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24A-010 (9) 130 PROSPECT AVE BP-2020-0279 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block:24A-010 CITY OF NORTHAMPTON Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: ROOF BUILDING P E RM I T Permit# BP-2020-0279 Project# JS-2020-000471 Est.Cost:$14300.00 Fee: $40.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor. License: Use Group: SEXTON ROOFING CO 99689 Lot Size(sq.ft.): 61419.60 Owner. BASS GWENDOLYN& Zoning: URB(l00)/ Applicant: SEXTON ROOFING CO AT. 130 PROSPECT AVE Applicant Address: Phone: Insurance: P O BOX 6327 (413) 534-1234 WC HOLYOKEMA01041 ISSUED ON:9/4/2019 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 Si(,nature: FeeType• Date Paid: Amount: Building 9/4/2019 0:00:00 $40.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner IL Department use only City of Northampton Status of Permit: .N'>f Building Department Curb Cut/Driveway Permit 212 Main Street Sewer/Septic Availability Room 100 WaterNVell Availability Northampton, MA 01060 _. Two Sets of Structural Plans phone 413-587-1240 Fax 4187-127F I\. Plot/Site Plans �---- -" Other Specify APPLICATION TO CONSTRUCT,ALTER, REPAIR,RENOVAT O MOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION 1.1 Pro a Address: J NORTHAMP?ON.MA 01060c� se tion to be completed by office Map g W .Lot L/` � Unit Zone Overlay District Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2. wner of Record: N me(Print) nCurre ili ss: 461 u / Telephone Signature uthorized A ent: 19h, Name( not Current Mailing Address: - -:" .� 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 This Section For Official Use Only Building Permit Number: Date Issued: % q Signature: Building Commissioner/Inspector of Buildings Date EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR) k 1 yc'. 4 � � .. ., `� .� _ _ *, r .�fl e� �-.� h� �5 � • � • ` � , � � �I �_.. f ' Yy frame' p �, � � tom. _ � ;(�: - r ` i .. .r S���`; � D 1� ._.. _ y � f „/ _ �� _ { . � �..-; .. � i tiS .� � � b � �'. _ ti r -. i r -� s , -- i 1. � �3 � + ' e - � ; �. _ _ i� ` ; I ` ,y fw .. ^ 1 � � � � . �`, - � _ t � ,.' � �.� � f � _ ;. - �. � • 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 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 bee issued for/on the site? NO O DONT K W O ES O IF YES, date issued: IF YES: Was the permit rec rded at the Registry of Deeds. NO O NT KNOW O YE IF YES: enter B k Page and/or Document# B. Does the site contain brook, body of water or wetlands? NO DONT KNOW O YES O IF YES, has a per it been or need to be obtained from the Cons ation Commission? Needs to be o tained ® Obtained © to Issued: C. Do any signs xist on the property? YES O NO O 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 O IF YES, describe size, type and location: E. Will the construction activity disturb(clearing, grading, excavation,or filling)over 1 acre or is it part of a common plan that will disturb over 1 acre? YES © 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 Alteration(s) ❑ ] Roofing Or Doors D Accessory Bldg. ❑ Demolition ❑ New Signs [O] Decks [[] Siding[0] Other[CQ Brief Description of Proposed Work: Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll -Sheet 6a. 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 h family unit: Number of Bathrooms c. Is there a garage attache ? d. Proposed Square footage of w construction. Dimensions e. Number of stories? f. Method of heating? Fir ces or Woodstoves Number of each g. Energy Conservation Compliance. Masscheck Energy Compliance form attached? h. Type of construction i. Is construction within 100 ft. of wetl ? Yes No. Is construction within 100 yr. floodplain Yes No j. Depth of basement or cellar or below finished grade k. Will building confo o the Building and Zoning regulations? Yes No. I. Septic Tank City Sewer Private well City water ply SECTION 7a-OWNER AUTHORIZATION-TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, w as Owner of the subject property hereby authorize to act on my beh f all rs relativ o work auth rized dy this buildingpermi Dplicaftion. �'_)6 / ure of Owner brate as Owner/Authorized Agent hereby declare that the statements and information on the foregoing applioefion are true and accurate,to the best of my knowledge and belief. Sig ed nder the pains n penalti sof perjury. -Sv Lc.. Print Name Sig ure of Owner/Agent Da SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applica le ❑ Name aLicense Holder: l Li nse Number -55 119 Ad ess Expiration Date Signa Teleph ne 9. Home Imomement C :� Not Applicable ❑ �- a tl � 1/ ci a Na Fle istr ion 7N —bet 2 ress '/ ation to CJ Telephone r 23 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....... M--' No...... ❑ City of Northampton Massachusetts DEPARDRNT OF BUILDING INSPECTIONS z 212 Main Street • Municipal Building Northampton, MA 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, conversion, improvement, removal, demolition, or construction of an addition to any pre-existing owner-occupied building containing at least one but not more than four dwelling units....or to structures which are adjacent to such residence or building"be done by registered contractors. Note:If the homeowner has contracted with a corporation or LLC,that entity must be registered Type of Work: Est. Cost: Address of Work: 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 y apply for a b ilding permit as the agent of the o er:: VV ►J l ate Contractor Name HIC Registration No. OR: Notwit tandi the above notice, I here ply for a building permit as the owner of the above property: Date Owner Name and Signature City of Northampton ` c Massachusetts r, ty�1 DEPARTMENT OF BUILDING INSPECTIONS h 212 Main Street •Municipal Building Northampton, 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 being performed at: �S -Pe, (Please prinT house dumber and street name) Is to be disposed of at: (Please print name and location of facility) Or will be disposed of in a dumpster onsite rented or leased from: (Compan Name and Address) Signature of Permit Applicant or Owner Date 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. Proposal SEXTON ROOFING AND SIDING INC www.sextonroofing.com 0to =41MASTER Setting the Standard P.O. Box 6327 p. 413.534.1234 Holyoke, MA 01041 f. 413.539.9906 MA HIC # 118239 sexton roofin hotmai1.com SUBMITTED TO Gwen Bass PHONE n DATE 4/15/19 STREET 130 Prospect Ave JOB NAME CITY, STATE,ZIP Northampton, Ma. JOB LOCATION SEXTON ROOFING HEREBY SUBMITS SPECIFICATIONS AND ESTIMATES FOR: 1) Strip and remove existing shingles and dispose of in proper landfill. 2) Inspect roofing deck and replace as needed @ $75.00 per sheet. 3) Install new metal edging to rakes and eaves of roof. (8") 4) Install ice and water shield on eaves ( 6'), vent stacks, in valleys, chimney, Skylights, and at intersecting roofs. 5) Install #15 synthetic roofing felt on remainder of roof. 6) Install new flanges over existing vent stacks. 7) Install starter shingles on eaves and rakes of roof. 8) Install IKO Architectural style roofing shingles as per manufacturers' specifications. 9) Reflash chimney with new lead flashing. 10) Install new cap over ridge vent. 11) Supply manufactures Lifetime warranty and SRC 25 yr. workmanship warranty. I We Propose hereby to furnish material and labor - complete in accordance with the above specifications, for the amount of Fourteen Thousand Three Hundred Dollars (14,300.00) Payments to be made as follows: Due in full upon completion All Material is guaranteed to be as specified. All work to be Authorized completed in a workmanlike manner according to standard Signatureht practices. Any alteration or deviation from above specifications (T 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 Note: This proposal may be withdrawn by us if not beyond our control. Not responsible for water damage during accepted within (14) days. construction. Owner to pay responsible legal fees for non- payment,and applicable interest. u_ The Commonwealth of Massachusetts Department of Industrial Accidents UV Office of Investigations 600 Washing on Street Boston,Mass. 02111 www massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/OrgmizatiorAndividuW):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.?t I am a general contractor and I 6.'1 New construction employees(full and/or part time).* have hired the sub-contractors 7•f!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' 9. f Building addition [No workers'comp.insurance comp.insurance.+ required] 5.7We are a corporation and its 10. f i Electrical repairs or additions 3. I am a homeowner doing all work officers have exercised their 11. I'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_X Roof repairs employees.[no workers' 13. F Other comp.insurance required] *Any applicant that checks box;ll must also fill out the section below showing their workers'compensation policy information. i Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors most submit a new affidavit indicating such. $Contactors that check this box most attach an additional sheet showing the name of the subcontractors 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 provi'din,,workers'compensation insurance for my employees.Below is the policy and job site information. Travelers Property Casualty Company of America Insurance Company Name:--­ Policy ame: - -- -- — — --- Policy#or Self-ins.Lic.#:U B-OG078982-19 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 der the pains and penalties of perjury that the information provided above is true and correct Signadure: Date: Print Name: Phone#: Y13 Official use only Do not write in this area to be completed by city or town official City or Town: Permit/license M Issuing Authority(circle one): ].Board of Heath 2. Building Department 3.Cityfrown Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact person: Phone#• • �+� © DATE(MMIDD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 06 TTIFICATE 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 he endorsed_ If SUBROGATION IS WAIVED,subject to the terns 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 AGC:Y PHONE FA)( PO BOX 713 (A/C,No,Ext): ()IC,No): WFS'C SPRINGFIELDE-MAIL,MA 01090 ADDRESS: 2861F INSURER(S)AFFORDING COVERAGE NAIC# INSURED INSURER A: TRAVELERS PROPERTY CASUALTY Y CONIPANY OF AMERICA SEXTON ROOFING&SIDING INC INSURER B: INSURER C: PO BOX 6327 INSURER D: HOLYOKE,MA 01041 INSURER E: INSURER F-- COVERAGES :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 PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATF-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. L SR DD UBR POLICY EFF DATE POLICY ED(P DATE LTR TYPE OF INSURANCE NSR WVD POLICY NUMBER (MN)IIDDIYYYY) (MLRDDIYYYY) LIMITS GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY CLAINIS MADE F-1 OCCUR_ DAMAGE TO RENTED $ REMISES(Ea occurrence) ED EXP(Any one person) $ GEN'-AGGREGATE LIMIT APPLIES PER: ERSONAL&ADV INJURY $ ENERAL AGGREGATE $ POLICY PROJECT LOC RODUCTS-COMP/OP AGG $ AUTOMOBILE LIABILITY COMBINED SINGLE i$ ANY AUTO LIMIT(Ea accident) ALL OWNED AUTOS BODILY INJURY ;$ SCHEDULE AUTOS Per person) HIRED AUTOS BODILY INJURY $ NON-OWNED AUTOS Per accident) PROPERTY DAMAGE $ (Per accident) UMBRELLA L1AB OCCUR EACH OCCURRENCE !$ EXCESS LIAB 8 CLAIMS-MADE AGGREGATE $ DEDUCTIBLE ;$ RETENTION $ �$ A WORKER'S COMPENSATION AND WC STATUTORY OTHER EMPLOYER'S LIABILITY YIN UB-0G078982-1906/04/2019 06/042020 x LIMITS ANYPROPERt70R/PARD(ECUTIVE N!A OFEL EACH ACCIDENT Is 1,000,000 FlCEF2/MEIABER EXCLUDED? (Mandatory in NH) E.L DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS belux EL DISEASE-POLICY LIMIT 5 1,000,000 DESCRIPTION OF OPERATIONSILOCATIONSTVEHICLES/RESTRICTIONSISPECIAL ITEMS THIS REPLACES ANY PRIOR CERTIFICATE ISSUED TO THE CERTIFICATE HOLDER AFFECTING WORKERS COMP COVERAGE. THE INSUREDS MA WORKERS COISPENSATION POLICY AND ITS UNITED OTHER STATES ENDORSEMENT AUTHORIZES THE PAY NI1N-T OF BENEFITS FOR CLAIMS MADE BY THE INSL='S tifA 1.2NIP1.0YEFS IN STATES 0 D IER THAN NLA- NO AUTHORIZATION IS GIVEN TO PAY CLAMIS FOR BENEFITS IN STATES OTHER THAN MA IF THE INSURED HIRES,OR H--XS HIRED EMPLOYEF_S OUTSIDE OFMA, 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. AUTHORIZED REPRESENT F ACORD-25(2010105) The ACORD name and logo are registered marks of ACORD 1988-2010 ACORD CORPORATION. All rights reserved. The Commonwealth of Massachusetts Department oflndustrialAccidents I Congress Street,Suite I00 Boston,MA 02114-2017 mvjv_mas&gov/dia 1YOrkers'Compensation Insurance Affidavit Builders/Contractors/Fiectricians/Plnmbers_ TO BE FILED VVrM TBE PERNgyTNG AUTHORITY_ Applicantlnformation Please Print Legibly Name(Business/Organrzation/IndMdual):NRC Construction Inc Address: 66 Water St Apt 2 City/State/Zip:Milford, Ma_ 01757 Phone 37:774-287-1485 Zam ou an employer?Chee6 the appropriate box_ 4 Type of project(required). a employer with employees(M and/or part time)_* 7. New construction 2-❑I am a sole proprietor sir partnership and have no employees working far me in any capacity[No woricers'comp.insurance regrmed_] g. Remodeling 3.OI am a homeowner doing all ivak mymif[No workers'co t 9- ❑Den1QIItiOII rap_uutsarec required_] 4.❑I am a homemvner and win be hiring contractors to conduct all work on m ra 10 1:1 Building addition ensw-e that all workers ' m either have work 'compensation m,, ante or are sole I will 11_Q Electrical repairs or additions proprietors with no cmployees_ 50 I am a general contractor and I have hued the sub-contractors listed on the attached sheeL 12_❑Plumbing repairs or additions These suh-contractors have employees and have workers'comp_inscuance: 13.n,( repairs 6.❑We are a wrporrtion and its officers have exeresed then right of exemption per MGL c. 14-❑Other 152,§1(4),and we have no employees_[No workers'comp_insurance required_] 'Any applicant that checks box al must also III out the section belowshnsvmg their zwdcers'compensation policy mfocma2ion t flomcowners wbo submit this affidavit indicating they are doing all work and then him outside conhac-tnrs must submit anew affidavit indicating such =Contractors that check this box must attached an additioual sheet showing the name of the sub-contcacmrs and state whether or not those entities have employ— Ifthe sub contras m have employes they mist providetbeir xvorkers'comp.policy number_ I am_an employer fl;at is providing x'orkers'compensation znsurmtee for sny enrplayees. Belatp is thepolicy mrd job site information Insurance Company Name:Atlantic Casualty '/ Policy tt or Self-ms.Lic_9: w �7�l y" Expiration Date_ ' Lt Job Site Address: City/State/zip: Attach a copy of the workers'compensation policy declaration page(shoring 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 2500.00 and/or one-year imprisonment as well as civil penameS 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 ver cation_ I do hereby under the pains mid penalties of perJu7Y that the inform z IV on provided rzb "e u e and correct, Sitnature- Date: Phone��74-287-1485 -- F��, a only- DO not write in this area,to be completed by city or town of wiaZ n:. Permit/Ucense# hority(circle one): Health Z Building Department 3_CStylTownClerk 4_Electrical Inspector 5_Plumbing Inspector son: Phone#: ACC7RD" CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYYY) 08/20/2019 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(ies)must have ADDITIONAL INSURED provisions or 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 Brazway Insurance NAME ISABELE CORDEIRO PHONE 97841455-5M4 - F 2 Courthouse Lane Unit 14 (A/C. t __ — _WgW978 g�q Chelmsford MA 01824 AOO = yly-� _ --.. URERtS1 AFF014IDYIGCOV6tAOE NAIC9 - — — - IMSA-ATLANTIC CASUALTY MF GROUP M►tsIaLED AINSURANCE CO _... NRC CONSTRUCTION INC IsYGUARDm-- - .-- 118 E MAIN ST INSURERC- _ MILFORD MA 01757 WSUR6top._ IMSIIRERE: COVERAGES CERTIFICATE NUMBER: __I IIINSURERIF: 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 I I IIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO AL1 THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR -- iADDL'SUBR - .._.___,__.._—.....-.___.. __ _ LTR TYPE OF INSURANCE I D UIV POLICY NUMBER PfHICY EFF POLICY D[p -- � --- - COMMERCIAL GENERAL LIABILITY I EACH OCCURRENCE :1,000,000.00 CLAIMS-MADE OCCUR bAiui-U� Wi REN-T-0-- A - -- A L307000225-0 PREMLSESLFa.9,lend, s 100,000._00_ -- -- - 08127!2018 08/22/2019 IIS 09(Ivy aw person) $5,000.00 �ALaADV KMY s 1.000,000.00 GEWLAGGREGATE LIMIT APPLIES PElt -- — J POLICY 1:1PEO -CT El Loc GENERAL AGGREGATE s 2,000, - - -- - - 000.00 -- PRODUCTS-COMPI OP AGO s 2,000,000.00 . OTHER' AUTOMOBILE LIABILITY $ COMBINED SINGLE LIM(F $ ANY AUTO � l4-_accid _ ^. BODILY INJURY(per person) s OWNED SCHEDULED AUTOS ONLY AUTOS BODILY Pmw(per ao�Lit" s HIRED NON-OWNED f�ROPlAAAACiE -OAUTOS NLYTOS ONLY (Per accxk q__ S UMBRELLAOCCUR EACH OCCI�ICE s EXCESS LICIAIMS�IADE -- -— DFD RETENTIONS AGGREGATE -- -- WORKERS COMPENSATION s AND EMPLOYERS,LIABILITY YIN STATUTE.. ER ANYPROPRIETORIPARTNER/EXECUTI V E OFFICERIMFMBEREXCLUDED0 Y JNIA E__L_EACH_ACCIDENT s 1,000,000.00 B ,(MmdatorynNH) C050945 08/1612019 OSl1WI020 - under EL DISEASE-6A s 1,000,000.08 OF OPERATIONS DeluTvEL DISEASE-P01,1(,'YL/iIMT s 1,)00,OOO.QB __T DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) CARPENTRY,ROOFING,PAINTING. CERTIFICATE HOLDER CANCELLATION SEXTON ROOFING 8r SIDING INC SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE PO BOX 6327 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 102 PINE ST ACCORDANCE WITH THE POLICY PROVISIONS- HOLYOKE,MA 01040 AUTHORIZED REPRESENTATTIVE�, �? ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD Produced using Forms Ross Web Software.www.FormsBoss.com(c)Impressive Publishing 800.208-1977 � 0 IA. N - D fgJ L1 yw uo in ' cl �„� •. 'o � O O �� 5 aY y d u. p A . p o . .� � Lj LU � o w IA Q IN21 ,s 4 • V 0 Office of Consumer Affairs and Business Regulation 1000 Washingtgn Street-Sufte 710 Boston_ t usats 02118 Home IrrnrrovernLinfCordractor Reglsiaa on Types Cor raiior. S�ON ROORNG&SDING INC - Re nu ??823 �_O.SOX 63 _ :" m �/14r.M21 HOLYOKF_MA 01041 - - -s3 EY REIT j SE KTON SR 110ME FAMM �'T CONTRACTOR 'PO BOX 6327 EVERVE rTj SEXTON SR HO YOB,M& 01L43 W-Piac St HOLYOb"._._,MA. U3� o4 2A-jj SEXTON ROOM G S SIDMG CO Lis-d HEf NO. EXPIRES HIO.a6G53S3 If131 S 11130/M9 slGNEp --- Division of ProfesswRa-'Lmenswe Board of Budding Regulations and Standards .SU"�'�r'i_:S^vF CSSL-99968 F Dires:10ID512L'19 HOLYCKEMA 01041 P£3 80�5327 Commissioner