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17C-081 (4) 41 HIGH ST BP-2018-0105 'GIS#: COMMONWEALTH OF MASSACHUSETTS • Map:Block: 17C-081 CITY OF NORTHAMPTON Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: KITCHEN RENO BUILDING PERMIT Permit# BP-2018-0105 Project# JS-2018-000177 Est.Cost: $82800.00 Fee: $538.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: THOMAS DADMUN 107919 Lot Size(sq. ft.): 17903.16 Owner: CAMMY JUSTIN D&RACHEL RUBINSTEIN Zoning:URB(100)/ Applicant: THOMAS DADMUN AT: 41 HIGH ST Applicant Address: Phone: Insurance: 60 SCHOOL ST (413) 387-7381 HATFI ELDMA01038 ISSUED ON:7/31/2017 0:00:00 TO PERFORM THE FOLLOWING WORK:KITCHEN REMODEL INCLUDING NEW WINDOW 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 7/31/2017 0:00:00 $538.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner File#BP-2018-0105 APPLICANT/CONTACT PERSON THOMAS DADMUN ADDRESS/PHONE 60 SCHOOL ST HATFIELD (413)387-7381 PROPERTY LOCATION 41 HIGH ST MAP 17C PARCEL 081 001 ZONE URB(100)/ THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid C4.#9 yBuilding Permit Filled outFee Paid Typeof Construction: KITCHENEL INCLUDING NEW WINDOW New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/Statement or License 107919 3 sets of Plans/Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INF RMATION PRESENTED: Approved Additional permits required(see below) PLANNING BOARD PERMIT REQUIRED UNDER:§ Intermediate Project: Site Plan AND/OR Special Permit With Site Plan Major Project: Site Plan AND/OR Special Permit With Site Plan ZONING BOARD PERMIT REQUIRED UNDER: § Finding Special Permit Variance* Received&Recorded at Registry of Deeds Proof Enclosed Other Permits Required: Curb Cut from DPW Water Availability Sewer Availability Septic Approval Board of Health Well Water Potability Board of Health Permit from Conservation Commission Permit from CB Architecture Committee Permit from Elm Street Commission Permit DPW Storm Water Management Demolition Delay � 7 Z7 Signature of Building Official 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. / 1 / /Iy - .,a City of Northampton «s ��� ,i,.'� „ V f ' -�/ ,: Building Department �i�� ��� „ ; b' ill ,i,, 212 Main Street 'i; *, /_ _ �� i, ��,� '' i '''''/w'///4i ?sir i % i/�� V/��i , i Room 100 �r� �,� ,�i�ri���sa�s. a Northampton, MA 01060 A',(,; , ' ; �m.'/';,;,,.._',',f',./,4,/%/41',..;%,'/... 47/4';,//,','";',/;,/,� „ , x ' phone 413-587-1240 Fax 413-587-1272 , � % ��' ��% ,0 1/* ACJ*/:' , .. APPLICATION TO CONSTRUCT,ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION 1.1 Property Address: This section to be comp] /by office 4( (-1-160c St, Map Lot ((�� Unit F `%IFirst.f, 1 It/'6C 6106'2, Zone Overlay District Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: ,)St ) Vel i K c1 I—R to tlito 4( 11164fir, , 42.r-04., I"u oiocc2 Name(Print) Current Mailing Address: 4 1 -b lit) M2211 Telephone Signature ',9--'-'/--1/4---- 2.2 Authorized Agent: _%c wtk Did)M, 60 &th t, Sr,i 14-rikA,D, MA 61036 Name(Print) ^ Current Mailing Address: � � it� tNw� 4113 -367-/ 5b1 Signature Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building I i; I L2,5 ''° (a)Building Permit Fee 2. Electrical I' O 5 u° (b)Estimatedtf + ConstructionTofromal Cost(6)o 3. Plumbing i1 I`[ 7°. co Building Permit Fee 4. Mechanical (HVAC) I C115'6 . 5. Fire Protection n 6. Total=(1 +2+3+4+5) ¢ 52tBOO . ”' Check Number c/ /r7 23J This Section For Official Use Only Building Permit Number: I sssuu ed: Signature: Building Commissioner/Inspector of Buildings Date —r°MA) Cad VA9Kor5De> , GotA EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR) Section 4. ZONING All Information Must Be Completed. Permit Can Be Denied Due To Incomplete Information Existing Proposed Required by Zoning This column to be filled in by Building Department Lot Size Frontage . ...... .........._..... . .. Setbacks Front Side L: ....... .: 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 0 DON'T KNOW YES 0 IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO 0 •DONT KNOW 0 YES 0 IF YES: enter Book Page and/or Document# B. Does the site contain a brook, body of water or wetlands? NO DON'T KNOW 0 YES 0 IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained 0 Obtained , Date Issued: C. Do any signs exist on the property? YES NO IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property ? YES 0 NO 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 0 NO IF YES,then a Northampton Storm Water Management Permit from the DPW is required. SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable) New House ❑ Addition ❑ Replacement Windows Alteration(s) Roofing Or Doors CI Accessory Bldg. ❑ Demolition ❑ New Signs [El] Decks [[J Siding [I a] Other[o] Brief Description of Proposed h Work: Wt�(•F KAL o0flw Iti%-LUoiCs NL ) Wt►.90�„� Alteration of existing bedroom Yes X No Adding new bedroom Yes X. No Attached Narrative Renovating unfinished basement Yes X No Plans Attached Roll -Sheet 6a.If New house and or addition to existing housina,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 r (P'}wA W , as Owner of the subject property hereby authorize 114 Mn/ DAV NIN to act on my behalf, in all matters relative to work authorized by this building permit application. j Signature of Own r Date b P1 k P IO M '3 , 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. —1-11-000-6 1)/ti7h Print Name �p di-Owl-J.- c�. ,,,,___ , uti 1 El, 7017 Signature of Owner/Agent Date SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable 0 Name of License Holder: t l4 1,441-`5l c5 1 b719 License Number deo Sai-0,r.. S j. . tAncia D, 14A o tc t; `T /14 /?_ t7 Addres , ,, Expiration Date 413 .'3bl-93(3 ( Signature Telephone S.Registered Home Improvement Contractor: Not Applicable 0 114. TU GK. CSP , ��c 17b� Company Name Registration Number 60 Q4i_ S1, , 141--- .Lo, 1OA ©, 3b blit iLoI`13 Address Expiration Date Telephone 413-367-73M 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 14 No 0 City of Northampton Massachusetts VA ' ‘ 4 DEPARTMENT OF BUILDING INSPECTIONS 212 Main Street • Municipal Building Northampton, MA 01060 AFFIDAVIT Home Improvement Contractor Law Supplement to Permit Application The Office of Consumer Affairs and Business Regulation ("OCABR")regulates the registration of contractors and subcontractors performing improvements or renovations on detached one to four family homes. Prior to performing work on such homes,a contractor must be registered as a Home Improvement Contractor("HIC"). M.G.L. Chapter 142A requires that the"reconstruction, alteration, renovation, repair, modernization, conversion, improvement, removal, demolition, or construction of an addition to any pre-existing owner-occupied building containing at least one but not more than four dwelling units....or to structures which are adjacent to such residence or building" be done by registered contractors. Note:If the homeowner has contracted with a corporation or LLC,that entity must be registered. Type of Work: IL-1 ttOttj 0 0(r Est. Cost: Address of Work: tit 1416i. 1:1412.fis9C,t 10A 0106 2.. Date of Permit Application: .%\4.59 2i latri I hereby certify that: Registration is not required for the following reason(s): Work excluded by law(explain): Job under$1,000.00 Owner obtaining own permit(explain): Building not owner-occupied Other(specify): OWNERS OBTAINING THEIR OWN PERMIT OR ENTERING INTO CONTRACTS WITH UNREGISTERED CONTRACTORS OR SUBCONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK ARE NOT ELIGIBLE FOR AND DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER M.G.L.Chapter 142A.SUCH OWNERS ALSO ASSUME THE RESPONSIBILITES FOR ALL WORK PERFORMED UNDER THE BUILDING PERMIT.SEE NEXT PAGE FOR MORE INFORMATION. Signed under the penalties of perjury: I hereby apply for a building permit as the agent of the owner: -114° 94-1)Ntu-0 17q t9b2_ Date Contractor Name HIC Registration No. OR: Notwithstanding the above notice, I hereby apply for a building permit as the owner of the above property: Date Owner Name and Signature City of Northampton Ns 4,f) Massachusetts • , At" ' ,fr A w DEPARTMENT OF BUILDING INSPECTIONS 212 Main Street eMunicipal Building Northampton, MA 01060 Debris 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. The debris from construction work being performed at: 41 H Sr') (Please print house number and street name) Is to be disposed of at: (Please print name and location of facility) Or will be disposed of in a dumpster onsite rented or leased from: AA- 11C160/111k. Kalati)(7.S1b1E346, (Company Name and Address) ',.).41.47-w-r-2,-- 1/41 12-tt7 Signature of Permit Applicant or Owner Date If, for any reason, the debris will not be disposed of as indicated, the Applicant or Owner shall notify the Building Department as to the location where the debris will be disposed. The Commonwealth of Massachusetts Department of Industrial Accidents l>• — Office of Investigations "�= 5 600 Washington Street Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information -� Please Print Legibly Name (Business/Organization/Individual): 1)-kl 9t)1.6, L,J3t 4 -11t v3 Address: 60 L S f, ll City/State/Zip: R- 'i'1=1C..L7l Mi tip L5 Phone #: 411 65'J- '-)5t> l Are you an employer? Check the appropriate box: Type of project (required): 1.❑ 1 am a employer with 4. I am a general contractor and I 6. E New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. I. 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. ❑ We are a corporation and its officers have exercised their 10.0 Electrical repairs or additions required.] 3.❑ I am a homeowner doing all work right of exemption per MGL 11.0 Plumbing repairs or additions myself. [No workers' comp. c. 152, §1(4), and we have no 12.0 Roof repairs insurance required.] t employees. [No workers' 13.0 Other comp. insurance required.] *Any applicant that checks box#1 must also fill 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 their workers'comp.policy information. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins. Lic. #: Expiration Date: Job Site Address: 41 k€4i 5i, City/State/Zip: 1:1-0 e. l 0662_ 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 MGL c. 152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 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. Be advised that 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 penalties of perjury that the information provided/above is true and correct. Signature: �� �. ' Date: 71 Z7( 24'17 Phone#: 41�✓ - yo-.7776 ( D Official use only. Do not write in this area, to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1. 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 Board of Building Regulations and Standards rut un n Supt.r'+rki r- License: CS-107919 THOMAS DADi4?CV3+t . 60 SCHOOL STR,EE? Hatfield MA 01018 o-.0.,..1J..c Expiration Commissioner 09124/2017 „,z,., ,,...„ . : ti?, 201n4n,04tevea , 0/ - r-W f ././,/ ,i0/#,///i/Jacie,/taeft:a 9 Office of Consumer Affairs and BUsiness Regulation fC:0-_°,..,---';” 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement eontractor Registration ., Registration: 179682 : : / 1 � ACORD CERTIFICATE OF LIABILITY INSURANCE DATE(MMlDD/YYYY) 4.1.----- 12/14/2016 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 CONTACT Susan Fleury, CIC, CISR King & Cushman Inc, (A/C No.Eat) (413)584-5610 FAX Aic No:(413)584-9322 P.O. Box 447 AIL ADDRESS:SFleury@KingCushman.com 176 King Street INSURER(S)AFFORDINGCOVERAGE NAIC0 Northampton MA 01061 INSURER A:Main Street America Assurance Co. 29939 INSURED INSURER B: DADMUN DESIGN & CONSTRUCTION INSURER C: 60 SCHOOL ST INSURERD: INSURER E: HATFIELD MA 01038-9747 INSURERF: COVERAGES CERTIFICATE NUMBER:CL16121401819 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. INSR TYPE OF INSURANCE AWL SUBR POLICY EFF POLICY EXP LIMITS LTR fNSD WVD POLICY NUMBER (MM/ODIYYYYI (MM/OD/YYYY) X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 TA CLAIMS-MADE X OCCUR PRERENTED PREMMI DAMAGE SES ( RENTED occurrence)Ea accurnce} S 500,000 MPT4694Q 11/13/2016 11/13/2017 MED EXP(Ary one person) $ 10,000 PERSONAL&ADV INJURY $ 1,000,000 GE 'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY I I PROT- 1 JECI LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: Identity Recovery $ AUTOMOBILE UABILITY COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO BODILY INJURY(Per person) $ ALL OWNED — SCHEDULED BODILY INJURY(Per accident) $ AUTOS __ AUTOS HIRED AUTOS NON-OWNED PROPERTY DAMAGE $ AUTOS (Per accident) _ $ UMBRELLA LIAB OCCUR EACH OCCURRENCE S EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ S WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY YIN STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVEE.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? I ] N/A (Mandalory in NH) EL DISEASE-EA EMPLOYEE S If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached H 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 ACCORDANCE WITH THE PIE'0 PROVISIONS AUTHORIZED REPRESENTATIVE U, HIwI�4�1'.. J 01 CORPORATION, All rift hts rest ved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD imcnOc rx„wnn - DADMUN Design + Construction Project Address: SubContractor List 41 High St July 27,2017 Florence, MA 01062 Subcontractor: Has Employees: Yes No SMG Plumbing and Heating X James Elkins Electrician X Alexander Leonardi X SDL Home Improvement X Right Way Drywall X New England Granite X Cortina Tile X Dion and Sons Flooring X ACC0RE1a CERTIFICATE OF LIABILITY INSURANCE DATE(MWDDIYYYY) 9/16/2016 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 CONTACT Elizabeth Carballo NAME: Finck & Perras Insurance Agency Inc. (AIc°N o Ext); (413)527-5520 FAX No ):(413)527-5970 6 Campus Lane E-MAIL DoR ss:bcarballo@finckandperras.com INSURER(S)AFFORDING COVERAGE NAIC p Easthampton MA 01027 INsuRERAArbella Insurance Group 17000 INSURED INSURER B: S M G Plumbing & Heating INSURER C 133 Wyben Road INSURER D: INSURER E: Westfield MA 01085 INSURERF: COVERAGES CERTIFICATE NUMBER:CL1691602490 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. INSR TYPE OF INSURANCE ADDL SUBR — POLICY EFF I POLICY EXP LIMITS INSD WVD POLICY NUMBER IMMIDDIYYYY) IMMIDDIYYYY! X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 AMAG7O RENTED A CLAIMS-MADE I X 1 OCCUR PREMISES Ee occurrence) $ 50,000 9520043004 9/4/2016 9/4/2017 MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GE 'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY LOG PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: $ AUTOMOBILE LLABIUTY COMBINED SINGLE LIMIT $ E.accident) ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS I AUTOS —.. NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS (Per accident) UMBRELLA LIAB OCCUR EACH OCCURRENCE $ __ EXCESS LIAB CLAIMS-MADE AGGREGATE DOD RETENTION$ $ WORKERS COMPENSATION PER AND EMPLOYERS'LIABILITY Y/N STATUTE ,_ER H_ ANY PROPRIETOR/PARTNERJEXECUTIVE E.L.EACH ACCIDENT $ _ OFFICER/MEMBER EXCLUDED? NIA — — (Mandatory in NH) EL DISEASE-EA EMPLOY $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) Proof of Coverage CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Tom Dadmun / D+C THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 60 School St. ACCORDANCE WITH THE POLICY PROVISIONS. Hatfield, MA 01038 AUTHORIZED REPRESENTATIVE E Carballo/BETH `a' "K� '" 1�'� ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(20.14(01) The ACORD name and logo are registered marks of ACORD I NS025(201401) Alm ACORD CERTIFICATE OF LIABILITY INSURANCE °A'E`MMIDD'YYYY' 7/27/17 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 POUCIES 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 ZONTACY NAME: Bresnahan Insurance Agency, In PHONE FqX 100 Whiting Farms Road E-MAIL EMI: (413) 536-0536 �� Na; (413) 534-4291 ADDRESS: Holyoke, MA 01040 INSURE R(S)AFFORDING COVERAGE NAIC INSURER A:Mapfre/Commerce Insurance Co. INSURED INSURER B James Elkins _ INSURER C: 2 Williams Street INSURER D: Holyoke, MA 01040 —' INSURER E: INSURER F COVERAGES CERTIFICATE N UMBER: 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 SUCI-I POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDL SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER (MM/DD/YYYY} (MM/DD/YYYY) LIMITS A GENERAL LIABILITY ,8008030003716 5/5/17 5/5/18 EACH OCCURRENCE 1 $, 1,000,000 © COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED •REMISFS fEa occurrence) $ 100,000 ■ CLAIMS-MADE I X OCCUR MED EXP(Anyone person) $ 5,000 PERSONAL&ADV INJURY $ GENERAL AGGREGATE $ 2,000,000 I GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS-COMP/OP AGG $ 2,000000 PR - X I POLICY, , F CT I LOC d I $ AUTOMOBILE UABIUTY COMBINED SINGL E L IMIT ._(Ea accident) ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED I BODILY INJURY(Per accident { $ AUTOS AUTOS ) NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS (Per accident) i $ UMBRELLA LIAB _OCCUR I EACH OCCURRENCE $ I EXCESS LIAB CLAIMS-MADE I AGGREGATE DED RETENTION$ $ WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS'LIABILITY Y/N _ TORY I WITS FR ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? NIA E.L EACH ACG DENT (Mandatory in NH) E.L.DISEASEEA EMPLOYEE $ J If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT ($ tt 3 _ 1 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) Electrician CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DEUVERED Dadmun Design & Construction ACCORDANCE WITH THE POLICY PROVISIONS. 60 School St. Hatfield, MA 01038 AUTHORIZED RE TATlVE if/t, ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD Phnna• Fav• C ____,n_._ ..,_. 1 CCCERTIFICATE OF LIABILITY INSURANCE DATE 6' ACORN17 TI-IS 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 CONTACT NAME: Katelyn Litchfield Mirick Insurance Agency PHONE FAX (A/C.No.Fxtl• (413) 625-9437 (A/c,No): (413) 625-9473 POB 375 E-mAIADDRESS: klitchfield@mirickins.com 28 Bridge Street INSURER(S)AFFORDING COVERAGE NAIL# Shelburne Falls, MA 01370 INSURER A_Concord Group INSURED — _ —....—. INSURER B: Alex Leonardi INSURER C: • Cold River Builders INSURER D: 68 Newhall Rd INSURER E: Conway, MA 01341 INSURER F: COVERAGES CERTIFICATE N UMBER: 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 TI-E POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDL SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSR WVD POUCY NUMBER (MM/DD/YYYY) (MM/DDYYYYY) LIMTS A GENERAL LIABILITY 20004583 5/8/17 5/8/18 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED X_ COMMERCIAL GENERAL LIABILITY PREMISES(fa o.. rrence)_.._. $ CLAIMS-MADE X I OCCUR MED EXP(Anyone person) $ 5,000 PERSONAL&ADV INJURY $ _ GENERAL AGGREGATE $ 2,000,000 GEN'LAGGREGATE LIMIT APPLIES PER PRODUCTS-COMP/OP AGG $ 2,000,000 POLICY J ? LOC $ AUTOMOBILE LIABIUTY COMBINED SINGLE LIMIT (Ea accident) ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident)) $ AUTOS AUTOS NON-OWNED I PROPERTY DAMAGE $ HIRED AUTOS _ AUTOS (Per accident) $ UMBRELLA LIAR _OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE ( $ DED RETENTION$ $ WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS'LIABILITY Y/N •' u . F R ._ ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACO CP NT $ OFFICE RMIEMBER EXCLUDED? I N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ IDeSsCdeTrIOunF eOP ERATIONS below E.L.DISEASE-POLICY LIMIT $ I DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,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 DEUVERED IN Tom Dadmun ACCORDANCE WITH THE POLICY PROVISIONS. Dadmun Design and Construction 60 School Street AUTHORIZED REPRESENTATIVE Hatfield, MA 01038 Katelyn Litchfield ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The AC ORD name and logo are registered marks of ACORD Phone: Fax: E-Mail: tomd@dadmundc.com ® A CERTIFICATE OF LIABILITY INSURANCE DAT(MM/DDYYYY) /3/2017 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 CONTACT Cynthia Henderson, CISR NAME: y Webber & Grinnell PHO N Ext); (413)586-0111 (Nc,No). (413)586-6481 8 North King Street AIL ADDRESS:chenderson@webberandgrinnel1.com INSURER(S)AFFORDING COVERAGE _NAIC# Northampton MA 01060 INsURERA:Selective Ins Co of S Carolina __ INSURED INSURER B:Selective Ins Co of Southeast 39926 SDL Home Improvement Contractors Inc. INSURER C: I 24 Chestnut Street INSURERD: INSURER E: I _, Hatfield MA 01038 INSURER F: COVERAGES CERTIFICATE NUMBER3saster 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. INSR TYPE OF INSURANCE ADM.SUBR POLICY EFF POLICY EXP LIMITS LTR INSD WVD POLICY NUMBER (MM/DD/YYYY),(MMIODIYYYY) X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED A I CLAIMS-MADE X OCCUR PREMISES(Ea occurrence) $ 100,000 S2204065 2/1/2017 2/1/2018 MED EXP(Any one person) $ 10,000 PERSONAL&ADV INJURY $ 1,000,000 GE AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 3,000,000 X POLICY I JECT LOC PRODUCTS-COMP/OP AGG . $ 3,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 (Ea accident), AIII ANY AUTO BODILY INJURY(Per person) $ ALL OWNED v SCHEDULED1 A9100328 2/1/2017 2/1/2018 BODILY INJURY(Per accident) $ AUTOS AUTOS HIRED AUTOS ! X NON-OWNED PROPERTY DAMAGE $ AUTOS (Per accident) 1 Underinsured motorist 81 split $ 100,000 X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 1,000,000 A EXCESS LIAB CLAIMS-MADE AGGREGATE $ 1,000,000 DED , X RETENTIONS 10,000 S2204065 2/1/2017 2/1/2018 $ WORKERS COMPENSATIONX PER XERH- AND EMPLOYERS'LIABILITY Y/N _ STATUTE , ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 500,000 B OFFICER/MEMBER EXCLUDED? Y N/A -- (Mandatory in NH) WC9024456 2/23/2017 2/23/2018 ELDISEASE DISEASE-EA EMPLOYEE $ 500,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT I $ 500,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) The Workers Compensation policy does not include coverage for Paul Schmidt, Kendrick Dempsey and Douglas Schmidt. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE DADMUN Design + Construction THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 60 School Street ACCORDANCE WITH THE POLICY PROVISIONS. Hatfield, MA 01038 AUTHORIZED REPRESENTATIVE C Henderson, CISR/CIN ..-41" g "a" ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD INS025 r7m4nt, A�o® CERTIFICATE OF LIABILITY INSURANCE DATE 4/3 '17 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 CONTACT NAME: Matthew Brown Dale A Frank Insurance Agency, (A "NQ Fitt): (413) 665-8324 (a/XC No): (413) 665-1280 PO Box 455 DRE ADSS: info@DaleFrankInsurance.com Sunderland, MA 01375 INSURE R(S)AFFORDING COVERAGE NAIL p_ INSURER A:Providence INSURED INSURER B:Progressive Rightway Drywall Inc. INsuRERc:Guard Brian Johnson INSURER D: 206 Coles Meadow Road INSURER E: Northampton, MA 01060-1111 INSURERF: COVERAGES CERTIFICATE NUMBER: 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. —.. —. —. INSR ADDL SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) LINTS A GENERAL LIABILITY BOP0093210 1/15/17 1/15/181 EACH OCCURRENCE $ 1,000,000 © COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED P•EMISES(Ea occurrence) I $ 50,000 CLAIMS-MADE IOCCUR MED EXP(Any oneperscn) $ 5,000 PERSONALE ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GENII.AGGREGATE LIMIT APPLIES PER PRODUCTS-COMP/OP AGG $ 2,000,000 POLICY I ,ECT LOC $ B AUTOMOBILELIABIUTY 02849700-1 1 1/26/17 1/26/18 CONatc3cI EDtSINGLELIMIT $ ANYAUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) ,500 000 AUTOS AUTOS J r NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS _ AUTOS (Per accident) 1 UMBRELLA LIAB _OCCUR EACH OCCURRENCE i $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ C WORKERS COMPENSATION R2WC815297 3/8/17 3/8/18 I .0 STATU- I I0TH- AND EMPLOYERS'LIABILITY - — ANY PROPRIETOR/PARTNER/EXECUTNE Y/N E.L.EACH ACCIDENT $ 100,000 000_ OFF ICERMEMBER EXCLUDED? N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 100,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT i $ 500,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is regd red) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DEUVERED IN Tom Dadmun ACCORDANCE WITH THE POLICY PROVISIONS. 60 School St Hatfield, MA 01038 AUTHORIZED REPRESENTATIVE Matthew Brown ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The AC ORD name and logo are registered marks of ACORD Phone: Fax: E-Mail: Aco CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) L../ 10/20/2016 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 CONTACT KPeters, Ext 103 NAME: y Foley Insurance Group Inc. PHONE Ext: (413)214-7474 __ (A/C No): ase (413)214-7447 37 Elm Street E-MAIL k eters@fole insurance rou ADDRESS: p y g p'com INSURER(S)AFFORDING COVERAGE NAIC# West Springfield MA 01089-2703 INSURERA:PatronS Mutual Insurance Co of CT 20028 INSURED INSURERB:Travelers Indemnity Co of CT 25682 ANDREY KORCHEVSKIY DBA New England Granite LLC INSURER C: ATTN: Andrey Korchevskiy INSURER D: 75 West School Street INSURER E: West Springfield MA 01089 INSURERF: I COVERAGES CERTIFICATE NUMBERCL16102009434 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. INSR ADDL SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MMIDD/YYYY) (MMIDDIVYYY) LIMITS X COMMERCIAL GENERAL LIABILITY I EACH OCCURRENCE I $ 1,000,000 I I DAMAGE TO RENTED $ 300,000 A j CLAIMS-MADE LX OCCUR PREMISES(Ea occurrence) BOP2741752 5/23/2016 5/23/2017 MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GE 'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY i PRO- LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER. $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO BODILY INJURY(Per person) $ ALL OWNED ' SCHEDULEDi AUTOS AUTOS BODILY INJURY(Per accident) $ NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS (Per accident) $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ WORKERS COMPENSATION X MUTE EMPLOYERS LIABILITY Y/N STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 100,000 OFFICER/MEMBER EXCLUDED? Y N I A —" - --' B (Mandatory in NH) 1E131321914876716 10/22/2016 110/22/2017 E.L.DISEASE-EA EMPLOY$ 100,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT I $ 500,000 I DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Proprietor/Partner/Executive Officer/Member exclusion applies on Workers Compensation. CERTIFICATE HOLDER CANCELLATION tomd@dadmundc.com SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THOMAS DADMUN THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 60 SCHOOL STREET ACCORDANCE WITH THE POLICY PROVISIONS. HATFIELD, MA 01038-9747 AUTHORIZED REPRESENTATIVE Brian Foley/LYNNE "- T.; ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD INS025 nn14n1 t Client#:41601 CORTII ACORDTM CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 4/07/2017 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 CAM ONTACT Mary A. Henderson People's United Ins.Agency MA PHONE — 413 781-6871 FAX (AIC,No,Ext): (A/C,No): 1391 Main Street, 3rd Floor a DRESS: Mary.Henderson@peoples.com PO Box 4950 — Springfield, MA 01101 _ INSURER(S)AFFORDING COVERAGE NAIC# INSURER A Merchants Mutual Insurance Co 23329 INSURED INSURER B: Cortina Tile of West Springfield —u.. INSURER C: 1645 Riverdale ST W. Springfield, MA 01089 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 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. INSR ADDLSUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER (MMIDD/YYYY) (MM/DD/YYYY) LIMITS A X COMMERCIAL GENERAL LIABILITY X BOPI071849 03/30/2017 03/30/2018 EACH OCCURRENCE $1,000,000 DAMAGE TO RENTED CLAIMS-MADE X OCCUR PREMISES(Ea occurrence) $500,000 X Blkt Al Per Prior MED EXP(Any one person) $5,000 Written Contract PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 PRO- POLICY X JECT LOC PRODUCTS-COMP/OPAGG $2,000,000 OTHER:. AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS ■ AUTOS (Per accident) A x UMBRELLA LIAB X OCCUR CUP9146566 03/30/2017 03/30/2018 EACH OCCURRENCE $1,000,000 EXCESS LIAB _CLAIMS-MADE AGGREGATE $1,000,000 DED X RETENTION$10000 _ $ A WORKERS COMPENSATION WCAI033448 03/30/2017 03/30/2018 X STATUTE r '24H- :AND EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N E.L.EACH ACCIDENT $500,000 OFFICER/MEMBER EXCLUDED? N N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $500,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $500,000 DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space is required) Blanket Additional Insured per Merchants form MU8277(1111); Blanket Additional Insured-Completed Operations per Merchants form MU8530 (1111) Proof of Insurance CERTIFICATE HOLDER CANCELLATION DADMUN Design+Construction SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Attn: Tom Dadmun ACCORDANCE WITH THE POLICY PROVISIONS. 60 School Street Hatfield, MA 01038 AUTHORIZED REPRESENTATIVE ©1988-2014 ACORD CORPORATION.All rights reserved. ACORD 25(2014/01) 1 of 1 The ACORD name and logo are registered marks of ACORD #S812656/M795873 MADCT / , ® DATE(MM/DD/YYYY) ACORD CERTIFICATE OF LIABILITY INSURANCE 7/27/2017 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 CONTACT Barbara Grynkiewicz Webber & Grinnell PHONE (413)586-0111 FAX (413)586-6481 (A/C.No.Eel): (A/C,No): 8 North King Street E-MAIL ADDRESS: g �r b kiewicz@webberandg rinnell.com INSURER(S)AFFORDING COVERAGE — NAIC# _ Northampton MA 01060 INSURER A:Patrons Mutual Iris. Co. of CT INSURED INSURER B:S tate Auto Property & Casualty Ins. _ A. Dion & Son Floor Contractors, LLC INSURER C: — Attn: Donald & Daren Dion INSURER 0: P.O. Box INSURER E: —. Hadley MA 01035 INSURER F: COVERAGES CERTIFICATE NUMBER:Exp 7/1/18 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. INSR ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MM/DD/YYYY) IMM/DD/YYYY) X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 2,000,000 DAMAGE TO RENTED 300,000 A _ CLAIMS-MADE X l OCCUR PREMISES(Ea occurrence) $ B0P2906463 03 7/1/2017 7/1/2018 MED EXP(Any one person) $ 5,000 PERSONAL 8 ADV INJURY $ 2,000,000 GE 'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 4,000,000 I X POLICY X JECPROT- LOC PRODUCTS-COMP/OPAGG $ 4,000,000 — — -- OTHER: $ AUTOMOBILE LIABILITY COMBINEDISINGLE LIMIT $ _ 1,000,000 " BODILY INJURY(Per person) $ A _ ANY AUTO ALL OWNED I X SCHEDULED BAp2406132 03 7/1/2017 7/1/2018 BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ X HIRED AUTOS X AUTOS (Per accident) --- $ 8,000 X 19 PIP-Basic X UMBRELLALIAB OCCUR EACH OCCURRENCE $ 2,000,000 A EXCESS UAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ CXS2125771 03 7/1/2017 7/1/2018 $ WORKERS COMPENSATION x PER STATUTE X ERTH- AND EMPLOYERS'LIABILITY Y/N ANY PROPRIETOR/PARTNER/EXECUTIVEN/A E.L.EACH ACCIDENT $ 1,00o 000 OFFICER/MEMBER NH) WCP222768EXCLUDED? 9 03 7/1/2017 7/1/2018 B (Mandatory inME.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached It more space is required) CERTIFICATE HOLDER CANCELLATION tomd@dadmundc.com SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Tom Dadmun THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 60 School Street ACCORDANCE WITH THE POLICY PROVISIONS. Hatfield, MA 01038 AUTHORIZED REPRESENTATIVE M Horan, CIC, CISR/BK ©1988-2014 ACORD CORPORATION. All rights reserved. 4CORD 25(2014/01) The ACORD name and logo are registered marks of ACORD NS025(201401)