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24D-004 (2) 229 PROSPECT ST BP-2020-0591 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Biock:24D-004 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# BP-2020-0591 Project# JS-2020-001014 Est.Cost: $3800.00 Fee: $40.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: SEXTON ROOFING CO 99689 Lot Size(sg. ft.): 6621.12 Owner: MCGHEE WILLIAM O& Zoning: URB(100)/ Applicant: SEXTON ROOFING CO AT. 229 PROSPECT ST Applicant Address: Phone: Insurance: P O BOX 6327 (413) 534-1234 WC HOLYOKEMA01041 ISSUED ON:11/7/2019 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 Deaartment 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 Sisinature: FeeType: Date Paid: Amount: Building 11 7/2019 0:00:00 $40.00 212 Main Street, Phone(413)587-1240, Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner Department use only r�r City of Northampton Status of Permit: Building Department Curb Cut/Driveway Permit r � . { 212 Main Street Sewer/Septic Availability Room 100 Water/Well Availability Northampton, MA 01060 Two Sets of Structural Plans phone 413-587-1240 Fax 413-587-1272 Plot/Site Plans Other Specify APPLICATION TO CONSTRUCT,ALTER, REPAIR, RENOVATE OR DE OLI$4-1 A ONE OR TWO FAMILY DWELLING ON.PA'o 0 )6�°NS 6 0- '>o - S-�l SECTION 1 -SITE INFORMATION 1.1 Property Address: This section to be completed by office Map Lot v�r O Unit 229 Prospect St Zone Overlay District Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: William Mcghee 229 Prospect st northampton Nam (Print) Current Mailing Address 584-2843 Telephone Telephone Signature 2.2 Authorized Agent: Name(Prin 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 =0 +2+3+4+5) Check Number a This Section For Official Use Only Building Permit Number: Date Issued: Signature: Building Commissioner/Inspector of Buildings Date )OZ V 2C2.(� @ /�O EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR) �'7 SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable) New House ❑ Addition ❑ Replacement Windows Alteration(s) Roofing Or Doors ED Accessory Bldg. ❑ Demolition ❑ New Signs [O] Decks [Q 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 each family unit: Number of Bathrooms c. Is there a garage attached? d. Proposed Square footage of new construction. Dimension e. Number of stories? f. Method of heating? F' places 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 wetlan Yes Is construction within 100 yr. floodplain Yes No j. Depth of basement or cellar floo elow finished grade k. Will building conform to t Building and Zoning regulations? Yes �No. I. Septic Tank City Sewer Private well City wat Supply SECTION 7a-OWNER AUTHORIZATION-TO BE COMPLETED WHEN OWNER S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT (I, l(I as Owner of the subject property hereby authorize � — to act on my alf, in all matters relative to work authorized by this building per it application. I ( ( S1t � Signature of Owner Date as Owner/Authorized Agent hereby declare that the statements and information on the f regoing application are true and accurate,to the best of my knowledge and belief. Signed under the pain=nalties of perjury. �N Print Name A� lilt- IF Signat of Owner/Agent Da e SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder: PUyek �Y� --J 99e/1111 Liven a umber Address ( / Expiration Date S Sign re Telephone 9.Reaistered Home Improvement Con ctor: Not Applicable ❑ C Vj h/ omban Name Registration Number ;k-," to)— r Address II (p Expiration Date Telephone l 2 7 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....... IT-- No...... ❑ City of Northampton r Massachusetts k DEPARTMENT 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 budding"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 hereby apply for a building permit as the agent of the own w tZ6 e 't �J, 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 �P— 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: f,/6"5 -ems - S� (Please print in, n,lnihpr and street name) Is to be disposed of at: OAsz,tl,� (Please print name and location of facility) Or will be disposed of in a dumpster onsite rented or leased from: (Company 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. ------------------------------------Propos a ---------------------------------------- SEXTON --------------------------------------- SEXTON ROOFTNG AND STDING INC www.sextonroofing .com P.O. Box 6327 setting the Standard o ly o ke 9 MA. 010 41 p . 413 .534 .1234 f.413 .{ 39 .9906 MA HIC # 1 1 8239 s e_xt onroof ing @hotmail.com SUBMITTED TO William Mcghee PHONE 584-2834 DATE 10/29/ 19 STREET 229 Prospect St. JOB NAME Front Roof CITY, STATE,ZIP -NI Z71 JOB LOCATION PT`c t -.t ee SEXTON ROOFING HEREBY SUB S PECIFICATIONS 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 15 yr. workmanship warranty. We Propose hereby to furnish material and labor - complete in accordance with the above specifications, for the amount of Three Thousand Eight Hundred Dollars $3,800.00) Payments to be made as follows: Due in full u on completion All Material is guaranteed to be as specified. All work to be Author completed in a workmanlike manner according to standard Signa re practices. Any alteration or deviation from above specifications involving extra costs will be executed only upon written orders,and ---- ------ will become an extra charge over and above the estimate. All _-----_ _ agreements contingent upon strikes,accidents or delays beyond our control. Not responsible for water damage during construction. Note: This proposal may be withdrawn by us if not Owner to pay responsible legal fees for non-payment,and applicable interest. accepted within (14) days. The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,Mass. 02111 www massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Orgmizationandividual)_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. 1: I am an employer with _ 4.A I am a general contractor and I 6. :1 New construction employees(full and/or part time).* have hired the sub-contractors 7.1 ' Remodeling 2. :' I am a sole proprietor or partner- listed on the attached sheet. ship and have no employees "These sub-contractors have 8. 1: Demolition working for me in any capacity. employees and have workers' 9. 1; Building addition [No workers'comp.insurance comp.insurance.++ required] 5. ' We are a corporation and its 10. 1. Electrical repairs or additions 3. I am a homeowner doing all work officers have exercised their 11.1 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. 1 Other comp.insurance required.] --- — — *Any applicant that checks box#1 must also fill oat the section below showing their workers'compensation policy information• tHomeow hers who submit this affidavit indicating they are doing aft work and then hire outside contractors most submit a new affidavit indicating sacb. $Contactors that check this box mast attach an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. if the sub-coutraetors have empbyees,they most provide their workers'comp.policv number. I am an employer that is providing workers'compensation insurance for my eWloyees.Below is the policy and jab site information. Travelers Property Casualty Company of America Insurance Company Name: Policy#or Self-ins.Lic.#:UB-OG078982-19 E 06/04/2020 xpfratto Date: Job Site Address: ((�S 5 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 herbycertify r der the pains andpenalties ofperjury that the information provided above is true and correct. Signature: Date: Print Name_ E✓ ZTl" Phone#: �-} /y • aid-` - J �; 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): I.Board of Heath 2. Building Department 3.Cityffown Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact person: Phone#• CERTIFICATE OF LIABILITY INSURANCE °ATE(MM/DD/YYYY) TAIL&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 BETWLEN THE ISSUING INSURER(S).AUTHORIZED REPkESEN T AT1VF OR PRODUCER AND THE CERTIFICATE HOLDER. ,IMPORTANT:If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require and endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement's). PRODUCER CONTACT NAME: ORMSBY INS AGCY PHONE FAX PO BOX 718 (A/C,No,Ext): (A1C.No): E-MAIL WEST SPRINGFIM D,MA 01090 ADDRESS: 286TF INSURER(S)AFFORDING COVERAGE NAIC 9 INSURED INSURER A: TRAVELERS PROPERTY CASUALTY COMPANY OF AMERICA SEXTON ROOFING&SIDING INC INSURER B: INSURER C: INSURER D: PO BOX 6327 INSURER E: HOLYOKE,MA 01041 INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY 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 CLAWS. WSR CDDL3UBR POLICY EFF DATE POLICY EXP DATE LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER (MM1DD\YYYY) (MMDD%YYYY) LRAITS GENERAL LIABILITY CH OCCURRENCE 5 COMMERCIAL GENERAL LIABILITY S CLAIMS MADE OCCUR. AMAGE TO RENTED REMISES(Ea o=ffmnce) ED EXP(Arty one prison) 5 ERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: ENERAL AGGREGATE �$ POLICY 0 PROJECT O LOC RODUCTS-COMP/OP AGG Is AUTOMOBILE LIABILITY COMBINED SINGLE $ ANY AUTO LIMIT(Ea accident) ALL OWNED AUTOS BODILY INJURY $ SCHEDULE AUTOS Per Pin) HIRED AUTOS BODILY INJURY s Per accident) NON-OWNED AUTOS PROPERTY DAMAGE $ Per accident) UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS UABL_J CLAIMS-MADE AGGREGATF $ DEDUCTIBLE $ RETENTION $ 5 A WORKER'S COMPENSATION ANDWC STATUTORY OTHER EMPLOYER'S LIABILITY Y/N UB-OG078982-19 06/04/2019 06/042020 X OMITS ANY PHOPFRITOR/PARTNFR/EXECUTIVF NIA E.L EACH ACCIDENT $ 1,000.000 OFHCERMFLIP,ER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe urxler DESCRIPTION OF OPERATIONS below E .DISEASE-POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONSJLOCATK)NS/VEHICLES/RESTRICTtONS/SPECWL ITEMS TIES RF:PLACFS ANY PRIOR CERTIFICATE ISSUED TO THE CERTIFICATE HOLDER AFFECTING WORKERS COMP COVERAGE. THE INSURED'S MA WOR]CER.S COMPENSATION POLICY AND ITS LIMnFD OTHER STATES ENDORSEMENT AUTHOREMS THE PAYMENT OF BENEFITS FOR CLAIMS MADE BY THE INSURE SMA EMPLOYEES IN STATES OTHER THAN MA NO AUTHORIZATION IS GIVEN TO PAY CLAIMS FOR BENFFnS IN STATES OTHER THAN MA IF THE INSURED HIRES,OR HAS HIRED EMPLOYEES OUTSIDE OF MA THIS POLICY DOES NOT PROVIDE COVERAGE FOR ANY STATE OTHER THAN MA CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENT7E ACORD 25(2MWD% The ACORD name and logo are registered marks of ACORD 1988-2010 ACORD CORPORATION. All rights reserved. The Commonwealth of Massachusetts Department of Industrial Accidents I Congress Street,Suite 100 s Boston,:ifA 02114-2017 ,mss www-mas&gov/dia t�orkers'Compensation Insurance AfTid"it:General Businesses. TO BE FILED%17TN THEPERyiCfT1NG ACTHORITti'. Applicant Inform�tiori PlceSt. Print I c.!,thly Business/Organization name:MNP CONSTRUCTION INC Address:45 EXCAHNGE ST City"Istate;?,ip:MILFORD. MA.01757 Pone x:508-498-8870 -- - Are you an employer?Check the appropriatebox: Business Type(required): ` I•Q l am a employer with 5 `employees(full and 5• ❑Retail _'.❑ or part-time).'' 6. RestauranL Bar Erring Establishment 1 am a sole proprietor or partnership and have no 7 Office and,or Sales(incl.real estate,auto.etc.) employees working for me in any capacity. [No workers'comp.insurance required] g- O Non-profit ❑ We are a corporation and its officers have exercised 9. []Entertainment their right of exemption per c. 152,$1(4),and%c have no employees.jNo workers'comp.ins 10-❑Manufacturing p. trance requiredj' 4.❑ We are a non-profit organization,staffed!iy volunteers, 11.Q Health Care s+ith no employees.[No workers'comp,insurance req.j 12.0 other CONTRACTOR Am applicam that checks t—,fl must also till our the secimn beloN shaam licit workers"cotnlrnsauon poitcs ttttorrtta[turt "If the ccxpmate offkvrs hmt c exempted themselt e..;.hitt the co organization,hound check hos#i rpcxatton has other empltnres a workers"compensation policy is required and such an i am an emplm er that is proriding workers'compensation insurance or nn•e f mpto}•ees. Below is the polid•informarinlr. Insurance Company Name:HARTFORD UNDERWRITERS INS. CO. TRAVELERS-RMD Insurer's Address:P O. BOX 5600 City-State.Zip: HARTFORD,CT.06102 - Policy;;or Self-ins.Lic.4 IK709706 1 1116/2019 Attach a copy otthe workers'compensation _. Expiration Date: Pe Policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of fine up to SI,500.00 and or one-year imprisonment.as well as civil penalties in the form of STOP til ORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of In%esti;ations of the DIA for insurance coverage verification. 1191 !do/rerebc certr u t p r19trJ p ftrlties of peryuty that the information provided above is true and c•orrec7. St attire: 'f !'�'' / / �.. Date: 1 Phone-..978-403-5942 Fial use onie. Do not toile in rftis area,to be completed In•cit}•or town offidaL or Town• Permit/License# ngAuthority(circle one): ard of Health 2.Building Department 3.Cit 6.Other.__ V/Town Clerk 4.Licensing Board -5..Selectmen'sOffice .- LL—t-ef Person: Phone#: '%%A%,Mass CERTIFICATE OF LIABILITY INSURANCE DATE(MruDnmrrl THIS ca;ffwCERTIFICATE DOE IS ISSUED A5 A MATTER OF INFORMATION ONLY AND CONFERS NO RIGh75 UPON THE CERTIFICATE HOLDER_ 9 t!S CERTIFlCATE DOES NOT 05/i0/2019 BELOW. AFFIRMATIVELY Oil NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES THIS CERTIFICATE OF (NSUR M CE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING iNSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CER'17f-7CrgTE HOLDER. IMPORTANT. If the certificate hoiden is an ADDf7iONAL the terms and conditions of INSUREDy(ies),the POIPcmust be endorsed. If SUBROGATION IS WAIVED,subject to the P�icY�cetrlairt po certificate hoiden in lieu of such endorsement{s)_licies m aY require an endorsement. A statement on this certificate does not confer rights to the PRODUCER ONE FAMILY INSURANCE AGENCY LLC COHrACT NAME An Cl PHONE - — lA7C NgEzn: {9T$)403-5942 1 Main St Suite 15 n cnRgss: aCatVlll012$�Q yahOp_ - - _— LVnen17Uf9 _ —._._._ iHSURER(s)AFFORDING COVERAGE i _MA 01462 NA1C= u+stlReD -— '- —- _ n+sur ILA_ HARTF_O_RD UNDERWRITERS INS CO 1 30104 MNP CONSTRUCTION INC — e+simExC_— --- i 45 EXCHANGE ST APT 3E u URst D - ---- —- MILFORD SI!f rE — COVERAGES MA Oi757 INSURER F: -- — CERTIFICATE NUMBER: 401083 THIS IS TO CERTIFY TSiAT Tl lc POLICIES OF INSURANCE LISTED BELOW HAVE gcEJN REVISION NUMBER: INDICATED. NOTyyli}{STi4fVOLNG ANY REOUIREMENT, TER OR CONDITION OF ANY Ci.SSt1ED TO THE INSURED NAMED ABO FOR THE CERTIFICATE MAY BE ISSUED OP,MAY PERTAIN, THE INSURANCE ADITION O BY E POLICY PERIOD EXCLUSIONS AND CONDMONS OF SUCH POLICiES.LIMITS SHOkN MAY HAVE OTHER DOCUMENT WIT}{RESPECT TO WHICH THIS THE POL1C(E$DESCRIBED HER IS SUBJc'C7 TO ACL THE TERMS, ii�sR 1- BEEN REDUCED BY PAID CLApNS. LTR TYPE OF INSURANCE —..—!iDDUSUBR�-— ---.._ C 014MERCIAL GENE Pot ICY NUMBER I POLICY E'FF I q-�--- ----_— _. - _ RAL LlABi11TY i ' I DSS "DE L CCCUR k I EACR OCCURRENCE I 1DAr.IAt;,E" ki'jim S P-R--�MiSES�Ear - S-- - - - AtEb EXD NIA ( —�-1 3— -- - ' l GE1MOLTAYGEGfRL EGATcWITA __- I 1 iI PERSONAL SL&-CA0D1V1WINJURY/OPE , - I Ss —PK ?PRO- JECT IEGAT�IEAGGAUro0LiAlirl P�O _— -- i -- iIs �!ANY AUTO j as �✓•:dc�i (TALL S —'�UT� -J AUTOSED , 11Ai INJURY(I m persenT_T5 I HIRED AUTOS ! I NDN'ol ' � F AUTOS 300r�Y RiJURY(Pet __ -- --�uuAs OCCUR ! i (I s -- - -j Excess LtAB I CLPJ%M R ADE! N/A I I EACH s DED RETEM70M5--_r i i 1 i AG(,fiEGATE WORK—COMPENSATION t �—MBRELLA D E.SWLDYERS'LIA31LItY j I is A a WROPRLETORr•+r ARTNERIExZCUT� YIN• i I I X. ATU:E !E{ i ICERIMEADEREXCLUDEM N/A,�NIA ' NIA' torylANH) 6SEOU81K70970618 1 11/16/201$1 11/1612019!= EACHAtrCtD�r s 1,000,000 I OESCRd�lf)N O OPERATIONS bell ! I � -=A�LOVF-E s 1,000,000 I 1 i EL DISEASE-POLICYLtEAiT i S 1.000,000�- i ! NIA OESCRITYION OF OPERATIONS".—TION VEHICLES(ACOR0101,Additional Remarks Seht-- m Workers Compensation benefits v+il!be paid to Massachusetts employees onh_Pursuano Endorsement WC 20 t)3 DIE B,nc authorization is given:o pay clais required) ims for be to employees in states other than Massachusetts if the insured hires,or has hired those employees outside o€Massachusetts. This certificate of insurance shows the policy in force on the date l this Cer'issue date of this cer ificale Of insurance)_ The status of this Coverage can be monitored dairy y accessing theificate was issued(unless thl Prooforation atCo Coverage-Coverage Veri ication4 Search tool at mvw_mass.govRwdtwOrkers-co Policy precedes the InRensatio�nvesJtgaliorlJ_ CERTIFICATE HOLDER i CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE SEXTON ROOFING 8 SIDING INC THE EXPIRATION DATE THEREOF, NOTICE WILL 6c DELiVERED iN 102 PINE ST ACCORDANCE WIT}{r}iE POLICY PROVISIONS_ HO!YOX� AUTHORQED REPRESEhTATivE MA 01040 I `L Daniel M.Cro'v)ny,CPCU,Vice President-Residual t.4arket-WCRIBMA j ACORIJ 25(2014101) The ACO 1988-2014 ACORD CORPOi�AT15 Att rights reserved_ RD narne and loco are registered marks of ACORD office of�t eF rs and Business °n-�,` �e�-scree��uta&on Home lnvov�,� P�O Sj G types HOLYb , 01041p 118239 - 4aw{ C '11 PO , ��.f021T SP, HOME IMP ~ I©�fOlUr At33t3 � ESR TT SEX T CONTRACTOR TON SR 102 Pine St HOI �� 01040.2411 SF XTO N ROOFING SIDI 111C.0605383' G co S�kED 12 1/2019 EXp4on" 11/30/2020 Commonwealth of Massachusetts— ' Divisionof Professional Licensure Board of Building Regulations and Standards Constructio�r5dpeP& Qr Specialty CSSL-099689 EVERETT J SEXTON expires:10/0.5/2021 PO BOX 6327- HOLYOKE MA-.01041 r ��'�.t•::tib yt Commissioner