Loading...
22B-037 (5) 24 CORTICELLI ST BP-2020-1054 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block:22B-037 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-2020-1054 Proiect# JS-2020-001785 Est.Cost: $6000.00 Fee: $40.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: LOWES HOME CENTERS INC 049918 Lot Size(sq. ft.): 12893.76 Owner: GLADSON SHARON Zoninp,: URB(96)/WP(93)/SI(4)/ Applicant. LOWES HOME CENTERS INC AT: 24 CORTICELLI ST Applicant Address: Phone: Insurance: 22 GRANVILLE RD (413) 272-89310 WC SOUTHWICKMA01077 ISSUED ON:4/6/2020 0:00:00 TO PERFORM THE FOLLOWING WORK.-INSTALL 6 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 4/6/2020 0:00:00 $40.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner a"17 M100410 S Department use only City of Northampton Statu8l7of Permit: r r.. Building Department APR — Curb Cut/Driveway Permit 212 Main Street 21 Sewer/Septic Availability y. Room 100 _.__ _ Watej/Wellr'S'Structural vailability Northampton, MA O IPO' Ft%uornr Two Sets oPlans Ir/s; 5T N �/S te Plans 413-587-1240 Fax41 jl Other Specify APPLICATION TO CONSTRUCT,ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION This section to be completed by office 1.1 Property Address: l Z19 (�r�+�C2�� Map c�� Lot ��!7 Unit Zone Overlay District � �D Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: Name(Print) Current Mailing Address: yg(4� Telephone Signature 2.2 Authorized Agent: L0w Pe) vvr✓ t.�,wP� gl.�l�, 1+90&>A':)'v (ire, Name(Print) Current Mailing Address: Signature Telephone SECTION 3 -ESTIMATED CONSTRUCTION COSTS —7 Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building �r v (j (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) / G Check Number 0 T1 This Section For Official Use Only Building Permit Number: !>,7( � �' 10� / Dsued Signature: Building Commissioner/Inspector of Buildings Date 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 'nils column to he filled in hN Building Department Lot Size Frontage Setbacks Front Side L: R: L: R: Rear Building Height Bldg. Square Footage 40 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 Q DON'T KNOW 0 YES Q IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DON'T KNOW 0 YES Q IF YES: enter Book Page and/or Document # B. Does the site contain a brook, body of water or wetlands? NO 0 DON'T KNOW 0 YES Q IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained 0 Obtained O Date Issued: C. Do any signs exist on the property? YES 0 NO Q IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property ? YES 0 NO 0 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 0 NO Q 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 Vyindows Alteration(s) Roofing Or Doors Accessory Bldg. ❑ Demolition ❑ New Signs [O] Decks [p Siding [0] Other[0] Brief Description of Proposed Work: I o4i k i l I 't, A/0 �ti',10-4 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 to act on my behalf, in all matters relative to work authorized by this building permit application. icf)✓I i -cc,it Signature of Owner Date l "Lvei 4&4,-- Ce, PS 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. AJ Print Name re& "�—'�7 - Signature of Owner/Agent Date SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor:^) Not Applicable ❑ Name of License Holder: MANL ) �O(� b`(q Qq License Number 14 Tdl►°� D(L E4 fl4g"t&ti, MC� 6(0211 1Z.—Z1—?y Addr Expiration Date U('7-` 44 - i(v Signature Telephone 9.Registered Home Improvement Contractor: Not Applicable ❑ Lij � we5 �/^-e c e li-e, S ( L( ��o�� Company Name Registration Number ( o- Address / Expiration Date C��r�}zo��', /j'1r•'1P� �v�c/�j Cs� Telephone c{��,-Z�Z-y� 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 Massachusetts -- 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 entiti,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 pen-nit 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 DEPARTMENT OF BUILDING INSPECTIONS T, ' 212 Main Street • Municipal Building yvf �r v Northampton, MA 01060 Massachusetts Residential Building Code Section 110.R5.1.2 Homeowner: Person (s) who own a parcel of land on which he/she resides or intends to reside, on which there is, or is intended to be, a one or two family dwelling, attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Section 110.R5.1.3.1 Any homeowner performing work for which a building permit is required shall be exempt from the licensing provisions of 780 CMR 110.R5, provided that if a homeowner engages a person(s) for hire to do such work, then such homeowner shall act as supervisor. Such homeowner shall submit to the Building Official, on a form acceptable to the Building Official, that he/she shall be responsible for all such work performed under the building permit. As acting Construction Supervisor your presence on the job site will be required from time to time, during and upon completion of the work for which this permit is issued. Also be advised that with reference to Chapter 152 (Workers' Compensation) and Chapter 153 (Liability of Employers to Employees for injuries not resulting in Death) of the Massachusetts General Laws Annotated, you may be liable for person(s) you hire to perform work for you under this permit. City of Northampton Massachusetts Al DEPARTMENT OF BUILDING INSPECTIONS J 212 Main Street •Municipal Building tet, a Northampton, MA 01060 Ss7W t�" 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: l Car-.i(e I( r S } (Please print house number and street name) Is to be disposed of at: ZEN r��.��� ' n/L c., 01 dC� 6 (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. The Commonwealth of Massachusetts Department of Industrial Accidents I Congress Street,Suite 100 Boston,MA 02114-2017 www mass.gov/dia AVorkers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information / n Phase Print Lc�-ihh t..t7t Name (Business/Organization/Individual): fjj 4Um 0 C-Idem Address: (oyo bdg" ; hC'U1) City/State/Zip: Vhoc,,,no�II e, NC 761-) Phone Are you an employer?Check the appropriate box: Type of project(required): 1.❑1 am a employer with employees(full and/or part-time).* 7. ❑New construction 2.F1 I am a sole proprietor or partnership and have no employees working for me in 8. ❑ Remodeling any capacity.[No workers'comp.insurance required.] 9. ❑Demolition 3.F1 1 am a homeowner doing all work myself.[No workers'comp.insurance required.]' 10E] Building addition 4.E�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 I I.❑Electrical repairs or additions proprietors with no employees. 12.❑Plumbing repairs or additions 5.❑1 am a general contractor and 1 have hired the sub-contractors listed on the attached sheet. ]3.[:]Roof 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 till 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: h A H (4 Policy#or Self-ins. Lic. #: L,J C 0 Z?7 DqCO Expiration Date: Job Site Address: 2L( w/'+t 61I t I G, City/State/Zip: F401,-0,1C.0 11 M i 6166 Z 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 p ' . nd penalties of perjury that the information provided above is true and correct. Signature C.!�l, Date: Phone#: (A J-7 — 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. Plunthin,; Inspector 6. Other ( ontact Person: Phone#: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152,§25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152,§25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractor(s)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers'compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street, Suite 100 Boston, MA 02114-2017 Tel. # 617-727-4900 ext. 7406 or 1-877-MASSAFE Fax#617-727-7749 Revised 02-23-15 www.mass.gov/dia Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An emplgver is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However,the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152,§25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152,§25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary, supply your insurance company's name,address and phone number along with a certificate of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers'compensation insurance. If an LLC or LLP does have employees,a policy is required.Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers'compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year, need only submit one affidavit indicating current policy information(if necessary). A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture(i.e.a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street Boston, MA 02114-2017 Tel. # 617-727-4900 ext. 7406 or 1-877-MASSAFE Fax# 617-727-7749 www.mass.gov/dia Form Revised 02-23-15 ` 1 iNsrA_LA-•�,%sTPEEr A')ORES$ csry sTArE MA z` 01062 J 24 corticelli St. Florence Install five RB 3900 seies vinyl DH windows white on white full screen dual pane glass, low-E Arogon1 Foam filled frames, o grids, u tear outconstruction, New r c mo on emenror. Interor trim - I frovideid by customer- (not sold at[owes)will need three 8'nieces per window labor for Installing tLim is cluded if trim is present at day of install. NOTICE TO CUSTOMER-PRiCE CALCULATIONS:In order to property perform the instarfation of certain Goods.the Contract Price may incluCP more 1( Goods thana lud ly coin be msialleArea.-,,based on the measured square fools"of the Project Ar .As a result,the parties agree that the IUmp-SLm Price 1 staN,1 in this Contract is cak�irlaled upon both the value of estimated Goods required to NO the Contract(including waste),which may exceed the actual Isquare ruu:a{a of the Protect A,ea.and the labor which may be estimated based on the amount of Goods required to fulfill the Contract(including waste). By wnmg Ctrs Contract bekyA.Customer acknowteCges receipt of this notice and agrees and understands that the Price includes these costs which may I rot be refunylea once I"Installation Services arc performed _ t� ;Are permits required for this installat on?:YN [ J Contract Total Yes No *applicable tax included $5085.00 NOTICE TO CUSTOMER: Federal law requires Lowe's to provide you with the pemplet Renovate Right By signing this Contract, Customer acknowledges having received a copy of this pamphlet before work began Informing Customer of the potential risk of the lead hazard exposure Irom ren_ovalion activity to be performed in Customer's dwelling unit NOTE: If rotted wood is discovered during installation additional charges will 99PKYou will be given a quote and a change order } must be completed and signed by the customer for any additional charges{ Customer must initial. l, 'Any wo,*,ry rrworia rot saec.hed is rrul inUuacd in isi-contrail Any changes or addibcrx wig be at an ad I charge for the material and labor. {aPHOTO RELEASE Customer grants to Lowe's and Lowe's employees and independent contractors the right to lake photographs of the Premises where Ir,stalixion Sennces will be performed aria all work performed at the Premises related to this Contract,and irrevocably grants to Lowe's all right,title and interest in and to the photographs for use in all markets and media.worldwide,in perpetuity.Customer authorizes Lowe's to copyright.use and publish the photographs in pnnl and:or electronically.and ag•ees that Lowe s may use such photographs for any lawful Pug.but not limited to,marketing. adven,sing,pt.bbGty i'lustration.training aril Web content By initialing here.Customer agrees to the foregoing (Customer to initial to the left) y . i WorVs o� nce upon reasonable availability of Contractor and/or any spacial°� r ustomer made G d(s)which is anticipated to be 3 11 (rill In date).Estimated completion date is D_ -a (fill in date]. Sac estimated substantiai completion date is riot of the essence.A statement or any contingencies that would materially change said estimated substantial coma:et,on date is as follows: VVE TH R PERMIT D (if applicable,insert a statement of such contingencies). OF THE CONTRACT TOTAL IS$1,000.00 OR LESS Customer must pay in fuu. I CORIPLETE TH $ ONLY WHEN THE CONTRACT TOTAL EXCEEDS$1,000.00, J(10 Deposit $ ��� ,6( to be paid upon signing contract.Any deposit collected at the lime this Contract is signed will not exceed ane-third '(1'3)of the contract price:and 2' rent of :_�Q_--to be collected upon or after the cornmencenxrtt of wortNNe auth nze Lowe's to do one of the to aM g(check appropriate box bebwl. ( C large mytour credit card for the amount of the payment indicated above upon or after the commencement of work: Or 1( I Deposit my,our check for the amount of the payment indicated above upon or after the commencement of work:and (3)Final payment of S100,00 to be paid upon completion of the installation and both parties'satis faiction, 1NOTICE_REGARDITRATION AGREEMENT FOR CLABMS COVEREQAY M.G.L c.142A LOWE'S AND OY/NER HEREBY MUTUALLY AGREE IN ADVANCE THAT IN THE EVENT LOWE'S HAS A DISPUTE CONCERNING THIS CONTRACT,THAT LOWE'S MAY SUBMIT SUCH DISPUTE TO A PRIVATE ARBITRATION SERVICE WHICH HAS BEEN APPROVED BY THE SECRETARY OF THE EXECUTIVE OFFICE OF CONSUMER AFFAIRS AND BUSINESS REGULATIONS AND THE OWNER SHALL BE REQUIRED TO SUBMiIT TO SUCH ARBITRATION AS PROVIDED IN M'G L.c 142A.THE SIGNATURES OF THE PARTIES BELOW APPLY ONLY TO THE AGREEMENT OF THE PARTIES TO ALTERNATIVE DISPUTE RESOLUTION IHM TED.Y LOwES PURSUANT TO MAL,L c 142A TH€OWNER MAYBE PERMITT7<D TO INITIATE ALTERNATIVE DISPUTE RESOLUTION EVEN WHERE Tij1S_S CTiON I5 NOT, PARAT A0 SiGNED BY THE PARTIES.If customer has a complaint which cannot be resolved infomhafly,the home Improvement Contractor Law(M.G-L.c.142A)may provide Customer with the right to request arbitration through a private arbitration program approved by the Director o'the Office d Consumer Affairs and Business Regulation.as an aftemative to court action.The same right is not afforded to Lowe's unless this Notice is signed and dated by Lmrre's and Customef.Ail claims by Customer of Lowe's concerning this Contract which cannot be restlivved nforrnalty,and wfiicth are not covered by M G L. c 1 a2A or sub to the a ci n of a small claims court,shall t>e resolved by I>WkV arbitration as set forth in the General Terms and Conditions. Date: 3-3-2020 L e's A oriled RepresentaU're XBy c.---'- Date: 3 Customer DO NOT SiGN THiS CONTRACT IF THERE ARE ANY BLANK SPACES AND UNTiL YOU HAVE READ THE TERMS AND CONDITIONS CONTAINED ON THE REVERSE SiDE OF THIS PAGE AND THE FOLLOWING PAGES OF THIS CONTRACT BY SIGNING BELOW, YOU ARE ACKNOWLEDGING THAT YOU HAVE READ,UNDERSTAND AND AGREE TO THE TERMS AND CONDITIONS SET FORTH ON THE REVERSE SIDE OF THIS PAGE AND THE FOLLOWING PAGES OF THIS l CONTRACT. YOU ARE ENTITLED TO A COPY OF THIS CONTRACT AT THE TIME OF SIGNATURE. WITNESS OUR HAND(S)AND SEAL(S)BELOW THIS 3 DAY OF march Zn2� Lowe's Ho Centers, LLC �a� Y Laive s Authorized Repr ative Owner Co-owner or witness Customer acknowledges receipt of s true copy of this contract which was completely filled In prior to Customers execution hereof.You,the buyer,may cancel this transaction at any time prior to midnight of the third business day after the date of this transaction.See the attached notice of cancellation farm for an explanation of this right. en 98016 09117 CUSTOMER COPY OtoW Iowr'rOta»+'sathevoekocog •!• cow tadamuhcs d u •hM r, Scanned with CamScanner (FIN TM,s a'+r s Ox"t.V.rxrp,Arvhfe wa wvron vnw4 boom Thu beams in apPill- uDm Parrot h•N Me=W k-'dne PtEAs PE EEAD Kl TERMS AND O.0 ,o,T tS ON Tt{RE��MDE�MSPAGE ip"4iO0.9 01101d.11mirft �a� s b.ftWiIiiiii!b WOR'tft Y �. 614-721-5253 iNSTA.tnrlpN STREET ADDRESS cr" STATE ma zjP 01 062 24 corticelii St. Florence IJV --rise lvJ_I five R 3900 seies vinyl DH windows-white on white full screen dual pane glass, low-E Aro on, Foam filled frames, No grids, Full tear out Construction, New PVC Brickmoldon exterlror. Interor trim Provided by customer, (not sold at lowes)will need three 8'pieces per window. labor for installing trim is included it trim Is present at day of Ins tall. NOTICE TO CUSTOMER-PRICE CALCULATIONS:In order to property perform the instailatJoni of certain Goals,the Contracl Price may include more Goods than actualfy wilt be-installed based on the measured square footage d the Project Area.As a result,this parties agree that the tump-sum Pnce States to this Contron act is calZrlated upboth the value of estimated Goods required to hrtfill the Contract(inctud'ng waste),which may exceed the actual squn•e•ootage of the Protect Area.and the labor which may be estimated based on the amount of Goods required to Will the Contract(including waste) ! By s,gnrng this Contract below.Customer acknowledges receipt of this notice and agrees and understands that the Prig includes these costs which may not be refunded once the Installettcr Services are performed. IAre permits required for this installation?: [X Yes ( ]No Contract Tout $5085.00 tt _ •applicable tax included NOTICE TO CUSTOMER: Federal law requires Lowe's to provide you with the pamptet Renovate Right By signing this Contract, Customer acknowledges having received a copy of this pamphlet before work began Informing Customer of the potential risk of the lead hazard exposure from renovation activity o be performed in Customer's_dwelling unit NOTE: If rotted wood is discovered during installation additional charges,,M.You will be given a quote and a change order must be completed and signed by the customer for any additional charges. Customer must Initial. I 'Any s;^rs mateni!not soecired,s not ncluded•n this contract Any changes a additions wfl be at an tional charge for the material and tabor PHOTO RELEASE Customer cranes to Lowe's and Lowe's employees and independent contractors the right to take photographs of the Premises where JInVa'al,or Services will be performed and all work performed at the Premises related to this Contract and irrevocably grants to Lowe's all right,toe and interest in aid to the photocraphs for use in all rrarkets and media,worldwide,in perpetuity.Customer authionz s Lowe's to copyright.use and publish the pho:oyraphs in print andlor electronically,and agrees that Lowe's may use such photographs for any lawful pu ng.but not limited to,marketing. advertising.publicity,illustration,training and Web content.By initialing here.Customer agrees to the f 'ng. (Customer to initial to the left) Work is to commence upon reasonable availability of Contractor andlor any specialr h tomer made od(s)which Is anticipated to be .13-2-2020-2020 [fill in date]. Estimated completion date is 6Lref'�u [fill in date). Said es:,mateo substantial completion d is not of the else)fie.A statement of arty contingencies that would materially change said estimated substantial co-pletior date is as follows: leather p.Qrmlred (if applicable.insert a Statement of such contingencies). IF THE CONTRACT TOTAL IS S1,000.00 OR LESS Customer must pay in full COMPLETE THIS N[7��n_rLY WHEN THE CONTRACT TOTAL EXCEEDS S1,000.tXT: (1)Deposit S �v to be paid upon signing contract.Any deposit collected at the time this Contract is signed will not exceed one-third (11)of The contract t2)fayn ew o f S 3' 0 to be cocected upon or after the commencement of work.Vl authorize Lowe's to do one of the fdlormiN(othedc appropriate box Wrw) M Charge mykvx credit card for the amount of the payment indicated above upon or after the commencement of work; or ( i Deposit myrour check for the amount of the payment indicated above upon or after the commencement of work;and (3)Final payment of 5100.00 to be paid upon completion of the installation and both parties'satisfaction. ` NOTICE REGARDING ARBITRATION AGREEMENT FOR CLAIMS COVERED BY M G L c 1426 i LOWE S AND OWNER HEREBY MUTUALLY AGREE IN ADVANCE THAT IN THE EVENT LOWE's HAS A DISPUTE CONCERNING THIS CONTRACT, THAT LOWE'S MAY SUBMIT SUCH DISPUTE TO A PRIVATE ARBITRATION SERVICE WHICH HAS BEEN APPROVED BY THE SECRETARY OF THE EXECUTIVE OFFICE OF CONSUMER AFFAIRS AND BUSINESS REGULATIONS AND THE OWNER SHALL BE REQUIRED TO SUBMIT TO SUCH ARBITRATION AS PROVIDED IN At.G.L.c.142A THE SIGNATURES OF THE PARTIES BELOW APPLY ONLY TO THE AGREEMENT OF THE PARTIES TO ALTERNATIVE DISPUTE RE§QLtJiTION INITIATED BYLOWFS PURSUANT TO M.G.L.c 1420 THE OWNER MAY BE PERIFTTED TO INMATE ALTERNATIVE DISPUTE RESOLUTION EVEN WHERE THIS SECTION IS NOT SEPARATELY SIGNED BY THE PARTIES. N customer has a complaint which cannot be resolved informatly,the home lmprovement Contractor Law(M.G.L.C.142A)may provide Customer with the right to request arbitration through a private arbitration program approved by the Director of the Office of Consumer Affairs and Business Regulation,as an alternative to court action.The same right is not afforded to Lowe's unless this Notice is signed and dated by Lowe's and Customer.Alt claims by Customer or Lowe's concemirg this Contract which cannot be resolved informally,and which are net covered by PSG.L 042A or s4 ed tGmall Claims court,shall be resolved by binding arbitration as set forth in the General Terms and Conditions the" ion o a s 1 By: Q/!� Date: �-3-2020 owe's hprted Representative 3 6 Z XBy: Date: customer DO NOT SIGN IS CONTRACT IF THERE ARE ANY BLANK SPACES AND UNTIL YOU HAVE READ THE TERMS AND CONDITIONS CONTAINED ON THE REVERSE SIDE OF THIS PAGE AND THE FOLLOWING PAGES OF THIS CONTRACT. BY SIGNING BELOW,YOU ARE ACKNOWLEDGING THAT YOU HAVE READ,UNDERSTAND AND AGREE TO THE I TERMS AND CONDITIONS SET FORTH ON THE REVERSE SIDE OF THIS PAGE AND THE FOLLOWING PAGES OF THIS CONTRACT.YOU ARE ENTITLED TO A COPY OF THIS CONTRACT AT THE TIME OF SIGNATURE. WITNESS OUR HANC(S)AND SEAL(S)BELOW THIS 3 DAY OF ma 2020 OW H e crit rs, LLC X Lowe's Authorized Reprppntahve Owner Co-owner or Witness Customer acknowledges receipt of a true copy of this contract which was completely ed In prior to Custorner's execution hereof.You,the buyer,may cancel this transaction at any time prior to midnight of the third business day after the date of this transaction.See the attached notice of cancellation form for an exolsnation of this richt. Scanned with CamScanner NOTICE OF RIGHT TO CANCEL (enter date of transaction) 3-3-2020 (Date) You may CANCEL this transaction,without any Penalty or Obligation,within THREE BUSINESS DAYS from the above date. If you cancel, any property traded in,any payments made by you under the contract or sale,and any negotiable instrument executed byyou will be returned within TEN BUSINESS DAYS following receipt by the seller of your cancellation notice,and any security interest arising out of the transaction will be cancelled. It you cancel,you must make available to the seller at your residence,in substantially as good condition as when received,any goods delivered to you under this contract or sale,or you may if you wish,comply with the instructions of the seller regarding the return shipment of the goods at the seller's expense and risk. If you do make the goods available to the seller and the Seller does not pick them up within 20 days of the date of your notice of cancellation,you may retain or dispose of the goods without any further obligation.If you fail to make the goods available to the seller,or if you agree to return the goods to the seller and fail to do so,then you remain liable for performance of all obligations under the contract. To cancel this transaction,mail or deliver a.signed and dated copy of this cancellation notice or any other written notice,or send a telegram,to LoweS [Name of seller] at____Hadley MA NOT LATER [Address of seller's place of business] THAN MIDNIGHT OF 3-6-2020 [Enter date 3business days aft"transaction date above(or longerasrequ;red [Date) by applkable law);include Saturdays but not Sundays and Federal Holidays I I HEREBY CANCEL THIS TRANSACTION. (Date) (Buyers Signature) ACKNOWLEDGMENT OF RECEIPT OF DISCLOSURES AND CERTIFICATION On this 3 day of march 202 (year),each of you hereby acknowledges receipt of two(2)copies of the foregoing Notice of Right to Cancel;each of you who is a party to the Contract hereby acknowiedges receipt of one(t)copy of the fully executed and dated Contract Number 19054 (SEAL) (SEAQ)"� (Witness) NOTE: Each Customer who Is a party to the Contract must sign above. Rev(01110) Customer Copy#2 td is ;, r Scanned with CarnScanner Installation Proposal - vvrrluvw- Date: Store aSales Specialist (if3 f�ll, f ` Customer Name (7 1 {`��rd Ucense# 2nd Contact Name Home Phone Job Site Address 7 t a I , l�//J Sf Work/Cell Phone City,State and Zip t 1, f�, y Customer"Email Preparation: Additional Considerations: D3 re-installation inspectionnstall new interior casing L')Provide appropriate protection to home during installation stall new exterior trim (-k- /4),1 ry GObtain and post any necessary permits El Install new exterior wrap(trim coil) Qbedicated project support staff will be in contact with you 0Custom work: every step of the way i Installation: Clean-up/Final Inspection: ]Remove and haul away existing windows omplete final cleanup and haul away all job related debris [Check existing windows for leaks and evidence of pest est product and perform complete inspection with customer infestation 1W-09 4- t7lO C Install new windows and window accessories,including required caulk,stops,and fasteners xa- �Y) tz? 3 Soo DIiiv,�►y� w,� -5, ��, , / ,�� Total Investment 7v�P All Installation services are guaranteed by Lowe's labor warranty.Additional charges may apply for permit fees Professional installation available through Independent contractors licensed and registered where applicable.License numbers and certifications held try or on behalf of Lowe's Home Centers,LLC and/or Lowe's Home Centers,Inc.:AL 08187;AK 1139289;AR#0037290514;AZ PROC291645;CA 11991832,Bond#106055877;,CT#HIC0634387,NMCO.0903044;DE#1993102030;FL JICCC1326824,NCGCS508417,NCRC1327732,#FR04517;GA#RBC0005306;HI NC-33489;IL 9104014837;KS-Arkansas City NR-2010-0036,Wichita#5495,Johnson County 02012-6366;KY-Lexington#11562;IA NC110383;10 NAGE-38637;IN-Hammond#017105-02;LA-ULMP248L CBC#16533,#554408;MA N148688,#35194; MO N91680-22;MI#2102144445;MN#BC629859;MS#R17568;MT#161006;NC#70220;NO#30316;NE#23319;NM#382385;NY-New York City N1291730,#1291733,01375178,01351065,Nassau NH1777890000,#H1777890100,RH1777890200,Suffolk#43906-H,#48295-ME,#44066-MP,#41444-HF,Buffalo#556853,Putnam#PC2742-A,Tonawanda XCN0391,Rockland#H-11092 Bf,-W 00, Westchester XWC-23319-H 10;NV#W79079;OH-Columbus 01G5872,NHIC4565,Lancaster#500596,Warren 94266;OK#48191,60000341,002337;OR#202237;PA-Sunbury 0751,Johnstown 00467;RI #20575;SC NG116664G 118696;TN#64743,N3070;TX NTACLB24674E,0EC-29349;UT 99002087-5501;VA 112701036596A;WA#LOWESHC863DH;WV#WV014656;and WI 01133309. L!cer sw numbers) and certifications may be subject to change in accordance with local or state government processes.For the most current listing of license numbers and certificatlons held by or on behalf of Lowe's Home Centers,LLC and related entities,please visit http://www.lowes.com/licenwnumbers. IMPORTANT:This Is an estimate only.This estimate Is subject to change and dues not bind you or Lowe's.This estimate Is not a contract nor will it modify any future contract you may sign with Lowe's for the installation services.You may accept this proposal only by signing the appropriate Exterior Solutions Installed Saks Contract with Lowe's and making payment according to the terms and conditions therein.(Estimate good for 30 days).Installation fees will be and additional charges may be based on total product required to fulfill order(Including waste),which exceeds actual area square footage.If you would like to discuss the measurements or would like a copy of this document,please contact the Lowe's Store Associate.Please review your contract carefully for all charges prior to signinR. 5110 REV,7/15 t + • i . • , t i ! 1 1 { tits i i i i t t i t t t t t { t t { i • i t + t t i ! t i + , t • , + s a',`• . , , , s . , .", ."i a. •'i•t+s�i+.�, .�. , ,�. , ,�• , , t •i} { } f i } } +4 } f} } } } • 4 1 t! i t 4 }1 } } } } s i t } • t} ♦ } } } } s i a t t t i , • , , a + , , . i 1. • • • • ♦. . . . t • + � i / . t i t Y 4 1 i i 1 }.}!!.t S S i S! 1 } 1 1 7 i S } S } S S } 1 } t / . • } �} } { • t t i • • i ti , • . . aa,a• , . , • •♦ • t• a• . a • • • a a , . . ♦ t a bit i 1 t{:},4-{ }}Y f i 1.♦i !♦ a a a a,L♦t ♦ • . • , . ♦ a • t t • • • t • a • • a a • a , . , Scanned with CamScanner `i'"II., QlligA: Ouota LOWE'S 140NIE CENTERSL . Lcai916 282 RUSSELL STREET 1AP9406VINGHADLEY,MA 01035-0000 Date:03%0512020 USA (413)588-0270 Project M; Customer Name: 613482395 SUARON GLADSON Description: Customer Phone: Pse windows(lodoin) Castomcr Address: (610)316-4942 24 CORTICELLI ST FLORENCE,MA 01062 USA Line Item Frame Size Product Code 001 Description Unit Price Quantity Total Price Size=37-in W x 39 1/4-in Ii Manufacturer:Reliabilt Atrium 15%off Select SOS Windows and Doors from 02/27/20 to 3/11/20*** 5278.53 5 SIJ92,6. ***Meets Energy Star Requirements for North-Central/Southentral/Southern Regions***U-Value:0.28,SHGC:0.20 -DP60:Size Tested 36-in x 74-in ***DP Code and Florida Approval Code only valid up to indow size tested*** Division:Millwork Product:Windows ype: Double Hungs anufacturer:Reliabilt by Atrium ill this product be installed by Lowe's:Installed By Lowe's Product Type:Double Hungs Product Line:Replacement Series: 3 900 Install Only ouble or Triple Pane Glass:Double Pane Unit Configuration:Single Unit ail Fin: Yes Sash Configuration:Equal ctual Width:37-in ctual Height:39 1/4-in I ts Opening Width:37 1/2-in its Opening Height:39 3/4-in onfiguration:Integrated Lift Handle olor: White ***See in-store displays for exact color samples for both interior d exterior color.*** nterior Laminate:None lass Energy Efficiency: Ultra Low-E w/Argon lass Color: Clear ***The graphics present an estimation of the color and are not a ompletely accurate representation.*** lass Strength/Safety: Single Strength Spacer: Standard Spacer rid Type: No Grids rid Style:No Grids Hardware Color:Color Matched Double Sash Locks: Yes ood Extension Iamb:None creep:Clear View Mesh Full Scr= (owes.coMm2o_b/mediumQuote.jsp?projectld=182803973 112 Scanned with CarnScanner z" 70 OWN rows FiNd Fes.irs 1�d F *11-" ed Ht's Litf uxw L.al v wwr2on-[.WLUIIF--, F FE GLASS BRFAKhGE WARPANTY Tvw.15 RFs total 1 :�1t�4KS ftelect total: 51 12.O Salr+prrs+rn: DhtilFL 1`Lh11E1CTYtisl1161�F1) Ati+e ted Isy: Dile,n]t>y"n"n Print DetaiM!d Ot*% 1 his quote,is an estimate only and%-slid for 30&0 as dl teguladq priced Wemni Fou Pel ittmt please refer to the dates kf-i nhovc. This cstimatc does"irKhWt tax yr ddi adrytNtwpm Ettvw� arrival will be determhred at the time of purchase AAI nf the ahovc quint it ws,dimenorm%,specif►ratimm artld aerewwri a Lame keen retifled sad accepW by the customer. aa` MIS bd s y r' -k yy Scanned with CarnScanner Rep/eceinent Window Locabon Drawing Detail specMcamms Data: Cuwtm I r: Ctstamr prone In�l!aer. CUMMnsr MIM be hem ft in t on All mee8urremeA19 rnuef be in Inchee Looetion aty Width Height WfdUI Height.. Style rCOmont ' �.�c(11c:•..,� 3 S 37.5 35.�s 38,75 �� 4 6 e 37 S 39 �5 r e . o . • Scanned with CarnScanner • Lowe's Window Operineet� ,; , .t H+s Needs Assessment Form What is motivating You to purchase new windLTyys( energy savings,etc)? Are there any particular featuresrs You are looking for in your new windows? •fC Do you have specific areas/rooms with problems(hot/cold,leaks,etc)? Vv Are you having difficulty maintaining your windows(clean,paint,etc)? Is there a specific type or style of window You are interested in? �� li, Current •�+�71fb T4 L'r:ft 1� °tr, Ja •r Wood Style•_„_•i Vinyl Configuration 6 ration Cull 'rimer .c Grid Inserts:Y (/ Interior Finished:Y/N Style: GBG RMV SDL " Calor Pattern:� (w x H) Exterior Color: White Almond Other (may need co roll to match) Blind&Screen Options: Hardware Preferences: Blinds or Shades >>Color___ _ Style Screens(Type&Size) Color/Finish Jamb Extension: Glass Package: in�Ii!{IUV� a 1`tt ;ir t � �a��z• ^�r S�`�1d kv 3iii. Tiz'Z'�,h.�K Rc,R�' � interior Casings: Exterior Trim Accessories. Size Finish/Color Coil Clad Tri Style Stock/SOS Brickmould Profile Jamb Extensions Frame Expanders Additional installation information: Custom Comments/Other customer preferences: { ; Scanned with CamScanner � 9 ET IT INSTALLED R' Window Installation Made Easy Through 9 Loweps Ho m e. Services We're happy you've entrusted Lowe's with your window installation project. Inistaltation Pre-Installation loctudes: Checklist: 191 Installation of new window in same a/J A Professional Independent Contractor size,square opening in reasonable gwill contact you to schedule your good condition(no rotten wood). Installation URemoval and Haul Away of your old Er Ensure the space around and below windows. the work area is accessible and clear Pro to caulk and insulate windows of all debris Ef to meet manufacturer specifications. Pets should be kept clear from the Repair of torn screens and light construction site blemishes/scratches. Ensure an adult at least 18 years old is Review warranty and product present during the installation instructions with you. Ef That's itl sit back and enjoy your Clean-up of job site. window installation completed through Lowe'sl Please note: Customer is responsible to inform us if property is governed by Historic District Regulations or HOA. Installation Does Notlndude: • removal or reinstallation of existing security system hardware,shutters,valances,or interior blinds. art of the Lowe'sprogram Indel intin or staining Remember, in order tou heso be a t rating test of all you . All Inde, � g Contractors pass the 9 • Major structural modification Contractors are background checked,licensed(where applicable)ant call 877-505-4923 Contact your loci Cat( 888-516-1010 in these states:FL.OK.T'A '] / (.� ' )n these states:vA,MO,wv,iN,MtR-GK t MOAR.KS.NE,MN.SC.IO.UT.N (QUESTIONS? ! —v 7S-ese States:SC.GA, (NC,TH.KYZ QI0AA CT.RL1tA NH.Mt.YT ? U MS.AK,HI.WY.NC �teonlrxtor�.dcens Installation aarriea•quem^teed by(.owa•a bbor warranty ie on b1*�u� �}t�C•ntrrf.LLC wMr>s opp�Me.Lkeme numben t pirtdiations M by E t�tOt1 t•«• 1 owE 5°^a w G.W Mansaro u..�o"ar. $ea Lowesmllicensinq for currtnt license numbers. .co rcpttcr:Mtr�d"n�rl'sotlf.liC r Scanned with CamScanner x r"%�r�arrrrrrrrrmrtrf�r tf''" t ;Strr�tr.'ejf` Office of ConsumerAffr1irs&Bu>ineso Reguhifion HOME IMPROVE MEN .-NTRACTOR TYPE:ir+c7iv;dual Registration Expiration 159137 04/03/2020 MARK JODOIN DIB/AJODOIN HOME IMPROVEMENT MARK S.JODOIN 15 JONES DR EASTHAMPTON.MA 01027 Undersersretl,y Commonwealth of Massachusetts Division of Professional licensure Board of Building Regulations and Standards Constrttc lbn'Supervisar CS-049918 Expires: 12129/202 MARK S JODOIN 15 JONES DR '. EASTHAMPTON-MA 01027 .,�� �4, Commissioner DATE(MMIDDIYYYY) 4CC�Ro® CERTIFICATE OF LIABILITY INSURANCE 03/2612020 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: PHONE FAX 100 North Tryon Street,Suite 3600 AAIC,No Ext►: LAIC,Noy Charlotte,NC 28202 EMAIL ADDRESS: INSURER(S)AFFORDING COVERAGE NAIL N CN102776519-Lowes-SI.20-21 _ INWRER A:National Union Fire Ins Co.of Pittsburgh PA 19445 ------ -- ------ -- -- INSURED22829 Lowe's Companies,Inc. INSURER 0:Interstate Flre&C8SU811y CO and subsidiaries INSURER C:New Hampshire Ins Company _— _ 23841 1000 Lowe's Boulevard Mooresville,NC 28117 INSURER D INSURER E INSURER F: COVERAGES CERTIFICATE NUMBER: ATL-004934190-11 REVISION NUMBER: 15 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. _ /NSR TYPE OF INSURANCE ADOL UBR POLICY NUMBER MMOIIDID EFF MMILDICIYYYYYI LIMITS LTR COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE_ __ $ CLAIMS-MADE I OCCUR Self Insured•See below PREMISES(Ea occurrence) $ MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY PRO JECT n LOC PRODUCTS-COMP/OP AGG $ �-,rtirp $ AUTOMOBILE LIABILITY CA6631232 (AOS) 04/01/2020 04/01/2021 COMBINED SINGLE LIMIT $ 5,000,000 _ (Ea_accident)_- X ANY AUTO CA6631231 (MA) 04/01/2020 04101/2021 BODILY INJURY(Per person) $ OWNED SCHEDULED I CA6631233 VA 04/01/2020 0410112021 )I AUTOS ONLY AUTOS ( ) BODILY INJURY(Per accident) $ HIREDNON-OWNED PROPERTY DAMAGE +S -_ AUTOS ONLY AUTOS ONLY S X UMBRELLA LIAB X OCCUR USZ00024220 04/01/2020 04/01/2021 EACH OCCURRENCE $ 10.000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE $ 10,000,000 DED X RETENTION$ $ C WORKERS COMPENSATION WCO23096086(AK,AZ,IL,NC,NH,VT) 04/0112021 X STATUTE ETH _ AND EMPLOYERS'LIABILITY '-------- O ANYPROPRIETOR/PARTNER/EXECUTIVE YIN N WCO23096087(ND,WA,WI,WY) 04/01/2020 04/01/2021 E.L.EACH ACCIDENT $ 2,000,000 C OFFICERIMEMBEREXCLUE N/A WCO23096085CO,DC,DE,HI,ID,MI, 04/0112020 04/0112021 (Mandatory in NH) ( E.L.DISEASE-EA EMPLOYEE $ _ 2,000,000 If yes,describe under MN,MT,NE,NM.NV,RI,SD,TN,TX) E.L.DISEASE-POLICY LIMIT $ 2,000,000 DESCRIPTION OF OPERATIONS below A 'Excess Workers'Compensation XWC6559368(FL) 0410112020 04/01/2021 (WC per statute) 3,000,000 A Excess Workers'Compensation XWC6559367(AOS) 0410112020 04/01/2021 (WC per statute) 3,000,000 I DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Commercial General Liability policy is Self-Insured,effective 4/1/2020 to 4/1/2021. SEE SECOND PAGE FOR ADDITIONAL WORDING CERTIFICATE HOLDER CANCELLATION Lowe's Companies,Inc. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE and its subsidiaries THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 1000 Lowes Boulevard ACCORDANCE WITH THE POLICY PROVISIONS. Mooresville,NC 28117 AUTHORIZED REPRESENTATIVE of Marsh USA Inc. Manashi Mukherjee ©1988-2016 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: CN102776519 LOC#: Charlotte ACORO ADDITIONAL REMARKS SCHEDULE Page 2 of AGENCY NAMED INSURED Marsh USA Inc. Lowe's Companies,Inc. and subsidiaries POLICY NUMBER 1000 Lowe's Boulevard Mooresville,NC 28117 CARRIER NAIC CODE EFFECTIVE DATE: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: Certificate of Liability Insurance TX Employers XS Indemnity Policy Number EE14062802 Safety National Casualty Corporation Policy Effective Date:01-Apr-2020 Policy Expiration Date:01-Apr-2021 Limits:$8M Each Occurrence 1$20M Aggregate XS$2M SIR TX Employers XS Indemnity(Excess) Policy Number-XC83064 Evanston Insurance Company Policy Effective Date:01-Apr-2020 Policy Expiration Date:01-Apr-2021 Limits:$15M Each Occurrence/$20M Aggregate XS$2M SIR Workers'Compensation and Excess Workers'Compensation policies include a self-insured retention of$2,000,000. General Liability:The insured is self insured for$10,000,000 each occurrence for the period of 4/1/2020 to 4/1/2021. The Automobile Liability policy evidenced above is subject to additional self-insured retentions excess of limits shown for various perils covered. Regarding Auto Liability and Umbrella Liability: Any party with which the Named Insured has a contractual agreement to include as additional insured is included as such under the policies if required by written contract with the named insured,subject to the policy terms and conditions.Coverage under the policies only applies to the extent of the coverage required by such contractual requirement and for the limits specified in such contractual requirement,but in no event for coverage not afforded by the policies nor for limits in excess of the applicable limit of the policies. Insured is self-insured for Automobile Physical Damage for the period of 4/1119 to 411/20 Regarding Workers Compensation,Excess Workers Compensation,and Umbrella Liability: Any party with which the named insured has a contractual agreement to provide Waiver of Subrogation is included as such under the policies if required by written contract with the named insured,subject to the policy terms and conditions.Coverage under the policies only applies to the extent of the coverage required by such contractual requirement and for the limits specified in such contractual requirement,but in no event for coverage not afforded by the policies nor for limits in excess of the applicable limit of the policies. Additional Information: The Named Insured includes Lowe's Companies,Inc.and its subsidiaries,including but not limited to Lowe's Home Centers.LLC,Orchard Supply Company,LLC,Allied Trade Group,LLC,and Maintenance Supply Headquarters,LP. ACORD 101 (2008/01) ©2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD AC" CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYYY) `..i" 08/14/2019 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 CONTACT NAME: Marie Proulx INSURANCE CENTER OF NEW ENGLAND PANIC, o (413)750-7106 FAX Nql:_-___ E-MAIL P ADDRESS: m roulx Icne.com 1070 SUFFIED ST INSURE R(S)AFFORDING COVERAGE NAICN AGA_WAM _ MA 01001 INSURER A: AIM MUTUAL INS CO___ 33758 INSURED INSURER 8: MARK JODOIN INSURERC: JODOIN HOME IMPROVEMENT INSURER D: 15 JONES DRIVE INSURER E: EASTHAMPTON MA 01027 INSURER F: COVERAGES CERTIFICATE NUMBER: 436810 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. IADDLSUBRPOLICY EFF POLICY EXP LTR R TYPE OF INSURANCE IVSD WVD POLICY NUMBER MMIDDIYYYY MM/DDIYYYY LIMITS LT COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS-MADE OCCUR PREMISES EE RENTED $ MED EXP(Any one person) $ N/A PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY ElPRO- ❑LOC PRODUCTS-COMP/OP AGG $ JECT OTHER I $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS N/A BODILY INJURY(Per accident) $ NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS Per accident _ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE N/A AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION X I STATUTE EORH AND EMPLOYERS'LIABILITY ANYPROPRIETOR/PARTNER/EXECUTIVE Y/N E.L.EACH ACCIDENT $ 500,000 A OFFICER!MEMBEREXCLUDED? N/A N/A NIA AWC40070296132019A 08/31/2019 08/31/2020 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 500,000 If yes describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 N/A DESCRIPTION OF OPERATIONS I LOCATIONS I 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/. Sole proprietor has not elected coverage. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Lowes Companies Inc and any and all subsidiaries ACCORDANCE WITH THE POLICY PROVISIONS. Mail Code A3ESS 1000 Lowes Blvd AUTHORIZED REPRESENTATIVE Mooresville NC 28117 Daniel M.Crowley,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 office of Consumer Allain&gusiness Regulation HOME IMPROVEMENT CONTRACTOR TYPE:SuDdement Card Rei 10;1712021 148688 LOWE'S HOME CENTERS.LLC CHRISTOPHER MWE 1000 LOW ES BLVD Undersecretary SERVICES COMPLIANCE MOORESVILLE.NC 28117