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32C-244 (7)
112 HAWLEY ST BP-2021-1098 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 32C-244 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-2021-1098 Project# JS-2021-001859 Est.Cost:.$18300.00 Fee: $40.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: SEXTON ROOFING CO 99689 Lot Size(sq. ft.): 5314.32 Owner: KAUFMANN ANDREW H Zoning: URC(100)/ Applicant: SEXTON ROOFING CO AT: 112 HAWLEY ST Applicant Address: Phone: Insurance: P O BOX 6327 (413) 534-1234 WC HOLYOKEMA01041 ISSUED ON:4/2/2021 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. f i 1 .52 IV) Certificate of Occupancy Signature: FeeType: Date Paid: Amount: Building 4/2/20210:00:00 $40.00 212 Main Street, Phone(413)587-1240,Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner g, The Commonwealth of Massachusetts tl. ' Board of Building Regulations and Standards FOR I Y Massachusetts State Building Code,-780 OAR,7 edition MUNICIPALIUSE Building Permit Application To Construct,Repair,Renovate Or Demolish a Revised January, One-or Two-Family Dwelling 1,2008 • This S tion For Official Use Only Building Permit Nun r:9i'• ')- /0q Date Applied: Signature: . _ // • • • 2-/- 2-2•02.1 . Buil mg Commissioner/Inspector of Buildings Date • ' SECTION 1:SITE INFORMATION I.1173er tdw s; . ^ 1.2�As ors Map&Parcel Nurnbet 1.1a Is this an accepted street?yes no Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use �_ Lot Area(sq ft) Frontage(ft) 1.5 Building Setbacks(ft) Front Yard Side Yards • Rear:Yard Required Provided Required Provided Required Provided . 1.6 Water Supply: (M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Public CI Private❑ Zone: ` Outside Flood Zone? Municipal 0 On site disposal system 0 Check if yes❑ • SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of Record: vy� //P n� �`• , /� � /-�rvhr,�,w •[�a-, ,•lGY'•+ rI.'l o� �2 /1 zf Name(Print) Address for Service: S ,(..� • S- 3 -- 5"/ 33 Signature Telephone • SECTION 3: DESCRIPTION OF PROPOSED WORK2(check all that apply) New Construction 0 Existing Building❑ Ow epairs(s) ❑ Alteration(s)'Q Addition 0 Demolition ❑ Accessory Bldg.0 Number of Units -3 _ Other 0 -Specify: • • Brief Description of•roposed Work2: "Pt eu( A'a..�_u vac' f - 6 i u,-- • SECTION 4:ESTIMATED CONSTRUCTION COSTS. - • Estimated Costs: Item Official Use Only (Labor and Materials) • 1.Building $ 1. Building Permit Fee:$ Indicate how fee is detennined: 0 standard City/Town Application Fee 2.Electrical $ - ❑Total Project Cost'(Item 6)x multiplier . x 3.Plumbing $ ' 2. Other Fees: $ 4.Mechanical (HVAC) $ List: 5. Mechanical (Fire $ Total All Fees:$ • Suppression) '// Check No—No -1/9 Amount: Cash Amount: 6. Tota I Project Cost: $ /i/ 360 0 Paid in Full 0 Outstanding Balance Due: SECTION 5: CONSTRUCTION (�! SERVICES 5.1 / T�Construction Supervisor License(CSL) / tvere ) too License Number i pin iiiiaic Name of CSL Holder j �j ) n I 3�, ?C/ BOX (l j List CSL Type(scebelow e t.. No.and Street Type Description J /}�/D /j in 13 Unrestricted(Buildings up to 35,000 Cu-ft.) U t- t� t' 1 R Restricted l&2 Family Dwelling City/Tkol, State,ZIP M Masonry RC Roofing Covering WS Widow and Siding SF Solid Fuel Binning Appliances 1 Insulation _._._---- - Telephone Email address D Demolition .___ l 5.2 Registered Home Improvement Contractor(HIC) p` 1 I i 3 3exfnn. &o r and 31t 14I - r _ i 1 pa Nun IiIC Retort Number Expiration Da`tc HIC Co airy Name or ._,Registrant Name � - - No.and Street �7 /' PXfGn��ii 1 //1��0/)d/TI1Ql/, 2177 jilg1 4 �, P7 C)/Mill _4/3�.'3L�/..3 q F it address CityTl wn,State,ZIP Telephone SECTION.6: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 ' 'irk ' No .Cl SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT 1,as Owner of the subject property,hereby anrhorize>2)e )fl I7Or v1 w d , A h, LnC to act on my behalf;in all matters relative to work authorized by this but1ditiaeratit application.) eopiro r� of ie ed 3 1 i// r Prim Owner's Name(Electronic Signature) Date Date SECTION 7b:OWNER'OR AUTHORIZED AGENT DECLARATION By entering my name below,I hereby attest under the pains and penalties of perjury that all of the information contained in this plication is true and accurate to the best of my knowledge and understanding. /e_"? ( MUST BE SIGNED by Owner or Authorized Agent Date NOTES: I_ An Owner who obtains a building permit to do his/her own work,or an owner who hires an unregistered contractor (not registered in the Home Improvement Contractor(HIC)Program),will ay/have access to the arbitration program or guaranty fund under M.G.L.to 142A.Other important information on the HIC Program can be found at www•.mass_gov!oca Information on the Construction Supervisor Liri-,se can be found at ww sv:mass.ttovidps 2. When substantial work is planned,provide the information below: Total floor area(sq.ft.) (including garage,finished basement/attics,decks or porch) Gross living area(sq.ft.) Habitable room count Number of fireplaces Number of bedrooms Number of bathrooms Number of half/baths Type of heating system Number of decks/porches Type of cooling system Enclosed Open 3. "Total Project Square Footage"may be substituted for"Total Project Cost" Vropotiat www.sextonroofing.corn NO tii Uine tilt! • tit;uul.uil MA HIC# 118239 sextonroofing@n,hotmail.com SUBMITTED TO Andrew Kaufmann PHONE 563-5133 DATE 12/29/20 STREET 298 Loudville Rd JOB NAME Rental Property/sgginl( gmail.com CITY/STATE/ZIP Easthampton,Ma. JOB LOCATION 112 Hawley St Northampton,Ma. SEXTON ROOFING HEREBY SUBMITS SPECIFICATIONS AND ESTIMATES FOR: Main Roof,Front Porches 1) Strip and remove existing shingles and dispose of in proper landfill. 2) Install new decking ( '/2" CDX 4 ply) 3) Install new metal edging to rakes and eaves of roof. (8') 4) Install ice and water shield on eaves roof. (6') 5) Install starter shingles on eaves and rakes of roof. 6) Install synthetic roofing felt on remainder of roof. 7) Install new flanges over existing vent stack. 8) Install IKO Architectural style roofing shingles as per manufacturers' specifications. 9) Install new lead flashing on chimney. (Add$250.00 per chimney if needed) 10) Install new cap over ridge vent. 11) Supply manufactures 50 warranty and SRC 10 yr. workmanship warranty. 12)Install new vinyl siding on upper back dormer. ***Covering valuables and Attic Cleanup responsibilty of homeowner*** We Propose hereby to furnish material and labor-complete in accordance with the above specifications,for the sum of: Eighteen Thousand Three Hundred DOLLARS($18,300.00) Payment to be made lows: upon completion All Material is guaranteed to be as specified. All work to be completed in a Authorized workmanlike manner according to standard practices. Any alteration or Signature deviation from above specifications involving extra costs will be executed only upon written orders,and will become an extra charge over and above the estimate. All agreements contingent upon strikes,accidents or delays beyond Note:This proposal may be withdrawn by us if not accepted our control. Not responsible for water damage during construction. Owner within(14)days. to pay responsible legal fees for non-payment,and applicable interest. acceptance of f ropooai The above prices,specifications and conditions are satisfactory and are hereby accepted. You Signature are authorized to the work as specified. Payment will be made as outlined above. Signature Date of Acceptance. e" Department oflndustrialAccidents ,, `9_ • ,---,i_,, Office of Investigations 14 Lafayette City Center r/ 2Avenue de Lafayette, Boston,MA 02111-1750 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual):Sexton Roofing & Siding, Inc _ Address:P.O. Box 6327 City/State/Zip:Holyoke, MA 01041 Phone#:413-534-1234 Are you an employer? Check the appropriate box: Type of project(required): 1. 4. I. I am a general contractor and I ❑ I am a employer P Yer with 6. ❑New construction employees (full and/or part-time).* have hired the sub-contractors listed on the attached sheet. 7. ❑Remodeling 2.❑ I am a sole proprietor or partner- ship and have no employees These sub-contractors have 8. ❑Demolition workingfor me in anycapacity. employees and have workers' p t5' 9. ❑Building addition [No workers' comp.insurance comp. insurance.$ required.] 5. ❑ We are a corporation and its ' 10.0 Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions myself. [No workers' comp. . right of exemption per MGL 12.©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. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors 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.#:7P4UB0G07898220 Expiration Date:6/4/21 n Job Site Address: 1 ' f-- 17W ) City/State/Zip:A1447)-- Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL 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 i trance coverage verification. I do hereby certify under t ins and penalties of perjury that the information provided above is true and correct. Signature: - Date: `, `2-74 i 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): 1❑Board of Health 2111 Building Department 311City/Town Clerk 4.❑Electrical Inspector 5lumbing Inspector 6.0Other Contact Person: Phone#: A ITJ 'CERTIFICATE OF LIABILITY INSURANCE DATE(IMMIDDNYYY) * 06/09/2020 THIS CERTIFICATE IS ISSUED AS A MA 1 L EN 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 fAic"No,Exti, (413)737-0300 FAX No)_ ADDRESS: khutchinson@ormsbyins.com P 0 BOX 718 ; INSURERS)AFFORDING COVERAGE NAIL# WEST SPRINGFIELD MA 01090 INSURER : TRAVELERS PROPERTY CAS CO OF AM 25674 INSURED INSURER B: SEXTON ROOFING&SIDING INC INSURERC: ' _ INSURERD: 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 8Y PAID CLAIMS.' POLICY EFF. POLICY EXP 'LW TYPE OF INSURANCE MST? VIVID POLICY NUMBER ,(MMIOD(YYYY) (MMIDDIYYYYL LINT COMMERCIAL GENERAL UABIUTY EACH OCCURRENCE $ • DAMAGE TO RENTED I CLAIMS-MADE OCCUR PREMISES(Ea occurrence) S MED"E CP(Any one person) S N/A • PERSONAL 8 ADV INJURY S GEN'L AGGREGATE UMITAPPUESPER: .' GENERAL AGGREGATE $ POLICY JET LOC • PRODUCTS-COMP/OP AGG $ ' OTHER $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ . (Ea aaident) _ANY AUTO -• ,BOOELY INJURY(Perperson) S ALL OWNED SCHEDULED AUTOS AUTOS N/A BODILY INJURY(Per accident) $ HIRED AUTOS NON-OVVNED . PROPERTY DAMAGE $ AUTOS (Per accident) - $ S . UMBRELLA A UAB OCCUR EACH OCCURRENCE $ EXCESS'JAB CLAIMS-MADE N/A AGGREGATE $ DED RETENTIONS $ WORKERS COMPENSATION PER OTH- AND EMPLOYER LIABILRY YIN X STATUTE ER S ' ANYPROPRIETORIPARTNERlEYECUTIVE EL EACH ACCIDENT $ 1,000,000 A OFRCERAIEMEERD<CUJDED? NIA WA N/A 7PJUBOG07898220 06/04/2020 06/04/2021 - (Mandatory inNH) EL DISEASE-EAEMPLOYEE$ 1,000,000 IF yes,describe under DESCRIPTION OF OPERATIONS below EL DISEASE-POLICY UMIT $ 1,000,000 WA ' DESCRIPTION OF OPERATIONS/LOCATIONS 1 VEHICLES(ACORD 101,Additional Remarks Schedule,may be atta.lted Winery space Is required) Workers'Compensation benefits will be paid to Massachusetts employees only.Pursuant to Endorsement WC 20 03 06 B,no authorization is given to pay claims for benefits to employees in states other_than Massachusetts if the insured hires,or has hired those employees outside of Massachusetts. This certificate of insurance shows the policy in force on the date that this certificate was issued(unless the expiration date on the above policy precedes the issue date of this certificate of insurance). The status of this coverage can be monitored daily by accessing the Proof of Coverage-Coverage Verification Search tool at www:mass.gov/lwd/workers-compensation!'investigations/. - - CERTIFICATE HOLDER CANCELLATION - 1 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 DREPRESENTATIVE T Amherst MA 01002 '{ L Daniel M.C y,CPCU,Vice President—Residual Market—WCRIBMA ©1988-2014 ACORD CORPORATION. All rights►eaerved. ACORD 25(2014101) The ACORD name and logo are registered marks Of ACORD • ACORD� DATE(MIA/DD CERTIFICATE OF LIABILITY INSURANCE 6262020 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 Ormsby Insurance Agency,Inc. PHONE _ (413)737-0300 F(AjcAX No, (413)737-0617 698 Westfield Street E-r AIL.Extl ADDRESS: West Springfield,MA 01089 INSURERS)AFFORDING COVERAGE NAIC# INSURER A; Colony Insurance Company 39993 INSURED INSURER B Sexton Roofing and Siding Inc INSURER c: 102 Pine Street INSURER D .Holyoke,MA 01040 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CEI(I IFY THAT THE POLICIES OF INSURANCE US I tl)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. INSLL1R IN R TYPE OF INSURANCE SD I wvo POLICY NUMBER . M/ Y EFF POLICY EXP LIMITS (NmNDD/YYYYI (MMlDDlYYYY) A X COMMERCIAL GENERAL LIABILITY 101PKG002159905 6/2_5/2020 6/252021 EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE X OCCUR DAMAGE TO RENTED PREMISES(Ea occurrence) S 100,000 MED EXP(Any one person) s 5,000 PERSONAL BADV INJURY I s 30,000 GEM_AGGREGATE IJMIT APPLES PER: 4, GENERAL AGGREGATE $Z,000,000 • X POLICY LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER s AUTOMOBILE LLABIUTY COMBINED SINGLE LIMIT (Ea accident) ANY AUTO BODILY INJURY(Per person) $ •• ALLO5N� Al1TOSU� BODILY INJURY(Per accident) $ NON-OWNED PROPER 1 Y DAMAGE HIRED AUTOS AUTOS _ (Per accident) s • $ UMBREU.ALIAB _ OCCUR EACH OCCURRENCE $ EXCESS UAB CLAIMS-MADE AGGREGATE S DID I RETENTIONS y WORKERS COMPENSATION I FSITATUTE OTH- ER AND EMPLOYERS LABILITY YIN ANY PROPRIETORIPARTNER/E'IECUDVE N/A EL EACH ACCIDENT S OFFICER/MEMBER EXCLUDED? (Mandatory in NH) EL DISEASE-EA EMPLOYEE 5 If yyes,desrn"be under DESCRIPTION OF OPERATIONS below EL DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(ACORD 101,AddElonal Remarks Schedule,may be attached if more space is required) 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. 111 AUTHORIZED REPRESENTATIVE C� I ©1988-2014 ACORD CORPORATION_ All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD _ The Cemehostroarkikellitassteefeseretts _ AM02114-2017 -.—— Premeanass,geilsree _ . Lmtrsiace A$t�et: TO=MUD WITHThE A caipt pirrae - Please PAR Leightsr Nauss r UP ('Qfr 'i4Dfl 7n( Acidic= f Q 15 14: 10-2atnciorr*ilk emAo9'ea $amdkapat-iiimv* 7 z New construction 0Imaaoicropi lorarp airalinr-aucavivovesirndigg&mein 3� Iam t=aztenw � eadcagailvu �d �ts fIAJoav camp.ia I* El 4.0 Ina abae raeraadviaIrliaegcvmo atocaodactaH . k uypmpasy.Ivies 300 eosin titan cmaaamiciiiieritee.a i causxrar=sale ILO Bectrikai repairs or additions paairilIeaoemployees_ • SIT ama cs adoira iIbrieTaaithe s&stedaa deaas_odsbect �'Q PInmbingrepaits c iditioBs "Arse sb-oaetado igerc ariploycesamlhaeviado±: ,iusecaeccA - 1.3- fin we sae acorporationagd its o harcaloaadti cirrightoleaoaiagprrM1i£.c P`Ootl» 152.fI(4}.and vor tome aoempi s.IND =Bp.iIISCirlIDICZrz&] - !Any ap4iicastrtcberishoo[ll>aetaEafill out iesesmtvbdonraboaci tbeanorkes' a5»tiort. }gticoOD' *ko - li9az afl ciodlf aussiliesaulnooaaeest t=asal�3eeTs�t�slch- ContnraalartcirskthisIasmetatadredanad�OiiadsiecsioorirsdsmacofSc mad stracs t ome ffihemi t arackiesbeccuployees,>hey Jwv deecir>vatiere amp.p ikyi 1 era era ra rir that&prori amspesessereetionansncefilr a9►employees. Rehm,is the piracy eamip„bs Insurance Company Nam= ---V4--)c-A. 0 n6Quirik-p_i.....) _i_ ,fn OD Polles►#orScIS I #: (Z tiOtt 1 If)10q1 010R0 ExpiFfarnDat= 11) HDtc Sob Site Addresm *per Attach.a copy of the compensation parity declarati page(Amen the pobey masher and capitation date). Fail to seam aovaagc as untkrlGL+o_152,§25A is a criminal violation-punishable by a fine up to SI,5O0-0O and/or onayearimprisomoect,as welt as civil pcaaltiesin the form afs STOP WORK ORDER and afmc of up to 52541Xp a day against the v10at0LA copy of this statcoi may beday against the vidator.A copy of this statement may be forwardedtothe°ffceofinvesig ionsoftheDIAforiianamx coverage Ida hereby corn teat {rthe losdp reperfrrytiuttkeirtforseerampropited above is trite tea correct Sigdme jt! - ' m I i 1/6 I - Pi �ltrseordye. De rrotivrae ER this ar to be cva.rpkred by city sr form City or Town: P m t/Lke# - Issang Authority(chide one 1_Board afWe�2 ) agD 3_City/Town Clerk 4.$kid Inspector 5; I ContaetPa Phonel F AC Rom CERTIFICATE OF LIABILITY INSURANCE DAZE(MI►imoJrrrr) 11/13/2020 • 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: tf the certificate holder is an ADOmONAL INSURED,the policy(ies)must be endorsed_ tf 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 p Edson DeSouza MAYFLOWER INSURANCE GROUP INC PHONmic.Ho ,: (774)773 9702 FAX C.HR)_ ADDS SS: Edson@mayflowerinsurance.com 299 Court Street INSURER(S)AFFORDING COVERAGE NAIC Plymouth MA 02360 INSURER A: HARTFORD UNDERWRITERS INS CO 30104 INSURED INSURER B MNP CONSTRUCTION INC INSURERC: INSURER D: --_ 45 EXCHANGE ST APT 3E INSURER E MILFORD MA 01757 INSURERF: COVERAGES CERTIFICATE NUMBER: 595621 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED_ NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES_LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDL SUER POLICY EFF POLICY EXP LIMITS LTR TYPE OF INSURANCE INSD_WVD POLICY NUMBER (MMIDDIYYYY) (MMJDD/YYYY) COMMERCIAL GENERAL LUIBIUTY EACH OCCURRENCE S _ DAMAGE TO RENTED CLAIMS-MADE j OCCUR PREMISES(Ea occurrence) MED EXP(Any one person) $ N/A PERSONAL&ADV INJURY $ GENL AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY JECOT- I LOC PRODUCTS-COMP/OP AGO $ OTHER S AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) ANY-AUTO BODILY INJURY(Per person) S ALL OWNED SCHEDULED AUTOS AUTOS N/A BODILY INJURY(Per acddent) $ P HIRED AUTOS AUTOS NON-OWNED ROPERTY DAMAGE (Per accident) S UMBRELLA LWB _ OCCUR EACH OCCURRENCE S EXCESS IJAB ,CLAIMS-MADE N/A AGGREGATE $ LIED I RETENTIONS _ OTH- ER 5 WORKERS COMPENSATION X STATUTE AND EMPLOYERS.LIABILITY _ A OAoERJMEMBEREXC DDF�ECun EL EACH ACCIDENT $ 1,000,000 VE NJA WA WA 6S60UB1 K70970620 11/16/2020 11/16/2021 (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 I LOCATIONS 1 VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Workers'Compensation benefits will be paid to Massachusetts employees only.Pursuant to Endorsement WC 20 03 06 B,no authorization is given to pay claims for benefits to employees in states other than Massachusetts if the insured hires,or has hired those employees outside of Massachusetts. This certificate of insurance shows the policy in force on the date that this certificate was issued(unless the expiration date on the above policy precedes the issue date of this certificate of insurance)_ The status of this coverage can be monitored daily by accessing the Proof of Coverage-Coverage Verification Search tool at www.mass.gov/lwd/workers-compensation/investigations/. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Sexton Roofing & Siding Inc ACCORDANCE WITH THE POLICY PROVISIONS. 102 Pine St AU—THHORQED REPRESENTATIVE Holyoke MA 01041 { CL Daniel M.C y,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 • ACCP CERTIFICATE OF LIABILITY INSURANCE D"'E""'DD/YYYY) 11/24/20 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,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 NAI,Ie Art Calvillo One Family Insurance ( Nry 978-403-5942 (cite,a): 978 403-5943 1 Main St Suite 15 DAO : artPn 1famiIyinsurance.com Lunenburg,MA 01462 INSURER(S)AFFORDING COVERAGE NAIC NI INSURER A: Evanston Insurance Company INSURED INSURER B: MNP CONSTRUCTION,INC. INSURER C: 45 EXCHANGE ST APT 3E INSURER D MILFORD,MA 01757 INSURER E: INSURER F COVERAGES CERTIFICATE NUMBER: REVISION NUMBER THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE US I Ell 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 ALLTHE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS_ INSR ADDLSUDR POLICY EFP POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MNIDDIYYYY) LUUTS X COMMERCIAL GENERALLwe>tm EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED CLAIMS-MADE X OCCUR PREMISES(Ea occurs, ) $ 100,000 MID D(P(Any one perk) $ 5,000 A _ Y Y 3ET9385 11/20/20 11/20/21 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE OMIT APPLIES PER GENERAL AGGREGATE 5 2,000,000 RO- POLICY JECT LOC PRODUCTS-COMP/OP AGG S 2,000,000 OTHER S AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ - (Ea accident) ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY (Per $ - AUTOS ONLY AUTOS ( ) HIRED NON-OWNED PROPERTY DAMAGE AUTOS ONLY AUTOS ONLY (Per accident) UMBRELLA LIAB OCCUR EACH OCCURRENCE S EJ(I tSSIl!•R CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS LIABILITY STATUTE ER YIN ANY PROPRIETOR/PARTNER/EXECUTIVE N/A E L-EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? (Mandatory in NH) EL DISEASE-CA EMPLOYEE $ If yes.descnbe under DESCRIPTION OF OPERATIONS below EL DISEASE-POUCY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,AddiEorral Remarks Schedule,may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCFI I FD BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN SEXTON ROOFING&SIDING INC ACCORDANCE WITH THE POLICY PROVISIONS. 102 PINE ST P.O.BOX 6327 AUTHORIZED REPRESENTA HOLYOKE,MA 01040 arA . ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD