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24B-072 (11) 80 BARRETT ST-BUILDING 2 BP-2020-0120 GIS#: COMMONWEALTH OF MASSACHUSETTS MR-.Block:24B-072 CITY OF NORTHAMPTON Lot:-000 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL e.142A) Category: ROOF BUILDING PERMIT Permit# BP-2020-0120 Proiect# JS-2020-000197 Est.Cost: $29400.00 Fee: $210.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: SEXTON ROOFING CO 99689 Lot Size(sg.ftp: Owner: ASTER ASSOCIATES Zoning. Applicant. SEXTON ROOFING CO AT. 80 BARRETT ST - BUILDING 2 Applicant Address: Phone: Insurance: P O BOX 6327 (413) 534-1234 WC HOLYOKEMA01041 ISSUED ON.7/31/2019 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: FeeTvpe: Date Paid: Amount: Building 7/31/019 0:00:00 $210.00 �12 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner Version 1.7 Commercial Building Y Permit May 15 2000 _ CDepartment use only G ity of Northampton Status of Permit: Building Department Curb Cut/Driveway Permit - JUL 3212 Main Street Sewer/Septic Availability Room 100 Water/Well Availability Northampton, MA 01060 Two Sets of Structural Plans FGL1Lm1GA1Pbbne 41_3-587-1240 Fax 413-587-1272 Plot/Site Plans DEPNORTNAt�t'TON• -- Other Specify APPLICATION TO CONSTRUCT, REPAIR, RENOVATE,CHANGE THE USE OR OCCUPANCY OF,OR DEMOLISH ANY BUILDING OTHER THAN A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION 6 1.1 Property Address: This section to be completed by office &'W_ # S- Map Map Lot �" Unit Vc At�Al l V01- Zone Overlay District `✓u i V/^ Elm St District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: 4-C l�G� ���C 1 � 3 6 Name(Print) Current Mailing Address: 0o',-���t ,a &-c' -�.( Signature Telephone 2.2 Aut orized Agent: Al-c - _'de .-L7 rL- Name(Print) Curren Mail' Address: // 73 �/ z � Signature Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building (a) Building Permit Fee 2 Electrical (b) Estimated Total Cost of Construction from 6 3 Plumbing Building Permit Fee 4. Mechanical (HVAC) 5. Fire Protection 6. Total=(1 +2+3+4+5) Check Number o2 This Section For Official Use Only Building Permit Number Date Issued Signature: /�z �f Building Commissioner/Inspector of Buildings Date 3� Zo I/ .�. 4 .� ( � �'— a �'� �.. � T _ _ _ t 1 � ♦S i Version 1.7 Commercial Building Permit May 15,2000 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 l Inter 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 ❑ A72 ElA-31:11A ❑ ❑ A-4 ElA-5,,, ❑ 113 ❑ B Business ❑ 2A ❑ E Educational ❑ 2B I ❑ F Factory ❑ F-1 ❑ F-2 2C ❑ H High Hazard ❑ 3A ❑ Institutional ❑ 1-1 ❑ 1-2 ❑ 1-3 ❑ 3B ❑ M Mercantile ❑ 4 ❑ R Residential ❑ R-1 ❑ R-2 ❑ R-3 ❑ 5A ❑ S Storage ❑ S-1 ❑ S-2 ❑ 5B ❑ U Utility ❑ Specify. M Mixed Use ❑ Specify. S Special Use ❑ Specify. COMPLETE THIS SECTION IF EXISTING BUI ING UNDERGOING R OVATIONS, ADDITIONS AND/OR CHANGE IN USE Existing Use Group: Propose Use Group: Existing Hazard Index 780 CMR 34). Proposed azard Index 780 CMR 34): SECTION 6 BUILDING HEIGHT AND ARES` BUILDING AREA EXISTING �� PROPOSED NEW CONSTRUCT N OFFICE USE ONLY i Floor Area per Floor(so 1s' � 151 2nd 2nd 3 d 3rd 4 4m in Total Area (so Total Proposed New Construction (so Total Height(ft) Total Height ft 7.Water Supply(M.G.L. c.40,§54) 7.1 Flood Zone Information: 7.3 Sewage Disposal System: Public ❑ Private ❑ Zone Outside Flood Zone❑ Municipal ❑ On site disposal system E] r i 1 T 1 _ r,. }, 8. NORTHAMPTON ZONING Versionl.7 Commercial Building Permit May 15,2000 Existing Proposed Required by Zoning This column to be filled in by Building Department Lot Size Frontage Setbacks Front Side L: R: L: R: Rear Building Height Bldg.Square Footage % Open Space Footage % (Lot area minus bldg&paved parking) #of Parking Spaces Fill: (volume&Location) A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO O DONT KNOW er YES O IF YES, date issued: IF YES: Was the permit recorded at the Regist 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 O DONT KNOW erYES O IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained O Obtained © , Date Issued: C. Do any signs exist on the property? YES 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: E. Will the construction activity disturb(clearing, grading,excavaUon,or filling)over 1 acre or is it part of a common plan that will disturb over 1 acre? YESO NO IF YES,then a Northampton Storm Water Management Permit from the DPW is required. Version 1.7 Commercial Building Permit May 15,2000 SECTION 9-PROFESSIONAL DESIGN AND CONSTRUCTION SERVICES-FOR BUILDINGS AND STRUCTURES SUBJECT TO CONSTRUCTION CONTROL PURSUANT TO 780 CMR 116(CONTAINING MORE THAN 35,000 C.F.OF ENCLOSED SPACE) 9.1 Registered Architect: Not Applicable ❑ Name(Registrant): IC Registration Number Address Expiration Date Signature Telephone 9.2 Registered Professional ngineer(s): IA— Name Area of Responsibility Address Registration Number Signature Telephone Expiration Date Name Area of Responsibility Address Registration Number Signature Telephone Expiration Date Name Area of Responsibility Address Registration Number Signature Telephone Expiration Date Name Area of Responsibility Address Registration Number Signature Telephone Expiration Date 9.3 General Contractor ��X •�/Eva t ri7 j- S,�l �� Not Applicable ❑ Company Name: ReWonsible In Charge of Construction Address Signature Telephone Version 1.7 Commercial Building Permit May 15,2000 SECTION 10-STRUCTURAL PEER REVIEW(780 CMR 110.11) Independent Structural Engineering Structural Peer Review Required Yes ® No (D--- SECTION 11 -OWNER AUTHORIZATION-TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I. - �^-� L-Z---c, as Owner of the subject property hereby authorize v-f 7 ✓✓ rz.,— t i f— J 1 c%C/ �j.. -��'L� to act on my behalf, in all matters relative to work authorized by this building permit application. Signature of Owner Date im as Owner/Authorized Agent hereby declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge and belief. Signed under the pains a penalties of perjury. Print Name 7 Signature of Owner/Agent Date SECTION 12-CONSTRUCTION SERVICES 10.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder: `� r License Number �f X �/ [b /`e 1 /0 — — l Address Expiration Date Signature Telephone SECTION 13-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 O City of Northampton 212 Main Street, Northampton, MA 01060 Solid Waste 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. Address of the work: The debris will be transported by- The debris will be received by. Building permit number: Name of Permit Applicant )24- /1 / Date Signature of Permit Applicant Proposal SEXTON ROOFING AND SIDING INC www.sextonroofing.com ffo Box 6327 P.O.Holyoke, MA 01041 Setting the Standard p. 413.534.1234 f. 413.539,9906 MA HIC# 118239 sextonroofing-.hotmail.com SUBMITTED TO Aster Associates LLC PHONE 303-9701 DATE 7/11/19 STREET P.O.Box 1130 JOB NAME Aster Fields 80 Barrett St. Northampton, Ma CrrY/STATE/ZIP Easthampton,Ma. JOB LOCATION Building 2 SEXTON ROOFING HEREBY SUBMITS SPECIFICATIONS AND ESTIMATES FOR: 1) Strip and remove existing shingles and intersecting wall siding, dispose of in proper landfill. _2)__Replaee roof sheathing as needed @$70.00 per sheet to match existing. (Sister in rafter as needed @ $40.00 per) 3) Install new metal edging to rakes and eaves of roof. (.019 F-8 white) 4) Install ice and water shield 6'on eaves, intersecting walls, and in vallies. 5) Install starter shingles on eaves and rakes of roof. 6) Install new .019 step flashing and ice and water shield at intersecting walls. 7) Install new flanges over existing vent stack. (Bathroom exhaust damper vent to remain.) 8) Install IKO Architectural style roofing shingles as per manufacturers' specifications. 9) Install new cap over ridge vent. 10) Supply manufactures 50 warranty and SRC 15 yr. workmanship warranty. *Vertical Wall Replacement Will Be At$80.00 Per Sheet Of Plywood And$9.00 Per Sq.Foot For Vinyl Siding We Propose hereby to furnish material and labor—complete in accordance with the above specifications,for the sum of: Twenty Nine Thousand Four Hundred DOLLARS $29,400.00 Payment to be made as follows:Due in full upon com letion All Material is guaranteed to be as specified. All work to be completed in a Authorized �g workmanlike manner according to standard practices. Any alteration or Signature deviation from above specifications involving extra costs will be executed only upon written orders,and will become an extra charge over and above the estimate. All agreements contingent upon strikes,accidents or delays beyond Note:This proposal may be withdrawn by us if not accepted our control. Not responsible for water damage during construction. Owner within(7)days. to pay responsible legal fees for non-payment,and applicable interest. Acceptance of Proposaf The above prices, Signature specifications and conditions are satisfactory and are hereby accepted. You are authorized to the work as specified. Signature Payment will be made as outlined above. Date of Acceptance. A► t The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations u,p 600 Washington Street Boston,Mass. 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/OrganizationMdividual):Sexton Roofing & Siding Inc Address:P.O. Box 6327 City/State/Zip:Holyoke, Ma. 01041 Phone4:413-534-1234 Are you an employer?Check the appropriate box: Type of project(required): 1. ❑ I am an employer with 4.A I am a general contractor and I 6. ❑New construction employees(full and/or part time).* have hired the sub-contractors 7. ❑ Remodeling 2. ❑ I am a sole proprietor or partner- listed on the attached sheet. ship and have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. employees and have workers' [No workers'comp.insurance comp.insurance.$ 9. El Building addition required] 5.❑ We are a corporation and its 10. ❑Electrical repairs or additions 3. ❑ I am a homeowner doing all work officers have exercised their 11. ❑Plumbing repairs or additions myself [No workers'comp. right of exemption perm MGL insurance required]t c. 152, § 1(4),and we have no 12.J$'Roof repairs employees. [no workers' 13. ❑Other comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. tHomeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $Contactors that check this box must attach an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees.Below is the policy and job site information. Travelers Property Casualty Company of America Insurance Company Name: Policy#or Self-ins.Lic.#:U B-OG078982-1 9 E 06/04/2020 Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration(date). Failure to secure coverage as required under Section 25a of MGL 152 can lead to the imposition of criminal penalties of 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 $250.00 a day against violator.Be advised that a copy of this statement maybe forwarded to the Office of Investigations of the DIA for coverage verification. I do herby certify T der the pains and penalties of perjury that the information provided above is true and correct Signature: Date: Print Name: _f-�LiC �T�'" h' C�a gra Phone#.* t a � 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 Heath 2. Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact person: Phone#: CERTIFICATE OF LIABILITY INSURANCE DATE(M 01201 YYY) TkLS�Ef2TIF1CATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER- THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW_ THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER AND THE CERTIFICATE HOLDER - IMPORTANT.If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed_ If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require and endorsement A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: ORMSBY INS AGCY PHONE FAX PO BOX 713 (A1C,No,Ext): (A1C,No): E-MAIL WEST SPRINGFIELD,MA 01090 ADDRESS_ 286TF INSURER(S)AFFORDING COVERAGE NAIC# INSURED INSURER A: TRAVELERS PROPERTY CASUALTY COMPANY OF AMERICA SEXTON ROOFING&SIDING INC INSURER B: INSURER C: INSURER D: PO BOX 6327 INSURER E_ HOLYOKE,MA 01041 INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERM INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES, LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAm CLAIMS_ WSR CkDD UBR POLICY EFF DATE POLICY EXP DATE LTR TYPE OF INSURANCE tNSR WVD POLICY NUMBER (MMIDMYYYY) (MMIDDIYYYY) LIMITS GENERAL LIABILITY EACH OCCURRENCE $ i COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED 3 CLAIMS MADE F-1 OCCUR. REMISES(Ea occurrence) i ED EXP(Arty one person) ERSONAL&ADV INJURY $ GEN'LAGGREGATE LIMIT APPLIES PER- ENERALAGGREGATE is POLICY F-1 PROJECT LOC RODUCTS-COMP/OP AGG $ AUTOMOBILE LIABILITY COMBINED SINGLE Y$ ANY AUTO LIMIT(Ea accident) ALL OWNED AUTOS BODILY INJURY i$ SCHEDULE AUTOS Per person) HIRED AUTOS BODILY INJURY �$ Per accident) ) NON OWNED AUTOS PROPERTY DAMAGE Is (Per accident) UMBRELLALIABBOCCUR EACH OCCURRENCE $ EXCESS L1AB CLAIMS-MADE AGGREGATE $ DEDUCTIBLE is RETENTIONS � A WORKER'S COMPENSATION AND WC STATUTORY OTHER` EMPLOYER'S LIABILITY YM UB-00078982-19 0610420'19 06/042020 LIMITS ANY PROPERITORIPARTNER]EXECUTIVE OFFICER/MEMBFR EXCLUDED? NIA E.L EACH ACCIDENT IS 1,000,000 (Mandatory in NH) E_L DISEASE-EA EMPLOYEE S 1,000,000 If yes,describe render DESCRIPTION OF OPERATIONS below E.L DISEASE-POLICY LIMIT 5 1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLESTRESTRICTTONS)SPECIAL ITEMS THIS REPLACES ANY PRIOR CERTIFICATE ISSUED TO TIM CERTIFICATE HOLDER AFFECTING WORKERS COMP COVER.9GE. THE INSUREDS MA WORKERS COMPENSATION POLICY ANTD ITS LIMI'T'ED OT]tER STATES ENDORSEMENT AUTHORIZES THE PAYMENT OF BENEFITS FOR CLAIMS MADE BY THE INSUREDS 1,1A EMPLOYEES IN STATES OTHER THAN iv1A NO AUTHORIZATION IS GIVEN TO PAY CI..AIMS FOR BENEFITS IN STATES OTHER THAN MA IF THE LNSLRED HIRES,OR HAS HIRED E.NIPLOYEES OLT17SIDE OF MA- THIS POLICY DOES NOT PROVIDE COVERAGE FOR ANY STATE OTHER THAN MA_ CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS- AUTHOR REPRESENTT ACORD 25(201010 The ACORD name and logo are registered marks of ACORD 198&2090 ACORD CORPORATION_ All rights reserved. The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street,Suite 100 .r Boston,MA 02114-2017 www.mass.gov/dia Workers'Compensation Insurance Affidavit:General Businesses. TO BE FILED WITH THE PERMITTING AUTHORITY.Applicant Information Please Print Legibly Business/Organization Name:MNP CONSTRUCTION INC Address:45 EXCAHNGE ST City/State/Zip:MILFORD, MA. 01757 Phone#:508-498-8870 Are you an employer?Check the appropriate box: Business Type(required): 1.0 1 am a employer with 5 employees(full and' 5. ❑Retail or part-time).* 6. Restaurant/Bar/Eating Establishment [2.❑ 1 am a sole proprietor or partnership and have no 7. Office and/or Sales(incl.real estate,auto,etc.) employees working for me in any capacity. [No workers' comp.insurance required] 8. 0 Non-profit ❑ We are a corporation and its officers have exercised 9. 0 Entertainment their right of exemption per c. 152,§1(4),and we have 10.0 ;Manufacturing no employees.[Ni o workers' comp. insurance required]* 4.❑ We are a non-profit organization,staffed by volunteers, 1 I.0 Health Care with no employees. [No workers'comp.insurance req.] 12.0 Other CONTRACTOR *Any applicant that checks box 41 must also fill out the section below showing their workers'compensation policy information. "If the corporate officers have exempted themselves,but the corporation has other employees,a workers'compensation policy is required and such an organization should check box 4 I, f am an employer that is providing workers'compensation insurancefor my employees. Below is the polio information. Insurance Company Name:HARTFORD UNDERWRITERS INS. CO_ TRAVELERS-RMD lnsurer's Address:P.O. BOX 5600 City/State/Zip: HARTFORD, CT. 06102 Policy#or Self-ins.Li,.#1 K709706 Expiration Date: 11/16/2019 Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of NvIGL c. 152 can lead to the imposition of criminal penalties of a tine up to S 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 S250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do herebi•cernf u � p r s 6 "!ties of perjure that the information provided above is true and correct. Signature: L Phone#:978-403-5942 Fal use only. Do not write in this area,to be completed by ci1P or town officiar Town: Permit/License# g Authority(circle one): rd of Health 2. Building Department 3.Cityrrown Clerk 4.Licensing Board 5.Selectmen's Office ct Person: Phone#: wwwmass guv/dia ;�►coR�n® CERTIFICATE DATE(MM/DD ATE OF LIABILITY INSURANCE "Y" THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the Policy(les) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT ONE FAMILY INSURANCE AGENCY LLC PHONE Art Calvillo PHONE -M No•Ell, (978)403-5942 i FAX I(A/C.Nor 1 Main St Suite 15 ADD 1ESS : acalvillo128@yahoo.com INSURE 5 AFFORDING COVERAGE NAIC 0 Lunenburg INSURED MA 01462 INSURER A: HARTFORD UNDERWRITERS INS CO 30104 MNP CONSTRUCTION INC INSURER B: INSURER C: 45 EXCHANGE ST APT 3E INSURER 0: MILFORD INSURER E MA 01757 INSURER F. I COVERAGES CERTIFICATE NUMBER: 401083 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSRIADDLISUBR LTR I TYPE OF INSURANCE POLICY NUMBER I MM/DD EFF I EXP COMMERCIAL GENERAL LIABILITY MM/W00DD LlMfis — 1 1 EACH OCCURRENCE 13 CLAIMS-MADE L OCCUR DAMA E TO RE-N70 I PREMISES Ea occurrence $ NIA MED EXP(Any one person) 3 S � GEN'L AGGREGATE LIMIT APPLIES PER: PERSONAL&ADV INJURY POLICY D SRO--ECT LOC GENERAL AGGREGATE S OTHER ! PRODUCTS-COMP/OP AGG S AUTOMOBILELIABILITY I I MBINI3 COED SINGLE LIMIT S Ea accident) I PANY AUTO ALL OWNED SCHEDULED BODILY INJURY(Per person) I S AUTOSHAUTOS AUTOS NIA BODILY INJURY(Per accident) 3 HIREDAUTOS NON-OWNED PROPERTY DAMAGEF1 i I Per accident $ UMBRELLA LIAB ` I S OCCUR EACH OCCURRENCE 13 EXCESS- 1 ! I CLAIMS-MADE( N/A - AGGREGATE S DED I I RETENTION S =WORKERS COMPENSATION 13 EMPLOYERS*LIABILITY PER ANYPROPRIETORIPARTNER/EXECUTIVE YIN Xi STATUTE I ERH A OFF ICER/MEMBER EXCLUDED7 NIA'N/A NIA NIA E.L.EACH ACCIDENT 13 1,000,000 (Mandatory In NH) 6S60UB1K70970618 11/16/201$ 11/16/20191--- II yes.describe under I E.L.DISEASE-EA EMPLOYEE"$ 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICYLIMIT j S 1,000,000 N/A DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may bi attached if more space is required) Workers'Compensation benefits will be paid to Massachusetts employees only.Pursuant ac Endorsement WC 20 03 06 B,no authorization is given to pay claims for benefits to employees in states other than Massachusetts if the insured hires,or has hired those employees outside of Massachusetts. This certificate of insurance shows the policy in force on the date that this certificate was issued(unless the expiration date on the above policy precedes the issue date of this certificate of insurance). The status of this coverage can be monitored daily by accessing the Proof of Coverage-Coverage Verification Search tool at www.mass.gov/lwd/workers-compensationfiinvestigations/. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN SEXTON ROOFING & SIDING INC ACCORDANCE WITH THE POLICY PROVISIONS. 102 PINE ST AUTHORIZED REPRESENTATIVE HOLYOKE MA 01040 "'( ` (i Daniel M.Crowjey,CPCU,Vice President—Residual Market—WCRIBMA ACORD 25 2014!01 ©1988-2014 ACORD CORPORATION. All rights reserved. ( ) The ACORD name and logo are registered marks of ACORD Office of Consumer Affairs and Business Regulation 1000 Washington Street- Suite 710 Boston, Massachusetts 02118 Home Improvement Contractor Registration SEXTON ROOFING&SIDING INC Tom' Corporation P.O.BOX 6327 Registration_ 118239 HOLYOKE,MA 01041 Expiration. 02/14/2021 Sr-'k 1 C: T- Update Address and Return Card. EVERET I SEXTON SR "! PO BOX 6327 HOME 1MPROVEMENI'CONTRACTOR HOLYOKEMA 01041 EVExETT J SEXTON SR 202 Pine St HOLYOKE,bIA 01040-2411 SEXTON ROOFING&SIDING CO LIC./REG NO. ECTIVE FHC.0605383 /01/2013 EXPIRES 11/30/2019 ,77 Commonwealth of Massachusetts Division of Professional Licensure Board of Building Regulations and Standards Constructicz.SL;pae-sor Specialty CSSL-099689 Expires: 10105/2019 EvERErT J SEXTON >, PO BOX 6327 HOLYOKE MA 01041 Commissioner V'r�