24A-229 12 PILGRIM DR BP-2019-1402
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block:24A-229 CITY OF NORTHAMPTON
Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Buildina DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Calemory:ROOF BUILDING PERMIT
Permit# BP-2019-1402
Project# JS-2019-002259
Est.Cost:$11862.10
Fee:$40.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor. License:
Use Groom VISTA HOME IMPROVEMENT 111478
Lot Size(sa.B.): 9931.68 Owner. WILSON PHIL A&SHELLY BERKOW ITZ
Zoning: URA(100)/ Applicant.- VISTA HOME IMPROVEMENT
AT.- 12 PILGRIM DR
Applicant Address: Phone: Insurance:
2003 RIVERDALE ST (4131382-0249 WC
WEST SPRINGFI ELDMA01089 ISSUED ON.6/6/2079 0:00:00
TO PERFORM THE FOLLOWING WORK:ST RI P & SHINGLE ROOF
POST THIS CARD SO IT IS VISIBLE FROM THE STREET
Inspector of Plumbing Inspector of Wiring D.P.W. Building Inspector
Underground: Service: Meter:
Footings:
Rough: Rough: House# Foundation:
Driveway Final:
Final: Final:
Rough Frame:
Gas: Fire Department Fireplace/Chimney:
Rough: Oil: Insulation:
Final: 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 6/620190:00:00 $40.00
212 Main Street, Phone(413)587-1240,Fax:(413)587-1272
Louis Hasbrouck—Building Commissioner
` , Department use only
-� City of North mpt -EIVE sof ermir.
..>/r Building Dep rtm nt Cu Cu Driveway Permit
(. 212 Main tree JUN - 6 2019 se rfS
pt
Availabili y
:( Room 1 0 W ter II Avallabllity
Northampton, A FS��p�evse of Structural Plans
phone 413-587-1240 1 8fatiirtp 'mao Sit Plans
APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
ATION
SECTION I -SITE INFORM .5 052-
1/�-/ [ c/}
1.1 Property Address:
/�Iy �.�•It�j�./r 7I� ' u , Thyis�section to be completed
/ by office
y / M Un
it� r Map� Lot
N m
Q/*OZone Overlay District
Elm St District CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
wn r (R
211 6 + ah��,Q�P.r �;�►{Z 01 ���(l�rirn flit.ra(Print) �— rmnt Mails�} ress:
I rt
Irelepillkelis
azure
EE C ren ailingAtldress:ow yL?��1�0
hone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by emit applicant
1. Building r 1 (a)Building Permit Fee VL40
2. Electrical - (b)Estimated Total Cost of
Construction from 6
3. Plumbing Building Permit Fee
4. Mechanical(HVAC) a
5. Fire Protection �-
8. Total=(1 +2+3+4+5) Check Number
This Becton For Official Use Only
Building Permit Num DateIssued:
Signature: C- L 2019
Building Commissionerllnspector of Buikings pate
EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR)
Section 4. ZONING All Information Most 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 O O O
Frorla e 0 0 0
Setbacks Front O O
Side GQ R:0 L:= I
Rear 0 0
Building Height o o D
Bldg.Square Footage o o /o D O O
Open Space Footage % O
(Lot arca minus bldg&paved Q O O
arka
N of Parking Spaces 0 O O
Fill:
(volume&L«arium
A. Has a Special Permit/Variance/Finding r been issued for/on the site?
NO O DONT KNOW YES Q
IF YES, date issued:F-
IF YES: Was the permit recorded at the!Rmsw of Deeds?
NO O DONT KNOW YES O
IF YES: enter Book Page and/or Document p�
B. Does the site contain a brook, body of water or wetlands? NO O 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 YI
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:
E. Will the construction activity disturb(clearing,grading,a ation,or filling)over 1 acre or is it part of a common plan
that will disturb over 1 acre? YES O NO
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
SECTION IF DESCRIPTION OF PROPOSED WORK(check all applicablel
New House ❑ Addition ❑ [Repllaoc.ement Windows AKeration(s) ❑ Roofing
Accessory Bldg. ❑ Demolition ❑ Signs [O] Decks [O Siding[OI Other(O]
Brief Description of Proposed
Work:
Alteration of existing bedroom—YesNo Adding new bedroom YesNq/
Attached Narrative Renovating unfinished basement as
A No
Plans Attached Roll -Sheet �T
ea.If New house and or addition to existing 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 construction. Dimensions
e. Number of stories?
f. Method of heating? Fireplaces or Woodstoves Number of each
g. Energy Conservation Compliance. Masscheck Energy Compliance form allached?
If. Type of construction
I. Is construction within 100 h.of wetlands? Yes No. Is construction within 100 yr. floodplain_Yes No
I. Depth of basement or cellar floor below finished grade
k. Will building conform to the Building and Zoning regulations? Yes No.
I. Septic Tank City Sewer Private well City water Supply
SECTION 7a-OWNER AUTHORIZATION-TO BE COMPLETED WHEN
!-In S AGENTORCONTRACTOR APPLIES FOR BUILDING PERMIT
1, l 1 -rLas Owner of the subject
property
hereby authorize
t ct on my Deha II matters relative to work authoriz by is building ermn application.
on my 17 l ��! g
SiSure of Owner Date
as Owner/Authorized
Agent hereby declar s elements and infilmnation on the foregoing application are true and accurate,to the best of my knowledge
and belief.
Si under the pains and penalti of perjury
id
Print Name
nal r enl I Data
SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction Su ervisor: Not Applicable ❑
Name o1 License Holder
License Num r
Lc_ l �
Md Erpiretion o
O
e Telep
.R isixed Homa Im memerd Contra Not Applicable O
Stra MUM _ \rn!pm, Mto at ► LpSOSFS
Company Name Registration Number
AA reser— E'p1iration Date
Teleph ne O'"t `-1 b
SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L c.1S2,§2SC(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 buil ing permit.
Signed Affidavit Attached Yes.... .. No...... ❑
City of Northampton
Massachusetts
a.
DEPARTMENT OF BUILDING INSPECTIONS
212 Main Strwt • Municipal Building
North ton, Mx 01060 '+
AFFIDAVIT
Home Improvement Contractor Law
Supplement to Permit Application
The Office of Consumer Affairs and Business Regulation("OCABR")regulates the registration of contractors and
subcontractors performing improvements or renovations on detached one to four family homes. Prior to
performing work on such homes,a contractor must be registered as a Home Improvement Contractor("HIC").
M.G.L.Chapter 142A requires that the"reconstruction, alteration,renovation,repair, modernization, convention,
improvement, removal, demolition, or consnucu'on of an addition to any pre-existing owneroccupled building containing
at least one but not more than four dwelling units....or to structures which am adjacent to such residence or building"be
done by registered contractors.
.Note:Ifthe homeowner has contracted with a corporation or LLC,that entity must be registered.
Type of Work: rD o 16 Est.Cost: �lnc;z .9y
Address of Work: C;? I r.
Date of Permit Application:
1 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.C.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 pequry: V 1 CL Nym ' ff y�,��p�y i-
I hereby apply for a building permit as the agent of the owner: �f ' uVU t�
balq q.n d � �oanss
Date rontactor ante egistration 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 "?
D212 Min Street OF BOZLDZNO ZBB uildin BS r
day}- 21Y Msin hon, n ipel Building
Com' Northampton, NA 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:
I � n ► hirtrN4 ) E.
( ease priDose rylber and street name
Is to be disposed of at:
ISO�a�uA,� o. ►� �; Y,
Please pnnt name and I kon f facility)
Or will be disposed of in a dumpster onsite rented or leased from:
l� �--1[lia..l.1 n �
(Company Name and Address \J
ZSiof Permit Appl' t or Owner Date — I ��
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.
The Commonwealth ofMassaehuselts
Department of IndustrialAccidents
1 Congress Street,Suite 700
Boston,MA 02114-2077
W. www moss.gov/dia
R m'kers Compensation Insurance Affidavit: Builders/Contractors/Eimtncmns/Plumben.
TO BE FILED WITH THE PERMITTING AUTHORITY.
Applicant Information I Please Print Lellibiv
Name(BwinesstOrganimaoMndividml): ,,,
Address: �uQx
City/State/Zi - .. 06 r9#:
Are you an employer?Che h appropriate box:
e a Type of project(required):
1 em a employer with nnployccx(Poll and/or part-time).• 7. ❑New construction
2. amasole pmpriesurcr patmershipand haven.employees working far.in 8. Remodeling
any capacity.[No workers comp.insurance minimal
3.Cj1 an a Iwm. wncr doing all work myself INo wotken''comp.insurance"t irmi.l 9. ❑Demolition
4,01 am a homcown and will M hiring commeters to conduct all work on my propetry, ]will 10❑Building addition
ensure that all contractors either have workers'compensation insurance m we sole I.[]L❑Electrical repairs or additions
proprietors with no cmploytts.
12.❑Plumbing repairs or additions
SQ lama general i^ntrectureemplohave es and
wrontrxtonlixrenuranc attached shttt. [3 �Roof rep
There xubc.ntncmrs base employees and have workers'comp.insurance:
fi.❑We arca eorporates.and its officers have exercised their right of exemption per MGL a 14.95IFffier
152,51(4),and we have no employees.[No workers'comp.insurance revered.]
*Any applicant that checks box p1 must also fill out the section below showing their workers'compenertion policy information.
I Homeowners who submit this affidavit indicating they arc doing all work and then hire outside contractors must submit a new affidavit indicating such.
k i...tractor,that check this box must anached an additional sheet showing the name of the subconuecmrrs and state whether or not those entities has c
cronoyce, n'Mc sub-conoacters have employes,they must provide their workers'comp.pulicy number.
lam an employer that is providing worken'compensation insurance for my employees. Below is the policy and job site
information. ' / yy[ t/�
Insurance Company Named %r XJ �)T-s-wL i 1 /s/y / ,c'
Policy#or Self-ins.j.ic.#. ` / �/ r� IO�✓I % ration Date: l QLOart
Job Site Address: /9 10 1 r• Ciry/State/Zip: ✓ -/n}�1 M ul(7
Attach a copy of the worke 'compena tion policy declaration page(showing the policy number and expirit ll ndate). y /o
f C)
Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by a fine up to$1,500.00 6 l0
and/or one-year imprisonment,as well as civil penalties in the fort 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 rerti an the pains and n des of rju that the information provided above is true and correct.
Si alure: Date:
Phone#:
Oficial 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):
I.Board of Health 2.Building Department 3.City/Town Clerk 4. Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person: Phone#:
Page 1 of 7
2097 Riverdale Street Vista}., MA Lie#162056
West Springfield, CT Lio#0621646
V
MA 01089 � rLnT l � cM
9ROME IMPROVEMENT vistahomemprovement.com
Phone: 888.597.2323
Fax: 413.382.0241 ROOFING CONTRACT
All home improvement contractors and subcontractors must be registered and any inquiries about a contractor or
subcontractor relating to a registration should be directed to:
Office of Consumer Affairs and Business Regulation Ten Park Plaza, Suite 5170
Boston, MA 02116 Phone: 617.973.8700
Customer Information
Shelly & Phil Berkowitz (413)348-3397 Date: 05/24/2019
12 pilgrim drive szbjsbach@aol.com Rep: Steven Wakefield
Northampton MA 01060
Roof Specifications
Owens Corning Roof Systems Platinum Roof System
Color Onyx Black
Drip Edge Color white
Number of Layers 1
Attic plywood
Location Main
Underlayment Pro Armor
Ice&Water Shield 6feet
Supply and Install Ridge Vent yes
Vista Home Improvements agrees to do the following:
Acquire all permits for roofing work Yes
Supply Dumpster Included
Dumpster location Tod
Inspect Decking for damage Yes
Ice and Water all valleys, penetrations, eaves and chimneys Yes
Supply and install pipe boot flashing Yes
Total Job Clean-Up Yes
Additional Details
Special Instructions
Repair damaged ceiling area in front walk in area as needed. In sight solar will be Installing solar after we do roof. Prep roof
Properly for solar install.
I, Shelly & Phil Berkowitz, have read the terms stated herein, they have been explained to (me/us), and (I/We) find
them to be satisfactory and hereby accept them.
TPis apace mten Cm n.ally lett hL,
Page 2 of 7
Roof Sketch / Photos
Steven Wakefield,Authorized Representative Shelly&Phil Berkowitz
05/24/2019 05/24/2019
Date Date
Tros sl x e inrentionally left blank
Page 3 of 7
Homeowner's Association NO
WORK SCHEDULE
Contractor will not begin the work or order the materials before the third day following the
signing of this Agreement, unless specified herein. Contractor will begin the work on or about 06/24/2019
Barring delay caused by circumstances beyond Contractors control, the work will be completed by 06/24/2019
WARRANTY
The Contractor warrants that the work furnished hereunder shall be free from defects in materials and workmanship
for the period stated below following completion and shall comply with the requirements of this Agreement. In the
event any defect in workmanship or materials, or damage caused by the Contractor, its subcontractors, employees
or agents, is discovered after completion of any job, Including cleanup, the Contractor shall, at its own expense,
forthwith remedy, repair, correct, replace, or cause to be remedied, repaired or replaced, such damage or such
defect in materials and workmanship. The foregoing warranties shall survive any inspection performed in connection
with the agreed-upon work.
Warranty Period Lifetime
Measure Section
Measure Set With -- Rick
Total Contract Amount (All Discounts Applied) $11,862.24
Pa ment
Amount Due Upon Signing Contract (1/3 Maximum) $3,954.08
Amount Due At Start $3,954.08
Amount Due Upon Completion $3,954.08
Form of Payment Upon Signing Cash
Payment Form At Start Cash
Payment Form Upon Completion Cash
Acceptance of Proposal I have read both sides of this document and accept the prices, specifications and
conditions stated. I understand that upon signing, this proposal becomes a binding contract. You are authorized to
do the work as specified. Payment will be made as outlined above.
You may cancel this agreement if it has been signed by a party thereto at a place other than an address of the
Seller, which may be his main office or branch thereof, provided you notify the Seller in writing at his main office or
branch by ordinary mail posted, by telegram sent or by delivery, not later than midnight of the third business day
following the signing of this agreement. Please refer to the Notice of Cancellation below contents of which are
referred to above and incorporated herein by reference.
DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES.
NOTICE OF CANCELLATION
Page 4 of 7
YOU MAY CANCEL THIS TRANSACTION, WITHOUT ANY YOU MAY CANCEL THIS TRANSACTION, WITHOUT ANY
PENALTY OR OBLIGATION; WITHIN THREE BUSINESS DAYS PENALTY OR OBLIGATION; WITHIN THREE BUSINESS DAYS
FROM THE ABOVE DATE. FROM THE ABOVE DATE.
IF YOU CANCEL, ANY PROPERTY TRADED IN, ANY PAYMENTS IF YOU CANCEL, ANY PROPERTY TRADED IN, ANY PAYMENTS
MADE BY YOU UNDER THE CONTRACT OR SALE, AND ANY MADE BY YOU UNDER THE CONTRACT OR SALE, AND ANY
NEGOTIABLE INSTRUMENT EXECUTED BY YOU WILL BE NEGOTIABLE INSTRUMENT EXECUTED BY YOU WILL BE
RETURNED WITHIN TEN BUSINESS DAYS FOLLOWING RETURNED WITHIN TEN BUSINESS DAYS FOLLOWING
RECEIPT BY THE SELLER OF YOUR CANCELLATION NOTICE, RECEIPT BY THE SELLER OF YOUR CANCELLATION NOTICE,
AND ANY SECURITY INTEREST ARISING OUT OF THE AND ANY SECURITY INTEREST ARISING OUT OF THE
TRANSACTION WILL BE CANCELLED. TRANSACTION WILL BE CANCELLED.
TO CANCEL THIS TRANSACTION, MAIL OR DELIVER A SIGNED TO CANCEL THIS TRANSACTION, MAIL OR DELIVER A SIGNED
AND DATED COPY OF THIS CANCELLATION NOTICE OR ANY AND DATED COPY OF THIS CANCELLATION NOTICE OR ANY
OTHER WRITTEN NOTICE, OR SEND A TELEGRAM TO: VISTA OTHER WRITTEN NOTICE, OR SEND A TELEGRAM TO: VISTA
HOME IMPROVEMENT, 2097 RIVERDALE STREET WEST HOME IMPROVEMENT, 2097 RIVERDALE STREET WEST
SPRINGFIELD, MA 01089 NOT LATER THAN MIDNIGHT OF SPRINGFIELD, MA 01089 NOT LATER THAN MIDNIGHT OF
THE THIRD BUSINESS DAY FROM 05/24/2019 THE THIRD BUSINESS DAY FROM 05/24/2019
Vista Home Improvement Vista Home Improvement
2097 Riverdale Street 2097 Riverdale Street
West Springfield, MA 01089 West Springfield, MA 01089
NO LATER THAN MIDNIGHT OF THE THIRD BUSINESS DAY NO LATER THAN MIDNIGHT OF THE THIRD BUSINESS DAY
FROM THE DATE OF THIS CONTRACT. FROM THE DATE OF THIS CONTRACT.
I HEREBY CANCEL THIS CONTRACT. I HEREBY CANCEL THIS CONTRACT.
BUYER'S SIGNATURE DATE: BUYER'S SIGNATURE DATE:
Buyer(s) Acknowledge Receipt of the Cancellation Notice
/\ i
Shelly& Phil Berkowitz
05/24/2019
Date
Thh space Intentionally left bunk
Page 7 of 7
Contractor will be responsible to Owner or any third party for any property damage or bodily injury caused by itself,
its employees or its subcontractors in the performance of, or as a result of, work under this Agreement. Contractor
agrees to carry insurance to cover such damage or injury.
Construction Related Permit Acquisition:
Contractor, under provisions of Chapter 142A of the Massachusetts General Laws, is required to apply for and
obtain all construction related permits. Contractor shall not be deemed responsible for delays in the work described
in this agreement caused by regulator, permit granting or inspectional agencies, authorities or individuals.
NOTICE: If Owner obtains his/her own construction related-permits for the work described under this
Agreement, Owner is hereby advised that in the event of a dispute,judgment and non payment of Contractor,
Owner will not be entitled to make claim to or collection from the guaranty fund established in M.G.L. c. 142A.
Modification:
This Agreement, except as to concealed conditions or delays occasioned thereby or by restarts, cannot be changed
except by a written statement signed by both Contractor and Owner. However, cancellation by Owner is allowed in
accordance with the Notice of Cancellation. Owner hereby grants Contractor a limited Power of Attorney to
complete incomplete documents on Owners behalf.
Completeness of Contract for Execution:
Owner is hereby advised not to sign this Agreement unless and until all blank sections have been filled in or marked
as void, deleted or not applicable, and until all exhibits and related or referenced documents that are incorporated
herein are attached hereto.
Attorney's Fees/Costs
Owner agrees to pay all costs of collection, including reasonable attorney's fees, cost and expenses. Furthermore,
interest shall be charged at the highest lawful rate of interest on any and all overdue payments.
Copy of Agreement to be given to Owner:
This Agreement is governed by the laws of the Commonwealth of Massachusetts. It must be executed in duplicate,
and an original, signed copy hereof given to the Owner at the time of execution. No work under the Agreement shall
begin prior to the signing of the Agreement and transmittal to the Owner of a copy therefor.
Shelly & Phil Berkowitz
05/24/2019
Date
Steven Wakefield Authorized Representative
05/24/2019
Date
= CERTIFICATE OF LIABILITY INSURANCE DATE(MWD
TkIJ%A,ERTIFICATE 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 R.
IMPORTANT:If the certificate holder IS an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to
the[arms and conditions of the policy,Certain policies may require and endorsement Astatement on this certificate does not confer rights to
the certificate holder in lieu of such endonsem s.
PRODUCER CONTACT
NAME:
SOUTH W ICK INS AGENCY INC PHONE C'
P O BOX 100 (NC,No,EAU: (ArcZ
.No):
EMAIL
SOUTHWICK.MA 01077 ADDRESS:
28TKC INSURER(S)AFFORGINGCOVERAGE NAICM
INSURED INSURER A: TRAVELERSPROPERTYCAS111 IICOSIC11y 111111 RIC
SAMBRICO LLC DBA VISTA HOME IMPROVEMENT INSURER B:
INSURER C:
INSURER D:
2097 RIVERDALE STREET WNSUSURER E:
WEST SPRINGFIELD,MA 01089 !:!MR!N F:
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
THISISTOCERTFYTHATTHE POLICIES OF INSURANCE LISTED BELOW IUVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDCATED,
NOTWITHSTANDING ANY REQUIREMENT,TERM ORCONOTTON OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO MICH THISCERTIFICATE ELY BE ISSUED OR IMY
PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LWRS SHOWN MAY
NAVE BEEN REDUCED By PAID LIMNS.
INSR ADO SUB POLCYEFFDATE POLCYEIPMTE
LTR TYPE OF INSURANCE L R POLICY NUMBER (NMDDYYYYI nompYYYYYI LIMITS
GENERAL LIABILITY 1ACH OCCURRENCE $
COMMERCIAL GENERAL LIABILITY
MAGETOS
CLAIMS MADE OOCCUR. REMISES(EaaDarccoun renre)
ED EXP(Any on.Ireton) $
ERSONAL&AW INJURY $
GEN'L AGGREGATE LIMIT APPLIES PER. ENERALAGGREGATE $
POLICY OPROJECT OLOC RODUCTS-COMPIOP AGG $
AUTOMOBILE LJABLQY COMBINED SINGLE $
ANYAUTO JAUT(Ea acdanti
ALLOWNEDAUTOS BODILY INJURY S
SCHEDULEAUTOS (Per peon)
HIREDAUTOS BODILY INJURY ,E
Per aasrlen9
NON-OWNEDAUTOS PROPERTYDAMAGE E
(Par acanen9
UMBRELIA LLB OCCUR EACH OCCURRENCE S
EXCESS LLB CIAIMSNADE UGGREGATE E
DEDUCTIBLE a
RETENTION $ $
A WORKER'S Cp&PENSATION AND X WE STATUTORY OTHER
EMPLOYER'S LIABILITY YM U&2EOM1aZt9 ONIM019 031l2CXQO LIMITS
ANY PRWERITIXtRARTNEIUEXECUTIVE ONIAE.LEACHACCIDENT S 5DDAD0
OFFICERMEMBER EXCLUDE'
(M .,.NHI EL DIHE EA
EMPLOYEE S 50D.ODD
IlyW EaeGEeuMer E.L DISEASEPOLICYLIMIT IS 1,000,000
DESCRIPTION OF OPERATIONS ENM
DESCRIPTION OF OPERATI]NSh TIONSNEHnUVRESTRICT MPECIA DOW
THIS REPLACES ANY PRIOR CERTIFICATE ISSUED TO THE CERTIFICATE HOLDER AFFFCTING WOREERS COMP COVERAGE.
CERTIFICATE HOLDER ICANCELLATION
TOWN OF WEST SPRINGFIELD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED
BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED
26 CENTRAL STREET IN ACCORDANCE WITH THE POLICY PROVISIONS. /
AUTHORIZED REPRESENT l
WEST SPRINGFIELD,MA TONS
ACORD 25(2010N)S) The ACORD name and logo are registered marks of ACORD 1980-2010 ACORD CORPORATION. All rights reserved.
Office of Consumer Affairs and Business Regulation
1000 Washington Street • Suite 710
Boston, Mi Wtachusetts 02118
Home ImproverRerit.Contractor Registration
Type: LLC
Registration: 162058
VISTA HONE IMPROVEMENT Expiration: 01/02/1021
2097 RIVERDALE ST
WEST SPRINGFIELD,MA 01088
Update Address and Return Card.
SCs 1 0 2 MLW17
ROME
IMM OMMalEeNl�CONfRA1cTOR w,
Reptstnte expirtifor date.It round
rent'
TYPE:LLC Office of
data. abund return to:
Hap 2(158 olOII l 1001) of Consumereet- and Business Regulation
182058 OtA122M1 rood Washington svaet.suite»p
VISTA HOME IMPROVEMENT Boston,MA 02118
BRIAN RUDD ' r //��
2007 RIVERDALE ST \�.,�l:r-- M 7 sa'baak
WEST SPRINGFIELD, MA WON L
Undersecretary Not valid without Signature
CERTIFICATE OF LIABILITY INSURANCE "}•PAYS°P""
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.NIS CERTIFICATE 15 ISSUED M A MATTER OF INFORMATION ONLY AND COMMIT NO RIGHTI UPON TME CERTFICASE HOLDER, MIS
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