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42-128 (2) 960 WESTHAMPTON RD BP-2019-0017 GIS#: COMMONWEALTH OF MASSACHUSETTS Map.Block:42- 128 CITY OF NORTHAMPTON Lot-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit. Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Cateeorv: ROOF BUILDING PERMIT Permit# BP-2019-0017 Protect 9 JS-2019-000021 Est. Cost: $8000.00 Fee: $40.0 PERMISSION IS HEREBY GRANTED TO. Const Class Contractor: License: Use Group: SEXTON ROOFING CO 99689 Lot Size(sq.ft): 16857.72 Owner: MICOLINI ALEXANDRIA zonine, Applicant: SEXTON ROOFING CO AT: 960 WESTHAMPTON RD Applicant Address: Phone: Insurance: P O BOX 6327 (413) 534-1234 WC HOLYOKEMA01041 ISSUED ON.71512018 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: Oil: Insulation: Final: mo e: Final: THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Certificate of Occupancy Sienature: FeeType: Date Paid: Amount: Building 7/5/20180:00:00 $40.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Louis Hasbrouck-Building Commissioner P,CC)F- Department:use only i City of Northampton Status of Permit Building Department Cur)CuVDwewey Permit 212 Main Street SmKO'Sepac Availability Room 100 WalimMell AvilaWity Northampton, MA 01060 Two Seta of Structure;Plans phone 413587-1240 Fax 413-587-1272 PwvBite,plane APPLICATION TO CONSTRUCT,ALTER REP A ONE OR TW O FAMILY DWELLING SECTION 1 -SITE INFORMATION JUL -' 2 2019 w- I/ - 1 7 1.1 ProoerN Address. is on to be completed by office / / ® 1I'Q�I � DEPT 9THUIL01N(INSPECTIONS y /� %0/Cn W ll�_�.. n/ T 09 BUILOV Lot Und Zone Overlay Disbict Elm St District CB DII&W SECnON 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Oamer of Record, 4l e x A KA91 A $4 9�Q Name(Pnm) Cu w;,b7 Adomss. �r � nfiru -Tae �l Te"pma SS -,�g� -s�ao eP ro SignaNre 2.2 Auth�oraed A ant: � p vTo Yb r ( 6 J7 e�r eH k L ��—tb1 -1 -7 061 Name(Pnnt1/", Curmn Mali Address: y / S-2 Signature Telephale SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only com letedk pemnit applicant 1. Building (a)Building Permit Fee 2. Elecmcal (b)Estimated Total Cost of Construction from 6 3. Plumbing Building Permit Fee w O 4. Mechanical(HVAC) •/7 5. Fire Protecron 6. Total=(1 +2+3+4+5) Ir 00(f Check Number (y']/ This Section For Official Use Only Building Pennit Number Date Issued Signature: BuiNinp Cgnmissia /Inepector of Buildings Dale 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 i be 1 in by Building Dxpartmrnt Lot Size Frontage Setbacks Front Side L: R: L: R: Rear Building Height Bldg.Square Footage Open Space Footage (Lot area minus bldg&paved ml im #of Parking Spaces FiII: volume&Location A. Has a Special/anVariance/Findi ever issued for/on the site? NO OONT KNOW YES O IF YES, date issue IF YES: Was therecorded the Registry of ? NO ODONT OW O YES O IF YES: enterok Page and/or Document N B. Does the site coroo , body of water or wetlands? 0 © DONT KNOW O YES O IF YES, has a or need to be obtained from the servation Commission? Needs to be oO Obtained O , Date Issued:C. Do any signs exia property? YES ONO IF YES, describype and location:D. Are there any prhanges to or additions of signs intended for the pr ? YES O NO O 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 vnll disturb over l arse? YES O NO O IF YES,than a Northampton Storm Water Management Permit from the DPW is required. SECTION S DESCRIPTION OF PROPOSED WORK(check all aoslicablel New House ❑ Atldition Replacement Windows Atieration)s) Roofing [Er— Or Doors 0 Accessory Bldg. ❑ Demolition ❑ New Signs i01 Decks IO Sidingiol Otheri0j Brief Description of Proposed Work �EIYtOaR .C/�'�c/ �p�OP f, Yx 14, �� r /«-'Q / Alteration of existing bedroom__yes No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Ves --No Plans Attached Roll -Sheet S&if New house and or addition to existing housing-Complete the followirw� a. Use of building One Famity 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 constmctio Dimensions e. Number of stones? I 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 f wetlands? No. Is construction within 100 yr. floodplain Yes_No f Depth of basement list floor below finished gra k. Will building orm to the Building and Zoning fegulati s? Yes No. L Septic Tank_ CitySewer Private well City water Supply SECTION Ta-OWNER AUTHORIZATION-TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT 1, 4/,P r A z 9,f ,2 D0/ /C G�i �'/ ,as Owner of the subject property, I herebyauthorize "2Lv76&,/ L41'rY f S�Cto act on my behalf, in all matters relative to work authorized by this builchrig permit application. � Sgnat re of Owner Date I, ad ) AV l K G\ as Owner/Authorized Agent riereby declare that tIle merge and infortriadon foregoing application are true and accurate,to the best of my knowledge and belief. Signed under the pains nalties of perjury IQ t A-C4 T. 5✓� Prim Na signature,of Owner/Agent D e SECTION 8-CONSTRUCTION SERVICES 81 Licensed Construction Sh�u/verviw}r::/: c\ y, Not Applicable ❑ Name of License Hdtler:� V'P/1 // V-cklV� 9y /n (�G7 License Number PO ox ��3a -7 Ch1,1,v to - I:;- Add s Expiration Date Signature Telephone T)7101=77 . a s``.,,, N m Ins rovemant Cron ra /r: Not Applicable ❑ o )7101 �d� l11 a lo�6n/C1 �2.G // E ) 79 ComComn NameName Registration Number Atldm_gys,_ �-y FxPiration Date 11 Q " 1 Le , 4� 610 Telephone 7 i U /L3 L� SECTION 10.WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.152,S 26C(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 AffidavttAtfached Yes....... Er— No...... ❑ City of Northampton Massachusetts N Y 1>6Plln'OffiiT OS 8rrrr.DZHG T9aPla:a'r0Na � n 212 I n St t • Mmicipa a 1,un9 aorUapWv, as 01060 +ryi yj�0 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, orconstruchon of an addition to any pre-existing owneroccupied building containing at least one but not more than four dwe/ling units....or to structures which are adjacent to such residence or buffdlrV'be done by registered contractors. Note.If Ike homeowner has contracted with a corporation or LLC,that entity mast be registered Typeof Work: n /cl�F r '''/te. Est. Cost: Pa)li— 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$1,000.00 _Owner obtaining own permit(explain): Building not owneruccupied —Other(specify): OWNERS OBTAINING THEIR OWN PERMIT OR ENTERING INTO CONTRACTS WITH UNREGISTERED CONTRACTORS OR SUBCONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK ARE NOT ELIGIBLE FOR AND DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER M.G.L.Chapter 142A.SUCH OWNERS ALSO ASSUME THE RESPONSIBILITIES FOR ALL WORK PERFORMED UNDER THE BUILDING PERMIT.SEE NEXT PAGE FOR MORE INFORMATION. Signed under the penalties of perjury: I hereby apply for a building permit as the agent of the owner: �� Date Contractor Name r HIC Registration No. OR: Notwithstanding the above notice,I hereby apply for a building permit as the owner of the above property: Date Owner Name and Signature City of Northampton % Massachusetts may= s s�Os� s \ � ' IffiAaaaD$rx OF BVZLDIIDG IHSpB,C12008 312 a . Lawton,, sAipni 6B ldin Debris Disposal Affidavit In accordance of the provisions of MGL c 40, 554, 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: (PSI esa pont house number a street name) Is to be disposed of at: (Please pont nam a I of faaldy) Or will be disposed of in a dumpster onsite rented or leased from: )4-q&c./. 1<ej 1ve&ciss 3s!) �a�55�r s7 . SP O ria (Company Name and Address) ,2� 11,12,11, 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 ratify the Building Department as to the location where the debris will be disposed. \ �J Proposal SEXTON ROOFING AND SIDING INC www.sextonroofina.com VATO MASTER Sating the Smndard P.Q. Box 6327 p. 413.534.1234 Holyoke, MA 01041 f. 413.539.9906 MA HIC#116239 sextonroofin ri Ohotmaii.com SUBMITTED TO Alexandra Mkwlini PRONE 854-18835W DATE SM7N8 STREET 96001mmampton Rd. JOB NAME CITY.STATE.7rP NorUtanptm Ma JOB LOCATION SEXTON ROORNG HEREBY SUBIBTSSPECWWATIONS AND ESTIMATES FOR 1) Ship and remove existing shingles and dispose of in proper landfill. 2) Inspect roofing deck and replace as needed. ($2.75 per sq.fL) 3) Install new metal edging to rakes and eaves of roof. (8") 4) Insist ice and water shield on eaves(61),vent stacks,in valleys,chimney,entire main roof,and at intersecting roofs. 5) Install#15 synthetic roofing felt on remainder of roof. 6) Install neer flanges over existing vent stacks. 7) Install starter shingles on eaves and rakes of roof. 8) Install KO Architectural style roofing shingles as per manufacturers'specification. 9) Retlash chimney with new lead flashing. 10)Install new cap over ridge vent. 11)Supply manufactures Lifetime warranty and SRC 25 yr.workmanship warrarNy. ALL CONTRACTS INSURED WIN PROPERTY LL4BILnY AND WORKYANS4:OMPENSATION. We Propose hereby to furnish notarial and tabor—complete in accordance with the above specifications,for the amount Of Eighi ThoUMW 110112M($8.000.00)P to be made as foli w .Dire In Tutl upon mnWeeon nr NaMd bguamtaadbbe:apaefwa ver weans mrnrTpebd�na Authorbad worMm Wm nwrw aaardrg b ste xw pmcbw AnyatareeUn or Signature daviehmfrom abae We cadom kWoMp entre antis we freer ally upon wean atlas,and wa bx w anw dwipwerard above tlieestrrwB. Naeaenreds anrWgant upm amt�es.aadtle�ar dera4a bayed aaataat Nat rwpa.bta br wabr damage datg Note:This proposal may be vAxIn rn by us if not accepted amebuctbo. Owrrm d fws b pay raWonsbe kgfor ronpayment,aM within(14)days. rrlergt Acceptance of Proposal The above prices, specifics ions and condi8ons are saWadory and are Zii9naftine hereby accepted. You are au8aodmd to Bre work as specified. Payment veal be made as outlined above. _ Date of Acceptance. / Z,p yg Signature The Commonwealth of ZY sarhu ets ibepan7nent aflndvstrialAccidents . . . office ofzmulgadons . 1 Congra S'SS}ez; Surtz I00 _ 303iO;MAA02III-00I7 svrw�-mass.goyAEL .. _ . worleas' Co�pen.satioaInsvrxaceAfSt.avt:Bnlders/Contra ors�ectriciaas/Pl4nbeis A7plica�-1 Zafnrmatioa ' Please PtlIl`.Le�rP Name Seaton Roofing & Sidiaz Inc .' Adclress: P .O. Bos '6327 -Ct7/,It�:Holyoke, MA 01041 Phone n: 413-534-1234- Are 13-534-1234Are YOU.an employer? Checl=the appropriate bom: - Type ofpr.j ect(regairea): 1.❑ I am a erixplot¢w1m 4. I m xgeneaalcmniractoc aadI employees(fnH asd/epazt-time).: have hiie'th.,vlb aitact�rs ❑ . . n _ 2 L Iem asaleprogietac ox patine[-. . listrd sheet 7. ❑Reraodeheg Lame snUc mua* t.lay. ' ship andlaave no employees _.' ❑Demolition . tvara-ingfsxneinmycapacity.. . employeesandhayagiorkers' 9. ❑Bmla—>ad4jioa UovamIr"' c®p insmaDea comp:.nissffice.. . . regoixedl We se a caxpocsi�aadits 1D.❑Eie-.uzalrepghs or addRiom. 3.❑I ma h.me er doing allwoL ofacm Late,exercasc tic-ir 11.❑Plmnbingxopaics or aaa:di s I¢yself [Noyyorkem' c right of esemptionperMGL u 1?rn�of-pam? ' mnnance rogmxed.]t c.152, §1(4), andv,' bin m . employcss13.❑QLor ."p,IDsi ..xegtti[c3) *-Aq ,R* .tiEt oh.cb Daz#lmnst elso,fsJ rmPms ionpo gmf,., .t- . tge$vronca wln _ ' .'bcxm5s " r me,pNmO&cddowrrY•mdoxn offoatade zLwjmmsmntsvbieanmvaodoitm�d,meaveh iCmtrmkv tbrt oheoLiLivbox®sf�rhedmeddAmilsWdaDmmyBwnau rffihc sobruatw•(ov sods�.whstbesornot�ose cutmubavc �toyesa..umes�ccasanar<�y�a.msmwry�riasm�w�'c�-n�es�� . . I inn ms empioysr dt�ieprpviding Ys�k�;r'comp m.re.Yott vurormire for tt7 e'ttP�Ye�'.. BeZaW is'JiepaHcy old jab s•tle. . �forn>ab'ux Lnsm'mce C-11a Nano: 1 -f-qL"-("/c cpq-S rn-s `c t� Paliry.#e Saki-ma.Lie#_- ''�jff.II/(( •�IIU B O l7 0 7�( O+Z/ P- �pn�d±onnaaie: 6/'f//Q -. 'Job Site9ddtass:s d W�.tY'�Cs. ✓�/ �td CtT1S&'Jap:/./ A.ttachacopy of�er�os$eis' cw-npeusationpoliry dedaratinnpage(shoz�gthe poLcyn�bex and expixaiion date).. Maze to seea_*n coyerage m regehed raider Se5f_ioa25A oiMGL c.152 cmleadin-ale imposUm of®mal per of x fine tip tis$1,500.00 and/or ane yes ffipriso+m'ent, m weB m eNl-pmiatues inthe f m.of a STOP WORK ORDER amd afine ofn2toV5D.00 eday aganastthe Piolabm Be advlaedtiA a copy of this strement*syrybe fa- mdedto the Dfice of ' h3 gtgaff= oifheM,formsmaace coverageyex*hcafion Ido heeby ceriify surds paint•m,dp4,,1du•afpuj�,Y&afbee mform¢ffoxprmn/ded above b Due aed Yhane# 4135349234 [0,ff'Ck�ial We only. 'Lo mI verde m tier meq to be cc7,q.T +'a byc or',a11'n oj15do1ty or Town:mmgAnt homy C-4eBoard of%eal'E 2.BnrldingDepartnmt 3.CtYfToRClerk 4.ElectxicalIaspector.S.Plnmbmglnspectortheront2oi l usom Phone#: - OA—Z ' The Commonwealth of Massachusetts Department of Industrial Accidents Office oflnvesdgadons 600 Washington Street Boston,MA 02111 wtvw.rnassgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Q Please Print Lcgib Name(Bwmesi/Organizatilov/Inldlwdual):L (� l� (f Address.,--(.Q(0 000 er L,,//�� I N0� 4 nn'' I City/State/Zip: a 6 A Phone#: I � –� Are you an employer?Check the ppropriate boa: - Type of project(required): 1.Lri r am a employer with 4. E] I am a general contractor atoll 6. ❑New construction employees(fell and/or port-time).' have hired the sub contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These subcontractors have g_ ❑Demolition working for me in any capacity. employees and have workers' 9 ❑Building addition [No workers'comp.insurance comp.iastaance.I required] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions myself[No workers'comp. right of exemption per MGL 12.❑Roofrepairs msmance required.]t c. 152,§1(4),and we have no employees. [No workers' 13.❑ Other comp.insurance required] •Any applicmt that checks hox#1 man also fill aw We secdoa below showiagthmr.rkers'compevsatiw policy iaformation. t Homeowners who submit this affidavit indicaaag they are doing all work eadthen hive o toide contractors mus[submit anew affidavit indicating such. :Conrad.that check this box must a[mched.additional sbeet showing the....fflx snb-covtradors and qw,wbatcr....t those eofifi.have employees. IfWembmatr mhaveemployees,Neymustpmvide Nen workerscomp.politynumber. I om an employer that is providing workers'compensation insurance for my employees. Below is the policy andjob site information. (1r Insurance Company Name: �"Ql'IcP�[I'SC%X'11 — Pohcy#or Self-inspLic..#/#: l l�,,�.�,� /l /ItY�—�— ' Enpharion Daten: ' �- )' Job Site Address: 66) City/State/Zip: Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under 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. Ido hereby c unde the pains and penalties ofperjury that the informationprovided above is true and correct onS _ Date, Co (2-6 /`J-- 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.Building Department 3.City/Tom Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: A ® CERTIFICATE OF LIABILITY INSURANCE1 DyzfinBha 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 ADOETIONAL INSURED,the policy(ka)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED,subject m the terms and Conditions of the policy,certain policies may requlm an endorsement A statement on this certificate does not confer rights to the certificate holder in lieu of such endomeme s). PRDDIICER Co"TUMEACT ISABELE CORDEIRO Brazvray Insurance PxaxE ,978d5545991 a NI 978-456-9934 345 Main St Unit B1 noi""IDA,a,info@brazwayimumnceagency.com Tewksbury MA 01876 INSU s AFFORDINGGURR MGE C. INSURERA.ATLANTIC CASUALTY INS CO INSURED Ixsurce D:ACEAMERICAN PJS SUPERIOR CONSTRUCTION INC NSURF"C: 66 WATER ST APT A MILFORD MA 01757 INSURERE: ISUReRF: 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. NOTWDHSTANDING 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, EXCLUSIONSAND CONDITIONS OF SUCH POLICIES-LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. sun LM AR TYPEOFINSONLE CTPoI9HVMBER TEfF TEV a. ose Unarm LEMBERLMLGEXEML WBILIiY FgCN OCCURRENCE 52,000,000 LUIMSM9pE OCCUR PREMISES Ea---`N--` $ 100x000 MED EQP(Aq ore pnvn) .5,000 A L117002783 OMW2017 03108/2018 PERSONU B ADV INJURY f 1,000,000 GENLAGGREGATELIMITAPPLIES PER: GENERALAGGREGATE 5 2,000,000 PoLICY�jEi LOC PRODUCTS-COMPIOPAGG f 2,000,000 On ER' f AUTOMOBILE WBILIIY COMBINE SINGLE LIMB $ ANY AUTO BODILYINNRY(Pw I-AOp) 5 AUTOS ONLY A1R05 OWNED SCHE➢IILEO DOpLLYINJURY(P—a U $ AIRED NUNSONLY RiCPERttpAM4GE f Al.ONLY AUTOS ONLY Ptte�M f W UMBNEUL UAB CUR EACH OCCURRENCE $ "CER me CWMSM4BE AGGREGATE 9 CFD I I RETENHCRS 5 MWERSCOMPE"911noN ✓ PER DTI+ ANORORREPPS LWBIUTY SrA E ER 8 anwaaRlETORmaamER.ErEcmrvE YI" 6562UBAH25120-2-17 .0610212017 08/02/2018 EL FACAAccIDWT 61,000,000 (�"iniallxcwoFnt Y xIA 1,000,000 EL msEwsE-EA EMPLorE 5 TYea lxnbe annex ELDISFABE-POLICY UMn 51.000,000 OERCRIFUNON OF OPERATIONS W& 0 0 DFsewpnon oroREnwnonsrwcAnoxsrvExleLEs pe0REm5,amm�mw R�m.,as.I,mIIM,m.y l,eanasNN nmm..wwl....yul,ml CARPENTRYIROOFINGISIDINGMAINBNG. CERTIFICATE HOLDER CANCELLATION SEXTON ROOFING&SIDING INC SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 102 PINE ST-PO BOX 6327 THE EXPIRATION DATE THEREOF, NOTICE NAL BE DEIUME D IN ACCORDANCE WITt5 THE POLICY PROV 1510X3. HOLYOKE MA 01041 SEXTONROOFING@HOTMAILCOM aumoR�ORERRESFxraTn's ®1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD pmCnnC,Wng Fomu Buts WeE Sanxa,e xxwPom,iBm.wm 1=)Imprtaelrr PuE4aN,g E00.999A9P Acoyzo CERTIFICATE OF LIABILITY INSURANCE DATE GBIC017 HIS 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 BYTHE POLICIES BELOW. HIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S)r AUTHORIZE REPRESENTATIVE Oft PRODUCER,ANO THE CERTIFICATE HOLDER IMPORTANT:If the car ficate MOST Is an ADDITIONAL INSURED,the policy(les)ra l be endoand.It SUBROGATION IS WANED,subject to the eNf —dand —dilloof the policy, cent. p.II may requim an-endorsement.A statement on this Certificate does not confer rights to the ill...heldar in lion of such endomemenua. PRODUCER CONTACT NAMEAAW Hutchinson Ormsby Insurance Agsnty,Inc PHONE IAIC,No.ELI: AllDll-0rh0 FAX(NC,N* PO Box Tis EFAIL ADDRESS:khetcalesenae,msbylne.COm West Sprfiniffrd,MA 010$9 INSURERS AFFORDING COVERAGE NAICO e INSURED INSURER A:Colony Insurance Company J999> SWXk H Bonn,and SIdIm,m. INSURER& PO it..0317 INSURER C: Holyob,MA 010414327 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: - REVISION NUMBER: - MIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REOVIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN.THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS. EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS POLICY EFF POLICY May HS DO'L SUER OAT. OAIE LTX TYPE OF LOWRANCE RSR O WVO. POUCIXNMBER I....HrYl WADI) Users A X COMMERCIAL GENE RAL LIABILITY IMPNEp0e IS9m1 SQ.17 6DWO10- EACH OCCURRENCE St 000.WO OAMAGETORENTED 5100.OW CLAIMS MADE IT)U OCNR PREMISEB Ea Oannence MEDEV(Anyonaporson) SSAW PERSONAL$ADV INJURY SI.ONPW ENL AGGREGATE LIMB APPLIES PER: GENERALAGGREGATE SZDOCOW Y POLICY N❑jECT OLOU PROCUCIS-COMPNPAGG 52000.00) O ER: COMBINED SIGNED LIMB S UTOMOBILE LIABILRY (Ea—heart ANY AUTO _ BODILY INJURY(Per person) S ALLOWNED SCHEOULED BODILY INJURY(Per S AUTOS AUTOS eaden) HIRED AUTOSNON-CNVNED PROPERN DAMAGE S a p IS AUTOS Per aeedenI MBRELLA LIAR OCUR EACHOCCURRENCE s CEBS IJAB UIMBTMADE AGGREGATE S EC TENTIONS S WORKERS COMPEHSATIOMAXD pER OTH EMPLOYERS'UABIOtt STATUTE - ER ANT PROPRIETOWPARTNERIEXECUTIEL EACH ACCIDENTOFFICERWEMBER EXCLUDED) EL OSEASE�EA (Mandatory M HH) EL S IFyes,dea.B.uMer PMPILOYEE DESCRIPTICN OF OPERATION:3 MIpNI EL DISEASE-POLICY LIMIT IS DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES PCORD 101,AEEIIIe..I moment SNeduN,it mon Iowa A ruins) CERTIFICATE HOLDER CANCELLATION sown ofAmnersl SHOULD ANY IC THE ABOVE L IVICON POLICIES BE WITH THE BEFORE THE EXPIISHCA TION PATE - I THEREOF.NOTICE WILL BEfIEWERFD IX ACCOPOAXCE WITH TXE POLICYPPOVI$10X3. AUTHORIZED REPRESENTATIVE FOUND 25(201U01) , 0 1988-2014 A00RD CORPORATION,All rights reserVed The ACORO name and logo am Tegl.lemd marks of ACOHD Office of Consumer Affairs and Business Regulation 10 Park Plaza- Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Type: Corporation Registration:. 118239 SEXTON ROOFING &Siding Inc Expiraf= 02114!2019 P.O. Box 6327 Holyoke, MA 01041 Update Auldreas and return card. Mark reason for change. Y i Commonwealth of Massacbuselts r Gn"an n of Professional ticensura Board of Building Regulations and Standards Constructioa•Supei'r.(rsotSpecialty CSSL-099689 z r/ _ ,FA Re.: 10/05/2019 BVEREtTJ SEXTON_+ P06OXGW2 , tO.YOKC MA 01 Commissioner L '^ STATE OF CONNECTICUT HOME IMPROVEMENT CONTRACTOR EVEREITJSEXTONSR 102 Piot St HOLYOKE,NfA 01050-2411 i SEXTN ROOFING A,SWING CO U IREG EEVfECTIVV ,%FIRE HIC.0505383 12/01/2017 11/30/2018 SIGNEU ----^