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23D-168 (2) 134 MAPLEWOOD TER BP-2022-0030 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block:23D- 168 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-2022-0030 Project# JS-2022-000049 Est.Cost: $4800.00 Fee:$40.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: SEXTON ROOFING CO 99689 Lot Size(sq. ft.): 144837.00 Owner: HARRIS FAYE C Zoning: URB(100)/ Applicant: SEXTON ROOFING CO AT: 134 MAPLEWOOD TER Applicant Address: Phone: Insurance: P 0 BOX 6327 (413) 534-1234 HOLYOKEMA01041 ISSUED ON:7/8/20210:00:00 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. Certificate of Occupancy Signature: ),9 . . FeeType: Date Paid: Amount: Building 7/8/2021 0:00:00 $40.00 212 Main Street, Phone(413)587-1240,Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner sZ4., The Commonwealth of Massachusetts • • Board of Building Regulations and Standards MUNICIPALITY FOR Ne• Massachusetts State Building Code,7S0 CMR,7 edition USE Building Permit Application To Construct,Repair,Renovate Or Demolish a Revised January One-or Two-Family Dwelling 1,2008 This Section For Official Use Only Building Permit N bb�er: g1'-f y�".v� Date Applied: 0 Signature: (0 • . ' • . • -7-g7202,I m 1 Building Commissioner/Inspector of Buildings Date z- °° c rn SECTION It SITE INFORMATION D c r- 1. aperty Address: 1.2 Assessors Map&Parcel Numbers a 1 HAS/c t r/u,.e y-1 Z3,D • - I Ce co 1 this an accepted street?yes no MapNmber Parcel Number a • m 2 1.rn ing Information: 1.4 Property Dimensions: n o p Zoi3 District Proposed Use -_ Lot Area(sq ft) Frontage(It) z 1 O0 1.5 Building Setbacks(ft) . • FrontYard - Side Yards Rear-Yard Required Provided Required Provided Required Provided . • 1.6 Water Supply: (M.G.],c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Public 0 Private❑ Zone: ^ Outside Flood Zone? Municipal❑ On site disposal system 0 Check,if yes0 SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of Record: . , s (3y ,4 - .,/ , ,4. • 1.'ame Print) Address for Service: e-sa-z A" • 5-ei-Y- ss-, PA ,c e Ue'ti a .„,A:4— • signature Telephone SECTION 3: DESCRIPTION OF PROPOSED WORK2(check all that apply) New Construction❑ Existing Building 1:11,"'O wner-Occupied 0 Repairs(s) ❑" Alteration(s) 4 Addition 0 Demolition 0 Accessory Bldg.❑ Number of Units f , Other 0 'Specify: • Brief Description of Proposed Work2: V • Pe-414 , eji. /ce,e ! s.-4 44 5-z ,'`l ce • SECTION 4:ESTIMATED CONSTRUCTION COSTS • Item •• Estimated Costs: • Official Use Only (Labor and Materials) • 1.Building $ 1. Building Permit Fee:$ Indicate how fee is determined: 0 Standard City/Town Application Fee 2.Electrical $ - ❑Total Project Costa(Item 6)x multiplier_ x 3.Plumbing $ ' 2. Other Fees: S 4.Mechanical (HVAC) $ List: OZO S.Mressi i 1 (Fire $ Total All Fees:$Suppression Check No:73I ((Check Amount: Cash Amount: 6. Total Project Cost: t $ :-K kc " 0 Paid in Full 0 Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) (f(� Q Q oki License cense Number uatia`a Dar-- Name of CSL Holder/ le/C 7�, ? <L3 V ! List CSL Type(see below) ! I.(} No.and Street Type Description /, eKe , L/� /1�/� J IS Unrestricted(Buildings up to 35,00u ft o c ) t-(U v ! R Restricted lit/Family Dwelling City/ State ZIP _ M Masonry RC Roofing Covering WS Window and Siding SF Solid Fuel Burning Appliances I Insulation - -- Telephone Email address D Demolition ll 5.2 Registered Home Improvement Contractor(HIC) p` 1` / '�3 ,3('xfnn olefin and ,W f f R I 1 'a.3 _ HIC Registration Number EupireDoit Date HIC Co any Name or Registrant Name 8e,x 1v3 7 exfonra-Vin ah[1/maii '7 No.and Streit )address P7R C)/t1-4/(/ 4/3 a34/ 3� Citylw-n,State,ZIP Telephone SECTION.6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(114.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 ❑ 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 3e nil > (�''7/1 `J/(,l/��j' h 6- to act on my behalf;in all matters relative to work authorized by this but1ditermit application. fifth)eoninmit eh 6/3 ti-2 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. /50/z MUST BE SIGNED by Owner or Authorized Agent 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(HIC)Program),will lag have access to the arbitration program or guaranty fund under M_GZ..c.I42A Other important information on the HIC Program can be found at www.rnass.govinca Information on the Construction Supervisor License can be found at I.vww:masc govklps 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 Massachusetts 4t %\ ( i �_� .: * . �c t 4, 11 DEPAR NENT OF BUILDING INSPECTIONS s s a' ��► � 212 Main Street • Municipal Building J a' Northampton, MA 01060 Gf ,^c 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: 7G7) ll/'y-? / r Sal §/yeii( The debris will be transported by: Name of Hauler: 4-//(-ek '`-SpcS Signature of Applicant: Date: (3c., /2_ ( Proposal SEXTON ROOFING AND SIDING INC www.sextonroofing.com VINO P.O. Box 6327 �� .. Holyoke, MA 01041 SellIn 2 the Standard .■ r4�� A*AIM MUM MINN ai■lrrn►vim wrr• p. 413.534.1234 f. 413.539.9906 MA HIC =` 118239 sextonroofing@hotmail.com SUBMITTED TO Fay-Harris I PHONE 584-6554 I DATE 6/8/21 STREET 134 Maplewood Terrace - fa.har@verizonnet CITY,STATE,ZIP Florence, Ma. roofr SEXTON ROOFING HEREBY SUBMITS SPECIFICATIONS AND ESTIMATES FOR: Front section 1 side as noted on photo 1) Strip and remove existing shingles and dispose of in proper landfill. 2) Inspect roofing deck and replace as needed @ $105.00 per sheet. 3) Install new metal edging to rakes and eaves of roof. (white) 4) Install ice and water shield on eaves ( 6'), vent stacks. 5) Install synthetic roofing underlayment on remainder of roof. 6) Install new flanges over existing vent stacks. 7) Install starter shingles on eaves and rakes of roof. 8) Install 1KO Architectural style roofing shingles as per manufacturers' specifications. 9) Install new cap over ridge vent. 10)Supply manufactures Lifetime warranty and SRC 5 yr. workmanship warranty. ATTENTION HOMEOWNERS:PLEASE COVER All PERSONAL BELONGINGS IN THE ATTIC,GARAGE,OR STORAGE AREAS DUE TO POSSIBLE ROOFING DEBRIS OR DUST COMING THROUGH CRACKS OF WOOD DECKING. We Propose hereby to furnish material and labor-complete in accordance with the above specifications,for the sum of Four Thousand Eight Hundrded DOLLARS (S4,800.00) PAYMENTS TO BE MADE AS FOLOWS: due in full upon completion All Material is guaranteed to be as specified. All work to be compietect in Authorized a workmanlike manner according to standard practices. Any alteration or Signature deviation from above specifications involving extra costs will be executed only upon written orders,and will become an extra charge over and above the estimate.oAmAces 70 BUSKS AND O'3-ER'AGE-AMOK'WARKsorti ,s=►RAI(S_ Note:This proposal may be withdrawn by us if not accepted t.,NAvarABLE AND ws AREv x+ s t;ss. Not responsible for water damage within (14) days. during construction. Owner to pay responsible legal fees for . non-payment,and applicable interest Acceptance of Proposal The above prices, specifications and conditions are satisfactory and are Signature hereby accepted. You are authorized to the work as specified. Payment will be made as outlined above. Signature Date of Acceptance. department oflndustrialAcciderits �—a+y Office of Investia ations io ' .. Lafayette City Center . k,.. ,_:__,,p ,,,,,- - - 2Avenue de Lafayette, Boston,MA 02171-1750 - = www.mass.gov/dia Workers' Compensation Insurance Affidavit:Suilders/Con-tractors/E1ec#ricians/P1umbers Applicant Information Please Print Legibly Name(Business/Orr,.;i.=iion/tndividual):Sexton Roofing&Siding, Inc . Address:P.O. Box 6327 , • ' ' . City/State/Zip:Holyoke, MA 01041 Phone#:413-5341234 ' • Are you an employer?Check the appropriate boa: • Type ofproject.(required): - 1.❑ I am a employer with 4. Q I am a general contractor and I employees(full and/or pa t time).*- have hired the sub-contractors 5 ❑New consttLction 2_❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑RemodeFru; . - ship and have no employees .These sub-contractors have 8. 0 Demolition . • working for roe in an c a employees and have workers' Y ap 3' 9. ("Building addition • - [No workers' comp.insurance comp.insmance.t . required.] • 5. LI We area corporation and its ' I0.❑Electrical repass or additions 3.[]I am a homeowner doing all work . officers have exercised their •1 L❑Plumbing repairs or additions myself us•To workers' comp. ; .right of eacrut,lion per MGL • 12.1 Roof repairs in ins 'ance requiredl t c.152, §1(4'),and we have no - employees. [No workers'- '13.❑Other - comp.insurance required.] • . 'Any agpflcantthmr checks boa#1 Most also fill cetthe section below showingthefr workers'compensation policy information_ • . t Homeowners who submitthis afSdavitindicatingthe,y are doing all work audthrrahire outside contractors must sulantit anew.efEdnvitiodicatiog such- • 3Caatractors that clieckthis boxmust attached an additional sheet showmg the na ne of the sub-contractors and state whether or not thole entities have . ' employees. if the sub-contracans have employees,they must provide their workers'camp.policy number, . I wn an employer that is providing workers'compensation insurance forniy employees 'Below is the polity and job site ' • information: . Insurance Company Name:Travelers Property CAS CO OF AM ' • • Policy#orSelf--ins.Lie.#:7P,IUBQG07898220 • Expiration D e_614I29% ' . • Job Site Address: �, , ill,ti,,l eu 0.- \k ( City/State/zip: wall %'° 'A'.t 4 ' ' Attach a copy of the workers'compensation policy declaration page(showing the policy number and eipiration date). ' Failure to secure coverage as required under Section 25A ofMGL c.152 can lead to the imposition of criminal penalties'of a - fue 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 tlie Office of . Investigations of the DIA for'pittance coverage verification • I do hereby certify under thi6 '- and penalties.ofperjtrry that the information provided above is tree and correct �Sicrnatirre: Date: Ce (�v /2 I _ Phone#: 413-534-1.234 • Official use only. Do not write in this area,to be completed by city or town official •City or Town: • - PermitlLic ens e# • - Issuing Authority(check one): 1.0Board of Health 20 Building Department 311City/Town Clerk 4.0Electrical Inspector 5. lambing . Inspector 6.0Other • . • - Contact Person: V Phone ® DATE(MMIDD/Y YY) ACCPREP CERTIFICATE OF LIABILITY INSURANCE 06/14/2021 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: Eric Dembinske ORMSBY INSURANCE AGENCY (ac°.Ne,E ): (413)737-0300 (A/C,No): E-MAILeembinske ormsb in ADDRESS: d s.com� Y P 0 BOX 718 INSURER(S)AFFORDING COVERAGE NAIC# WEST SPRINGFIELD MA 01090 INSURER A: TRAVELERS PROPERTY CAS CO OF AM 25674 INSURED INSURER B: SEXTON ROOFING &SIDING INC INSURERC: INSURER D: PO BOX 6327 INSURER E: HOLYOKE MA 01041 INSURERF: COVERAGES CERTIFICATE NUMBER: 665015 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADOL SUBR POLICY EFF POLICY EXP LIMITS LTR INSD WVD_ POLICY NUMBER (MM/DD/YYYY) (MMIDD/YYYY) COMMERCIAL GENERAL LIABILITY EACH OCCURRENCEDAMAGE TO RENTE $ CLAIMS-MADE OCCUR 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 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 AND EMPLOYERS'LIABILITY X SOTH- TATUTE ER ANYPROPRIETOR/PARTNER/EXECUTIVE Y/N EL.EACH ACCIDENT $ 1,000,000 A OFFICER/MEMBEREXCLUDED? N/A N/A N/A 7PJUBOG07898221 06/04/2021 06/04/2022 (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 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Daniel M.CroW ey,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 • = - less, , :`=. = MA0211¢2017 • Wes' • TOES WITIIIIIE - - AppliMallflEllt2001R Meuse Priait Utah' Name 'll (L o ?n i n 1-()a, tickle= 45"eK.Q_VanT_3\- -kp-\\-- / F: - _ Cilyj t1 Pik ` -- 1-11#1" -6 - = 7 II New co 2E1Irsaa,okj_ iilororramr g fiukciel • 8. rR iftrmz 3.QIamabomcorrs-domg sit rafayleif/No umbers'asap.iscXmliee s It a.0 Ism alarvr a3..3tbx- ga we SaHuPeeYcemfrecr Iva , 14 0 mull ing easixe Hecuta o¢odscriac.nrketeca xi i i aitas=Tc Iin Bettritai repairs or achruions a Ianocs f 12-IIPlumhiqg or aikfltiaos - J m; ithcs -cic�aaEvcdoade=mrh'd-a+rr* Q�?Iahtse haiccmpivyc:saodhmels' nQ,arrt -- 6.0Ti esze corpoadionaod aficcshac c Acaiictaf�t verM�i,c_ i4:U _ 152. a� [rio, '�-mil - - *Any,am mtre ci..--1,-12=11rsuctaliniillottl- tioa inicsusatica. I-Ecrocownts-utpseimitibiszEridreitiocizatimerseyamdaiigaih adc2rddratllarootsidcmoizapoa>artsMohozitis.stf3dolisa atinz- lecniXicrics La cieckthabar vast*tithed aaa3c keslsiettsiouriq the some ar stale vd3etli=mmeltAgass btYs cmpicpyrs ff8s 3 �pio�ec tbcymrtprosi3c crow.policy atunbm • I cart ant rr €rsp faragr employers Betew lime arljob s?e i -insin-2Th-r-C.cralporiNax=4-40c(A Ondo-tof\-4T3 j fr'') OD, Sob Site Adam ( g= Atttata copy oftheworkers?coarpefflatios portcy dedamtionpe( the p yusucber'aad£ioRdate) Failure to secure caveragc as required trader-M .C 152:§25A isvacriminal lioleticonoonishalc by a fine up to SI,5110-40 Una& iroOriibbineut,[asiiiell as rndi tatoratiesiii the form ofa SLOP WO1 K ORDERandaE a of up to$250_00 a thy -the vio A topy offs maybe forwardedto The Off=ofIrvesfigatio-nsofffieDIA for insurance coverage vim.. I Li;hereby r ' .the artdpasabSrs of perjtrf tkitilte-isfrnewrsoftprirsiireith re is tie andcorrect_ Sirs turc 6v _ ►t- i t 1 (G ( .25.PJ Phone rr offical rise wiry_ Do art-wraebetkisarer4143Ire[ etedby city rrr town O,fitZa� a City or Town # - ` Issuing Au rity(circle oT I_Board of Hr:lth 2 RQ Ikpaz t#3 City/Town Clerk 4_E1edrkl iwportnr I batff nr 6.Other Cant elPan any_ Phone TE r A`�o® CERTIFICATE OF LIABILITY INSURANCE °A " "` ' 11/13/2020 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NG 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 NAJ,IE Edson DeSouza - MAYFLOWER INSURANCE GROUP INC No• 1: (774)773-9702 c ro> Edson@mayfowerinsurance.com 299 Court Street - - INSURER(S)AFFORDING COVERAGE NAIL It Plymouth MA 02360 uusURERA: HARTFORD UNDERWRITERS INS CO 30104 INSURED INSURER B: MNP CONSTRUCTION INC INSURERC: INSURER D: 45 EXCHANGE ST APT 3E INSURER E: _ MILFORD MA 01757 INSURER F: COVERAGES CERTIFICATE NUMBER: 595621 REVISION NUMBER: THIS IS TO CEKI IFY THAT THE POLICIES OF INSURANCE US I t1J 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 POUCIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADOLSUBR POLICY EFF POIJCYEXP LIMITS LTR TYPE OF INSURANCE N IY SD INVD POLICY NUMBER p.mvoDYYY) (Y YY)M/DD/YY COMMERCIAL GENERAL LIABOJTY EACH OCCURRENCE $ DAMAGE TO REN7ED CLAIMS-MADE OCCUR PREMISES(Fa occurrence) $ MED ESP(Anyone person) $ N/A PERSONAL&ADV INJURY $ Galt • �' FN GENERAL AGGREGATE $ POLICYI C LOC PRODUCTS-COMP/OP AGG $ OTHEEz AUTOMOBILE LIABILITY COMBINED SINGLELIMir $ (Ea accident) ANY-AUTO - BODILY INJURY(Per person) S _ ALL OWNED SCHEDULED AUTOS AUTOS N/A BODILY INJURY(Per acaderd) $ _ NON-OWNED PROPERTY DAMAGE $ _ HIRED AUTOS _ AUTOS (Per accident) $ UMBRELLA LIAR OCCUR EACH OCCURRENCE S EXCESS LIAR CLAIMS-MADE N/A AGGREGATE $ DED RETENTION S $ WORKERS COMPENSATION X STATUTE OTH- ER • AND EJdPLOYl3RS'LIABILITY Y 1 N ANYPROPRIETOR/PARTNER EXF_CmVE EL EACH ACCIDENT $ 1,000,000 A OFRCERIMEMBERE(CUJDED? WA WA WA 6S60UB1K70970620 11/16/2020 11/16/2021 ELEACHAE ACCIDENT EA EMPLOYEE $ 1,000,000 (Mandatory in NH) If Yes.describe under DESCRIPTION OF OPERATIONS below EL DISEASE-POLICY LIMIT $ 1,000,000 N/A DESCRIPTION OF OPERATIONS1 LOCATIONS 1 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(unlesv 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 arrescing the Proof of Coverage-Coverage Verification Search tool at www.mass.gov(Iwd/workers-compensafwnhfyestigations/. 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. Sexton Roofing &Siding Inc 102 Pine St AUTHORIZED REPRESENTATIVE Hol oke MA 01(}41 rL A- CL Y l Daniel M.C y,CPCU,Vice President—Residual Market—WCRIBMA ©1968-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD ACQRD) DATE(YY1D D7ri'YY) CERTIFICATE OF LIABILITY INSURANCE 11/24120 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 certifii..ite holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed 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 T Art Calvillo One Family Insurance Para Mo mil. 978-403-5942 FAX 978403-5943 1 Main St Suite 15 Lunenburg,MA 01462 DADDAn : artg1faraityinsurance.com ENSURER(S)AFFORDING COVERAGE NAIC INSURER A: Evanston Insurance Company INSURED INSURER B MNP CONSTRUCTION,INC. INSURER C: 45 EXCHANGE ST APT 3E INSURER D NIILFORD,MA 01757 INSURER E: INSURER F COVERAGES CERTIFICATE NUMBER: REVISION NUMBER THIS IS TO CERTIFY THAT THE POLICES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CON1J ON OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERI AIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIED)HEREIN IS SUBJECT TO ALLTHE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ILTR TYPE OF INSURANCE [NNSDL SUER POLICY NUMBER (MI D HYYYYYY)jM7 YDrfYYPYL ITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S 1,000,000 DAMAGE I-20,iELI CLAIMS-MADE X OCCUR PREMI�I om Ea lrreace) S 100,000 MID E(P(Any ane person) S 5,000 A Y Y 3t U 9335 11/20/20 11/20/21 PERsoNnL a ADv INJURY $ 1,000,000 GEN-L AGGREGATE LI)ATAP PLIES PER � GENERAL AGGREGATE S 2,000,000 POLICY PERO CT LOC PRODUCTS-COMP/OPAGG S 2,000,000 OTHER: AUTOMOBILE LIABILITY - COMBINED SINGLE LIMIT (Ea acadrsrt) ANY AUTO BODILY INJURY(Per person) S OWNED SCHEDULED BODILY INJURY(Per accident) S AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE AU I US ONLY AUTOS ONLY (Per accident) S UMBRELLA LIAB OCCUR - EACH OCCURRENCE S ECG`~LIAB CLAIMS-MADE AGGREGATE S DED RETENTIONS S WORKERS COMPENSATION I STATUTE I ER AND EMPLOYERS LIABILITY Y/N ANY PROPRIETOR/PARTNER/EXECUTIVE L N/A E EACH ACCIDENT S OFF10ER/MEMBER EXCLUGEtt1 (Mandatory In NH) EL DISEASE-EA EMPLOYEE $ I desrnbe Omdsr DESCRIPTION OF OPERATIONS belew EL DISEASE-POLICY LIMIT S n DESCRIPTION OF OPERATIONS/LOCATIONS I VE39CCLES (ACORO 1111,Additional Remarks Schedule,may be./11..r 7u1 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 SEXTON ROOFING SIDING INC ACCORDANCE WITH THE POLICY PROVISIONS.102 PINE ST P.O.BOX 6327 AUTHORIZED REpRESExrA HOLYOKE,MA010- 0 A /1". ©1988-2015 ACORD CORPORATION- All rights reserved. ACORD 25(2016/03) The ACORD name and Togo are registered marks of ACORD