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36-127 (6) 271 BROOKSIDE CIR BP-2020-0019 GIS u: COMMONWEALTH OF MASSACHUSETTS Map:Bl0ck:36- 127 CITY OF NORTHAMPTON Lot: PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL 042A) Category, ROOF BUILDING PERMIT Permit tt BP-2020-0019 Proiect# JS-2020-000020 Est.Cost:$7976.00 Fee:$40.0o PERMISSION IS HEREBY GRANTED TO.- Const. O:const.Class: Contractor: License: Use Group: VISTA HOME IMPROVEMENT 111478 Lot Size(so. R.): 26528.04 Owner: MIGLIORE HOLLY A Zoning: Applicant: VISTA HOME IMPROVEMENT AT: 271 BROOKSIDE CIR Applicant Address: Phone: Insurance: 2003 RIVERDALE ST (41 3) 382-0249 WC WEST SPRINGFIELDMA01089 ISSUED ON:713/2019 0:00:00 TO PERFORM THE FOLLOWING WORK:STRIP & 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 7/320190:00:00 $40.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner r po Department use only City of Northa ptoFiECEI V� rmit: Building Depa met CuIriveivay Permit 212 Main S real JU` Se r/SicAvailabilitRoom 1 0 _ 3 2019 We er/ AvailabiliNorthampton, 0 060 T Sef Structural Plans phone 4l&587-1240 ax49r8- rn ,rnsPEc Sitans NOmN4MPtOrAApfrSdy APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 7 -SITE INFORMATION 6p—t4— // 1.11�P•rop llAddress: N` 1�.{n . /This section to be completed by office I•�� f I � I �� CA �' " map Lot /-) 7 Unit MRDI Ud'L Zone Overlay District Elm SL Dishict CBDistrict SECTION 2-PROPERTY OVIINERSHIPIAUTHORUED AGENT caner of R �,'� I �15d(J\k��dQ Gree e riot) urmnt Mating Tel Signature 2.2 Authorized Agent; I Qq n2111,0rr,bk S) Name( 'ni) (Lurrenelling Atltlres Jill hfyy Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Oficial Use Only completed bpermit applicant 1. Building (a)Building Permit Fee O 2. Electrical (b)Estimated Total Cost of Construction from 6 3. Plumbing Building Permit Fee 4. Mechanical(HVAC) 5. Fire Protection 6. Total=(1 +2+3+4+5) Check Number •This Section For Official Use Only Date Building Permit Numb Issued: ��nn Signature: 7. 3 -Z61 Ip Building Commissionerllnspeotor of Buildings Date �11��� C_ � VIStr, !-1mnc.im�rr�VPrv�n+. Com, 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 m by Building Department Lot Size O O O Frontage 0 0 0 Setbacks Front O O O Side L:= R:= L:= R:0 Rear 0 Building Height O O O Bldg. Square Footage Open Space Footage O O / O (l,ot aminus bldg&paved #ofParking Spaces O Fill: Ivolume&Location A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO O DONT KNOW O YES O IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO O DONT KNOW O YES O IF YES: enter Book F Page and/or Document#� 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 O IF YES, describe size, type and location: F D. Are there any proposed changes to or additions of signs intended for the property? YES O NO O IF YES, describe size, type and location: E. Will the construction activity disturb(clearing,grading,excavation,or filling)over i acre or is it part of a common plan that will disturb over 1 acre? YES O NO O 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 Alteratlon(s) ElRoofing Or Doors 0 Accessory Bldg. ❑ Demolition ❑ New Signs (O] Decks 1Q Siding 101 Other(Cj Brief De option of Proposed Work: 1t I►[J,yn� ` //ll �� Alteration of existing bedroom Yes Adding ne oom Yes No Attached Narrative Renovating unfinished basement __Yes No Plans Attached Roll -Sheet w on.If New house and or addition to existing housing, complete the following. t a. Use of building : One Family Two Family Other b. Number of rooms in each family uni . Number of Bathroo c. Is there a garage attached? d. Proposed Square footage of new construction. Dimensions e. Number of stories? f. Method of heating? 'replaces or Woo oodstoves Number of each g. Energy Conservation Compliance. Mas eck Energy Compliance form attached? h. Type of construction I. Is construction within 100 Zand Yes No. Is construction within 100 yr. floodplain_Yes No j. Depth of basement or cellade k. Will building conform to thgulations? Yes 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 +inI, as Owner of the subject property hereby authonze to on my behalf,in ma ere relative to work authorized by this building emi application. Signature of Owner I, .as Owner/Authorized Agent hereby declare'1115t the statements and information on the foregoing application are true and accurate,to the best of my knowledge and belief. S' oder the pains and penaltif perjury. it) 17 id Print Nam l I atu er/Agent Date SECTION 8•CONSTRUCTION SERVICES 8.1 Licensed Construct n Su a visor: /Not Applicable ❑ Name of License Holder: ( S � ) �--' tense Number q9 r Adre Borallon Dale I An ell Si Telephone 9. Reaistered Home Improvement Contractor. Not Applicable ❑ �� � i M tau �t C a Name eglstration Number Sr dress 6l atAe- LkLykb Telepho / I 5 3 ao 61 � l 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...... ❑ • i City of Northampton P P Massachusetts 0 R OF BUILDING IN S NS 212 Win Stut .Mieipsl 6ullanq i NorNe ton, M 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: 2-n 1 -1iM lCo- GY1L lease print house number and street name) Is to be disposed of at: N L (Please prim name And location of fa lity) �r will be disposed of in a dumpster onsite rented or leased from: (Company Name and Address) (,— n of Permit Applica r ate 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 Comtnonweahh ofMassachmsetts Department of IndustrialAccidents I Congress Street,Smile 100 Boston,MA 02114-2017 www.massgov/dia Wil.irkers'CompensiMion Insurance Affidavit:Builders/Contraetors/Elmrieions/Plumbers. TO BE FILED WITH THE PERMITTING At THORITY. Aoolieent Information Please Print Legibly Name(Business/Orgmizati NIndiddua0t vista home improvement Address:2097 retardate street City/State/Zip:'"'est spnngfield ma Phone#:4133024740 Art yeas so enpkwM.Cbeca the tppmpritle hos: Type of project(required): I.EJ I min.employer with 9 employeos(full allNor pan-time)• 7. ❑New construction 2.❑l am a sole proprietor orparmership and have no employees working for me in g. ❑Remodeling atMoraicity.INoworkers comp.insur. emitted ❑3 I am a homeowner doing all work myself[No workers comp.insurance reauird9. Demolition.l' 4E I am a homeowner and will be hiring contractors to conduct all work on my property. 1 will 10❑Building addition ensure that all contractors either have workers adeacrsaion insvramaor are sole II.❑Electrical repairs or additions proprom a with no employees. 12.❑Plumbing repairs or additions 5[:]I am a general coarmoor and I have broad the sub<anmwmrs hold on Ne aaached shat. 13❑Roof repairs These sul.cantractors Tuve emr'employees and have workers comb.insurance 6.❑Weare.ca tionand its omcerahmeexeeteithnr rihtofexem i 14.QOtherrero0f ryore g pl on ter MGI,c. 152,11141.andwe have no employeos.INo workers'comp.insurance reyuired.l 'AM triturated that checks box#1 must also fill our the section below showing their workers compensation policy infomution. I Homeowners who submit this affidavit indicating they are doing all work and men hire outside eulnractols must submit a new affidavit indicating such. :Contmetors that check this box must atschd an additional sheet showing the name ofthe subcontractors and slate whether or not these entities have employees. If tM1e subcontractors have employes,they must provide their workers'comp.policy number. I am an employer that is providing workers'rompensadon insurance for my employees. Below is the policy and job site information. Insurance Company Name:soutlamCk insurance agency inc Policy#or Self-ins.LLii�c.#:ub2u072183-119 �1 Expiration Date:03/12/20 (/�/� Job Site AddressrJi" I V F•+c�1 c. _ \ r(—U City/State/Zi�'Q1 �Q ' , IA Attach a copy o they workers'compensation policy declaration page(showing the policy number and expiration date).O t W 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. /do hereby 'y under the pains and ¢s of perjury that the information protideedd�above is nue and correct. Si t� 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.CityrFown Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: M \ J i Page 1 of 7 2097 Riverdale Street Vista MA Lic# 162058 West Springfield, CT Lic#o6218a8 MA 01089 ® �LA `I N li h1 IMPROVEMENT vistahomeimprovement.com Phone: 888.597.23239-01WE 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 HOLLY MIGLIORE hnmig@comcast.net Date: 06/24/2019 271 Brookside Cir Mobile: (413)695-6362 Rep: Murray Fanning Florence MA 01062 Home: (413)584-2172 Roof Specifications Owens Corning Roof Systems Preferred Roof System Color Quarry Grey Drip Edge Color white Number of Layers 1 Attic plywood Location Partial Underlayment Deck Defense Ice &Water Shield 6feet Supply and Install Ridge Vent yes Vista Home Improvements agrees to do the following: Supply Dumpster Included Dumpster location TBD 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 Cut In New Braun Vents 1 I, HOLLY MIGLIORE, 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. This space tentionally left blank Page 2 of 7 Roof Sketch / Photos I Murray Fanning, Authorized Representative HOLLY MIGLIORE 06/24/2019 06/24/2019 Date Date This space intentionally left bunk Page 3 of 7 Homeowner's Association NO WORKSCHEDULE 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 07/24/2019 Barring delay caused by circumstances beyond Contractors control, the work will be completed by 08/24/2019 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 -- Call To Confirm with customer Total Contract Amount (All Discounts Applied) $7,976.00 Pa ment Amount Due Upon Signing Contract (1/3 Maximum) $2,659.00 Amount Due At Start $2,659.00 Amount Due Upon Completion $2,658.00 Form of Payment Upon Signing Credit Card Credit Card Mastercard Credit Card Number 5243-6620-1930-2515 Expiration Date 01/2025 Credit Card CCV 662 Name as it appears on card Molly Migliore Payment Form At Start Credit Card Payment Form Upon Completion Credit Card 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 Thk space '3 on[iona`ly ler[ Mall. 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 06/24/2019 THE THIRD BUSINESS DAY FROM 06/24/2019 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 � Y HOLLY MIGLIORE 06/24/2019 Date This space Intr:ntio nally left blank 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 offtthe � Agreement and transmittal to the Owner of a copy therefor. HOLLY MIGLIORE 06/24/2019 Date Murray Fanning Authorized Representative 06/24/2019 Date This space intentionally lett blank r IFFCmRrpnwealtn of Massachusetts Division of Prolessummi Lcensore Board of Building Regulations and Standards COnstrUCHOn Supervisor CS-111678 r Expires:D112112021 BRIM FEEDING in 115 COYOTE CIRCLE FEEDING HILLS Meq 01050 CommisOroner ✓T CERTIFICATE OF LIABILITY INSURANCE °"Hose""'D D9/02/2918 THIS CERTIFICATE Is ISSUED AB A MATTER OF INFORMATION ONLY ANO CONFERS NO RIGHTS UPON TIRE CERTIFICATE HOI.OER THUS CERTIFICATE 00E6 NOT AFFIRMATIVELY OR NEGATIVELY MEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTINICATE OF INSURANCE DOES NOT CONSTITUTE A CONTAl BETWEEN THE ISSUING INMIRER(B), MTHOREEEO REPRESENTATWE OR PRODUCER,AND THE CERTIFICATE HOLDER. MP ANT ifdx =DREAM hower, N M INSURED, Me pnikylln) muaer-domo6. I 11 R , inubjeAlt to Ne Items And coMlOgne d 0)M WHAT. owl poll.— my mquFe en ewonement. A statement on MD cadricots does, Not ceMsr 'hNA on Me ceNIIGM holder In NIAN W EVEN a Wunarn er4a). moouccn �.�..` NM 0 MIS WILLIAM Jr MIS INSURANCE xe�. (413) 568 - 6111 Rlggl]) 572 - 9191 156 EL.V ET 0x TRsx9xacD, MA 019e5 RgYN APgeYRmypgY wPe IxewERA:IOLTVLA6 INS CO ... YwYe: BAMBRICO i.LC/VI8'Il NOIR zMPROVRffiT[ xxR Ac: TOOL RIVEROALB ROM MST SMINGEIRM MA 01085 IMaIRAe: eeuEAP: COVWGES GERtt1CATE NUMBER: IIEVIBgN NIIYBER: 18 TO NSR Y .1 HE NO TED BEL H.V. 1 O r E Rs L11 PEREAND RxE.ETFD. EXTADISTANDING AN, RIWKcINi. TERM OR CONDITION OF ANY CIXRMLT Get OTHER DOCUMENT WITH RESPECT TO WINCH THIS CRADEICATE My Be ISSUED OR WY PERTAIN. THE INSURANCE ATO.PDFD BY ME P"Offil DESCRIBED REPAIR O MUSLIM TO A. THE TERM4 FSCLl16gM5 AND CIXNMTION40FSUC11 PoILEB LMITS SWM NMV N W BEENRGIXILEDBTPMD GAMS. Trre¢NMwArA NM ww FaNr MI�1No . LAIDo " �'L"^R"^ j EAtlIMLRIIEIEE s 1,000,000 rAANRrmaYeuwwTY G3679203 06/01/20 00/01/2019 meAeaalEBaeNAMI s 100,DDO CWLRNML< ❑Dural NEOLw VENAPPRE' IN s 5000 _ rEneuuLaYvwxwr i _ OBNenN AIMAwTe f 2,000,000 AIM1MR4N,E uerwPDEartR ,uwEW.Bern6w.9R a 2,000,000 ours m L¢ .nLAraeLUNun Ms. S AN.AVro emur AUAYIM1rPmml a REPAND M{qA® AWILV NAPY1M1rMpwry i YRM AVfDIt NYDeNte YN ra TO E f VEBIHIIDY ¢qIq EEGMMffiHCE i EIPRY MY CJ MC.YNe AGDPFGR E rtMCH f MVFYAC AYBPIWIMIBORMH Ylx Mie 6lRRMNMROcLm DrNNa ❑ xM u,uwn¢oExl s IYMMVTRMS uMYM.eWUNMEE s Io�n°aNmw,w wwruxa eeM. 9.L.DBLM[ KyXbUMiY McP�IATXP PEMTKN>/L¢arlbn/xuGY 1.1YIr M0110111.xmlunu R�AeNeuN.11.roe epa i.m/n0 CERTIFICATE HOLDER CANCELLATION VISTA ROME IMPROV EW 2003 RIVIORDAL6 91REBT SHOULD ANY ON THE ABOVE DESCRIBED POLICIES EE CANCELLED BEPORE THE EaA.DOH DATE DEVELOP. NOTICE PALL BE OELNEAEO IN WIST S%tINGFIELD NA 01aS9 ACCOROWCEMMTNEPOLICY PROVISIONS. quixCalrSTxPrP x:AneE WISMM10ACOR000RPOMllIX AIN9MareesmD. ROUND IS(2010)03) The ACOROnsmee:Mle9oece A0lsbre Fad ACORO I Office of Consumer Affairs and Business Regulation 1000 Washington Street- Suite 710 Boston, Mos'3achusetts 02118 Home ImproverRent<Contractor Registration Type: LLC Registration: 162058 VISTA HOME IMPROVEMENT Expiration' 011022021 2097 RIVERDALE ST WEST SPRINGFIELD,MA 01089 xA i a zoR-mn f Update Morass and Return Card. gl C Mna n HOME tMPIRDVEMENT CONTRACTOR eMe expirldfordate. dual only TYPE:LLC Offlbefore. Meexpirationdeb. R feantl return to: BeEsroSs O 01,02Q021 100D aConsumer AffaiStreet and Business Regulation 1620.5E 01Al2rzOt1 100D Washington MA 0ton sveat.gui4 Pto VISTA HOME IMPROVEMENT fimton,MA 02118 BRUIN RUDD Sab� 2097RDSr �,♦:,Cc{,,,a-- IYMf.{M1R-e'V WEST7 SPRINGFIELD, ELD,IAA 010ss Not valid without signature Undersecretary CERTIFICATE OF LIABILITY INSURANCE I DATE tMNJDOIYYY 1 nvigonig TlIfILCEI(TIFICATE 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 CMFICATE HOLDER IMPORTANT:If Ne certificate holder Is an ADDITIONAL INSURED,the policy(ies)must tMI endorsed. If SUBROGATION IS WAIVED,sublectto the torms and conditions of the policy,certain policies may requlm and endorsement A statement on this certificate does not confer rights TO the certificate holder In lieu of such endommen s. PRODUCER CONTACT NAME: SOUTHWICK INS AGENCY INC PHONE FAx P O BOX 100 I=.No,END IAIC.Nol: E-MAIL SOUTHWICK.MA 01077 ADDRESS: 28TKC INSURERIS)AFFp1Daq COVERAGE NAICH IIBIIAED INSURER A: IR.%%FI LRS PROPERTY CASUALTY COMPANY OF AMERII' SAMBRICO LLC DBA VISTA HOME IMPROVEMENT INSURER B: INSURERC: INSURER D: 2097 RIVERDALE STREET IxauaER E: WEST SPRINGFIELD,MA 01089 Ix3URER F: CtTMEA s CERTIFICATE NUMBER: REVISION NU ER: FS OF INSURANCE LGTED FELON HAVE BE"ISSUED TO THE INSURED IMMED ABWE FOR THE POLICY PEWDINtlCATED W WRNBT.MMID ANY REQUIREMENT,TERMOR CONMTION OF ANY CONTRACT OR.T.ER U.NT WITH RESPECT TO NMICH THIS CERTF.TE MAYBE ISSUEDOR MAY PERTMN THENWMNCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TOALLTME TERMS.ELCLUSADNSAND COND ONS OF SUCH POLCfES, LIMITS SHOWN MY HAVE BEFN REWCED BYPMDCLAIMB New ADD NO MUCYEFFDATE POLICYFSPWTE LTR TYPE OF INSURANCE L R POLICY NUMBER puslasTYYY) (MMOUYYYYI LIMITS GENERAL LWBILITY CH OCCURRENCE 3 COMMERCIAL GENERAL LIABILITY VVNSMADE ETORENTEO i C [:]OCCUR. FRAISES(Ea amanDa) ED MR(A,One pelMM) s ERSONAL&ADVINJURY s GEN'L AGGREGATE LIMIT APPLIES PER: ENERALAGGREGATE 3 POUCY []PROJECT[]LOC RODUCTS-COMP/OP AGO 3 AUTOMOBLE UABARY COMBINED SINGLE IS ANY AUTO LIMIT(Ea amanll ALL OWNED AUTOS BODILY INJURY s SCHEDULEAUTOS (Par Nemo) HIREDAUTOS BODILY INJURY s NON-0WNED AUTOS IParsoodenq PROPERTY DAMAGE s (Per NKddent UMBRELLA LMBOCCUR EACH OCCURRENCE s EXCESS LMB C.:.DE RELATE 3 DEDUCTIBLE § RETENTION 3 S A WORKER'S COMPENSATION AND X WC STATUTORY OTHER EMPLOYER'S LMBXT' YM UB-2EWNBSIB 0911/2019 OL1Yl020 LIMITb ANY PROFERiiOPNPRTUDED,` GJIIVE OMA E.L.EACH ACCIDENT E 500,000 CFFICERIYEMBEfl EMCLUOEV+ pYYNryMMM EL DISEq$E-EA EMPLOYEE § SOD,ODD H W.9Neb IFYM CE.SCMmIDIa OPERATIXNSIebi E.L.OSEASE-POLICY LIMIT E 1.000,l1W OESCRIPl10NKOPEMTK1N31LOCATXXI&VENICLE&RESTRICIIONNPECIALITEMB THIS REPLACES ANY PRIOR CERTIFICATE ISSUED TO THECERTIFICATE HOLDER AFFECTMG WORKERS COMPCOVERAGE, CERTIFICATE HOLDER CANCELLATION TOWN OF WEST SPRINGFIELD SHOULD ANY OF THE ASOVE DESCRIBED FOUCIES BE CANCELLED 26 CENTRAL STREET BEFORE WE EXPIRATION DATE THEREOF,NOTICE WILL SE DELIVERED IN ACCORDANCE WITH WE POLICY PROMSIONS. JAUTHOFUZEDREPIUESENT WEST SPRINGFIELD,MA 01069 ACORD 25(20101M) The ACORD nadew,and logo are registered marks of ACORD 1888-2010 ACORD CORPORATION. All rights reserved.