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38B-121 (6) 160 SOUTH ST BP-2019-0697 GIs#: COMMONWEALTH OF MASSACHUSETTS Ma�Block:38B- 121 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-2019-0697 Proiect# JS-2019-001136 Est.Cost:$8800.00 Fee.$40.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: SEXTON ROOFING CO 99689 Lot Size(sq.ft.): 8276.40 Owner: Renee O'Dga zoning;URB(100)/ Applicant: SEXTON ROOFING CO AT: 160 SOUTH ST Applicant Address: Phone: Insurance: P O BOX 6327 (413) 534-1234 WC HOLYOKEMA01041 ISSUED ON:12/13/2018 0:00:00 TO PERFORM THE FOLLOWING WORK:STRIP SLATE ROOF & 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# Foundations Driveway Final: Final: Final; Rough Frame; Gas: Fire Dgpartment Fireplace/Chimney: Rough: 0�1: 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 Occuganck sienature: FeeTIpe: Date Paid: Amount: Building 12/13/2018 0:00:00 $40.00 212 Main Street,Phone(413)587.1240,Fax:(413)587-1272 Louis Hasbrouck---Building Commissioner Department use only City of Northampton Status Of Permit .� Building Department Curb Cut/Driveway Permit ,A' ' 212 Main Street Sewer/Septic Ayailabft '[ Room 100 Water/Well Availability ' Northampton, MA 01060 Two Sets of Structural Plans phone 413-587-1240 Fax 413-587-1272 Plot/Site Plans Other Specify APPLICATION TO CONSTRUCT,ALTER,REPEE!lMfLISW A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION (b�— f `�� "j� q /7 1.1 Property Address: 8 2018 his silliction to be completed by office MapLot �1 Unit DEPT.OF E�UILDING INSPECTIONS NORTHAM"WhgAO1060 Overlay District Elm St District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: J f -e- a 'o P� 1n g S OWW/AJ s� 6l rlellfc e Na a(Print) Current Mailing Address: 0w T Telephone Signature 2.2 Authorized A ent: In3 Name( t Current Mailing Address: _fi3V / 235� Signature Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official 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 7� 4. Mechanical(HVAC) v 5. Fire Protection 6. Total=(1 +2+3+4+5) Check Number This Section For Official Use Only Building Permit Number: DateIssued: Signature: Building Commissioner/Inspector of Buildings Date EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR) Section 4. ZONING All Information Must Be Completed. Permit Can Be Denied Due To Incomplete Information Existing Proposed Required by Zoning This column to be filled in by Building Department Lot Size Frontage Setbacks Front Side L: R L: R: Rear Building Height Bldg.Square Footage % Open Space Footage (Lot area minus bldg&paved parking) #of Parking Spaces 00, Fill: volume&Location) A -T A. Has a Special Permit/Variance/F' ding er been issued for/on the site? NO O DONT KNO © YES IF YES, date issued: IF YES: Was the permit reco ed at the Regis of Deeds? NO O T KNOW © YES O IF YES: enter B age and/or Document# B. Does the site contain brook, body of water or wetl ds? NO © DONT KNOW O YES O IF YES, has a per it been or need to be obtained fr the Conservation Commission? Needs to be o ained © Obtained , Date Issued: C. Do any signs xist on the property? YES O NO IF YES, cribe size, type and location: D. Are th a any proposed changes to or additions of signs intended for the property? YES 0 NO 0 IF YES, describe size, type and location: E. Will the construction activity disturb(Gearing,grading,excavation,or filling)over 1 acre or is it part of a common plan that will disturb over 1 acre? YES © NO IF YES,then a Northampton Storm Water Management Permit from the DPW is required. SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable) New House Addition [] Replacement Windows Alterations) ❑ Roofing EB--- Or Doors D Accessory Bldg. ❑ Demolition ❑ New Signs [O] Decks [Q Siding[O] Other[raj Brief Description of Proposed ' R in T Work: R ca � '� Lr_ f � Alteration of existing 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 existina housing, complete the following: a. Use of building:One Family Two Family Other b. Number of rooms in each family unit: Number of Bathrooms c. Is there a garage attached? d. Proposed Square footage of new struction. Dimensions e. Number of stories? f. Method of heating? Fir s or Woodstoves Number of each g. Energy Conservation Compliance. Masscheck Energy Compliance form attached? h. Type of construction i. Is construction within 100 ft.of wetla ? Yes Is construction within 100 yr. floodplain Yes No j. Depth of basement or cellar r below finished grade k. Will building conform he Building and Zoning regulations? Ye No. I. Septic Tank ---Clt-y fewer Private well City water Supply SECTION 7a-OWNER AUTHORIZATION-TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT as Owner of the subject property S /� hereby authorize j1J r/1 ✓� *� to act on my behalf, in all matters relative to work authorizeb by this building pgkmit7application. 0,- ,,,eL 4& 4_1( /16--/ 1- Signature of Owner Date I T�✓) G �<<2 as Owner/Authorized tements Agent hereby declare that he staand information on the foregoi app cation are true and accurate,to the best of my knowledge and belief. Signed under the pains and penalties of perjury. f�2L-rJ� v 1 �UL J L C Print Name Signature of Owner/Agent Date SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Sumrvisor: Not jApplicable / 11Name of License Holder: t T_�[( J( / License Number c� C3Leo (C-o-- /41) - � - / Address L Expiration Date C 7S Signature Telephone S.Reap tared Horne IrnmyemeM Contractor. Not Applicable ❑ Co a Name T RL-gistration Rumber Address Expiration Date '-/6 Telephone 6---�V i 23 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 F. DEPARTMENT OF BUILDING INSPECTIONS In 212 Main Street • Municipal Building yvd•... �a� Northampton, MA 01060 rs .,• ��o 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("NIC"). M.G.L.Chapter 142A requires that the"reconstruction, alteration, renovation, repair, modernization,conversion, improvement removal, demolition, or construction of an addition to any pre-existing owner-occupled building containing at least one but not more than lour dwelling units....or to structures which are adjacent to such residence or building"be done by registered contractors. Note.If the homeowner has contracted with a corporation or LLC,that entity mustd be registered. Type of Work:7R , 1 Est. Cost: t- Address of Work: (+ Date of Permit Application: 1 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 RESPONSIBILIT'ES 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: - ,4- d I S Y;- 3 7 Date Contractor Name HIC Registration No. OR: Notwithstanding the above notice,I hereby apply for a building permit as the owner of the above property: Date Owner Name and Signature City of Northampton Massachusetts �� A� 3 • DEPARTMENT OF BUILDING INSPECTIONS �• 212 Main Street •Municipal Building Northampton, MA 01060 Debris Disposal Affidavit In accordance of the provisions of MGL c 40, S54, I acknowledge that as a condition of the building permit all debris resulting from the construction activity governed by this Building Permit shall be disposed of in a properly licensed solid waste disposal facility, as defined by MGL c 111, S 150A. The debris from construction work being performed at: kW Z41 (Please print use number and street name) Is to be disposed of at: (Please print name and location of facility) Or will be disposed of in a dumpster onsite rented or teased from: c &ddlia, U-)'(-KC-kNS Company Name and Address) &141k Signature of Permit Applicant or Owner Date If, for any reason, the debris will not be disposed of as indicated, the Applicant or Owner shall notify the Building Department as to the location where the debris will be disposed. �ro�o�a�Y SEXTON ROOFING AND SIDING INC (4 13) 534-1234P.O. Box 6327 FAX (413) 539-9906 Holyoke, MA 01041 sextonroofing'@hotmail,Gom CT HIC#0605383 MA HIC#118239 www.sextonroofing.com Since 1985 SUBMITTED TO CJ e CJ 'I-)gEPHONE DATE S� STREET 1,60 NAME CITY STATE ZIPCODE (`_ JOB LOCATION Proposal to furnish and install the following EMAIL ❑ Re-Roof ear-Off 4- Main House ❑ Garage ❑ Shed Complete Roof Preparation Home exterior to be protected by tarps and plywood "rubs,landscaping,trees to be protected ❑ Entire existing roofing material to be removed to existing decking, Including flashing,etc. wtite to be cleaned everyday with roll magnet debris removed at project completion e'"Deteriorated existing decking replaced at$2.50 per sq.ft ❑ Insta I all new decking/type: Whit wn metal drip edge installed at eaves and rakes �-8 ❑ F-5 ❑ Rake Edge a,,—New flashing will be installed where necessary(see Special Requirements) al Install new pipe boot flashing ❑ Bathroom Exhaust Vent U �Reflash chimney with new lead &i' We shall acquire all appropriate permits etc.for all roofinq work Complete Roofing System V' Leak Barrier installed at all eaves to protect from ice dams(and meet codes in the north) ❑ 3' 0"V `£ t r—Leak Barrier installed at valleys,around penetrations and chimneys to protect critical areas Install Roof Deck Underlayment on remainder of roof ❑ #15 Felt ❑ Synthetic Felt Shingles , 9/111<0 ❑ GAF ❑ CertainTeed ❑ Tamko / ❑ 30 year ❑ 50 year Ifetime Color �` ` � install Attic ventilation system U'Cap over Ridge Vent O Roof Louvers slet, Warranty Options '3 ❑ We guaranteed our workmanship for 25 full years 3Rr oft her y to furnish mat Baal and labor-complete ig accordance with the above���fications,for the sum of: - 11 Pv �"N dollars($ i .l'"yt<""� ) PAYMENT TOISE MADE AS FOLLOWS sv, Z77 r t' G'r AN Material is guaranteed to be as specified.All work to be completed in a wDrkmenlike manner Authorized according to standard practices. Any alteration or deviation from above specifications involving extra costs will be executed only upon written orders,and wiN become an extra charge over and Signature above the estimate.AN agreements contingent cponstrikm,accidents or delays beyond our control. Note:This proposal may be Not responsible for water damage during construction.Owner to pay responsible legal fees for Withdrawn by us if not accepted within days. interestI non-payment and applicable 1v2% Esa Wap"-The above prices,specifications and conditions Signature and are hereby accepted.You are authorized to do the ied.Payment will be made as outlined above. Signature ATTENTION HOMEOWNERS:Please cover all personal belongings in the attic,garage or storage areas due to the possibility of roofing debris or dust coming in through the cracks of the wood. Sexton Roofing and Siding will not be responsible for debris or dust in the attic or storage areas. The ComntonweaM ofMwachuseits Det oflndust*dAccWenis -1 Congress Street,Suite 100 Boston,MA 02114-2017 �• "Mm mass gov/dia arkers'Compensation Insurance Affidavit:BaBders/Cont mctorsM bem TO BE FILED VffM TBE PE LNffrnNG AUTHORITY. Applicant Information Please Print Legibly Name(13osinesslprgani,,ion/tndi„idua1):Sexton Roofing&Siding Inc Address:P.O. Box 6327 City/StaWZip_H01Yoke,Ma,01040 Phone#:413-534-1234 Are you as dyer?Check the appreprvtte box: Type of project(required): LD.I am a employer with employees(fill a"-part t-)) 7- ❑New construction 22[]I am asole proprietor rpautmship and have no employees woddng for me m 8. Remodeling - Any amity-[No workers'comp.k—aMe require&] 3.[]I am a homeowner dvmg an work myself[No worktas'comp_bmum=require]t 9. ❑Demolition 10.Q Building addition 411I am a homeowner aodAYA be hiring contraetrs to conduct all work on my property.1 well eosm fliat all contra dors eidrer have workerscompensation imwance or—sole ll-0 Electrical repairs or additions proprietors with no employees_ 12Q Plumbiraa repairs or additions 5.✓1 I am a general conhactor and I have hired the moors listed on the attached sheet I3-�Rnof repairs These sub-cantiactors have employees and have woda:&comp_ice.= 6.❑We are a corporation and its officers have exercised their right ofearemptioo per MGL c. 14-00iher ISL,§1(4)and we have no employers.[No workers'comp_iastuanoe 17 fp ed] *Any applicant that checks box#1 most also fill out the section below showing dwir wodcets'compensation policy information. t Homeowners who submit this affidavit they ata doing all work and tt m hire outside extractors must submit a new affidavit indite such. `+Coofractors that check bis box must attached an addidomi sheet awwmg the nate of the sub conhado s and state where ormtthose entities have employem lftyre bave employees,they must provide the-s wodome comp.policy mmtber.- I am anenrkyer that it providmgworkers'eompensahon insurm cefornW emrployeet~ Below is thepoScy mid job site informeaf wL Insurance Company Name_Travelers Property Cas Co of Am Policy#or Self-ins.Lic.#:7PJUBGo7898212 Expiration :6/4/19 Job Site Address: 1 City/Statelzip: t°,? C- e Attach a copy of a workers'compensation policy declaration page(sh6widg the policy un6ber and expiration date Failure to secure coverage as requhvd 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 form of a STOP WORK ORDER.and a fine of up to$250.00 a day againstthe violator.A copy of this statement may be forwarded to the Office-of Investigations ofthe DIA for insurance coverage verification. I do hereby certify under th us and penalties of perjury diad the information provided above is&me and correct Si Date- 1t I /I Phone#: Official use only. Do mot write in dela area,to be completed by dty or town offrdaL City or Town. Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Buu'ldmgDepartment 3.CitylTown Clerk 4.Electrical Inspector 5 Plumbing Inspector 6.Other Contact Person: Phone#: The Commonwealth of Massachusetts Department of IndustrialAccidents d I Congress Street,Suite 100 Boston,MA 02114-2017 www mass.gov/dia Warkers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers- TO BE FILED WITH THE PERMi'TTING AUTHORITY. Applicant Information Please Print Lezibly Name(Business/Organization/Individual):NRC Construction Inc Address: 66 Water St Apt 2 City/State/Zip:Milford, Ma 01757 Phone#:774-287-1485 Are you an employer?Check the appropriate boa: Type of project(required): 1.Q I am a employer with 4 employees(full and/or part-time).* 7. []New construction 2.❑I am a sole proprietor or partnership and have no employees working for me in 8. E]Remodeling any capacity.[No workers'comp.insurance required] ❑ 3.n-I am a homeowner doing all work myself.[No workers'comp.insurance required.]t 9. Demolition Q4.El am a homeowner and will be hiring contractors to conduct all work on my property. I will 10 Building addition ensure that all contractors either have workers'compensation insurance or are sole 11.0 Electrical repairs or additions proprietors with no employees. 12.Q Plumbing repairs or additions 5.❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.oRoof repairs These sub-contractors have employees and have workers'comp.insurance.: 6.❑We are a corporation and its officers have exercised their right of exemption per MGL c. 14.[:]Other 152,§1(4),and we have no employees.[No workers'comp.insurance required.] IL *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information- t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such :Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees Below is thepolicy and job site information. Insurance Company Name:Atlantic Casualty Policy#or Self-ins.Lie.#:R2WC947397 Expiration Date:8/16/19 Job Site Address: 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 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 form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby ce fy under thepains and penalties ofperjury that the information provided above is true and correct Si ature: Date: Phone#.774-287-1485 Official use only. Do not write in this area,to be completed by city or town official City or Town:. Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: AC,DiZa' CERTIFICATE OE LIABILITY INSURANCE DA3F6/26r1D1S S CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO FIGHTS UPON THE CM11FICATE HOLDER.THIS EKII CATE DOES NOT AFFWCAATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFOIWE0 BYTHE POLICIES BELOW S CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHO ESENTATWE OR PRODUCER,AND TiTE CERTIFICATE HOLDER PORTANT:If the certificate holder is an ADDITIONAL INSURED,the policy(ies)guest be endorsed.If SUBROGATION 1S WAIVED,subject to the eras and conditions of the poTrry, certain policies may require an endorsement.A statement on this cerci Ec2tP does not confer rights to the ertificatehoWerin lieu ofsach endorsemergs). PRODUCER CONTACT NAWE: athi Hu"inson Ormsby Insurance Agency,hut. PHONE(AIC,No Ezt) 41473741300FAX(AIC NoT PO Box 718 E-MMI-ADDRESS.khutdilns0o@ormshyir cmn West Springfield MA 01089 INSURERS AFFORDING COVERAGE NA)C$ INSURED INSURERA:Colony Insurance Company •39993 Sexton Roofing and Siding Inc INSURER B: PO Boz 5327 INSURER C_ FJalyofce IIIA 01047 6371 INSURER D: INSURER E JNSURER F: COVI MAGES: CERTIFICATE NUNRER_ 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 L;L-K1 FU:ATE 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 POUMES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS_ POUCTIFF POLICYEXP N - D01 BR DATE DATE IT TYPE OF INSURANCE NSRD YJVO POLICY NIMMER LUSQS A COtEUYfr12C1AL GENERAL LIABILITY IOIGLOMIS9903 62smi6 fi✓2572019 EACH OCCURRENCE S1,D00,000 X CLAIMS MADE M OCCUR PREMISES RENTED re) S100 M0 MED EXP{Arty ane person) 55.000 Ea OCUITrEn PERSONAL&ADV INJURY S1.00D.000 GENtAGGREGATE LIMIT APPLIES PER GEI-IFS2ALAGGREGATE $2.D00,000 Y J� n LOC PRODUCTS-COMP/OP AGG SZDOO,OW POLICY E OTHER COMBINED S AUTOMOBILE LIABDJTY 415a ) ANYAUTO BODILY INJURY(Perpemm) S ALL OWNED SCHEDULED BODILY INJURY(Per S AUTOS AUTOS c6dent)' HIRED AUTOS NON-OWNED PROPERTY DAMAGE S AUTOS (Per acddent) JUW3 FiElLA LIAB CCUR EACH OCCURRENCE S CESS LIAR US MADE AGGREGATE 5 PED NTION S 5 WORKERS COMPENSATION AND EMPLOYERS, YIN M S 113e E? ANYPROPRIETORIP EL EACH ACCIDENT S OFRCERIL NBER EXCLUDED? ❑ WA (Mandataryin NH) EL DISEASE-EA S IFyes.desuibe under EMPLOYEE DESCRIPTION OF OPERATIONS hekwi EL 131SEASE-PDLJGY UW S DESCRIPIR]N OF OPERATIONS I LOCATIONS I VEHIC LES(ACORD 101.Add anal Remarks Sc6edulS If mote space is requ'ved) CERTIFICATE HOLDER CANCEL L.AnON SHOULD ANY OF THE ABOVE DESCRIED POLICIES BE CANCELLED BEFORE THE E•7 MATION DATE THEREOF.NaTIC£WILL BE DELIVERED IN ACCORDANCE%WM THE POLICY PROVISIONS. AUTHDMZED REPPESFTiTATNE ACORD 25(10.74101) ®1988-2014 ACORD CORPORATION.AD rights reserved. The ACORD name and logo are registered marks of ACORD DATE(MMIDD/YYYY) �'c R CERTIFICATE OF LIABILITY INSURANCE 09/10/2018 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACTISABELE CORDEIRO NAME:ME: Brazway Insurance PHONE 978-455-5991 FAX (,/c,,,):978-455-9934 345 Main St Unit B1 E-MAILpRSS:infb@brazwayinsuranceagency.com Tewksbury MA 01876 INSURER(S)AFFORDING COVERAGE NOJC# INSURER A:AMGUARD INSURANCE CO INSURED NRC CONSTRUCTION INC INSURER B:ATLANTIC CASUALTY NIF INSURER C: 66 WATER ST APT B INSURER D MILFORD MA 01757 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 THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR I ADOLSUBRPOLICY EFF POLICY EXP LTR TYPE OF INSURANCE IINSD Vivo POLICY NUMBER MMIDDfYYYYI (MMIDDYYYYJ LIMITS COMMERCIAL GENERAL LIABILITYLi EACH OCCURRENCE $1,000,000 DAMAGE TO RENTED CLAIMS-MADE M OCCUR PREMISES Ea occurrence $100,000 L307000225-0 08/22/2018 08/22/2019 MED EXP(Any one person) $5,000 PERSONAL BADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERALAGGREGATE $2,000,000 POLICY❑JT F-1 LOC PRODUCTS-COMP/OP AGG $2,000,000 OTHER: $ AUTOMOBILE LIABILITYCOMBINS $INGLE LIMIT Ea accidenED t ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY(Per accident) $ HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per accident b UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION AND EMPLOYERS'LIABILITY STATUTE ER Y ANYPROPRIETOR/PARTNER/EXECUTNE � N/A A (Mandatory ) EL EACH ACCIDENT $1,000,000 OFFICE EMNHR2WC947397 08116/2018 08/16/2019 EXCLUDED? EL DISEASE-EA EMPLOYEE $1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below EL DISEASE-POLICY LIMIT $1,000,000 Lill DIF-1 O DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached it more space is requinsi) CARPENTRY,ROOFING,PAINTING. CERTIFICATE HOLDER CANCELLATION SEXTON ROOFING 8r SIDING INC SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE PO BOX 6327 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 102 PINE ST HOLYOKE, MA 01040 AUTHORIZED REPRESENTATIVE ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD Produced using Forms Boss Web Software.www.ForrnsBoss.com(c)Impressive Publishing 800.208-1977 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 Expiration: 02/14/2019 P.O. Box 6327 Holyoke, MA 01041 Update Address and return card. Mark reason for change. r"1 w n a..n.�...�1 n c n• f"'I 1 nca r`a..i Commonwealth of Massachusetts Division of Professional Licensure Board of Building Regulations and Standards Construction=Supervisor Specialty CSSL-099689 E�pires: 10/0512019 y ` I f, EVERETT J SEXTON: 1 PO BOX 6327 HOLYOKE MA 01.041 Commissioner F77- STATE OF CONNECTICUT OF iPROTECTION HOME IMPROVEMENT CONTRACTOR EVERETT J SEXTON SR 102 Pine St HOLYOKE,MA 01040-2411 J SEXTON ROOFING&LA CO LIC.I REG NU EFFECTIVE EXPIRES HIC.0605383 12/01/2017 11/30/2018 SIGNED