Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
38B-285
15 WINTHROP ST BP-2018-1351 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block:38B-285 CITY OF NORTHAMPTON Lot -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category ROOF BUILDING PERMIT Permit# BP-2018-1351 Proiect# JS-2018-002398 Est.Cost:$8875.00 Fee: $40.00 PERMISSION IS HEREBY GRANTED TO: Const Class: Contractor: License: Use Group: GENE BOROWSKI 106527 Lot Size(sq.ft.): 6316.20 Owner: PEAKE PHILIP K Zoning URB(100)/ Applicant: GENE BOROWSKI AT. 15 WINTHROP ST Applicant Address.- Phone: Insurance: 117 SUNNYMEADE AVE (413) 687-3777 WC CHICOPEEMA01020-1780 ISSUED ON.6118.12018 0:00:00 TO PERFORM THE FOLLOWING WORFLINSTALL METAL ROOF OVER EXISTING 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: QiL 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: FeeTyoe: Date Paid: Amount: Building 6/100180:00:00 540.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner RECEIVED (Lcor ' Department use only City of Northampt n ��N ) qL Lest Building Departm nt 8 Met/ Permil w 212 Main Street SewerbllityRoom 100 oNorthampton, MAO rvoarrvAMPlans �.- phone 413-587-1240 Fax 413-587-1272 PloVSse Plans - Omer Specify APPLICATION TO CONSTRUCT,ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION I -SITE INFORMATION n�Q , D- I �/ 7.7 Property Address: This section to be completed by office Map 30 � Lot Unit Ifle � �p,�.�! /"Qa Q/C�© Zone Overlay District Elm St District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner f Recoo d� 4 'i // Name(Print) Curren)MaJinq tltlress' Telephone Signature 2.2 Authorized Agent: Name(Print) Current Mail iddress: Signature Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only comicleted by permitapplicant 1. Building (], .f� (a)Building Permit Fee 2. Electrical b (b)Estimated Total Cost of Construction from 6 3. Plumbing Building Permit Fee 4. Mechanical(HVAC) 7WIf�T 5. Fire Protection U 6. Total= (1 +2+3+4+5) Check Number This Section For Official Use Only Dale Building Permit Number Issued: Sig tures Building Com inner/Inspector of Buildings Dale EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR) Section 4. ZONING All Information Must Be Compandc.Permit Can Be Denied Due To Incomplete Information Existing Proposed Required by Zoning This column 1.be filled in by Building Deparnmeni Lot Size Fronto e Setbacks Front / Side L:/S R. /b L . R ... Rear Building Height /z Bldg. Square Footage % -- Open Space Footage % rLo1 mea minor bldg&pavW j p., 1n,7 p of Parking Spaces �.. Fill: (volume&Lot'sliov) __-. A. Has a Special Permit/Variance/Finding ii been issued for/on the site? NO O DONT KNOW YES O IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO O DON'T KNOW O YES O IF YES: enter Book Page', and/or Document# B. Does the site contain a brook, body of water or wetlands? NO (D/ DONT KNOW O YES O IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained O Obtained © , Date Issued: C. Db any signs exist on the property? YES O NO Cr IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs Intended for the property? YES O NO IF YES, describe size, type and location: E. Will the construction activity disturb(clearing,grading, vsrfi or filling)over 1 acre or is it part of a common plan that will disturb over 1 acre? YES O NO IF YES,then a Northampton Storm Water Management Permit from the DPW is required. SECTION 5-DESCRIPTION OF PROPOSED WORK(check II Pplieablel New House ❑ Addition ❑ Replacement Windows Alteration(s) Roofing 0, Doors D Accessory Bldg. ❑ Demolition ❑ New Signs [0] Docks 1p Siding IDj OtherJ[:1] Brief Description of Proposed Work: G )—Q l/ ✓"/P' -e Alteration of existing bedroom_Yes o Adding new bedroom Yes No Attached Narrative Renovating unfinished basemen[ as No Plans Attached Roll -Sheet Be. If New house and or addition existlnq housing, complete the following a. Use of building: One Family V Two Famil 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 storie0 f f. Method of heating? Fireplaces or Woodstoves Number of each g. Energy Conservalton Compliance. Masscheck Energy Compliance form attached? h. Type of construction n I. Is construction within 100 ft.of wetlandsv_Yes No. Is conrtion within 100 yr. floodplain_Yes No j. Depth of basement or cellar floor below finished grade // k. Will building conform to the Building and regulations? Yes No I. Septic Tank . is City Sewer V Private well_ City water Supply I�/_/ SECTION 7a-OWNER AUTHORIZATION -TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, ( -Pas Owner of the subject property //�� hereby authorize Prf Ccs 6 rl a../Z'I nlS to act on my ehalf,in II ers relative t work authorized by this buildi ermit applic lion. Signature of Owner Date I, �elL2 �,�/r0 . / ,as Owner/Authonzed 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 poi s and penalties of perjury, Pdnt Name Signature Vf Own Agent Date SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Constructions Supervisor:// Not Applicable ❑ Narri License Holder: �P�'e &e"!>1P-, i C�slf/0!� License Number Address I / Expiration pate . r 8 Signature Telephone S.Registered Home Innivement Contractor. Not Applicable ❑ Company Name Registration Number 1741673 Address Expiration Date Telephone ..--,, � J/l0 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....... ❑ No...... ❑ City of Northampton Massachusetts �. � DEPARTMENT OF BUILDING INSPECTIONS 212 Main Street 6 MYMAC1Pa1 Building �,s NoxNampton, HA 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 preexisting 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. Nate:)f 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 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 net: GlgG� w� � Date ontractor 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 .5 - -"- Massachusetts DEPARTMENT OF BUILDING INSPECTIONS 212 Min Street • Nunicipal Building JS V Northeepton, NA OID60 Massachusetts Residential Building Code Section I I O R5.1.2 Homeowner: Person (s) who own a parcel of land on which he/she resides or intends to reside, on which there is, or is intended to be, a one or two family dwelling, attached or detached structures accessory to such use and/ or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Section I I O R5.1.3.1 Any homeowner performing work for which a building permit is required shall be exempt from the licensing provisions of 780 CMR 110.R5, provided that if a homeowner engages a person(s) for hire to do such work, then such homeowner shall act as supervisor. Such homeowner shall submit to the Building Official, on a form acceptable to the Building Official, that he/she shall be responsible for all such work performed under the building permit. As acting Construction Supervisor your presence on the job site will be required from time to time, during and upon completion of the work for which this permit is issued. Also be advised that with reference to Chapter 152 (Workers' Compensation) and Chapter 153 (Liability of Employers to Employees for injuries not resulting in Death) of the Massachusetts General Laws Annotated, you may be liable for person(s) you hire to perform work for you under this permit. _ City of Northampton " Massachusetts hss� c DEPARTMENT OF BUILDING INSPECTIONS V '_ 212 NeinStreet •Municipal Building .. Northampton, NA 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: (Please print house numbe and street name) Is to be disposed of at: (Please print name and location facility) Or will be disposed of in a dumpster onsite rented or leased from: &n//' &AlS �/7 JG✓l?G ytF� Lqbmpany Name and Address) Sign lure of P rmit 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 jl 1 Congress Street, Suite 100 Boston, MA 0211 4-2 01 7 www.mass.gov/dia i:WWI R orkers'Compensation Insurance Affidavit:Builders/Contractors/Electdcians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information PlortionPrint Tainib Name (Business/organixatioNmdn,iduap: Address: // 7 5 .n �ha�,lo 9TN l ler/ // '.�O �-7 City/State/Zip: Phi #: r ,,3 pQ`7_?!]. i / Are_nu employer?Check the appropriate box: Type of project(required): I. 1amaemployorwith -employees(full nnd/orpan-time)* 7. []New construction ❑ I canticle proprietor or partnership and have no employees working for me in Na workers'cora S. ❑Remodeling any capacity,[ p insurance required] 3 am a homeowner doingall work m IC[No workcri com suranc 9. ❑Demolition e ysc p v crcquircdl' 4-❑I am a homeowner and will be hiring contractors m conduct all work on my 10❑Building addition b Yrc sole y. will en rnnat all mno-acmra either have workers mmpcnsmloninsumnco or arc sole Il.❑Electrical repairs or additions promemr,with no employees. 12.❑Plu ng repairs or additions S�l am a general amemem,and l has,moral the sab-comradora lasted rally attached sheet. 13. Of repairs These suboontracmrs have employees and have worker'comp_insurance 6.❑We are a corporation and its offecrs have exercised their right of exemption pct MGL a 74. Outer 152.§114),and we have no employee.[No workeo'comp-insurance required] 'Any applicant that checks box CI must also fill out the section below showing their workers`compensation policy iormoution. 'Homeowners who submit this affidavit indicating they are dries all work and then hire outside contractor'must submit a new affidavit indicating sucll. Contractors that check this box most attached an addifanal sheet showing the name of the sub-comaccurs and state whether or not those entities have onployces. If the sobsomme tars have employees.they must provide their workers omp.poliev number_ I am an employer that is providing workers'compensation insurance for rap employees. Below is the paunry and job site information. r, Insurance Company Name: J _ ��'QY P" Policy#or Self-ins.Lic. Expiration Date: --/2 Job Site Address: l6 a/in Teen "F = City/State/Zip: .r. ep.O/�Z� Attach a copy of the workers'w m policy declaration page(showing the policy number and ex riratio date). Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the forth of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify un er the p s aqd penalti ofperjury that the information provided above s true nd correct. $ g t D t ��5�� Phone#: S Official use only. Do not write in this area,to be completed by city or town ofjreial 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#: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute,on employee is defined as"...every person in the service of soother under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein.or the occupant of the dwelling house of another who employs persons to do maintenance,cons[mction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such cnfploymcm be deemed to be an employer." MGL chapter 152,§25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152,§25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance ofpublic work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the woffers' compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractors)name(s),addresses)and phone number(s)along with their Certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers'compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insumnce license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple perm ulicense applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in_(city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. Anew affidavit must be filled out each year.Where a homeowner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e, a dog license or permit to bum leaves etc)said person is NOT required to complete Ws affidavit. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street, Suite 100 Boston,MA 02114-2017 Tel. #617-727-4900 ext. 7406 or 1-877-MASSAFE Fax At 617-727-7749 Revised 02-23-15 Www.mass.gov/dia Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees- Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in ajoint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However,the owner of a dwel ling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152,§25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required" Additionally,MGL chapter 152,§25C(7)states"Neither the commonwealth on any of its political subdivisions shall enter into any contract for the performance ofpublic work until acceptable evidence ofeompliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary, supply your insurance company's name,address and phone number along with a certificate of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers' compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. .Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or ifyou are required to obtain a workers'compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number.In addition,an applicant that must submit multiple perran/hatuse applications in any given year,need only submit one affidavit indicating current policy information(if necessary). A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture f.e,a dog license or permit to bum leaves em.)said person is NOT required to complete this affidavit. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents I Congress Street Boston, MA 02114-2017 Tel. # 617-727-4900 ext 7406 or 1-877-MASSAFE Fax# 617-727-7749 www.mass.gov/dia Foam Revised 02-23-15 Number C-60552 June 4,2018 PO# C3452 Gene Borowski Licensed&Insured General Contractor MA Iia CS-106527 117 Bunny Meade Ave. Chicopee,MA 01020 (413)687-3777 CUSTOY DESIGNS NEW KXMES•PDDrpmm.RE oVATI0N6 CONTRACT SUBMITTED TO: JOB SUE: Phil Peak Rental Property 26 Vernon St. 15 Winthrop St. Northampton, Ma.01060 Cell (413) 335-3607 RE: Rental property off South Street SCOPE OF WORK: Strip off top layer of shingles only and attach purling directly to rafters/install charcoal color steel roof. Permits/Insurances/Protections: 10 File building and demolition permits as required. 2# Furnishing a certificaze of general liability and work compensation insurance,upon request. 3# Set temporary fencing,barricades,and/or temporary signage around worksite 4# Make work site accessible to work - 5# Provide continuous supervision over workers and sub-contractors. Permits/Filing Fee $ 250.00 Insurance Fee $ 100.00 Sub Total $ 350.00 Demolition/RootrRidee-Yentdnstall Purlines/Metal Roof (14sq) I# Strip off top layer of shingles and install purling fastened to rapers. 2# Install new 5"drip edge and new flashing as required. 3# Install charcoal color steel metal .of with matching valleys/Uim. 44 Re-Flash chimney and install addition flashing as required. 54 Install ridge vent and metal cap. 6# Clean up and remove ail waste. Stripping/Waste $ 550_00 Material/Misc. $ 3,975.00 Labor $ 4.000.00 Sub Total $ 7,215.00 TOTAL BID S 8,875.00 Deposit$4,500.00 required to start contract,with the balance of S 4,375.00 due upon completion of contract. We look forward to the possibility of working with you on this project.Should you have questions regarding this project,please contact me at(413)687-3777. Sincerely, Cene Borowski (Owner) BEYONDBUILDERS °" E'MM"°" AC RO o® CERTIFICATE OF LIABILITY INSURANCE lk . 01/25/2017 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(les)must be endorsed. If SUBROGATION IS WANED,subject to the terms and conditions of the Policy,certain policies may require an endorsamem. A statement on this certificate does not confer rights to the certificate holder In lieu of such endoreemenos. PRODUCER 41377817075 4137817076 `CANT:"`T Eric Froebel Fred C Froebel Ins FHONF you.41377817075FZ NP 4137817076 321 Park Street nAC ness:efroebel@mmcast.net West Springfild, Ma. 01089 INSURE sAFFOREUG COVERAGE xAICX INSURERA: Nautilus INSURED INSURER e:Travelers Eugene Borowski/DBA Beyond Builder's INSURERC 117 Sunny Meade Ave INSURER D. Chicopee, Ms. 01020 INSURER E: NSURER 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 ,OFINSUMNCE ADDLISUBR POLJCYEFF POLICY EXP LlR POLICY NUMBER ! MMNEDI1YYY MMNDIWYY LJMIrS Y/ COMMRJ ERCIALGENE�LUABNTY EACXOCCURRENCE ;2000000 A CLAIMs.w.°E LCL OCCUR AOwszs iE.n,P„ e f 50 000 NN540774 01/232017 01/232018 MEOEXp IAnywo,, ml 35000 PERSONAL 3 ADV INJURY f 1,000,000 GENL AGGREGATE LIMIT APPLIES PER: GE.ERALAGI 32000000 POLICY C RECO C LOC FR000CT5-OCN.PAGG s2,000,000 OTHER. 3 AUTOMOBILE UABII TY COMBINED SINGLE LIMIT $ ANY AUTO BODILY INJURY Pel person) E AU-OVrNED AUTOS LEO AUTOS AUTOS FIR PE INJURY 0 aaEmBi E HIRED AUTO NON-OVME° pq sERTY°AMAGE 3 OS f UMBRELLA UJS OCCUR EACH OCCURRENCE if ESCESSUAS CIAIMSJMDE AGGREGATE 3 DEC I I RETENTION$ f ACRNERSCOMPENMTgI PE0. 0'" BIIJT AND EMPLOYERS UAY YIN STATUTE ER B ANY OFFICERMFMBEPROPPIETOF EXCLUOEDV ECUTIY£ © NIA IE.L EACH ACCIDENT ; 100000 IMenJelgyln NI 2E67637-2-16 �.DISEASE. I aaao unan 1/23/2017 1/23/2018 E EA EMPLOYE 3500000 DESCRIPTIONOF OPEMTIONS Mxur E L DISEASE�POLICY LI Mn 5100000 °FSCRIPTION OF OPEMnOXB I LOCATIONS I VEHICLES IACORD 1.1,Ad.n.1 Remahe BerIN la,may...SICU ttmmn ePe[e b,IRP, CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ®1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(201000 The ACORD name and logo am registered marks of ACORD