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31B-108 (5) 19 BRIGHT ST BP-2021-1324 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block:31B- 108 CITY OF NORTHAMPTON Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: ROOF BUILDING PERMIT Permit# BP-2021-1324 Project# JS-2021-002190 Est.Cost:$8460.00 Fee:$40.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: CESAR ALVES 113974 Lot Size(sq. ft.): 3789.72 Owner: KATZ CATHERINE I Zoning: URC(100)/ Applicant: CESAR ALVES AT: 19 BRIGHT ST Applicant Address: Phone: Insurance: 12 SILVER AVE WC BELLINGHAMMA02019 ISSUED ON:5/11/2021 0:00:00 TO PERFORM THE FOLLOWING WORK:STRIP & SHINGLE ROOF POST THIS CARD SO IT IS VISIBLE FROM THE STREET Inspector of Plumbing Inspector of Wiring D.P.W. Building Inspector Underground: Service: Meter: Footings: Rough: Rough: House# Foundation: Driveway Final: Final: Final: Rough Frame: Gas: Fire Department Fireplace/Chimney: Rough: Oil: Insulation: Final: Smoke: Final: THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMP ON ON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. • 1. ,1 • • • II Certificate of Occupancy Signat re: FeeType: Date Paid: Amount: Building 5/11/2021 0:00:00 $40.00 212 Main Street,Phone(413)587-1240, Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner i- The Commonwealth of Massachusetts ifJ W rBoard of Building Reulations and Stadar Q OR 'MU CIP LITY Massachusetts State Building Code, 780 Cl�,•o� ���/ US Building Permit Application To Construct, Repair,Renovate� ri�' R• ised ar 2011 One-or Two-Family Dwelling -.•N Mq c ol s This Section For Official Use Only J Building Permit Number: 91 -yi Date A lied: 4.31J Z /7/7 5'1I"2OZi Building Official(Print Name) Signature Date SECTION 1: SITE INFORMATION 1.1 Property Address: 1.2 Assessors�rrs ap& Parcel Num 1 O 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: Zone: _ Outside Flood Zone? Public l� Private❑ Check if yeslB" Municipal CYOn site disposal system 0 SECTION 2: PROPERTY OWNERSHIP' 2.1 caner'of Record� �r��• �v R- Mr&namp n A- 0(060 Name(Print) City,State,ZIP tit * fk4_ 433?0 56153 L +4J rm1Q.Airnai • (cm No.and Streer Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply) New Construction 0 Existing Building 0 Owner-Occupied ID Repairs(s) i Alteration(s) i Addition 0 Demolition 0 Accessory Bldg. 0 Number of Units 1 Other 11 Specify: Brief Description of Proposed Work': cn nL.1✓4— SECTION 4: ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1. Building $ ` %b0 1. Building Permit Fee: $ Indicate how fee is determined: ❑Standard City/Town Application Fee 2.Electrical $ ❑Total Project Costa(Item 6)x multiplier x 3.Plumbing $ 2. Other Fees: $ 4.Mechanical (HVAC) $ List: 5. Mechanical (Fire $ r, Suppression) Total All Fees: if IS, Check N Check Amount: Cash Amount: 6.Total Project Cost: $ O'1vu 0 Paid in ull 0 Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES/, 5.1 Construction Supervisor License(CSL) S 3g11-1 I i? (O/?a� � y L 1,(es License Number Expiration Date Name of CSL Holder V 12 �,t t 'r List CSL Type(see below) No.and Street Type Description ,/„Q m yl 0?O/g U Unrestricted(Buildings up to 35,000 Cu.ft.) City/Town,State,ZIP f1 "I R Restricted 1&2 Family Dwelling M Masonry RC Roofing Covering WS Window and Siding /'- 1 / __,, ��,// SF Solid Fuel Burning Appliances 114 d troll OP(O s-)^uc4Lv 4mle.6 ►tiK. I Insulation Telephone Email address D Demolition 54 Registered Home Improvement Contractor(HIC) VI I �y/3' ''a`� I' ve's HIC Registration Number `Expiration Date HI-p an am or C Registrant Name r- C ` ruUh e C 1mA�n. ` 1 No an Street U'Qt4 I t7,� Email address X City/Town,St te,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 0 SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIESFOR BUILDING PERMIT I,as Owner of the subject property,hereby authorize e - ,, k t tit7t- to act o y behalf,in all ma rs rel 've to work authorized by this building permit application. _511 I?-02-1 Pn wner's am (Elec'onic Signature) Date SECTION 7b: OWNER' OR AUTHORIZED AGENT DECLARATION By entering my name below ereby attest under the pains and penalties of perjury that all of the information con fined in this applicat. is e and accurate to the best of my knowledge and understanding. Pr' t wner's or Authorized Agent's Name(Electronic 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(H1C)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 lgrmr}rw 4 ° ' • Massachusetts Z. \� H` yV DEPARTMENT OF BUILDING INSPECTIONS 212 Main Street • Municipal Building vtiJ D p... Northampton, MA 01060 sNh TO`\ 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: Pntt4an 12eMOUa The debris will be transported by: Name of Hauler: �� 9Ul 1/14,72.491.40--e„. of Applicant: f6A1---- /46 Date: 5/7/20Q11 '"'' The Commonwealth of Massachusetts . ,,--- -''s Uej urtttrc'nt of Industrial Accidents _= r`" �':• , I Congress Street,Suite 100 Boston, MA 02114-2017 <v�:� `` www.mass.gor/dia 11 i ikers'Compensation Insurance.1,ffidav it:Buildersi'('untractorsrElectricians Plumbers. Up Ht.VIt_ha)SS 1111 1 tit- I't•:RMfl'1'1tit:aft I'tlORII I. _faineant Information ] y�/1 Please Print Leeihis Name IHusin ss Or'Itanxzatton:Indtv'iduall: ` I/4 nq in a,. r^ ,,11 J Address: 1(Z L/ o S4- Cityr State.Lip: fx•thU/lep a'Yl') m O V/01 Phone #:/1 C{d-Lii-1 I bid Are ria an employer:'t hcct,the apptuprtalc Inly: 1-ape of project(required). I.ream a employer urth 3 . employ:cs dull and or part-timer' 7. 0 Neu construction 2.01 am a sole prupnctur or t:urtnershtp and have nu enniloyees work!ua fur me in K. a Remodeling any capacity.(Nu wur►crs'wimp.unuranev required.) 9_ ❑ Demolition .❑I am a homeowner dutrrp all work myxll.[No*micas'comp-rn.urmue required j• 0 0 Building addition 4.0 1 am a humeuwnc-r and will be hiring cxrntraetun to conduct all work on my property. I will ensure that all contractors either have workers"compensation insi:lanne in are sole 11.0 Electrical repairs or addition prupricWn with no employees. l2.❑Plumbing repairs or addition I am a general contractor and I have hued the sub-ctintractuni h%t:d on the attached sheet These sub-contractors have employees and ha%a workers'camp.insurance. 1 3. ►1 repairs 14.0 Other 6.0 Vic an:a ex►apuraiaun and its utfr:e'rs have exercised their right of e.temption per MGil_c. — 152.S lilt,and we have an empluyees.INu w mixes•clump.Irma;ince required.) •Any applied that chocks box at must also till uut the section below shi.-.s in their workers'compensation puii..y informatwa_ t Homeowners who submit this affidavit indicating they are doing all w of k and then hue outside emitractors must subriut a new affidav it indicating such. t:'untractnrs that cheedt this bolt must attached an additional sheet show in_:the name of the subreontraitors and slaw w hither or nut those entities base util. . I 1 1- . t arplutces.they trust preside th._i ,oi,rkcrs'e irir.pAle?.nuniher I am on evnplrli r 1 Aerie ry providing ivorLers'compensation insurance fine my employees. Below is the p olicy and job site In/Urination. , ,, Insurance Company Name:_ Ain() /'LLivai nJp C" Policy#or Self ins. Lie. v Wc. (t p O 1 iD 1 3 at il" Expiration Date: 0 Z/011 71 Job Site Address: iolr> U• City Stag zip: /tQrzwi arnp frA- ©(C66 Attach a cups of the workers'compensation policy declaration page(showing the polio number and expiration date). Failure to secure coverage as required under M( L c. 152. w 25A is a criminal violation punishable by a tine 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 S250.00 a day against the violator. A copy of this statement may be fi+rwarded to the Office of Investigations of the DIA for insurance coverage verification. 1 do hereby eery i'under the Indus and penalties of perjure that the In farmariun provided above is true and correct Sr'naEutc. (� 1'16i.1 Date. ./7 Phone z: `-11 q)-41/ilv 7 7 Official use only. Do not write in this urea.to be completed ted by city or town uflic inl. ('Its or'limn: Prrntiiit.ieense to Issuing.1uthority (circle one): I. Board of Health 2.Building Department 3.('ityrlown(clerk 4.Electrical Inspector 5. l'luinhiiit Inspector 6.Other Contact Person: I'li,rtet =: City of Northampton r Massachusetts .> 4). .l DEPARTMENT OF BUILDING INSPECTIONS M f 212 Main Street • Municipal Building J`, s Northampton, MA 01060 :kw -1,-) 4 � HOMEOWNERS'EXEMPTION ELIGIBILITY AFFIDAVIT I, CaAht L� I-4" (insert full legal name), born (insert month, day, year), hereby depose and state the following: 1. I am seeking a building permit pursuant to the homeowners' exemption to the permit requirements of the Massachusetts State Building Code, codified at 780 CMR 110.R5.1.3.1, in connection with a project or work on a parcel of land to which I hold legal title. 2. I am not engaged in, and the project or work for which I am seeking the aforementioned homeowners' exemption, does not involve the field erection of manufactured buildings constructed in accordance with 780 CMR 110.R3. 3. I qualify under the State Building Code's definition of"homeowner"as defined at 780 CMR 110.R5.1.2: Person(s) who owns a parcel of land on which he/she resides or intends to reside, on which there is,or is intended to be, a one-or two-family dwelling, attached or detached structures accessory to such use and/or farm structures.A person who constructs more than one home in a two-year period shall not be considered a home owner. 4. I do not hold a valid Massachusetts construction supervision license and, except to the extent that I qualify for and will abide by the Massachusetts State Building Code's requirements for the supervision of the project or work on my parcel, I am not engaged in construction supervision in connection with any project or work involving construction, reconstruction, alteration, repair, removal or demolition 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 the 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 l- day of May , 20 a(. Signature) ���► onnr air' Liam uiuulriflb 112 GROVE ST BELLINGHAM MA (508) 202-3156 Katz, Catherine 19 Bright St, Northampton, MA 01060, USA Project Description . replacement roof Work Description • There will be a Manager on the project • Install Safety equipment before starting work • Tarps will be hung from the eaves of the roof to stop debris from damaging siding, decks and/or flowers. The debris will also get funneled onto a ground tarp. After the waste is removed the yard will be raked and a 3 ft magnet will be used to pick up nails that may have missed the tarp. • Job will take a total of 1 to 2 days from start to finish weather permitting. • Strip roof shingle all the way strait to the wood • Re-nail all loose roof boards • Install Leak Barrier/ Ice and Water Shield: • Install 6 ft of ice and water shield throughout the house • 3 feet on the valley, and 1/2" Overhang to the fascia, 18" under the flashing, around the chimneys, and pipes. • Install architectural 50 years certainteed landmark lifetime shingles. • Replace all vent pipe boots, and bathroom vents. • Install synthetic Underlayment synthetic paper certainteed • Install Drip Edge: 8" to the roof deck and 1" Overhang to the fascia aluminum to all edges. • . Ridge vent will be cut into main house and a ridge vent will be placed on roof top for symmetry. • Install Ridge Cap Shingles • Apply Starter Strip Shingles to be aligned next to one another with sealant toward the eave on all eaves and up the rakes. • Install Metal Flashing at every dormer and Wall Areas • If need replacement plywood will be cost $50,00 per sheet • Install New Roof Shingle with 6 nails. • Clean up of any job related debris including sweeping yard with magnet to pick up any loose nails. Total asphalt roof replacement $8460,00 The above prices, specifications and conditions are our understanding, they are satisfactory and are hereby accepted. Payments will be made as outlined above. USA Roofing, Inc. is authorized to pull a permit for above work on the behalf of the homeowner and to do the work as specified. All proper workers comp and liability of insurance will be expected upon signing of contract. T IA-i,Ago- g lAzol�?� /67z, ,� • 4/22/21 4 18 sq ACC)I? CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 05/06/2021 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 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: Edina Braga _ ALPHA INSURANCE AGENCY INC (aCC.No.EMI: (978)459-4547 IA/C. ADDRESS: business@alphainsuranceinc.com 648 CENTRAL ST INSURER(S)AFFORDING COVERAGE NAIC# LOWELL MA 01852 INSURER A: AIM MUTUAL INS CO 33758 INSURED INSURER B: USA ROOFING INC INSURERC: INSURER D: _ 112 GROVE STREET INSURERE: BELLINGHAM MA 02019 INSURER F: COVERAGES CERTIFICATE NUMBER: 652360 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 ADDL SUBR POLICY EFF POLICY EXP LTR JNSD WVD POLICY NUMBER (MMIDD/YYYY) (MM/DD/YYYY) LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS-MADE OCCUR DAMAGE TO RENTED PREMISES(Ea occurrence) $ MED EXP(Any one person) $ N/A PERSONAL 8 ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY PRO- JECT LOC PRODUCTS-COMP/OP AGG $ OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED N/A BODILY INJURY(Per accident) $ AUTOS AUTOS HIRED AUTOS NON-OWNED PROPERTY DAMAGE AUTOS (Per accident) UMBRELLAUAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE N/A AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION X PER OTH- PEATUTE AND EMPLOYERS'LIABILITY Y I NER ANYPROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 1,000,000 A OFFICER/MEMBEREXCLUDED? N/A N/A N/A VWC10060220732021A 02/09/2021 02/09/2022 (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 N/A DESCRIPTION OF OPERATIONS/LOCATIONS/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/. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Town of Northampton ACCORDANCE WITH THE POLICY PROVISIONS. 19 Bright St AUTHORIZED REPRESENTATIVE Northampton MA 01060 Daniel M.Crowley. CPCU,Vice President—Residual Market—WCRIBMA ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD ACT C)RL CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) 05/06/21 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 NAME: EDINA BRAGA Alpha Insurance Agency a/C,No,Ext): 978-459-4547 FAX No): 978-459-6131 648 Central St E-MAIL Lowell, MA 01852 ADDRESS: BUSINESS@ALPHAINSURANCEINC.COM INSURER(S)AFFORDING COVERAGE NAIC# INSURER A: GEMINI INSURANCE INSURED INSURER B: PILGRIM USA Roofing Inc INSURER C: NAUTILUS INSURANCE 112 Grove St INSURERD: AIM MUTUAL INSURANCE Bellingham, MA 02019 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. 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 ADDLSUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE E CLAIMS-MADE X OCCUR PREMISESO(Ea occcur ence) $ 100,000 MED EXP(Any one person) $ 5,000 A VGG005024 05/14/20 05/14/21 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY X PRO JECT LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 (Ea accident) ANY AUTO BODILY INJURY(Per person) $ B X OWNEDTOSONLY AU X SCHEDTOSULED CSC00001009822 03/31/21 03/31/22 BODILY INJURY(Per accident) $ AU HIRED x NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY _ AUTOS ONLY (Per accident) X UMBRELLA LIAB OCCUR EACH OCCURRENCE $ 1,000,000 C EXCESS LIAB CLAIMS-MADE AN084280 03/31/20 05/14/21 AGGREGATE $ 1,000,000 DED RETENTION$ $ WORKERS COMPENSATION X PER OTH- AND EMPLOYERS'LIABILITY STATUTE ER Y/N ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 1,000,000 D OFFICER/MEMBER EXCLUDED? N N/A Assigned Risk 02/09/21 02/09/22 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Workers Compensation coverage is in force for the state of Massachusetts. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN Town of Northampton ACCORDANCE WITH THE POLICY PROVISIONS. 19 Bright St Northampton, MA 01060 AUTHORIZED REPRESS TATIVE ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD 1/8/2021 WI N_20201201_13_54_54_Pro.j pg Cornrnon i/ a� Li ;pOr_.fiu. S> ttS Division of Pri `>' .!$ional Lic*'nsure Board of Building R-t ui tru;tis Standards Conht►u t .gin Suptorvisor CS-113974 Expires: O1. 26 2O23 CESAR L ALVES 12 SILVER AVENUE BELLINGHAM MA 02019 Commissioner h https://mail.google.com/mail/u/1/#sent?projector=1 1/1 1/8/2021 WI N_20201201_13_55_10_Pro.jpg Office of Consumer Ar atrs & Bu mess Regulation HOME IMPROVE MENT CONTRACTOR T' P ,,. In v du 1 . '74 03. 2021 CEA.R ALVES CESAR ALVES 12 SILVER AVE .. r. BEL LiNGHAM, MA i " Undersietany https://mail.google.com/mail/u/1/#sent?projector=1 1/1