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29-365 (7) City of North mptan� Department use only s Building Dep rtm t State of rma:MAY 9 201 urb ut/ i way Permit A. 212 Main c treat Se /Sep c Availability Room 1 0 /well vailatidy Northampton, A09`044,"H�,y�oN ";Pets o Structural Plans �. phone 413-587-1240 ax - - o ite Plans 011ier Specify APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION /-��/-y �(Z'C"O 1.1 Prno a1 Address. � f This section to be completed by office Map Lot 1 mp25 Unit ONQt+(4 C" Zone Overlay District Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Deeper of Record: Brehdw �eU�oa -7a Av -j- �lj Circ(.v ,-e (jj(�6J Name(Pop / Current Mailing A9 rp:_ �R6- ( o Telephone �( S gnat re 2 2 Jigutinarl Agent: os b N ou,"rit) Current Mailing Address: Ni ?- da7-W�� Si acme Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only Completed by permit applicant 1. Building �l � O 6 (a)Building Permit Fee 2. Electrical d ������ //// V (b)Estimated Total Cost of w`C Construction from 6 3. Plumbing q O Building Permit Fee 4. Mechanical (HVAC) 5. Fare Protection 6. Total=(1 +2+3+4-5) Check Number This Section For Official Use Only Date Building Permit Number: Issued: Signature: 50)-2019 Building Commissionedinspector of Buildings Data 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 Depamnwc Lot Size Frontage Setbacks Front Side L: R: L R- Rear Building Height Bldg. Square Footage % Open Space Footage % (WI area minas bldg&penal ,arknod #of Parking Spaces Fill: vomme&tnrafinn A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO O DONT KNOW �D- YES O IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO O DONT KNOW YES O IF YES: enter Book Page and/or Document# B. Does the site contain a brook, body of water or wetlands? NO n- DONT KNOW O YES O IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained O Obtained O , Date Issued: C. Do any signs exist on the property? YES O NO IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property? YES O NO IF YES, describe size, type and location: v� E. Will the construction activity disturb(clearing,grading excavation,or filling)over 1 acre or is H part of a common plan that will disturb over t acre? YES O NO W IF YES,then a Northampton Storm Water Management Permit from the DPW is required. SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicablel New House ❑ Addition ❑ Replacement slows Alteration(s) Roofing Or Doom �1 Accessory Bldg. ❑ Demolition ❑ New Signs (OI Decks [0 Siding Other[Qj Brief QLscriptio of Proposed I Work: I s-T-.0 I U 0( we,..a c..c� � PJe� moor Moo r-G tUZ� Pew � uuy� Sta�+ry Zyv<k Alteration of existing bedroom-Yes X No Adding new bedroom Yes >,— No Attached Narrative Renovating unfinished basement _Ves k� No Plans Attached Roll -Sheet Be.If New house and or addition to existing housing, complete the following: a. Use of building:One Family Two Fani Other b. Number of rooms in each family unit: Number of Bathrooms c. Is there a garage attached? d. Proposed Square footage of new construction. Dimensions e. Number of stories? I. Method of heating? Fireplaces or Woodstoves Number of each g. Energy Conservation Compliance. Masscheck Energy Compliance form attached? In. Type of construction 1. Is construction within 100 ft.of wetlands? Yes _Na. Is construction within 100 yr. floodplain_Yes No j. Depth of basement or cellar floor below finished grade k. Will building conform to the Building and Zoning regulations? Ves_No. I. Septic Tank_ City Sewer Private well City water Supply SECTION Ta-OWNER AUTHORIZATION-TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT req Q as Owner of the subject property hereby authorize ('t to act on my..ehjlf, in aII afters ati to work authorized by this.building permit application. Sr natur Dorf OOvraer i �� /� a Data pt.c v as Owner/Authorized Agent hereby declare that the statements an information on the foregoing application are true and accurate,to the best of my knowledge and belief. r Sig ad Ithinsa aWe duty. �PdmSignatureent Date SECTION 8-CONSTRUCTION SERVICES 81Liceneed Construction n"Supervisor' nNot ApplicaybblleG❑ Name of License Holder: �l � '-C 7'� LA�Ii O �" ` �(0 License Number a6 Ad ress Expiration Date 1/(r255fo KZ 5 oture Telephone 9. g 'stared Hom I ement Con 11 Not Applicable ❑ 1 G es CDuc X 0L, 11 101 om an Name At' r 1 Registration Number Address t Prr � ST S — °� a A1tltl_ress oto 'I (� Expiration Date Lok.,y �1nPC�UW lJ 1. tl b Telephone C�I -Sd r `7X 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 buildi ermit. Signed Affidavit Attached Yes.....X No..._. ❑ City of Northampton ✓ Massachusetts _ x p212 Beim S OF B& ftn ni al Building MJF ` M 010 Nein Street a Municipal Building C � \ NocNavpton, Mr. e1e60 sxp y�P 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 fora family homes.Prior to performing work on such homes,a contractor must be registered as a Home Improvement Contractor("HIC"). M.G.L.Chapter 142A requires that the"reconstruction, alteration,renovation, repair,modernization, conversion, improvement, removal, demolition, or construction of an addition to any preexisting owner-occupied building containing at least one but not mora than four dwelling units....or to structures which are adjacent to such residence or building"be done by redstered contractors. Note:Lf the h cowne(r`has contracted with a corporation or LLC,that entity must be registered. Type of Work76 W �tOLV� SkZ t Est Cost, � Ir o �6,A Address of Work: 79 F- - \, ci (, c P Y10V gkCp (lK et Date of Permit Application: I hereby certify that Registration is not required for the following reason(s): _Work excluded by law(explain): —Job under$1,000.00 _Owner obtaining own permit(explain): _Building not owner-occupied Other(specify): OWNERS OBTAINING THEIR OWN PERMIT OR ENTERING INTO CONTRACTS WITH UNREGISTERED CONTRACTORS OR SUBCONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK ARE NOT ELIGIBLE FOR AND DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER M.G.L.Chapter 142A.SUCH OWNERS ALSO ASSUME THE RESPONSIBILITES FOR ALL WORK PERFORMED UNDER THE BUILDING PERMIT.SEE NEXT PAGE FOR MORE INFORMATION. Signed under the penalties of perjury: I here` apply for a building permit as the agen of the Ow er. � l eUts C� tirwc ,a� 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: S- ?- (9 Date Owner Name and Signature City of Northampton -� Massachusetts ss �Oje� DOF BUILDING INSPECTIONS 212 Wins i 112 Win strut • Municipal Building NortAamptoq Nfi 03460 Massachusetts Residential Building Code Section 110.R5.1.2 Homeowner: Person(s)who own a parcel of land on which he/she resides or intends to reside, on which there is, or is intended to be, a one or two family dwelling, attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Section 110.R5.1.3.1 Any homeowner performing work for which a building permit is required shall be exempt from the licensing provisions of 780 CMR 110.R5,provided that if a homeowner engages a person(s) for hire to do such work,then such homeowner shall act as supervisor. Such homeowner shall submit to the Building Official, on a form acceptable to the Building Official, that he/she shall be responsible for all such work performed under the building permit. As acting Construction Supervisor your presence on the job site will be required from time to time, during and upon completion of the work for which this permit is issued. Also be advised that with reference to Chapter 152 (Workers' Compensation) and Chapter 153 (Liability of Employers to Employees for injuries not resulting in Death) of the Massachusetts General Laws Annotated, you may be liable for person(s) you hire to perform work for you under this permit. City of Northampton Massachusetts ti < ' 1 D212 i in S ee BUILDING INSPECTIONS 4�1 31'1 Nein Street *Municipal Building � NOrLM1amp[on. 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 beingperformed at: 701 Alc4t( . o "6 (Please print house number and street name) Is to be disposed of at: p� ULL 110 C DU W SHS tt-- lease print name and location of fa lily) Or will be disposed of in a dumpster onsite rented or leased from: PA ( k- < pUsAer (Company Name and Address Sig ature &Permit plicant o wner Dale If, for any reason, t debris will not be disposed of as indicated, the Applicant or Owner shall notify the Building Department as to the location where the debris will be disposed. �\ The Commonwealth of Massachusetts Department of Industrial Accidents I Congress Stree4 Suite 100 Boston,MA 02114-2017 www.mass.gov/dia U,krken'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legibly Nance(Busuresss/Otga1omeatioIo/fodividual): Cp &v-k / b � Address: 3 'k ,`kMJKL`PF]' [,{),.p �r 5 -�- /�G l-.c ),t,..1r-�O t ) City/State/Zip: lM f^ d L G-� � Phone#: 6S- (7?f A.rey�na sn.mpinya.a Ossek1ae. "roue bn:: Type of project(required): I,,rllam acncloyerwrb L � employees(full anNor nait-tlme7.• 7. New construction 2. Igmamle pmpnctar or Pmntership®d havcvo emPloYen working fierce. $.remodeling any capacity.[No work.'camp.insurance required.] (LTJ 3.�I aura homeowner damning work r, rkms'cem . sorancetcgmom. ' 9. Demolilian ga rover, wo pin ] 4.E]I am a homeowner and will be hiring commissions to conduct all work onoYPrs10❑Building addition marine that all rontrauors either have workers'campeose6on tremors sir me sole Iwill 11.[-]Electricalrepairs or additions proprietors win no ex loyees. [2.7 Plumbing repairs or additions 5,M I am a general mnoaclar and t have lured the sutrcontradon listed on he atmclsdsAeet 13�Roof repairs These sub-contmm crs have employees and hriaveworkeromp.for anrei 6_E]We me aw con wed La otxnen have their right ofea non per MGL e. 14.QOther ryora g emp 152,§l(4),arM we have rw employees.[No workers'cony,.ivsumn¢required] •Any applicmt that checks box#1 most also fill out the section below showing their workers'enwarunion policy in6rmanon. I Romenwmers who submit Nis arrogant indicating they are doing 91 work and Neu hire outside caooacmrs must submit a new of idavil indicating such. IContnctors tM1ut check Nis we mast imarwd an additional sheet showing the time of the sub-conuactms and one whether or not those entities have employees. Ifthe sub-co enamors have employees,they mast provide them workers'wmp.policy number. I am an employer that is providing workers'compensation insurance far my employees. Below is the policy and job site information. I/ n /^� Insurance Company Name: ("`�l`r/f��jj���\Z I1� L) /`tt kl-, \ j--IJ U P Policy#or Self-ins.Lic.#: WIC ©V C)dS?7 Expiration Date: K- 2-1` 9 Job Site Address: -71 Od'CJ� cL, Cor-eU City/State/Zip: F1 or-etfe--C e, 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 v rification. I do herebyertify u p ' s d names of perjury that the information provided above is true and cornet Si nature: Date: Phone#: Oficial use a*.. 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.Cityffown Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuant to this statute,an employee is defined as".-every person in the service of another under any contract of hire, express or implied,oral or written" An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or tmstee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152,§25CRd also states that"every state or beat licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152,§25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-conmactor(s)Daniels),addressh a)and phone number(s)along with their certificate(,)of insurance. Limited Liability Companies(LLC)or Limited Liability Parmendups(LLP)with no employees other than the members or partners,are not required to carry workers'compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the pennit/licenw number which will be used as a reference number. In addition,an applicant that most submit multiple pe rnit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in_(city or Wish."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street, Suite 100 Boston,MA 02114-2017 Tel. #617-727-4900 ext. 7406 or 1-877-MASSAFE Fax#617-727-7749 Revised 02-29-15 www.mass.gov/dia Office of Consumer Affairs and Business Regulation One Ashburton Place - Suite 1301 Boston, Massachusetts 02108 Home Improvement Contractor Registration Type: COrporabon CHARISTA CONSTRUCTION SERVICES,INC, Rt4171982 Ei PO BOX]06138 HARKNESS AVE xp*atlon.iraCron: 05j09(2020 E.LONGMEADOW,MA x1028 Update AdGreseand Realm Card. ae �ul ojif t sumOWNIE C - Regal nen HOME IEEP"RE:cOnt,` N RACTOR bafcOXR,eOradonvaaI,d for ato.Iffol nd orny TVPE:Gaoaration Cerore theeOdOOnondate. a dBu iO. to: Real E3'�rflMB OneGlfioaA th Consumer a-s.s and Business Re9wa[ion t]t982 O5b9/?A20 One Ashburton Place-Sade 1301 GHARISTA CONSTRUCTION SERVICES,INC, sedan.MA 02108 JOSEPH KENNEDY PO BOX 706138 HARKNESS AVE E LONGMEA00W,10A 01028 Upder52I.IlyN�111idlthl.f118tOTS Commonwealth of Massachusetts. ' Division of Pml¢ssional lic¢nsur¢ SoarC of B tF q Regulations an4 Sfarv4ar45 ConstrAWt61 tope"isor CS-066440 Expires: 07122/2020 JOSEPH AlSE�xM'EO� 1S FOREST S� Po Eox»ss *` Commissioner �/"" aTConn® CERTIFICATE OF LIABILITY INSURANCE ra;2p"a 1 THIS CERTIFICATE 15 ISSUED ASA MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATNELY OR NEGATNELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS cERTIFWATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURERIS).AUTHORQED REPRESENTATNE OR PRODUCER,ANO THE CERPFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,[he palirylias)must M1ave ADDITIONAL INSURED pfovislons no be endorsed. If SUBROGATION IS WAIVED,subject to the terms and c mditlens of the policy,certela policies may require an endomemeal. A almement on this cd,,W.W does not confer rights to the cerdi icate holder in lieu of such endorsementls6 >ROoucER nnMF Marion Lemes BErkinp¢IOSUrenc¢GrouO.lnc vxONN (413)935-1200 qA, Nq_ (413)562.5300 136lenameadow SL A. mirnles@aerkshlreinsurancegrouPcom .Muss, S)ACFOROINGCOVEMGE NAIC. Longmea00w MA 01105 INSVRERP: Sldr lnSUldnC¢CemaAlry 18023 NISVRERO- Chansla ConslNdlon Services,Inc. INSURER C 36 Halknesd AVanue INEDRERE—��d. EaH Longmeadow MA 01026 IxsuRER F: COVERAGES CERTIFICATE NUMBER: CL1662654112 REVISION NUMBER: TM1I515 TO CERTIFY THAT THE POUCHES OF INSURANCE LISTED BELOW HAVF BEEN ISSUEDTO THE MI$UREO NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWRHSTANOING ANY REQUIREMENT TENM OR CONDITION OF ANY CONTRACT OR OTHER OOCUMENT WITH RESPECT TO NNICH THIS CERTIFICATE MAY HE ISSUEO OR MAY PERTAIN,THE?NSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SURJECT TO ALL THE TERMS. EXCLUSIONS AND CONDITIONS Cf SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. IIB ffi,,Tl ASMVUaftRAhcA INp WJp PoLICYNUM9ER MMNaryVYY MMIa Ypn'EW1" UNITe CAMMERGALGENERALU0.81UTY FgCx OCCURRENCE S CUIMSMADE ❑OCCVR PR MSE$ EatteunMce S MEp EXP' viral d PERSONAISAW AMY S GENTPG6REGA1E LNnITORPDESPER GENERALAGGREWTE E PoU[v❑EP LCL PROptItiS.COM .I ,T6 S Oi,M 4UTOYpmL£UABIUM1 61NEp 9NGLE UMIT f ANV AVTO BDDILYIfWPY IPn is wn) L O"Pcoev ^cHOESULEd IITAIAHJVRY(R.—.r", 5 Al.A..TM, PUc..E) PROeR MAGE UMRPEIlALIPa pCGUp FACN OCCURRENCE i EXCQeS UAB .—.DE AGGREGATE S OED RETExTgN i t VKneasn'CDAPEaMARM, CIATUT EII Tx NncaeLOYERe UAEAHY IN A ANYeEOPRAEr0.aRARTLNug ECuTNE EL FAGHncOwENi $ 1.000,DOO OO1F'CgCMOEREX BY NIA M0o02537 0610312018 O61p&2019 EL PSEP EAEMPWYEE S 1.000AW xrm 1000,000 CERTIFICATE OEGLPIpIION OCCPFRATIONS Eebw E4.aIBFA$E.FpLIGYUMIi f OESCR1DipH OF pDEMTgJYLCCPTCNSI VEW.CLES IgCORD tet,AOE41ona1 Ramahr SCMEWe.maY GallacMJTmere sOace lr nqui,ap) CERTIFICATE HOLDER CANCELLATION SHOULOANY OF THE ABOVE DESCRIBED POUCIE$BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE MOW SE OEINEREO IN Ch.MI,I CCA`,tod0n A.. ACCORDANCE WITH THE POLICY PROVISIONS, AUTNORIZEp REPRESENignVE ®1988-2015 AGORD CORPORATION. All fights reserved. CORD 25 t20903) The ACORD name and logo are registered WAS 0 ACORO A Ro ve CERTIFICATE OF LIABILITY INSURANCE THIS CERTIFICATE IS ISSUED ASA MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGA LYAMEND,EXTEND OR ALTER THE COVERAOE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INS IRER(S),AUTNORRED REPRESENTATIVE OR PRODUCER AND THE CERTIFICATE HOLDER. IMPORTANT. If the cerdflaaW holler b an ADDITIONAL INSURED,the popey(Ns)must have ADDITIONAL INSURED proYlabin or be l ndamee. It SUBROGATION IS WANED,subject hadvo temp and conditional atone policy,cal In poll may require an efWoraement A ahteTlMnt on this candidates does not confer dghls to the oeNRcft holder In Ilse 0seat a OMONMnt(a). PRopU[ER RAIN: FRnc08 L Leahy Leahy&13r lmluance.Really,Inc. ! Hq)TB&8383 AF Xo (a13)TBBM52 535 Allen Sheet,SutlB 1 �: Aeelly®many,incil M com MIRIRBMeIAFFp MCOV M Mac Spnn9held MA 01119-2008 MWINAA: ATLANTIC CASUALTY 21752 INSURED IMM, ARSELLAPROTEOTION Chsiste cahmcton Stlwwa !MMC: W Hartness AVM,M MSURPAp: NeURER l: Seat LDnnneadwi MA WIDE MSVAPAF: COVERAGES CERTIFICATE NUMBER: A18fb CBNecals(201s) REVISION NUMBER: THIS IS TO CERTIFY THATTHE POLICES OF INSURANCE LISTED BELOW HOVE SEEN ISSUEDTO THE INSURED NAMEDASOVE FOR THE POLICY PERIM INDICATED. WT STMMNGAWREOUIREMEW,TERMORCONDITIONOFAWCOWRACTOROTHERDOCLMEWMA RESPECTTOWMCHTMS CERTIFICATE MAYBE ISSUED OR MAY PERTAIN,THE INSLMANCEAFFORDEO BY THE POLICIES DESCRIBED HEREIN IS SUBJECTTOALLTHE TERMS, EXCLUSIONSAND CONDITIONS OF SUCH POLICIES.LIMITS SHOPM MAY HAVE BEEN REDUCED BY PAID CLAIMSINGIR . 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Alnxw@nwwENIATME 01+883016 ACORO CORPORATION. All rights Iamamd, ACORD 26(2016M) The ACM name and logo are mgsWW malls&ACORD