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23A-169 (5) 47 PINE ST BP-2020-0428 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block:23A- 169 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 PERMIT Permit# 13P=2020-0428 Project# JS-2020-000730 Est.Cost: $26000.00 Fee: $40.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: VISTA HOME IMPROVEMENT 111478 Lot Size(sq. ft.): 13198.68 Owner: LEBEL CHRISTINE Y&MARK O PAGI: Zoning: URB(100)/ Applicant. VISTA HOME IMPROVEMENT AT. 47 PINE ST Applicant Address: Phone: Insurance: 2097 RIVERDALE ST (413) 382-0249 WC WEST SPRINGFIELDMA01089 ISSUED ON:10/4/2019 0:011:00 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: Gars: 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 10/4/2019 0:00:00 $40.00 212 Main Street, Phone(413)587-1240, Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner ( 5 ff Depart ent use only City of Northar�ipt0 Status of Permit: sir Building Depa) me EC Curb Cut/Driveway Permit *, 212 Main S,t eet �I of/Septic Availability i p A { Room 100 er/Wgll Availability I.. ' Northampton, MA 1060Cr — 3Tw Set�of Structural Plans phone 413-587-1240,,Fax 13-587-1272 2019 PI t/Sit 'Plans o� her pAi- tjlf ecify APPLICATION TO CONSTRUCT, ALTER, REPAI , a � 7DFMO ISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION 1.1 Property Address: This section to be completed by office 1� P Map Lot Unit V1 r\ I ,1 � r� Zone Overlay District Elm St.District CB District SECTION 2 -PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: ame(Print) C rent MTg Address: Telepho e 15�nature Authorized A ent: o Na a rint) urrent Mailinq Address: i9 Te phone S TION 3 -ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building C (a) Building Permit Fee 2. Electrical (b) Estimated Total Cost of Construction from 6 3. Plumbing Building Permit Fee 4. Mechanical (HVAC) �G/ 5. Fire Protection 6. Total = (1 +2+ 3+4+ 5) Check Number 761 Y This Section For Official Use Only Building Permit Number: Date Issued: Signature: 4)aUAXj Building Commissioner/Inspector of Buildings Date @ (bf EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR) �(J� ► 1 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 tilled in by Building Department Lot Size Frontage Setbacks Front (� Side L:= R:0 L:= R:0 0 Rear 0 Building Height Bldg. Square Footage 0110, Open Space Footage % (Lot area minus bldg&paced parking) #of Parking Spaces Fill: (volume&Location) A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO ® DON'T KNOW YES IF YES, date issued: IF YES: Was the permit recorded at the Regist f Deeds? NO O DON'T KNOW YES O IF YES: enter Book ^ Page and/or Document # B. Does the site contain a brook, body of water or wetlands? NO DON'T KNOW O YES O IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtainedQ Obtained © , Date Issued: C. Do any signs exist on the property? YES O NO IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property? YES 0 NO IF YES, describe size, type and location: E. Will the construction activity disturb (clearing, grading, a avation, or filling)over 1 acre or is it part of a common plan that will disturb over 1 acre? YES O NO IF YES,then a Northampton Storm Water Management Permit from the DPW is required. SECTION 5- DESCRIPTION OF PROPOSED WORK(check all applicable) New House ❑ Addition ❑ Replacement Windows Alteration(s) Roofing Or Doors 1:1 Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [[] Siding [O] Other[Q Briefc iption o Pro osed Work: 1.1 f Alteration of existing bedroom es No Adding ne rm Yesly No Attached Narrative Renovating unfinished basement Yes V 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 each family unit: Number of Bathrooms c. Is there a garage attached? d. Proposed Square footage of new construction. Dimensions e. Number of stories? f. Method of heating? Fireplaces or Woodstoves Number of each g. Energy Conservation Compliance. Masscheck Energy Compliance form attached? h. Type of construction i. Is construction within 100 ft. of wetlands? Yes No. Is construction within 100 yr. floodplain Yes No j. Depth of basement or cellar floor below finished grade k. Will building conform to the Building and Zoning regulations? Yes No. I. Septic Tank City Sewer Private well City water Supply SECTION 7a -OWNER AUTHORIZATION -TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, M, as Owner of the subject property herebyauthorize to act on h all matters relative to work authorized by this building permit application. Njoi , Ig Signature of O er Date IF I, as Owner/Authorized Agent hereby declara4hat the statements and information or _thbforegoing application are true and accurate, to the best of my knowledge and belief. Si ed under the pains an enaltie5 of perjury. Y (an IA" Name f) Si a of 04erl4A Date SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License HolderSlu.� t License Number d e ��jj E iration Date S)?.-Ib D Q a ure Telephone 9. Registered Home Improvement Contractor: Not Applicable ❑ _ V 1.S 0 V 0� I�'yl r0 n) 1��.rY�P ll / / ,0" S y Corwany Name Reg' tra n Number 1 t Addressy� /lExx/piiration ate Telephone 7 V 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 buildi 'permit. Signed Affidavit Attached Yes......: No...... ❑ City of Northampton - Massachusetts c DEPARTMENT OF BUILDING INSPECTIONS � x 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 entitl,must be registered Type of Work: I k_ moo Est. Cost: be 0 Address of Work: P + fti (� Date of Permit Application:101 `�I 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 hereby pply for a building permit as the agent of the owner: idi �IZA �AML ) �d:L"'Ss batJ Contractor Name HIC Registration No. OR: Notwithstanding the above notice,I hereby apply for a building permit as the owner of the above property: Date Owner Name and Signature City of Northampton •'' Massachusetts w � DEPARTMENT OF BUILDING INSPECTIONS z 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: H-1pickf \l�I J— (Please print house number and street name) Is to be disposed of at: �As PC WLuh aG rtw N i (Please print name and loc ion of facility) Or will be disposed of in a dumpster onsite rented or leased from: (Company Name and Address) II q ,*�aof Pe mit Applicant or Owner Da e If, for any reason, the debris will not be disposed of as indicated, the Applicant or Owner shall notify the Building Department as to the location where the debris will be disposed. The Commonwealth of Massachusetts UVDepartment of Industrial Accidents 1 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 N I. ta A Please Print Le ibl Name (Business/Organization/Individual): Address: 91 K I -) - City/State/Zip: (�(64one#: (U I dW"I L4 6 Are you an employer. Check t e appropriate b : Type of project(required): am a employer with employees(full and/or part-time).* 7. ❑New construction //2.'❑1 I am a sole proprietor or partnership and have no employees working for me in 8. ❑Remodeling any capacity.[No workers'comp.insurance required.] 9. El Demolition 3.E]1 am a homeowner doing all work myself.[No workers'comp.insurance required.] 10❑ Building addition 4.❑I 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 ❑1 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.[ JA Other ' 6❑We are a corporation and its officers have exercised their right of exemption per MGL c. 152,§1(4),and we have no employees.[No workers'comp.insurance required.] *Any applicant that checks box#1 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 hire outside contractors must submit a new affidavit indicating such. :Contractors that check this box must attached 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 ispro 'ding workers'compensation insurance for my employees. Below is the policy andjob site information. � 1 UC Insurance Company Name: Policy#or Self ins. Lic.#: 1 Expiration Date: Job Site Address: `-'i 1 0 I ��1 '✓CJC� L City/State/Zip: Ay_-,( nu_M Attach a copy of the'workersi compensation policy declaration page(showing 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$1,500.00 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. I do hereby certify u r the pains a enalt' s o perjury that the information provided above is true anf d ccorreet. Si a re: Date: U l Phone#: 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#: Page 1 of 7 2097 Riverdale Street MA Lic# 162058 West Springfield, CT Lic# 0621848 Vista MA 01089 Vis{-a PLATINUM HOME IMPROVEMENT vistahomeimprovement.com Phone: 888.597.2323 Fax: 413.382.0241 ROOFING CONTRACT All home improvement contractors and subcontractors must be registered and any inquiries about a contractor or subcontractor relating to a registration should be directed to: Office of Consumer Affairs and Business Regulation Ten Park Plaza, Suite 5170 Boston, MA 02116 Phone: 617.973.8700 Customer Information Christine Lebel (413)320-1134 Date: 09/29/2019 Mark Page (413)320-1132 Rep: Chris Burns 47 Pine St CYLGECKO@YAHOO.COM Florence MA 01062 Roof Specifications Owens Corning Roof Systems Preferred Roof System Color Colonial Slate Drip Edge Color white Number of Layers 2 Attic plywood Location Main Underlayment Pro Armor Ice & Water Shield 6feet Supply and Install Ridge Vent yes Vista Home Improvements agrees to do the following: 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 Large Chimney Relead 1 I, Christine Lebel,Mark Page 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 intentionally left blanc Page 2 of 7 Roof Sketch / Photos Ck2A- Chris Burns, Authorized Representative Christine Lebel 09/29/2019 09/29/2019 Date Date Mark Page 09/29/2019 Date This space intentionally left blank Page 3 of 7 Homeowner's Association NO WORK SCHEDULE Contractor will not begin the work or order the materials before the third day following the signing of this Agreement, unless specified herein. Contractor will begin the work on or about 10/29/2019 Barring delay caused by circumstances beyond Contractors control, the work will be completed by 11/29/2019 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) $26,000.00 Payment Deposit already taken $8,666.67 Amount Due Upon Signing Contract (1/3 Maximum) $0.00 Amount Due At Start $8,666.66 Amount Due Upon Completion $8,666.66 Form of Payment Upon Signing Check Check# 105 Check Date 09/29/2019 Payment Form At Start Check Payment Form Upon Completion Check 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 This space intentionaliv left blar l 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 09/29/2019 THE THIRD BUSINESS DAY FROM 09/29/2019 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 14� ' Christine Lebel Mark Page 09/29/2019 09/29/2019 Date Date This space intentionally left hla Page 7 of 7 Contractor will be responsible to Owner or any third party for any property damage or bodily injury caused by itself, its employees or its subcontractors in the performance of, or as a result of, work under this Agreement. Contractor agrees to carry insurance to cover such damage or injury. Construction Related Permit Acquisition: Contractor, under provisions of Chapter 142A of the Massachusetts General Laws, is required to apply for and obtain all construction related permits. Contractor shall not be deemed responsible for delays in the work described in this agreement caused by regulator, permit granting or inspectional agencies, authorities or individuals. NOTICE: If Owner obtains his/her own construction related-permits for the work described under this Agreement, Owner is hereby advised that in the event of a dispute, judgment and non payment of Contractor, Owner will not be entitled to make claim to or collection from the guaranty fund established in M.G.L. c. 142A. Modification: This Agreement, except as to concealed conditions or delays occasioned thereby or by restarts, cannot be changed except by a written statement signed by both Contractor and Owner. However, cancellation by Owner is allowed in accordance with the Notice of Cancellation. Owner hereby grants Contractor a limited Power of Attorney to complete incomplete documents on Owners behalf. Completeness of Contract for Execution: Owner is hereby advised not to sign this Agreement unless and until all blank sections have been filled in or marked as void, deleted or not applicable, and until all exhibits and related or referenced documents that are incorporated herein are attached hereto. Attorney's Fees/Costs Owner agrees to pay all costs of collection, including reasonable attorney's fees, cost and expenses. Furthermore, interest shall be charged at the highest lawful rate of interest on any and all overdue payments. Copy of Agreement to be given to Owner: This Agreement is governed by the laws of the Commonwealth of Massachusetts. It must be executed in duplicate, and an original, signed copy hereof given to the Owner at the time of execution. No work under the Agreement shall begin prior to the signing of the Agreement and transmittal to the Owner of a copy therefor. Christine Lebel Mark Page 09/29/2019 09/29/2019 Date Date Chris Burns Authorized Representative 09/29/2019 Date CERTIFICATE OF LIABILITY INSURANCE DA03119TE(MM//2019 Y) TWLS.GERTIFICATE 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 endorsements . PRODUCER CONTACT NAME: SOU hHWICK INS AGENCY INC PHONE FAX 1'O BOX 100 (A/C,No,Ext): (AIC,No): E-MAIL SOUTHWICK,MA 01077 ADDRESS: 28TKC INSURER(S)AFFORDING COVERAGE NAIC# INSURED INSURER A: I R\\ELERS PROPERTY CASUAI I) COMPANY OF AMERW SAMBRICO LLC DBA VISTA HOME IMPROVEMENT INSURER B: INSURER C: INSURER D: 2097 RIVERDALE STREET INSURER E: WI ST SPRINGFIELD.MA 01099 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 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 ADD SUB POLICY EFF DATE POLICY EXP DATE LTR TYPE OF INSURANCE L R POLICY NUMBER (MMIDDIYYYY) (MMIDDIYYYY) LIMITS GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY CLAIMS MADE OCCUR DAMAGE TO RENTED S PREMISES(Ea occurrence) MED EXP(Any one person) $ It PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER GENERALAGGREGATE $ POLICY [::]PROJECT F__]LOC PRODUCTS-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 $ (Per accident) NON-OWNED AUTOS PROPERTY DAMAGE $ (Per accident) UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ k WORKER'S COMPENSATION AND h WC STATUTORY OTHER EMPLOYER'S LIABILITY Y/N UB-2E072183-19 03/12/2019 03/12/2020 LIMITS ANY PROPERITOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? NIA E.L.EACH ACCIDENT $ 500,000 (Mandatory in NH) E L.DISEASE-EA EMPLOYEE $ 500,000 If yes describeunder DESCRIPTIONIPTION OF OPERATIONS below E L DISEASE-POLICY LIMIT $ 1,000.000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLESIRESTRICTIONS/SPECIAL ITEMS I I IIS REPLACES ANY PRIOR CERTIFICATE ISSUED TO THE CERTIFICATE HOLDER AFFECTING WORKERS COMP COVERAGI- CERTIFICATE HOLDER CANCELLATION TOWN 01 WEST SPRINGFIELD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED 26 CENTRAL STREET BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENT,r}�VE - C / WTST SPRINGFIELD.MA 01080 i (j ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD 1988-2010 ACORD CORPORATION. All rights reserved. I 1 1CZrGLCl�G/•r� Office of Consumer Affairs and Business Regulation 1000 Washington Street - Suite 710 Boston, Mastachusetts 02118 Home ImprovernbrIlt.- ontractor Registration Type: LLC Registration: 162058 VISTA HOME IMPROVEMENT Expiration: 01/02/2021 2097 RIVERDALE ST WEST SPRINGFIELD,MA 01089 Update Address and Return Card. SCA 1 0 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 162058 01/02/2021 1000 Washington Street-Suite 710 VISTA HOME IMPROVEMENT Boston,MA 02118 BRIAN RUDD / •/-- 2097 RIVERDALE ST \,k cz.(�� l�(•C' Sab"UY WEST SPRINGFIELD, MA 01089 Not valid without signature Undersecretary TE AC® CERTIFICATE OF LIABILITY INSURANCE DA07/12/2WD019 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(iss)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 CONTACTNAME: WM J MIS WILLIAM J MIS INSURANCE PHONE 413-568-6111 FAX 413-572-9191 156 ELM STREET Amoss: BILL@BILLMISINSURANCE.COM WESTFIELD MA 01085 _ INSURER S�)AFFORDING COVERAGE � NAIC# INSURER A: NAUTILAS INS CO INSURED INSURER B: SAMBRICO LLCNISTA HOME IMPROVEMENT INSURER C: 2097 RIVERDALE RD INSURER D: WEST SPRINGFIELD MA 01089 INSURER E_ 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 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. L TYPE OF INSURANCE POLICY NUMBER POLICY EFF PDt pCY EXP LIMITS - X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 !_ DAMAGE TO RENTED CLAIMS-MADE 00000, -- X�OCCUR PREMISES(Ea $ 1 MED EXP(Any one person) $ 5000 Y G3679203 .08/01/2019 08/01/2020 -PERSONAL&ADV INJURY $ 1,000,000 GENL AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,W0,066 _ POLICY❑JJEEC171 LOC PRODUCTS-COMP/OPAGG $ 2,000,000 OTHER: $ !AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED ' ~BODILY INJURY(Per accident) $ AUTOS AUTOS PROPERTY DAMAGE NON-OWNED accident HIRED AUTOS AUTOS $ $ UMBRELLALIAs _ OCCUR EACHOCCURRENCE $ EXCESS LIAB — CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATIONR AND EMPLOYERS'LIABILITY Y/N', _ STATUTE ANYPROPRIETOP/PARTNER/EXECUTIVE ❑ NIAA EL EACH ACCIDENT $ OFFICER/MEMBEREXCLUDED? - --- - (Mandatory In NH) E.L.DISEASE-EA_EMPLOYE $ 0 yyes.describe under - - DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS 1 LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,maybe attached If more space Is required) 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. SAMBRICO LLCNISTA HOME IMPROVEMENT 2097 RIVERDALE RD AUTHORIZED REPRESENTATI WEST SPRINGFIELD MA 01089 t ©1 014 ORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered ma s of ACORD ® Commonwealth of Massachusetts Division of Professional Licensure Board of Building Regulations and Standards Construction Supervisor CS-111478 Expires: 01/21/2021 BRIAN RUDD 175 COYOTE CIRCLE FEEDING HILLS MA 01050 Commissioner I