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70 SPRUCE HILL AVE BP-2021-1473 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block:29- 145 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: Door Replacement BUILDING PERMIT Permit# BP-2021-1473 Project# JS-2021-002449 Est.Cost: $2300.00 Fee: $40.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: LOWES HOME CENTERS INC 049918 Lot Size(sq. ft.): 43995.60 Owner: GRABON SHERYL A Zoning: Applicant: LOWES HOME CENTERS INC AT: 70 SPRUCE HILL AVE Applicant Address: Phone: Insurance: 1000 LOWES BLVD (413) 272-8931 () WC MOORESVI LLENC28117 ISSUED ON:6/10/2021 0:00:00 TO PERFORM THE FOLLOWING WORK:DOOR REPLACEMENT POST THIS CARD SO IT IS VISIBLE FROM THE STREET Inspector of Plumbing Inspector of Wiring D.P.W. mowing 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. • • )2 - (11%7 ' Certificate of Occupancy Signature i ' FeeTvpe: Date Paid: Amount: Building 6/10/2021 0:00:00 $40.00 212 Main Street,Phone(413)587-1240, Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner es �%The Commonwealth of Massachusetts JG� FOR . q( _ Board of Building Regulations and.St. • ds . ��`� ALITY , Massachusetts State Building Code, 78.9 .! © .9 US " ised ar 2011 Building Permit Application To Construct. Repair,Renov T po c-molisrar One-or Two-Family Dwelling Toi',/,1< o This Section For Official Use only go;�or. Building P rmit Nurnber: �� 73 Date A lied: �sotis li L- i0-zvzl LU 1� ��55 Building Official(Print Name) Signature Date SECTION 1:SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map&Parcel Numbers '16 5fO-kce )4t1( 10 21 15rs 1.la Is this an accepted street?yes no Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Area(sq ft) Frontage(ft) 1.5 Building Setbacks(ft) Front Yard Side Yards Rear Yard Required Provided Required Provided Required Provided 1.6 Water Supply: (M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Public❑ Private 0 Zone: Outside fyesOFlood Zone? Municipal 0 On site disposal system 0 Check if yes SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner"of Record: Pry G•r,,C�h Plat.ONc e, a(O(o1 k Name(Print)I City,State,ZIP 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 0 Demolition 0 Accessory Bldg. 0 Number of Units Other 0 Specify:_ Brief Description of Proposed Work' tA1&4L• Let"�•r e(a/( • A.ru c-1,Lt. (.'. tI Coc-v7(1-C SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1.Building $ .-1, —7 p v 1. Building Permit Fee: $ Indicate how fee is determined: ❑Standard City/Town Application Fee 2.Electrical ❑Total Project Cost3(Item 6)x multiplier x 3.Plumbing $ 2. Other Fees: $ 4.Mechanical (HVAC) $ List: #i 5.Mechanical (Fire $ Total All Fees: $ �,�] 4� ii Suppression) ���� Check No. 111,ldlfeck Amount: 1 Cash Amount: 6.Total Project Cost: $ e r 5 0 0 0 Paid in Full 0 Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) 0 %01(C/ PA-0,K_ J i IJot N License Number Expiration Date Name of CSL Holder �....4 �PS �+Q List CSL Type(see below) No.and Street _- Type Description /� kRn107-��'i AI n e't �> U Unrestricted(Buildings up to35,000cu. tt.) (/ `t'7` Restricted 1&2 Family Dwelling City/Town,State,ZIP M Masonry RC Rooting Covering WS Window and Siding f SF Solid Fuel Burning Appliances �i(" ` -017/ lnaN�nr.IM1e I *i4r)/5 j�`Gj ,� I Insulation Telephone Email address U" D Demolition 5.2 Registered Home Contractor(HIC) G/' KD LuA,0,7 1 (e k/S --- HIC RegistrationDl Number Expiration Date HIC Company Name or HIC Registrant Name I Ova ccAu.-05 R .✓n C���,}vP6e,_ f'lc No.and Street Email address City/Town,State,ZIP Telephone SECTION 6:WORKERS' COMPENSATION INSURANCE AFFIDAVIT(M.G.L.a 152.§ 25C(6)) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the Issuance of the building permit. Signed Affidavit Attached? Yes ......... - No...........❑ SECTION 7a: OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I,as Owner of the subject property,hereby authorize to act on my behalf,in all matters relative to work authorized by this building permit application. Print Owner's Name(Electronic Signature) Date SECTION 7b:OWNER'OR AUTHORIZED AGENT DECLARATION By entering my name below,I hereby attest under the pains and penalties of perjury that all of the information contained in this application is e d ccurat to the best of my knowledge and understanding. Print Owner's or Authorized gent's ame(El Signature) Date 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(I ITC)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 ,w,mass.gov/oca Information on the Construction Supervisor License can be found at wwww..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" Z CITY OF NORTHAMPTON SETBACK PLAN MAP: LOT: LOT SIZE: REAR LOT DIMENSION: REAR YARD SIDE YARD SIDE YARD FRONT SETBACK FRONTAGE 4 City of Northampton .> � Massachusetts l�, A illSt DEPARTMENT OF BUILDING INsehCTIONS Si. 44, 7 ' 212 Main Street • Municipal Building Northampton, MA 01060 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: 144)714()/ r` ^{,C /1-7h 01(6 The debris will be transported by: Name of Hauler: 1710A ti iNqfze n1Q f14, ) Signature of Applicant: Date: . , - is ,Z‘k, The Commonwealth of Massachusetts tr.: I•a f ,.; •;',-. - r ;a=e; Department of Industrial Acci,dents I Congress.Street,Suite 100 -„,-- , Boston, MA 02114-2017 www.mass.gov/dia Waiters'Compensation Insurance Affidavit:Builders/ContractorsfElectricians/Plumbers. TO RI.FILED WITH THE PERMITIING AUTIIORJTY. Applicant information Please Print Treads Name 1 Business/01-10mila ion'Ind t i,ichtal : (-4A/1/11. )‘'1k/te I e")4-4-6- Address: 0-y- i1A €4) ‘• i ) City"StateiZip: Vli di f4'Cr-ithe/ /Le .2.--61 f-. Phone#: 1—(( Are,au an empiwyer?Cheek the apprapriate hoc Type of project(required): 1 0 I am a employer witty , , ____erripkwees(full asuinir part-61nel* 7. CI Neve'eimstruction 2 r_wi I am a suk proprietor or picrinefthip and have no employees sworkan.ti for roe in 8.. Q Remodeling any%Amway.Nu w oricen'comp.utaur.u,or imkus-cd) 9.. El Demolition 30 I am,a holm:vivito doing all work ens [No erorkes%'corm.in,Lirance rc(4uned.)' I 0 0 Building addition 4.0 I am a homeowner and will he hirinE cAmtraours to conduct all*ork on on pro/wity. I will ensure that all contraelorS either have vioriem"cornprivatitai insurance or are r.ole 11.0 Electrical repairs of additions proprietors with no employees. I 2.0 Plumbing repairs or additions 30 I am a ipmeral Eunitador and I have hared the ad:remit-actors lish-d on the anat.:tied iirwei. i 3.E3Roofrepairs These wh-ekiraractors have employer;and has e worker,'comp.alsoranee.`, 14.0 Other 6.0 we are a corporation and air officer(have exerriaed their right ot exemption per Milil.c. . _ 152,§114),and we have no anplovei.No wori.eri'comp,incriance reyowed.1 *Any applicant that check.%box 41 UAW also till out thesection below 01(0444 their worker, compcmarrun pokey intirrieurtion.. f Homeowners who tabnIli this allistalat indicating they are doing all skyik and then hire outside contractori must submit a new Aldan it isaditurg r.-uch.. :Contractor(that check this box roust attra:hed an add),iona)sheet show erre the name Of the suli-corin actor,and oate whether 114 not rhose enntiot luoc cinpluyeci. lithe sub-contractor,lidNc employ cei,they inuvt pi..idc the ir worker,',.nitip.policy matihci I am an employer that is providing workers'cotnpensation insurance for my employees. Below is the polity and job site information. Insurance Company Name: 01 pi1_,c, )4 ki6,/)-- t t, _ Policy#or Self-ins.Lie.#: V•00(6<776(-41627 Expiration Date: ti— I — Job Site Address: —76 c'f)(4(-C' ).4,)( /)-e.i& City!StateiZip; pC164AerCei (14 Attach a copy of the vtorkers"compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL c. 152. §25A is a criminal violation punishable by a fine up to 51,500.00 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.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. Ida hereby certif• e ns and o perjury that the infOrmation provided above is trite and correct Phone it: : Official u„se only Do not write in this area,to he completed hi'City or town official City or Towa: Permit/License# .._ Issuing Authority(circle one): I. Board of Health 2.Building Department 3.(7ity!Town Clerk 4.Electrical Inspector S.Plumhint; Ins[pet-tut : 6,()ther ('olitact Person:I Il Phone#: _ City of Northampton Massachusetts _ %e 1n; mE 'i DEPARTMENT OF BUILDING INSPECTIONS 212 Main Street • Municipal Building 0ac`•, r11' 4 j" x Northampton, MA 01060 :4")1V HOMEOWNERS'EXEMPTION ELIGIBILITY AFFIDAVIT I, (insert full legal name), born _ (insert month, day,ye hereby depose and state the following: 1. I am seeking a building permit pursuant to the homeowners' exemption to th. sermit requirements of the Massachusetts State Building Code, codified at 780 CMR 110.R5.1.3.1, in cone Hon with a project or work on a parcel of land to u ' h I hold legal title. 2. 1 am not engaged in, an' e project or work for which 1 am see ' g the aforementioned homeowners'exemption, does not involve the field ere► 'on of manufactured buildings instructed in accordance with 780 CMR 110.R3. 3. I qualify under the State Buildin: odes definition . homeowner"as defined at 780 CMR 110.R5.1.2: Person(s)who owns a parcel of F.. d on wh. he/she resides or intends to reside, on which there is, or is intended to be, a one-or two-fa • •elling, attached or detached structures accessory to such use and/or farm structures.A person w . constructs more than one home in a two-year period shall not be considered a home owner. 4. I do not hold a valid Massac setts constructio supervision license and, except to the extent that I qualify for and will abide by the Mas 'chusetts State Buildin: Code's requirements for the supervision of the project or work on my parcel, I am n• engaged in construction su.enrision in connection with any project or work involving construction, rec. action, alteration, repair, rem. or demolition involving any activity regulated by any provision of the assachusetts State Building Code. 5. If I engage y other person or persons for hire in corn;ction with the aforementioned project or work on my parcel,I ac owledge that I am required to and will act as e supervisor for said project or work. Signed under the pains and penalties of perjury on this day of . 20_. (Signature) INSTALLER COPY INSTALLATION SERVICES CUSTOMER CONTRACT-MWORK-INT/EXT/PATIO DOOR OWE'S OF HADLEY,MA STORE#1916 STORE PHONE:(413)588-0270 82 RUSSELL STREET SALESPERSON.BRUCE HUNTER ADLEY, MA 01035-0000 SALESPERSON ID:1508948 Document Print Date 05/26/2021 This is only a Quote for the merchandise and services printed below.This becomes an agreement upon payment and issuance of a Lowe's receipt,upon which the entire agree- ment,including the specifically completed pages of this document,the Terms and Conditions included with this document,the applicable portion(s)of Lowe's receipt,and any other addenda or attachments hereto,shall be referred to herein as this"Contract." PLEASE READ THIS ENTIRE DOCUMENT.INCLUDING THE"TERMS AND CONDITIONS."BEFORE SIGNING. Lowe's Registration or Contractor License Number/Lowe's Contractor Name Lowe's Home Centers,LLC's MA HIC NO.:148688 Lowe's Home Centers,LLC's FEIN:56-0748358 Customer Name Home Phone S SHERYL GRABON 413-584-1050 O Customer Address Other Phone 70 SPRUCE HILL AVE. 413-320-1892 L City State/Province Zip/Postal Code D FLORENCE MA 01062 Installation Address T 70 SPRUCE HILL AVE. O Installation City Installation State/Province Installation Zip/Postal Code FLORENCE MA 01062 MERCHANDISE AND INSTALLATION SUMMARY MERCHANDISE SUMMARY 58593:TBM166-VR-SD:SOS:SOS BMTT PRESTAINED FBGLSS TEXTUR:PRE-STAINED WOOD GRAIN SINGLE DOOR UNIT VARISSA:TRU LO- GISTICS INCORPORATED-QTY 1 15634:230612:STK:12OZ DOOR AND WINDOW FOAM:12OZ DOOR AND WINDOW FOAM:DOW CHEMICAL COMPANY THE-QTY 1 34660:356-PFJ7:STK:PFJCSE 356 2-1/4-INX11/16-INX7-FT:PFJCSE 356 2-1/4-INX11/16-INX7-FT:METRIE INDUSTRIES INC-QTY 3 42330:FB5ON V GEO 619:STK:SCH SN COMBO SGL GEORGIAN:SCH SN COMBO SGL GEORGIAN:SCHLAGE LOCK-QTY 1 147316:INSTALTAPE50:STK:PELLA 3-IN X 50-FT WINDOW TAPE:PELLA 3-IN X 50-FT WINDOW TAPE:PELLA CORPORATION-QTY 1 585250:20297817:STK:LARSON QUICKFIT HDL KIT BN:LARSON QUICKFIT HDL KIT BN:LARSON MANUFACTURING CO INC-QTY 1 758239:14904032:STK:LAR SIG CLASSIC 36 FRAME WHITE:LAR SIG CLASSIC 36 FRAME WHITE:LARSON MANUFACTURING CO INC-QTY 1 Store 1916 Project No.684165710 for SHERYL GRABON Page 1 of 4 INSTALLER COPY Materials Price $1621.03 INSTALLATION DESCRIPTION Door type:Exterior Location of new door(s):Front Door Select new door:Single Pre-Hung Hardwood door:No Sidelights or transoms:No Number of additional holes bored for accessories:None Install specialized mortise hardware:No Install storm door:Install new storm,screen or security door Select storm door:Storm Door Lead safe practices:No Total linear feet of custom trim to be Installed:0 Deliver door:Yes Customer understands scope of the project:Yes Permit Fee:Yes Additional Mileage:0 Access fee:None Dump entry Fee:None Additional Work:None Comments:in stock avrissa and the signature storm door. Labor Charges $ 641.00 Detail Deduction -$ 35.00 Additional Specifications: Notation:Lowe's will not make structural modifications,remove cabinetry to accommodate new appliance,or upgrade electrical service. Additional Specifications: LEAD SAFE INFORMATION:Federal and applicable state laws require that You be provided with a lead hazard information pamphlet such as the Renovate Right:Important Lead Hazard information for Families,Child Care Providers and Schools.By signing this Contract,You acknowledge having received a copy of this information pamphlet before work began informing You of the potential risk of the lead hazard exposure from renovation activity to be performed in Your dwelling unit or facility.A copy of the pamphlet is also available at the following website: pttosJ/www epa gov/sites/oroduction/files/documents/renovaterightbrochure.odf.For more information see:httosJ/www.eoa gov/lead/lead-renovation-repair-and-painting-program. PHOTO RELEASE:Customer grants to Lowe's and Lowe's employees and independent contractors the right to take photograghs of the Premises where Installation Services will be performed and all work performed at the Premises related to this Contract,and irrevocably grants to Lowe's all right,title,interest in and to the photographs for use in all markets and media,worldwide,in perpetuity. Customer authorizes Lowe's to copyright,use and publish the photographs in print and/or electronically,and agrees that Lowe's may use such photographs for any lawful purpose,including,but not limited to,marketing,advertising,publicity,illustration,training and Web content.By initialing here,Customer agrees to the foregoing. [Customer to initial to the left]. NOTICE TO CUSTOMER-PRICE CALCULATIONS:In order to properly perform the installation of certain Goods,the Contract Price may include more Goods than actually will be installed based on the measured square footage of the Project Area.As a result,the parties agree that the lump-sum Price stated in this Contract is calculated upon both the value of the estimated Goods required to ful- fill the Contract(including waste),which may exceed the actual square footage of the Project Area,and the labor which may be estimated based on the amount of Goods required to fulfill the contract (including waste).By signing this Contract below,Customer acknowledges receipt of this notice and agrees and understands that the Price includes these costs which may not be refunded once the Installation Services are performed.. NOTICE OF ARBITRATION AGREEMENT This Contract provides that all claims by Customer or Lowe's will be resolved by BINDING ARBITRATION.Customer and Lowe's GIVE UP THE RIGHT TO GO TO COURT to enforce this Contract (EXCEPT for matters that may be taken to SMALL CLAIMS COURT).Lowe's and Customers rights will be determined by a NEUTRAL ARBITRATOR and NOT a judge or jury.Lowe's and Customer are entitled to a FAIR HEARING.But the arbitration procedures are SIMPLER AND MORE LIMITED THAN RULES APPLICABLE IN COURT.Arbitrator decisions are as enforceable as any court or- der and are subject to VERY LIMITED REVIEW BY A COURT.FOR MORE DETAILS:Review the section titled ARBITRATION AGREEMENT,WAIVER OF JURY TRIAL AND WAIVER OF CLASS ACTION ADJUDICATION found in the Terms and Conditions of this Contract. Store 1916 Project No.684165710 for SHERYL GRABON Page 2 of 4 INSTALLER COPY TOTAL CHARGES OF ALL MERCHANDISE AND SERVICES "whore applicable SUB-TOTAL $2227.03 `TAX $ 0.00 DELIVERY $ 0.00 ORDER TOTAL $2227.03 BALANCE DUE Store 1916 Project No.684165710 for SHERYL GRABON Page 3 of 4 INSTALLER COPY WAIVER OF LIEN and ONE YEAR WARRANTY(TO BE SIGNED BY CONTRACTOR) I,the undersigned Installer!Independent Contractor,having been employed by the Customer who signed the Certificate of Completion below do hereby certify that the work for this project will be or has been completed in a workman like manner and to the Customer's satisfaction.In consideration of the receipt of one dollar and other good and valuable consideration,and to the extent permitted by ap- plicable law,I hereby waive and relinquish all liens and all rights and claims of liens which I,the undersigned,now have or may hereafter have for labor or materials furnished,and Further certify that all work performed and materials furnished,if any,by any other party or parties upon the order of the undersigned,have been fully paid for.Further,I the undersigned,agree to cause the prompt release of any mechanic's lien(s)which may be filed against the Customer's premises by any subcontractor,laborer,mechanic or material supplier claiming the right to file such a lien through work related to Customer's Contract with Lowe's.In addition to any warranties provided by law or specified elsewhere,including the Customer's Contract with Lowe's,the undersigned further warrants that all work fur- nished for this project shall be free from defects either in material or workmanship.If any defects in material or workmanship shall be discovered in the work furnished or material used during the course of the work or within one year from the date of the Certificate of Completion,the undersigned agrees to replace or correct such deflective work or material,free from all expense to Lowe's and the Cus- tomer in a manner satisfactory to the Customer. I further represent that I have given Customer the option of retaining some or all of the surplus materials or having some or all of such surplus materials removed from the Customer's premises. If applicable to the performance of the work required for this project,I,the undersigned installer/Independent Contractor,do hereby certify that I have complied with all requirements of the Lead Renov- ation,Repair,and Painting Program Rule("LRRPP RULE"),40 C.F.R.sec 745.8Oet seq.,or any applicable state laws or program regulating lead-based paint safe work practices,including compliance with all information distribution,notice requirements and work practice standards in performing the work required for this project.I certify that I have provided the Customer with all documentation re- quired to be supplied under the LRRPP Rule or state program,shall retain all records required by law,and have attached to this document copies of all the records required to be retained by the LRRPP Rule or applicable state program. Signed and delivered this day of (Seal) SubContractor Print Name CERTIFICATE OF COMPLETION 1. I,the Customer,certify that the Installers/Independent Contractors or their sub-contractors,have furnished all Goods and/or services,that installation,repairs and alterations or improvements("the installation services")have been completed as set forth in my/our contract with Lowe's,and that I have been offered the oppor- tunity to request that Lowe's allow me to retain some or all of any unused,receipted surplus materials rather than have such surplus materials remain the property of Lowe's. 2. Buyer's initials(Buyer INITIAL ONE only) There were no such surplus materials. I accepted all surplus materials I wanted. I declined to receive any surplus materials. Date: Owner's Signature Owner's Printed Name Store 1916 Project No.684165710 for SHERYL GRABON Page 4 of 4 AID CERTIFICATE Cr)tr„ 9 DATE(MM/DD/YYYY) 1A. CERTIFICATE OF LIABILITY INSURANCE 03/29/2021 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACTNAME: Marsh USA Inc. PHONE FAX 100 North Tryon Street.Suite 3600 (A/C.No.Ext): (A/C,Not: Charlotte,NC 28202 E-MAIL ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# CN102776519.Lowes-SI-21-22 INSURER A:National Union Fire Ins Co.of Pittsburgh PA 19445 INSURED INSURER B:Interstate Fire&Casually Co 22829 Lowe's Companies,Inc. and subsidiaries INSURER C:AIU Insurance Co 19399 1000 Lowe's Boulevard INSURER D:New Hampshire Insurance Company 23841 Mooresville,NC 28117 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: ATL-004976909-08 REVISION NUMBER: 10 THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR INSD WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS-MADE OCCUR Self Insured-See below DAMAGE TPREMISES(Eaoccu RENTED nce) $ MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY PRO- JECT LOC PRODUCTS-COMP/OP AGG $ OTHER: A AUTOMOBILE LIABILITY CA7030892 (AOS) 04/01/2021 04/012022 COMBINEEDI SINGLE LIMIT $ 5000000 (Ea acciden A X ANY AUTO CA7030891 (MA) 04/01/2021 04/01/2022 BODILY INJURY(Per person) $ — A OWNED SCHEDULED CA7030893 (VA) 04/01/2021 04/01/2022 BODILY INJURY(Per accident) $ AUTOS ONLY _ AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ _ AUTOS ONLY AUTOS ONLY (Per accident) $ B X UMBRELLA LIAB X OCCUR USZ00024220 04/01/2021 04/01/2022 EACH OCCURRENCE $ 5.000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE $ 5,000,000 DED RETENTION$ $ C WORKERS COMPENSATION WC016393105(AOS) 04/01/2021 04/01/2022 x PER _ TUTE ER AND EMPLOYERS'LIABILITY D Y/N WC016393104(ND,WA.WI,WY) 04/01/2021 04/01/2022 2,000,000 ANYPROPRIE TOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? n N/A 2,000,000 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under 2,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ A Excess Workers'Compensation XWC1647266 (FL) 04/01/2021 04/01/2022 (WC per statute) 3,000,000 A Excess Workers'Compensation XWC1647265 (AOS) 04/01/2021 04/01/2022 (WC per statute) 3,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Commercial General Liability policy is Self-Insured,effective 4/12021 to 4/1/2022, CERTIFICATE HOLDER CANCELLATION Lowe's Companies,Inc.and Subsidiaries SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 1000 Lowes Blvd. THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Mooresville,NC 28117 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE of Marsh USA Inc. Manashi Mukherjee --n' - - .-- — X�--^.a^+4...'- I ©1988-2016 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: CN102776519 Loc#: Charlotte ACORD/ ADDITIONAL REMARKS SCHEDULE Page 2 of 2 AGENCY NAMED INSURED Marsh USA Inc Lowe's Companies,Inc. and subsidiaries POLICY NUMBER 1000 Lowes Boulevard Mooresville,NC 28117 CARRIER NAIC CODE EFFECTIVE DATE: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: Certificate of Liability Insurance TX Employers XS Indemnity Policy Number:EP0003016700 Carrier:North American Specialty Policy Effective Date:01-Apr-2021 Policy Expiration Date:01-Apr-2022 Limits:$8,000,000 Each Occurrence/$35,000,000 Aggregate XS TX Employers XS Indemnity(Excess) Policy Number XCB3095 Cartier:Evanston Insurance Company Policy Effective Date:01-Apr-2021 Policy Expiration Date:01-Apr-2022 Limits:$15,000,000 Each Occurrence/$35,000,000 Aggregate XS Workers'Compensation and Excess Workers'Compensation policies indude a self-insured retention of$2,000,000. General Liability The insured is self insured for$10,000,000 each occurrence for the period of 4/1/2021 to 4/1/2022. The Automobile Liability policy evidenced above is subject to eddtional self-insured retentions excess of baits shown for various pens covered. ACORD 101 (2008/01) ©2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD ,-----•-""" JODOHOM-01 MPROULX ,4W---- CERTIFICATE OF LIABILITY INSURANCE DAT/23/2D/YYYY) �„�,,....-- 6l23l2020 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). CONTACT PRODUCER NAME; HUB International New England LLC arc No,Ext):(800)243-$134 (arc.No):(413)731-9539 1070 Suffield Street E-MAILAgawam,MA 01001 ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC N INSURER A:Nautilus Insurance Co 17370 INSURED INSURER B:Commerce Insurance Company 34754 Jodoin Home Improvement INSURER C: e/o Mark S Jodoin 137 Porter Lake Drive INSURER D: Longmeadow,MA 01 1 0 6-1 246 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 ADOL SUBR POLICY EFF POLICY EXP LIMITS LTR TYPE OF INSURANCE INSD 4WD POLICY NUMBER (MMJDD/YYYY) (MMIDDI�'YYYL. A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAMS-MADE X OCCUR X NN1119917 6/26/2020 6/26/2021 PREMISES tOEa occEr encei $ 100,000 MED EXP(Any one perscn} $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $ 2,000,000 POLICY PRO LOC PRODUCTS-COMP/OP AGG $ 2,000,000 _ OTHER: $ B AUTOMOBILE UABILnY (Ea aacBcliid DtSINGLE LIMIT $ 1,000,000 _ ANY AUTO X RPJ989 3/26/2020 3/26/2021 BODILY INJURY(Per person) S AUTOS ONLY X AUTOSULtD BODILY INJURY(Per accident) $ X H RRE���Dp X NON OWNFD {eOa Rl (Y DAMAGE $ AUTOS ONLY _ AUTOS ONLY $ _ UMBRELLA UAB OCCUR EACH OCCURRENCE $ EXCESS LIAR CLAMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY STATUTE ER YIN ANY PROPRIETOR/PARTNER/EXECUTIVE n E,L.EACH ACCIDENT $ OFFICE JME BEC EXCLUDED? N 1A NH) E.L.DISEASE-EA EMPLOYEE $ If yes;describe under 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) Vendor#97826 Lowe's Companies Inc.and any and all subsidiaries are named as additional insured as respects to General Liability and Auto Liability per Mass Business Auto Forms CA0001 and MM9911 an applicable Mass.State Laws as per written contract only. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF. NOTICE WILL BE DELIVERED IN Lowe's Companies Inc. ACCORDANCE WITH THE POLICY PROVISIONS. and any and all subsidiaries Mail Code A3ESS -�- 1000 Lowe's Blvd AUTHORIZED REPRESENTATIVE Mooresville,NC 28117 9211.4 ,� 7..ta '-��-"--, ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD a AC RE CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYW) �,. 07/27/2020 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies)must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: Marie Proulx HUB INTERNATIONAL NEW ENGLAND LLC (ac°.No.Ex1): (413)750 7106 FAX No): E-MAIL ADDRESS: marls.proulx@hubintematlonal.COm 600 LONGWATER DRIVE INSURER(S)AFFORDING COVERAGE NAICA NORWELL MA 02061 INSURERA: AIM MUTUAL INS CO 33758 INSURED INSURER B: MARK JODOIN INSURER C: JODOIN HOME IMPROVEMENT INSURER D: 15 JONES DRIVE INSURER E: EASTHAMPTON MA 01027 INSURER F: COVERAGES CERTIFICATE NUMBER: 557741 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR TYPE OF INSURANCE INSD,WVD POLICY NUMBER (MMIDDIVYYY) (MM/DDIYYYY) COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ DAMAGE TO RENTED CLAIMS-MADE OCCUR PREMISES(Ea occurrence) $ MED EXP(Any one person) $ N/A PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATEPRO- $ POLICY JECT LOC PRODUCTS-COMP/OPAGG $ OTHER: AUTOMOBILE LIABILITY (Ea aBINED1SINGLE LIMIT $ ANY AUTO BODILY INJURY(Per person) $ALL OWNED - SCHEDULED AUTOS N/A BODILY INJURY(Per accident) $ AUTOS NON OWNED PROPERTY DAMAGE HIRED AUTOS AUTOS (Per accident) $ UMBRELLA LIAB _ OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE N/A AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION X PER OTH- AND EMPLOYERS'LIABILITY Y/N /� STATUTE ER ANYPROPRIETORlPARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 500,000 A OFFICER/MEMBEREXCLUDED? NIA N/A N/A AWC40070296132020A 08/31/2020 08/31/2021 (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 500,000 If yes.describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 N/A DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Workers'Compensation benefits will be paid to Massachusetts employees only.Pursuant to Endorsement WC 20 03 06 B,no authorization is given to pay claims for benefits to employees in states other than Massachusetts if the insured hires,or has hired those employees outside of Massachusetts. This certificate of insurance shows the policy in force on the date that this certificate was issued(unless the expiration date on the above policy precedes the issue date of this certificate of insurance). The status of this coverage can be monitored daily by accessing the Proof of Coverage-Coverage Verification Search tool at www.mass.gov/Iwd/workers-compensation/investigations/. Sole proprietor has not elected coverage. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Lowes Companies Inc and any and all subsidiaries Mail Code A3ESS 1000 Lowes Blvd AUTHORIZED REPRESENTATIVE Mooresville NC 28117 Daniel M.Crowjey,CPCU,Vice President—Residual Market—WCRIBMA l ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD OMleaf C0ssolnerAttsim&Ettstaar NOM E IMPROVEM EN 7 RACTOR TYPE:ir. dual . E2117.119.11913. . o4x,v4=.02o MANI(J • or DOW NOME4MPFIOVE!vIEN MARK S ,10001N 01;12 ConimonwoM111 ot 7,1assatlit-tsetIs Ow:sion of P4(.114.tssional Litenstire Do.krd of RonW.1tans and Stanciartts 17•04•Is-.44,...ton CS-049918 Exp .2:s: 12129202 • MARK S JODOiN 15 JONES OR ,,• EASTHAMPTON MA 01027 Commissioner • 8e • CO of Consumer Affairs&Business Reguiatlon HOME IMPROVEMENT CONTRACTOR TYPE: Individual Registration, i~xpiiotion 159137 04/0312022 MARK 'ODO N D/B A J•D©IN HOME IMPROVEMENT MARK S J000IN 15 JONE. OR ,€ . EASTH, PION, MA 01027 Undersecretary — Cl X http. ,,my.Kensecn..,o-ar'f:retioMDetaiha»sx:r..,t<I* i r �r ,-. .1 ._ .. �eerrh_. P S fr'�krcras fcl(tararcc Centeags)H 5certhlie,tAt i rile Edit View Favorite', roofs $Il11534 K1TYMUeP PacvP.e ON,4,WEE)m;1,1M(111MHaM��u41amri,atl mr rbxtn w•rMttwfa Public Safety ire,i Mass. Licensee Details nnmcerephk h.eoe tion Pile Name..... ____... e)ARIC S JOIX)IN -.. License Address Information Cay. _astflamptan _............ _._............... state StA country- unpcooe ited sates (this.'Inforrontirvn _. ..... ' ¢ Llc e,e NU. C8.049918 License T Construction Su Profession: Badpoiq LYcenses DeedLast Renewal: 1Z1S.2020 "�\V issue Dale 12 9YI010 E�xatan Oate 1229t2022 License status Active Tetley's Dale tit9i202i Secondary License Type: Do og Business AS Dtaau Change season' Louse Renen'Z'. pcervgeequ infirnn.p4m No FreresuNBe informatic't._... .... NO Available Do UMentS......... ....... ..__...... .....: _.. [btcelMdr p{� tlt:mm1-1 w I 'Eteasuxs,Ma sae PiBNix: in0r.dtJe i • Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR TYPE:Suco,ernent Card Bs 148688 7'2021 LOWE`S HOME CENTERS,LLC CHRISTOPHER MIME s+ f.d. 1000 LOW ES gLV° SERVICEVCOE COMPLIANCE Undersecretary