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30B-075 (5) 150 FEDERAL ST BP-2019-0100 GIS#: COMMONWEALTH OF MASSACHUSETTS MapHlock: 3013-075 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-2019-0100 Project# JS-2019-000160 Est.Cost:$7600.00 Fee:$40.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: RCI ROOFING 74334 Lot Size(sp.fl.): 6403.32 Owner: KLEKOT MARIE Zoning:URB(100)/ Applicant: RCI ROOFING AT: 150 FEDERAL ST Applicant Address: Phone: Insurance: 6 LINE ST (413) 527-4775 Workers Compensation SOUTHAMPTON MAO 1073 ISSUED ON.712 5/1 07 8 0.00:00 TO PERFORM THE FOLLOWING WORIGSTRIP & SHINGLE ROOF - NOT ON SIDE 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: 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 7/25/2018 0:00:00 $40.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck-Building Commissioner CI y of Northampton lSfalVu GllRepZnrt B Wing Department t^ptbK°vuodlwaw�y PenrJrtlt,,,�; - ��� 2 4 2018 12 Mein Street Be�aP(�aP aA ananpny Room 100 rwgito(„NN,reu.ayrd uatnllrty,,: _ r ort mpton. MA 01060 T+l�+A gedg'4of,S`Irwoown ':Fler*s 'PT °@F'^ 7.1240 Fax 413.587-1272 IPIlleliPlama 1 APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR OEMOLIGH A ONE OR TWO FAMILY DWEELL-LIIfN�G L_CT:ION SITE. INFORMATION. .n eronert Atl I]Lgs: y1 - �7�1�fImlYrsep4ln'n dor be 000m'p'llated'Ihpa.4fl'ra La,t,�SL/> ---Umil T IOY2!')L'r?r MA Elm et,©lMml ICTIOH2 PRO PERT7 OWN ERS HIPFAUTH OR.i2E 0. GENT 7.1 Owner o(, eoo(fi: _ti12 k�klekol I G�� hn. (h a'—. :eine(wlnp Ourrenl Melling Addddreea'0,6 _ Set( �a�-�— __ Telephone onawre _ ._�,Attiho{LEed eLli � -_-- ?JI L'r -i%� "`e I„ti �}9e1 7 VLSa-l. name (Pring /r” � � Curren[Malling Addl'esel .� elvre Telephone __ _ CCTION a CS LIMA &D GOj>LS=p'�UC;rION O'OSTS e» Estimated Cost(Dollen)to be UfltptaLUae..Only completed by permit eppllcanb _ ___ I Budding (a)Buliding,P.ermlt Pee _7T 00. ' Flectntcel (r+1 EstlmaeuF T©lel Coat al __ ._,_ Oansleu211on.from (8) Pwmbing Bullding Per.rnit Fee mechanical (HVAC) Z -I e Proiedon_ Tplah(112 + S+ 4 + e0[7, Ckaok Ndrnben rhle Sector) Per©fliclal Use Only, 3uilt(iny Permit Numoell'„_- Q9'i0' Binding Comml f .erCln$poster ql Bulldings. sec ION e,OF��,RIpTlo�v nF aanEosBo-wARK� hacka�l e II trleh New House ❑ Addition ❑ Replacement Windows Alterations) Roofln Or Doors ❑ ___ ❑ Lg� l Accessory Bldg. El Demolition ❑ New Signs 0] Decka Iq Sldinglol Otherlol 1 Brief Descoplion of Proposed a to Alleral'mn of exlsling bedroom Yes _No Adding new bedroom Yes - No Attached Narrative Renovating unilnlshed basement Yes _No Plans Allaoned Roll - Sheet ea. If New hoiwa�.e a tl (- fadidlL`plon:4fl,eawfs101m mho'Wa'PrYsr cOrmlgPeta:,8�i�,�I aw�h-'.'p a. use of building One Family Two Family Other b. Number of rooms in each family unit'. Number of Balhrooma___,__ Is [hero a garage allaohed? d. Proposed Square footage of new oonscucllon. Olmenaona e_ Number of stories? f Method of heating? Fireplaces or Wcodsloves_ Number of each _ q. Energy Conservation Compliance. Masscheck Energy Compliance farm allached? I) 'type of construction Is conslruo[lon within 100 it of wstrands?_Yes __ No. Is construction within 100 yr. floodplain —Yes Ne 1. Depth of basement or cellar flooa'below finished grade ,<. Wg[building conform to the Building and Zoning regulations? Yes No . Sepuc Tank__ City Sewer_ Private well— City water Supply___ S€CTION 7a -OWNER AIJ7MORit`ATION .TO BE COMPLETEDWHEN OWNERS AGENT OR, CONfRACTOR[APPLIES PORI 9U141NG PERMIT k1f-KOI as Owneiwf the Subleol properly hereby au[hori a to ac[ on my behalf, in all matters relative to work authorized by This building permit aRlloutlon. t Slgnemre 01 Owner ® Data �0 n,e /1 lFu'10Y17 P,� Rf1PVr�' _, as OwnerlAu(hon2ad t Agent hereby declare that Iho statements and Informallon on a foregoing application are (rue and accurate, (o the best of my knowledge and belief, Signed under the pains and penalties of perjury. Pnnl Neme ,.� Slynelure of OvmerlAgsnl __— Dale 10_'J8 CCCONS'TRU'CTION B:ERVtl _L.1pe ,sedconti1ry@}LonSuoervl,jgli Not Applmsble o �,o s[Lo�1a911p141 dikL��C. �iCin -- _member License Number .eIL n r)fln t (y)4 0IClr7�,, -(p-S rtes Explrellon Dale ��� ��J I�� �3 art • Lr�t�." �..Ive Telephone cutdmcaLlygfr,g,jyD gUreaaten ClolpiGna;eStrr.1: Not Appllolabbllel '❑I` Iy pear nylape ,,J � Registration Number uh f ---- n S .. Q S �a_ cress Expiration Dere S'aL1j'1'aav4wi nnil aaephoneLl � L�175 CTION 10 WDRVt6ERS'CAMPENS,ATI0N INSURANCE AFFIDAVIT LMLO L. c,162, § 26Cyli)) ,rrers Compensation Insurance ellldavll must be completed and submitted with Ihla application :allure to provide this a(lldavll will result ne denial of the Issuance of the building permit. ---_ _ It Attached Yes....,., E( No,,,,., iatl Allidav_—____.__,_ Owzt�er' xemma The current exemption for"homeowners"was extended to Include Owner ;xSjtgjed Dwellines of one(1) of Iwo(2)famrlles end to allow such homeowner to engage an Individual for hire who does not possess n license, provided that the ew ei acts hs sup iso yLR 780, Sixth Edltlon Sect1on108,3,5,1, 1LeziftonHo w erl Person (s) who own a parcel of land on which he/she resides or Intends to valise,on Wall thoe is,or is intended to he, a one or two family dwell Ing,attached or detached ntrualures accessory to such use and/or farm $trurhves ®,yLClSon wha s stgets more than one home lu a hyo-YGgLpelJpd shall not be considered a bwneo ne Such "homeowner"shall submit to the Bulding Official,on a form acceptable to the Build Ing Offrolal t tat e he shall e resgssLp eye for a „such worl(iterfQrni under the huildine o rmlL As acting C ns rule It on 8_uperyuor your presence on the Job site will be reti Aom time to time, during and upon complelon of the work forwhloh this permit Is issued, Also be advlsed that with reference to Chapter 152 (Workers' Compensation) and Chapter 153 (Liability of Employers to Employees for Int its not resulting In Death) of the Massachusetts General Laws Annotated, you mnv be till for person(s) you hire to perform work for you under this permit, The undersigned"homeowner" certifies slid assumes responsibility for compliance with the State Building Code,City of Northampton Ordinances, State and Local Zoning Laws and State of Massachusetts C9eneial Laws Annotated. Nameorvuer Signa Gine_ C0.�C.tp�p(� _—__ SCA1 0 20M-05111 d rmrrmrusrilNe e�( aJweed. Olflce of Consumer Affair F&Business Regulation HOME IMPROVEMENT CONTRACTOR TYPE:Partnership Exolretlon ' 116gms 05/0512020 RCI ROOFING Commonwealth of Massachusetts ' MARK T,DELISL �] R ®1 DIVlslon of Professional Licensure 6 LINE ST /�/ �T'" Board of BUilding Ra Mations and Standards SOUTHAMPTON,Mk' 01023Undersecretary Cons`1ytSit IfIS1Tp�,rvisor CS-074934 SXPlres 06/0912020 Registration valid for Individual use only before the expiration date. If found return to: MARK THOM'� S DEIiIS} /R v,, Office of Consumer Affairs and Business Regulation 69 BRIGGS STpp 1 '` 1000 Washington Street-Suite 710 EASTHAMPTON SIA 0102, * � •-K, Boslon,MA 02118 � Commissioner Not valid without signature Mon �, OMMONWEA`LTH OF M $gOHUSETTS.� HOME SMPRQVPvMENT QONTRACTOR i& ° ° a e e R C f ROOP1jNG 4LP ." '/^`+ eD g IILIN8ST8HEET , OR Q' ISSWEcS.FF{E FOL NGR6fNJSE �.. . 'SOUTHA1MPT0Y�,� 01073 UN E�57RJOTED K T DELISLE �� RIGOS HIC 0624741 12/01/2017 11/30/2018 EAST�"gl' ` SIGNED 13276 usps'?jd rp6122020 466498 ` ','(P-,00 M M0NWE LTH40 F,MX,' .S OH 175E;?.:S �y,°•I�E4, q-1 .SHEO`,Taf96 'L'WORK > ISSUES TT'c FOLLOWII .'VrSE 503 „�tl� 3" 8 BUSINESS / J MA E Id �=S &ROOFING+aG 6 LIN EASYrP ,ON{,.Ng 1T V! 11 r a°d `dy091012019 a 342236 q�'"� ' . 42 +n., .e \ The Commonwealth of Massachusetts = Department of Industrial Accidents lLiISCongress Street, Suite 100 Boston, MA 02114-2017 www.mass.gov/dia Workers' Compensation lusnrance Affidavit: Builders/Conti actors/Elechicians/Plumbers. TO BE PILED WITH THE PERMITTING AUTHORITY. Applicant mfrmsm on /� /� n Please Print Legibly Name (Business/OrganizatioNIndividual): lLCI LL.P Address: (o .Ain& City/State/Zip: S0uil7i A11-1 0/073 Phone >R: (/7/3) x'-3'7 - 4/ 775 Are you an employer?Check fire appropriate box: Type of fund cl(required): LQ i em a employer with -Z O wrobwees(full endler,cr imeJ." 7. New construction 2.�lam aspic proprietor or pennership end haveno employees working for meta 8, �Remodeling any career,IN.workers'comp.interstice required.] 3 l am a homeowner doing all work myself (No workers'acon,insurance required.]1 9. Demolition 4.❑1 am a homeowner and will be hiring contractors to conduct all work on my property. I will 10 Q Building addition ensure that all contractors either have workers'compensation insurance or are sole I .❑Electrical repairs or additions proprietors with no employees. 12,Q Plumbing repairs or additions 5 1 am a general contractor and I have hired the subbommutors listed on the attached sheet. These sub contractors have employees and have workers'comp_insurance.t 13. 2,Roof repairs 6.Q we are a corporation and its officers have exercised their right of exemption per MGL c. 14.Q Other 152,§1(4),and we have no employees.[No workers'compinsurance required.) r Any applicant that checks box q I must also fill cut the section below showing their workers compensation policy information. t Homeowners who submit this affdwil indicating they are doing in work and then hire outside contractors must submit a new affidavit indicating such. iCent,raw s that check this box must attached an additional sheet showing the name of the subaonta ude and state whether of not those entities have employees. lithe subcontractors he,,employees,they must provide their workers'comp.policy number. I am an employer that Is providing workers'compensation Insurancefar my employees, Below Is the policy andjob site infarmadon. Insurance Company Name: 4.1,np7 mrl fish./ZJ'I SttYrtr9�e CeJ. Policy#or Self-ins, Lia #: Expiration Date: /0 Job Site Address: /57Aedeti City/State/Zip: ac`:69rt rnR O106a. Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration 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/olone-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. A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification, - !do hereby cer(iJ.yunder th ants d penalties of per)ury thal the Information provided above is true and correct. Signal re `"' - Date: Phari ('d{/'pi ) ,6-:� 7 -- '-/775 Official use only. Do not write in in is area,to be completed by city or town offrdat City or Town: Permit/License N Issuing Authority(circle ane): 1. Board of Health 2. Building Department 3, Cky/Town Clerk 4, Electrical inspector 5, Plumbing Inspector 6, Other Contact Person: Phone at RRoofing Estimate Date 6 Line St. Southampton,Ma. 01073 620/2018 Phone(413)527-4775 Fax(413)527-9469 Name I Address Job Location Marie & Mike Klekot 150 Federal St. 1 Gaston Street Florence, MA Easthampton, MA 01027 Terms Rep Estimate valid for 30 days Chris Description Total Remove existing roofs. 7,600.00 Furnish& install aluminum drip edge,pipe flashings, chimney flashings(if needed)and step flashings. Furnish&install CertainTeed Winterguard ice&water barrier,6 feet along eaves and 3 feet in valleys. Furnish and install synthetic underlayment over existing deck. Furnish and install Lifetime CertainTeed Landmark Series shingle. Furnish and install CertainTeed approved ridge vent. All exterior roofing related debris to be removed by R.C.I. Roofing. All work will be performed according to manufacturers'specifications. Lifetime CertainTeed material warranty included, All related permits will be obtained by R.C,L Roofing. Add$250 per sq. ft. for wood decking replacement if needed. Pricing does not include side porch. WE LOOK FORWARD TO DOING BUSNESS WITH YOU. Total $7,600.00 TERMS OF PAYMENT 5%Deposit Customer Signature: Balance upon completion Registration 4 126235 Date Construction License M 074334 Insured by Banns&Fickert Ins. - (413)527-2700 Shingle Color Selection: '�C City of Northampton 212 Main Street, Northampton, MA 01060 Solid Waste Disposal Affidavit In accordance of the provisions of MGL c 40, S54, I acknowledge that as a condition of the building permit all debris resulting from the construction activity governed by this Building Permit shall be disposed of in a properly licensed solid waste disposal facility, as defined by MGL c 111 , S 150A. Address of the work: /SD Gderml V. 6Iarenee , /YA am�� The debris will be transported by: Uf' 94 lint arrA�2eu�/ing The debris will be received by: WesMrn RP6UC//4 %rahsterGaeel !� Building permit number: ( /� Name of Permit Applicant Date 7_/� /� Signature of Permit Applicant u u 7VAM A D No, 2462 P. 1/1 CERTIFICATE OF LIABILITY INSURANCE THIS CERTIFICATE Ia IsaueDggA MATTEROFINFORMATIONONLYAND CONFERS NO RICMTS UPON THIS CERTIFIca rE HOLDER. rws UENTIFICAT „o e EDO SNOrAFFIRMA TIVELY OR NEGA7IVELYAMEND,EXTEND OR ALTER THE COVERAGEAFFORDED vrHE voucrEsoane RIES THIS gER"'ICATEQFINSUR4NCEDOE$NO7CONSTITUTEACONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED E@PRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER, IMPORTANT. If the Certlfleato,_... is an A001I IONAL INURED,Me PONcy(Ias)must pave ADDITIONAL INSURED proYlsions or be entlorsed H SUBROGATION I$WAIVED,subject to the t2m$and conditions of the polity,certain Policks may require an endorsement. A statement On this cartf Cote does not confer ri hts to the Certificate holder in l leu of such endoneomenl(s). PAOOUOfR AME; Michael R.BBnas Banas&Fiekart PNC"a 410-527-2700 Pi AA ANe: 413.627-0849 633Majaln Street Agency n DOFFS$t mb@b2nas1n5umrance.coS Easlhamplon,MA 01027 INSURERS Aarosoluo ooYERAce rvAlce INsuRERA: AtlmlrollOsuance Co. 26856 INSURED INSURERa: Safety Insumne.Co. 09454 RCI Roofing,LLP INSURERS: Admiral Insurance CO. 24856 6 Line$treat INSUREBO: Southampton,MA 01073 INS RER E; IN6URE0.F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THATTHE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR TME POLICY PERIOD INDICATED, NOTMTHSTANOINGANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECTTO 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, ILTP --,7E OF INSUMNCEPOLICY NUMBER MMI O Er•P IMOIU"mf I LIMITS X OOMMERCIALGENERALUAMLITY [ACH OCCURRENCE S 1,000,000 CWMSAMDE lOCCUR S 50,000 MEDE%P AA om S 10,000 A X CA000020963-04 03104/18 03/04/16 PER NA eADv vudurry E L000,000 GEN'LA¢CREGATELIRRMITAPPLIESPER, GENERA OREOATf E 2,000,000 POLICY❑X jE¢T LOU PRODUCTS-COMPIOP AGO 6 2,000,000 OTHER', AUTOMOBILE LUMMUN M IN ELIMIT S 1000,000 ANYAUTO BODILY INJURY IPar prrwn) a OWNED 6CHECI B A'DOONLY fix/ Auroa X 820/161 09130/17 09130/16 eomplwuarlParacaeen1) s X AUTOS HIRED ONLY ^ AUTOS ONLY PBI I Bnl f S S UMBRELLA LIAR D0000. EACH OCCURRENCE S 5,000,000 C EXCESS A. cul_ -MASE X GX000000385.02 03/04/18 03104/18 A¢¢R[GAre E 5,000,000 OED x RSTCNTIONS 10,000 i WORKERS COMPENSATION6R TN AND EMPLOYERS LIABILITY YIN TA R PROMEN)" DEI NIA E.L,EACN ACCIDENT S I -W,In NHI f.L DISEASE SEA EMPLOYEE E ryes duc4de uM.l DESCRIPTIONOF P PIONS cwow .OI E-POLICY LIMIT S O63CRl7roN OF OFERATONS r LOCATONS IYEMICLES (ACORD 101,AdditlMal Remnb SchaduH,may M iM<bE If mora apace Is recuirad) ROOFING CONTRACTOR. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE bELNEREO IN REA'SRENCE COPY. ACCORDANCE WITH THE POLICY PROVISIONS. AVTNOAIifD R[P 6 - - ------ "JgBW6ACQFUO CORPORATION. All rights reserved. AOORD 26(2016(03) The ACORD name antl logo are registered marks ofACORO �A TE OF L/ABt61TY INSURANCE °4101Mw2017 `� x toJxsnov L�R1( }r,�� ry y�r'�+ R OF}NpOftMATION ONLY AND OONFERS NO RIGHTS UPON THE GERTIfiC0.TE HOLDER, THIS A [ pp PCAT' rFLY OR NEGATIVELY AMENDr EXTEND, 0R ALTER THE COVERAGE AFFORDED BY THE POLICIES PAL, 4CE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER($), AOTHORIZED "ERTIFICATE HOLDER. T�it me certiji Q conditlanr 41.INSURED, the policy(ies)must be endorsed. if SUBROGAMN IS WANED,subject to ide[In lieu -require an endorsement. Astatement oathls certificate does not confer tights to the 1 ,007 i�i>iuj Branch 13'18-1 '-4E_._r. __ loc. - Exq� te13J 519-0188 f��Z ryo,; !9131523 A809 o 'eEfif9AfE49WN9SRYE$bQ�.�—_�.—JiffiG k.—.. insurance Company . 31758__ acoRD" CERTIFICATE OF LIABILITY INSURANCE �I. 1012612017 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 WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate dots not confer rights to the certificate holder In lieu of such endorsement(s), pry PRODUCER 01976-001 kpMEACT BY.RCh 1916-1 MRBoras Insurance Agency Inc PNL RNNoNE u.Ell: 14]3)$2]-0208 (pI�.NP.: (4131527 OBi9 60 Main Street [�'6kEss Easthampton.MA 01027 i -- --- -- - I c RER A A.I.M.Mutual Insurance Company INSURED INSURER D. RCI ROOFING LLP 6 LINE SMI INSURER D. SOUTHAMPTON, MA, 01073 INSURER E:.. _. INSURER I COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS 10 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 VATH 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. _.. gooL 3llgp _-- -- r� TYPE OF INSURANCE INsp yryO POLICYHVMfiEfl IM � IL�M��T .,y,l LIMIi4 GENERALUARLITY �EACHOLCURRENCE f COMMERCIAL DAMAOETOaam60I/LL GENERAL LIAf _ __ EDEXP6(Fyo easel , I ._ 1CLAIMSMAGE OCCUR MEG C%PIAny ne person) 9 PERSONAL A ADVINJURY a GENERALAGGREGATE 4 GEN LAGGREGATELpIMqIi MPLI ES PER PR -as COMWOPAGG 4 POLICY IIEG I pc AUTOMOBILELIACILIry lE K COWERED SINGLE LIMIT b ANYAUTC eOpLY INJU0.Y(Pe,panoq 4 nLLONTOMNED AUTOS IED ACIDLY INJURY IN,occtlnn) f HIREOAUTOS ;N1161 1 pROPERTYOAMAGE f IAUT6 (P cGeopO UMBRELLA Ups OCCUR EACHOCCURRENCE $ EXCESS LIAB CW.IS MACE i AGGREWTE y OEO 'RE'EmNNG f 5 MSd���@t89€R'FNPdait474 `— -- � ---t X,Yd£3C�T14s1 _ °€d'T p� eEIdEcunvE Y(x 1 000 000 00 A A'IIeNdM L ( y xIA VWO-100-6022647.2017A 101612017 101512010 E L EACH ACc°ENT s- MYYaffnS5Caeeoffry��pp1n��NnN�18f EL 019 FRSE EA EMPLOYEE,b 1.000 Ogg.QO. BEJL�IVsIDNSFVPERTIONSMIow ELDISEASE.POLICY LIMIT b _1,OODVOD,RO. DDRGIP90H OF OPERATI I LOCA90NS I VEHICLES(Al.11 ACORD I°1,Aleal.nCI RB.CN.ShceCulO,11 maro cpacx le rtpulrotll "Proof of Coverage" Worker's Compensation Coverage Applies to Massachusetts Employees On ty No Partner is covered by the workers compensation policy. CERTIFICATE HOLDER CANCELLATION RCI Roofing LLP 6 Line Street SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Southampton,MA 91073 THE EXPIRATION DATE THEREOF, NONCE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVEpoll 918083010 ACORD CORPORATION.All rights reserved. ACORD 25(2010106) The ADDED name and logo are registered marks of ACORN