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22D-051 34 RYAN RD BP-2018-1126 GIs#: COMMONWEALTH OF MASSACHUSETTS Map:Block:22D-051 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Cateeory ROOF BUILDING PERMIT Permit# BP-2018-1126 Project JS-2018-002028 Est. Cost: $10400.00 Fee: $40.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: SEXTON ROOFING CO 99689 Lot Size(sa.ft.): 37766.52 Owner: HATHAWAY CHARLOTTE Zoning:URA(100)/WSP(100V Applicant., SEXTON ROOFING CO AT. 34 RYAN RD Applicant Address: Phone: Insurance: P O BOX 6327 (413) 534-1234 WC HOLYOKEMA01041 ISSUED ON.51112018 0.00.00 TO PERFORM THE FOLLOWING WORK.STRIP & SHINGLE ROOF POST THIS CARD SO IT IS VISIBLE FROM THE STREET Inspector of Plumbing Inspector of Wiring D.P.W. Building Inspector Underground: Service: Meter: Footings: Rough: Rough: House# Foundation: Driveway Final: Final: Final: Rough Frame: Gas: Fire Department Fireplace/Chimney: Rough: O_I: 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 5/1/20180:00:00 $40.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner gp_ �d- iia L..i J t:U Decarment use only City o No ampton Status of Permit � .rf' Buldi D artment Curb CuNDnveway Permit ' '!� �. PR 3 0 201112 ai Street SewenSepticAvailabigly ' om 100 Water/Well Availability oFPUitoinc to MA 01060 Two Sets of Structural Plans <S'T DPtL94 - Fax 413-587-1272 PIo1ISile Plans Other Specify APPLICATION TO CONSTRUCT,ALTER REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWEWNG SECTION i -SITE INFORMATION f,aO F 1.1 Property Address: This section to be completed by office -?,Cf un Jit Map ]aD Lot 6-451 Unit —1 WJ Zone Overlay District Elm SL District CB Mobict SECTION 2-PROPERTY OWNERSHIPIAUTHORIZEDAGErdT 2.1 Owner of Record: 0—hc otfe UA` LQI 4(4 y(--2ojeP4,! P , IAM Nam(Print) t, CuZ Maif Addans- Q;,Ik /ce. TelePMne Signature 22 Authori red Acerd: Name(PnM) cunent Mailing Atltlress: `S3Y iz3 ! Sgnature Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Oficial Use Only completed by permit applicant 1. Building (a)Building Permit Fee 2. Electrical (b)Estimated Total Cost of Construction from 6 3. Plumbing Building Permit Fee 4. Mechanical(HVAC) WW 5. Fire Protection 6. Total=(1 +2+3+4+5) (() Check Number Ip(d1� This Section For Official Use Only Building Permit Number. Date Issued. Signaturti �f l/� Buildingissbnei/Inspector of Buildings Date EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR) SECTION S DESCRIPTION OF PROPOSED WORK(check all applicablel New House ❑ AAdition ❑ Or Doors Risplacemerd Wind. Alteration(.) ❑ Roofing 55/ El Accessory Bldg_ ❑ Demolition ❑ New Signs [01 Decks U Siding[01 Oder[E:A Brief Description of Proposed Work' 12D WLOJ-Z eC�h� 1`e-L�✓ -� �iL. ���� I� L Aflerabon of ensfing bedroom_Yes "NO Adding new bedroom Yes No Attached Narrative Renovating unfinished basement — Yes — No Plans Attached Roll -Sheet 6a. If New house and or addition to ex!Wnq housing, complete the followinw a. Use of building:One Family T"Family Other b. Number of rooms in mily unft Number of Bathrooms c. Is there a garage attachetlI tl. Proposed Square footage of new Iruction. Dimensions e. Number of stories? f. Methpd 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 If of wetlands? Yes Is construction within 100 yr. floodplain_Yes No j. Depth of base or cellar floor below finished grade k. Will build conform to the Building and Zoning regulations? Yes No. L Septic Tank_ CtiiSewior Private well City water Supply SECTION 7a-OWNER AUTHORIZATION-TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, W,.-*anti w I as Owner of the subject property 0 hereby auMrorizey �(-�.h: 1,i- to act on my behalf,m all matters relative to work auflwn¢ed by this bui ding permit application. 1f��_f � Y/z�/rP Sigr�i/al/lure of Ovrtier /,/�/� / �`NEW— � Da/le' I, 7 . .fitY a �Y�lt� X/'Ol�b� J S•a'rI -(9 rl tL asOwner/Authorized Agent hereby'declare that ttte statements and information on the foregoing application are true and accurate,to the best of my knowledge and belief rSign under the pains and penalties of perjury. � ir? 6 S:e PdmN e Sfgnature of ovmedAgem e SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Suoenisor: Not Applicable ❑ Name of License Holder: E�(�f � V't"171J A�k -%fz, 1q License Number Address Expiration Date ov- Y 7j Sg um Telephone 9.Reaistmed Nome Nnorovemeot Contractor: Not Applicable ❑ S--e, l« ') 3Y Com n Name Registration Number C-,)4- 3 � � 1� l �op� W\. 3-rS- l9 Address Expiration Date Telephone S5VI Z3'f SECTION 14 WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L c.152,§25C(e)) 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 pemlit. Signed Affidavit Attached Yes....._ 1ir' No— ❑ *5 W6 Proposal u Sc 6fsf taw G(05( by oh 1�yjvSP on �1`la . WNTON ROOFING AND SJDTNG� INC wwwsextonroofini!.com hxfa( kedoti lk tqhonel uut1- d-(`dpzrt qef tGePlea) es(�w(cefe Soling the Standard MA HIC# 118239 I-Ige ha(�' I C(t�ar(Ct{2. �Pf110(z my u �5YriCt' ( • .r seztonroofing@hotmaiixom SUBMITrEDIUC40fok ,L PHONE 4(3 (Q 8"Z �(Q(( . DATE MIMS STREET 34 Rin Rd JOB NAME CITY,STATE,ZIP Fbtence,Ma. JOB LOCATION SEXTON ROOFING HEREBY SUBMUMPECHTCATTONS AND ESTIMATES FOR: 1) Strip and remove existing shingles and dispose of in proper landfill. 2) Inspect roofing deck and replace as needed. ($2.75 per sg.ft.) 3) Install new metal edging to rakes and eaves of roof.(8"Broom)) 4) Install ice and water shield on eaves(6'),vent stacks,entire left side addition,chimney, and at intersecting roofs of main house. 5) Install#15 synthetic roofing felt ran remainder of roof. 6) 1install new flanges over existing vent stacks. 7) Install starter shingles on eaves and rakes of roof. 8) Install IKO Architectural style roofing shingles as per manufactmers'specdicatira s. 9) Reflash chimney with new lead flashing. 10) Install new cap over ridge vent on main house. Il) Supply manufactures Lifetime warranty and SRC 25 yr.workmanship warranty. ALL CONTRACTS INSURED WITH PROPERTY LIABILITY AND WORKMANS-COMPENSATTON. We Propose hereby to famish material and labor—complete in accordance with the above specifications,for the amount of Ten Thousand Four Hundred Dollars($10.400.00)Payments to be made as follows:Due in full upon completion _All Marerul�r guarevu•ed bbe as ryecified All wmk to be aouptesed in a Amhoriz woa:rmNike morn accort4 glo sraMard pra'ti�ez. An}alteraaonm I derianon fmm above spmfiarions inrolrm� etre msts will be ecewnd oNT ! Signa upon wnarn oreers.md wdl beeome mexme clwge ore act abme the i �,,(� a esnmere. All agreanrnts coning..upon smkes,eccNeons m delays brymd om ` C4Y "Ll e. T l Q Lt- CCU room,]. Na responsible far wuerdm during carewrnon. rhaner to P.r Note:This proposal ma)'be withdrawn by us if tort accepted mponsiMelegal Tee fm mn-paymeor.and applsmb]e imesesr. ; within(14)days. City of Northampton Massachusetts mks cQe � m c DriF� OF BUXLDLFD In SP ROBS 212 Me- atxmt a MmiciPal MAIC in ecru \ aocthaaptov, ep 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"mconstruction, alteration, renovation,repair, modernization, conversion, improvement, mmoval,demolition, "construction of an addition to any pre-existing ownerbccupied 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 remstered contractors. Note:If the homeowner has contracted with a corporation or LLC,that entity must be registered Type of Work: Est.Cost: Address of Work: Date of Permit Application: 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 owneroccupied 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: �125/lr S,X- Dw� Q �� . ' ���< ll8 � '49 Dat Contractor Name HICRegistration 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 �qf Massachusetts 1. I14PAa1]SaT or Bmrw s nas ZCTXays \ 212 N n SGc t •t4aaicipa 9 1i ng y aortt,avpton, M 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 ffrrom construction work being performed at: (Plea a printrhouse number and street name) Is to be disposed of at: �9�eLt/d�s� �fb �Ih ST Cycle G - (P2 lease print name and location of facility) Or will be disposed of in a dumpsterr onsite rented or leased from: Company Name and dress) Signature of Permit Applicant or Owner bafe 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 COT raonYveeith of2lassachuse-= 3 gartr ent of lndus'trialAccilents - . Ofj ece of Imesiigatian.s ' 1 Congress Steei, SuiL 100 3os'fon,_Nr�' 02L420Z7 - . www.rr�ss.;av/'?tc .. . worl<exs' cis A -plicant 73iorma'uon ' PInse PTiat LeLi171_y N2Tne (Be. esslOc�ls=aii�-,rt t�vihezl): Sexton Roofing & Siding, Inca. Ade_ , P :.0. Box 6327 Cj7ty/State,/7ipt Holyoke, MA 01041 Phone;(: 413-534-1234 Fjsl�# �ah�� employer? erezpprop �l oZppe oiproj e[tespleyer� 4. USam zgeneil tivn4ac0n sdI ees(full aad/orpat-Gme) hrve hued h.mbons c 61'.sted oa'ac at`ohed shat 7. Pxmodesole�v�ictex orpaxine:-. � �dha7 no employees 'hese solicjeoiztsrs'ha7e ' '8Dcmelttimsformemanc early empiny"e andhuv warners' Y aP 9: Q P-0-9 adep ion o; mss' comp."L�sisrnce comp.oozrmce.ir-- S. � we are a coporatm MEis 1010 mock ec npeirs or addio..mhomeownex acmg x21 Wm1t ofucers 1s27e exercised&en 11.❑Pltnhbsgsepaus or aMilioro - myself (_No woilcexs camp. right of exemptionperbfGL 12❑gnofrepais - insoranceragin=,L)T c. 152,§IC4), mawe hzye no —Tkyccs (No7iasiozs' . - 13.0 Other co -4rmurmce-11n 1 .=A Y�Phem'.�n:cLec{3baz$lmwtalno�odthv secliazbeloyq sho-visgtheswmkm'eonpmsxSrmpoh'ry miromari� tgomcepneo wDn su oot*m dorog z Vodc dAmLueo�dc mspwtna mnRanbmii anew a€daatmdica.m;sw.h fCo¢hee5se&�chec'�'xbozmust afmcbcd madd�milshcasTowmgtnern+.o`be mb-ewttae(oa mdsia2 Whe°ws ornC-[bosi mtacs bow eemlo ,,If-Eae sub<m4actrath:rc raplejcc4 l�s'tPec)'+a'6caw hn'co p-P�-O➢n®b'cc Sara ex empioya th=isp,-widmgWOrkas'compmreh'att tum efor my employees. Below i,ney,og gndjob sile. - Insar'ance Caapffiy Name: n / 'Tob Site A-ddtess����Qi1L12o CrYIS�ILrp: - . Attrch a cepy compensation policy aeaL ation p age (sherltigrbt policy s=ober and expiration date). Papiae to seoare coyerage as rege¢edmider Scchm 25A ofMCd,c.152oanleadto the imposidmx oflirirul pmi es of e. iso ttp to 51,500.00 and/or one-year nnpsisa�eni, as WeIl as eivilpenaldes mibt,-l of a STOP WORT ORDFR cid afne cfup to,�'s.50.G0ad_ry aocainsie sAlai�. Be aisedrhz`izcopy ofthissa¢rt*�aybe;a-vr¢dedte ibe Dince of sves[gaa' oos effSeDIA for�ce co7ead yerd..tio>L l do horeby ce,ti(yund ep�.s msdprj�etice¢fperjs ysa-ai the uformaSonprorzled above it true end=ea spa on Dsie' phone# 4135341234 OfT.LZ use mzy, '-Dl n0YH Ler,Chir m'eq to be mnophog by mYy or i,1on ojTdrzl City or Town: Pexrolt/fScense# Ssso Antheaity(circle onc): . 1.Board ef3ealtli 2.BwldingDepar�mt 3.CkrpTor Clerk 4.ElectricalIospeaor.S.Plnsbmglnspector 6. Other - - 'contactBersou: -Phone k: ✓quu The Commonwealth ofMassachasetts Department of IndustrialAccidents Office oflnvestigadons 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information (� Please Print Le 'bl Nme(Buines/Orgmizaton/Individual): QQ ] Address: ""lD 00 G , �j Ie�— City/State/Zip: ( 4 jjPhone#: Are you an employer?Check the ppropriate box: 4. ❑ 1 am a general contractor and I employees Type of project(required): l. employer with l� o eloyees(fulland/or part-time).' have hired the sub-contractors 6. L]New construction 2.❑ 1 am a sole proprietor or partner- listed on the attached sheet 7. ❑Remodeling ship and have no employees These sub-contractors have g. ❑Demolition working for me in any capacity. employees and have workers' [No workers' comp.insurance romp. insurance.: 9. ❑Building addition required.] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions 3.❑ 1 am a homeowner doing all work officers have exercised their I1.❑Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.[—] Roof insurance required]t c. 152,§1(4),and we have no repay employees. [No workers' 13.❑Other comp.insurance required.] ­ *Any applir t[fist checks box#1 must also fill out Ne section below showing their workets congrensatim pohcy ivfommfio t. t Hum...who submit this affidavit indicating they are doing all work and th m hire outside contractors must submit a new affidavit indicating such, iCon ms,w,s that check this box must attached an additional sheet showing the noun¢of the sub.rwsxtors and state whether or rmtthbse entities have employees. Ifthe sub<ontrecta s have employees,they must provide Neu workers'comp.policy vumber. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. ��r r Insurance Company Name: ��0�QOF �aai 't%_Y 1 i� Policy#or Self-ins.Lie.#: fIJ/�/J D u — U5 I 0—,;)— ' 7 Expiration Date: Job Site Address: rt�-G1�Y[� � City/State/Zip:;L t Attach a copy of the workers'hompensafion 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 ce unde the pains artd penalties ofperjury that the information provided ab ire is True artd correct Signature: Date' Zrrh/14-- Phone#: 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.Budding Department 3.Cityfrown Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: A� CERTIFICATE OF LIABILITY INSURANCE 1y'� Y 018 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(fes)most have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the polity, certain Policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such andomement(s). PRODuceA cAMEomAcT ISABELE CORDEIRO BniN : 345 Malu Arc y Insurance PxoxE 978-455-5991 ' FAX o978455-9934 xo Etl: 1 N : 345 Main St Unit B7 ADDRE..inf brazwa insumnceageney.eom Tewksbury MA 01876 INSUREIRRSAFROMANGCOwRAGE NMC# _ wsURERA:ATLANTIC CASUALTY INS CO INSURPo mwBER,ACE AMERICAN PJS SUPERIOR CONSTRUCTION INC on..C: 66 WATER ST APT A INSURER D: MILFORD MA 01757 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 V.MICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONSAND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID C WMS. MSR ADDL SUER .1EFF PoULYFXP LTA TYPEOFINSURAME POUCYNUMBER MWp M UMIR `/ COMYE0.CIALGENERKLKRIIfIY EACH OCCURRENCE 52,000,000 )ANI RENTED CLAIMSM40E O OCCVR pgEMSEe Ea-- S 100,000 MED os(AAy old Aesw) $5,000 A L117002783 ON0812017 ONOW2018 PERsONAL..D INJURY $1,000,000 GENL AGGREGATE LIMIT APPLIES PER GENERALAGGREGATE E 2,000,000 POLICV OECOT OC 0LPRODUCTS-0010MIAGG 52,000,000 O HER $ AUTOMOBILE WBIUEYLj CEOMB1NEp SNGLELIMn $ ANY AUTO BODILY INJURY(par Parsm) $ OWNEU SCHEDUtEO BODILY INJURY(Per uiam) $ AUTOS ONLY I AUTO$ HIRED NONDWNEO pgOPERTYOAMAGE S AUTOS ONLY AUTOC ONLY peramOe,I[ S Us... OCCUR EACHO=URRENCE $ ESCESS LAR CWMSMAOE AGGREGATE $ OEO RETENTIONS E WORAERS CLIVEXSATON ✓ PER OFTH- AND EMPLOYERS UADIUIY B o cEPIDETOEPE'R of C'U" M NIA 6S62UB-BH25120-2-17 0WOV2017 0WOV2018 ELEAGHACGIDENT s1,000,000 (Na,Malayin HXl EL.DISEASE-EA EMPLOYE E 1,000,000 DESCRIPTION OF OPERATIONS I— EL DISEASE-POLICY LINT 51,000,000 OFSCMEU0N0F0PERAn0NS1U0cXR0NSIVEHICIES(ACORD1A1,gJGTpW gemarb srJ tWq nny peatlxllM tlmarespxe¢,puvM) CARPENTRY/ROOFINGISIDINGIPAINTING. CERTIFICATE HOLDER CANCELLATION SEXTON ROOFING S SIDING INC SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 102 PINE ST-PO BOX 6327 THE EXPHUODON DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WDHTHEPOLICYPROVISIONS. HOLYOKE MA 01041 SEXTONROOFING@HOTMAIL-COM AUTNDRREO BERRESFNTATNE LKx�'v - ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD Pmelr.W IaAs ExAR eoe.wee salare.w.w.FOAAae�.�olA Iq IrePre:s.e v�euenlAB Eoo-me-nn ACROCERTIFICATE OF LIABILITY INSURANCE DATE W2102017 HIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY ANO 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. HIS CERTIFICATE OF INSURANCE DOES NOT CONSTRLITE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZE REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER - IMPORTANT!If the Certificate holder Is an ADDITIONAL INSURED,the policyQes)must be endorse0.If SUBROGATION IS WAIVED,subject to the antl comcie.e. of the policy, ultelo Pollclas may-Rule en eneore nnumt A statement On this lumflcate does Net Centel D,hts lolBe certificate holder in lieu of such endomement(s. PRODUCER CONTACT NAMEARIN Hutchinson Ormsby Insurance Agency,Inc. PHONE IAAC,NOExI):(413)029300 EA.I D.A.): PO Box 718 E-MAIL ADDRESS:khulaMnscn®mmsbylns.eom _ West Sterrelffirld,MA 01089 INSURERS AFFORDING COVERAGE NAUNI INSURED INSURER A:Colony Insurance Company 31993 Sexton Roofing and SIdIng Inc INSURER 0: PO Bax 0327 INSURER C: Holyoke,MA 010tl6]2T INSURER P, INSURERE: 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 hE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS POLCYEFf PGLICYEXP XST DO'L SUB' DATE DATE ITS ttPE OF MSUMNLE HERB WVD. POLICY NUMB ER MMNDM' MMND ENDS A X COMMERCIAL GEN101EKW02159902 62S=17 N2W2018 EACH OCCURRENCE 51,00.1.000 IE-RAyL LIABILITY CLAIMS MADEuOCCURNR DAMAGERENTEO $10000 0 PREMISESS flEMa 0[DONnenW MED EYP(Any One INJURY $5.000 PERSONAL 11.11.000,000OO,O EN'L AGGREGATE LIMB APPLIES PER: GENER4L gGGREGATE GGREGATE 32.000.000 Y POLICY IFS OLOC PRODUCTS-0OMPIOP AGE 52.000.000 OTHER: COMBINED SIGNED LIMIT 5 UTOMOBILE LIABILITY IEa aminent) ANY AUTO BODILY INJURY(Per Lannon) 5 ALL OWNED SCHEDULED BODILY INJURY(Per S AUTOS AUT05 recenU HIRED AUTOS HNON OWNED PROPERTY DAMAGE 5 'I AUTOS (per a-aenl) S MBRELLA LIAB CUR EACH OCCURRENCE S CESS LIAR IAIMS MADE AGGREGATE 5 ED TENNQN$ S WORKERS COMPEXSATIONAXO EMPIAYENS'LIABILITY YIN SiP1VlE ERH ANYPROPRIETORWARTHERIEYECUTIVE❑ EL EACH ACCIDENT 5 OFFICERJMEMBER EXCLUDED) NIA (Mantlalory In NH) EL0ISEASE EA S If yes,Eese*be uMer MPLOYEE DESCRIPTION OF OPERATIONS below EL DISEASE-POLICY LIMIT S DESCRIPTION OF OPERATIONS;LOCATIONS;VEHICLES ACORO let.Axon...I Remarks Smeeule,If mart apw Is nyu RPh CERTIFICATE HOLDER - CANCELLATION Town Ol A,mral SHOULD ANY OF THE ABOVEE DESCRIBED CANCELLED BEFORE THE EXPIRALIFION GATE THE'EOf,NOTICE WILL BE DELIVERED IM ACCORDANCE WDM THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE NTATIVEUIHfl AC0R025(2014101) ®,98&2014AC0RD CORPORATION.All rights mserveE. The ADDED name and logo are raglstaratl marks of ACORD � Office of Consumer Affairs and Business Regulation 10 Park Plaza- Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Type: Corporation SFXegistration: 118239fON ROOFING & Siding Inc!nc P.O. Box 6327 E�yka im: 02114/2019 Holyoke, MA 01041 Update Morass and return card, Mark reason for change. -.• .• -. . ..t n tm r y^^Pna 1"t 1 nvr t)aa ComnWnwealth or Massachusetts �� Revision at Professional Ecenmre Board ofBuilding Regulations and standards Construetlomspper taor Specialty CSSL-099689 Eipires: 10/05/2019 EVERETT J SEXTON PO BOX$327% HOLYOKE MA 010dt / /' }d rad Commissioner C,4 STATE DEP-J" ,T OF V �� HOME IMPROVEMENT CONTRACTOR EVERETTJ SEXTON SR 102 Pihe Sc I HOLYOKE,MA 01040-2411 —CIr;`i R SEXTON RNO.OOFING 8 SiDWC CO eG c ECTN EXAIR ..� HIC.0605383 12/01/201 11/30/2028 SicrvEU