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29-562 62 BIRCH HILL RD BP-2020-1043 GIs#: COMMONWEALTH OF MASSACHUSETTS Map:Block:29-562 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: Door Replacement BUILDING PERMIT Permit# BP-2020-1043 Proiect# JS-2020-001771 Est.Cost: $10012.00 Fee: $40.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: HOME DEPOT AT HOME SERVICES 104327 Lot Size(sa.ft.): 111513.60 Owner: COLLINS CHRISTOPHER H zoning: Applicant: HOME DEPOT AT HOME SERVICES AT. 62 BIRCH HILL RD Applicant Address: Phone: Insurance: 5 RIVERVIEW DR (401)935-2633 () Workers Compensation NORTH PROVIDENCER102904 ISSUED ON:3/30/2020 0:00.00 TO PERFORM THE FOLLOWING WORK.-INSTALL 1 REPLACEMENT PATIO DOOR 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 3/30/2020 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 Northpgtpton Status of Permit: •I Building DepirrflQnt �, Curb Cut/Driveway Permit 212 Main Stke f0 ��, Sewer/Septic Availability Room 1013-5\ Water/Well Availability Northampton, MA 01Q40 �� Two Sets of Structural Plans phone 413-587-1240 Fax 443'-587-1�72 Plot/Site Plans Other Specify 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 1 / .— ` Map Lot 5 Unit 119— 2 Zone Overlay District Elm St.District CB District SECTION 2-PROPERTY OWNERSHIPIAUTHORIZED AGENT 2.1 Owner of Record: 1,2 e>gni �/z/ lq/) Name(Print) Current MMAc)d G I of oW2,- Signature 7 2.2 Authorized Agent: Name �� Curren fliFE: i A �` •D/�� O Signature Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS —7 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) v Z • Check Number /This Section For Official Use Only Date Building Permit Number: �' t `� Issued: Signature: Building Commissioner/Inspector of Buildings Date JonAdw eb-,?-)l EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR) 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 filled in by Building Department Lot Size Frontage Setbacks Front J j Side L: R: L: R: Rear Building Height I Bldg. Square Footage % C� Open Space Footage % (Lot area minus bldg&paved Arkin #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 O DONT KNOW O YES O IF YES: enter Book Page and/or Document# B. Does the site contain a brook, body of water or wetlands? NO O DONT KNOW O YES O IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained © Obtained O , 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. SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable) New House ❑ Addition ❑ Replacement W' ow n( Alterations) ❑ Roofing ❑ Or Doors Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [M Siding[0] Other[Q Brief Descri t_ign oppd Work: dV G 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. 1. 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 , i as Owner of the subject property hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit application. 113c� 'TPP Signature of Owner Date P/ (1� 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 a'ns a penalties of�y'ug4. Print Name Signature of Owne Agent Date /I SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ �, Name of License Holder: �i `�� ''�v�c v� �,c.� _az,, L/ 2 � License Number -2/ Address Expiration Date Signature Telephone 9. Registered Home Improvement C ntractor: Not Applicable ❑ �1 Company Name Registration Number :qkl� Addr ss �,, j/ Expiration Date i jfw /�,n �/ � Telephone/ 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 build in ermit. Signed Affidavit Attached Yes....... No...... ❑ City of Northampton Massachusetts • DEPARTMENT OF BUILDING INSPECTIONS 212 Main Street • Municipal Building �0 Northampton, MA 01060 � ., p n � 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 constniction 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 lb`e)registered. Type of Work: P//v Est. Cost: /v D/ 2 " Address of Work: A 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 peript as the agent 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 I` DEPARTMENT OF BUILDING INSPECTIONS y. ' 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: b2-- 01A,4 1Q1- )l) (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) 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. Home Improvement Agreement: Pagel Home Depot License #'s - For the most current listing www.Homedepot.com/LicenseNumbers MA: 107774, 112785 Kyle Harmon 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. Collins Chris New England South 1-U4G674Q Customer Last Name Customer First Name Store # / Branch Name Customer Lead/ PO# 62 birch hill road Florence MA 01062 Customer Address City State Zip (413) 237-6686 maureen.collins0508@gmail.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 1 777 Shrewsbury MA 01545 Address City State Zip Or Email: 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 PUR RIGH NCEL. Acknowledged by: o2/z9/2o20 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: $ 110012.00 Includes all applicable taxes. Excludes finance charges.' Sales Tax: $ 10.00 (If applicable) *Maximum deposit ONL Y applicable in MD, MA, ME(33%), NJ, Wl (99%) Dep. 1 25.0 1 % Deposit Amount $ 1 2503 Remaining Balance $ 1 7509.00 The Home Depot-2455 Paces Ferry Road,N.W.Bldg.B-3,Atlanta,Georgia 30339-Customer Care:1-800-466-3337 460 FI HDE Customer Agreement(24 Jul.18) Generated Date Lead/PO# v 01.11 r 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 lWindows A more detailed description of the work to be performed is included in the section entitled cope o Work which appears on page = of this Agreement. Anticipated Delivery Date/Installation Schedule Approximate Start Date: 04/25/2020 Approximate Finish Date: 05/23/2020 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. By4ialing 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 oft is Agreement. Keep it to protect your legal rights. X 02/29/2020 I The Home Depot Customer's Signature Date Service Provider Name X 1 /29/2020 908 Boston Turnpike Unit 1 licable) Date Service Provider Address X 02/29/2020 Shrewsbury MA 01545 S ature n Beha of Home Depot Date City State Zip Service Provider Phone Number 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 460 FI HDE Customer Agreement(24 Jul.18) Generated Date Lead/PO# v 0.1.11 Andersen Wood SPEC SHEET SC: Kyle Harmon Measure Tech: INSTALLER: Branch Name: New England South Job#: 1-U4G674Q Prepared By: ISM: Ship To Location: Customer Name: chris collins Date: 02/29/2020 Pal NEW WINDOW UNIT Screen (Standar is FULL DH Frame included Existing Window Andersen FRAM INSER Sash Glass in Base TEM Type Window TYPE Color/Finish SC SIZE SOLD(Tip to TIP) MEASURE TECH SIZE ONLY ONLY Option Casement Handling Options OPTION price) Grille Options(PER SASH PRICING) TOTAL MT/ISM Interio TW SC UI Standard #Bars #Bars #Bars #B Location Existin Series indo Exterio Finish Jam Standar (WIDT Size Grid Exterior Interior VertHoriz Vert He Windom Type Style Color Color Liner Size A + CODE WALLSILL Sash Hing Temp Screen Type Grid Grid Pattem (per (per Locatio (Per (P Roo Floc Code CODE COD CODE COD Cob Code W dt Height HEIGH Width Height DEPT ANGL Split Venting/Handing Style CODE Options COD Color Color CODE sash) sash) CODE Sash) Sa 1 LIV 1st PD4- SPR- FWG White Whit 138. 77.00 215 Fine FR-C Anders D-4-1 a 00 light en A- 11068 3/4 Series GBG all panel S BAY/BOW WINDOW SCnnstaller Notes:(Include Misc.Labor,Mull Stack Options,special conditions,Use Item d to Ida Projection Angle:(Bay;300 or 45o) Top of Window to Soffit(inches) SPR-(1)-Add.Info.:Top Hung gliding screen(2)w/astrogal kit Bay Window Flankers(DH/Casement) Width of Overhang(inches) Newbury Hardware/trim pieces-Bright brass Construct Roof 1(Yes/No) If tied to Soffit,color of Soffit material HP Low-e4 temepered glass 1 There is no guarantee that new shingles will match existing color. NEW DOOR UNIT ITEM Andersen MEASURE FULL FRAME Glass Scree Hinge MULL/STA( # Existing Door Type Door TYPE Color/Finish SC SIZE SOLD(Tip to TIP) TECH SIZE ONLY Grille Options(PER SASH PRICING) OPTION Option Option Hinged and Gliding Door Options OPTIONS PD Assemb TOTAL (200, Location Interio UI RO/ Inswing PD PD Gliding Hinged 400,& TExistingSerie Exterio Finish Standar (WIDTH TIP Ext Extensio Grid Exterio Interio #ea #Ba Door Door A-Ser Lock Lock Options Door Type Style Color Color Size AW + to Jamb Jamb Type Grid Grid Patter ert( riz( bscur Scree IN or # Venting Venting gliding HRDW HRDW Keyed Mulled/ Spa R. Fl., Code COD COD CODE CODE Code Width Heigh HEIGHTWidthHeigh TIP Size Location CODE Color Color CODE Sash)Sash) CODE CODE OUT Panels Handing Handing only) Type Finish Lock Stacked No Approval Print Name chris collins Title Home Owner Th CU.mmore lPttit'� D l/��3Sii%lftt[iel?i ���" (� Deaartntznt �j'lndustr'ial.=#c:idencs I Congress Street, Suite 100 Boston, -bf.� 011J.,1_2#17 ' www,mass.0,0VIdia Workers' Compensation Insurance Affidavit.-Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTIIYG AUTHORITY. Applicant Information Please Print Lea'biv N13122e (BusinesssiOrganizatiututndividual): e,- Address: o "i ("S57LZs p City/State/Zip: . 30 3 Phone#: 77Y ',::iq7 Ate you an amplover'!Check the appropriate box: Type of project(required): l.❑lam a anployer with anployees,full and/or part-lintel.' 7. Q New construction 2.❑l an r sole proprietor or partnership and:cave no,mployees working for me in 3. [temodeling any capacity.[No workers'comp.insurance required.l 9. 3.F7 ram a homeowner doing all work inyself.(No workers'comp.insuranc.required.1' 10 Q3 Demolition 1Building addition 4.Q ram a homeowner and will 5e hiring contracrors v conduct all work on my property. r will mure,liar all contractors either have•workers'compensation insurance or are sole I LC] Electrical repairs or additions proprietors with ao amployees. 12.C]Plumbing repairs or additions 5.�l am a general contractor and have;tired rite sub-contractors:iswd on tte,attached.;heel [3.Q Roof repairs Fnese sub-contractors have.mployees ind'have workers'comp. insurance.- fi.❑we are a corporation and its oi'Eicers;rave axercised their:ight of axemprion per.%fGL c., 14.dKther.. 152,,Il(a),and we have no:mployees.(No workers'comp.insurance required. 'Any ipplicanrthat checks box 1$1 must also fill out he section below showing their workers':ompensation policy information. homeowners who iubmit chis affidavit indicating they ire doing all work and hen hire ourside contractors must submit i new affidavit indicating such. tContractors liar check this pox must coached as additional;beet showing the name of the sub-contractors and irate whether sr not those.apdties'have etnpleyees. If the itrh-contractors have-iployees,they must arovide their workers'comp.pokey aumber. f am an employer that is providing workers'compensation insurance for my employees. Below rs rhe policy and job site information. _ /� /' �' CoInsurance Company Name: A /NT/ewL l V/l/Z� / i P� �S C - Policy#or Self-ins,Lie.#: K W (, 135— .Expiration date: 3 Job Site Address: � �/g � City/StataMp: 0�--�°►'65 Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiratii4n date). Failure to secure coverage as required under N,[GL c. 152,�25A is a criminal violation punishable by a fine up to S 1,300.00 and/or one-year imprisonment,as well as civil penalties in.the form of a STOP WORK ORDER and a fine of up to.3250.00 a day against the.violator.A copy of this statement may be forwarded to the Office of Investigations of the DEA for insurance coverage veriFcation, [do hereby eertr under t pains es of rjury t the injorntution provided above is true art'`dclorrect Si ature: Daw: -7 Phone#: Ofeiel use only. Do nat write n dLis area, to be:ompleted by city or town official City or Town.- Permit/License Issuing Authority(circle one): 1. Board of Efealth 2.Building Department 3.City/Town Clerk I. Electrical Inspector S.Plumbing Inspector 6. Other Contact Person: Phone#: CERTIFICATE OF LIABILITY INSURANCE 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 poiicy(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 andorsement(s). ?RODUCER NAME: MARSH USA,INC. T'NO ALLIANCE CENTER IPA ii a C No): 3560 LENOX ROAD,31-17=74-0 _-,MAIL ATLANTA,GA 30326 ADDRE33. INSURER(S)AFFORDING COVERAGE NAIC 4 :P1'01542069-HomeD-GA,N:20-21 _ INSURER A:Dd Y.ecubllc Insur3Cce:C 2414' ''NSURED THE HOME DEPOT.INC. INSURER s:New HamPshlre'ns_'0 23841 HOME DEPOT U.S.A.,INC. INSURER C:HcmePisk.-,active insurance.ompan 2455 PACES FERRY ROAD BUILDING C-20 INSURER 7 ATLANTA,GA 30339 INSURER E INSURER F COVERAGES CERTIFICATE NUMBER: ATL•004353439-33 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. INSRPOLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSO WID SUBR POLICY NUMBER MM/DDIYYW MMIDDIIYYYY LIMITS A X COMMERCIAL GENERAL LIABILITY MWZY314574 03101,2019 03/01/2022 EACH OCCURRENCE I $ 1;000,000 CLAIMS-MADE a OCCUR PREMISES"Ea occurrence $ 1,000,000 X SIR:$1,000,000 MED EXP(Any one person) $ EXCLUDED I PERSONAL 3 ADV INJURY $ 1,000.000 I �LEWL AGGREGATE LIMIT APPLIES PER: I GENERAL AGGREGATE $ 2:000,000 POLICY E� [7 LOC 2,000,00C PRODUCTS•COMP!OP AGG $OTHER: $ AUTOMOBILE LIABILITY j MWT3314573 03/0112019 03/0112022 COMBINED SINGLE LIMIT $ IF a accident _ X ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED SELF INSURED AUTO PHY OMG BODILY INJURY(Per accident) $ I AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Psr accident $ UMBRELLA LIAR H OCCUR EACH OCCURRENCE s EXCESS LIAR CLAIMS-MADE AGGREGATE is DED RETENTIONS $ 3 i WORKERS COMPENSATION WC 023096004(AK.NH.I\1J.\/T) 03!0112020 0 1011 1X PER TH- AND EMPLOYERS'LIABILITY STATUTE ER_ B ANYPROPRIETORIPARTNER/EXECUTIVE YIN WC 023096005(WI) 03/01x2020 03101!2021 5,000,000 OFFICER/MEMBEREXCLUDED? NIA E.L.EACH ACCIDENT $ (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 5,000,000 If Ies.describe under Continued on Additional Pae 5,000.000 DESCRIPTION OF OPERATIONS below 9 E.L.DISEASE-POLICY LIMIT $ Excess Auto 297110011002020 03101;2020 03/01/2021 Limit: 4.000.000 A Excess General Liability MWZX 314580 03101/2019 03101022 Limit: 9.000.000 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) EVIDENCE OF INSURANCE CERTIFICATE HOLDER CANCELLATION ,OME DEPOT USA,INC SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 2450 PACES FERRY ROAD THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 3UILDING 0.20 ACCORDANCE WITH THE POLICY PROVISIONS. rLaNTA,GA 30339 AUTHORIZED REPRESENTATIVE of,Harsh USA Inc. Manashl Mukherjee D4 %A PO rJ 1988-2016 ACORD CORPORATION. All rights reserved. ACORD 25(2010/03) The ACORD name and logo are registered marks of ACORD A J=-100Y CUSTOMER ID: C+N i J 6a?G6.a LCC : ACOR" ADDITIONAL REMARKS SCHEDULE Page 2 of 3 4JENC'! N,>!d NSURED HARSH SA.'PiC - E ONIE GE: NC �G�bIE DEPCT 73-.A., NC. PCUCY NUMBER 2153 P=ALES`EPRv PCAD 31ADING C-7r AT_jjvi7�. 3a ;0339 :ARRIER NAiC-.00E F=PECTIVE DATE: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: Certificate of Liability Insurance Norkers Compensation Continued: Carrier Indemnity!nsurance Company of.North America (A ` , .M . . . . . .N`r.NY'olcy:Number WLR C56922716 Effective Date:03101,2020 Expiration Date:03101,2021 EL)Limit:35,000.000 Amer New Hampshire Insurance Company Policy Number'NC 023096003(CC.DE.HIANADANATAY.RI) Effective Date:03/0112020 Expiration Date:03101;2021 EL)omit:35.000,000 carrier.ACE Amencan Insurance Company Policy Number'NCU C'66922753 yQSI) (AZ.CA.IL.NC,OR.VA,'NA) Effective Date:03101;2020 Expiration Date:03101021 (EL)Limit:34.000,000 31R:31,000.000 SIR for the states of,AZ.CA,IL,NC,OR,VA,'NA Cartier.National Union Fire insurance Company Policy Number XWC 8559356 f,QSI)(CO.CT GA.MEAI.NV,OH,PA,UT) Effective Date:03101/2020 Expiration Date:03101;2021 (EL)Limit:S4,000.000 31,000.000 SIR for the states of CO.ME,NV.MI,CKPA.UT 3750.000 SIR for the Mate of GA 1350.000 SIR for the state of CT Carder National Union Fire Insurance Company Policy Number:XWC 8559357(QSI)(MA) Effective nate:03/01;2020 Expiration Date:0310112021 � ► y/�' � (EL)Limit:34,500,000 SIR:3500.000 TX Employers XS Indemnity: Camer illimos Union insurance Company Policy Number TNS 066932345(TX) Effective Date:03/01,2020 Expiration Date:03/01;2021 ;EQ Umit:310.000,000 31R:31.000.000 ACORD 101 (2008/01) 9)2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD 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 Update Address and Return Card. SCA 1 ES 20M•05/17 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 112785 04/22/2021 1000 Washington Street -Suite 710 HOME DEPOT USA INC Boston,MA F18 i RICHARD TROIA 2455 PACES FERRY RD C-11 HSC �'"i0�� ATLANTA,GA 30339 UndersecretaryNot valid without signature 12!3/2019 Alliance Home Improvement-LIC-CS-MA-2021-S Suprunchuk.jpg Commonwealth cit Massachusetts Derision of Professional Licensure Sowd of Buffing Requiations, and Standards Cons r CS-104327 _ Expires: 11 /291202 ,1. SERGIY SUPRUNCHUK 148 BERKSHIRE DRIVE ESTFIELD MA 01086 j2 m�.5 y�'mss .+IM�*.,s».-,-.• � __ Commissioner