Loading...
31B-020 (4) 8 ALDRICH ST BP-2020-0430 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block:31 B-020 CITY OF NORTHAMPTON Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: window replaced BUILDING PERMIT Permit# BP-2020-0430 Project# JS-2020-000735 Est.Cost: $1488.00 Fee: $40.00 PERMISSION IS HEREBY GRANTED TO. Const.Class: Contractor: License: Use Group: HOME DEPOT AT HOME SERVICES 104327 Lot Size(sq.ft.): 5662.80 Owner: RICE RACHEL Zoning: URC(100)/ Applicant. HOME DEPOT AT HOME SERVICES AT. 8 ALDRICH ST Applicant Address: Phone: Insurance: 5 RIVERVIEW DR (401)935-2633 ) Workers Compensation NORTH PROVIDENCER102904 ISSUED ON.1011012019 0:00:00 TO PERFORM THE FOLLOWING WORK.-INSTALL 2 REPLACEMENT WINDOWS POST THIS CARD SO IT IS VISIBLE FROM THE STREET Inspector of Plumbing Inspector of Wiring D.P.W. Building Inspector Underground: Service: Meter: Footings: Rough: Rough: House# Foundation: Driveway Final: Final: Final: Rough Frame: Gas: Fire Department Fireplace/Chimney: Rough: Oil: Insulation: Final: Smoke: Final: THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Certificate of Occupancy Signature: FeeType: Date Paid: Amount: Building 10/10/2019 0:00:00 $40.00 212 Main Street,Phone(413)587-1240, Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner Department use only City of Northa ton Perm'at: Building Depa en OCT Curb C t/Driv oway Permit Y1} 212 Main S eet ` 3 2 �ewer epti Availability L Room1 0 DEPT F Wate /Well vailability c Northampton, M TyA�cOjNrr Two ets Structural Plans phone 413-587-1240 Fax 413-5 - qpF A ite ans r Sp cify __ APPLICATION TO CONSTRUCT,ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION 1.1 Property Address: / This section to be completed by office Map_ Lot C)C:`d Unit Zone Overlay District Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: ' 142- Name(Print) Current MajJingddr Tp ele h�-'olbnes'L �^—i Signature 2.2 Authorized Agent: 12)z4kA71 -74) Name(PrlA Current Maili g Address: �j y Signature Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building J� [�9 (a)Building Permit Fee 2. Electrical /`7 (b)Estimated Total Cost of Construction from 6 3. Plumbing Building Permit Fee , 4. Mechanical(HVAC) �'Z /n 5. Fire Protection 7L/ 6. Total=0 +2+3+4 +5) G Check Number 67 This Section For Official Use Only Building Permit Number: Date Issued: Signature: Building Commissioner/Inspector of Buildings Date 10 EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR) SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable) New House ❑ Addition ❑ Replacement Wi ows Alteration(s) ❑ Roofing ❑ Or Doors Accessory Bldg. ❑ Demolition ❑ New Signs [[3] Decks Siding[O] Other[a Brief Descri io Pro o 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 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 as Owner of the subject property hereby authorize .�'� '� //��lez' to act on my behalf, in all matters relative to work authorized by this building permit application. Signature of Owner Date I, 9)14*7� 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. C Print N 7 Q Signakde of gen Date SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder: License Number 7-6 ZQ)5:411 ,ir Address Expiration Date Signature T lephone 9. Registered Home Improvement Contractor: Not Applicable ❑ Company Name Registration Number eWW 13,�TO;;7 77>/-)� Z/— .�-> Address � c Expiration Date�t t✓� " �/ ' 1Y�s/� Telephone W 4 3. SECTION 10-WORKERS' COMPENSATION INSURANCE AFFIDAVIT(M.G.L. c. 152,§25C(6)) Workers Compensation Insurance affidavit must be completed and submitted with this application.Failure to provide this affidavit will result in the denial of the issuance of the building permit. Signed Affidavit Attached Yes....... � No...... ❑ City of Northampton \5 Tl Massachusetts is DEPARTMENT OF BUILDING INSPECTIONS 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: 1,t11J✓A901411 k4�C'e��r Est. Cost: Address of Work: Date of Permit Application: 9 Z 9 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: 1 hereby apply for a building permit as the ent of the owner: 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: Date Owner Name and Signature City of Northampton Massachusetts DEPARTMENT OF BUILDING INSPECTIONS 212 Main Street •Municipal Building Jti �D Northampton, MA 01060 sS" 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 beingperformedat: 7 (Please print house number 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: (Company Name and Address) _2 �7 ignature of Permit A licant 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. Home Improvement Agreement: Pagel Home Depot License #'s - For the most current listing www.Homed-apQt.com/LicenseNum,bers MA: 107774, 112785 Rayon Robertson Salesperson Name: Registration No. (if applicable): Home Depot U.S.A., Inc. ("Home Depot") or Service Provider named below will furnish, install and/ or service the equipment listed below at the price, terms and conditions as outlined on this form. rice 1 rachel New England South 1-MNOUQUV Customer Last Name Customer First Name Store # / Branch Name Customer Lead/ PO# 8 Aldrich Street Northampton MA 01060 Customer Address City State Zip (413) 588-1295 sukiandlucy@hotmail.com Home Phone# Work Phone# Cell Phone# Customer Email Address NOTICE OF RIGHT TO CANCEL: YOU MAY CANCEL THIS AGREEMENT WITHOUT PENALTY OR OBLIGATION BY DELIVERING WRITTEN NOTICE TO HOME DEPOT AT: 908 Boston Turnpike Unit 1 Shrewsbury MA 01545 Address City State Zip Or Email: I customercancellationnortheast@homedepot.com Service Provider Email Address BY MIDNIGHT ON THE THIRD BUSINESS DAY AFTER SIGNING, UNLESS THE STATE SUPPLEMENT PROVIDES A DIFFERENT CANCELLATION PERIOD. THE STATE SUPPLEMENT CONTAINS A FORM TO USE IF ONE IS SPECIFICALLY PRESCRIBED BY LAW IN YOUR STATE. YOUR PAYMENT(S) WILL BE RETURNED WITHIN TEN (10) BUSINESS DAYS AFTER HOME DEPOT'S RECEIPT OF YOUR NOTICE. YOU MUST MAKE AVAILABLE FOR PICKUP BY HOME DEPOT OR SERVICE PROVIDER, AT YOUR SERVICE ADDRESS, AND IN SUBSTANTIALLY THE SAME CONDITION AS WHEN DELIVERED, ANY MERCHANDISE OR MATERIALS DELIVERED TO YOU. OR YOU MAY CONTACT HOME DEPOT FOR INSTRUCTIONS REGARDING RETURN SHIPMENT AT HOME DEPOT'S EXPENSE. THE LAW REQUIRES THAT THE HOME DEPOT GIVE YOU A NOTICE EXPLAINING YOUR RIGHT TO CANCEL. PLEASE SIGN BELOW TO ACKNOWLEDGE THAT YOU HAVE BEEN GIVEN ORAL AND WRITTEN NOTICE OF YOUR RIGHT TO CANCEL. Acknowledged by: 09/11/2019 Customer's Signature Date Contract Price and Payment Schedule : Payment of the Contract Price is due upon signing unless a different payment schedule is required by law, specified below or in a payment addendum. Contract Price: $ ;14ss� oo Includes all applicable taxes. Excludes finance charges.* Sales Tax: $ o.00 (If applicable) *Maximum deposit ONL Y applicable in MD, MA, ME(33%), NJ, Wl(99%) Dep. 125.0 7 % Deposit Amount $ 1372 Remaining Balance $ 11116.00 The Home Depot-2455 Paces Ferry Road, N.W. Bldg. B-3, Atlanta, Georgia 30339-Customer Care: 1-800-466-3337 460FI HDE Customer Agreement(24 Jul.18) v J.1.8 Home Improvement Agreement: Page2 Finance Charges: *Any interest payments or other finance charges will be determined by Customer's separate cardholder or loan agreement, to which The Home Depot is NOT a party, and will be in addition to Customer's payment under this Agreement. Customer is subject to the terms and conditions of the cardholder or loan agreement, as applicable. No funds should be made payable to Service Provider; however, Service Provider may collect Customer's payment(s) made payable to The Home Depot. Insurance proceeds will will not be used to pay some or all of the total amount of sale. Description of Work to be Performed: Installation of 1windows A more detailed description of the work to be performed is included in the section entitled Scope o Work which appears on page 0 of this Agreement. Anticipated Delivery Date/Installation Schedule Approximate Start Date: 11/os/2o1s Approximate Finish Date: 12/04/2019 All dates are approximate and subject to change based on unforeseen events including inclement weather, permitting delays, and delays in confirming insurance coverage of Your claim for any repair, if applicable. Electronic Records Authorization: You are entitled to a paper copy of this Agreement if you choose. If you consent to an e-mailed copy, your consent applies to this Agreement and all subsequent documents and written communications related to this agreement. By contacting your Service Provider, you may update your email address, withdraw your consent, or obtain a paper copy of the Agreement or related documents at no charge. By providing your consent and verifying your email address above, you confirm that you have access to a computer that can receive and open emails and PDF documents. By initialing this paragraph, I consent to receive only electronic records related to this transaction. %) Initial Acceptance and Authorization: By signing below, you authorize Home Depot to (a) arrange for Service Provider to perform Installation and/or (b) order and arrange for the delivery of special order merchandise, including special order merchandise that may be custom made, as specified in this Agreement. Do not sign if blank or incomplete. (Service Provider's/permitting information may need to be provided to You later.) By signing, you acknowledge that you have read, understand, and accept this Agreement in its entirety, including the General Terms and Conditions and State Supplement, if any. You further acknowledge receiving a complete copy of this Agreement. Keep it to protect your legal rights. X 09/11/2019 IThe Home Depot Customer's Signature Date Service Provider Name X 1 09/11/2019 908 Boston Turnpike Unit 1 Co-Signer (if applicable) Date Service Provider Address Shrewsbury _ 54X 09/11/2019 ] 5 i na a Behalfo t Date tate i Se erovider P r Service Provider License Number The Home Depot-2455 Paces Ferry Road, N.W.Bldg.B-3, Atlanta, Georgia 30339-Customer Care: 1-800-466-3337 460M HOF Customer Agreement(24 Jul.18) v O.1.8 WINDOW SPECIFICATION SHEET - Spec.Sheet#: 1-MNOUQUV Sheet: 1 of 1 Customer: rachel rice Job#: 1-MNououv Consultant: Rayon Robertson Date: 09/11/2019 New Window Existing Window Hinge Locations Measurements Grids Product Options Labor Options From outside, Left to Right Bays,Bows Location Color Rough Opening #of bars #of bars Csmnts.1 Pnl, use L,R or S Glass Hardware Misc Items Cade Screens For doors use LL c c c Mull "S"=stationary or Style Wraps g o t R t X"=operating w S Room Floor Code (YM) Style Code Series Code S w 3 x r E6 o a > M .� > i STD,White, WRAP,LSR 1 BED 1st DH Y DH 6100 WH WH 32 57 89 F, WH,W C ALL 2 1 ALL 2 1 GlassPack:Standard GBG H STD,White, WRAP,LSR 2 BED 1st DH Y DH 6100 WH WH 32 57 89 F, WH,W C ALL 2 1 ALL 2 1 GlassPack:Standard GBG H SPECIAL CONSIDERATIONS: 1:While,2:White Wrap Color nterior Casing Type Bay or Bow window: atboard material(vinyl only-Birch or Oak) ay Project Angle(30 or 45) ay Flanker Type(DH,SH,or Csmnt) op of window to soffit(inches) f tied to soffit,color of soffit material I have reviewed and agree with all the job specifications above and the Construct Roof(Yes or No)' Special Terms and Conditions on the following page Garden Window: eatboard Material(vinyl only-White Plonite,Birch or Oak) SKOTI 0, CS-1043- Xpir : r CE APEE MA 010" the' f 41 .. - _t•-.''�" .dCr Vai':c-C-.. t71.- f L r= i�' '_•Owti``.L?'� n.i.VV r;z,, r'i�Crl ]•(f«I` .\;C:�:t:t92irJ.ti-a� del = ='S:i•—_-� j( .�.f21�'.vim. .Ti(8-^"(:r!�a�fr �f i�IG r 1�rn_ !� r. f�!-t SS if l:: {�1f��0-:sOfi C�I;ZS + 0=7 s G.!�� __4-UAC!(5e!OF-RMI!t71i:!f NTN Ri'MPIC-i~S!CC( i 0.24 :I ADDI!(ON_z.L 1=-EtRtrflR[!9ANCE RAi PIfi� 'I cI�LU��tp�I�LclEt�liA?fRO'c?E11D[[s11EI��ip � ' ItLii 1: !_),4 1; :i `_.—.-_---- _. c_t. -- = '-_-- _ _'----= —=-tam-•_'-'>-�.- --..�:.__�.�_=iii .f •t..�v •• :i- -��:' /r U..h`•.•_ _ it gcfifice,.�.for ENERGY r---- -r •..>:f. i,_ STn,.ti r=gicn(C):1(o�tr�r;1, _ f hs:-1 �;�%�::•,=?�:a�, r-- :_ 'iL I CrUl Sentra centmi, x €1 f,r. "'St���;�=.:`�•a��:r1' .•r,�;��-'='-�^•%- SI:.1:(f:E.iZ I ?M'3"•.� '`i !� � _' ""�'=fs�!� �+-�+•tel 2�flLt't���•''-��`.�r�3:,; .� _ >��:•�-`_�-•ter a.;��„ -— �- `= a =� - Sf-C 2!? f: i I= •�s�r1 1, fIMC.:R*in001G-(ass PruSaarA4-LC26 of i I esia0 Size_^�"X 30" ' i( tr.-CIiG';!1rCGUG!'!%7�;7c;ar:i'�Lti iG: !1 li ! e t � Aaaficaaie a 'cS .ri�:�ys: ilBli-��iRRl�11J:u�_iO;f.S^ AA;1`;i1f�JDi' AtCSA It j �f!j�t.5. in�i'�',L:1u.i_�f`;:P-=5�+t�tlir'vtCSniG,t1.SJA�•^-G8, �� • �� ------- 1:=;�GS,t-Gc CSI+=C.f2i:Slitl�7i � . E� �8afi78010 i aE333� S E is=:zl i 640009:2:. �j � :�r.�sec�: -a3�s_�� :._= :.fin�_�-_<ni:.uua�k�ai=�•, i� r-�w•�-wri— -^•�^>_�ti��_'3—�_� -.S�Yf.��i LY:iG�'�.-ice�y�t'L:•8•'-��r.:iG wF t� f - :a i Office of Consumer Affairs and Business Regulation 1000 Washington Street - Suite 710 Boston, Massachusetts 02118 Home Improvement Contractor Registration Type: Supplement Card HOME DEPOT USA INC Registration: 112785 P O BOX 105451 Expiration: 04/22/2021 ATTN: LICENSE MGMT TEAM ATLANTA, GA 30348 SCA 1 s 20M�W•17 Update Address and Return Card. Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only TYPE:Suoolement Card before the expiration date. If found return to: Registration Expiration Office of Consumer Affairs and Business Regulation i 127F5 04/22/2021 1000 Washington Street -Suite 710 HOME DEPOT USA INC Boston,NIA 0 Ila RICHARD TROIA 2455 PACES FERRY RD C-11 HSC �!�•,"<� ATLANTA,GA 30339 Undersecretary Not valid without signature The Commonwealth Lf1t_rflS:sf1C'IttlSelt,S 0773eprrt•tnzent of IndasitiftlA cidents• I Congt ass Std eat,Sttit e 100 t — Bovflln, AM 02114-2017 W)V)ti.1171ISS•.-01,11lla W(jrhet's'Compensation Insuranee AFfidavit:(3uiltiers/ContractnrslElecfricians/Plumbers. TO BE FILEM WITH THE,PER1dITPJiNci AiJ'i i1QitIT!', An rliear.t infat-rtlation Please Print Legibly 1 Name (Busincss/Organiutiordlndividual): E Address: I City/State%%ip::_ Phone u- —;7Z i Are ynu an crtrploye:l Chcch the appropriat hoa: JI Type of project(required): t L❑1 am a employer with cmployces(full and/urpart-time).' 7. []New construction 2.0 1 an,a sole proprietor or partnership and have no entployeas working for me in coy cap;city.f;lo workers-comp_insurance reyuir�d.) 8. ❑ Remodeling 3.❑1 am a homeowner doing all work myself fo t:crkcrs'coma,inatrance required.]t i y ❑ Demolition = 4❑I am a homcustner end,ill b: hiring contractors to conduct all work on my PrPo ^rty. i will 10❑Building addition - cnsur--hat all contractors either imve wnrl:ers'eoropens pion insurance or are sole I i.❑Electrical repairs or additions pr 1ctors with no cmployecs. 3- gznem!contrctor and 1 have!tired the sub-contractors listed on the attached sheet. Plumbing repairs or additions These sub-cct:tracturs have employees and'nave ivorkers'comp.inswance: 13_❑Roof repairs d.❑WC Ire a corporation and its officers have exercised their right of exemption per AdGI c. 14•K:�61her 1 � 152.J 1(4),and we have no cmp;oyees.[No%:Porkers'comp.insurance reGuirdd.j Any applicant that check box#11 mets[also till out th- ..,t.-durt[•clow shu:ving their tverkers'eompnsallon policy i;formiiion_ g Honeowvners who submit this affidavit indicating they aro doing all w•orl:and then hire otuside cunuactors Must submit a newal-1davil indicating such. e+ Contractors dint check tlris hox must anachcean additional sheet shaeving the name of the sub-eontractors and state Micth-cr or not those entities have empluyecs. It'tile sub-contracture have emplayees,they mist provide their woi!.i •Comp policy number. tt 1 11111 tiff efrrploj+er t?fgt is providizr;ivorlcers'c•ofnpeflsutioff i,isrlraitce ft-r nfy employees. 3ela3v is fire policv alld job site ifzj'ornlntion. �Q / insurance Company Name: !'\�� f �i���2 644111Qw Policyi"or Self-ins.Lie.'%:X __ Expiration Datc: !( s p Job Site Address: ? r�U�—��'� >l ^ City/Statejzip: ��•• r Minch n co 13fthe lvorkers Com tensaiion policy declaration rage howino the olio number and ex tea on nate� 'J 0 Copy 0 ' I Y page 1 P Y p ) 0 Failure to secure coveragerequired ,� as re 4i ed under I�iGL c. =.. 1 , §25A is a criminal violation punishable by a fine up to S1,500.00 and/or one-year imprisonment,as well as civil penalties in the four;of a STOP tiVOUI ORDER and a fine of up to$250.00 a u day abainst the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance ccvcrage VoriiieailGi7. 1 def hereby certify jphde Gifts fttl lin -•'s of p jury that life irtfifr;nlNinff provided uba>>e is true fffui correct. t, Si nature: G .__ i a / Date: / p Phone `72, R Official t1se ortlj'. Do riot wrlee in this ores to be completed by efty or toivit ofCff( a � City or Town: 'Permit/License:'1_ la Issuing Authority(circle one): } 1,Board or health 2.Building Department 3.Cit l-Fotyn Clerk 4.Electrical Inspector 5.Plumbing Inspector t fi.Other, �3s uf. I Contact Person: Phone N: -t E DATE(MMIDDIYYYY) A`ORO® CERTIFICATE OF LIABILITY INSURANCE 02106/2019 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 MARSH USA,INC. NAME: TWO ALLIANCE CENTER A/CONNo Ext): AIC,No): 3560 LENOX ROAD,SUITE 2400 E-MAIL ATLANTA,GA 30326 ADDRESS: INSURERS AFFORDING COVERAGE NAIC# CN1 01642069-HomeD-GAW-1 9-20 INSURER A:Old Republic Insurance Co 24147 INSURED THE HOME DEPOT,INC. INSURER 13:New Hampshire Ins Co 23641 HOME DEPOT U.S.A..INC. INSURER C:HomeRisk Captive Insurance Company 2455 PACES FERRY ROAD INSURER D: BUILDING C-20 ATLANTA,GA 30339 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: ATL-004353439-28 REVISION NUMBER: 21 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 SUER POLICY NUMBER MM DDY EFF POLICY EXP LTR1H.1&WVD /YYYY) (MMIDDIYYYYI LIMITS A X COMMERCIAL GENERAL LIABILITY MWZY 314574 03/01/2019 0310112022 EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE a OCCUR PREMISES Ea occurrence E 1,000,000 X SIR:$1,000,000 MED EXP(Any one person) $ EXCLUDED PERSONALS ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE y 1,000,000 X POLICY PRO- JECT F LOC PRODUCTS-COMP/OP AGG $ 1,000,000 OTHER: b A AUTOMOBILE LIABILITY MWTB314573 0310112019 0310112022 COMBINEDident SINGLE LIMIT E 1,000,000 Ea ax X ANY AUTO BODILY INJURY(Per person) b OWNED SCHEDULED SELF INSURED AUTO PHY DMG BODILY INJURY Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per accident $ UMBRELLALIAB OCCUR EACHOCCURRENCE b EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED I I RETENTIONS L B WORKERS COMPENSATION WC 012717099(AK,NH,NJ,VT) 19 03101/2020 X I PER OTH- B AND EMPLOYERS'LIABILITY STATUTE ER ANYPROPRIETOR/PARTNERIEXECUTIVE 'Y/N N WC 012717100(WI) 03/01/2019 03/0112020 5,000,000 OFFICER/MEMBER EXCLUDED? � NIA E.L.EACH ACCIDENT S (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE E 5,000,000 Ir es,describe under Continued on Additional Page 5,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT b C Excess Auto 297110011002019 03101/2019 0310112020 Limit: 4,000,000 A Excess General Liability MWZX 314580 03101/2019 0310112022 Limit: 8,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,maybe attached if more space is required) EVIDENCE OF INSURANCE CERTIFICATE HOLDER CANCELLATION HOME DEPOT USA,INC SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 2455 PACES FERRY ROAD THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN BUILDING C-20 ACCORDANCE WITH THE POLICY PROVISIONS. ATLANTA,GA 30339 AUTHORIZED REPRESENTATIVE of Marsh USA Inc. Manashi Mukherjee dirt Quyon.� �liQ, t�rw d ei ©1988-2016 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD