMAGES FOR THE GREATER OF THE COMPANY'S ACTUAL DAMAGES OR 25%OF THE AGREEMENT FOR RESTOCKING FEE.
18. ANY CHANGES TO MATERIALS BY THE CLIENT(BRAND,STYLE,COLOR,ETC.)AFTER SAID MATERIAL HAS BEEN DELIVERED OR IS IN ROUTE TO THE CLIENT COULD RESULT IN A 5%RE-STCIXING FEE
BASED ON THE COST OF SAID MATERIALS.
19. THIS AGREEMENT SHALL BE EFFECTIVE ONLY UPON ITS EXECUTION BY ALL PARTIES HERETO,PRIOR TO WHICH TIME IT SHALL BE DEEMED A PROPOSAL.THE COMPANY RESERVESTHE RIGHT TO REVOKE
THIS 90 OAY5 FROM DATE IT IS EXECUTED BY THE COMPANY IF IT IS NOT EARLIER EXECUTED BY THE CLIENT AND THE REQUIRED DOWN PAYMENT RECEIVED PRIOR TO THE EXPIRATION OF
SUCH 9D DAY PERIOD;AFTER 90 DAYS,AND IN THE EVENT COMPANY DOES NOT REVOKE THE PROPOSAL,COMPANY RESERVES THE RIGHT TO REVISE ITS PRICE IN ACCORDANCE WITH ITS COSTS IN
EFFECT AT SUCH TIME.
20. IF ANY PROVISION OF AGREEMENT SHOULD BE HELD TO BE INVALID OR UNENFORCABLE.THE VALIDITY AND ENFORCEBILITY OF THE REMAINING PROVISIONS OF THIS AGREEMENT SHALL NOT
BE AFFECTED THEREBY.
21. ARBITRATION,IN THE EVENT THE CLIENT AND COMPANY HAVE A DISPUTE REGARDING ANY OF THE TERMS,CONDITIONS,PROVISIONS,OR PERFORMANCE OF THIS AGREEMENT,THE PARTIES AGREE
TO LACE THE MATTER INTO ARBITRATION BEFORE AN INDEPENDENT ARBITRATOR ASSIGNED BY THE AMERICAN ARBITRATION ASSOCIATION TO RESOLVE THEIR DISPUTE.
ZZ, ANY DISCOUNT,PROMOTION,REIMBURSEMENT,OR OTHER PROGRAM THAT IS PART OF A STATE SPONSERED UTILITY PROGRAM II E.MASS SAVER)IS SUBJECT TO THE AVAILABILITY OF QUALIFYING
STATE SPONSERED PROGRAM AND WILL BE SUBJECT TO TERMINATION IF THE STATE SPONSERED UTILITY PROGRAM IS DISCOUNTINUED, FURTHERMORE.THE TERMS AND CONDITIONS OF STATE
SPONSERED UTILITY PROGRAMS MAY BE ALTERED
D OR UPDATED PERIODICALLY WITH OR WITHOUT NOTICE.
23. IS
AGENT OF ANY UTILITY COMPANY OF OTHER VENDOR WORKING BY.THROUGH,OR UNDER THE MASS SAVE'ENERGY PROGRAM
24. WESTERN
MASSACHUSETTS ELECTRIC COMPANY(THE UTILITY)IS ENTITLED TO 100%OF THE ENERGY BENEFITS ASSOCIATED WITH ALL ENERGY CONSERVATION MEASURES,EXCLUDING THE VALUE
OF ENERGY SAVINGS BY THECLIENT,BUT INCLUDING ALL RIGHTS TO ALL ASSOCIATED 15O-NE ENERGY,CAPACITY AND RESERVES PRODUCTS.COMPANY AGREES TO PROVIDE THE UTILITY WITH
SUCH FURTHER DOCUMENTATION AS THE UTILITY MAY REQUEST TO CONFIRM THE UTILITY'S OWNERSHIP OF SUCH BENEFITS AND PRODUCTS.
25. ACKNOWLEDGES THAT COMPANY IS NOT AN AGENT,VENDOR OR SUB-VENDOR OF THE UTILITY WITH RESPECT TO THE INSTALLATION OF ANY ENERGY EFFICIENCY
UNDERSTANDSMEASURES IN THEVENT OF THE FAILURE OF ANY ENERGY CONSERVATION DEVICE TO PERFORM AS EXPECTED,CLIENT AGREES THAT CLIENTS SOLE RECOURSE S TO THE COMPANY AND NOT TO
CONSERVATION SERVICES GROUP(CSG)OR TO THE UTILITY.THE UTILITY AND ITS OPERATING COMPANIES SHALL NOT MAINTAIN,REMOVE OR PERFORM ANY WORK WHATSOEVER ON THE ENERGY
CONSERVATION MEASURES CLIENT UNDERSTANDS AND ACKNOWLEDGES THAT ITS PARTICIPATION IN THE MASS SAVE HOME ENERGY SERVICES PROGRAM IS VOLUNTARY AND THAT IT
COMPANYHAS CONSENTED FOR TO INSTALL THE PROPOSED ENERGY CONSERVATION MEASURES.
26, CLIENT AGREESTHAT O HANOT HOLD CSG,THE UTILITY,THEIR AFFILIATES OR OPERATING COMPANIES LIABLE FOR COMPANY'S FAILURETO PERFORM ITS OBLIGATIONS UNDER THIS AGREEMENT,
FOR FAILURE OF THE ENERGY CONSERVATION MEASURES TO FUNCTION.FOR ANY DAMAGE TO CLIENT'S PREMISES CAUSED BY COMPANY OR FOR ANY AND ALL DAMAGES TO PROPERTY OR INJURY
TO PERSONS CAUSED BY THE ENERGYCONSERVATION MEASURES.
D. CLIENT IS RESPONSIBLE FOR THE PAYMENT OF ANY AND ALL FEDERAL,STATE,OR LOCAL TAXES THAT ARE APPLICABLE TO THIS AGREEMENT.
LIMITED TIME OFFER.THE PRICES AND INCENTIVE OFFERED IN THIS CONTRACT ARE SUBJECT TO CHANGE IN ACCORDANCE WITH THE WESTERN MASSACHUSETTS ELECTRIC COMPANY MASS SAVE HOME
ENERGY SERVICES PROGRAM OFFERS.
MA CLIENTS:You may cancel this agreement NN has been signed by a party thereto at a place other than an address of the seller,which may be his main offke or
branch thereof,provided you notify the seller in writing at his main office or branch by ordinary mail posted,by telegram sent or by delivery.not later than midnight
of the third business day following the signing of this agreement. See the attached notice of cancellation form for an explanation of this right.
DATE CLIENT'S SIGNATURE
DATE COMPANY REPRESENTATIVE'S SIGNATURE
Massachusetts-Department of Public Safetygr—
Unrestricted-Buildings of any use group which
Board of Building Regulations and Standards Contain less than 35,000 cubic feet(991m3)of
CLicen e:C 5106178 r enclosed space. - -.
License:CS-108178 `
WESLEY COUTuIJtE '%f.
166NORIHMAIS j
South Hadley 01
((VVFailure to possess a arrent edition date Massachusetts
/�� State Building Code is cause for revocation of this license.
r..L.� l._31161 Expiration For PPS licensing Information visit: www.Maes.GPr/OP5
Commissioner 00/28/2017
0774e W cc/eicpid
11 Office of Consumer Affairs and Business Regulation
10 Park Plaza- Suite 5170
Boston, Massachusetts 02116
Home Improvemerl(-Contractor Registration
Type: LLC
- Registration: 065082
AMERICAN INSTALLATIONS,LLC. Expiration: 06/26/2019
130 COLLEGE STREET SUITE 100
SOUTH HADLEY,MA 01075
Update Address and return card. Mark reason for change.
SCA I a zouas/n n Address 0 Pao_1_11mixtaymant-n t"atCeld..
r'14( ft/yam/tam/id.ink mdmiel6
place of Consumer Akre&Business Rgulaeon
HOME IMPROVEMENT CONTRACTOR Regletrauon valid for Individual use only
TYPE:LLC before the expiration date. k found realm b:
6 0 Winton Office of Consumer Affairs and Business Regulation
175982 0628/2019 10 Perk Plaza-Suite 5170
ERICAN INSTALLATIONS,LLC. Boston,MA 02118
WESLEY COUTURE Vrafl.. — / /"
130 COLLEGE STREET SUITE tm L -"-P
SOUTH HADLEY,MA 01075 UndersecretaryvaBd without signature
The Commonwealth of Massachusetts
p w'—y Department of Industrial Accidents
-_,_)KII Office of Investigations
'- 600 Washington Street
''''= a
r. > Boston,MA 02111
www-nass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name oturineu/Otganizaiiorindividualy. American Installations,LLC
Address: 130 College Street,Suite 100
City/State/Zip: South Hadley,MA 01075 Phone#:_113-552-0200
Arc you an employer?Check the appropriate box: Type of project(required):
I-RRI I am a employer with 3 I,,,,,,rt_, 4. 0 i am a general contractor and 1 6. 0 New construction
employees(full and/or part-time).' have hired the sub-contractors
2.0 I am a sole proprietor or partner- listed on the attached sheet,1 7. C] Remodeling
ship and have no employees These sub-contractors have 8. ❑ Demolition
working for me in any capacity. workers'comp. insurance. 9. ❑Building addition
[No workers'comp.insurance 5. 0 We are a corporation and its
required.} officers have exercised their 10.("]Electrical repays or additions
3.0 I am a homeowner doing all work right of exemption per MGL 11.Ti Plumbing repairs or additions
myself. [No workers'comp, c. 152,§I(4),and we have no 12,D Roof repairs
insurance required.]t employees.(No workers'
comp.insurance required.] 13.[A Other Insulation
'Any applicant that checks box gt must also frit out the suction below showing their workers'compensation policy information.
t tlomeowners who submit this affidavit indicating they are doing all work and Om hire outside crwnactors must submit a now affidavit indicating such.
:Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and Moir workers'comp.policy information.
t an,an employer that is providing workers'compensation insurance for my employees. Hetow is the policy and job site
information.
Insurance Company Name: Guard Insurance Companies
Policy a or Self-ins. Lie. #: AMWC731455 Expiration Date: 09/04/2017
-�....-. LL.� tt f� r t� t� /�
Job Site Address: 50 on soft Age.• City/State/Zip: F iOctet,/af tAtA V[0�C
Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date).
Failure to secure coverage as required under Section 25A of MOL c. 152 can cad to the imposition of criminal penalties ofa
fine up to S1,50U.U0 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine
of up to$25000 a day against the violator. Be advised that a copy of this statement may be forwarded to theOffice of
Investigations of the DIA for insurance coverage verification.
I do hereby certify an�daer the pains and penalties of perjury that the information provided/above is nue and correct
Signature: Sty 4? rat .rt.. •
_. Date: _._L,q I(0 11-+
Phone e: 413-55200
Official use only, Do not write in this area,to be contptrted by city or town official
City or Town: , Permit/License a
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 t:
•
'°E d CERTIFICATE OF LIABILITY INSURANCE 00 ,fi,
THS 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 POIJCIES
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(les)must be endorsed. N SUBROGATION IS WAIVED,suhtect to
the terms and conditions of the policy,certain polkies may require an endorsement A statement on this certificate does not confer rights to the
certificate holder In lieu of such endorsements).
PRODUCFA R CONTACT Linda Powers
Plat
Webber 6 Grinnell ) Fen. (413)586-0111 FAX
Rol:(413)586-64818 North King Street AaroREEs5:1powers@Webberandgrinnell.u®
INSURERS).AFF0R0MG COVERAGE NAIL•
Kort
hanpton Mk 01060 MWRERA Bmployere Mutual Casualty
INSURED IXSUREaa Berkshire Hathaway GUARD Ins. Co
American Installations, LLC INSURER C:
Attn: Wee 6 Susanne Couture MSuFERD:
130 College Street, Suite 100 INSURER E:
South Hadley NA 01075 INSURER F:
COVERAGES CERTIFICATE NRMBER34aster Zap 9-2017 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 CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
WSR AWL MEM PgNY EFF POLICY ESP
LTR TYPE OF INSURANCE ASO MD' POLICY RUNNIER IMWOWTYYYI IMMI WYYYO URNS
COMERLLL GENERAL WBMPY EACH On''RRENCE I 1,000,000
A % CLAIMS-MADE I DAMAGE IO RENTED 500,000
PREMISES Ma vesw) -
X liONOr Liability EXmPr")P11 _ 10,000
PERSONAL&ADV INJURY 1,000,000
GENT AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE 2,000,000
_% POLICYrn
JEpi ILGC PRODUCTS•COMPSIP AGG 2,000,000
OTHER-
AUTOMOBILE LIA191121Y
THERAUio o LEWMUn COMBINED MED OLLIMIT 1,000,000
(Ea saRlea
A ANY AUTO
ABODILY INJURY(Per person)
)_T1l .
AUTOS OPINED AUTOS R;SCHEDULED HON-OWNED
583535217 9/4/2016 9/4/2011 BODILY POLICS
PIP-eavc 5.000
%I UMBRELLA LIAB OCCUR • EACH OCCURRENCE i 1,000,000
p EXCESS WB CLAIMS-MADE •
• I AGGREGATE 5 1,000,000
ICED %1-RETENIons 10,000 533535217 9/4/2016 19/4/2017 ) S
WORKERS COPENSATORR PER I0TH-
REDEISPLOYERS'WWlln �I STATRE _ EA-
YIN •
FROPRLETCamARTNER.EXECUT1E EL_EACH ACCIDENT '.S 500,000
OF RCERiEMBER EXCLUDED' NIA
N -
IWndMuyInNm OP14C609917 9/4/2016 9/4/2017 EL DISEASE-EA 5 EMPLOYE 500,000
NYM Lxmbe under OPERATIONS Ww' E $r
DESCRIPTION OF OPERAL DISEASE-POLICY LIMIT 5 500,000
A Ca®frcial Property .SA3939311 9/4/2016 9/4/1077 1 ewurtwSt M] $20,000
r=+=$1. $40,000
j 1
LESCMPRON OF OPWUTIONSI LOCATIONS/VEHICLES IACORD SM,AdWeJ Rmraea sdmdula,may b attached If more spate N rewired)
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESEPHATWE
(Kevin Joyce/LMP 93^�
ID 1988-2014 ACORD CORPORATION. All rights reserved.
ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD
INS02501141111