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36-195 (5) 778 BURTS PIT RD BP-2021-1204 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 36- 195 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: Door Replacement BUILDING PERMIT Permit# BP-2021-1204 Project# JS-2021-000587 Est.Cost:$2000.00 Fee: $40.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: LOWES HOME CENTERS INC 049918 Lot Size(so. ft.): 31450.32 Owner: LAFLAMME JOHN Zoning: Applicant: LOWES HOME CENTERS INC AT: 778 BURTS PIT RD Applicant Address: Phone: Insurance: 1000 LOWES BLVD (413) 272-8931 0 W(' MOORESVI LLENC28117 ISSUED ON:4/22/2021 0:00:00 TO PERFORM THE FOLLOWING WORK:NEW DOOR POST THIS CARD SO IT IS VISIBLE FROM THE STREET Inspector of Plumbing Inspector of Wiring D.P.W. Building Inspector Underground: Service: Meter: Footings: Rough: Rough: House# Foundation: Driveway Final: Final: Final: Rough Frame: Gas: Fire Department Fireplace/Chimney: Rough: Oil: Insulation: Final: Smoke: Final: THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. sel • )2 . cADIT Certificate of Occupancy Signatur FeeType: Date Paid: Amount: Building 4/22/2021 0:00:00 S O OO 212 Main Street, Phone(413)587-1240,Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner r i _ " i r------ f_ ,i i,fi*. / The Commonwealth of Massa usalf FOR Board of Building Regulations an Standards2 0 202/ 1 MUNICIPALITY ,i, / Massachusetts State Building Coglc,74 1�R USE ;.., ti Quip ., -- Building Permit Application To Construct, Re'pait; <Or Detn a 1�Revised Mar 2011 One-or Two-Family Dwelling _ �ONs This Section For Official Use Only Building Pe it Number: 16P—.2l..I 20 - Date AA lied: &o-,5 _- L--ZI-ZOZI Building Official(Print Name) Signature Date SECTION 1:SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map&Parcel Numb n q e 45 P�� i2 j) 3(if I1s 1.1 a 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 0 Private 0 Zone: _ Outside Flood Zone? Municipal 0 On site disposal system 0 Check if yes❑ SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of Record: --oh n LA Ic4Mrn2 I 61-Pn(Pr 414 a I d( L Name(Print) n City,State,ZIP ff c( No.and Street Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply) New Construction 0 Existing Building 0 Owner-Occupied 0 Repairs(s) ❑ Alteration(s) 0 Addition 0 Demolition 0 Accessory Bldg.❑ Number of Units Other 0 Specify: Brief Description of Proposed Work': ke v ,Q e14.--,, d ui r t AI 0 54(N t �`h C i c-v y re.._ SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1.Building $ JU° 1. Building Permit Fee: $ Indicate how fee is determined: 2.Electrical $ ❑Standard City/Town Application Fee ❑Total Project Costa(Item 6)x multiplier x 3.Plumbing $ 2. Other Fees: $ 4. Mechanical (HVAC) $ List: 5.Mechanical (Fire $ Suppression) Total All FeestA 46 Check No. _Check Amount: Cash Amount: 6.Total Project Cost: $ a duo 0 Paid in Full ❑Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) (9 41-9 „u, / "v Ilh1( A(/t..i License Number Expiration Date Name of CSL Holder ( ��e List CSL Type(see below) fI No.and Street l Type Description U 9�rV4 (1^S C)(a�) Unrestricted(Buildings up to 35,000 cu. ft.) �L � R Restricted 1&2 Family Dwelling City/Town,State,ZIP M Masonry RC Roofing Covering WS Window and Siding SF Solid Fuel Burning Appliances 4(1-e.),1,(0�I 3't 5(4. h V j/hp/CPP41 S g 90.a,I.Cd' I Insulation Telephone Email address D Demolition 5.2 Registered Home Improvement Contractor(HIC) (c(t(,7-sr to-0` , 1 ( k 5 HIC Registration Number Expiration DDate HIC Company Name or HIC Registrant Name (cy.,0 C'114" AC(i() ('C1-('S f oQLer. 41 i'.`P c G^ No.and Street Email address INA)rei of (l, 4/( 111 t(e17—2 7�=5S`►''( City/Town,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 No ❑ SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S 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. Print Owner's Name(Electronic Signature) 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 application is tru acc ate to the best of my knowledge and understanding. Print Owner's or Authorized Agent's Name(Ele is Signature) Date NOTES: 1. 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 not have access to the arbitration program or guaranty fund under M.G.L.c. 142A.Other important information on the HIC Program can be found at www.mass.gov/oca Information on the Construction Supervisor License can be found at www.mass.gov/dps 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" CITY OF NORTHAMPTON SETBACK PLAN MAP: LOT: LOT SIZE: REAR LOT DIMENSION: REAR YARD SIDE YARD SIDE YARD FRONT SETBACK FRONTAGE City of Northampton ,HAM - •µ._-- A,v, ',, ...,lC; Massachusetts t'V 4-- '<<. 1 i DEPARTMENT OF BUILDING INSPECTIONS �`. ; S`'-. ht wX, . . 212 Main Street • Municipal Building J mob' �ao Northampton, MA 01060 ssbiy. '^+-\ CONSTRUCTION DEBRIS AFFIDAVIT (FOR ALL DEMOLITION AND RENOVATION PROJECTS) In accordance of the provisions of MGL c 40, S54, a condition of Building Permit Number is that all debris resulting from this work shall be disposed of in a properly licensed waste disposal facility, as defined by MGL c 111, S 150A. The debris will be disposed of in: p_ct,,,,,, 7 '.-4 Location of Facility: 0 `s /1/4 The debris will be transported by: Name of Hauler: AO( a)cl (c ,>5 ` " /PC 4 5- Signature of Applicant: Date: (4`(4 ' '1"I_ The Commonwealth of Massachusetts Department of Industrial.A ceidents 1 Congress Street,Suite 100 7,1 Boston, MA 02114-2017 www.mass.govidia kt-rs' ton pcnsation Insurance Affidavit:Builders/Contractorsenectricions/Plumbers. It)BE FILED WITH'EHE PERNIEITING ArnioluTv. Applicant Information Please Print Leeihts Name(ilosineasOrgantzattow Individual); Lai1'6 (Mk° C e 111,101( Address: (01)0 CLA''''°. P-76,0) City/State/Zip: V\(10( 54.• I 10 (1--( eIgit-) Phone#: Are ynat easokrser?Cheek the apprnpriate hot; Type of project(required): in I ant a employer with _employees atill andur part-tirrio.• 7. 0 New construction 20 I am a sole proprietor or purtnerthip and have nu Critploym.-s working for t in 8. 0 Remodeling any capacity [No workers'cotnp insuranoe required 9.0 I am a homeowner doing all work myself.ENO%writers'cori.i rnorance required"* 0 Demolition 10 El Building addition 4.0 lam a hurnixistner and will be hiring oueuraidors to conduct all stink on nts property.. I wilt ensure that all contractors either have workers'compensation insurance or ate ii.0 Electrical repairs or additions proprietors with no employe-ea. 12. Plumbing repairs or additions 5.0-batiii a general contractor and I have hired the sob-euntractors listed on the attached sheet LAO Roof repairs These sob-contractors base employees and ItaYe workers emir.insurance. 14.0 Other 6.0V.e aic a wip,,,,ration and its officers have exercised then neat of es.eruption per MT&c. 152,fl(4),and we haw no ixriplowes.[No workers'comp.insurance required.] Any applicant that checks hol. I must also fill out the section below show trig their workers'eompensation policy information *Homeowners who submit this affidavit indicating they arc doing all work and then hue outstdc ce.ntraeters must submit a new liffid.as it indicating such :Contractors that check this boa must attached an additional sheet show Inc the name of the stitt-contractors and state whether or not those entities hate employees If the sub-contractors ha employ its they most pros Itic their ,Noricc,"omilp poitk numbcr lain an employer that is providing workers'compensation insurance fir my emplo)ees. Below is the policy and job site information_ Insurance Company Name: /11\ C. ,)-( LI C14— 47C ( Policy#or Self-ins.Lie.#: L/C \(0-27q 0 Expiration Expiration Date:Job Site Site Address: 7 ?q P-141 4, pt..) (2..) City/StateiZip: -A/I''‘c49 ./t10(Ci6 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$I,500.00 andior 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 Iolzoor.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance crage N I do hereby certify under th s and penaltie8 of perjury that the information pro sided above is true and correct. C( (‹ Signature: Date: Milne : 14 2--)2-r (. Official use only. Do not write in this area.to be completed by city or town officiaL ('its-or Town: Permitaicense Issuing Authority(circle one): I. Board of Health 2.Building Department 3.CB:ill-own Clerk 4.Electrical Inspector 5. Plumbing Inspector 6.Other Contact Person: Phone#: City of Northampton Massachusetts • * DEPARTMENT OF BUILDING INSPECTIONS . 212 Main Street • Municipal Building Northampton, MA 01060 Jst-ty ary11' HOMEOWNERS'EXEMPTION ELIGIBILITY AFFIDAVIT I, (insert full legal name), born _ (insert month, day, year), eby depose and state the following: 1. I am seeking a •, ilding permit pursuant to the homeowners' exemption to the permit requirements of the Massachusetts State ' ilding Code, codified at 780 CMR 110.R5.1.3.1, in connection with a project or work on a parcel of land to which old legal title. 2. I am not engaged in, and the p 'ect or work for which I am seeking the aforementioned homeowners'exemption, does not involve the field erection • manufactured buildings constructed in accordance with 780 CMR 110.R3. 3. I qualify under the State Building Code definition of"homeowner"as defined at 780 CMR 110.R5.1.2: Person(s) who owns a parcel of land o, which he/she resides or intends to reside, on which there is, or is intended to be, a one-or two-family • • elling, attached or detached structures accessory to such use and/or farm structures. A person who co ucts more than one home in a two-year period shall not be considered a home owner. 4. I do not hold a valid Massachusetts construction su• ision license and, except to the extent that I qualify for and will abide by the Massachusetts State Building C.••' requirements for the supervision of the project or work on my parcel, I am not engaged in construction supervise: in connection with any project or work involving construction, reconstruction, alteration, repair, removal or • 4 olition involving any activity regulated by any provision of the Massachusetts State Building Code. 5. If I engage any other person or persons for hire in connection with th• aforementioned project or work on my parcel,I acknowledge that I am required to and will act as the supervisor for said project or work. Signed under the pains and penalties of perjury on this day of , 20 . (Signature) ® DATE(MM/DD/YYYY) /�`��� CERTIFICATE OF LIABILITY INSURANCE 03/29/2021 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. FAX PHONE 100 North Tryon Street,Suite 3600 (NC.No.Ext): (A/C,No): Charlotte,NC 28202 E-MAILRESS: INSURER(S)AFFORDING COVERAGE NAIC ft CN102776519-Lowes-SI-21-22 INSURER A:National Union Fire Ins Co.of Pittsburgh PA 19445 INSURED INSURER B:Interstate Fire&Casualty Co 22829 Lowe's Companies,Inc. and subsidiaries INSURER C:AIU Insurance Co 19399 1000 Lowe's Boulevard INSURER D:New Hampshire Insurance Company 23841 Mooresville,NC 28117 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: ATL-004976909-08 REVISION NUMBER: 10 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 SUER POLICPOLICY NUMBER (MM/DDY EFF POLICY EXP /Y LTR INSD TYPE OF INSURANCE INSD,WVD YYY) (MM/DD/YYYY) LIMITS LT COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS-MADE OCCUR Self Insured-See below DAMAGE TO RENTED PREMISES Es occurrence) ,$ MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ PO- POLICY JET LOC PRODUCTS-COMP/OP AGG $ OTHER: $ - A AUTOMOBILE LIABILITY CA7030892 (AOS) 04/01/2021 04/01/2022 COMBINED SINGLE LIMIT $ 5,000,000 (Ea accident) A X ANY AUTO CA7030891 (MA) 04/01/2021 04/01/2022 BODILY INJURY(Per person) $ A OWNED SCHEDULED CA7030893 (VA) 04/01/2021 04/01/2022 BODILY INJURY(Per accident) $ AUTOS ONLY _ AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY _ AUTOS ONLY (Per accident) $ B X UMBRELLA LIAB X OCCUR USZ00024220 (14/01/2021 04/01/2022 EACH OCCURRENCE $ 5,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE $ 5,000,000 DED RETENTION$ $ C WORKERS COMPENSATION WC016393105(AOS) 04/01/2021 04/01/2022 X STATUTE OTH- ER D AND EMPLOYERS'LIABILITY Y/N WC016393104 (ND,WA,WI,WY) 04/01/2021 04/01/2022 2,00�,000 ANYPROPRIETOR/PARTNER/EXECUTIVEE.L.EACH ACCIDENT $ OFFICER/MEMBEREXCLUDED? N N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 2,000,000 If yes,describe under 2,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ A Excess Workers'Compensation XWC1647266 (FL) 04/01/2021 04/01/2022 (WC per statute) 3,000,000 A Excess Workers'Compensation XWC1647265 (AOS) 04/01/2021 04/01/2022 (WC per statute) 3,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Commercial General Liability policy is Self-Insured,effective 4/1/2021 to 4/1/2022. CERTIFICATE HOLDER CANCELLATION Lowe's Companies,Inc.and Subsidiaries SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 1000 Lowe's Blvd. THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Mooresville,NC 28117 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE of Marsh USA Inc. Manashi Mukherjee - ..u�� -, '-----va__. ©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 A o ADDITIONAL REMARKS SCHEDULE Page 2 of 2 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:EPG000016700 Carrier:North American Specialty Policy Effective Date:01-Apr-2021 Policy Expiration Date:01-Apr-2022 Limits:$8,000,000 Each Occurrence/$35,000,000 Aggregate XS TX Employers XS Indemnity(Excess) Policy Number:XCB3095 Carrier Evanston Insurance Company Policy Effective Date:01-Apr-2021 Policy Expiration Date:01-Apr-2022 Limits:$15,000,000 Each Occurrence/$35,000,000 Aggregate XS 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 4/1/2021 to 4/1/2022. The Automobile Liability policy evidenced above is subject to additional self-insured retentions excess of limits shown for various perils covered. ACORD 101 (2008/01) ©2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD ® DATE(MM/DD/YYYY) ACORE7 CERTIFICATE OF LIABILITY INSURANCE 4.1.......---- 07/27/2020 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: Marie Proulx PHONE HUB INTERNATIONAL NEW ENGLAND LLC A/C.No.Ext1: (413)750-7106 (A/C,No): ADDRESS:E-MAIL marie.proulx@hubinternational.com 600 LONGWATER DRIVE INSURER(S)AFFORDING COVERAGE NAIC# NORWELL MA 02061 INSURER A: AIM MUTUAL INS CO 33758 INSURED INSURER B: MARK JODOIN INSURERC: JODOIN HOME IMPROVEMENT INSURERD: 15 JONES DRIVE INSURER E: EASTHAMPTON MA 01027 INSURERF: COVERAGES CERTIFICATE NUMBER: 557741 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 SUBR POLICY EFF POLICY EXP LIMITS LTR TYPE OF INSURANCE INSD WVD POUCY NUMBER IMM/DD/YYYYI,(MM/DD/YYYY) COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ DAMAGE TO RENTED CLAIMS-MADE OCCUR PREMISES(Ea occurrence) $ MED EXP(Any one person) $ N/A PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY PRO JECT LOC PRODUCTS-COMP/OPAGG $ OTHER: AUTOMOBILE UABIUTY 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 STATUTE OTH- ER AND EMPLOYERS'UABIUTY Y I N ANYPROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 500,000 A OFFICER/MEMBER EXCLUDED? N/A N/A N/A AWC40070296132020A 08/31/2020 08/31/2021 (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/Iwd/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 " k C.- I Daniel M.CroOey,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 __�'.. .40 JODOHOM-01 MPROULX A�o�o CERTIFICATE OF LIABILITY INSURANCE DATE 6/23/22312DIYYYY) 020 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). CONTACT PRODUCER NAME: HUB International New England LLC PHONE I nrc,No);(413)731-9539 1070 Suffield Street (A/c,No,Ea):(800)243-8134 Agawam,MA 01001 E-MAIL INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Nautilus Insurance Co 17370 INSURED INSURER B:Commerce Insurance Company 34754 Jodoin Home Improvement INSURER C: c/o Mark S Jodoin 137 Porter Lake Drive INSURER D: Longmeadow,MA 01 1 0 6-1 24 6 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWTHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUBR W POLICY NUMBER D/POLICY EFF POLICY EXP LIMITS LTR INSD, VD ,IMM/DYYYYI IMM/DDIYYYYI A X COMMERCIAL GENERAL LIABIUTY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE X OCCUR X NN1119917 6/26/2020 6/26/2021 pREM SES°(Ea occur ence) $ 100,000 MED EXP(Any one person) $ 5,000 PERSONAL&ACV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER. GENERAL AGGREGATE $ 2,000,000 POLICY PEI°T LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER. $ COMBINED SINGLE LIMIT 1,000,000 B AUTOMOBILE LIABILITY (Ea accident) $ ANY AUTO X RPJ989 3/26/2020 3/26/2021 BODILY INJURY(Per person) $ — OWNED X SCHEDULED BODILY INJURY(Per accident) $ AUTOS— ONLY AUTO�SVyt.� X HIREDTO ONLY X AUUTNOS ONL� (Per PROPERTY DAMAGE $ $ — UMBRELLA LIAB — OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY STATUTE ER YIN ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? N I A (Mandatory m NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS 1 VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Vendor 497826 Lowe's Companies Inc.and any and all subsidiaries are named as additional insured as respects to General Liability and Auto Liability per Mass Business Auto Forms CA0001 and MM9911 an applicable Mass.State Laws as per written contract only. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPTIONTHEREOF, Lowe's Companies Inc. ACCORDANCE WITH THE ATE POLICY P OVISIONSCE WILL BE DELIVERED IN and any and all subsidiaries Mail Code A3ESS 1000 Lowe's Blvd AUTHORIZED REPRESENTATIVE Mooresville,NC 28117 924, 9. 7—c s 1 ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD 7A, i,/,ww nrrVW/d f4a-Y1oc/ri3rl/4 Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR TYPE: ul:iglement Card ""•' _ ..1 011 71202 1 LOW E'S HOME GCE 'uC CI-IRISTOPHE • R MtN1E1 t000 LOW ES BLVD Undersecretary SERVICES COMPLIANCE MOORESVILLE,NC 28117 { f I j 2 r r•r.iirriiir•r.rff� 1/, l?P're.khv+Yki,30415 • Ice of Consumer Affals&Business Regulation HOME IMPROVEMENT CONTRACTOR TYPE' Individual Registraatior Exoiration 159117 04/03/2022 MARK ODOIN D/B/A J•DOIN HOME IMPROVEMENT MARKS JODOIN 15 JON . DR ''r4G '¢,C k' EASTHA PION, MA 01027 Undersecretary %r l�,rr ra=r,n ntlirr r(;,.�1.r.:rrr.h1•..,sC. Mice of Consumer Aff sirs&8us4nes3 Regufi.fion HOME IMPROVEMENT CONTRACTOR TYPE:individual Registration Eg(rMl2I1 MARK JODOIN • DIB/AJODOIN HOME I;c4PROVEME MARK S.JODOIN JONES Dfa EASTHAMP1ON,t:a .0•1 Underseere*.a1+ (Commonwealth of Massachusetts �` Division of Professional ticensure Board of Building Regulations and Standards Construction Supervisor CS-04'991$ r E7tpires: 12129/202 MARK S.tU DOIN 15 JONES DR EAS'IHAMPTON MA 01027 Canirnissioner 0 X 6 , https ;a,rlc :-J mylicense.comlVeliticakiontails.aspr>resLa. .'k;.:.;. a aacJB,i; - i i Search... P @+ Kronas Workforce Central(R)8.... .'#tti'f 5ults E�(De Details = , File Edit View Favorites Tools Help The oft.,W'ebete of M.E,,eem olke a erxrrn,me O 01oo of Praleoo 000I Laename.7.7;....:.s1.,'m> liti '+11�1 ' ` e Public Safety r fig- ., Licensee Details Full Name: MARK S JODOIN t%'�a t .�^ * 4 '..d'r` `e Owner Name x-'�- License Address Information_.... 2 m i''',�' Ye '. lty nW ZlSta tpcoede: 0 027 - Y ` mA Country: United States o r P IJcmx lnforniation ___.. ._.._.-—'_-_-_—........... ..._ r�i-� License NO- Building License Type: Constiuctlon Supervisor r �'- ,a-'�' . l` Profession: Buildingg Licenses Date of Last Renewal 12116l2020 issue Date Date. 1 212 912 01 0 Expiration Date: 12I2912022 � _ License Status: Active Today's Dale: 1/19/2021 a -. r Secondary license Type: ' 1' "� r: 3' Doming Business As. , �: r .gy, ' <; �' a 'v ;, Status Coanue Reason License Renewal -- - x�. a � a sa,. , e,., . . ` m «. ,� ;:ar R'eregoLalte infort;witlon s .,, ' No Prer ufsite Information .r '•" No Available Docurnents Clan YAMtmr f,2011 censeunwease of MassaCteseil: Site PCIKIC'- CCI:t1i.i,_ STORE COPY INSTALLATION SERVICES CUSTOMER CONTRACT- MWORK- INT/EXT/PATIO DOOR LOWE'S OF HADLEY, MA, STORE# 1916 STORE PHONE: (413)588-0270 La1E' ry 282 RUSSELL STREET SALESPERSON: BRUCE HUNTER HADLEY, MA 01035-0000 SALESPERSON ID: 1508948 Document Print Date : 04/05/2021 This is only a Quote for the merchandise and services printed below. This becomes an agreement upon payment and issuance of a Lowe's receipt, upon which the entire agree- ment, including the specifically completed pages of this document, the Terms and Conditions included with this document, the applicable portion(s) of Lowe's receipt, and any other addenda or attachments hereto, shall be referred to herein as this "Contract." PLEASE READ THIS ENTIRE DOCUMENT, INCLUDING THE "TERMS AND CONDITIONS," BEFORE SIGNING. Lowe's Registration or Contractor License Number/Lowe's Contractor Name Lowe's Home Centers, LLC's MA HIC NO.: 148688 Lowe's Home Centers, LLC's FEIN: 56-0748358 Customer Name Home Phone S JOHN LAFLAMME 413-210-5294 O Customer Address Other Phone 778 BURTS PIT RD L City State/Province Zip/Postal Code D FLORENCE MA 01062 Installation Address T 778 BURTS PIT RD O Installation City Installation State/Province Installation Zip/Postal Code FLORENCE MA 01062 MERCHANDISE AND INSTALLATION SUMMARY MERCHANDISE SUMMARY 6550 : 235002 : STK : 5/8-IN J-CHANNEL WHITE 306-WH : 5/8-IN J-CHANNEL WHITE 306-WH : BLUELINX CORPORATION - QTY 3 34660 : 356-PFJ7 : STK : PFJCSE 356 2-1/4-INX11/16-INX7-FT : PFJCSE 356 2-1/4-INX11/16-INX7-FT : METRIE INDUSTRIES INC - QTY 3 124018 : TS433 : STK : 4-IN X 33-FT TITE SEAL (-288884) : 4-IN X 33-FT TITE SEAL (-288884) : CO-FAIR CORPORATION - QTY 1 238345 : 2827 : STK : 1-6-8 ROYAL PVC BOARD : 1-6-8 ROYAL PVC BOARD : METRIE INDUSTRIES INC - QTY 1 238348 : 2828 : STK : 1-8-8 ROYAL PVC BOARD : 1-8-8 ROYAL PVC BOARD : METRIE INDUSTRIES INC - QTY 1 1510671 : 47KD7280FRWHT : STK : DISTINCT 6068 KD FRAME : DISTINCT 6068 KD FRAME : UNITED WINDOW DOOR MFG INC - QTY 1 1510672 -47KDBRZSECLOCK : STK : DISTINCT 6068 REV PNL OPER 1LITE : DISTINCT 6068 REV PNL OPER 1LITE : UNITED WINDOW DOOR MFG INC - QTY 1 Store 1916 Project No. 675448074 for JOHN LAFLAMME Page 1 of 8 STORE COPY 1510673 : 47KD7280RHFPWBBG : STK : DISTINCT 6068 REV PNL FIX 1 LITE : DISTINCT 6068 REV PNL FIX 1 LITE : UNITED WINDOW DOOR MFG INC - QTY 1 2515864 : 47KD6080SCREEN : STK : UNITED 6068 PATIO SCREEN : UNITED 6068 PATIO SCREEN : UNITED WINDOW DOOR MFG INC - QTY 1 Materials Price $ 880.39 INSTALLATION DESCRIPTION Door type : Patio Location of new door(s) : Back Door Select new door : Sliding Sidelights or transoms : No Number of additional holes bored for accessories : None Install specialized mortise hardware : No Lead safe practices : No Total linear feet of custom trim to be Installed : 0 Deliver door : Yes Customer understands scope of the project : Yes Permit Fee : Yes Additional Mileage : 0 Access fee : None Dump entry Fee : None Additionai VVork : None Comments : United slider no mini blinds Labor Charges $ 859.00 Detail Deduction -$ 35.00 Additional Specifications: Notation: Lowe's will not make structural modifications,remove cabinetry to accommodate new appliance,or upgrade electrical service. Additional Specifications: LEAD SAFE INFORMATION: Federal and applicable state laws require that You be provided with a lead hazard information pamphlet such as the Renovate Right:Important Lead Hazard Information for Families, Child Care Providers and Schools. By signing this Contract,You acknowledge having received a copy of this information pamphlet before work began informing You of the potential risk of the lead hazard exposure from renovation activity to be performed in Your dwelling unit or facility.A copy of the pamphlet is also available at the following website: https://www.epa.gov/sites/production/files/documents/renovaterightbrochure.pdf. For more information see:https://www.eoa.gov/lead/lead-renovation-repair-and-painting-program. PHOTO RELEASE:Customer grants to Lowe's and Lowe's employees and independent contractors the right to take photograghs of the Premises where Installation Services will be performed and all work performed at the Premises related to this Contract, and irrevocably grants to Lowe's all right, title, 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 print and/or electronically, and agrees that Lowe's may use sycf),pf ptographs for any lawful purpose, including, but not limited to,marketing,advertising,publicity, illustration,training and Web content.By initialing here,Customer agrees to the foregoing. /f .f [Customer to initial to the left]. NOTICE TO CUSTOMER-PRICE CALCULATIONS: In order to properly perform the installation of certain Goods,the Contract Price may include more Goods than actually will be installed based on the measured square footage of the Project Area.As a result,the parties agree that the lump-sum Price stated in this Contract is calculated upon both the value of the estimated Goods required to ful- fill the Contract(including waste),which may exceed the actual square footage of the Project Area,and the labor which may be estimated based on the amount of Goods required to fulfill the contract (including waste). By signing this Contract below, Customer acknowledges receipt of this notice and agrees and understands that the Price includes these costs which may not be refunded once the Installation Services are performed.. NOTICE OF ARBITRATION AGREEMENT This Contract provides that all claims by Customer or Lowe's will be resolved by BINDING ARBITRATION. Customer and Lowe's GIVE UP THE RIGHT TO GO TO COURT to enforce this Contract (EXCEPT for matters that may be taken to SMALL CLAIMS COURT). Lowe's and Customer's rights will be determined by a NEUTRAL ARBITRATOR and NOT a judge or jury. Lowe's and Customer are entitled to a FAIR HEARING. But the arbitration procedures are SIMPLER AND MORE LIMITED THAN RULES APPLICABLE IN COURT.Arbitrator decisions are as enforceable as any court or- der and are subject to VERY LIMITED REVIEW BY A COURT. FOR MORE DETAILS: Review the section titled ARBITRATION AGREEMENT, WAIVER OF JURY TRIAL AND WAIVER OF CLASS ACTION ADJUDICATION found in the Terms and Conditions of this Contract. Store 1916 Project No. 675448074 for JOHN LAFLAMME Page 2 of 8 STORE COPY TOTAL CHARGES OF ALL MERCHANDISE AND SERVICES *where applicable SUB-TOTAL $ 1704.39 *TAX $ 0.00 DELIVERY $ 0.00 ORDER TOTAL $ 1704.39 BALANCE DUE Work is to commence upon reasonable availablity of Contractor which is anticipated to be 4' '" 7 / [fill in date]. Estimated completion date is 5 [fill in date]. NOTICE TO CUSTOMER All items listed in this contract and specification sheet(s) are to be installed under conditions agreed upon at time of purchase and at the price appearing on this contract form. This assumes sound existing substructures, superstructure and points of attachments. Extra labor or material incident to installation necessitated by defective substructures, superstructure, points of attachment, or the moving of fixtures or appliances to be billed at extra cost to custom- er. IF THE CONTRACT TOTAL IS $1,000.00 OR LESS. Customer must pay in full. COMPLETE THIS SECTION ONLY WHEN THE CONTRACT TOTAL EXCEEDS $1,000.00: N. Customer to use the following payment schedule: (1) Deposit of $ tribe paid upon signing contract. Any deposit collected at the time this Contract is signed will not exceed one-third (1/3) of the contract price; and (2) Payment of $ /1 to be collected upon or after the commencement of work. I/We authorize Lowe's to do one of the following (check ap- propriate box below): Charge my/our credit card for the amount of the payment indicated above upon or after the commencement of work; or [_] Deposit my/our check for the amount of the payment indicated above anytime upon or after the commencement of work; and (3) Final payment of$100.00, to be paid upon completion of the installation to both parties' satisfaction. DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES AND UNTIL YOU HAVE READ THE TERMS AND CONDITIONS CON- Store 1916 Project No. 675448074 for JOHN LAFLAMME Page 3 of 8 STORE COPY TAINED IN THIS CONTRACT AND WHICH FOLLOW THE SIGNATURE PAGE(s). BY SIGNING BELOW, YOU ARE ACKNOWLEDGING THAT YOU HAVE READ, UNDERSTAND AND AGREE TO THE TERMS AND CONDITIONS SET FORTH IN THIS CONTRACT. YOU ARE ENTITLED TO A COPY OF THIS CONTRACT AT THE TIME OF SIGNATURE. NOTICE REGARDING ARBITRATION AGREEMENT FOR CLAIMS COVERED BY M.G.L. c.142A LOWE'S AND OWNER HEREBY MUTUALLY AGREE IN ADVANCE THAT IN THE EVENT LOWE'S HAS A DISPUTE CONCERNING THIS CON- TRACT, THAT LOWE'S MAY SUBMIT SUCH DISPUTE TO A PRIVATE ARBITRATION SERVICE WHICH HAS BEEN APPROVED BY THE SECRET- ARY OF THE EXECUTIVE OFFICE OF CONSUMER AFFAIRS AND BUSINESS REGULATIONS AND THE OWNER SHALL BE REQUIRED TO SUB- MIT Tn CI Ir.- ARRITRATrN AC DRf vI c.rrIN t G I 142A gy, r� - Date: �/ /,/��=' Lowe's Home Cent* LC y: - =� , l f Date: 11 1?1. I , , ) 1 Owner By: Date: Co-owner or Witness THE SIGNATURES OF THE PARTIES ABOVE APPLY ONLY TO THE AGREEMENT OF THE PARTIES TO ALTERNATIVE DISPUTE RESOLUTION INITIATED BY LOWE'S PURSUANT TO M.G.L. c.142A. THE OWNER MAY BE PERMITTED TO INITIATE ALTERNATIVE DISPUTE RESOLUTION EVEN WHERE THE SECTION ABOVE IS NOT SEPERATELY SIGNED BY TH�E. ARTIES. WITNESS OUR HAND(S) AND SEAL(S) BELOW THIS �l DAY OF �/7) r' /, :.2 Lowe's Home Centers, LLC By: i9 (Seal) /1 Print Name: Z- /'v c c"`�` / L- f-> e .r i / 1, -2 8-/1 ,4 11 .5; 5-'6J/ ›:' V' ---k. ---1 1. . -%_._ i Address /- (Seal) Owner) ' ‘' (/'' 7 ,1' 1-7().> 5- )() 4 i- i ',- 1 City State/Province Zip/Postal Code Print Name (Seal) Co-Owner or Witness Store 1916 Project No. 675448074 for JOHN LAFLAMME Page 4 of 8 STORE COPY Print Name Customer acknowledges receipt of a true copy which was completely filled in prior to Customer's execution hereof. You the customer may cancel this transaction at any time prior to midnight on the third business day after the date of this transaction. See the attached Notice of Right to Cancel for an explanation of this right. Store 1916 Project No. 675448074 for JOHN LAFLAMME Page 5 of 8 STORE COPY TERMS AND CONDITIONS 1."LOWE'S" DEFINED.Within this Contract(as defined on the front page of this Contract),the term"Lowe's"shall refer to Lowe's Home Centers,LLC,a North Carolina limited liabity company. 2.GENERAL DESCRIPTION. By executing this Contract, Customer and Lowe's agree that 1) Lowe's shall provide Customer the goods and/or materials(the"Goods"),2) Lowe's shall procure on Customer's behalf,the services to install the Goods(the"Installation Services") in or on the premises identified on the face of this Contract(the"Premises")and 3)Customer shall pay Lowe's the lump-sum Contract Total stated on the face of this Contract(the"Price")and according to the provisions of the"Contract Documents".The Installation Services shall be perfomed in the specific rooms or areas of the Premises identified on the face of this Contract("Project Area").The"Contract Documents"shall consist of(1)the face of this Contract, (2)these Terms and Conditions, (3)the applicable portion(s)of Lowe's receipt and(4) any attached sketches,materials lists,floor plans,and/or specification sheets and other addenda or attachments hereto.The Contract Documents do not include any correspondence,advertisements,estimates or other documents that are not attached. 3.INSTALLATION SERVICES.Customer authorizes Lowe's on Customer's behalf to(a)arrange for the Installation Services to be performed by an independent contractor(the"Installer") (licensed when leg- ally required), (b) issue a work order to the Installer to perform the Installation Services, (c)have the Installer's work inspected,should Lowe's in its discretion choose to do so(it being agreed that Lowe's has no obligation to do so),and(d) pay the Installer after completion of the work and after receipt of a certificate,signed and dated by Customer,that the work has been satisfactorily completed(the"Certificate of Completion").Customer understands that Lowe's will rely upon the Certificate of Completion in paying the Installer for the Installation Services.Customer agrees that the Installation Services do not include ar- chitectural/engineering services or structural changes to the Premises or any other services beyond the ordinary and routine installation of the Goods as specifically provided in this Contract.Customer is re- sponsible,at Customer's cost,for providing any necessary architecturaVengineering services or structural changes to the Premises or any other services not specifically identified in this Contract. 4.GOODS. Lowe's will arrange for delivery of the Goods to the Premises. Customer agrees that title to goods does not pass to Customer until installed in Customer's home, building,or on Customer's prop- erty.Customer agrees Contract is being offered for the total Price(per below).Customer further agrees any surplus materials upon completion of the Installation Services are not the property of customer and, if instructed by Lowe's,such surplus materials shall be returned to Lowe's by the Installer. Upon request from Customer at the time of job completion,Lowe's,in its discretion,will allow all or part of the unused, receipted surplus materials to be retained by the Customer. 5.PRICE.The Price covers the Goods, Installation Services,and applicable taxes.The Price assumes sound existing substructures,superstructure and points of attachments.The Price shall be increased by the cost and reasonable profit to Lowe's of having to provide additional Goods and/or Installation Services as a result of defective substructures,superstructures,or points of attachments or the existence of any other Undisclosed Condition(per below).In the event of an Undisclosed Condition or the foregoing,Customer will execute a change order or a new replacement contract upon Lowe's request. 6. DISCOUNTS and PROMOTIONS. From time to time, Lowe's provides various promotions,offers and discounts that may apply to Goods and/or Installation Services. See specific promotion,offer and dis- count for terms and conditions that may apply.All discounts are taken at the time of Customer's purchase.Applicable discounts or discounted Prices will appear on the Lowe's receipt and/or on the Contract. 7.PAYMENT.If the Price is$1,000.00 or less,payment of the Price by Customer to Lowe's is due in full uopon execution of this Contract.If the Price is over$1,000.00,Customer agrees to pay Lowe's accord- ing to the payment schedule set forth in this Contract. 8.LICENSES,PERMITS,SAFETY RULES, BUILDING CODES,ZONING ORDINANCES,AND OTHER LAWS.The Installer shall be solely responsible to Customer for obtaining any and all licenses,regis- trations and certifications which are legally required to perform the Installation Services.The Installer shall also be solely responsible to Customer for the Installation Services being performed in compliance with all applicable safety rules and all existing buidling codes,zoning ordinances and other laws.Lowe's shall be responsible to Customer for obtaining building permits which are legally required to perform the Installation Services where Lowe's is legally required to obtain such permits.Where Installer is required to obtain such permits then Installer will be responsible to Customer for obtaining such permits.Custom- ers who secure their own building permits will be precluded from claiming against certain state guaranty funds relating to home improvements.Neither the Installer nor Lowe's shall be responsible for any pre- existing violations of safety rules, building codes,zoning ordinanaces or other laws and shall not be required to address or correct same. If prior to the completion of work a change occurs to any applicable safety rule,building code,zoning ordinance or other law which requires additonal Goods and/or Installation Services to perform this Contract,Customer agrees to pay Lowe's the cost and reasonable profit for such additional Goods and Installation Services and to execute a resulting change order or new replacement contract as requested by Lowe's. No additional work will be performed under this Contract due to any change to any applicable safety rule,building code,zoning ordinance or other law that occurs after the completion of work. 9.CUSTOMER'S WARRANTY AGAINST VIOLATIONS OF EASEMENTS,COVENANTS,AND THIRD PARTY RIGHTS.Customer warrants that performance of Installation Services will not violate any exist- ing real property easements,covenants,homeowner's association rules or rights of third parties holding an interest in the real property being improved. 10.UNDISCLOSED CONDITIONS IN PREMISES. If any defect,weakness or dangerous condition including,but in no way limited to,mold,mildew,rot,asbestos or infestation ("Undisclosed Condition")is dis- covered or identified in the Premises'structure, substructure,superstructure or points of attachment at any time prior to commencement or completion of the Installation Services,Customer must remedy the Undisclosed Condition at Customer's sole cost and expense and to Lowe's sole satisfaction. If Customer refuses to permit inspection of the Premises as set forth below, Lowe's may terminate or rescind this Contract without remedy or recourse by,or further obligation to,Customer,except as expressly provided below. If Customer and Lowe's disagree as to whether an Undisclosed Condition exists,Lowe's may in its sole discretion obtain the services of an inspector to inspect the Premises at Lowe's sole cost and expense,and if Lowe's chooses to do so,such inspector's report shall be final and conclusive as to wheth- er an Undisclosed Condition exists.In the event of any Undisclosed Condition that Customer does not remedy to Lowe's sole satisfaction,or any failure by Customer to perform any other obligation of Custom- er under this Contract,then at Lowe's option (i)Lowe's may rescind this Contract and return the Price to Customer without further cost or obligation by either Customer or Lowe's if Lowe's notifies Customer of its election to rescind this Contract prior to the earlier of delivery of the Goods and the Installer beginning performance of the Installation Services,or(ii) Lowe's may terminate this Contract without remedy or recourse by,or further obligation to Customer,except as expressly provided below if Lowe's notifies Customer of its election to terminate this Contract after the earlier of delivery of the Goods and the installer beginning performance of the Installation Services.In the event that Lowe's terminates the Contract as provided in this Section,then Customer may return the Goods(other than Goods that have been"custom- made")in their original, unopened condition,to Lowe's for a refund or credit.Any such return must be made within 30 days after Lowe's terminates this Contract.Customer will be charged a 15%restocking fee on any such returns. Goods not in their original, unopened condition, and custom-made goods, may not be returned. "Custom-made" goods include goods that have been uniquely altered, color-matched, shaped,sized,cut or otherwise designed or fitted to accomodate the requirements of a particular space or environment. Examples of custom-made goods include,but are not limited to,cabinets,countertops, floor and wall coverings,and window treatments. If Lowe's terminates this Contract as provided herein, Lowe's shall have no obligation to refund any portion of the Price(except as expressly provided herein) and shall have no obligation to restore the Premises to their original condition. Notwithstanding the foregoing,and alternative to rescinding or terminating this Contract as described above,upon discovery or identification of any Undisclosed Condition in the Premises, Lowe's may in limited circumstances and markets, and in Lowe's sole discretion,authorize the commencement or continuation of Installation Ser- vices upon Lowe's receipt of Customer's written agreement(to be furnished to Customer by Lowe's)to release and hold harmless Lowe's and installer from any and all liability arising out of or related to the Un- disclosed Condition and Customer's remedy of Undisclosed Condition. 11.CUSTOMER'S RESPONSIBILITIES:Customer agrees to pay Lowe's according to these Terms and Conditions.Customer agrees to facilitate the location of utility lines.Customer is responsible for identi- fying property lines.Customer agrees to ensure that work areas are free of vermin and pre-existing physical or environmental hazards,and building/zoning code violations.Customer agrees to provide the In- staller with access to work areas during working hours and to provide access to sanitary facilities or to pay the rental costs for such facilities. Customer agrees to ensure that any security system at the Premises will not interfere with performance of the Installation Services.Customer agrees to provide power to,as applicable,climate control in,the work areas.Customer agrees not to allow unattended minors at the Premises while the Installer is present.Customer agrees to control and keep pets away from work areas. Customer agrees to keep posted permits on display at all times.Customer agrees that if Cus- tomer or anyone Customer controls interferes with or delays performance of the Installation Services, Customer may be subject to transportation/storage charges or other resulting charges.Customer agrees not to assign or transfer this Contract. Customer agrees that any claim against Lowe's or the Installer under this Contract should be made to Lowe's within thirty(30)calendar days of the date Customer first Store 1916 Project No. 675448074 for JOHN LAFLAMME Page 6 of 8 STORE COPY becomes aware of a problem. (Lowe's will attempt resolution of any claim(s)within sixty (60) calendar days of receiving Customer's notice.) CUSTOMER ASSUMES THE RISK AND THE FULL LIABILITY OF PHYSICALLY ASSISTING WITH DELIVERY OF THE GOODS OR WITH PERFOMANCE OF THE INSTALLATION SERVICES.To Ensure Compliance with Smoke Alarm and Carbon Monoxide Detector Requirements. Prior to the start of the Installation Services, You will ensure the Premises have all necessary carbon monoxide detectors and smoke alarms("Detectors") needed for the Installer to obtain the necessary permits and complete the Installation Services. You are solely responsible for the proper number, placement, type, functioning, operation, installation, testing, as per the manufacturers' specifica- tions,and maintenance of any Detectors required by Local Regulations. Failure to meet Federal,State or Local Detector requirements, if any,will be considered an Undisclosed Condition. 12. MANUFACTURER WARRANTY FOR GOODS.Customer is entitled to any warranty provided by a manufacturer of the Goods sold under this Contract. The Installer will provide Customer with any manu- facturer consumer warranty information accompanying the Goods, and Customer may also obtain such information by contacting Lowe's. LOWE'S DOES NOT WARRANT THE GOODS AND EXPRESSLY DISCLAIMS ALL WARRANTIES.EXPRESSED OR IMPLIED.TO THE FULLEST EXTENT PERMITTED BY LAW, 13. LOWE'S WARRANTY FOR INSTALLATION SERVICES / LIMITATIONS OF LIABILITY. Lowe's does warrant that the Installtion Services will be performed by the installer in a good and workmanlike manner. Lowe's warranty for Installation services shall extend for a period of one year from the earlier of(1)the date the Certificate of Completion is signed by Customer or(2)the date that Lowe's determines that the Installation Services have been completed,or for such greater period as may be required by applicable law governing consumer warranties for workmanship (the "Warranty Period"). LOWE'S WAR- RANTY THAT THE INSTALLATION SERVICES WILL BE PERFORMED BY THE INSTALLER IN A GOOD AND WORKMANLIKE MANNER DOES NOT COVER, AND LOWE'S WILL NOT BE RESPONS- IBLE FOR,ANY DEFECT IN SUCH INSTALLATION SERVICES DUE TO(1) ANY DEFECT,WEAKNESS OR DANGEROUS CONDITION, INCLUDING BUT NOT LIMITED TO, MOLD, ROT,ASBESTOS OR INFESTATION IN THE PREMISES'STRUCTURE, SUBSTRUCTURE, SUPERSTRUCTURE OR POINTS OF ATTACHMENT, OR OTHER PRE-EXISTING PHYSICAL OR ENVIRONMENTAL HAZARD, OR (2) ABUSE, MISUSE, NEGLECT, OR IMPROPER CLEANING. LOWE'S WARRANTY FOR INSTALLATION SERVICES SHALL BE IN LIEU OF ANY OTHER WARRANTY, EXPRESSED OR IMPLIED.TO THE FULLEST EXTENT PERMITTED BY LAW. Customer acknowledges and agrees that Customer shall be limited to seeking recourse or remedy exclusively from Lowe's or the Installer(as applicable) and that no affiliate of Lowe's shall have any liability under this Contract. Customer must give Lowe's written notice within the Warranty Period of any warranty claim relating to Installation Services. Customer agrees that its sole and exclusive remedy against Lowe's for a warranty claim is reinstallation in a good an workmanlike manner,including the repair or replacement of any Goods if and to the extent resonably necessary to correct the defective Installation Ser- vices. CUSTOMER SHALL HAVE NO OTHER REMEDY FOR A WARRANTY CLAIM, INCLUDING WITHOUT LIMITATION REMEDY FOR LOSS OR DAMAGE CAUSED BY NORMAL WEAR AND TEAR, LOSS OR DAMAGE WHICH HAS NOT BEEN REASONABLY MITIGATED, OR LOSS OR DAMAGE CAUSED BY ACTS OF GOD. IN NO EVENT SHALL LOWE'S BE LIABLE FOR INDIRECT, PUNITIVE, CONSEQUENTIAL OR INCIDENTAL DAMAGES(SUCH AS, WITHOUT LIMITATION, LOST PROFITS, LOST SALES, AND INJURIES TO PERSONS OR PROPERTY), EVEN WHERE LOWE'S HAS BEEN ADVISED OF THE POSSIBILITY OF SUCH DAMAGES. WHERE, DUE TO OPERATION OF LAW, SUCH DAMAGES CANNOT BE EXCLUDED, THEY ARE EXPRESSLY LIMITED IN AMOUNT TO THE PURCHASE PRICE. In connection with any warranty claim,Customer agrees,at no cost to Lowe's or the Installer,to prepare the Premises and the reinstallation area in the manner described in Section 11 of these Terms and Conditions. 14. DISPUTE RESOLUTION FOR CLAIMS COVERED BY M.G.L. c.142A. Most questions or complaints are resolved informally. If Customer has a question or complaint, Customer agrees to contact the Lowe's salesperson whose name appears on this Contract and the manager of the Lowe's store at the address and/or phone number on the front page of this Contract. If Customer has a complaint which can- not be resolved informally,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 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 the "Notice Regarding Arbitration Agreement for Claims Covered by M.G.L. c.142A"on the front page of this Contract is signed and dated by Lowe's and the owner. If allowed by statute or applicable law, the arbitrator may awared statutory damages and/or reasonable attor- neys'fees and expenses. If Customer fails to pay Lowe's in accordance with this Contract, Lowe's shall be entitled to recover its reasonable attorneys'fees as provided by N.C. Gen. Stat. Section 6-21.2 or other controlling law. To the fullest extent permitted by law, Lowe's and Customer agree that no class action lawsuit or class action artibration of any type may be pursued by or on behalf of the Customer or ordered by a Court or arbitrator(s)under this Contract and,in addition,that there shall be no joinder of parties,except for joinder of parties to the transaction covered by this Contract. 15.ARBITRATION AGREEMENT,WAIVER OF JURY TRIAL AND WAIVER OF CLASS ACTION ADJUDICATION FOR CLAIMS NOT COVERED BY M.G.L.c.142A: All claims by Customer or Lowe's con- cerning this Contract which cannot be resolved informally, and which are not covered by M.G.L.c142A or subject to the jurisdiction of a small claims court, shall be resolved by binding arbitration conducted by a single arbitrator under the current applicable rules, procedures and protocols of JAMS, Inc. (JAMS) (www.jamsadr.com) (as amended) or the American Arbitration Association (AAA) (www.adr.org) (as amended).The parties agree that if JAMS or AAA are unable or unwilling to arbitrate the matter,the parties will agree upon a single arbitrator with a nationally recognized arbitration firm to arbitrate the matter. Claims to be resolved by binding arbitration include, but are not limited to(1)all claims directly or indirectly related to the signing of this arbitration agreement,the validity or scope of this arbitration agreement, or any attempt to set aside this arbitration agreement, (2)all federal or state law claims relating directly or indirectly to this Contract(including this arbitration agreement),the information Customer gave Lowe's before entering into this Contract and/or any past agreement or agreements between Customer and Lowe's, (3)all counterclaims,cross-claims and third-party claims, (4)all common law claims of any kind in- cluding claims based upon alleged product defect, contract,tort,fraud,or other intentional torts, (5)all claims based upon a violation of any state or federal constitution, statute or regulation, (6)all claims as- serted by Lowe's against Customer, including claims for money damages to collect any sum Lowe's claims Customer owes Lowe's, (7)all claims asserted by Customer individually against Lowe's and/or any of Lowe's employees, agents,directors,officers, shareholders, managers, members, parent company or affiliated entities (herein collectively referred to as "related third parties") or the Installer, including claims for money damages and/or equitable or injunctive relief, (8) all claims asserted on Customer's behalf by another person, (9) all claims asserted by or on behalf of a Customer as a private attorney general against Lowe's, related third parties and/or the Installer, (10) all claims arising from or relating directly or indirectly to the disclosure by Lowe's, related third parties or the Installer of any non-public personal in- formation about Customer, and/or(11) all other claims arising under or related to this Contract whether or not set forth above. If the dispute falls within the jurisdiction of a small claims court the claimant may, at its option,choose to arbitrate or file a small claims action.Any appeal of a judgment from a small claims court shall be resolved by arbitration as provided herein. Binding arbitration means that Customer waives: (1)any right to a jury trial; (2)any right to bring a lawsuit in a court(other than a small claims court as described above); and(3)any right to seek relief in any other forum or from any other agency.Any claim not decided by a small claims court will be decided by an arbitrator selected as set forth immediately above.Lowe's and Cus- tomer agree that binding arbitration provides a simple, cost efficient method to resolve disputes quickly. Lowe's and Customer agree that no class action lawsuit or class action arbitration of any type may be pursued by or on behalf of the Customer or ordered by a Court or arbitrator(s) under this Contract and, in addition,that there shall be no joinder of parties, except for joinder of parties to the transaction covered by this Contract.By agreeing to binding arbitration Customer and Lowe's waive any right to bring or participate in a class action lawsuit or class action arbitra- tion regarding any claim. How Arbitration Works: Lowe's may demand arbitration by sending written notice to Customer at the address listed in this Contract.Customer may demand arbitration by sending written notice to Lowe's at the following address: Mail code NB6LG, P.O. Box 1000, Mooresville, NC 28115. The arbitration shall be held in the city or county where the Premises are located or in such other convenient location as the Customer and Lowe's may mutually agree. Lowe's shall pay the filing, administrative, hearing and arbitrator's fees associated with the arbitration. Customer shall not be required to reimburse Lowe's for these expenses even if Lowe's wins the arbitration. Unless the arbitrator's award or controlling law specifically provides otherwise, Lowe's and Customer will each be responsible for its own attorneys' fees and other expenses,such as wit- ness and expert witness fees. At the timely request of Customer or Lowe's,the arbitrator will provide a written explanation of the award so long as such requirement is consisent with the then current rules, pro- cedures and protocols of the arbitration entity selected by the parties as set forth above.The arbitrator's award may be filed with and enforced by any court having jurisdiction. If allowed by statute or applicable law, the arbitrator may award statutory damages and/or resonable attorneys'fees and expenses. If Customer fails to pay Lowe's in accordance with this Contract,Customer agrees that Lowe's shall be entitled to recover its reasonable attorneys'fees and expenses as provided by N.C. Gen. Stat. Section 6-21.2 or other controlling law. The parties agree that this arbitration agreement is made in connection with a Store 1916 Project No. 675448074 for JOHN LAFLAMME Page 7 of 8 STORE COPY transaction involving interstate commerce and shall be governed by the Federal Arbitration Act,9 U.S.C. Sections 1-16(as may be amended) (FAA), but if for any reason the Federal Arbitration Act does not apply,then this arbitration agreement shall be goverened by the laws of the State of North Carolina. 16.GOVERNING LAW AND SEVERABILITY.This Contract shall be interpreted under and governed by the law of North Carolina,without regard to the choice of law rules of any state,except that the ARBIT- RATION AGREEMENT, WAIVER OF JURY TRIAL AND WAIVER OF CLASS ACTION ADJUDICATION is governed by the FAA. If any provision of the Contract is contrary to any law to which it is subject, such unlawful provision shall be ineffective without invalidating the other provisions,which shall remain in full force and effect. 17. CREDIT CARD/FINANCED TRANSACTIONS. If Customer uses a credit card or obtains financing to pay some or all of the Price,then Customer acknowledges that the terms of his or her cardholder agreement or financing documents may change the total amount of money Customer must pay to the credit card provider or lender,including any interest charges and fees.Customer acknowledges that his or her cardholder agreement or financing documents may have other terms and conditions to which Customer will be subject.Customer also acknowledges that Lowe's is not a party to any such cardholder or fin- ancing agreement. 18.WAIVER OF LIENS.Because responsibility for paying the Installer on Customer's behalf belongs to Lowe's,Lowe's will require the Installer,on behalf of itself and any of the Installer's subcontractors,ma- terialmen or suppliers,as a condition precedent to payment by Lowe's on Customer's behalf,to fully and unconditionally relinquish,waive and release any and all mechanic's liens, materialman's liens and oth- er liens in the Premises which the Installer or its subcontractors,materialmen or suppliers might have or acquire in the future,by operation of law or otherwise,as a result of this Contract. 19. UNAVOIDABLE DELAY OR FAILURE IN PERFORMANCE EXCUSED.Any delay or failure by Lowe's or the Installer in performing this Contract because of strike,fire,flood, epidemic,acts of terrorism, acts of God, inability to obtain Goods in a timely or commercially feasible manner,or any other causes beyond the reasonable control of Lowe's or the Installer shall be excused and shall not be breaches of this Contract. 20. ENTIRE AGREEMENT/CHANGES IN WRITING.Customer and Lowe's agree that this Contract accurately states the entire agreement between Customer and Lowe's concerning the Goods and Installa- tion Services and replaces and supersedes all prior agreements and understandings relating thereto, both oral and written,and all oral agreements and understandings entered into at the same time as this Contract.Any additions or changes to this Contract,or any waiver of rights under this Contract,must be in writing signed by Customer and Lowe's. 21.CAPTIONS.Titles or captions of sections contained in this Contract have been inserted only as a matter of convenience and in no way define,limit,extend,describe or otherwise affect the scope or mean- ing of this Contract or the intent of any provisions hereof. 22.ADDITIONAL INFORMATION.All contractors and subcontractors must be registered by the Administrator of the Board of Building Regulations and Standards.Inquiries about a contractor or subcontractor relating to a registration should be directed to the Administrator of the Board at One Ashburton Place,Room 1301,Boston,MA 02108,(617)727-8598. 23.QUESTIONS OR CONCERNS.Customer should speak to the Lowe's salesperson whose name appears on this Contract and the manager of the Lowe's store at the address and/or phone number on the front page of this Contract, regarding routine matters such as scheduling,any requested changes to Customer's order,or any concerns Customer may have about this Contract,the Goods or the Installation Services. Store 1916 Project No. 675448074 for JOHN LAFLAMME Page 8 of 8 NOTICE OF RIGHT TO CANCEL • Your Right to Cancel You are entering into LOWE'S Installed Sales Contract Number t /17 1'7(the "Contract") that may result in a lien or security interest on your home in which property (the "Property" ) is to be in- stalled pursuant to the Contract. You have a right to cancel the Contract, without cost, penalty or ob- ligation, at any time prior toO dnight of the third business day after the latest of (i) the date of the Contract, which is . ^, / , I (year), (ii) the date you received this Notice of Right to Cancel, and (iii) if you have paid or will be paying for the Contract by using your LOWE'S private label credit card, the date you received your Truth-In-Lending disclosures in connection with such credit card. Effects of Cancellation If you cancel the Contract, the lien or security interest on your home is also canceled. Within 20 cal- endar days (except in Connecticut where the period is 10 business days) of receiving your notice of cancellation, we must take any necessary steps to reflect the fact that the lien or security interest on your home has been canceled, and we must return to you any money or property you have given us or anyone else in connection with the Contract. How to Cancel If you decide to cancel the Contract,you may do so by notifyjng us in writing,by mail,telegram, or personal delivery,at: LOWE'S -Z 7)4" fs�'/1 Sf / '.e:� Ci t7'4'74" You may use any written statement that is signed and dated by you and states your intention to can- cel, or you may use this notice by dating and signing below. Keep one copy of this notice no matter how you notify us because it contains important information about your rights. To be effective, you must drop your cancellation notice in the mailbox, file it for telegraphic tran missigi , or deliver it to us by other means at the above address no later than midnight of (year) (or midnight of the third business day after the latest of the three events listed above). I WISH TO CANCEL. (Customer's/Resident Owner's Signature) (date) Print Name ACKNOWLEDGEMENT OF RECEIPT OF DISCLOSURES AND CERTIFICATION On this 5th day of April, 2021 (year), each of you hereby acknowledges receipt of two (2) copies of the foregoing Notice of Right to Cancel; each of you who i,s a party to the Contract hereby acknow- ledges receipt of one (1) copy of the fully executed and dated Contract; if any of you has paid or will pay for the Contract by using your LOWE'S private label credit card, you hereby acknowledge having received the Truth-In-Lending disclosures in connection with such credit card; and you certify, repres- ent and warrant to LOWE'S that you are all of the customers who signed the Contract and all of the persons who own and reside in the home in which the Property is to be installed pursuant to the Con- t ct. (SEAL) (SEAL) ' 1`)� G Y i 1'1 C t GlYY r Print,Name Print Name (SEAL) r� wane 71--f' Print Name NOTE : Each Customer who is a party to the Contract and each Resident Owner of the home must sign above.