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17A-161 (2) 27 FOX FARMS RD BP-2021-1342 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 17A- 161 CITY OF NORTHAMPTON Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: window replaced BUILDING PERMIT Permit# BP-2021-1342 Project# JS-2021-002215 Est.Cost: $18943.00 Fee: $35.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: RENEWAL BY ANDERSEN 090125 Lot Size(sq. ft.): 17990.28 Owner: KRAUSE STEVEN Zoning: URA(100)/ Applicant: RENEWAL BY ANDERSEN AT: 27 FOX FARMS RD Applicant Address: Phone: In.surauce: 30 FORBES RD (508) 919-0900 WC NORTHBOROMA01532 ISSUED ON:5/14/2021 0:00:00 TO PERFORM THE FOLLOWING WORK:INSTALL 5 REPLACEMENT WINDOWS 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 ORT.AMPT N ;VIOLATION OF ANY OF ITS RULES AND REGULATIONS. • i . Certificate of Occupancy Sit;nalu FeeType: Date Paid: Amount: Building 5/14/2021 0:00:00 $35.00 212 Main Street, Phone(413)587-1240,Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner 1 11 fk------.•rN M The Commonwealth of Massachusetts 4) , Board of Building Regulations and Standards ' OR Massachusetts State Building Code, 780 CN1R-�----,,,.. 2o2M CIPALITY , Op Building Permit Application To Construct, Repair,Renovate ter.'Do ¢Yis � -5,,Re sed Mar 2011 One-or Two-Family Dwelling r�•"°q o;�rioros This Section For Official Use Only `��_� (t% Buildin Permit Number: _J4 z''ft3 4 f 2- Date Applied: CCtJIN4.:0-ss Z 5'Iy"zeZI Building Official(Print Name) Signature Date SECTION 1:SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map&Parcel Numbers 27 Fox Farms Rd M_99623_895538 35-271-001 1.1 a Is this an accepted street?yes x no Map Number Parcel Number 1.3 ZoningInformation 10(( 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 El Private 0 Zone: _ Outside Flood Zone? Municipal❑ On site disposal system 0 Check if yes❑ SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of Record: Steve Krause Florence, MA 01062 Name(Print) City,State,ZIP 27 Fox Farms Rd 617-448-2865 steve.krausel7P,gmail.com 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) 0 Alteration(s) 0 Addition ❑ Demolition 0 Accessory Bldg. ❑ Number of Units Other la Specify:replacement Brief Description of Proposed Work'-:Replacement of 5 windows SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1. Building $18,943.00 1. Building Permit Fee: $ Indicate how fee is determined: 2.Electrical $ ❑Standard City/Town Application Fcc ❑Total Project Costa(Item 6)x multiplier x 3.Plumbing $0 2. Other Fees: $ 4. Mechanical (HVAC) $0 List: 5.Mechanical (Fire Suppression) $0 Total All Feet Check No% Check AmountV Cash Amount: 6.Total Project Cost: $18,943.00 0 Paid in Full 0 Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) cs-090125 10/06/2022 Jaime Morin License Number Expiration Date Name of CSL Holder List CSL Type(see below) U 86 Gardiner St -- No.and Street Type Description Lynn,MA 01904 U Unrestricted(Buildings up to 35,000 Cu.ft.) R Restricted 1&2 Family Dwelling City/Town,State,ZIP M Masonry RC Roofing Covering WS Window and Siding SF Solid Fuel Burning Appliances 508-351-2277 rbabostonpermitting@andersencorp.com I Insulation Telephone Email address D Demolition 5.2 Registered Home Improvement Contractor(HIC) 170810 12/22/2021 Renewal by Andersen HIC Registration Number Expiration Date HIC Company Name or HIC Registrant Name 30 Forbes Rd rbabostonpermitting@andersencorp.com No.and Street Email address Northborough, MA 01532 508-351-2277 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 0 No .0 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 Jaime Morin to act on my behalf,in all matters relative to work authorized by this building permit application. Steve Krause see contract 05/11/2021 Print Owner's Name(Electronic Signature) Date SECTION 7b:OWNER1 OR AUTHORIZED AGENT DECLARATION By entering my name below,I ereby attest under the pains and penalties of perjury that all of the information contained in this applicati is t e and accurate to the best of my knowledge and understanding. Jaime Morin 05/11/2021 Print Owner's or Authoriz nt'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(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 �0, HAM-,-. S`s S; ,';. Massachusetts �4? .�_ '(, (21- 1 , DEPARTMENT OF BUILDING INSPECTIONS y. 6. ., �. �. 212 Main Street • Municipal Building ti. O ''` Northampton, MA 01060 ssk , a;p\'\� i 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: 4 Technology Dr Westborough,MA 01581 The debris will be transported by: Name of Hauler: Waste Management Signature of ApplicanOk-----"---- Date: 05/11/2021 The Common wealth of Massachusetts Department of Industrial Accidents t / Congress Street,Suite 100 _ut - t, Boston, MA 02114-2017 www.ntass.gov/dia %%m'ker Compensation Insurance Ailidavit:Builders/U microtursiEleciriclansirlunthers. TO BE FILED WITH THE PERMl"litNG AUTHORITY. -tmilicant information Please Print Leeibtr Name(liusiness,Organizatioicindividualy Renewal by Andersen Address: 30 Forbes Rd City/State/Zip: Northborough, MA 01532 Phone#: 508-351-2277 Arc yuc an ontployer?Check the appropriate bos: Type of project(required): I. am a employer with 30 .._.._.._employees(full Wed+'err part-time 7. 0 New construction I Jilt If,rile p roprreten or partnership and have no employms i4urkntg fur use in 8. [3 Remodeling aux capaerty (No worker,'comp.insurance required.] 9. 0 Demolition i<. ]1 am a lions, react doing all work myself.[li{o worlters'wimp.tintannet rcttitired.]' 4.0 I AM homeowner and will he htrutg oxmetaclurs to conduct all work on my property. I will l0 Building addition 1 ensure that all contrralun eithier have workers'ccortapu.-ruaiscn nssuranrr or arc sole Ito Electrical repairs or additions pi upnoroes w it1;no crnpluvees_ 12.0 Plumbing repairs or additions - E 1.in inmeral contractor and i fuse dined the sub-contractors Itstco on the altacireat sAert_ 130 Roof ICi?atrTy I sub-contractors have employees and has a wurke&ramp.insurance.: tr. we area corporation and its officers have exercised their right.of exe ptwat per M(iL c. ]+ _ other replacement I c t t l i 4 t.and we ha se no cirtployees.[No workers'comp.insurance required.] 'Any applicant that chocks box al mint ihstr all out tie amine below showing their worriers'eumpe:nsatiun policy utfunnatiou_ t Homeowners who submit thus affidavit indicating they MCdaIng all work and then hire outside contractors must submit a new affidavit indicating such. C'untraetors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities hare employees_ If the sub-contractors have c-employees.they must pros idc their wurkers'cxrrnp.prulis.mother. I am an employer that is providing,worhers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Old Republic Insurance Co Policy#or Self-ins.Lic.#: MWC31415820 Expiration Late: 10/012021 job Site Alai: 27 Fox Farms Rd city/state/zip: Florence, MA 01062 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 ble by a fine up to S 1,500.00 orator 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 forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby cer ' ,u tier the pain%and penalties ofperjury that the information provided above is true and correct. Signature: Date: 05/11/2021 ['hone>: _ 8-351-2277 Offcial use only. Do not write in this urea.to he completed by city or town official f) city or Town: PerniittLicense# Issuing Authority(circle one): L Board of Health 2.Building,Department 3.Cie}[Loon Clerk -I. Electrical Inspector 5. Plumbing inspector 6.Other contact Person: Phone#: DocuSign Envelope ID:FA008D8A-F730-41FB-82B7-402F184DC278 �k $ Agreement Document and Payment Terms �'=J dba:Renewal by Andersen of Boston Steve Krause Legal Name:Renewal by Andersen LLC 27 Fox Farms Rd RENEWAL HIC#170810 Florence,MA 01062 br AN D E R S E N I.MU MOW A DWI IMAM Al 30 Forbes Road I Northborough,MA 01532 H:(617)448-2865 Phone:508-351-2200 I Fax:(508)986-7072 I rbabostonbookingeandersencorp.com C:(413)548-0558 Steve Krause 04/26/21 Buyer(s) Name Contract Date 27 Fox Farms Rd, Florence, MA 01062 (617)448-2865 (413)548-0558 Buyer(s)Street Address Primary Telephone Number Secondary Telephone Number steve.krause17@gmail.com Primary Email Secondary Email Buyer(s)hereby jointly and severally agrees to purchase the products and/or services of Renewal by Andersen LLC d/b/a Renewal by Andersen of Boston("Contractor"),in accordance with the terms and conditions described in this Agreement Document and Payment Terms,any documents listed in the Table of Contents,and any other document attached to this Agreement Document,the terms of which are all agreed to by the parties and incorporated herein by reference(collectively,this"Agreement"). Buyer(s)hereby agrees to sign a completion certificate after Contractor has completed all work under this Agreement. Total Job Amount: S18,943 By signing this Agreement,you acknowledge that the Balance Due,and the Amount Financed must be made by personal check,bank check,credit card,or cash. Deposit Received: SO Balance Due: $18,943 Estimated Start: Estimated Completion: Amount Financed: 12 weeks 1-2 days S18,943 Method of Payment: Financing We schedule installations based on the date of the signed contract and secondarily on the date in which we complete the technical measurements.The installation date that we are providing at this time is only an estimate.We will communicate an official date and time at a later date.Rain and extreme weather are the most common causes for delay. Notes: Buyer(s)agrees and understands that this Agreement constitutes the entire understandings between the parties and that there are no verbal understandings changing or modifying any of the terms of this Agreement.No alterations to or deviations from this Agreement will be valid without the signed,written consent of both the Buyer(s)and Contractor.Buyer(s)hereby acknowledges that Buyer(s) 1)has read this Agreement,understands the terms of this Agreement,and has received a completed,signed,and dated copy of this Agreement,induding the two attached Notices of Cancellation,on the date first written above and 2)was orally informed of Buyer's right to cancel this Agreement. NOTICE TO BUYER: Do not sign this contract if blank.You are entitled to a copy of the contract at the time you sign. YOU,THE BUYER, MAY CANCEL THIS TRANSACTION AT ANY TIME NOT LATER THAN MIDNIGHT OF 04/29/2021 OR THE THIRD BUSINESS DAY AFTER THE DATE OF THIS TRANSACTION, WHICHEVER DATE IS LATER. SEE THE ATTACHED NOTICE OF CANCELLATION FORM FOR AN EXPLANATION OF THIS RIGHT. c p--DocuSigned by: X Sfum, v'aUSt. L—E 1331CFB70044DF... - -----------__-------- Signature of Sales Person Signature Signature Adam Cain Steve Krause Print Name of Sales Person Print Name Print Name UPDATED: 04/26/21 Page 2 / 25 DocuSign Envelope ID:FA008D8A-F730-41FB-82B7-402F184DC278 Itemized Order Receipt dba:Renewal by Andersen of Boston Steve Krause Legal Name:Renewal by Andersen LLC 27 Fox Farms Rd RENEWAL HIC#170810 Florence,MA 01062 brAN�DERS�E�N` 30 Forbes Road I Northborough, MA 01532 H.(617)448-2865 NUSFIWEPhone:508-351-2200I Fax:(508)986-7072 I rbabostonbooking@andersencorp.com C:(413)548-0558 ID#: ROOM: DETAILS: 109 kitchen Window: Gliding, Double, 1:1, Active/ Passive, EJ Frame, Exterior White, Interior White, Glass: All Sash: High Performance SmartSun Glass, No Pattern, Hardware: White, Screen: TruScene, Full Screen, Grille Style: Grilles Between Glass (GBG), Grille Pattern: All Sash. Colonial 1 w x 311, Misc: None 110 dining room Window: Casement, Triple, 1:1:1, Left Vent/Stat/ Right Vent, EJ Frame, Exterior White, Interior White, Glass: All Sash: High Performance SmartSun Glass, No Pattern, Hardware: White, Screen: TruScene, Full Screen, Grille Style: Grilles Between Glass (GBG), Grille Pattern: All Sash: Colonial 1w x 5h, Misc: None 111 living room Window: Casement, Triple, 1:1:1, Left Vent/Stat/ Right Vent, EJ Frame, Exterior White, Interior White, Glass: All Sash: High Performance SmartSun Glass, No Pattern, Hardware: White, Screen: TruScene, Full Screen, Grille Style: Grilles Between Glass (GBG), Grille Pattern: All Sash: Colonial 1w x 5h, Misc: None 111 living room Window: Casement, Fixed Window, EJ Frame, Exterior White, Interior White, Glass: All Sash: High Performance SmartSun Glass, No Pattern, Grille Style: Grilles Between Glass (GBG), Grille Pattern: All Sash: Colonial 1w x 5h, Misc: Mull Deduct, Per opening. UPDATED: 04/26/21 Page 3 / 25 DocuSign Envelope ID:FA008D8A-F730-41FB-82B7-402F184DC278 • Itemized Order ReceiptNM dba:Renewal by Andersen of Boston Steve Krause Legal Name:Renewal by Andersen LLC 27 Fox Farms Rd RENEWAL HIC#170810 Florence,MA 01062 brANDERSEN• H:(617)448-2865 M,�,Q,M&p,o, , 30 Forbes Road I Northborough, MA 01532 Phone:508-351-2200 I Fax:(508)986-7072 I rbabostonbooking@andersencorp.com C:(413)548-0558 ID#: ROOM: DETAILS: 112 living room Window: Casement, Fixed Window, EJ Frame, Exterior White, Interior White, Glass: All Sash: High Performance SmartSun Glass, No Pattern, Grille Style: Grilles Between Glass (GBG), Grille Pattern: All Sash: Colonial 1w x 5h, Misc: None WINDOWS:5 PATIO DOORS:0 SPECIALTY:0 MISC:0 TOTAL $18,943 Renewal by Andersen is committed to our customers'safety by aEPA/ complying with the rules and lead-safe work practices specified by the EPA. UPDATED: 04/26/21 Page 4 / 25 The Commonwealth of Massachusetts Department of Industrial Accidents -Ar.j= Office of Investigations - ' Lafayette City Center I• �� 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 Renewal by Andersen Name (Business/Organization/Individual): Address: 30 Forbes Rd. City/State/Zip: Northborough, MA 01532 Phone #:508-351-2277 Are you an employer? Check the appropriate box: I am a general contractor and 1 Type of project(required): 30 4. 1.4 I am a employer with ❑ employees (full and/or part-time).* have hired the sub-contractors 6. El New construction listed on the attached sheet. 7. ❑ Remodeling 2.❑ I am a sole proprietor or partner- ship and have no employees These sub-contractors have 8. ❑ Demolition workingfor me in anycapacity. employees and have workers' p �' t 9. ❑ Building addition [No workers' comp. insurance comp. insurance. required.] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.0 Roof repairs insurance required.] t c. 152, §1(4),and we have no 13.�Other Replacement 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 a new affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Old Republic Insurance Co. Policy#or Self-ins. Lic. #: MWC 31415820 Expiration Date: 10/01/2021 Job Site Address: 27 Fox Farms Rd City/State/Zip: Florence, MA 01062 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 insurance coverage verification. I do hereby certify under the pains and pe ti f perjury that the information provided above is true and correct. Signature: /� ''� Date: 05/11/2021 Phone#: 08-351-2277 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): I❑Board of Health 20 Building Department 31:City/Town Clerk 4.0 Electrical Inspector 5Elumbing Inspector 6.0Other Contact Person: Phone#: r.' CosmoonrriasIh of Mutts Division of otassioruri Ucen litre Unrestricted-13aMdings of any use group Width contain Board of Mulidihp ulstions and StandefliS 3 less than 30.000 cubic feat psi cubic metes)of enclosed r. a ; c../a ,. ,,,,;ittc:f ems- 1 1 LA-000125 i ' ' . 1 0nm:10100/2022 WIRE I. - . + p . , , ill y 1 L'1N11 MS Si' ' / _ NtIpill fib ` ' Fatltre to possess a current edition of the Massachusetts ever State Building Code Is cause for revocation of this Nouns. LComm s&oner > a4nwa.. Far latannseon:-bout Of imams Call 017)727aaN or vimt liMilwatmes.govidp1 -,__ ,..._-_-___._- ; • ACE i /Ilw w eG€GCIL IeAóet l Office of Consumer Affairs and Business Regulation 1000 Washington Street-Suite 710 Boston, Massachusetts 02118 Home Improvement Contactor Reg! on Type: Supplement Clod RENEWAL BES R ANDERSEN LLC ` i _ ', ;70810 R��jltntitlorni: a12arjo¢ NORTfiBOROUGH,MA 01532 ( 1 _ " ,�!% tt f� Updats Address and RAMS Card. SCA 1 A 20M-05/17 c"C: OMN er taesssss tee:Malys&Ws:non PagiAsaide NOME IMPROVEMENT CONTRACTOR valid far indWidusl use only TYPE:Sudo: molt Card :Irthe axplratlon date. If found return to: Reoistrabop Mobilo pike of Consumer Maks and Business Regulation 170810 124212021 1000 Washington Street -Suite 710 r RENEWAL BY ANDERSEN Lie Boston,MA 02118 JNME MORIN l'4G� t' �� N .ls�r,--.---' RT 90 FORBES RD �„owolf4'aflo'afloat' -_ NOHBOROUGH,MA o1532 I in�i fr, Not valid out slgr Curs Page 1 of 1 DATE(MM/DDIYYYV) ACORO CERTIFICATE OF LIABILITY INSURANCE 09,21202 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 Willis Towers Watson Certificate Center NAME: Willis Towers Watson Midwest, Inc. PHONE c/o 26 Century Blvd _JAM.No.Eat); 1-877-915-7378 (AIIC Ns): 1-888-467-2378 E-MAIL certificates@willia.com P.O. Box 305191 ADDRESS: Nashville, TN 372305191 USA INSURER(S)AFFORDING COVERAGE NAIC#__ INSURER A: Old Republic Insurance Company 24147 INSURED INSURER B: _.. Renewal by Andersen LLC 30 C Forbes Road INSURER C: Northborough, MA 01532 INSURERD: INSURER E: INSURER F: I COVERAGES CERTIFICATE NUMBER:w17904932 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 PO W MILICY EXP LIMITS LTR INSD VD POLICY NUMBER (MMIDDIYYYYI (MDDIYYYYI X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 I DAMAGE TO RENTED 500,000 I CLAIMS-MADE I X ,I OCCUR PREMISES(Ea occurrence) $ A MED EXP(Any one person) $ 10,000 MWZY 314161 20 10/01/2020 10/01/2021 PERSONAL BADVINJURY $ 1,000,000 GEN t AGGREGATE UNIT APPLIES PER: GENERAL AGGREGATE $ 4,000,000 X POLICY JECOT- I j LOC PRODUCTS-COMP/OP AGG $ 4,000,000 OTHER: $ AUTOMOBILE UABILITY COMBINED SINGLE LIMIT $ 5,000,000 (Ea accident) X ANY AUTO BODILY INJURY(Per person) $ A OWNED SCHEDULED MWTB 314159 20 10/01/2020 10/01/2021 BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY (Per accident) $ UMBRELLA LIAB — OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS MADE AGGREGATE $ DED RETENTIONS $ WORKERS COMPENSATION X PER AND EMPLOYERS'LIABILITY STATUTE ER YIN A ANYPROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBEREXCLUDED7 No NIA MWC 314158 20 10/01/2020 10/01/2021 (Mandatory in NH) E.I.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under 1,000,000 DESURIF'I ION 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) 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 Evidence of Insurance it /- //v:r ©1988-2016 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD SR ID: 20103273 BATCH: 1820957 Glider Watt win agt*al sob Itspoilat twt iiteltilikrindstmt.:'") . , '13 _ i1 a \amidwrion.. illriket*ov.„ vow.. LiiikIWCIlir-- . . 1.1 _ •Gailit: '9 -a., • • it-twomb.L I • , _ _ .. •••Al, ' • - „mai p-,1 ....:,,,,-- - 4 41140P'1--' • A.t 41.44...-44 ,2":‘. :. . .• . .•...t...., . Vcalmill larly111111Sitt udwisratimom . _ , IS= ANK)-14411 • WcodiVInyi Campton.IT• . . rttii Argo Law-E4 Srasutgun Piadutlype,Midst INIONTY PrlatiNNANct'Atm U-FiFitor Saler Hest Gain Comanatent 0.29 : 1.65 E"1,-..21 k um,•-ei imirridsn . 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