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16B-051 209 NORTH MAIN ST BP-2021-1356 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 16B-051 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-2021-1356 Project# JS-2021-002231 Est.Cost: $9300.00 Fee: $40.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: SEXTON ROOFING CO 99689 Lot Size(sq.ft.): 19384.20 Owner: MALKOVICH MICHAEL G Zoning: URB(100)/ Applicant: SEXTON ROOFING CO AT: 209 NORTH MAIN ST Applicant Address: Phone: Insurance: P O BOX 6327 (413) 534-1234 WC HOLYOKEMA01041 ISSUED ON:5/17/2021 0:00:00 TO PERFORM THE FOLLOWING WORK:STRIP & SHINGLE ROOF POST THIS CARD SO IT IS VISIBLE FROM THE STREET Inspector of Plumbing Inspector of Wiring D.P.W. Building Inspector Underground: Service: Meter: Footings: Rough: Rough: House# Foundation: Driveway Final: Final: Final: Rough Frame: Gas: Fire Department Fireplace/Chimney: Rough: Oil: Insulation: Final: Smoke: Final: THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. (� • it of Occupancy Si#,nature: • ' , • s� • I ) FeeType: Date Paid: Amount: Building 5/17/2021 0:00:00 $30.00 212 Main Street, Phone(413)587-1240,Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner i , The Commonwealth of Massachusetts • Board of Building Regulations and Standards :..F.OR Massachusetts State Building Code,780 CMR,7th edition MUSE CIPALITY Building Permit Application To Construct,Repair,Renovate Or Demolish a Revisedlanuary One—or Two-Family Dwelling 1,2008 m c— c• '; This Section For Official Use Only r _,r_r t z o '"a!''1 g,r�.,� Date Applied: too! � B�IJ�r#g Permit Num er: �(Y Pp D a Si lire: . J-?�7 �2� t o- t i S Building Commissioner!Inspector of Buildings • Date Z r SECTION 1:SITE INFORMATION OT ' rU t ..7-• t 1.� ty/Addres • ,,— 1.2 Assessors Map&Parcel Nun¢er ,j l 2„, •---4- ilaIs this an accepted street?yes no Map Number Parcel Number • 1 1.3 Zor(ing Information: 1.4 Property Dimensions: Zoning District Proposed Use ___ Lot Area(so ft) Frontage(ft) 1.5 Building Setbacks(ft) - Front Yard V Side Yards Rear•Yard • Required Provided Required Provided Required Provided . • 1.6 Water Supply: (M.O.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 Owne r of Re ord• ilic ha-L-C l'efilg M P2e- 4 - .,.'14 ,./if,,t9/-7, --‘4,/ra,e7.e-- N. (Print) Address for Service: (4 / e - - $ 7S— — F36 Y . • Signature Telephone •V • SECTION 3:DESCRIPTION OF PROPOSED WORK'(check all that apply) New Construction 0 Existing Building WY—owner-Occupied foe—'Repairs(s) ❑ Alteration(s) Q Addition 0 Demolition 0 Accessory Bldg.0 Number of Units / Other 0 'Specify: Brief Descr' tion of Proposed Work: cam- le ' SECTION 4:ESTIMATED CONSTRUCTION COSTS. • • Estimated Costs: Item ' Official Use Only _ (Labor and Materials) 1.Building $ 1. Building Permit Fee:$ Indicate how fee is determined: b Standard City/Town Application Fee 2.Electrical $ - ❑Total Project Costi(Item 6)x multiplier - x 3.Plumbing $ • 2. Other Fees: $ 4.Mechanical (HVAC) $ List: 5.Mechanical (Fire $ Suppression) Total All Fees: • __Check No, Check Amount: Cash Amount: _ 6. Total Project Cost: $ '' 300 Paid in Full 0 Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES j 5.1 Construction Supervisor License(CSL) ! �`Q G' g �1` S,/ tv e re tr J A 1V r) License Number "E ptitatio-nf hate Name of CSL Holder j List CSL Typebelow) 6g/it.L3 g/it.L.J 'PO �? K W`I -�7 (see}C� J t No.and Street Type Description / `Xe ,'yyn/I ,' `�5J U Unrestricted(Buildings up to 35,000 cu.ft) +� / /�' L� (1 R Restricted 1&2 Family Dwelling City/TinaM,State,ZIP M Masonry RC Roofing Covering WS Window and Siding SF Solid Fuel Burning Appliances I insulation - -- " Telephone Email address D Demolition I Registered Home Improvement Contractor(HIC) p�3 ��`3'x &;c n d`5 q ICRe 9 Number / �� -�-��- I3IC Registration Number - Expiration Date if IC Company Name or Registrant Name Imo')8I X (ri3.t7 11, .. No.and Street o��� �� 0�r ai/,&127 1 4//.fO he, P7A C)/2"�/ 4/3 534e/ 3' F aadaress Cityfflwn,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 ' 'Ili(' No ❑ SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT 1,as Owner of the subject property,hereby authorize 3e ±o% 1/•1 G a!? �ll Gf i J-n e- to act on my behalf;in all matters relative to work authorized by this btuldidg.dermit application. ri! oehed /3 7 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 understanding. / /'?� MUST BE SIGNED by Owner or Authorized Agent /Da NOTES: I. An Owner who obtains a building permit to do his/her own work,or an owner who hires an unregistered contractor (not registered in the Home Improvement Contractor(HIC)Program),will gra have access to the arbitration program or guaranty fund under M.G.L.c.I42A.Other important information on the HIC Program can be found at www_snass.gov!oca Information on the Construction Supervisor License can be found at v.Atw_masc-gov%dips 2. When substantial work is planned,provide the information below: Total floor area(sq.ft.) (including garage,finished basementfattics,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 µ7M .:4"-' `� : Massachusetts 2S .. ct t „,t 4 E * ��; t 4 DEPARTMENT OF BUILDING INSPECTIONS 1 e ..+�► gA 212 Main Street • Municipal Building yJt- tea`•J, \\`^ f Northampton, MA 01060 msy .,. �� ,: 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: m The debris will be transported by: Name of Hauler: I-1-S SGC (4' ( 6 0 , /1, 1 &,/t.' e .Q Signature of Applicant: Date: titt3/,)/ Proposal SEXTON ROOFING AND SIDING INC Wvw.sextonroofing.com Via) P.O. Box 6327 ;ng t ,i Holyoke,MA 01041 ,Z anamiz as lam s. sill INNIS ."V:law p.413.534.1234 I.413.5341.9906 MA HIC S 118239 Sext aeroofiat% 1co, SUMMED TO Mind Iti 'PHONE S754314 DATE saw STREET 2/9!sorer Nab St _f_._nidnekeamillinkasaet. CITY.STATEZIR Flamm%Ia. ra# SEXTON ROOFIY(:HERE B1 4l MOTS SPECIFICATIONS AND ESTIMATES FOR: 1) Strip and remm a existing shingles and dispose of in proper landfill. 2) Inspect rooting deck and replace as needed * $95.00 per sheet. 3) Install new metal edging to rakes and eaves of roof.(white/brow n 4) Install ice and water shield on eaves(f'),vent stacks,in salkys.chimney. and at intersecting rnolh, 5) Install sy nthetic roofing underlay nient on remainder of roof. 6) Install new flanges over existing sent stacks. 7► Install starter shingles on eases and rakes of roof. 8) Install IKO Architectural style roofing shingles as per manufacturers'specifications. 91 Install new cap over ridge vent. 10) Kalish chimney as needed @ $300.00 II).Supply manufactures Lifetime warranty and SRC 5 yr.workmanship warranty. ATTES TKC)S N(NC!uw.*ILS:PU 4SE COOL*AU.PL s(3sAL RIIftw.rw.ti IN TNT ATTIC.4.ARA(.f.OR 5TCNIAGE AREAS DL E TO P(tssiaLE W *TM; DOWN on IMST COMM.TN*(i(GI1 MAPES(Mr MDO()DIA to 1iwn Anatar)a(itn4Ailisszsannaistain accordance with She abort_ lint_Ttookand Throe Nwndrad DOLLARS jso.3OO.QO1 MYsePITI_TO aE YAOl5.fO1.M& dun is full epos completion • • Department of IndustrialAccidents . �.1-e • is Office of Investigations RI Lafayette City Center �1A1 2Avenue de Lafayette, Boston,MA 02111-1750 • ;! www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name usiness/Ora ni?ation/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. o 4. MI.I am a general contractor and I ❑ I am a em 1 P Yer with 6. ❑New construction employees (full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- ' 'listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition workingfor me in anycapacity. .employees and have workers' P t3' 9. ❑Building addition [No workers' comp. insurance comp. insurance.t required.] • . 5. ❑ We are a corporation and its ' 10.0 Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have eiercised their '11.0 Plumbing repairs or additions myself. [No workers' comp. . 'right of exemption per MGL red iu 12.©Roof repairs insurance required.] t c. 152, §1(4), and we have no • • employees. [No workers' 13.❑ Other • comp. insurance required.] . *Any appli cant 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. • Tnsurance Company Name:Travelers Property CAS CO OF AM •. • Policy#or Self-ins.Lic.#..7PJUB0G07898220 Expiration Date:6/4121 . • Job Site Address: (>7 1 4J/1/ ,) City/State/Zip: f4,7eA• / e . Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER.and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for i . Trance coverage verification. • I do hereby certify under.t ins and penalties of perjury that the information provided above i true 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): • 1111Board of Health 2El Building Department 30City/Town Clerk 4.0Electrical Inspector 5 Iumbing • Inspector 6.❑Other . Contact Person: ' . Phone#: a ' , A�OREP 'CERTIFICATE OF LIABILITY INSURANCE DATE s/o9/2( 00Y 4. THIS CEMIFICATE IS ISSUED AS A MA IEH'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 ; NNAMME:ACT Kathi Hutchi• nson ORMSBY INSURANCE AGENCY 1A,°NN,eit): (413)737-0300 FAX ,No): • ADDRESS: khutchinson@onnsbyins.com 0 P 0 BOX 718 INSURERS)AFFORDING COVERAGE NAIC# WEST SPRINGFIELD MA 01090 INSURER a: TRAVELERS PROPERTY CAS CO OF AM 25674 INSURED INSURE%B: . SEXTON ROOFING &SIDING INC INSURERC: ' . INSURERD: ' PO BOX 6327 INSURER E: HOLYOKE MA 01041. INSURER F: COVERAGES CERTIFICATE NUMBER: 541733 • REVISION NUMBER: ' . THIS IS TO CERTIFY THAT THE POUCIES 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 9Y PAID CLAIMS.' INSR TYPE OF INSURANCE POLICY NUMBER ADOL SUER POLICY EFF. - POLICY EJCP UilffrS LTR INS() WVD (MMOCY W 7YYYY) (NDOrrYYY) . COMMERCIAL GE ERALLWBILnT EACH OCCURRENCE S " DAMAGE TO RENTFJD CLAIMS-MACE I OCCUR. PREMISES ni ES Ea occurrence) S . MED EXP(Any one person) S • N/A PERSONAL&ADVINJURY S ' GEN'L AGGREGATE UMITAPPUES PER: . GENERALAGGREGATE S • E I POUCY a �LOC PRODUCTS-COMP/OP . OTHER $ AllT'OMOBILE LrABTLnY • COMBINED SINGLE LIMTI' S (Ea accident)• . ANY• AUTO -. .BODILY INJURY(Perperson) S - ALL OWNED SCHEDULED AUTOS AUTOS N/A • BOOILYIt•W ¢Sd INJURY S • • NON-OWNED ) t GE S HIRED AUTOS AUTOS (Per aoddenl) . S • UMBRE1!A UAB I OCCUR _ • • EACH OCCURRENCE S EXCESS LIAB CLAIMS-MADE N/A AGGREGATE S • CEO RETENTIONS • +_ • S • WORHEIRSCOMPENSAMOM ' X PSTATUTE I0T • AND EMPLOYERSLIABrLnY . N " ANYPROPRIETORIPARTNERJEJCECUTNE EL EACH ACCIDENT S 1,000,000 A OFFICERIMEMBERE(CLUDED? WA WA WA 7PJUBOG07898220 06/042020 06/04/2021 ELdISEASE-EAt3APL0YEE S 1,1}00,00 (Mandatory in NH) . If yes,describe Larder DESCRIPTION OF OPERATIONS below _ ' • EL.DISEASE-POLICY UMrr S 1,000,000 • NIA DESCRIPTION OF OPERATIONS 1 LOCATIONS!VEHICLES(ACORD UN,Ad SBon+l RenaiicsSchedule,may be attached d'more space Is reclu'ir 1) 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 arrPcsing the Proof of Coverage.Coverage Verification Search tool at www_mass.govilwd/workers-compensationfinvestigations/. • CERTIFICATE HOLDER • CANCELLATION . • • SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCEL I Fr)BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED, IN ' ACCORDANCE WrrH THE POLICY PROVISIONS. AUTHORIYELD REPRESENTATIVE • _ . • • Amherst • MA 01002 �i� (- l Daniel M.Crn ey,CPCU,Vice President—Residual Market—WCRIBMA • ©1988-2014 ACORD CORPORATION. All rights I o rved. ACORD 25(2014101) The ACORD name and logo are registered marks Of ACORD • ACOR E1 CERTIFICATE OF LIABILITY INSURANCE S 02`a ' ` THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER THIS CtHI[MATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES ' BELOW. THIS GEFti1FICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORt'T1 REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: Ormsby Insurance Agency,Inc. PHONE (413)737-0300 I ram* (413)737-0617 ' (A/C,No.Hct): 698 Westfield Street E-MAIL ADDRESS: West Springfield,MA 0.1089 INSu RER(5)AFFORDING COVERAGE NAIC# INSURER; Colony Insurance Company 39993 INSURED INSURER B: Sexton Roofing and Siding Inc INSURER C: 102 Pine Street . INSURER D: ' .HoIyolce,MA 01040 INSURER e: . INSURER F: - i COVERAGES CERTIFICATE NUMBER: REVISION NUMBER THIS IS TO CtK I IFY THAT THE POLICIES OF INSURANCE LIS I IJJ 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 ��SUBR POLICY EFF POLICY EXP L1h71TS , LTR TYPE OF INSURANCE INSD IWW POLICY NUMBER • (MM/DO/Y TTT.I (MMIDD/YYYY) A X COMMERCIAL GENERAL 101PKG002159905 6/25/2020 6252021 EACHOccURRBICE s 1,000,000 DAMATO RENTED CLAIMS-MADE rX OCCUR PREMISE LLIES(Ea occurrence) S 100,00E ' MED EIIP(Any one person) S 5,000 PERSONAL&ADV INJURY I s 30,000 GENLAGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 'X POLICY jEo- LOC . PRODUCTS-COMP/OP AGG 5 2,000,000 OTHER S AUTOMOBILE L1A13t1]]Y ((Ea ac NED SINGLE LIMIT 5 ANY AUTO_ BODILY INJURY(Per person) S • ALL OWNED SCHEDULED • BODILY INJURY(Per accident) S • AUTOS AUTOS NON-0CNNED PROPtx I Y DAMAGE S HIRED AUTOS _AUTOS _ (Per �_ l S UMBRELLA LIAR OCCUR _ EACH OCCURRENCE S - EXCESS LIAB CLAIMS-MADE AGGREGATE S DID I RETENTIONS S WORKERS COMPENSATION I AT<rrE CITH_ ER . AND EMPLOYERS LIABILITY Y/N . ANY PROPRIETOR/PARTNER/EXECUTIVE 1 I NIA (Mandatory in NH) EL EACH ACCIDENT 5 OFFICERRMEMBEREXCLUDED? ) EI DISEASE-EAEMPLOYEE 5 . Jfyyes,RIPTIONSO EL DISEASE-POLJCYUMIT S DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS!LOCATIONS!VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is require[!) CERTIFICATE HOLDER CANCELLATION , SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE '! THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN .Ill • ACCORDANCE WITH THE POLICY PROVISIONS_ AUTHORIZED REF RE.SN N TA1E ! f....,0 C IAL..1.-,...-.,-- • , ©1988-2014 ACORD CORPORATION_ All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD • xallO rys PlzIxPara1 311213 maGJUSTO'ETualnIxetbil2miLma M °paroirr ` t""g`Y ry 9 1 I ] •133(1 !!• i5 r �I 73a►.i60 �'1K$37 pr g �" �- _ glac'Tway of zaummsnlitg via2quct suoilagsannijo zag3t3 zift capipm'K u J xi Lau SZ.3D Id=V"KCIROIA B oOSZS cq cin P=J1z`P� O dQIS$Y)�*�? RaPse j se s -2°Gm/pua -Om ussirildiat tuy Per=gm= j oidea_i 00 (ay r: csqicill-Opp -v.)(30)-kk\-7,m1,14cuzdinzo 33uzinsul `sly Fac -HE&lop= MWEOO ; [T °SIl °Q an l'aaelOi$`ZSI x3410 Ertl sircialjosLEIT[ z-zzygmcsca4' :5;++pit Pocs xIN r=-xgmFats3 mi-tgesay Fon atitupetropt=c4i vwxI lag - s s312tha2q4witial=171 1 } 3 DID „-"' L1�I IP*I Ytro3m3fasm*oaf= ass+W m p41E"Pas�Ka°xao4tQsI Ehr E-p2labze 3cmano a-dasxs .cltl 1,sadsa 6sa Zu.PIJu a ur=stxg Statou I'!°cimst uo!Ptalsocom,;REI f , sat e i *6a3134ial)___ - =aetalipriczaidczigvazo.pier rassreSaxv ] -- 1 : 1 v (MUMC �.. - - - .:.r _ VanivatlEalMaxisiWwwciassl lootlisig2dgmlrati iaiet - z1oz-nIts vw _ albiS —�=_ ViraViliFil"Vifir A ® DATE ry WDDlYY`CY) CERTIFICATE OF LIABILITY INSURANCE 11/13/2020 THiS CERIIFICATE IS ISSUED AS A MAI TER 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 CONSTITUiE A CONTRACT BETWEEN THE ISSUING 1NSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND TThE CERI a-ICATE HOLDER IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must he endorsecL If SUBROGATION IS WANED,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 hipme Edson DeSouza MAYFLOWER INSURANCE GROUP INC PH ON U74)773 9702 FAX (A/C,No): @meyfl DDRL ADORr=ss: Edson@mayflowerinsurance.com 299 Court Street INSURER(5)AFFORDING COVERAGE NAIC Js Plymouth MA 02360 INSURER A: 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 Tl-iAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICAJ EU_ NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PEiTIAIN, 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_ ILTRR TYPE OF INSURANCE ADM_ SU6R POLICY NUMBER POLICY EFF POLICY ERP YY' LIMITS s�we (i,+wonmYYL1uruooryYYY)_ COMMERCIAL GENERAL LIABILITY • EACH OCCURRENCE $ DAMAGE TO RENTEDCLAIMSMADE OCCUR PREMISES(Ea occurrence) $ MED EXP(Any one person) S N/A PERSONAL&ADV INJURY 3 GEML AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $ PRO- r POLICY JECT LOC - - PRODUCTS-COMP/OP AGO S OTHEl • $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) _ ANY-AUTO BODILY INJURY(Per person) S ALL OWNED r—SCHEDULED AUTOS AUTOS AUTO N/A BODILY INJURY(Per acdderd) $ HIRED AUTOS NON-OWNED PROPERTY DAMAGE AUTOS (Per accident) 3 UMBRF1 I A LIAB OCCUR EACH OCCURRENCE S EXCESS LIAR CLAIMS-MADE N/A AGGREGATE $ DED I 1 RETENTIONS 3 WORKERS COMPENSATION X RTUTE I OT STAAND EMPLOYERS'LIABILITY YINANY ' A oOFFFICEr�MEMEERE CJJDDE r cNI� N/A NIA NIA 6S60UB1K70970620 11/16/2020 11/16/2021 EL EACHACCJDENr s 1,000,000 (Mandatory inNH) EL.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS beaw - EL DISEASE-POLICY LIMIT $ 1,000,000 • NSA DFSTRIPTION OF OPERATIONS/LOCATIONS I VEUCLES(ACORD 101,Additiorral Remark Schedule,may be attached if more spas is required) Workers'Compensation benefits will be paid to Massachusetts employees only_Pursuant to Endorsement WC 20U3 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 expildtien dale 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-compensatiorl(nvestigaiions/. CERTIFICATE HOLDER • CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCFI I Pr)BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED iN ACCORDANCE WiTH THE POLICY PROVISIONS_ Sexton Roofing &Siding Inc 102 Pine St AUTHORIZED REPRESENTATIVE Holyoke MA 01041 Daniel fN_Croy,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 ACQR CERTIFICATE OF LIABILITY INSURANCE DATE(LOUD OIYI YY) 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 certibLate holder is an ADDFTIONAL 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 po4cies may require an endorsement. A statement on this celtifiLate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CT N�Aa+e Art Calvillo One Family Insurance PHONE 378-403-5942 FAX 978-403-5943 1 Main St Suite 15 III' insurance.com Lunenburg,MA 01462 ADDADDRESS: art�lfamily I NSIIRERIS)AFFORDING COVERAGE NAIC S INSURER A: Evanston Insurance Company INSURED INSURER B: MNP CONSTRUCTION,INC. INSURER C: 45 EXCHANGE ST APT 3E INSURER D: MILFORD,MA 01757 INSURER E: INSURER F COVERAGES CERTIFICATE NUMBER REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LIS I EL)BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICA I ED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PEN I AIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALLTHE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS_ IL SCR TYPE OF INSURANCE ADDLSUUR POLICY EFF POLICY EXP LIMITSINst OA wve POLICY NUMBER (MMEDDlYYYY) (FIDOIYYYY) X COMMERCIAL.GERERALLIABILrr7 EACH OCCURRENCEDAMAGE TO RENTED S 1,000,000 Cl AIMS-MADE X OCCUR PRETAS Ea ommence) 5 100,000 MED E T'(Any ana pem c) S 5,000 A Y Y 3ET9385 11/20/20 11/20/21 PERSONAL&ADV INJURY S 1,000,000 GENT AGGREGATE OAT APPLIES PER: GENERAL AGGREGATE S 2,000,000 RO- POLICY JE LOC PRODUI.IS-COMP/OP AGG S 2,000,000 OTHER _ 5 AIITOMOBII F LIABILITY COMBINED SINGLE LIMIT S . (Ea accident) ANY AUTO BODILY IN JURY(Per person) S OWNED SCHEDULED BODILY INJURY(Per accident) S AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE S AUTOS ONLY AUTOS ONLY (Per acceded) S UMBRELLA LIAB OCCUR EACH OCCURRENCE EXCESS LAB CLAIMS-MADE - AGGREGATE S BED RETENTIONS __ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'I IARO III' Y/N STATUTE ER ANY PROPRIETOR/PARTNEREXECUTIVE N f A EL EACH ACCIDENT - S ED OFFICER/MEMBEREXCLUD ? (Mandatory in NH) EL DISFASE-EA EMPLOYEE S If yyeess,describe under DESCRIPTION OF OPERATIONS below EL DISEASE-POLICY LIMIT S DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Rrtnarhs Schedule,may be atrched if more space is taquired) CERTIFICATE HOLDER - CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCF1 I FD BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN SEXTON ROOFING&SIDING INC ACCORDANCE WITH S THE POLICY PROVISION 102 PINE ST P.O.BOX 6327 AUTHORED IREPrtES�7NTA HOLYOKE,MA 01040 Abe% 0 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD