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16A-029 (3) 426 SPRING ST BP-2021-1234 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 16A-029 CITY OF NORTHAMPTON Lot:-001 PERSONS CONTRACTING WI I I UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: ROOF BUILDING PERMIT Permit# BP-2021-1234 Project# JS-2021-002056 Est.Cost: $10800.00 Fee: $40.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: SEXTON ROOFING CO 99689 Lot Size(sq. ft.): 110642.40 Owner: EVA PETERS Zoning: URA(100)/WSP(23)/ Applicant: SEXTON ROOFING CO AT: 426 SPRING ST Applicant Address: Phone: Insurance: P 0 BOX 6327 (413) 534-1234 WC HOLYOKEMA01041 ISSUED ON:4/27/2021 0:00:00 TO PERFORM THE FOLLOWING WORK:STR I P & 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. I Certificate of Occupancy Signatur. FeeTvpe: Date Paid: Amount: Building 4/27/20210:00:00 $40.00 212 Main Street, Phone(413)587-1240, Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner T .-- The Commonwealth of Massachusetts U &, ' Board of Building Regulations and Standards . FOR �� Massachusetts State Building Code,-780 CMR,76 edition MUNICIPALITY USE at i f q BuiIding Permit Application To Construct,Repair,Renovate Or Demolish a Revised January �, !c 'L One—or Two-Family Dwelling i,2008 ru irn1 This Section For Official Use Only • -" 1 c''' 0i4Ung Permit Number: F,P' 3'all Z q Date Applied: #>tine: • 7/`oZ) 0 p Buil g Commissioner/Inspector of: dings Date z I. f m SECTION 1:SITE INFORMATION 1......_ 1.1 Property Address: L2 Assessors Map&Parcel Numbers ;tc, _Stele( S/! • 144 029 . 1.1 a Is this an accepted street?yes no ?clap Number Parcel Number ' 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use __ Lot Area(sq ft) Frontage(it) 1.5 BuiIding Setbacks(ft) - Front Yard Side Yards • Rear•Yard • Required - Provided Required Provided Required Provided . • 1.6Water Supply: (M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: - Public O Private Cl Zone. __ Outside Flood Zone? Municipal ClOn site disposal system 0 Checks if yes0 • SECTION 2: PROPERTY OWNERSHIP' 2.1Y// rrofIr�r¢: S • 97a2-e ,5r,e/4 S/' c-IoroC • Name int) Address for Service: t. • Signature Telephone • SECTION 3:DESCRIPTION OF PROPOSEI)WORK2(check all that apply) New Construction O Existing Building I Qwner-Occupied t Itepairs(s) U Alteration(s)•0 Addition 0 Demolition 0Accessory Bldg.@-- Number of Units / Other CI ;peaty: . Brief Desc piton of Proposed Wor !: • SECTION 4:ESTIMATE))CONSTRUCTION COSTS. • • Estimated Costs: Item ' Official Use Only_ (Labor and Materials) • 1.Building $ 1. Building Permit Fee:$ Indicate how fee is determined: • ❑Standard City/Town Application Fee 2.Electrical $ 0 Total Project Cost (Item 6)x multiplier . x_ 3.Plumbing ' . $ 2. Other Fees: $ 4.Mechanical (TIVAC) $ List: S.Mechanical} (Fire $ Total All Fees: da O Suppression ��j Check No,�3 Cheek Amount t Cash Amount: 6.Total Project Cost: $ :-1 61 )v 0 Paid in Full 0 Outstanding Balance Due: SECTION 5: CONSTRUCTION(�SEERVICES 5.1 Construction Supervisor License(CSL) 7 / y &Pere -3e tor) rate Name of cs�tll�loada//,_ !`� List CST.Type(serbdaw) 6L�//,�C.i No.?Of �t t� I Type Description f�anaJSrmc�/ /� �)/ ,C� 10` O. / 7!'Y fJl0 !/ 13 'Unrestricted(Buildings up to 35,O00 cu.ft_) / B. Restricted 1�42 Family Dwelling taty/ Sate,BOP M Masonry RC Roofing Covering WS Window and Siding SF Solid Fuel Burning Appliances I Imitation -_- -= - Telephone Email address D Demolition __,.-- 5.2 Registered� �JM e ent Contractor ott r�C) i J�a3 9 t)PxTl N! /')L oc"/IQ anal Ahnq rat;. MC Registration Number F atioi Date HIC Name or WAegisnam Name .l . P.9 SEA �3 7 ,) -onrt- )/NOh viol/.Crv77 No.and Street F 1 address f�dig() mA 0i0.5% 203-53'/-i q Cityff4wn,State,ZIP Telephone SECTION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.152-§2SC(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. Sued Affidavit Attached? Yes Sr' 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 Dar—on&to/ zrdL.//al n Th to act on my behalf,in all matters relative to work authorized by this buil'' • . application. (nfre f cP eha 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 plication is true and accurate to the best of my knowledge and mrderstauding. MUST BE SIGNED by Owner or Authorized Agent Date NOTES: I. An Owner who obtains a building permit to do his/her own wont,or an owner who hires an unregistered contractor (not registered in the Home Improvement Contractor(HIC)Program),will gig have access to the arbitration program or guaranty fiord under M_G.L.c.I42A.Other important information on the HIC Program can be found at www.wass.gov/oca won on the Construction Supervisor License can be found at www_mass gov!4as 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.II) Habitable mom count Number of fireplaces Number of bedrooms Number of bathrooms Number ofhalf/batbs Type of heating system Number of decks/porches Type of cooling system Enclosed Opal 3. "Total Project Square Footage"may be substituted for"Total Project Cost' - • • ;.a.fir ill n7Cril; 2. *r. e....+-_.... ifique Tali ii(..0 ! r 4r,l1.1(p p .+- .:, r sy +-.s, 1i6"L1 `'ram'?04.Srh�cfiS j_Apc-i'eqc?.suz.;9•{...mo r r; i.;d41. }Scut i5- .n 1-04 ''.....�..�..._-......._..._.._ ..,.-... „I...�:.... ep'a -ra :t ..Y.Le.pu eli+ .-:s]+tuttsg..a]rs ,.14:^s4a.tot.ndc p.7 c ,4u+, y • • jas,;,�,,. r r ?'r i ..ftith:.Rl(''rS,Tg' {tL '01,4 fJ:(' C1.444 i! .4(Z."7 pc.1 v; I air �i�$iw'et%C.�, 1t� n ��., d"�?`'i 1�>rw' ., • 44,1c r("i*.;i.-1,.."17.:,.„,c,i P•astgast Gcli rs .(ftIC'a t,oitt itiy nu"n 107Ti ilte `ya to 4.14;91.24,491::v!? t i' ./17 OtA.i!--z.. 1 3 a tPtil?t{At3a i.',74.itiif t')Wt Trk, i..kitii to,014e at rlizty•t.'¢4] '.f:$}rR{.? LCw C wr rt r i'1glei r.."Klfxd•x",p,-, >r.;;' .: ' "J V4aut ..o_ �.._....,.. _»_ , 4 aft s::stt.,us:is t ; i;}Leis ;:uCA7* �r `n Ert ;mac };t3< s fr > �. 3 pa m.rn' %tYKaY.lilt if c ' as:d`=_!1FJf(bc 1: T,3..t. .m i..a.s^t 14 lit at ;a4)4vfloat I ;OZ''il1'' r ]+tzA 3M;d (a ::wit z:xcav• '1d �,sa,�t� �I; ST' l • t :,YiCY r' 'L:xt G!r:S�3F1 MCLt2' ; u ►' •t.�s:s �[ ( \'". .,.f�,, . �'a' �•t "' —_ .._- !o.ii Ef3 V irE''•. !, Gi #.115",PC)I Vsxia Ttm.re' t:Y.S artivutte imsoiLL1 • 'e .1(Yl:a ettii,ii.Elf vcs.w)WiliC114,it3 i$E A) I;ork..Aftt ki•A i4 _ _.._ I • za �. • • a t. G rtCF_ , gaaarr 1f t rt PC., ao.G mar azt. : ... • . ._____ __._ _ . o t_�I.▪d al'`, E?K ,Lbi:a i.Wt : n '. aie) `�'f.M1' itrYikLi. 4 is'� .c F?'3-a1 :r,rete)) • i . 14 ' " i .; • r+[tra.a:. (. a - sv4446'.91 �49 \ 5 t. .I.iI A . 'k< 146aG , +j Aro +tw i z' r, Oni..6 ‘ t i 'v.f^w+ i 3f a :q a L i3'" u *tttlifigiCt=P • r :rw V' -ratrz.t t '' ''' "t'• ::'Av. t ' '" ... ..�-_ . ...- 4,.-- w ff�"i g ' `6 fir•. gR t. a.+ L ,,,.,,, 4 Ou I>ur ,' r 1 v n s i. .r 37t,tl7 s :i* - ............�.._- *c A^"`_t E`l --., ."SLbli..yfi.J j'ralt I • r d^x•a .>.�!6S;rxlb f.eW..!r1i. s°6 5 Y^1 tcarl. -.....,._.-«.... _".a.. .__. _^ 1 City of Northampton ' ' s Massachusetts ••-�.' i DEPARTMENT OF BUILDINGINSPECTIONSS afr a 212 Main Street • Municipal Building Buil O. a• �,.. Northampton, MA 01060 .P.S*:•..., 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: Location of Facility: "7O n MA - I 11 1--tD (9-rJe The debris will be transported by: , I Name of Hauler: Svc- r ark �,t � q I,e//x£'Ckt `> Signature of Applicant: Date: Y/97 /2../ Proposal SEXTON ROOFING AND SIDING INC www.sextonroofing.com VICO amsTER • •er �r .,e . ramComeror Setting the Standard — — 's' *- P.O. Box 6327 p. 413.534.1234 r•tr•�+ s• Holyoke, MA 01041 f. 413.539.9906 MA HIC# 118239 sextonroofimg0hotmail..com SUBMITTED TO Eva Peters ' PHONE 727-2162 I DATE 6/19/19 STREET 426 JOB NAME CITY;STATE,ZR;.. Pl areace Ma. JOB LOCATION SEXTON 1R0OPIWG HEREBY SUBMITS SPECIFICATIONS AND ESTIMATES FOR: 1) Strip and remove existing shingles and dispose of in proper landfill. 2) Inspect roofing deck and replace as needed @$75.00 per sheet. 3) Install new metal edging to rakes and eaves of roof.(8") 4) Install ice and water shield on eaves(6'),vent stacks,in valleys,chimney Skylights,and at intersecting roofs. 5) Install#15 synthetic roofing felt on remainder of roof. 6) Install new flanges over existing vent stacks. 7) Install starter shingles on eaves and rakes of roof. 8) Install ILO Architectural style roofing shingles as per manufacturers'specifications. 9) Install new cap over ridge vent. 10)Supply manufactures Lifetime warranty and SRC 15 yr.workmanship warranty. We Propose hereby to furnish material and labor—complete in accordance with the above specifications,for the amount of Ten Thousand Eight Hundred tears(10,800.00)Payments to be made as follows:Due' full upon completion All Material is guaranteed to be as specified. All work to be completed in a Authorized i workmanlike manner according to gambol practices. Any alteration or SigeittlIre 0:11r 4/, a! ri — � ' v� deviation from above specifications knakkilstra costs will be executed only upon written orders,and will become an extra dame over and above the estimate. All agreements contingent upon scathes,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 usponsible legal fees for non-payment,and applicable interest Acceptance of Proposal The above prices,specifications and conditions are satisfactory and are hereby accepted. You Signature ()ACC-,are authorized to the work as specified. Payment will be made as outlined above. Signature Date of Acceptance. 1 • i . ,, _ . .., , ( • 914,i.:if c.„.,`:.ira gn qq* ,,,i 5 g '£i ' k ..3'31i fa.ft 06 T11H ! Jb'I Sri ?'•.S{ 31s d 9Gfd31A'1t��S s f*�E? r!"t�Jf i6i`t� f} y of ,....a €TRIG t`t"j,1, s !,, ,...a te.! ._... i `4 t ii '"" h 1,1 3.t as 13,t'„+'f a ;e .Et 2�)+si" .s „ti7 . . + o..�`" S . 1 • 1 • t {,51�` e..c, .,(.sA .;:GSa'�GI II �+ ........ 1-,..1fi . 311E/A •......... 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E..At. . . -,L • a S . 1 ;" %'j� Department of Industrial Accidents _, Office of Investigations ! Lafayette City Center i tr 2 Avenue 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. Q I am a general contractor and I ❑ I am a employer with 6. ❑New construction employees (full and/or part-time).* have hired the sub-contractors listed on the attached sheet. 7. ❑Remodeling . 2.0 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 ty- 9. ❑Building addition [No workers' comp.insurance comp. insurance. required.] 5. ❑ We are a corporation and its ' 10.❑ Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their '11.❑ Plumbing repairs or additions myself. [No workers' comp. . right of exemption per MGL 12.©Roof repairs insurance required.] t c. 152, §1(4), and we have no 13.❑ Other employees. [No workers' 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 anew affidavit indicating such. :Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees_ If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. . Insurance Company Name:Travelers Property CAS CO OF AM Policy#or Self-ins.Lic.#:7PJUBOG07898220 Expiration Date:6/4/21 Job Site Address: X SI 41 3 / City/State/Zip: ka/Tike...Z-- ' Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under 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- . trance coverage verification. . I do hereby certify under i ins and penalties of perjury that the information provided ab v is tr e and correct Signature: Date: 2 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 2❑Building Department 30CitylTown Clerk 4.111 Electrical Inspector 50Plumbing Inspector 6.0Other Contact Person: Phone#: Aco i® 'CERTIFICATE OF LIABILITY INSURANCE DATE(U,V �"Y' �� IDD 06/09/2020 THIS CERTIFICATE IS ISSUED AS A MA I I Eft 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 POUCIES 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 mic"o E No. (413)737-0300 IAICNng ADD R : khutchinson@onnsbyins.com P 0 BOX 718 ; INSURERS)AFFORDING COVERAGE NAIL# - WEST SPRINGFIELD MA 01090 INSURER A: TRAVELERS PROPERTY CAS CO OF AM 25674 INSURED INSURER B: SEXTON ROOFING&SIDING INC INSURER C:' INSURER D: PO BOX 6327 • INSURER E: HOLYOKE MA 01041 INSURERF: 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 POUCIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.' INE TYPE O.INSURANCE ADDL SUER P L/CY�" POUCY UP INsn WVD POUCY NUMBER (MwoosYYYY) IIM0.VDDlYYYY) - LIMIT COMMERCIAL GENERALLUIBILCTY EACH OCCURRENCE $ DAMAGE TO RENTED CLAIMS-MADE OCCUR PREMISES(Ea omarenre) $ MED.EXP(Any one person) S N/A • PERSONAL&ADV INJURY S GEN'L AGGREGATE LIMIT-APPLIES PER: f' GENERAL AGGREGATE $ POLICY JET 1 1 LOC PRODUCTS-COMP/OPAGG S OTHER: - S AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT S (Ea accident) ANY AUTO • ,BODILY INJURY(Perperson) S ALL OWNED SCHEDULED AUTOS AUTOS erac • N/A BODILY INJURY( � Pide S NON-OWNED. ' PROPI_KIYDAMAGE E _ HIRED AUTOS AUTOS (Per accident) S UMBRELLA A LWB OCCUR EACH OCCURRENCE S EXCESSLIAB CLAIMS-MADE N/A AGGREGATE S DED RETENTIONS _ I S WORKERS COMPENSATION - X PER STATUTE1 ER AND EMPLOYERS LIABILITY YIN ' ANYPROPRIETORIPARTNER/6(ECUTIVE EL EACH ACCIDENT $ 1,000,000 A OFRCER/MEMBERDCCLUDED? PEA WA PEA 7PJUB0G07898220 06/042020 06/04/2021 " (MandatoryinNH) ELDISE4SE-EAEMPLOYEE$ 1,000,000 If yes,describe larder DESCRIPTION OF OPERATIONS below EL DISEASE UNIT $ 1,000,000 N/A " 1 DESCRIPTION OF OPERATIONS!LOCATIONS I VEHICLES(ACORD 1u1,Additional Remarks Schedule,may be attached a'fiore 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 daims 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-compensationlinvestigations/. ' • 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. • AUTHORIZED REPRESENTATIVE • T L--�"'e C Amherst MA 01002 I Daniel M.Cro ey,CPCU,Vice President—Residual Market—WCRIBMA ©1988-2014 ACORD CORPORATION. All rights i erved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD '`e RE) CERTIFICATE OF LIABILITY INSURANCE DATE ' 2�""0° Y' 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 (A/C,No,Fst): (413)737-0300 FAX No): (413)737-0617 698 Westfield Street EL ADORERS: West Springfield,MA 01089 INSURER(S)AFFORDING COVERAGE NAIC C INSURER A: Colony Insurance Company 39993 INSURED INSURERS: Sexton Roofing and Siding Inc INSURER C: 102 Pine Street -- INSURERD: _ Holyoke,MA 01040 INSURER e: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO Ct t 11FY THAT THE POLICIES OF INSURANCE US Ill)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_EMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR SUBR POLICY EFF POUCY EXP LTR TYPE OF INSURANCE �WVO POUCY NUMBER (MM/DD/YYYY) (MMIDD/Y ITT) LIMrrs A X COMMERCIAL GENERALLIABILrrY 101PKG002159905 6/25/2020 6/252021 EACH OCCURRENCE $ 1,000;000 CLAIMS-MADE X OCCUR DAMAGE TO RENTED PREMISES(Ea occurrence) $ 100,00E MED EXP(Any one person) S 5,000 PERSONAL aADV INJURY I s 30,000 GEN'L AGGREGATE I.JMITAPPuESPER: GENERAL AGGREGATE $2,000,000 X POLICY jEo- LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ • AUTOS AUTOS NON-0VYNED PROPtrc I Y DAMAGE HIRED AUTOS _AUTOS (Peracddent) UMBRELLA UAB _ OCCUR EACH OCCURRENCE S EXCESS UAB CLAIMS-MADE • AGGREGATE $ DED RETENTION S WORKERS COMPENSATION - PER OTH- AND EMPLO S YER LIABILITY YIN (STATUTE ER ANY PROPRIETOR/PARTNER/E4=CU IVE EL EACH ACCIDENT S OFFICER/MEMBER EXCLUDED? J 1 N/A (Mandatory in NH) EL DISEASE-EA EMPLOYEE S If es,d�sal�e under DESCRIPTION OF OPERATIONS below EL DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES(ACORD 101,Additional Remarks St.halule,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. AUTHORIZED REPRESENTATIVE C ©1988-2014 ACORD CORPORATION_ All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD - - 4 =mid maiRclivriu03 j -17 Viala IIM01A! Z ITIP413OSneit� x MVP .+0 p Iiirlialdgma 211 07 w sPilatlaniallasi off ' P2Sn 114410 �J / ")] 1 i a � !s zutaituriffasuma-9-70—fisagrivadpire. . ATIPa2. 1 47 I -M IT1Q 3Q Ssaaul3azri3all at zq arkEul la3113almis S83OAd=Vvilefolit an mom at chip zuaY acusno inn=IT14ssq[au=1dnap I sz -oaalo s WOW=431 duff s 73 sc VSZ§`Zs[ se 21axs aa=EWA v SRof 1 1 i tPialn333441d3n1 Qe 10[ Q ( ll(�'j�) : - zo#tea 00 cal, r cidAtiomputiaesvotpegvieggiaipsfasserg Ist ' s �t.saifsiebv us yam assq _ 3oats:*gaslao lirFolowellomuscqs!ils ulf jt "VosigalleVamasalegfta=MFIFslsomrsiop apesjoo waW ilalig!oPa= al*s_aroomog; �.�7 WSJ K-.1V m [mspo q�{7/ti lail (}� 'a�ygTad .P P a+Q4 sgPaeno�mszomg,D9 x =lisp:apt= oo aSP pagrpmapezponlismartuaIlac sirompeio snestu2appaitrasaaforIma�ZI ca ggamogiujiced SUOMV121°Mq2d;a1MillMiai N ofasaesoz____.0 dataFr2Voao+onl saCnswR:lcalalassa gilIPPOlaaa Li El .$ E'p a5ai eoa g=poi.old E do fee • iminta3$°! +L erain aed daoaapa3oaaE sZmsi Etz =MalmoO 0 { sm -z - awl appelcuddlealmaao_* .a»=guy L - :# :.WIS CIO "OUP T 00- . jai) (I NA Aetwgivorsztwaloauxeiki BrilledeSXMIVIIMIE - -mar A DATE rynroomYr)CERTIFICATE OF LIABILITY INSURANCE 11,1020 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 NAkie Edson DeSouza MAYFLOWER INSURANCE GROUP INC WC,No d_ (774)773 9702 FAX (LAIC,Nei: ADDREss, Edson@mayflawerinsurance.com 299 Court Street INSURER(S)AFFORDING COVERAGE NAM:: Plymouth MA 02360 INSURERA: HARTFORD UNDERWRITERS INS CO 30104 INSURED INSURER B: MNP CONSTRUCTION INC INSURER C: 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 TYPE OF INSURANCE ADOL SUER POLICY EFF POLICY EXPLIR WETS VIVD POLICY NUMBER (MMJDOIYYYY) (MMIDD/YYYY) COMMERCIAL GENERAL LIABILITY EACH OCCURRENCEDAMAGE TO RENTED $ CLAIMS-MADE OCCUR PREMISES Ea oaalrtence) $ MED EXP(Any one person) $ N/A PERSONAL&ADV INJURY $ GENT c, 'L GENERAL AGGREGATEPRO- $ POLICY , o- LOC PRODUCTS-COMP/OP AGO $ OTHER $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) ANY-AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS N/A BODILY INJURY(Per acddent) $ _ NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS (Per accident) $ UMBRFI I ALIAB OCCUR EACH OCCURRENCE $ ExCESS LIAR CLAIMS-MADE N/A AGGREGATE $ CEO RETENTIONS $ WORKERS COMPENSATION X PER OTH- ER SfATLfrE ER AND EMPLOYERS'LIABILITY A o oERA+Ea BERE CLUDED? EEL EACH ACCIDENT $ 1,000,000 N/A NIA wA 6S60UB1K70970620 11/16/2020 11/16/2021 (Mandatory in NH) EL DISFASE-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 1111,Additional Remarks Schedule,may be aUer.ruul 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(unI cs 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-compensalionlirivestigations/. 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 AUTHORIZED REPRESENTATIVE Holyoke MA 01041 D Daniel M_C y,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 ACC:PREP CERTIFICATE OF LIABILITY INSURANCE DATE(YWDD/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 COMACT NAma Art Calvin° PHOAX One Family Insurance mjc.Ezt): 978-403-5942 ( NO: 978-403-5943 1 Main St.Suite 15 AL DAD : artW1farnilyinsurance.com Lunenburg,MA 01462 INSURERS)AFFORDING COVERAGE - NAIC# INSURERA: Evanston Insurance Company INSURED ENSURER B MNP CONSTRUCTION,INC. INSURERc: 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 ED 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 AUULSUUR LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER POLICY EFF POLICY OU' LIMITS EN X COMMERCIAL GERAL LIABDJTY �NNUDD^�'�) (ruunD/YYYV) EACH OCCURRENCE $ 1,000,000 DAMAGE-TO RENTED CLAIMS-MADE X OCCUR PREMIbts(Ea occurrence) $ 100,000 MED EXP(Arty ono perm) $ 5,000 A Y Y 3ET9385 11/20/20 11/20/21 PERSONAL 8 ADV INJURY E 1,000,000 GEN'LAGGREGATE LIMB-APPLES PER: GENERAL AGGREGATE 5 2,000,000 POLICY JE LOC PRODUI,IS-COMP/OP AGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) ANY AUTO BODILY INJURY(Per person) $ OWNED SCHmULID BODILY INJURY(Per accident $ AUTOS ONLY AUTOS ) HIRED NON-OWNED PROPERTY DAMAGE AU I US ONLY AUTOS ONLY (Per aoident) S UMBRELLA LIAR OCCUR - EACH OCCURRENCE $ EXCEss LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION I STATUTE I I FOR AND EM LOVERS'LIABILITY YIN ANY PROPRIETOR/PARTNER/EXECUTIVE NIA EL.EACH ACCIDENT - $ OFFICER/MEMBER EXCLUDED? (Mandatory in NH) EL DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below EL DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additimnl Remarks Schedule,may he attached if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCFI I Fr)BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN SEXTON ROOFING S SIDING INC ACCORDANCE WITH THE POLICY PROVISIONS_ 102 PINE ST P.O.BOX 6327 AUTHORIZED REPRESENTA re- ll HOLYOKE,MA 01040 +, r. ©1988 2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD