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32C-155 (6) 39 KINGSLEY AVE BP-2020-1287 GIs#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 32C- 155 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-2020-1287 Proiect# JS-2020-002159 Est. Cost: $8500.00 Fee: $40.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: SEXTON ROOFING CO 99689 Lot Size(sq. ft.): 6011.28 Owner., MORRIS MARYANNE Zoning:UPC(100)/WP(70)/ Applicant. SEXTON ROOFING CO AT. 39 KINGSLEY AVE Applicant Address: Phone: Insurance: P O BOX 6327 (413) 534-1234 WC HOLYOKEMA01041 ISSUED ON.6/26/2020 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 Si-,nature: FeeType: Date Paid: Amount: Building 6/26/2020 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 Northampton Status,of Permit: r . Building Department Curp"Orpriveway Permit I 212 Main Street �/UN ' SewerF�tic Availability a Room 100 c WaterMellAvailability Northampton, MA 01060 ;'Tom Two Sets of Structural Plans phone 413-587-1240 Fax 413-587-�('� � Plot/Site Plans ~�'oy'6 er Sp ify APPLICATION TO CONSTRUCT,ALTER, REPAIR, RENOVATE OR H A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION 1.1 Property Address: This section to be completed by office _ Map �tA C� Lot ��� Unit Zone Overlay District Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: lit IN X-( hit 1KA / -S2 ; �r Name(P696 Current Mailing Address: Telep ?one Signature 2, uthorized Agent: Esc i_ CP _S -7 Name(P nt Current Mailing Address: V/ Z -3Y Signature Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building ! (a) Building Permit Fee 2. Electrical (b) Estimated Total Cost of Construction from 6 3. Plumbing Building Permit Fee 4. Mechanical (HVAC) 5. Fire Protection 6. Total=(1 +2+ 3+4+5) Check Number This Section For Official Use Only Building Permit Numb Dated: Signature: 24 ZOZy Building Commissioner/Inspector of Buildings Date EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR) Eswvw 'YootfEw'p t:'k': t1E 4"1 F:w*,;l -1l:>"vlW.0l's l4F.t6 e .w.,s+s�w...w,..........rawR:wry»arr:.. rrwb.-. ...u.+r.,rM�l.-••/Prw'w.avw«dfw::amivaA+Nww::.... :..nyNwr..r•....K.....Y...-«w::,.,r .!.r.ww,r....w:-.;^Vy"'•Y,'.wf.�w.wssa..,s.ra4aMre..w�w-•.r...+rr�ws.,.rn %41 040 1 .f.�s3�, G3.,:}t l• Cw••xJi Yf:,t�� .' �"y/.FTI. ' w a r , 1 f .�� .. �'� ,e.r 'd��7.'' .•� '�..'!ia�'-meq.,3:�?is.r�'.�-t8 .J r..W. SAY iL� ��:t`,� ^:li��} i.r.�✓! s.i.��i'. rad + 3 Y. . aV .. .j * ♦.. ,Y :. ,�. 1. 1}o�r ijf i c� i`'.-Z'�i -- UP 5 A:I �. 1 `�� �Y'��� :R�,JS.f #1 V I¢ 4,IS✓ �ty��f' .+'R:.! � `3�".. k` � i Y•, •a' ..i{a 'Y 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 wilding Department Lot Size Frontage Setbacks Front Side L: 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/Vari ce/Fi ding ever been issued for/on the site? NO O DON KNOW YES IF YES, date issued: IF YES: Was the perm' recorded at the egistry of Deeds? NO O DONT KNOW YES IF YES: enter Book Page and/or Document# B. Does the site c ntain a brook, body of water o wetlands? NO O DONT KNOW O YES O IF YES, ha a permit been or need to be obtai ed from the Conservation Commission? Needs t be obtained © Obtained O , Date Issued: C. Do any 'gns exist on the property? YES © NO IF Y , describe size, type and location: D. Are t ere any proposed changes to or additions of signs int ded for the property? YESO NO IF escribe size, type and location: E. Will the construction activity disturb(Gearing,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. z,y:rx: f�. pi', r•1`' _�•� f,r16: # �,,}:,, ✓ i.. '��! ids.a..P h ., .�1°>v .<zey�y�i+','J 'd`L_'-f4:� ', 'i ,`•'�tC,4f•kR`!SK" �i.t,�3#.'� ery'': y,;2.# f!.,i tj�,H,. rls d, zi: . ?�' p � 4! ,��:`31i,"!:)tw .:.a•. ' ' C - •t, a. y'W� �t }.flt A 1i'•{� 1c'r`.l.'"T: 4,A :KJ`i,. t.,f,a+� } fi!! ';t'y,:, Z1m',S , •'.k.�rr f :: r}E;#y:tl :� l 6. ' {L.� :• : 11 �q"� Y y�g�♦ yyh #.,• .�' t�fiC i�,"w L1`1�T.,�°'H/�G 7i..�,�,1�1...'�'/.l��i. � , . 'ifw '� :�? .ir ^l ri,'x.,, .•J•xry #.'' ' .. <i.iAz" OL 0 �Al j Es ,3 ° Yte L,4i f ! =..�}.. y.f-r i YFt#; �'♦ t f.0+q.y.(" C r :�+f. '..-}, ='' �'�.i t� r - i..t4"K1.. '4.a'..S , 1-k46 cx, :.t'' �}:r�;,;idt 1. ,Cii>'1 '; !✓. °' ya �,'.. fr,4;. _ `� ;�.>t i�•e.P::.'.,.af� :ti.}}iil!EA,R�i, . ._ .'?!t�`(P.#.t}L'.•ft ern !.�,ii':, je hi1 :=2 f'-I SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable) New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing 0 Or Doors I] Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks Siding [0] Other[C7J Brief De Hiption of Proposed f 1 Work:�CjJ`(� �T Alteration of existing bedroom Yes��:;�ein��ovatin, ew bedroom Yes No Attached Narrative 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 footag f new construction. imensions e. Number of stories? f. Method of heating? Fireplaces or Woodstoves Number of each g. Energy Conservation Compliance. asscheck Energy Compliance form attached? h. Type of construction i. Is construction within 100 .of wetlands? Yes No. Is constru ' n within 100 yr. floodplain Yes No j. Depth of basemen r cellar floor below finished grade k. Will building onform 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 as Owner of the subject property hereby authorize X ' 4L toacact �on my behalf, in all matters relative to work authorized this building permit application. Signature of Owner Date as Owner/Authorized Agent he eby declare that 1he statements and information on the foregoing appli tion are true and accurate,to the best of my knowledge and belief. Signed unde t e pains and penalties of perjury. -t3riitif Name / < 2/ 2-, Signature of Owner/Agent Date .- r•_ '.�,.:$..t io>�?).�-. �r+'CA,�''.�sd. yS.. -.:. tw . .�?.,'�. �,��.7:'w 44 ... ...f ., �a` a z , •� t"if F.' S''! J * �� t?}37,,�ir �Fi:-'. EYkl�:a` a'3° i�`1S k .r fe�.!£° -i _, m ' �..,A. �•yk< _. i�r+.`i'1.; v �Y� 'y.� .. �i -.I' , .:0�.t: Y 1'f?�. Y J .- , «..,--r.:,..;•.:...r._: ,..,,«,..... ..,.:..w.w•.,.-. ..... .. .r•....w..,:,,...... .,.., ., ,..........:. :..:......,,,._...w.._..........".•,.w..+.... ..,yn's+w•..«,.,..,-.. .-. ...-,«. .. «..w+.....n ..,... .. ... ...w,._..� 1 €.. F ".... ,� dad ;e„�..j , �.i...:°"�, .'.. �.'±,_...,,w. J O„LS•.....'...,... ,ancon" r ., + _ P i - La t:is 4:'N. i.W+p.�^, 18"3.'.:it ctY; S u :y., � a ,Jj .. °i`. ..Y '-j�. .f..s ,,{w.. .3 I': e•7iiT.'�Jf .. �ti .. ` •.. .. . a:�`, ! WART AW.R'ry - 0 tlOi i-Y O l On 11,f, K! A., . me- !. r r • `r SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction rvisor: Not Applicable ❑ Name of License Holder: �M 32 License Number U Ad ress 'Expiration Date Signature bTelephone 9.ReWstered Home Im' E ment Contractor: Not 9Applicable ❑ Com-1fanv Name Registration Number e-zD 6�- (- ;)—/v-..?'/ A dres (4� Expiration Date 60 Telephone l Z 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...... ❑ 1. ( f � IC ,V Cr } bv, it ,Q, w {:^ {t'r...l,. - ., '�;.•t1'w 4�.u. ..., '1r:,�..�'?�s C'.:.':"`a�...s' ::f li:'f'i�t",�;:,�p:;,,�L1J7�, .`fit" :'.• ti?y� k ".�4� .,�r;- A� w� '�• 1' .awe... - • F . n ' ��' ' L.. t 4?;�7L+rt,. -_ �^ }i,F>.'����f•�ay' S},$.�7{`Gp T. r .. .... .- - ..... .. r «._.......».w.,:.:.. --�...-... .....,....... ......o.. .... ,. .....-.k........... .., ....yam.. ..._ .. _, ........ .. .,..... +..+ _..._.... { Off it j� ', City of Northampton . ..l Massachusetts SSS � S/C DEPARMENT OF BUILDING INSPECTIONS r ti 212 Main Street • Municipal Building yvk cD� Northampton, MA 01060 rsHh T',�4 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 stnictures which are adjacent to such residence or building"be done by registered contractors. Note.If the homeowner has contracted with a corporation or LLC,that entity must be registered Type of Work: 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 build i permit as the agent of the owner: z Date Contractor Name HIC Registration No. OR: Notwithstanding the above notice, l hereby apply for a building permit as the owner of the above property: Date Owner Name and Signature r ( e _.' ''{� tl lb". `•�1.�' i.r t =�e� ',.(F r� .. �'. 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'aS` •i,�... r5��c;'_":q.�4P, -�,F; 'k��Lk1�:f a�, `4?aC�e.9ti.': i:'. .+. :,y"�1i` .3•i �".���'.',{tA!'>�: , '�+� •�, •�+. 8':37't'ai, a x'` ,r .:.�.Ij "„s+,,.!! i.(:�.(f ,+r .:s�tLF}�t-t �r.. ...`.i�.;t ... .�a�,N�kS;.: 1�`r`;"5-. } ,....k�..{ w,•..i:. ..{,,-.ir.-lal .{t t' � .. v ii,, s } (+M ra:' . �}:.:l4.r 't�l/:� l-., ?.lE i. . �,( 12F�i..�• s: .!i'Y?ice•. + n.: . .7:i{!. f�" .. ' -y. ,. ;IaiS'F`f'F ;t;�t yjl..`. `-C'}:.>. .. ,,.'rjll': �f:r(l".tt`' {t�t,�";c.![,,�••s ,SY.. .1 a "'£;_ ./+ +St:..'�y.S y.!> fir. ,• ^, °A' _ -a ,,+�. Yytr.:�;7 Y..4;1{ .i�j.`t•" i,`!' !a?•la. r"t! �Ptl. i (. t 'fir; { .i,i+' ii .�i.}.n" C:,,. �.i! ,!P'i•! '. }y'.,;i:r Liii;.7'. 3 .,f{n`•..r ,. . `i3; 'iw3'-{�.. jwht, _ c) "o s• �4.. 'F -,ids' G .+cat 4F r j}� J, ff N �• ;� $� yw�• t, ,yi ,�.,.I� �'.N,w 1�� ..n..��� �� �'J X ' Y� �tµ�ra'� City of Northampton Massachusetts � DEPARTMENT OF BUILDING INSPECTIONS w 'J 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:(Please print housd numbCar 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. SEXTON ROOFING AND SIDING INC www.Sextonroofing.con P.O. Box 6327 Setting the Standard Holyoke, MA 01041 41J.534.1234 f. 413.539.9%6 MA FUC# 118239 sextouroofin&,alotmail.com SUBMITTED TO Mary Anne mor& J'!�H—oNt 320-2212 F8/20 MEFr 39 Kingsley Ava. 1 JOB NAME CITY,STATE,ZIP Nwthan4ton,Ma. i JOB LOCATION SEXTON ROOFING EMMY SUBMITS SPECIFICATIONS AND ESTIMATES FOIL 1) Strip and remove existing shingles and dispose of in proper landfill. 2) Inspect roofing deck and replace as needed @$75.00 per sheet. i. 3) Install new metal edging to rakes and eaves of roof.(811) 4) Install ice and water shield on eaves(61),vent stacks,in valleys,chimney, and at intersecting roofs. 5) Install#15 synthetic roofing felt on remainder of roof. 6) Install new flanges over existing vent stacks. 7) Install starter shingles on eaves and rakes of roof. 8) Install IKO Architectural style roofing shingles as per manufacturers' specifications. 9) Install new cap over ridge vent. 10)Supply manufactures Lifetime warranty and SRC 5 yr. workmanship warranty. W -PIfODase hereby to Annish AwtwW and A-awr-compApte Aw accanhmm tit rM ffm m*vm at me W F1 drfbr0w&wa#=fof NAw rh*=uwdF1whkw~DQLLAW (J&CO&M PAYAWWM7VMEMWA5F0L0ffiW due in full upon completion workmanlike manner ac=*ng to standard practices. AM alteration or All Material is guaranteed to be as specified. AD work to be completed in a Authorized deviation from above specifications involving extra costs will be executed only 7 upon written orders,and will become an extra charge over and above the estimate.DAmAGEs To BUSHES AND OTHER vEGrrATjoN'MARKS oN HOUSE MAY Note:This proposal may be withdrawn by us if not accepted BE ujAvotmxx AND wE ARE HEm HARMLESS. Not nrsponsible for water within(14)days. damage during construction. Owner to pay responsible legal fees for non- .'ent,and apjplicable interest. Ott of J)r9Wff1 The above prices,specifications Signature L,4 14 7,2 70 and conditions are satisfactory and are hereby accepted. You are authorized to the work as specified. Payment Will be made as outlined above. Signature Date of Acceptance. f. ILA. a..: Cs: Wyk Atzt *40r l- i4a,-! V1,10 Y li heFt�a t."!:�YS'•�Si '°�•✓''9*�-'..>ii"Y,ek-!t e ".N';�y(c�u.'".�,.a t iI'tAS.,.��.. y .L - [ .. . 41 I t ' � � •;, �P 1r'teg'�r 1�„ 'IMM�'t's,".''.;;sf i.Z 4 1 f�.. w -�,.�qr£Pk S A;��' .. .. _ ,.�.: � - kiq °37': .,. �:1 ".' .. ! ':. 171YY.F'�rla��t*-.S•' '" fi.:�".''a \ S 7i'.u.pR'i �'� S$�'li,�-" Vin. �s 4° a3 ` , i= '.lh,';. f. ..a t,eP`NF'� Vs.+;S• .'Yl''".,Pl.{�:\..fib �.„y�. 4P l 4'% '.wdya SY^.. ,�rY' � > a z 41r h 1,:q1 ;.<: r ., •1:.v g rrs- kkff :l,.i„A .x�$r;1!•X r6a•':«!f .. ,{,,.y:.,•s ' t��y , ��y� �• ppyy f�C f �i6ta,�4 is�YN � - .a ,+w•,. 'L "',) '�a'a $,�`' ": # gg t w4:(r! `, -°..`S^'�w'rw ;'" '�'roz aa'.. 'e�'is••=''a f'F.t ,d',� .¢4, c# ,4"t ,a•-'�,a`};b, a ?` + •i'4; { �!YIN1Y4�f l� .� ;-t', (rM 3 �,._,�• y��. i4r;1 '.y,,,i a.. - .SF•'.'{J��.y' b��•x �+. ( �1\., a,"p d�i3�1�'� " ��`:ar "rpt ,� 4�'�`' .�`�s`i�• :r:.`.� .iy�Dd �; �" �' '� l > �ae.•� y,� vpeiy ty •71" y {{ A 'fa ,K .. .. _mak... .5�.+� J- .xi e._ _ �k..�• J+,1,`,� ,�,p�.;,s�w��'s+"%�: � � �r�. a ,v + A" .tialtiSsa r. •�, .�"t,!inav .r:.W� Pan,- se. .. +�' ..... .tn r ' r The Commonwealth of Massachusetts Department of Industrial Accidents z X11 2 Office of Investigations 4 Lafayette City Center / 2Avenue de Lafayette, Boston,MA 02111-1750 ? =y www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual):Sexton Roofing &Siding, Inc Address:P.O. Box 6327 City/State/Zip:Holyoke, MA 01041 Phone #:413-534-1234 Are you an employer? Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. © I am a general contractor and I employees (full and/or part-time).* have hired the sub-contractors 6. New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have g, ❑ Demolition working for me in any capacity. employees and have workers' 9 ❑Building addition [No workers' comp. insurance comp. insurance.: required.] 5. ❑ We are a corporation and its 10.E] Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑ Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.0 Roof repairs insurance required.] t c. 152, §1(4), and we have no employees. [No workers' 13.❑ Other comp. insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. I 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:Travelers Property CAS CO OF AM Policy#or Self-ins. Lic..#:7PJUBOG07898220 Expiration Date:6/4/21 Job Site Address: � (_C1� u� City/StatelZip: AA Attach a copy of the workerscompensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of 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. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for#france coverage verification. I do hereby certify under t ins and penalties of perjury that the information provided' above is true and correct. Signature: Date: / 3 / Zr 76 Phone#: 413-534=1234 Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License# Issuing Authority(check one): 1013oard of Health 211 Building Department 3❑City/Town Clerk 4.0 Electrical Inspector 5alumbing Inspector 6.❑0ther Contact Person: Phone#: ACRD® CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) • `.-� 06/09/2020 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 Kathi Hutchinson ORMSBY INSURANCE AGENCY (PHE FAX Ate"N : (413)737-0300 Na: ADD, : khutchinson@omhsbyins.com P O BOX 718 INSURER(S)AFFORDING COVERAGE NAIC# WEST SPRINGFIELD MA 01090 INSURERA: TRAVELERS PROPERTY CAS CO OF AM 25674 INSURED INSURER B SEXTON ROOFING R SIDING INC INSURER C: INSURER D PO BOX 6327 INSURER E: HOLYOKE MA 01041 INSURER F: COVERAGES CERTIFICATE NUMBER: 541733 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.' ILTR TYPE OF INSURANCE IVSD WVD�� POLICY NUMBER POLICYMM1DEFF Df EXP ulurrs COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS-MADE 1:1OCCUR DAMAGE O R PREMISES Ea commence E MED EXP(Any one person) S N/A PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER- L' GENERALAGGREGATE $ POLICY❑PRI JET F—]LOC PRODUCTS-COMP/OP AGG $ OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea aurides ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS N/A BODILY INJURY(Per accident) $ NON-OWNED PROPERTYDAMAGE $ HIRED AUTOS AUTOS Perac�dent S UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAR HCLAIMS-MADE N/A AGGREGATE $ DED I I RETENTIONS $ WORKERS COMPENSATION X STATUTE OTH- ER AND EMPLOYERS'LIABILITYANYPROPRIETORIPARTNER/EXECUTIVE YIN EL EACH ACCIDENT $ 1,000,000 A OFFiCER/MEMBEREJXCLUDFD NIA NIA 7PJUBOG07898220 O6/04/2020 06/04/2021 (Mandatory in NH) _ EL DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below EL DISEASE-POLICY LIMIT $ 1,000,000 N/A DESCRIPTION OF OPERATIONS/LOCATIONS I VERICLES(ACORD 101,AdditicaW Re narks Schedule,may be attached it mm 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-compensationfinvestigations/. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHOR®REPRESENTATIVE Amherst MA 01002 Daniel M.Crq nr ey,CPCU,Vice President—Residual Market—WCRIBMA ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD SEXTO-2 OP I ACRD' CERTIFICATE OF LIABILITY INSURANCE °ATE1012099 07/110/20 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, ECTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW- THIS CERTIRCATE 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 poficy(ws)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 endorsemen4s). PROIJUCER 413-737-0300 cOME?cT Eric Dembinske Ormsby Insurance tfiAgency,Inc PRONE 413-737-0300 (AC No�413-737-0617 698 Weseld St PO Box 718 Enc Dee WestShrtkld MA 01090 ADDS em Iris rlrlS ytns t:nm — AFFOFMtNG COVERAGE NAIC 9 Rm INSURED A--Colony Insurance Go. �Nsu Sezton Roofing S Sidmg,Inc. INsrmgza-Quincy Mesal Fre Insurance 15Q67 PO Box 6327 OLSUFUER C_ Holyoke,MA 01041 INSURER D INSURERE- INSURER F- COVERAGES CERTIFICATE NUMBER REVISION NUMBER_ THIS IS TO CERTTFY 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- ILTRNSR TYPE OF WSURANCE EI1BR I Iwo POLICY MINBER POLICYIE F POLICY EXP Lnans A X coumEkcIALGENERALLmmurry i1,000,000 cLArlrs&vwE ❑X OTRZJR 101GLOG2159M 0612512019� EACH OCCURRENCE $W2012M guMkpEs(RENTED 5 100,000 IICD DP ane verset s .5,000 t� PERSONALE ADV INJURY S 1,000,000 GEN'L ACCIREGATE L[Wr APPLIES PER- I � GENERAL AG�GATE S 2.0100,000 POLICY a JECT ❑LDC I PRODUCTS-CO&rPIDPAGG S 000,000 OTHER- I S B AUTONOL;dE LLIBILI TY I i CDCO DINED SINGLE LIMIT $ ANY AUTO 1 BODILY INJURY S OWNED SCHEDULED AUTOS ONLYrx AUTOS ' BODILY NJJRY 5 O S MR® �yyN® 1 X AUTOS ONLY ONLY I I-F'er Pard--L -- S_----- --- 1 — 5 UMEWE-I I e UABOCCUR f EACH OCCURRENCE S EXCESS LIAR CLAIMS-MADE I - AGGREGATE S DED RETENTIONS ' I( 5 WORMERS cowPENSATroN I I PER OTH- ER AND EOPLOYSLS7 LIABILITY Y/N HE SENT SEPERATI3Y ' A . APROFRIETC)FUPARTNERIEXECUTIVE F--11 NY ` - CFRC (Mandatary j EXCLLIDEIT� - N/A i EL EACH ACCIDENT S EL DISEASE-E4 EMPLOYEE S If yes.desmbe under . DESCRIPTION OF OPERATIONS blow I EL DISEASE-POUCY LPMT S DESCWPr10N OF OPERATIONS I LOCATIONS f VEIRCLFS(ACORD 101,Ad&bowW Remarks Schedtd�_vary be alt, ed d mare spars 6 req-hrdl CERTIFICATE HOLDER CANCELLATION NONE-01 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELNERED IN Everett Sextan ACCORDANCE WITH THE POLICY PROVISLONS- - AUTHOFUZED REPRESENTATIVE ACORD 25(2016103) O 1988-2015 ACORD CORPORATION- All rights reserved. The ACORD name and logo are registered marks of ACORD f The Gonv➢lfJmw of MassachuseitS . Department oflndustrkdAccidents _ J I Confirm Street,Suite 100 EosYaT4 MA 02114-2017 www ma�mgov/dra Vw zkers-Compensation insaranre Affidavit:Build ers/C - lumbers TO BE FH"VMH THE PER-NM YL%G U,MO IFFY. Apalic.nt taformation r t ` Pose Print j ecrg- . Name(nusiness`org3nizatiorLindridual). ZULU L�tnj C ft1-t-+ti� Wit` Address: , � r"�1I..�v. .� >� r -f u +CitviStat&Zip: W"\,ib VA, 1AA Q i 7S7 Phone _ AM you 2n emptor e 7 Check the appropriate bo= { # T}-pe of project(required): 1 t am a ernpkrtiu a irh_ �emPloyces{fn i�dlor ome) - i� � ?_ E]New constntt:fion 2.Q i 3m a:de proprietm err parVmrship3rd hzve no employe=wo --ing for me in $ FIRemodeRng my©quit}-Plo workers'comp.tmamnre required.} i4 3-n i am a twmvmrKTdumgail work mysdf.{Noworins'comp.insraancc rrgrmed_]' 9_ El Demolition f IO[]Bailding addition -i D I am u homtowncrand vM1 be hiring contractors to caaAta all u:uk an ru}property. 1.v71 t atRuc that all cormxrtoa eitlu7 hnruvri`�rs'wn tPon�.,a•n• r nr are sots i '. ll-E]Electrical repairs or additions proprietors with no employers I? Plumbing repairs or additions. i S.III am a rnotractorand i have hired the sub-�fisted cffi the a shirt. � 13.F1 Roofr�s � These ctmshnremploycesandhavevwk=s-comp.iR�*na-= 1 ficacorporaiio =d its aMccrshasraesacdthcirngJuofa�mptioeMMGLe 14-❑0dwr .�wcarice. and ur Istat rw emptotres.[No nvrias'comp.iM�required_] n,a pphc tU=coeds bac;�I uta!a13.GH out the sawn mfncasr0on. t ubmit this affidava in h�t..gu y ere domg alt ,.L and then hire outside conft==must submit a mw affidm it md=wig suclL :Conti= is that c titin bon must attadbcd an addimwa)sbrti stmtvaT the n=e of the�mai:state Mx-dxror not those cnbties bale anplo,crs_ ifthestubcoirsactos'sa�tampbrees,ttxymustp:vvi&-their warkcrs'comp-policy number- tarn an employer drat is pravtdrng workm'compensation insurance for any employee. Bdaw is the poffey andlob stir inforramYor� '` �-, In-snrance Company Name: N VA- #'l l cl tf� Y L �. 5 _L VLS { Policy Y or Self-iris-Lic.9: E.Ypiration Date: Job Site Address: Citylstnelzip: Attacb a copy of the workers'compensation poi-try declaration pagge(showing the policy,number emd expiration date). Failure to secure coverage as required under MGL c.I52,§25A is a criminal violation punishable by a fine up to S 1,500.00 and/or one-year impriwmnent,as well as civil penalties in the form of a STOP WORK ORII$R and a fine of up to 5250.00 a (lay against the violator-A copy of diis statement ray be forwm-ded to the Office o:Investigations of the DIA for inst>rnnce coverage verification- I do hereby certify un der the pains mules of pry Zliat the iaforrraztian prom abase is trae and cunzrt Si- �-�� -ZZ/1, Dane '7! � Officifd ase oa4- Do not write-in this area,to he completed by city or toren q07CM1 City or Town: Permitil icense Issuing Authority(circle one): L Board of Health 2.Building Department 3_CityfFowu Cleric 4.Electrical Inspector S-Plumbing Lisgector ti.Other - Contact Person= Phone CERTIFICATE OF LIABILITY INSURANCE DATE(L1Gi1ppDIYYYY) THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE C 11127/2019 CERTIFICATE DOES NOT AFFIRMATTVElY OR NEGATIVELY AMEND, ERTIF7CATE HO ERLD—THIS BELOW_ THIS C EXTEND OR ALTER THE COVERAGE AFFORDED 13Y THE POLICIES CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INS ED AUTHORI7Fn REPRESENTATIVE OR PRODUCER,CER,AND THE CERTIFICATE HOLDER IMPORTANT_ If the certificate holder is ar..ADDITIONAL INSURED, 4 the terms and cnndd7ors of the ithe Pol`YVUS)must be endarsed. If SUBROGATION IS WAIVED,subject to certificate holder in lieu of such�'certain policies may require an endorsement q PRODUCER endors2merrt{s) statement on this certificate does not confer rights to the ONE FAMILY INSURANCE AGENCY LLC PHONE CaIvITIo Nn (978)403-5942 FAX 1 Main St Suite 15 AooR6s: acahnRo128@yahoo_rnm No Lunenburg INSU RAGE Nac>r UVSURED MA 01462 PLSIIRETRA: HARTFORD UNDERWRITERS INS GO 30104 MNP CONSTRUCTION INC INSURER B: INSURER C: 45 EXCHANGE ST APT 3E INSURER D: MILFORD INSURER E: COVERAGES MA 01757 INSURER F: CERTIFICATE NUMBS 478475 THIS IS TO CER THAT THE POLICIES OF ftp NCE USTEp BELOW tiq�g�ISSUED TO THE INSURED NAMED AAO FaR THE POLICY PERIOD INDICATED. REVISION NUMBF NOTyyT�STANDING ANY REQUIFtHy)xI TERM OR CONDITION OF ANY SSUED CT ORINSOTHER DOCAM[aIT 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 MAYHAVE BEEN RED BY PAID CLAIMS. WITH RESPECT TO WHICH THIS INSR LTR TYPE OF7�lSURAN(-'E ADDI �� PDLfCY EFF COMMERCIAL GENERAL LIABILITY POLICYNUMBER POUC-Y EXP j I U6�T5 CLkWs-WDE 1:1 OCCUR ! EACH OCCURRENCE S li DAMA TO RarrED PREMISES a=uTe ice S I NIA MED ECP(Arty ane person) S GEN'LAGGREGATEL"rAppUESPER:. y PERSONAL&ADV IMIURY 5 POUCYPRO- E] 1 JECT n LOC GENERALAGGREGATE S OTtl6Z ' J PRODUCTS-COMPIOPAGG S _ AUTOMOmLELIASU Ty _— ANYAUTO COMBINED SLNGLE LMIT OWNEDALL I S AUTOS UIHJ NIABOOILY INJURY(Pe person) S HIREDAUr05 NOM-OWNED BOOILYU�LRIRY(Per acodeng -- AUTOS � PROPERTY DAMAGE s UMBRELLA A LIAS OCCURS EXCESS UAB CLAIMS-MADE + NIA 1 EACH OCCURRENCE S DED l RETENTION$ - I 1 AGGREGATE S WORKERSAND EMPLOYERS,L UM ry 1 P� S ANYPROPRIETORIP OTH- ARTr'IER CLIIIVE YIN I X,STATUTE ER A OFFICaRnuraBEREXCLU EDm Nfq NIA 6S60UBiKT0970619 (M2nd"inNN) - 11/16/2019+1111612020 ELFACHACCIDENT $ 1,000,000 U es�SC descnbenON udder 1 1 EL DISEASE-EARL ' DESCRIPTION OF OPERATION56eImer I S 1,000,000 ' + EL DISEASE-POLICY UMlr S 1,000,000 NIA D6CRIPiFONOFDPERATIONSILGIZAMONSI __--- ----- — - .._..-- Workers'Compensation benefits vAll be paid to Ma 3sachusetts employees only-Pursuant to Endorsement WC 20 03 06 B,no auth claims for benefits to employees in states other than Massachusetts if the insured hires,or has hired those employees outside of Massachusetts,is given to pay achtru setis_ This Certificate of Lnsurance shows the policy in farce on the date that this certificate was issued(unless the Policy Precedes the issue date of this certificate of insurance)_ The status c f this coverage can be monitored daily by accessing the Proof of Co n the oli Search fool atww inass_govAwdfmrkec�m�:�onfi Coverage Coverage Verification m+es>agalions/ CERTIFICATE HOLDER CANCELLATION J01041 — ' D ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED I ED SEXTON ROOFING &SIDING INCDANEXPIREWI DATE THEREOF, NOTICE WILL BE DELIVER IN DANCEVYII}t THE POLICY PROVISIONS_ 102 PINE ST DREPRESENTATIVE - HOLYOKL ::MA _CrD v y,CPCU,Vice President—Residual Market—WCRIBMA ACORD 25(2014101) ©1988-2014 ACORD CORPORATION- All rights reserved The ACORD name and logo are registered marks of ACORD CERTIFICATE OF LIABILITY INSURANCE °A�`�'�°° ' �---� 11/27/19 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER-THIS CERTIFICATE DOES NOT AFFUMATIVELY 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 C 9MFICATE HOLDER- IMPORTANT. OLDERIMPORTANT: If the certificate holder is an ADDITIONAL INSURM the policy(ies)must have ADDITIONAL INSURED pmvsions 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 LUNIACI NAME= Art Calvlllo One Family Insurance PHONE . 97a-401—la42 FAX NO- 973403-5943 1 Main SL Suite 13 ADDRES Lunenhurg,MA 01462 S_ artOlfamlyinsurdnce-com ITERTRER(S)AFFORDING COVERAGE NAIL A ONSURERA: Evanston Insurance Company NSURED INSURER MNP CONSTRUCTION,INC. INSURER C: 45 EXCHANGE ST APT 3E MILFORD,MA 01757 WSURERD' INSURER E- rNSURER F_ COVERAGES CERTIFICATE NUMBER REVISION NUMBER- THIS UMBERTHIS IS TO CERTIFY THATTHE 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 CERTTF1CATE MAYBE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECTTO ALLTHETERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS_ LTR TYPEOFINSURANCEHSL YVVD POLICY NUiiBEFt AWL IUMC PODGY EFF PGO BW DIVdITS X COMMERCIAL GENERAL WV7T 31LY EACH OCCURRENCE S 1,000,000 CLAIMS-MADE rX OCCUR PREM � S 100,000 MED EXP one perms..m) S 5,000 A Y Y 3ET9385 11/03/15 11/03120 "PERSONAL SA.OVINJURY $ 1,000,000 G'-MAGGRE ATE UMff APPLIES PER. -G' GENERAL AGGREGATE S 2,000,000 POLICY❑�T E]LOC ' PRODUCTS-COMP/OPAGG S 2,000,000 OTHER: S AUTOMOBrLE LIABILITY CO BIINEO SINGLE LIMIT(Ea S ANY AUTO BODILY NJURY(Perpe ) ; OWNED SCI-DULm BOOILYWJURY(Pcami-f) 5 AUTOS ONLY AUTOS HIRED NOWOMED PROPERTY DAAGE S A=ONLY AUTOS ONLY . 5 UMBRELLA LU1B OCCUR EACH OCCURRENCE S E MMSS LIAS CLANS-MACE AGGREGATE S CEO I I RETENTIONS S WORI¢RS COMPENSATION ATUTE R AND eAPLOYEXS LUIBILnY YIN ANY PROPRIErORIPART1.E2"E❑ NIA FI EACH ACCIDENT S CFFICERINfE�7EEf2 EXCLUDED? (Mandamry is NH) EL DLffASE-FA EMPLOYEE S Ifyes,de5rnbe under DESCRIPTION OF OPERATIONS below EL DISEASE-POLICY LUAT S DESCRIPTION OF OPERATIONSI LOCATIONS f VEHICLES(ACORD 101,AddaSooal Re m•1¢Schedule,maybe a=ched ifmore 5p—s regrmecU p CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCEI I BEFORE THE EXPIRATION DATETHEREOF,NOTICE WILL BE DELVERED IN SEXTON ROOFING&SIDING INC ACCORDANCEWTTH THE POLICY PROVISIONS- 102 PINE ST P-O.BOX 6327 AUTHOR»RIFPRESENTATNE HOLYOKE,MA 01040 ART CALVILLO ©1988-2015 ACORD CORPORATION. All rights reserved- ACORD eservedACORD 25(2016103) The ACORD name and logo are registered marks of ACORD DiffeL rfr and Home b FLO r S SMHVGgqc 118239 it�'033pg��-j DROVE wC flims � T`TsE :;.o�v� C,oR $oLo`B1 _ goQ_y�u SEXra"1&ooFnv _'& 1 �''sa�rioa ING co - 1-:UC-0605383 ; 'S ED 11/30/2020 Imme,- Commonwealth o'.Massachus e#6 -� Oivisiort of Professional Licensure ` Board of Bcn7ding Regulations and Standards C°noIIPsgr Specialty csSL-099688 Expires-10105! �BRETT J SE7CfO7fkt �1 -. PO X E32�r HO YO " y Commissioner /L!