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23B-047 (32) 80 LOCUST ST-SMITH VOC BP-2020-0740 GIS#: COMMONWEALTH OF MASSACHUSETTS Man.Block:23B-047 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-2020-0740 Proiect# JS-2020-001277 Est.Cost: $118000.00 Fee: $0.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: WOJCIECH PIWOWARCZYK076146 Lot Size(sq.ft.): Owner: NORTHAMPTON CITY OF SMITH SCHOOL Zoning: URB(100)/WP(13)/M(0)/ Applicant. WOJCIECH PIWOWARCZYK AT. 80 LOCUST ST - SMITH VOC Applicant Address: Phone: Insurance: 2 CHECKERBERRY IS (508) 612-4008 WC WEBSTERMA01570 ISSUED ON.1212012019 0:00:00 TO PERFORM THE FOLLOWING WORK.-STRIP & SHINGLE ROOF POST THIS CARD SO IT IS VISIBLE FROM THE STREET Inspector of Plumbing Inspector of Wiring D.P.W. Building Inspector Underground: Service: Meter: Footings: Rough: Rough: House# Foundation: Driveway Final: Final: Final: Rough Frame: Gas: Fire Department Fireplace/Chimney: Rough: Oil: Insulation: Final: Smoke: Final: THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Certificate of Occupancy Signature: FeeType: Date Paid: Amount: Building 12/20/2019 0:00:00 $0.00 212 Main Street, Phone(413)587-1240, Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner (Lou Versionl.7 Commercial Building Permit May 15,2000 Department use only City of Northampton Status of Permit: Building Department Curb Cut/Driveway Permit 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,REPAIR, RENOVATE,CHANGE THE USE OR OCCUPANCY OF, OR DEMOLISH ANY BUILDING OTHER THAN A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION 1.1 Property Address This section to be completed by office 80 Locust St Map pZ 6 Lot a'�'7 Unit Zone Overlay District Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: Smith Vocational and Agr' ultural High School 80 Locust St,Northampton,MA Name(Print) /i' I Current Mailing Address: �, `C'10 ►1 (413) 587-1414 Signature( 1 — Telephone 10 5 t9 Q 2.2 Authorized Agent: Wojciech Piwowarczyk 2 Checkerberry Is,Webster,MA Name(Print) Current Mailing Address: (508) 612-4008 Signature Telephone P SECTION 3-EWTIMATEU,. ONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only complete by permit applicant 1. Building $118,000.00 (a) Building Permit Fee 2. Electrical (b)Estimated Total Cost of Construction from 6 3. Plumbing Building Permit Fee )/�► 4. Mechanical(HVAC) V 5. Fire Protection 6. Total=0 +2+3+4+5) -+7 1 Lto.cjc� Check Number This Section For Official Use Only Building Permit Number � 2 0- 7 0 Date -` "7 Issued Signature: WL �- T I Building Co issioner/Inspector of Buildings JU Date P ALTE/Z-0 WTI C-0 /v9pu C( 10 /1'/ (--0/*) 1J,A4d'G►Z 50(? // 9. //(-) n..P Version 1.7 Commercial Building Permit May 15,2000 SECTION 4-CONSTRUCTION SERVICES FOR PROJECTS LESS THAN 35,000 CUBIC FEET OF ENCLOSED SPACE Interior Alterations ❑ Existing Wall Signs ❑ Demolition❑ Repairs❑ Additions ❑ Accessory Building❑ Exterior Alteration ❑ Existing Ground Sign❑ New Signs❑✓ Roofing❑ Change of Use❑ Other ❑ Brief Description IDemolish existing asphalt shingle roofing system down to plywood Of Proposed Work. !sheathing.Replace any rotten or damaged plywood sheathing.Provide and install new asphalt shingle roofing system.Replace existing gutters and downspouts with new 6"aluminum. SECTION 5-USE GROUP AND CONSTRUCTION TYPE USE GROUP(Check as applicable) CONSTRUCTION TYPE A Assembly ❑ A-1 ❑ A-2 ❑ A-3 ❑ 1A ❑ A-4 ❑ A-5 ❑ 1B ❑ B Business ❑ 2A ❑ E Educational 2B I ❑ F Factory ❑ F-1 ❑ F-2 ❑ 2C ❑ H High Hazard ❑ 3A ❑ I Institutional ❑ 1-1 ❑ 1-2 ❑ 1-3 ❑ 3B ❑ M Mercantile ❑ 4 ❑ R Residential ❑ R-1 ❑ R-2 ❑ R-3 ❑ 5A ❑ S Storage ❑ S-1 ❑ S-2 ❑ 5B ❑ U Utility ❑ Specify: M Mixed Use ❑ Specify: S Special Use ❑ Specify: .i COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATIONS,ADDITIONS AND/OR CHANGE IN USE Existing Use Group: Proposed Use Group. Existing Hazard Index 780 CMR 34): Proposed Hazard Index 780 CMR 34): SECTION 6 BUILDING HEIGHT AND AREA BUILDING AREA EXISTING PROPOSED NEW CONSTRUCTION OFFICE USE ONLY Floor Area per Floor(sf) 1 St 1st nd�_. 2nd ( ._ 2 3rd 3rd 4"' I—f 4th L_. Total Area(sf) Total Proposed New Construction (sf) Total Height(ft) Total Height ft 7.Water Supply(M.G.L. c.40,§54) 7.1 Flood Zone Information: 7.3 Sewage Disposal System: Public ❑ Private ❑ Zone Outside Flood Zone❑ Municipal ❑ On site disposal system[—] Versionl.7 Commercial Building Permit May 15,2000 8. NORTHAMPTON ZONING Existing Proposed Required by Zoning This column to be filled in by Building Department Lot Size Frontage Setbacks Front Side L: R: L: R: Rear Building Height Bldg. Square Footage % Open Space Footage % (Lot area minus bldg&paved parking) #of Parking Spaces Fill: volume&Location) A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO O DONT KNOW O YES O IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO ® DONT KNOW Q YES o IF YES: enter Book Page and/or Document# B. Does the site contain a brook, body of water or wetlands? NO ® DONT KNOW e YES O IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained O Obtained © , Date Issued: C. Do any signs exist on the property? YES O NO O IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property? YES O NO O IF YES, describe size, type and location: E. Will the construction activity disturb(clearing,grading, excavation, or filling)over 1 acre or is it part of a common plan that will disturb over 1 acre? YES O NO O IF YES,then a Northampton Storm Water Management Permit from the DPW is required. Version 1.7 Commercial Building Permit May 15,2000 SECTION 9-PROFESSIONAL DESIGN AND CONSTRUCTION SERVICES-FOR BUILDINGS AND STRUCTURES SUBJECT TO CONSTRUCTION CONTROL PURSUANT TO 780 CMR 116(CONTAINING MORE THAN 35,000 C.F.OF ENCLOSED SPACE) 9.1 Registered Architect: 85 Chilson Rd,Wilbraham,MA Not Applicable ❑ Name(Registrant): 85 Chilson Rd,Wilbraham,MA Registration Number Address (413) 596-2360 Expiration Date Signature Telephone 9.2 Registered Professional Engineer(s): Name Area of Responsibility Address Registration Number Signature Telephone Expiration Date Name Area of Responsibility Address Registration Number Signature Telephone Expiration Date Name Area of Responsibility Address Registration Number Signature Telephone Expiration Date Name Area of Responsibility Address Registration Number Signature Telephone Expiration Date 9.3 General Contractor WPI Construction Inc Not Applicable ❑ Company Name: Wojciech Piwowarczyk Responsible In Charge of Construction 2 Checkerberry Is,Webster,MA 01570 Address (508) 612-4008 Signatur Telephone Versionl.7 Commercial Building Permit May 15,2000 SECTION 10-STRUCTURAL PEER REVIEW(780 CMR 110.11) Independent Structural Engineering Structural Peer Review Required Yes ® No e SECTION 11 -OWNER AUTHORIZATION-TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I. as Owner of the subject property hereby authorize �✓'I l to act on my inall ,matters relative to work authorized by this building permit application. x!"2/ /9//v Sig— n�of Owner Date l Wojciech Piwowarczyk , 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. C5)G.f��l PtwC�rC Zt,�� Print Narife SignatureOwner/Ag-en/ Date SECTION 12-CONSTRUCTION SERVICES 10.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder: Wojciech Piwowarczyk CS_076146 License Number 2 Checkerberry Is,Webster,MA 01570 01/02/2020 Address Expiration Date (508) 612-4008 Sign ure Telephone SECTION 13-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 (D No City of Northampton 212 Main Street, Northampton, MA 01060 Solid Waste 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. Address of the work: FU LOL,,y� S4- The debris will be transported by:C:Q� C1 W URO- 13145 k S V�� The debris will be received by: C�-sella bjC , �rvco Building permit number: Name of Permit Applicant WD : ec 11 tai �Jc t�e� �rc��-tom Date ZI I 4t11 Signature of Permit Applicant 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. Aonlicant Information Please Print Legibly Name(Business/Organization/Individual):WPI Construction Inc Address:2 Checkerberry Is City/State/Zip:Webster, MA 01570 Phone#:508-612-4008 Are you an employer?Check the appropriate box: Type of project(required): 1.E✓ I am a employer with 6 employees(full and/or part-time).* 7. ❑New construction I am a sole proprietor or partnership and have no employees working for me in any capacity.[No workers'comp.insurance required.] 9. E]Remodeling 9. El Demolition >.❑I am a homeowner doing all work myself.[No workers'comp.insurance required.]t 10 E]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 5.rl I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.WlRoof repairs These sub-contractors have employees and have workers'comp.insurance. 6.❑We are a corporation and its officers have exercised their right of exemption per MGL c. 14.❑Other 152,§1(4),and we have no employees.[No workers'comp.insurance required.] *Any applicant that checks box#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 is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name:Oxford Insurance Agency Policy#or Self-ins.Lic.#:6HUB9901 L94219 Expiration Date:01/01/2019 Job Site Address:80 Locust St City/State/Zip:Northampton,MA Attach a copy of the workers'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 under the pains and penalties of perjury that the information providedabove is true and correct. Si ature: 11�4 �+� Date: 1 2-119 Phone#: J�.p�- (z-(1 Uo d 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#: WPICONS-01 DKENNEY ACORO CERTIFICATE OF LIABILITY INSURANCE DATE (MM/ 11/20/20192019Y) 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 NAME: Oxford Insurance Agency,Inc. PHONE FAX PO Box 370 (A/C,No,Ext):(508)987-0333 A/C,No:(508)987-5517 Oxford,MA 01540 E-MDRIE :info@oxfordinsurance.com INSURERS AFFORDING COVERAGE NAIC# INSURER A:Penn-America Insurance Co. INSURED INSURER B:Green Mountain Insurance Company W P I Construction Inc. INSURERC: 2 Checkerberry Island INSURERD: Webster,MA 01570 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. INSR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF POLICY EXPLTR IMMIDDIYYYYI LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE I OCCUR PAV0214176 05/26/2019 05/26/2020 DAMAGE TO RENTED 5p000 PREMI E Ea occurrence) $ X BLANKET ADDITIONAL I 5,000 MED EXP An one person) $ PERSONAL&ADV INJURY 1,000,OOU GEN'L AGGREGATE LIMIT APPLIES PER: GENERALAGGREGATE $ 2,000,000 POLICY E-1 jECOT EILOC PRODUCTS-COMP/OP AGG $ 1,000,000 OTHER: BLANKET ADDITIO B AUTOMOBILE LIABILITY Ea acIED cld.n SINGLE LIMIT $ 1,000,000 ANY AUTO 20022002 12/22/2018 12122/2019 BODILY INJURY Perperson) $ OWNED SCHEDULED AUTOS ONLY Ix AUTNOpSyyN BOODILY INJURY Per accident $ X AUTOS ONLY AUOTOS ONED PPe�aPcEcRide�rk AMAGE $ UMBRELLA LIAB HOCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ WORKERS COMPENSATION PER I OTH- AND EMPLOYERS'LIABILITY Y/N ANY PROPRIETOR/PARTNER/EXECUTIVEE.L.EACH ACCIDENT OFFICER/MEMBER EXCLUDED? F—] MIA (Mandatory in NH) E .DISEASE-EA EMPLOYE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Workers Compensation Certificate issued separately CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION ATE THEREOF, Town of Northampton ACCORDANCE WITH DHE POLICY P OVISIONSCE WILL BE DELIVERED IN 210 Main Street Northampton,MA 01060 AUTHORIZED REPRESENTATIVE ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD DATE(MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 11/20/2019 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies) must 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 CONTANAME:CT Donna Kenney OXFORD INSURANCE AGENCY INC AICNo . (508)987-0333 FAX No: ADDRESS: dkenney@oxfordinsurance.com 300 MAIN ST INSURERS AFFORDING COVERAGE NAIC# OXFORD MA 01540 INSURERA: TRAVELERS INDEMNITY CO OF AMERICA 25666 INSURED INSURER B W P I CONSTRUCTION INC INSURERC: INSURER D: _ 2 CHECKERBERRY ISLAND INSURERE: WEBSTER MA 01570 INSURER F: COVERAGES CERTIFICATE NUMBER: 476062 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 15MLTR POLICY NUMBER MM/DD/YYYY MMID LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS-MADE E]OCCUR DAMAGE TO RENTED PREMISES Ea occurrence $ MED EXP(Any one person) $ N/A PERSONAL&ADV INJURY $ GEN'LAGGREGATELIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY❑PRO- LOC PRODUCTS-COMP/OPAGG $ OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS N/A BODILY INJURY(Per accident) $ HIRED AUTOS NON-OWNED PROPERTY DAMAGE $ AUTOS Per accident UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB HCLAIMS-MADE N/A AGGREGATE $ DED I I RETENTION$ $ WORKERS COMPENSATION X STATUTE ER AND EMPLOYERS'LIABILITY Y/N ANYPROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 1,000,000 A OFFICER/MEMBER EXCLUDED? NIA N/A NIA 6HUB9901L94219 01/01/2019 01/01/2020 (Mandatory in NH) E.L.DISEASE-EA EIMPLOYEd$ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT I$ 1,000,000 N/A DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Workers'Compensation benefits will be paid to Massachusetts employees only.Pursuant to Endorsement WC 20 03 06 B,no authorization is given to pay claims for benefits to employees in states other than Massachusetts if the insured hires,or has hired those employees outside of Massachusetts. This certificate of insurance shows the policy in force on the date that this certificate was issued(unless the expiration date on the above policy precedes the issue date of this certificate of insurance). The status of this coverage can be monitored daily by accessing the Proof of Coverage-Coverage Verification Search tool at www.mass.gov/lwd/workers-compensation/investigations/. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Town of Northampton ACCORDANCE WITH THE POLICY PROVISIONS. 210 Main street AUTHORIZED REPRESENTATIVE Northampton MA 01060 ""r L,; Daniel M.Cro y,CPCU,Vice President—Residual Market—WCRIBMA @ 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD Commonwealth of Massachusetts ® Division of Professional Licensure Board of Building Regulations and Standards Construction Supervisor CS-076146 Expires: 01/02/2020 WOJCIECH J PIWOWARCZYK 2 CHECKERBERRY ISLAND WEBSTER MA 01570 Commissioner CAV— CITY OF NORTHAMPTON MASSACHUSETTS CONTRACT FOR SMITH VOCATIONAL&AGRICULURAL HIGH SCHOOL CONTRACT NUMBER: BUDGET CODE: VENDOR NUMBER: CONSTRUCTION CONTRACT THIS AGREEMENT,executed this 20th day of November 2019 by and between: WPI Construction Inc hereinafter called "Contractor" and the City of Northampton, a municipal corporation in the County of Hampshire, Commonwealth of Massachusetts, party of the second part hereinafter called"Owner". WITNESSETH, that for the consideration hereinafter mentioned, the Owner and the Contractor shall agree to the terms and conditions contained in this contract, enumerated as follows: The Owner- Contractor Agreement, Advertisement, Bidding Documents, Contract Forms, Insurance Requirements, Specifications, and all addenda issued prior to and all Modifications issued after execution of the Contract. THE OWNER shall pay the Contractor for the performance of this contract in the sum of; $118,000.00 dollars in accordance with the terms of this contract. This contract shall not be altered in any particular without the consent of all parties to this contract. All alterations to this contract must be in writing and authorized as such by the Mayor and a Majority vote of the Board,Agency,or Committee signing this contract. In the event the Contractor is a corporation a certificate that the person executing this contract is duly authorized to sign, must accompany this contract. Final payment on this contract shall release and discharge the Owner from any and all claims against the Owner on account of any work performed hereunder,or any alteration hereto. This contract shall be deemed to be a Massachusetts contract and it's interpretation and construction shall be governed by the laws of Massachusetts and the Charter and Ordinances of the Owner. The City of Northampton is not bound by this contract until approved by the Mayor of Northampton. IN WITNESS WHEREOF the Owner caused these presents to be signed in quadruplicate and approved by David Narkewicz its Mayor and the said Contractor has caused these presents to be signed in quadruplicate and its official seal to be hereto affixed by its officer or agent thereunto duly authorized (by the attached corporate resolution). This instrument shall take effect as a sealed instrument. CONTRACTOR: WPI CONSTRUCTION INC COMPANY NAME it's THORIZED SIGNATURE PRESIDENT DATE 11/20/19 TITLE CITY OF NORTHAMPTON: BY: AGENCY NAME signatures Date bid filed with City Clerk: , Performance Bond Required?yes no Bid Date ; amount : Bonding Company 4l Date 1:2 —0 — �} Aud or, app oved as to appropriation. to ity S icitor, prove as to form. r Date �2 1 Mayr 6avid Narkewicz Certificate by Corporation to Sign Contract At a duly authorized meeting of the Board of Directors of the WPI CONSTRUCTION INC held on NOVEMBER 20,2019 At which all the Directors were present or waived notice, it was voted that, WOJCIECH PIWOWARCZYK , PRESIDENT (Name) (Officer) of this company, be and he hereby is authorized to execute contracts and bonds in the name and behalf of said company, and affix its Corporate Seal thereto, and such execution of any contract or obligation in this company's name on its behalf by such PRESIDENT under seal of the company, (Officer) shall be valid and binding upon this company, A TRUE COPY, , A (Clerk) PLACE OF BUSINESS �� �pCj,�t� 15 v. DATE OF THIS CONTRACT 1 hereby certify that I am the clerk of the WPI CONSTRUCTION INC that WOJCIECH PIWOWARCZYK is the duly elected PRESIDENT of said company, and the above vote has not been amended or rescinded and remains in full force and effect as of the date of this contract. .,-A%( eerrll�UW (Cor rate Seal) Tax and Reporting Compliance Certification Pursuant to M.G.L. Chapter 62C, Section 49A, I certify under the penalties of perjury that I have, to my best knowledge and belief, complied with the law of the Commonwealth relating to taxes, reporting of employees and contractors, and withholding and remitting child support. 01051762 WPI CONSTRUCTION INC Social Security Number or Signature of Individual or Federal Identification Number Corporate Name by: C porate O cer ( applicable) Foreign Corporation Certification AFFIDAVIT OF COMPLIANCE Form AF-4A 1178 EXECUTIVE OFFICE FOR ADMINISTRATION AND FINANCE The Commonwealth of Massachusetts MASSACHUSETTS BUSINESS CORPORATION NON-PROFIT CORPORATION FOREIGN (non-Massachusetts)Corporation 1. ��UUJP.1{4resident Clerk of ��y whose principal office is (Name of Corporation) located �9 CW_(W 4 r,� �,� 15 ��} � r M C 4s T,; BID FORM For completion of all work per the attached specifications,the amount of.$ 118,000.00 is bid. The undersigned certifies under penalties of perjury that this bid or proposal has been made and submitted in good faith and without collusion or fraud with any other person. As used in this certification, the word "person" shall mean any natural person, business, partnership, corporation, union, committee, club, or other organization, entity, or group of individuals. Date 11/20/19 WPI CONSTRUCTION INC Name of Bidder BY WO IECH PPOWARCZYK Name of Person Signing 2 CHECKERBERRY IS Business Address WEBSTER, MA 01570 City and State INSURANCE REQUIREMENTS 1. Workmen's Com end sation and other benefits as required under Chapter 152 of the Laws, as amended, and Section 34A of Chapter 149 of the General Laws. 2. RjQyer's Liability with a limit of at least$300,000 each accident. 3. Comprehensive Public Liability including Contractor's Liability as applicable to the Contractor's obligations; Elevators (if any on the Work): Completed Operations and Products Liability: all on the occurrence basis with Personal Injury coverage and Broad Form Property Damage. Remove the XCU exclusions relating to Explosion, Collapse,and Underground Property Damage. Completed Operations Liability shall be kept in force for at least two years after the date of final completion. Personal Injury and Accidental Death-General Liability, Each person/aggregate $100,000/$1,000,000 ProR2LVy Damage-General Liability Each Occurrence/aggregate $100,000/$500,000 Personal Iniuly,-Automobile Liability Each person/aggregate $100,000/$500,000 property Damage-Automobile Liability Each Occurrence/aggregate $50,000/$100,000