Loading...
29-533 (4) 12 GREGORY LN BP-20207.0405 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block:29-533 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: INSULATION BUILDING PERMIT Permit# BP-2020-0405 Proiect# JS-2020-000684 Est.Cost:$2850.00 Fee: $65.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: AMERICAN INSTALLATIONS LLC 106178 Lot Size(sg.ft.): 11586.96 Owner: SINGLER MONA A C/O MONA A WESTORT Zoning: Applicant: AMERICAN INSTALLATIONS LLC AT. 12 GREGORY LN Applicant Address: Phone: Insurance: 130 COLLEGE ST (413) 552-0200 WC SOUTH HADLEYMA01075 ISSUED ON:9/30/2019 0:00:00 TO PERFORM THE FOLLOWING WORK:ATTIC AND BASEMENT INSULATION AND AIR SEALING THROUGHOUT POST THIS CARD SO IT IS VISIBLE FROM THE STREET Inspector of Plumbing Inspector of Wiring D.P.W. Btiddiml- 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 Sianature: FeeT-vpe: Date Paid: Amount: Building 9/30/2019 0:00:00 . $65.00 212 Main Street, Phone(413)587-1240, Fax:(413)587- 272 Louis Hasbrouck—Building Commissioner A -22] - � � 3 �v .10- t/v.!�- HLUEIVEM Dep City of N rtha ton-- -- r' ,rte Building epa ment _. 212 M in S ee15EP 2019 NSULA TION , } '! 1013 Northampton, NA 01060 phone 413-587-1240 F (13r58M272-=cTlo ONLY RTHAMPTON. )tOr;i APPLICATION FOR INSULATION FOR A ONE OR TWO FAMILY DWELLING ONLY SECTION 1 -SITE INFORMATION INSULATION PERMIT 1.1 Property Address. This section to be completed by office pl Map Lot �)--5 Unit 12 & 14 Gregory Lane Zone Overlay District Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: Nlona Singh: 14 Gregory Lane Name(Print) CIyT�M 9�d ejss: See attached Telephone Signature 2.2 Authorized Agent: American Installations 130 College Street Ste. 100, South Hadley, MA 01075 Name(Print) Current Mailing Address: 1A) K- (413) 552-0200 Signature j Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building0OU (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 or 6. Total=(1 +2+3+4+5) -5'0.00 Check Number This Section For Official Use Only Building Permit Num Date er: Issued: Signature: Building Commissioner/Inspector of Buildings Date production @ americaninstallations.corn EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR) SECTION 4-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder: Wesley K. Couture 106178 License Number 130 College Street Ste. 100, South Hadley MA 01075 9129120 21 Address Expiration Date (413) 552-0200 Signature Telephone 9.Registered Home Improvement Contractor: Not Applicable ❑ American Installations 175982 Company Name Registration Number 130 College Street Ste. 100, South Hadley MA 01075 612612021 Address Expiration Date Telephone (413) 552-0200 SECTION 5-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...... ❑ Brief Description of Proposed Work NOTE: INS ULA TION ONLY Attic and basement insulation and air sealing throughout. I, American Installations - Weslcy Couture 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 and penalties of perjury. Wesley K. Couture Print Name 1A)PJJt I CCOA ZA A 9/25/2019 Signature of Owne Agent Date 1, , as Owner of the subject property hereby authorize American Installations to act on my behalf, in all matters relative to work authorized by this building permit application. See attached 9/25/2019 Signature of Owner Date City of Northampton ►'' Massachusetts � - %•. DEPARTMENT OF BUILDING INSPECTIONS ?' x 212 Main Street • Municipal Building ` •:;. Northampton, MA 01060 rf�iy,•- `�� 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: Insulation Est.Cost: 2850.00 Address of Work: 12 & 14 Gregory Lane Date of Permit Application: 9/25/2019 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 x Other(specify): Contractor pulling permit for homeowner 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 hereby apply for a building permit as the agent of the owner: 9/25/2019 Arnerican Installations 175982 Date Contractor Name HIC Registration No. OR: Notwithstanding the above notice, I hereby apply for a building permit as the owner of the above property: 9/2-1/2019 W" �( - Law Date Owner Name ana Signature City of Northampton sp' Massachusetts •_ '�;- � DEPARTMENT OF BUILDING INSPECTIONS S •a. I 212 Main Street •Municipal Building Northampton, MA 01060 ssyk..• �1J 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: 12 & 14 Gregory Lane (Please print house number and street name) Is to be disposed of at: Waste Management of New England, Chicopee, MA 01020 (Please print name and location of facility) Or will be disposed of in a dumpster onsite rented or leased from: (Company Name and Address) WVxW L LAA- 1 ` Lv 0 Signature of Yermit 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. --- City of Northampton Massachusetts DEPARTMENT OF BUILDING INSPECTIONS r 212 Main Street • Municipal Building Northampton, MA 01060 SbjY �1 MANDATORY FOR HOUSES BUILT BEFORE 1945 Property Address: 12 & 14 Gregory Line Contractor Name: American Installations Address: 130 College Street Ste. 100 City, State: South Hadley MA Phone: (413) 552-0200 Property Owner Name: Mona Singler Address: 12 & 14 Gregory Lane City, State: Florence,MA 01062 1, Wesley K. Couture (contractor) attest and affirm that the building I intend to insulate does not have any open air (knob and tube)wiring in the spaces to be insulated and that I have provided the property owner with a copy of this affidavit. Contractor signature Date 9/25/2019 Page 1 of 2 • mass save icensed&insured ' PARTNER MA rs a:106178 MA Regrstravon p 175982 American Installations www-AmericanInstallations.com 130 College Street Suite 100,South Hadley,MA 01075 • Office:(413)552.0200 Fax:(413)552.0202 • Email: support@Americanlnstallations.com Customer Name:Barbara Hodgens Email:Not provided Phone:413-320-7641 Premise Address: 12 Gregory Lane, Florence,MA 01062 Mailing Address: 12 Gregory Lane, Florence,MA 01062 Project ID:3894840 Date:Sept.20,2019 Job Description Measure Description Location Quantity Unit Total Cost Customer Cost Air Sealing at Estimated 62.5 CFM50 Per Hour Living Space 6 hr $555.48 $0.00 Exterior Door Weather Stripping (with AS hrs) Living Space 2 each $60.14 $0.00 Door Sweep (with AS hrs) Living Space 2 each $50.62 $0.00 Door- 2"Thermal Barrier Polyiso Living Space 1 each $90.44 $9.04 Hatch - 2"Thermal Barrier Polyiso Living Space 1 each $46.28 $4.63 Damming Living Space 28 each $66.92 $6.69 Attic Floor- 4"Open Blow Cellulose Living Space 468 SF $692.64 $69.27 Project Total $1,562.52 Weatherization incentive ($806.65) WARRANTY:American installations,LLC Will provide the above stated homeowner with a t-year workmanship warranty. American Installations,LLC hereby proposes to furnish all material and labor to complete the above scope of work in accordance with the above specifications and all local and state building regulations for the Total Contract Value as stated herein, ACCEPTANCE C- PROPOSA-: The above prices, speci`ications and condi;fons are TOTAL CONTRAC-VALUE= S satisfactory and are hereby accepted.You are authorized to do work as specified.Payment Down Payment=S ❑ Will he t/3 down prior to start of work,and balance due upon Completion. PAID Balance Due Upon Completion= 5 Signature Date Property Owner(Print) (Sign] Date Representative:(Print} (Sign) Date THIS AGREEMENT IS mMPOSED CF TSNS PAGE ANO TME REVERSE SIDE OF TNIS PAGE ANO SHALL BE CONSIDERED THE ENTIRE AGREEMENT IN THE PARTIES INVOLVED THIS AGREEMENT IS BETWEEN AMERICIN INSTALUTTIONS,LLC HEREINAFTER REFERRED TO AS 1C0MPA11-, AND THE CUSTOM[PIS)NAMED ABOVE,HEREINAFTER REFERRED TO AS-CLIENT'.AND WILLIE SUBJECT TO ALL APPRCPRMTE LAWS.REGUUITIONS AND ORDINANCES Of THE STATE OF MA55AOIUSE TS OR CONNECT ICU'RESPECTIVELY,ASW ELLAS ALL LOCAL IURISDICTIONS Page 2 of 2 • mass save Licensed&Insured PARTNER MA CSI M:706778 , MA Registration M 175982 American Installations www.AmericanInstallations.com 130 College Street Suite 100,South Hadley,MA 01075 • Office:(413)552-0200 rax:(413)552-0202 A Email: suppor L(i9Americanlostallations.com Customer Name:Barbara Hodgens Email:Not provided Phone:413-320-7641 Premise Address: 12 Gregory Lane,Florence,MA 01062 Mailing Address: 12 Gregory Lane,Florence,MA 01062 Project ID:3894840 Date:Sept.20,2019 Air sealing incentive ($666.24) Total Program Incentive -$1,472.89 Customer Total $89.63 WARRANTY:American Installations,LLC will provide the above stated homeowner with a 1-year workmanship warranty. American installations,LLC hereby proposes to furnish all material and labor to complete the above scope of work in accordance with the above specifications and all local and state building regulations for the Total Contract Value as stated herein. ACCEPTANCE 07 PRO-OSA_: -he above prices, sped'ications and conditions are TOTAL CONTRACT VALUE=5 89.63 satisfactory and are hereby accepted.You are authorized to do work as specified.Payment 30.00 = ®}C will he 1/3 down prior to start oF work,and balance due upon Completion. Down Payment S PAID Balance Due Upon Completion= S 59.63 Signature _)2tDote9/20/2019 Property Owner(Print) (Sign} Date Representative:(Print) Garrett Demers (Sign) Garrett Demers® Date 9/20/2019 THISAGREEMENTIS COMPOSED OF THIS PAGE AND-E REVERSE SDEOFTHISPAGEANO SHALLSECONSIOERED1IEENTIREAGREEMEMBY TIE PARTIES INVOLVED.THISAGREEMENTIS BETWEEN 4MERIUN NSTALLATONS,LLCHEREMAFTEAREFEIIREOTOAS'COMPANY, AN07HE WMMERIS)NAMED ABOVE,HERMAFTER REFERRED TO AS'CLIENT',AND W Ill SE SUBIECT TOALL APPROPRIATE LAW 5,REGULATIONS AND ORDINANCES OF TNI S7ATE OF MA55A01USETTS OR CONNECTICU*RESPECTIVELY.AS WELL AS ALL LOCAL lU RISOICTIONS Page 1 of 2 • mass save -icensed&Insured I PARTNER MAL:-SI#:z ll6 118 MA Rcgwronon a 175932 American Installations www.AmericanInstallations.com 130 College Street Suite 100,South Hadley,MA 01075• Office:(413)55z-ozoo rax:(413)5Sz-OzOz A Email: support@Americanlnstallations.com Customer Name:Mona Singler Email:Not provided Phone:413-320-7641 Premise Address: 14 Gregory Lane, Florence,MA 01062 Mailing Address: 14 Gregory Lane,Florence,MA 01062 Project ID:3894830 Date:Sept.20,2019 Job Description Measure Description Location Quantity Unit Total Cost Customer Cost Air Sealing at Estimated 62.5 CFM50 Per Hour Living Space 4 hr $370.32 $0.00 Exterior Door Weather Stripping (with AS hrs) Living Space 2 each $60.14 $0.00 Door Sweep (with AS hrs) Living Space 2 each $50.62 $0.00 Hatch - 2"Thermal Barrier Polyiso Living Space 1 each $46.28 $4.63 Damming Living Space 28 each $66.92 $6.69 Attic Floor-4" Open Blow Cellulose Living Space 468 SF $692.64 $69.26 Project Total $1,286.92 Weatherization incentive ($725.26) Air sealing incentive ($481.08) WARRANTY:American Installations,LLC will provide the above stated homeowner with a 1-Year workmanship warranty. American Installations,LLC hereby proposes to furnish all material and labor to complete the above scope of work in accordance with the above specifications and all local and state building regulations for the-otal Contract Value as stated herein. ACCEPTANCE O, r'ROAOSA_ -he above prices, speci`icatlons and conditions are TOTAL CONTRAC-VALUE=5 satisfactory and are hereby accepted.You are authorized to do work as specified.Payment Down Payment=S ❑ will be 1/3 dawn prior to start of work,and balance due upon Completion. RAID Balance Due Upon Completion= 5 Signature Date Property Owner(Print) [Sign) Date Representative:(Print) (Sign) Date -15 AGREEMENT IS COMPOSED CF THIS PAGE AND THE REVERSE SIDE R THIS PAGE ANOSHALL RECONSIDERED THE ENTIRE AGREEMENT 91'HE PARTIES INVOLVED'NISAGREEMENTISEETWEEAAMERICANINSTALL tION5,LLCHEREINAFTERREFERREDTOA5'COMPANY', ANDTHE CUSTOMERIS)NAMED ABOVE,HEREINAFTER REFERRED 70 AS-CLIENT'.AND WILL BE SUBJECT TOALL APPROPRVITE LAWS,REGULATIONS AND 0901MMEES 0F THE STATE OF MASSACHUSETTS OR CONNECTICUT RESPELTIVEM AS WELL AS ALL LOCAL JURISDICTIONS Page 2 of • Jcensed&Insured save red PA R T N E R MA CSI M:106178 , MA RegmtrotNon 111175982 American Installations ww w.Am erica n Install ations.cam 130 College Street Suite 100,South Hader,MA 01075 • Office:(413)552-0200 Fan:(413)552-0202 R Email: support(AAmericanlnstallations.com Customer Name:Mona Singler Email:Not provided Phone:413-320-7641 Premise Address: 14 Gregory Lane,Florence,MA 01062 Mailing Address: 14 Gregory Lane,Florence,MA 01062 Project ID:3894830 Date:Sept.20,2019 Total Program Incentive -$1,206.34 Customer Total $80.58 WARRANTY:American installations,LLC Will provide the above stated homeowner with a 1-year workmanship warranty. American installations,LLC hereby proposes to furnish all material and labor to complete the above scope of work in accordance with.he above specifications and all local and state building regulations for the Total Contract Value as stated herein. ACCEPTANCE OF PROPOSAL: The above prices, sped'ications and conditions are TOTAL CONTRAC-VALUE- S 80.58 satisfactory and are hereby accepted.You are authorized to dowork as specified.Payment 30.00 Will be 113 down prior to start of work,and balance due upon Completion. Down Payment=S Balance Due Upon Completion= 5 50.58 PAID Signature A41J Owe 9/20/2019 Property Owner(Pring (Sign; Date Garrett Demers Garrett Demers 9/20/2019 Representative:(Print) (sign) Date TMIS AGREEMENT IS COMPOSED CF TMIS PAGE AMC TME REVERSE SIDE R TMIS PAGE AND SMALL BE CONSIDERED TME ENTIREAGREEMENT IY THE PARTIES INVOLVED.THISAGREEMENT15 BETWEEN AMERICAN NSTALLATIONS,LLC HEREINAFTER REFERRED TO AS-COMPANY-, ANCTNE CUSTOMERS)NAMED ABOVE,HEREINAFTER REFERRED TO AS'C,IENT',AND WILL IE SUINECT TOALL APPROPRIATE LAWS,REGULATIONS AND ORDINANCES OF THE STATE Of MA55AOIUSETTS OR CONNECTICUT RESPECTIVELY,AS WELL AS ALL LOCAL NU RISDI CIIONS The Commonwealth of Massachusetts I Department of Industrial Accidents sr a I Congress Street,Suite 100 Boston, MA 02114-2017 www mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print LegibIN Name (Business/Organizatiotulndividual): American Installations,LLC Address: 130 College Street, Suite 100 City/State/Zip: South Hadley, MA 01075 Phone#: 413-552-0200 Are you an employer?Check the appropriate box: Type of project(required): 1.N I am a employer with 70 employees(full and/or part-tone).' 7. [:]New construction 2.❑i am a stile proprietor or partnership and have no employees working for me in 8. ❑Remodeling any capacity.[No workers'comp.insurance required.] 9. El Demolition 1❑I am a homeowner doing all work myself.[No workers'comp.insurance required.]} 10❑Building addition 4.❑1 am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers'compensation insurance or are sole 11.❑Electrical repairs or additions proprietors with no employees. 12.❑Plumbing repairs or additions 5.O I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.❑Roof repairs these sub-contractors have employees and have workers'comp.insurance.I 6.Q we are a corporation and its officers have exercised their right of exemption per MGL c. 14.❑X Other Insulation 152,§1(4),and we have no employees.[No workers'comp.insurance required.I 'Any applicant that checks box#I must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hue outside contractors must submit a new affidavit indicating such. Contractors that check this box must attached an additional sheet showing the umne 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 ant an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Berkshire Hathaway GUARD Policy#or Self-ins.Lic.#: AMWC049875Expiration Date: 09/04/2020 rti' Job Site Address: ` �Y�UU-'� City/State/Zip: 3 Attach a copy of the workers mpe sation policy declaration page(showing the policy number and expiratio date (12, 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 certffr carder the pains and penalties of peijuill that the information provided above i.s true and correct. n Signature: Date: Phone#: 413-552-0 00 _ 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 Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone#: _ Commonwealth of Massachusetts Construction Supervisor Division of Professional Licensure Unrestricted -Buildings of any use group which contain Board of Buildinq Regulations and Standards less than 35,000 cubic feet (991 cubic meters) of enclosed Construction Supervisor space. CS toFt'P Zxpires. 09129 2021 WESLEY COUTURE 139 PACKARDVILLE ROAD PELHAM MA 01002 Failure to possess a current edition of the Massachusetts State Building Code is cause for revocation of this license. Commissioner For information about this license ` Call (617) 7273200 or visit www.mass.gov/dpl ���7P v�/l?�Zt!'/Z-�f�PII.'��/L�..%�/ir1,'•1-1�1'��l.��f'��� Office of Consumer Affairs and Business Regulation 1000 Washington Street - Suite 710 Boston, Massachusetts 02118 Home Improvement Contractor Registration Type: LLC Registration: 175982 AMERICAN INSTALLATIONS, LLC. Expiration: 06/26/2021 130 COLLEGE STREET SUITE 100 SOUTH HADLEY,MA 01075 Update Address and Return Card. SGA 1 d 20M-05/17 Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only TYPE:LLC before the expiration date. If found return to: Registration Expiration Office of Consumer Affairs and Business Regulation 175982 06/26/2021 1000 Washington Street -Suite 710 AMERICAN INSTALLATIONS,LLC. Boston,MA 021118 WESLEY COUTURE �-' ✓ ` /� 130 COLLEGE STREET SUITE 100 —v— SOUTH HADLEY,MA 01075 Undersecretary "jot valid without signature AC�® 78T E(MM/DD/YYYY) C CERTIFICATE OF LIABILITY INSURANCE /2s/2o19 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 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 Linda Powers NAME: Webber s Grinnell PHONE (413)586-0111 FAX 413)586 A/ xt: A/C,No): 8 North King Street E-MAIL 1 Owers@webberand rinnell.com ADDRESS: p g INSURERS AFFORDING COVERAGE NAIC# Northampton MA 01060 INSURER A:Employers Mutual Casualty INSURED INSURER B:Berkshire Hathaway GUARD Ins. Co. American Installations, LLC INSURER C: Attn: Wes 6 Suzanne Couture INSURER D: 130 College Street, Suite 100 INSURER E: South Hadley MA 01075 INSURER F: COVERAGES CERTIFICATE NUMBER:Master Exp 9-2020 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. INSR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR POLICY NUMBER MM/DD/YYYV MMIDDIYYYY COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A X CLAIMS-MADE ❑ PREMISESS Ea occurrence $ OCCUR DAMAGE REMISES 500,000 PREMI 5D3535217 9/4/2019 9/4/2020 MED EXP(Any one person) $ 10,000 PERSONAL 8 ADV INJURY $ 1,000,000 GENIAGGREGATE LIMIT APPLIES PER: GENERALAGGREGATE $ 2,000,000 X POLICY � PRO ❑ LOC PRODUCTS-COMP/OP AGG $ 2,000,000 JECT OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 Ea accident A ANY AUTO BODILY INJURY(Per person) $ ALL OWNED X SCHEDULED 523535217 9/4/2019 9/4/2020 BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE X HIRED AUTOS X AUTOS Per accident) $ X Coll$2,000 X comp$2,000 PIP-Basic $ 8,000 X UMBRELLA LIAB OCCUR EACH OCCURRENCE $ 1,000,000 A EXCESS LAB HCLAIMS-MADE AGGREGATE $ 1,000,000 DED I X I RETENTION $ 10,000 5J3535217 9/4/2019 9/4/2020 $ WORKERS COMPENSATION x PERTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE E .EACH ACCIDENT $ 500,000 OFFICER/MEMBER EXCLUDED? ❑ N/A B (Mandatory in NH) AMWC994153 9/4/2019 9/4/2020 E.L.DISEASE-EA EMPLOYEE $ 500,000 If yes,describe under DESCRIPTION OF OPERATIONS below E .DISEASE-POLICY LIMIT $ 500,000 A Business Personal Property 5A3535217 9/4/2019 9/4/2020 dedud,ble$1.000 500,000 DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Evidence of Insurance THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE W Grinnell, CPCU, TC_ ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD INS025(201401)