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NorthamptonPermit442016 001Vereinnl 7 Cnmmercial Ruildina Permit Mav 16. 2000 SECTION 1 - SITE INFORMATION 1.1 Property Address: /CE>1n ee�y Sc-AzI SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: G � d� 4C lv" a#nPkw Y Name (Print) /%/!U f6/r a i,-, ! z. Map // /3 Zone Elm St District in to be completed by office Lot 6V I Unit Overlay District CB District j Lit' l/?7;V Si; 5, le.� Current Mailing Address: 4/13 -,5-917 -1,4,6' 2.2 Authorized Agent: Department use only City of Northampton Status of Pen ill Building Department Curb Cut/Dri way Permit 212 Main Street Sewer/Septic Availability Room 100 Water/Well A failabilitv tructural Plans Northampton, MA 01060 Two Sets of 4 phone 413-587-1240 Fax 413-587-1272 PlottSite Plan 1. Building Other Specify (a) Building Permit APPLICATION TO CONSTRUCT, REPAIR, RENOVATE, CHANGE THE USE OR OCCUPANCY OF, OR DEMOLISH ANY BUILDING OTHER THAN A ONE OR TWO FAMILY DWELLIF IG SECTION 1 - SITE INFORMATION 1.1 Property Address: /CE>1n ee�y Sc-AzI SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: G � d� 4C lv" a#nPkw Y Name (Print) /%/!U f6/r a i,-, ! z. Map // /3 Zone Elm St District in to be completed by office Lot 6V I Unit Overlay District CB District j Lit' l/?7;V Si; 5, le.� Current Mailing Address: 4/13 -,5-917 -1,4,6' 2.2 Authorized Agent: Name (Print) �% . ' 1 ��r)Y't?Id Current Mailing Address: / 9y? epi Signature Telephone 2G,` M SECTION 3 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollars) to be Official Use Only completed by permit applicant 1. Building 3 3 eivo (a) Building Permit Fee 2. ElecMcal fd[° (b) Estimated Total Cost of I Construction fr m 6 3. Plumbing 1 jQC Building Permit F 4. Mechanical (HVAC) 3, 5. Fire Protection GC0 6. Total=(1+2+3+4+5) 1 3-711 16C(l Check Number Building Permit Number Signature: K Date Issued Versionl.7 Commercial Building Permit May 1 11 2000 SECTION 4- CONSTRUCTION SERVICES FOR PROJECTS LESS THAN 35,000 CUBIC FEET OF ENCLOSED SPACE Interior Alterations ❑ Existing Wall Signs ❑ Demolition ❑ Repairs ❑ Additions ❑ Accessory Building ❑ Exterior Alteration ❑ Existing Ground Sign ❑ New Signs ❑ Roofing ❑ Change of Use ❑ Other ❑ Brief Description Enter a brief description here. Of Proposed Work: SECTION 5 - USE GROUP AND CONSTRUCTION TYPE USE GROUP (Check as applicable) CONSTRUCTION TYPE A Assembly A-1 ❑ A-2 ❑ A-3 ❑ 1A El ❑ A-4 ❑ A-5 ❑ 1B ❑ B Business 2A 2B 2C ❑ ❑ ❑ E Educational ❑ F Factory ❑ F-1 ❑ F-2 ❑ H High Hazard ❑ 3A 36 F1I Institutional ❑ I-1 ❑ 1-2 1:11-3 ❑ M Mercantile ❑ 4 ::::j:::::❑ ❑ R Residential ❑ R-1 ❑ R-2 ❑ R-3 ❑ 5A 5B ❑ S Storage ❑ S-1 ❑ S-2 ❑ U Utility ❑ Specify:I Specify: M Mixed Use ❑ S Special Use ❑ Specify: COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATIONS, NODITIONS AND/OR CHANGE IN USE Existing Use Group: Proposed Use Group: Existing Hazard Index 780 CMR 34): Proposed Hazard Inde 780 CMR 34): SECTION 6 BUILDING HEIGHT AND AREA BUILDING AREA EXISTING PROPOSED NEW CONSTRUCTION OFFICE USE ONLY Floor Area per Floor (so 1sr Znd .2nd 3`d 3rd e — 4�' Total Area (sf) Total Proposed New Construction (sf) Jd I L=4? Total Height (ft) 19 Total Height ft 7. Water Supply (M.G.L. c. 40, § 54) 7.1 Flood Zone Information: Zone Outside Flood Zone[t 7.3 Sewage Disposal System: Municipal On site disposal system C] Public 9iPrivate ❑ Versiont.7 Commercial Building Permit May 1 , 2000 S. NORTHAMPTON ZONING Existing Proposed I equired by Zoning s column to be fitted in by wilding Department Lot Size Frontage Setbacks Front Side L: R: L: R: Rear 5 Building Height Bldg. Square Footage % Open Space Footage % (Lot area minus bldg & paved parking) # of Parking Spaces Fill: volume & Location A. Has a Special Permit/Variance/Finding ever been issued for/on NO 0 DONT KNOW ® YES IF YES, date issued: ,2 J)CI I it, IF YES: Was the permit recorded at the Registry of Deeds? NO ® DONT KNOW ® YES IF YES: enter Book Page B. Does the site contain a brook, body of water or wetlands? NO 0 IF YES, has a permit been or need to be obtained from the Conse Needs to be obtained ® Obtained ® , C. Do any signs exist on the property? YES NO IF YES, describe size, type and location: T U VC & Lv i S D. Are there any proposed changes to or additions of signs intended for IF YES, describe size, type and location: E. Will the construction activity disturb (clearing, grading, excavation, or filling) that will disturb over 1 acre? YES ® NO IF YES, then a Northampton Storm Water Management Permit from the f site? I06-.Si&�v and/or Document # Pw `')e it, DONT KNOW @ YES 0 in Commission? Issued: property? YES ® NO 1 acre or is it part of a common plan I is required. Version 1.7 Commercial Building Permit May 1 1 2000 SECTION 9- CONSPROFESSIONAL ON SERVICES - FOR BUILDING ROL PURS NT TO 780 CMR 116 (CONTAINING MORE THAN 35 TTRUCTION CONTA ECT 3 AND STRUCTURES SPTO 0 C.F. OF ENCLOSED ACE) 9.1 Registered Architect: IN A Applicable ❑ gistration Number iration Date Name (Registrant): Address Signature Telephone 9.2 Registered Professional Engineer(s): rea of Responsibility Name egistration Number Address xpiration Date Signature Telephone I rea of Responsibility Name egistration Number Address Signature Telephone iration Date Name rea of Responsibility Address egistmtion Number Signature Telephone zpiration Date Name rea of Responsibility Address Signature Telephone egistration Number Expiration Date 9.3� Contractor /General p V'�'NCiwfrI2 1G7vLhl-!� Vu.tk`I�"� ib�� Not Applicable [3 Company Name: Responsible In Charbe of Construction 14 �I�r� D i j�rr M& 6, ) 3 Address Signature"'' Telephone VCiSlnn 1.7 Commercial Building Permit May 1 1, 2000 SECTION 10- STRUCTURAL PEER REVIEW (780 CMR 110.11) Independent StfuctUral Engineering Structural Peer Review Required Yes No 0 SECTION 11 -OWNER AUTHORIZATION - TO BE COMPLETED WHEN OR CONTRACTOR APPLIES FOR BUILDING PERMIT OWNERS AGENT as Owner of the subject property to I, hereby authorize act on my behalf, in all matters relative to work authorized by this building permit application. "Signatumwner Date I, 52 d(� t �,� �p�,� �(,j��v�l}�;�jLrt f ct{w - Sy j -fie• j _,a Owner/Authorized Agent hereby declare that the statements and information on the foregoing application are tru and accurate, to the best of my knowledge and belief. Signed under the pains and penalties of perjury. Print Name, Signatu of Owner/Agent Date SECTION 12 - CONSTRUCTION SERVICES 101 Licensed Construction Supervisor: Not Applicable ❑ ��,����'� S ""�V T� Name of License Holder, r License Number G ✓w '4V8 IU-," t gW q -y Address Expiration Date >�i3-7�lj y1�3 yj�/-1C 7 Telephone sigiralure CTION 13 -WORKERS'COMIKENSATION INSURANCE AFFIDAVIT (M.G.L. c. 152, § 25:(6)) Workers Compensation Insurance affidavit must be completed and submitted with this applia tion. Failure to provide this affidavit will result in the denial of the issuance of the building permit - Signed Affidavit Attached Yes 0 No Planning - Decision City of Northampton Hearing No.: PLN -2016-0024 Date: February 29, 2016 APPLICATION TYPE: SUBMISSION DATE: PB Intermediate Site Plan 2/2J2016 A.,..1'r n4'c IJamn• Owner's Name: Information: BRIDGE RD SITE ZONING: ACTION TAKEN: MAP: BLOCK I LOT: MAP DATE. SECTION OF BYLAW: 16B 00 1 Chpt. 350- 11: Site Plan Approval Book: Page: NATURE OF PROPOSED WORK Construct 36 X 60 MODULAR building for Parks and Recreation Department Headquarters HARDSHIP: CONDITION OF APPROVAL: 1) All utility connections must meet Department of Public Works 2). Prior to any site work, adequate tree protection measures shall bq installed to protect deciduous trees on the abutting parcels of 204 and 212 Spring Grove Ave. Anyuch measures shall be determined by the City's Tree Warden. 3). The light over the south building entrance shall be turned off when the building is not occupied. 4). Landscape shrubs shall be interspersed between and offset from he proposed Red Cedars unless the landscape architect determines in writing that such planting will I of thrive and/or will inhibit the growth of the Red Cedars. FINDINGS'. The Planning Board approved the request by Central Services Department for the City of Nortampton for Site Plan Approval based upon the following information and plans submitted with the application: 1. Site Plan Review Set, City of Northampton Parks and Recreation Modular Building by The rkshire Design Group, Inc. Revised Date February 24, 2016. Sheets L100, L101, L102, L201. 2. Modular Siding Trim Details Photographic Illustration. 3. Proposed Building Layout. In granting the Site Plan the Board determined that the criteria in 11.6 had been met: A. The requested use protects adjoining premises against seriously detrimental uses. The adi ition of the small office on the school grounds will be shielded from the abutting residential property with fast growing evergreen tr es, overflow stormwater will be directed to existing infrastructure after infiltrating on site. B. The requested use will promote the convenience and safety of vehicular and pedestrian RIC vement within the site and on adjacent streets. The building will share parking with JFK school- no additional parking is required. Bil ycle storage has been provided. The building is accessible from the existing sidewalks that connect to Bridge Road and the abutti g residential neighborhood.; and: C. The site will function harmoniously in relation to other structures and open spaces to the n 3tural landscape, existing buildings and other community assets in the area as it relates to landscaping, drainage, sight lines, buildin orientation, massing, egress, and setbacks. The recreation office use brings the administrative function to JFK site from which many recreational programs are operated. D. The requested use will not overload, and will mitigate adverse impacts on, the City's resou ces, including the effect on the City's water supply and distribution system, sanitary and storm sewage collection and treatment systems fire protection, streets and schools. GeoTMS® 2016 Des Lauriers Municipal Solutions, Inc NAMES NAME: NORTHAMPTON CITY OF NORTHAMPTON CITY OF J F KENNEDY SC ADDRESS: ADDRESS: Central Services Dept 210 MAIN ST 240 MAIN STREET TOWN:STATE: ZIP CODE: TOWN: STATE: ZIP CODE: NORTHAMPTON MA 01060 NORTHAMPTON MA 01060 PHONE NO.: FAX NO.. PHONE NO.: FAX NO.. EMAIL ADDRESS: EMAIL ADDRESS: Information: BRIDGE RD SITE ZONING: ACTION TAKEN: MAP: BLOCK I LOT: MAP DATE. SECTION OF BYLAW: 16B 00 1 Chpt. 350- 11: Site Plan Approval Book: Page: NATURE OF PROPOSED WORK Construct 36 X 60 MODULAR building for Parks and Recreation Department Headquarters HARDSHIP: CONDITION OF APPROVAL: 1) All utility connections must meet Department of Public Works 2). Prior to any site work, adequate tree protection measures shall bq installed to protect deciduous trees on the abutting parcels of 204 and 212 Spring Grove Ave. Anyuch measures shall be determined by the City's Tree Warden. 3). The light over the south building entrance shall be turned off when the building is not occupied. 4). Landscape shrubs shall be interspersed between and offset from he proposed Red Cedars unless the landscape architect determines in writing that such planting will I of thrive and/or will inhibit the growth of the Red Cedars. FINDINGS'. The Planning Board approved the request by Central Services Department for the City of Nortampton for Site Plan Approval based upon the following information and plans submitted with the application: 1. Site Plan Review Set, City of Northampton Parks and Recreation Modular Building by The rkshire Design Group, Inc. Revised Date February 24, 2016. Sheets L100, L101, L102, L201. 2. Modular Siding Trim Details Photographic Illustration. 3. Proposed Building Layout. In granting the Site Plan the Board determined that the criteria in 11.6 had been met: A. The requested use protects adjoining premises against seriously detrimental uses. The adi ition of the small office on the school grounds will be shielded from the abutting residential property with fast growing evergreen tr es, overflow stormwater will be directed to existing infrastructure after infiltrating on site. B. The requested use will promote the convenience and safety of vehicular and pedestrian RIC vement within the site and on adjacent streets. The building will share parking with JFK school- no additional parking is required. Bil ycle storage has been provided. The building is accessible from the existing sidewalks that connect to Bridge Road and the abutti g residential neighborhood.; and: C. The site will function harmoniously in relation to other structures and open spaces to the n 3tural landscape, existing buildings and other community assets in the area as it relates to landscaping, drainage, sight lines, buildin orientation, massing, egress, and setbacks. The recreation office use brings the administrative function to JFK site from which many recreational programs are operated. D. The requested use will not overload, and will mitigate adverse impacts on, the City's resou ces, including the effect on the City's water supply and distribution system, sanitary and storm sewage collection and treatment systems fire protection, streets and schools. GeoTMS® 2016 Des Lauriers Municipal Solutions, Inc Planning - Decision City of Northampton Hearing No.: PLN -2016-0024 Date: February 29, 2016 ited to a municipal office use. E The requested use meets any special regulations set forth in this chapter- there are none rei F. Compliance with the following technical performance standards: TBV: (1) Curb cuts onto streets shall be minimized. Access to businesses shall use common drivew ys, existing side streets, or loop service roads shared by adjacent lots when possible. More than one curb cut shall be permitted only m f7en necessary to minimize traffic and safety impacts. No site changes are necessary to accommodate the recreation office building. votes to (2) Pedestrian, bicycle and vehicular traffic movement on site must be separated, to the extent ossib/e, and sidewalks must be provided between businesses within a development and from public sidewalks, cycle backs and bike pairs. All projects shall include sidewalks and Vee baits abutting the street, except where site topography or other limitations make them infeasible. In such cases where the sidewalk is infeasible, the developershall install an equal number of feet of sidewalk and/or tre 3 belt in another area of the community as deemed by the Planning Board or Office of Planning and Sustainability. All sidewalks meet., 2/25/2016 (a) are constructed of cement concrete. . (b) Ramps allowing access to the sidewalk and street by variously abled persons shall be req u ed at the corner or within the curb area immediately adjacent to the sidewalk. VOTING DATE: COULD NOT DEROGATE BECAUSE: FILING DEADLINE: MAILING DATE: HEARING CONTINUED DATE: DECISION D TBV: APPEAL DATE' 2/412016 2(18/2016 Grant 3/10/2016 votes to Grant REFERRALS IN DATE: HEARING DEADLINE DATE: HEARING CLOSE DATE: FINAL SIGNINC BV: APPEAL DEADLINE'. 2/11/2016 4/7/2016 2/25/2016 3/10/2016 3/20/2016 FIRST ADVERTISING DATE: HEARING DATE: VOTING DATE: DECISION OA 2111/2016 2/25/2016 2/25/2016 2/29/2016 SECOND ADVERTISING DATE: HEARINGTIME: VOTING DEADLINE: DECISION DEA LINE' 2/18/2016 8:15 PM 5/25/2016 5/25/2016 MEMBERS PRESENT s VOTE: Theresa (Tess) Poe votes to Grant William Grinnell votes to Grant Alan Verson votes to Grant John Lutz votes to Grant Karla Youngblood votes to Grant Debin Bruce votes to Grant MINUTES OF MEETING: Available on the city website: www.northamptonma.gov/ 1, Carolyn Misch, as agent to the Planning Board, certify that this is a true and accurate decis that a copy of this and all plans have been filed with the Board and the City Clerk on the date I certify that a copy of this decision has been mailed to the Owner and Applicant. Notice of Appeal An appeal from the decision of the Planning Board may be made by any person aggrieved pu amended within twenty (20) days after the date of the filing of the notice of the decision with t appeal may be made to the Hampshire Superior Court with a certified copy of the appeal sent GeoTMS® 2016 Des Lauriers Municipal Solutions, Inc. made by the Planning Board and certify )wn above. rant to MGL Chapt. 40A, Section 17 as City Clerk. The date is listed above. Such the City Clerk of the City of Northampton. *Aa a s Department of i� � S(Oj! arrl Y Oiling Regulations and Eta ' se: h t ,4 f 3 Exp ration p 15t/sK3at City of Northampton 2121\/Iaiu Street, Solid Waste Disposal Aflidavit MA 01060 In accordance of the provisions of MGL c 40, S54, acknowledge that as a condition of the building permit all debris resulting from the construction activity governed by this Building Permit shall be dis osed of in a properly licensed solid waste disposal facility, as defined by ry GLc Il 1, S 150A. Address of the work: ��� ��r C RdG0/ The debris will be transported by: The debris will be received by: Building permit number: Name of Permit Applicant VY/M i\ +rl , (,A)" 14t/w, d l e Date Signature of Permit Applicant 0 0 Mark line ���� 8uildlr�g Green. Renee Santeusanio Vanguard Modular Building Systems 152 Sylvan Street, 3rd Floor Danvers, MA 01923 Re: Certified Provider & Installer of Modular Buildings Dear Renee, This letter certifies that Vanguard Modular Building Systems is an authorized and Line Industries' modular buildings. Regards, Mark Line Industries Terry Siegrist ~,marklineindustries.com November 11t11, 2014 provider and installer of Mark Mark Line - Indiana Mark Line - Pennsylvania 51687 county road 133 502 Alexander Drive d it caW7o-Smm 4968 Bristol, in 46507 Ephrata, PA 17522 TeL 574.825.5851 Tel: 717.733.1315 Fax: 574.825.9139 Fax: 717.733.1963 The Commonwealth of Massachusetts Department of IndustrialAccidents Office of Investigations I Congress Street, Suite 100 U11 Boston, MA 0211 4-2 01 7 wtvtv.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contrael Name (Business/Organization/individual): Vanguard Modular Building Systerhs, LLC Address: 3 Great Valley Parkway, Suite 170 City/State/Zip: Malvern, PA 19355 Phone #: Are you an employer? Check the appropriate box: ype of project (required): L ❑ I am a employer with 4. 0 I am a general contractor and I # New construction employees (full and/or part-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 sub -contractors have l. E] Demolition working for me in any capacity. employees and have workers' 1. ❑ Building addition [No workers' comp. insurance comp. insurance. required.] 5. ❑ We are a corporation and its 10. repairs or additions 3. ❑ I am a homeowner doing all work officers have exercised their 3.0 IQ Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 2.❑ Roof repairs insurance required.] t c. 152, § 1(4), and we have no 3.❑ Other employees. [No workers' comp. insurance required.] "Any applicant that checks box # t must also fill out the section below showing their workers' compensation polity information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors mus submit a new affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub -contractors ands to whether or not those entities have employees. If the sub -contractors have employees, they must provide their workers' comp. policy number. Ian: an employer that is providing workers' compensation lusurauce for ray employees. information. Insurance Company Policy # or Self -ins. Lic. #: Job Site is the policy and job site Attach a copy of the workers' compensation policy declaration page (showing the pot cy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the it position of criminal penalties of a fine up to $1,500.00 and/or one-year imprisonment, as well as civil penalties in the form o 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 forwarded to the Office of Investigations of the DIA for insurance coverage verification, do hereby certify corder flee pains and penalties of perjury that the information provide above is true and correct. 24/2016 Sianature r 11 ;`.` .: :;:.,...esC.l /+53i� f/a/ -`.: �.: ii: `% Dar e• 1 ;n -Z 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 6. Other Contact Person: Phone #: 5. Plumbing Inspector ��a CERTIFICATE OF LIABILITY INSURANCE DATE(MMIUDIVYYYI 2123/2016 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 MSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(les) must be endorse . 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 -Hambright a Davies, Inc, aglaview Blvd 110 . PA 19341 INSURED Vanguard Modular Building Systems, LLC 3 Great Valley Parkway Suite 170 Malvern, PA 19356.1417 F: Ice Compan 25615 npany, 26668 _ Cc of America 26674 pang of CT 25666 moo Company COVERAGES CERTIFICATE NUMBER: I REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF WSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSL RED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTUNTHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHE I DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DFSCRII IED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAI S. HURT AD L UBR__-- - -- --- __-- P LIC EFF [ POLIf)V E-- LTR TYPEOFINSURANCE p POLICY NUMBER M IODIYYYY AIM/DO � - --- - ------ LIMITS A X COMMERCIALGENERALLIABILITY EACH OCCURRENCE S 1,000,000 -" _ CLAIMS -MADE X OCCUR __ X X B30.6C153573-COF96 12131/2015 12131120 6 DAMAGET51MTET3— -" PRULI Eao nonce) „ -'- S_ 300,11116 MED EXP (Any one person) S 10,000 PERSONAL&ADV INJURY S 1,000,000 G_E_N'L AGGREGATE LIMIT APIPLIES PER: GENERAL AGGREGATE S 2,000,000 _.�POLICY [K JPEC `.X ) LCC PRODUCTS-COMPIOP AGO _ ...S $2,000,000 _. OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT$ fa aWitlenl 1,000,000 _ B X ANY AUTO X X BA-SC163573-IND-15 1213912016 12131120'6 BODILY INJURY (Per person) S ALLOWNEO SCHEDULED AUTOS AUTOS "----_------- e001LYINJURY(PmmzIdam) S -- NONAWNED PROPERTYOFMAGE 5 HIREDAUTOS AUTOS -(Pcratt_denl)_ 5 X UMBRELLA LEADX OCCUR EACH OCCURRENCE $ 11,000,000 C EXCESS LIAR CLAIMS -MADE XIX CUP-GC153573411.46 1213112016 12131120 6 AGGREGATE 11,0 5 000,00 _ OED X RETENTION 5 10,000 1 _ S WORKERS COMPENSATION X STATUTE ERH D AND EMPLOYERS'LIABILITY ANY PROPRIErORMARTNEIVEXECUTIVE YIN X YT-UB-SC1ti910A-16 12/31/2016 12131/20 6 EL EACH ACCIDENT $ 9,000,000 OFNCERIMEMBEREXCLUDEDT O (Mandatory lnN81 NIA -"'---- - $ 1,000,000 E.L. DISEASE -EA EMPLOYEE It es dascdbe under DESCRIPTION OF OPERATIONS bela,v E.L. DISEASE -POLICY LIMIT 3 1r000r0O0 E installation Floater 10033173.0003 1213112016 12131120 6 Limit: $1,000,000 Deductible: $10,000 E Leased I Rented Equipment 710033173.0003 1213112016 12131120 6 Limit: $150,000 Deductible: $5,000 DESCRIPTION OF OPERATIONS I LOCATIONS IVEHICLES iACORD 101, Additional Remarks Schedule, may be attached It more space lc qulmd) The City of Northampton is noted as an Additional Insured on the General Liability, Automobile, and mbrella pollcies only if required by written contract and to the extent required by written contract, subject to policy terms, conditions, limitatio , and exclusions. Waiver of subrogation applies to the General Liability, Business Automobile, Umbrella and Workers' Compensation and Emi loyer's Liability policies only if required by written contract subject to the policy terms, conditions, limitations, and exclusions and permitted by stale law. CFRTIFICATF NOI DER CANCELLATION I ©1988-2014 AC RD CORPORATION. All rights reserved. ACORD 25 (2014101) The ACORD name and logo are registered marks of ACO D SHOULD ANY OF THE ABO : DESCRIBED POLICIES BE CANCELLED BEFORE The City of Northampton 240 Main Street THE EXPIRATION DATE ACCORDANCE WITH THE PO HEREOF, NOTICE WILL BE DELIVERED IN ACY PROVISIONS. Northampton, MA 01060- AUTHORIZED REPRESENTATIVE , ©1988-2014 AC RD CORPORATION. All rights reserved. ACORD 25 (2014101) The ACORD name and logo are registered marks of ACO D VANGUARD MODULAR BUILDING SYSTEMS Project # 36169: City of Northampton Installation of D J.F.K. Middle School Site Location: 100 Bridge Road, Northampton, MA Subcontractors: AIM Plumbing & Heating PO Box 520 Assonet, MA 02702 Workers' Comp Policy #: WCC -500-5009577 Waterman Excavating, Inc. 2 Gavin Ave. Adams, MA 01220 Workers' Comp Policy #: AWC-400-7030752-2015A Nutmeg Technologies/ACE Technologies, Inc. 279 Nutmeg Road South South Windsor, CT 06074 Workers' Comp Policy #: WC902424200 Certificates Attached 152 Sylvan Street, 3rd Floor • Danvers, MA 01923 • p: 978.739.9390 Building at the f: 978.739.9383 CERTIFICATE OF LIABILITY INS THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BE REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. _ IMPORTANT: If the certificate holder is an At the terms and conditions of the policy, certain PRODUCER NM. F. Borhak insurance Agency 511 Plymouth Street Halifax, MA 02338 iallfax House Acct INSURED Heating, Inc. P.O.Box 520 Assonet, MA 02702 may require an endorsement A statement (Mmax YYVV) I'S UPON THE CERTIFICATE HOLDER. THIS COVERAGE AFFORDED BY THE POLICIES N THE ISSUING INSURER(S), AUTHORIZED this Certificate does not confer rights to the Insurance .-n.,mmwn_ec I REVISION NUMBER: VTHIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE IN INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OT CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESC EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAYHAVE BEEN REDUCED BY PAID CL 3URED NAMED ABOVE FOR THE POLICY PERIOD iER DOCUMENT WITH RESPECT TO WHICH THIS UBED HEREIN IS SUBJECT TO ALL THE TERMS, MMS. 'S L -MA TYPE OF INSURANCE SHOULD ANY OF THE AS VE DESCRIBED POLICIES BE CANCELLED BEFORE POLICY NUMBER MMN MMU BUILDING SYSTEMS LWrrS X COMMERCIAL GENERAL LIABILITYEACH AUTHORIZED REPRESENTATIVE DANVERS, MA 01923 Halifax House Acct OCCURRENCE $ 1,000,00 CLAIMS-MADEOCCUR 80392M8096 10128/2015 10128 016 PREMISES Eaoccurrence $ 300,00 MED EXP (My one person) $ 5,000 X Xtend End PERSONAL &ADV INJURY $ 1,000,00 X SLANKE XCU GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,0 00 PRODUCTS-COMPIOPAGG $ 2,000,00 POLICY � JECT 0 LOC OTHER: AUTOMOBILE LIASIL(TY COMBINED SINGLE LIMI $ 1,000,00 Ea acutlent _ BODILY INJURY (Per person] $ C ANY AUTOBAC471110, 11/0412015 11/04 016 BODILY INJURY (Per eccitlenU S ALL OWNED X SCHEDULED HRTEODAUTOS S AUTOSNON-OWNS X XAUTOS PROPERTY DAMAG $ Perattltlent UMBRELLA UABX OCCUR EACH OCCURRENCE $ 5,000,00 AGGREGATE $ 5,000,00 A X EXCESS LIAR CLAIMS -MADE EX-392MR096 10/2812015 101281!016 DED I I RETENTION$ Is B WORKERS COMPENSATION ANDEMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNEREECUTIVE YIN OFFICERIMEMBER EXCLUDEDT Nandalery in NH) CC-500-5009577 10128/2015 1012$ 016 X STATUTE EPERRµ E L. EACH ACCIDENT $ 500,00 E.L. 0 SEASE - EA EMPLOYEE $ 500,00 E.L. DISEASE -PoLICY LIMIT $ 500,0 If yes, describe un der DESCRIPTION OF OPERATIONS below A NLAND MARINE 680.392M8096 10128!2015 1(1128 016 FLTR 11,00 DED 1,00 DESCRIPTION OF OPERATIONS I LOCATIONS) VEHICLES (ACORD 101,Adele onal Remarks SchedWe,maybe aaEchedemerespacei roquire'l) Certificate Holder is listed as additional insured on general liability coverage when required by written contracrL CERTIFICATE HOLDER CANCELLATION VANGUAR 196B•ZU14 CUKU CUKPUKA I ION. All ngnts reserVea. SHOULD ANY OF THE AS VE DESCRIBED POLICIES BE CANCELLED BEFORE VANGUARD MODULAR THE EXPIRATION DA ACCORDANCE WITH THE THEREOF, NOTICE WILL BE DELIVERED IN POLICYPROVISIONS. BUILDING SYSTEMS 152 SYLVAN STREET AUTHORIZED REPRESENTATIVE DANVERS, MA 01923 Halifax House Acct 196B•ZU14 CUKU CUKPUKA I ION. All ngnts reserVea. ACORD 25 (2014!01) The ACORD name and logo are registered marks of I ORD DATE (MMIDDIYYYY) CERTIFICATE OF LIABILITY v THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGt TS UPON THE CERTIFICATE HOLDER. HE POUCIES BCERTIFICATE ELLOW. THIS OCOES NOT INTIVELY RNEGATIVELY EXTEND ALTER COVERAGE AFFORDED T CERTIFICATE CATE OF INSURANCE NSURAN DOES CONSTITUTE A CONTRACT ETWE N THE IISSUINGNSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the Policy(ies) must be endo If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement A statementn this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). CONTACT Kathleen O' PRODUCER NAME: Coakley Pierpan Dolan & Collins Insurance Agency PHOONE (413)664- 26 Union Street p�RESB; kobrien@cpc North Adams MA 01247 INSURED Waterman Excavating, Inc. 2 Gavin Ave .com Adams MA 01220 1 INSURER F: ____._.�.�........�..-n,.mc _ nnro QCVIRI711A1NIIMRPQ' (413)664-4723 �.- THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE I ISURFD NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR O HER DOCUMENT WITH RESPECT TO WHICH THIS MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DES RIBED HEREIN IS SUBJECT TO ALL THE TERMS, CERTIFICATE EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID IMS. INBR AWL POLICY NUMBER MMIDDrrCy MMMIU EXP LIMITS LTR TYPE OF INSURANCE X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 TO RENT D 300,000 PREMISES Ea occurrence $ A 1XIDAMAGE CIAIMS-MADE OCCUR MEOFXP(A,ormp.moIr) $ 15,000 X Y eER53574657 1/1/2016 1/1/ 17 PERSONAL& ADV INJURY $ 1,000,000 GEN -1- AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 PRODUCTS -COMPIOP AGO $ 2,000,000 POLICY [X] jECT El LOC Expense Mad Factor 1 $ OTHER' COMBINED SINGLE LIMIT $ 1,000,000 Ea amident) AUTOMOBILE UABIUTY _ BODILY INJURY(Per person) $ B ANY AUTO __ (PeraystleM) $ ALL OWNED SCHEDULEDBODILY X HA053574657 1/1/2016 1/1/ 17 AUTOS AUTOS NON -OWNED PROPS TYIA PROPERTY DAMAGE $ Per amiderd X HIRED AUTOS X AUTOS PIP -Basic $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB CLAIMS -MADE DED RETENTION$ $ WORKERS COMPENSATION X PER TH- STATUTE ER ANDEMPLOYERS LIABILITY YIN _. ANY PROPRIETORIPARTNERIEXECUDVE EL EACH ACCIDENT $ 500,000 C OFFICEWMEMBER EXCLUDEW (Mandatory in NH) N I A AWC-400-7030752-2015A 6/19/2015 6/19/ 016 E.L. DISEASE - EA EMPLOYE $ 5.5000 E.L. DISEASE - POLICY LIMIT I $ 500,000 If yes, describe under DESCRIPTION OF OPERATIONS below A Contractor's Equipment BKN53574657 1/1/2016 1/1/:017 DESCRIPTION OF OPERATIONS/ LOCATIONS I VEHICLES (AGORD 101, Additional Remarks Schedule, maybe attached if more spat is required) VANGUARD MODULARY BUILDING SYSTEMS, LLC & SCHIAVI LEASING CORPORATION, ATIMA ARE ADDITIONAL INSURED'S WITH RESPECT TO GENERAL LIABILITY WHEN REQUIRED BY WRITTEN CONTRACT OR AGREEMENT. WAIVER OF SUBROGATION IN FAVOR OF CERTIFICATE HOLDER INCLUDED ON GENERAL LIABILITY. nvrrerora ry unr nmo CANICFI I ATInM I (91110a -LU 4Al VKIJI,VKYVKAIIVK. AnnunwrY5erveu. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD INS025t7memt SHOULD ANY OF THE AS VE DESCRIBED POLICIES BE CANCELLED BEFORE Vanguard Modular Building Systems, LLC Schiavi Leasing Corporation, ATIMA, THE EXPIRATION DAT ACCORDANCE WITH THE THEREOF, NOTICE WILL BE DELIVERED IN POLICY PROVISIONS. 3 Great Valley Parkway Ste 170 Malvern, PA 19355 AUTHORIZED REPRESENTATIV K O'Brien/KATOBR (91110a -LU 4Al VKIJI,VKYVKAIIVK. AnnunwrY5erveu. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD INS025t7memt NUTME-6 OF 10: PJ CERTIFICATE OF LIABILITY INSURA CE M0(Mmir' 1 03/0812016 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIG ITS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THI 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. NIMIDDYEFF IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endo ed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement n this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER Serra & DelVecchio Insurance 386 Main Street 2nd Floor Middletown, CT 06457 Justin J. DelVecchio NTACT NAME. Michelle Hiner By _ PHNE 860.346-966 c Na Ert ° _.--a 110: 860343-1511 p)p'S; micheile@sdin '-uranCRgroup.COm INSURER(S)I FFORDING COVERAGE NAICp INSURER A: SeleCDVe Inst ranee 12572 121171 016 INSURED Nutmeg Technologies Ace Technologies,INC dba 279 Nutmeg Rd S INSURER B: INSURER C: South Windsor, CT 06074 INSURER D: INSURERE: NSURER F : CnvaoeaFa CFRTIFICATE NUMBER: I REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE It SURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR 01 4ER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DES( RIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID ClIMS. INSR LTR TYPEOFINSURANCE 1110) POLICY NUMBER NIMIDDYEFF MWDO P LIMITS A X COMMERCULLGENERALLIABIDTY ACCORDANCE WITH THE IOLICY PROVISIONS. SYSTEMS LLC AND SCHIAVI EACH OCCURRENCE $ 1,000,00 CLAIMS-MADE OCCUR LEASING CORPORATION ATIMA S219053800 12117/2015 121171 016 MAGETC� PREMISES Ea occurrence $ 100,00 MED EXP (Any we person) $ 10,00 PERSONAL B ADV INJURY $ 1,000,00 GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $ 2,000,00 PRODUCTS-COMP/OP ADD $ 2,000,00 POLICY PRO- � ECT LOC $ OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,00 denD BODILY INJURY(Per person) $ A X ANY AUTO MY100628300 12117/2015 121171 016 BODILY INJURY (Per accident) $ ALL OWNED SCHEDULED AUTOS OR NON-0,MED HIREDAUTOS AUTQS PROPERTY DAMAGE $ Per accldelrt UMBRELLA LwB OCCUR EACH OCCURRENCE $ 5,000,00 AGGREGATE $ 5,000,0000 A EXCESS LIAB COLIC, 5219053800 12117/2015 121171 016 DED X _ __-_MADE RETENTION $ 0 $ A WORKERS COMPENSATION AND EMPLOYERS LIABILITYSTATUTE ANY PROPRIETOWARTNERIEXECUTIVE YIN/A 0902424200 12117/2015 121171 16 PER OTH- I ER El. EACH ACCIDENT $ 500,00 OFFICERRAEMBER EXCLUDED? (Mandal°ry in NH) E.L. DISEASE - EA EMPLOYE $ 500,00 H yes. describe under DESCRIPTION OF OPERATIONS be. EL DISEASE -POLICY LIMIT $ 500,00 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Addiftnal Remmb Schedule, may be attached if morespace I, nupilmd) CERTIFICATE HOLDER IS ADDED AS AN ADDITIONAL INSURED AS RESPECTS THE INSUREDS OPERATIONS AND AS REQUIRED BY SIGNED CONTRACT. COVERAGE IS PRI MARY AND NON-CONTRIBUTORY FOR GENERAL LIABILITY AUTO AND UMBRELLA AND A WA VER OF SUBROGATION APPLIES FOR GENERAL LIABILITY, AUTO, AND WORKERS COMPEN ATION (UMBRELLA IS FOLLOWS FORM) CERTIFICATE HOLDER CANCELLATION ©1988-2014 4CORD CORPORATION. All rights reserved. ACORD 25 (2014101) The ACORD name and logo are registered marks of AC I RD VANGMOD SHOULD ANYOF THE AB VE DESCRIBED POLICIES BE CANCELLED BEFORE VANGUARD MODULAR BUILDING THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE IOLICY PROVISIONS. SYSTEMS LLC AND SCHIAVI LEASING CORPORATION ATIMA AUTHORIZED REPRESENTATWE — 3 GREAT VALLEY PARKWAY STE170 MALVERN, PA 19355 ©1988-2014 4CORD CORPORATION. All rights reserved. ACORD 25 (2014101) The ACORD name and logo are registered marks of AC I RD