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18C-105 (10) 51 GLEASON RD BP-2022-0049 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 18C- 105 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: REPAIR BUILDING PERMIT Permit# BP-2022-0049 Project# JS-2022-000083 Est. Cost: $28429.00 Fee: $188.50 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: 24 RESTORE NE LLC 103111 Lot Size(sq. ft.): 7143.84 Owner: LOHMEYER DEBORAH A Zoning: URB(100)/ Applicant: 24 RESTORE NE LLC AT: 51 GLEASON RD Applicant Address: Phone: Insurance: 9 CORPORATE RIDGE RD (508) 272-7912 WC HAMDENCT06514 ISSUED ON:7/14/20210:00:00 TO PERFORM THE FOLLOWING WORK:SI DI NG AND ROOF REPAIRS DUE TO TREE DAMAGE • 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 NORTHAMPTO UP VIOLATION OF ANY OF ITS RULES AND REGULATIONS. I ,� i • r i • I Certificate of Occupancy Signature: FeeType: Date Paid: Amount: Building 7/14/2021 0:00:00 $188.50 212 Main'Street, Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner �c �o Vie The Commonwealth of Massachus-,s ek, 1 �� � �� �c Board of Building Regulations and'Standa '4t °'�s a OR AVIc� : 1 Massachusetts State Building Code, 780 CMRg''sq,�ypo,,�, ? USCIPA TY ,._ roc Building Permit Application To Construct,Repair,Renovate Or,De • 4u ''vised ar 2011 One- or Two-Family Dwelling ''",.. °7osa%, This Section For Official Use Only / Building Permit Number:11 Q.• IA-Y'1-19 Date Applied: . "' Iii r it .• isii •-•,— 1 / BuildingOfficial(Print Name) Si Signature ``` - te - 1 SECTION 1: SITE INFORMATION 1.1.Property Addren 1.2 Assesso&Map&Parcel Numbers I GU:; , No�i4,0441301 h►Av 1 0 (� 1.1 a Is this an accepted street?yes_ no Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Area(sq ft) Frontage(ft) 1.5 Building Setbacks(ft) Front Yard Side Yards Rear Yard Required Provided • Required Provided Required Provided 1.6 Water Supply: (M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Public 0 Private 0 Zone.• — Outside Flood Zone? Municipal 0 On site disposal system 0 Check if yes❑ SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of Record; OaLoµIME. 4.(L 001410 eRh4 , MA mu, Name(Print) City,State,ZIP S( CALASOr) PO 913•Ip2(9•415'g, • No.and Street Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply) New Construction❑ Existing Building le Owner-Occupied 0 Repairs(s) EllAlteration(s) ❑ Addition 0 Demolition ❑ Accessory Bldg. ❑ Number of Units Other 0 Specify: Brief Description of Proposed Work2:(LL 1(111/4. pip gpl ajL 51010(r. el LJo flovh IG S1. k 4' )1,o� c IXto sc,,Aj' 1h-ep AOOJ'G. L . r-'f u 1,.i L • 41 �f- R ,k, s_i t444rtij , A'c- Ov145 OR to .0ti 14oh - SECTION 4:ESTIMATED CONSTRUCTION COSTS ' Item Estimated Costs: Official Use Only (Labor and Materials) 1. Building $ Li,LIZ,1 (01 1. Building Permit Fee: $ Indicate how fee is determined: 2.Electrical $ CIStandard City/Town Application Fee ❑Total Project Cost' (Item 6)x multiplier x 3. Plumbing $ 2. Other Fees: $ 4.Mechanical (HVAC) $ List: 5.Mechanical (Fire $ Suppression) Total All Fees: $ 0 a Check No.10 154 Check Amount: i Si' Cash Amount: 6.Total Project Cost: $2i•I VI GQ q 0 Paid in Full 0 Outstanding Balance Due: 1•61.So . • • • • , .• . . • • .. . , • . , • . , • . . $ t,t4.k, c . SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) CS•1o3I I I .Srj13I202.2 5'ASOy, Q. i el rib License Number Expiration Date Name of CSL Holder uo �t��� o� List CSL Type(see below) No.and Street` Type Description • n,p,, �� 02� U Unrestricted(Buildings up to 35,000 cu.ft.) L.0 R Restricted 1&2 Family Dwelling City/Town,State,ZIP M Masonry RC Roofing Covering WS Window and Siding SF Solid Fuel Burning Appliances SO$-Z721912 I Insulation Telephone Email address D Demolition 5.2 Registered Home Improvement Contractor(HIC) Z pl r Ogt OL IG frlg0� 3h�1 z3 HIC Registration Number Expiration Date HIC Company Name or HIC Registrant Name lb CV.WatiA s,f CiAbOrul �tY�G.�fo2� .cow` Np.and Street Emai address AN'O,s M A' 023l 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 . Itr 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 tru and accurate too the best of my knowledge and understanding. Ewa #aE► s ��,c to 1111102 Print Owner's or Authorized Agents 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 `'fat,, ,,-, _ S1�•' SAC r � < ' �`' Massachusetts 4�� fig , A:> � u 1� y , u Nl A' •y DEPARTMENT OF BUILDING INSPECTIONS 7I 11 {(a' of 212 Main Street • Municipal Building 3. J,.� . "�'' r.- " ' Northampton, MA 01060 ssy „grst CONSTRUCTION DEBRIS AFFIDAVIT (FOR ALL DEMOLITION AND RENOVATION PROJECTS) r 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: NOT SUt The debris will be transported by: Name of Hauler: MA- WOKE. Signature of Applicant: Ahtt.. /` T�� Date: li(14 2i The Commonwealth of lassaehusetts '�'' Department of Industrial Accidents :. s I Congress Street,Suite 100' °�a=. Boston,MA 02114-2017 '' ww amass gov9/rear % °orkers'Compensation Insurance Affidavit:Bturlders/C'ontractmirs EleetridiansiPlunthers. TO l3E FILED WITI1 I IE.PERMI.TTING.AUTHORIT_Y. - Applicant information - - - _ .. _. - _ _- .Please Print Legibly Nan1e.(Businessiorganizationirndividuni): 1 Hiles N - LU. Address: Ili C- u sT City/State/Zip:. fj49(0/" 7.. Phone#: :. I Are you an employer?Cheek the appropriate box: Type of project(required): La2<ota employer with 13 eat plows(fall ar,dror paca-uYc e).* 7_ CI New construction 201 am a sole proprietor or partnership•arid have no employees working force::in g. aReinodeling . any eapr city.[No workers'comp.insorance required.] 9. D Demolition 30 lent a hormauwner-doing all_work re,}.xlf.[No work rs'comp.irssucariee regain' r - 10 El Building addition. glla 1 ant a l onscarw n r and will be hiring emrtratt,ara CO conduct all work on my poperty. 1 will - ensure that all caanerat-turs either have workers'compensation insorant'e or arii..sole 11 E lectrical repairs.or'additions pro ..ritoaowit no employees 12.D Plumbing repairs or additions 50 1 it at,genmi1 contactor aid I hove hired the sub-contrat:tors listed on the attsehedsheet These sub•euntmeturs halm:employee and levee workers'comp_insurance.; l 3 41Of repine 14.Q.Other 6.Ell We are a corporation and its otTicect havo exercised their right of exemption per h9C L e. - 3 52.§1(4),and we]rite no anployecs.[No workers'comp.insinuate requued.4 *Any applicant that eltecks bare.1 moat also fill out the.4 section below,showing their wntkera'cutapensation policy cy information. t Homeowners who submit this affidavit indicating they are doing all work and than hire atutaide contractors must snbrsut a new affidavit indicating such. +Contractors that check this,bast rnn3t atesobed an...liliLional sheet showing the name of the aulrcontraetora and state whither or not those unr tititr have-. etnploycea_ If the stab-enraroctora bow taiapinyees,they must provide their workers`comp.policy number_ --,-_-_ - if am are-emplot`er that is providing workers'compensation insurance formyt employees. Below is the policy and fob site information. insurance.Coinpacty Nam.. : I4U`, I pliaottfc1O fJ(A l• J 1-y Polley#i or Self-ins.Lic.#: LA Z i.S POO I 64S'7 0 i Expiration ate:2I20 iZOZ 2 J'ob Site Address:S I 1 3.31:0 gg Cil'yiState,Zip HOPrilierlthIP,i1/4()I O(00 Attach a copy of the workers'compensation policy deelarationn page(showing the policy number and espiratlondate). Failure to secure'coverage as required under MGL,c. 152,§25A is a criminal violation punishable by a fate up to Si,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a tine of up to$250:01)a day against the violator_A copy of this statement may be forwarded to the Office of investigations of the DIA for insurance coverage verifications. - - - • /do hereby c t/fi under a le pa is and penalties.ofperirrrythat the information provided above is trice and correct. Sienattlre: e - -_- _ - - Date: /h 12O Z I . -.-. Phone#: Cb$-2IV-I`1)li - Official use only. Do not write in this area,to be completed by city or town offielat. City or.Town. PerinitJLieense#i • • Issuing Authority(circle one):- I.'Board of Health-2.Building Department 3.City'fTo 'n Clerk #.Electrical Inspector.5.Plumbing Inspector 6.Other, Contact Person: Phone . Kv-izeigeviaietodi 1://ge-iedidaeie,e&le/4, Office of Consumer Affairs and Business.Regulation 1000 Washington Street- Suite 710 Boston, Massachusetts 02118 Home Improvementp3ntractor Registration • Type: Supplement Card NE LLC. Registration: 174907 URCH 24 RESTORE 10 RE Expiration: 03/26/2023 S.EASTON,MA 02375 Update Address and Return Card. SCA 1 6 20M•05/17 • Office of Consumer Affairs&Business Regulation • HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only TYPE:.$upolement Card before the expiration date. If found return'to: plegistratior' Expiration Office of Consumer Affairs and Business Regulation 474837 u--. 03/26/2023 1000 Washington Street -Suite 710 • 24 RESTORE ME LLC. . r_f, Boston,MA 02118 • JAY FREITAS •• 10 CHURCH ST �,1. ✓�(Ct•�os*�' S.EASTON,MA 02375. Undersecretary Not valid Without signature • • Construction Supervisor Unrestricted-!Buildingsof any_use group:which contain less than 366,000 cubic feet(991 cubic meters)of enclosed space. • f Failure to possess a current edition of the Massachusetts State Building Code is cause for revocation of this•license. • For information about`this license Cell,(617)727.3200 or visit wrww.mass.gov/dpl • • Commonwealth of.Massachnsetts Division of Professional,Licensure Board of Building Regulations and Standards • ( ii 'Construc`t on Stypfe, v sor• ;. CS 10311G1 ^; £ Expires:05113/2022 JASON R FREITAS 1740 JENNA D,R { `), I DIGHTON MA.:Q2715+ ;I I -° Ill° 1 • ,4 Commissioner r„ `O hO . 1 '4 • 24RESTO-01 CWOODSIDE AC-E RO° CERTIFICATE OF LIABILITY INSURANCE DATE(M 2/22/202YYY) 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 License#1780862 CONTACT Gretchen Houghton NAME: HUB International New England PHONE I FAX 600 Longwater Drive (NC,No,Ext): (NC,No): Norwell,MA 02061-9146 ADDRESS:gretchen.houghton@hubinternational.com INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:National Fire&Marine 20079 INSURED INSURER B:Arbella Protection Insurance Company 41360 24 Restore NE LLC INSURER C:Ohio Casualty Insurance Company 24074 10 Church Street INSURER D: South Easton,MA 02375 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 TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS LTR INSD MAID POLICY (MMIDD/YYYYI A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 2,000,000 CLAIMS-MADE X OCCUR 42ESP00155701 2/20/2021 2/20/2022 DAMAGE TO RENTED 500,000 X X PREMISES(Ea occurrence) $ X CPL-Pollution MED EXP(Any one person) $ 10,000 X Environmental Impair PERSONAL&ADVINJURY $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 4,000,000 X POLICY X JECOT- X LOC PRODUCTS-COMP/OPAGG $ 4,000,000 X OTHER:Professional Liability $ B AUTOMOBILE LIABILITY • COMBINED SINGLE LIMIT 1,000,000 (Ea accident) _ ANY AUTO X X 1020094653 2/20/2021 2/20/2022 BODILY INJURY(Per person) $ OWNED SCHEDULED AUTOS ONLY v AUTOS BODILY INJURY(Per accident) $ X HIREDT ONLY X NON-OWNED ONLYY (Per PROPERTY DAMAGE A X UMBRELLA LIAB OCCUR EACH OCCURRENCE $ 3,000,000 EXCESS LIAB CLAIMS-MADE X x 42EXS00155801 2/20/2021 2/20/2022 AGGREGATE $ 3,000,000 DED RETENTION$ / $ C WORKERS COMPENSATION X STATUTE ER OTH AND EMPLOYERS'LIABILITY XW061039279 2/20/2021 2/20/2022 1,000,000 ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N X E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? N N/A (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under 1,000,000 DESCRIPTION OF OPERATIONS below • E.L.DISEASE-POLICY LIMIT $ C Bailee's Coverage BM2161013735 3/11/2021 3/11/2022 Inland Marine 250,000 • DESCRIPTION OF OPERATIONS/LOCATIONS!VEHICLES (ACORD 101,Additional Remarks Schedule may be attached if more space is required) The National Fire&Marine Insurance Policy#42ESP00155701 also includes the following: Contractors Pollution Liability Each Pollution Condition:$2,000,000 Contractors Pollution Liability Aggregate:$4,000,000 Transportation Pollution Liability Each Pollution Event: $2,000,000 Transportation Pollution Liability Aggregate:$4,000,000 Environmental Impairment Liability Each Pollution Condition:$1,000,000 Environmental Impairment Liability Aggregate:$1,000,000 SEE ATTACHED ACORD 101 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 24 Restore NE LLC THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Evidence of Coverage Only 10 Church Street South Easton,MA 02375 AUTHORIZED REPRESENTATIVE ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID:24RESTO-01 CWOODSIDE LOC#: 1 A O° ADDITIONAL REMARKS SCHEDULE Page 1 of 1 AGENCY License#1780862 NAMED INSURED HUB International New England 24 Restore NE LLC g 10 Church Street POLICY NUMBER South Easton,MA 02375 SEE PAGE 1 CARRIER NAIC CODE SEE PAGE 1 SEE P 1 EFFECTIVE DATE:SEE PAGE 1 ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: ACORD 25 FORM TITLE: Certificate of Liability Insurance Description of Operations/Locations/Vehicles: Professional Liability Each Wrongful)Act:$2,000,000 Professional Liability Aggregate:$4,000,000 Specified Professional Services Endorsement-Professional services means project management or supervision;or construction means,methods,techniques,_sequences and procedures in connection with the named Insured's contracting operations performed by the Named Insured in its capacity of a specialty trade or artisan contractor The National Fire&Marine Insurance Policy#42ESP00155701 includeds Blanket Additional Insured on a Primary and Non Contributory bases and Waiver of Subrogation that all apply when required by written contract or agreement. The Contractors Pollution and General Liability Policy includes the following endorsements: CG 00 01 12 07-Commercial General Liability Coverage Form-Occurrence form AWW ECC 0201 0414-Contractors Pollution Liability Form-Occurrence form AWW ECC 0310 0714-Automatic Additional Insured when required by written contract or agreement-Owners,Lessees,or Contractors CG 20 37 04 13-Additional Insured for Owners,Lessees,Contractors-Completed Operations Coverage AWW ECC 0311 1013-AUTOMATIC WAIVER OF SUBROGATION ENDORSEMENT AWW ECC 0313 1013-AUTOMATIC PRIMARY AND NON-CONTRIBUTORY INSURANCE ENDORSEMENT-DESIGNATED WORK OR PROJECTS AWW ECC 0377 0914-Amendment of Cancellation Notice Endorsement-30 Days and 10 day notice of cancellation for non payment of premium. The Commercial Auto Policy includeds blanket additional insured when required by written contract and Waiver of Subrogation. Worker's Compensation policy includes Waiver of Subrogation. The Umbrella/Excess Policies are follow form on the General Liability,Auto Liability and Employers Liability Evidence of Coverage Only • ACORD 101 (2008/01) ©2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD 24 Restore 9 Corporate Ridge Road 2111 Hamden CT 06514 RESPOND.REMEDIATE•REBUILD Insured: DEB LOHMEYER Home: (413)626-4581 Property: 51 GLEASON ROAD NORTHAMPTON,MA 01060 Home: 51 GLEASON ROAD NORTHAMPTON,MA 01060 Claim Rep.: Esther Oneill Company: Mapfre Estimator: Dave Worthington Business: (203)233-3106 Company: 24 Restore E-mail: Dworthington@24Restorene. Business: 9 Corporate Ridge Rd corn Hamden,CT 06514 Claim Number: TYVP01 Policy Number: BDQKDH Type of Loss: Wind Damage Date Contacted: 6/14/2021 Date of Loss: 6/8/2021 2:00 AM Date Received: 6/8/2021 2:00 AM Date Inspected: 6/15/2021 Date Entered: 6/16/2021 8:23 AM Date Est.Completed: 6/30/2021 12:53 PM Price List: MASP8X JUN21 Restoration/Service/Remodel Estimate: DEB LOHMEYER 24 Restore 9 Corporate Ridge Road 2111114 Hamden CT 06514 RESPOND•REMEDIATE•REDOILD DEB_LOHMEYER Main Level �3'8"-P3'10"4-3'8"-t Bedroom Height:8' ..4.,---1-7-4. T 298.89 SF Walls 114.92 SF Ceiling Bedroom 1 ' 413.81 SF Walls&Ceiling 114.92-SF Floor P3'3"4-3'8"4 12.77 SY Flooring 39.67 LF Floor Perimeter 1 a '• '1 Closet - 45.83 LF Ceil.Perimeter Door 2'6"X 6' 8" Opens into Exterior Door 3'8"X 6' 8" Opens into CLOSET Window 2' 10" X 4' Opens into Exterior Window 3' 10"X 4' Opens into Exterior DESCRIPTION QTY REMOVE REPLACE TAX O&P TOTAL 1. Drywall patch/small repair,ready 1.00 EA 0.00 97.20 0.22 19.44 116.86 for paint • 2. Seal the surface area w/PVA primer- 4.00 SF 0.00 0.62 0.02 0.50 3.00 one coat 3. Paint the walls and ceiling-two 413.81 SF 0.00 1.25 5.95 103.46 626.67 coats-2 colors 4. Contents-move out then reset 1.00 EA 0.00 69.12 0.00 13.82 82.94 5. Final cleaning-construction- 114.92 SF 0.00 0.27 0.00 6.20 37.23 Residential Totals: Bedroom 6.19 143.42 866.70 Total:Main Level 6.19 143.42 866.70 Exterior o�"�7,lo Front Elevation Height: 8' 378.11 SF Walls 147.07 SF Ceiling Windowsi(B1) 525.18 SF Walls&Ceiling 115.41 SF Floor Front Elevation ;, Frc 12.82 SY Flooring 47.26 LF Floor Perimeter 14' L 47.26 LF Ceil.Perimeter - -14'4".-t DEB_LOHMEYER 7/7/2021 Page: 2 24 Restore 9 Corporate Ridge Road "AHamden CT 06514 RESPOND.REMEDIAIE.REBUILD CONTINUED-Front Elevation Subroom: Front Elevation(1) Height:8' P--1T--o/ 16'7" 409.15 SF Walls 149.15 SF Ceiling wi 'ONv i? 558.30 SF Walls&Ceiling138.87 SF Floor Frol t Elev tion(1) ^ C it 6, I 15.43 SY Flooring 51.14 LF Floor Perimeter 1 51.14 LF Ceil.Perimeter ��12'4"- a Subroom: Front Elevation(2) Height: 8' 11'10"= 1 315.35 SF Walls 106.50 SF Ceiling Front EIMEntIM o, 421.85 SF Walls&Ceiling 58.05 SF Floor 1 6.45 SY Flooring 41.67 LF Ceil.Perimeter 35.67 LF Floor Perimeter DESCRIPTION QTY REMOVE REPLACE TAX O&P TOTAL 6. R&R House wrap(air/moisture 312.34 SF 0.05 0.33 3.32 23.74 145.75 barrier) 7. R&R Siding-vinyl 312.34 SF 0.54 3.78 33.58 269.88 1,652.77 8. R&R Fascia-vinyl-up to 8" 44.30 LF 0.43 5.11 5.65 49.10 300.17 9. Window screen, 1 -9 SF 1.00 EA 0.00 37.98 2.06 7.60 47.64 10. R&R Gutter/downspout- 48.20 LF 0.64 7.08 11.57 74.44 458.12 aluminum-up to 5" 11. R&R Gutter guard/screen 28.20 LF 0.48 3.22 2.33 20.86 127.53 Totals: Front Elevation 58.51 445.62 2,731.98 Left Elevation 1 Height: 8' �/\3\�`A �J3�JI„'3".......... 572.47 SF Walls 300.64 SF Ceiling ,v , (B1) win W (B2) ' 1 873.11 SF Walls&Ceiling 284.28 SF Floor Left Elevatio _ b, 31.59 SY Flooring 71.56 LF Floor Perimeter 25'8" •.1 71.56 LF Ceil.Perimeter (-26'2^-I DESCRIPTION QTY REMOVE REPLACE TAX O&P TOTAL 12. R&R House wrap(air/moisture 284.28 SF 0.05 0.33 3.02 21.60 132.64 barrier) 13. R&R Siding-vinyl 284.28 SF 0.54 3.78 30.56 245.62 1,504.27 14. R&R Fascia-vinyl-up to 8" 28.00 LF 0.43 5.11 3.57 31.02 189.71 DEB_LOHMEYER 7/7/2021 Page: 3 24 Restore 9 Corporate Ridge Road - Hamden CT 06514 RESPOND.REMEOATE.REBUILD CONTINUED-Left Elevation 1 DESCRIPTION QTY REMOVE REPLACE TAX O&P TOTAL 15. R&R Attic vent-gable end-vinyl 1.00 EA 10.54 119.68 4.90 26.04 161.16 16. Clothes dryer vent cover-Detach 1.00 EA 0.00 34.27 0.00 6.86 41.13 &reset Totals: Left Elevation 1 42.05 331.14 2,028.91 „fir-'7,-4.1's".:, T Roof! 1E--.15, F( F5 A)°°'- T1,571.07 Surface Area 15.71 Number of Squares 6" R�..I (R !_i;* 173.36 Total Perimeter Length 72.51 Total Ridge Length Fl(A) r U._ i-1 'II' - . -411 DESCRIPTION QTY REMOVE REPLACE TAX O&P TOTAL 17. Remove Sheathing-spaced 1"x 6" 1,571.07 SF 0.78 0.00 0.00 245.08 1,470.51 18. Sheathing-plywood-1/2"CDX 1,571.07 SF 0.00 4.04 240.57 1,269.42 7,857.11 19. Tear off composition shingles(no 15.71 SQ 47.45 0.00 0.00 149.08 894.52 haul off) 20. Laminated-comp.shingle rfg.- 17.33 SQ 0.00 247.82 121.22 858.94 5,274.88 w/out felt 21. Asphalt starter-universal starter 70.00 LF 0.00 2.45 3.11 34.30 208.91 course 22. Roofing felt- 15 lb. 11.51 SQ 0.00 35.04 4.68 80.66 488.65 23. Ice&water barrier 420.00 SF 0.00 1.72 11.55 144.48 878.43 24. Ridge cap-composition shingles 72.51 LF 0.00 4.69 5.62 68.02 413.71 25. Valley metal 54.97 LF 0.00 6.03 6.97 66.30 404.74 26. Drip edge 173.36 LF 0.00 2.82 11.05 97.78 597.71 27. R&R Chimney flashing-average 1.00 EA 23.73 431.77 5.08 91.10 551.68 (32"x 36") 28. Flashing-pipe jack-6" 1.00 EA 0.00 66.16 1.89 13.24 81.29 29. R&R Rafters-2x6 stick frame roof 108.00 BF 1.19 4.19 17.21 116.20 714.45 Totals: Roofl 428.95 3,234.60 19,836.59 Total:Exterior 529.51 4,011.36 24,597.48 . General Conditions DEB_LOHMEYER 7/7/2021 Page:4 -III24 Restore 9 Corporate Ridge Road Hamden CT 06514 RESPQND.REMEDIAME.REBUILD • CONTINUED-General Conditions DESCRIPTION QTY REMOVE REPLACE TAX O&P TOTAL 30. R&R Chain link fence w/posts& 21.00 LF 3.39 15.98 12.71 81.36 500.84 top rail-4'high-9 gauge 31. Dumpster load-Approx.40 yards, 1.00 EA 1,022.76 0.00 0.00 204.56 1,227.32 .7-8 tons of debris 32. Taxes,insurance,permits&fees 1.00 EA 0.00 100.00 0.00 20.00 120.00 (Bid Item) Roofing+$40 and siding=$60=$100.00 Totals: General Conditions 12.71 305.92 1,848.16 Labor Minimums Applied DESCRIPTION QTY REMOVE REPLACE TAX O&P TOTAL 33. Window labor minimum 1.00 EA 0.00 230.30 0.00 46.06 276.36 34. Heat,vent,&air cond.labor 1.00 EA 0.00 229.01 0.00 45.80 274.81 minimum 35. Drywall labor minimum 1.00 EA 0.00 398.39 0.00 79.68 478.07 36. Cleaning labor minimum 1.00 EA 0.00 73.43 0.00 14.68 88.11 Totals: Labor Minimums Applied 0.00 186.22 1,117.35 Line Item Totals:DEB_LOHMEYER 548.41 4,646.92 28,429.69 Grand Total Areas: 4,374.09 SF Walls 1,743.83 SF Ceiling 6,117.93 SF Walls and Ceiling 1,454.31 SF Floor 161.59 SY Flooring 534.70 LF Floor Perimeter 0.00 SF Long Wall 0.00 SF Short Wall 566.54 LF Ceil.Perimeter 1,454.31 Floor Area 1,915.32 Total Area 4,374.09 Interior Wall Area 4,292.25 Exterior Wall Area 457.83 Exterior Perimeter of Walls 1,571.07 Surface Area 15.71 Number of Squares 0.00 Total Perimeter Length 72.51 Total Ridge Length 0.00 Total Hip Length • Coverage Item Total % ACV Total % Dwelling 27,928.85 98.24% 27,928.85 98.24% Other Structures 500.84 1.76% . 500.84 1.76% Total 28,429.69 100.00%, 28,429.69 100.00% DEB_LOHMEYER 7/7/2021 Page:5 24 Restore 9 Corporate Ridge Road 211E4 Hamden CT 06514 RESPOND•REMEDIATE•REDURD Summary for Dwelling Line Item Total 22,827.59 Overhead 2,282.78 Profit 2,282.78 Material Sales Tax 535.70 Replacement Cost Value • $27,928.85 Net Claim $27,928.85 Dave Worthington DEB_LOHMEYER 7/7/2021 Page:6 24 Restore 9 Corporate Ridge Road 211114 Hamden CT 06514 RESPOND•REMEOIATE.RERURD Summary for Other Structures ° Line Item Total 406.77 Overhead 40.68 Profit 40.68 Material Sales Tax 12.71 Replacement Cost Value $500.84 Net Claim $500.84 • Dave Worthington • DEB_LOHMEYER 7/7/2021 Page:7 24 Restore 9 Corporate Ridge Road "AIM Hamden CT 06514 RESPOND.REMEDIATE.REBUILD Recap of Taxes, Overhead and Profit Overhead(10%) Profit(10%) Material Sales Tax Clothing Sales Tax Storage Tax(6.25%) (6.25%) (6.25%) Line Items 2,323.46 2,323.46 548.41 0.00 0.00 Total 2,323.46 2,323.46 548.41 0.00 0.00 DEB_LOHMEYER 7/7/2021 Page: 8 7 24 Restore 9 Corporate Ridge Road Il Hamden CT 06514 DESPOND.REMWIATE.REBUILD Recap by Room Estimate:DEB_LOHMEYER Area:Main Level Bedroom 717.09 3.09% Coverage:Dwelling 100.00% = 717.09 Area Subtotal: Main Level 717.09 3.09% Coverage:Dwelling 100.00% = 717.09 Area:Exterior Front Elevation 2,227.85 9.59% Coverage:Dwelling 100.00% = 2,227.85 Left Elevation 1 1,655.72 7.13% Coverage:Dwelling 100.00% = 1,655.72 Roofl 16,173.04 69.61% Coverage:Dwelling 100.00% = 16,173.04 Area Subtotal: Exterior 20,056.61 86.32% Coverage:Dwelling 100.00% = 20,056.61 General Conditions 1,529.53 6.58% Coverage:Dwelling 73.41% = 1,122.76 Coverage: Other Structures 26.59% = 406.77 Labor Minimums Applied 931.13 4.01% Coverage:Dwelling 100.00% = 931.13 Subtotal of Areas 23,234.36 100.00% Coverage:Dwelling 98.25% = 22,827.59 Coverage: Other Structures 1.75% = 406.77 Total 23,234.36 100.00% DEB_LOHMEYER 7/7/2021 Page:9 24 Restore 9 Corporate Ridge Road 7A1114 Hamden CT 06514 RESPOND.REMEOIATE.REBUILD Recap by Category O&P Items Total % CLEANING 104.46 0.37% Coverage:Dwelling @ 100.00% = 104.46 CONTENT MANIPULATION 69.12 0.24% Coverage:Dwelling @ 100.00% = 69.12 GENERAL DEMOLITION 3,655.09 12.86% Coverage:Dwelling @ 98.05% = 3,583.90 Coverage: Other Structures @ 1.95% = 71.19 DRYWALL 495.59 1.74% Coverage:Dwelling @ 100.00% = 495.59 PERMITS AND FEES 100.00 0.35% Coverage:Dwelling @ 100.00% = 100.00 FENCING 335.58 1.18% Coverage: Other Structures @ 100.00% = 335.58 FRAMING&ROUGH CARPENTRY 452.52 1.59% Coverage:Dwelling @ 100.00% = 452.52 HEAT, VENT&AIR CONDITIONING 263.28 0.93% Coverage:Dwelling @ 100.00% = 263.28 PAINTING 519.74 1.83% Coverage:Dwelling @ 100.00% = 519.74 ROOFING 13,597.40 47.83% Coverage:Dwelling @ 100.00% = 13,597.40 SIDING 2,571.79 9.05% Coverage:Dwelling @ 100.00% = 2,571.79 SOFFIT,FASCIA,&GUTTER 801.51 2.82% Coverage:Dwelling @ 100.00% = 801.51 WINDOW REGLAZING&REPAIR 37.98 0.13% Coverage:Dwelling @ 100.00% = 37.98 WINDOWS-WOOD 230.30 0.81% Coverage:Dwelling @. 100.00% = 230.30 O&P Items Subtotal 23,234.36 81.73% Overhead 2,323.46 8.17% Coverage:Dwelling @ 98.25% = 2,282.78 Coverage: Other Structures @ 1.75% = 40.68 Profit 2,323.46 8.17% Coverage:Dwelling @ 98.25% = 2,282.78 Coverage: Other Structures @ 1.75% = 40.68 Material Sales Tax 548.41 1.93% Coverage:Dwelling @ 97.68% = 535.70 Coverage: Other Structures @ 2.32% = 12.71 Total 28,429.69 100.00% DEB_LOHMEYER 7/7/2021 Page: 10 Main Level 11'2" I J 10' 6" L Bedroom Cr) 7' 5" 7' 1" Closet a` ~-3' 7" I 7'7" I L1 Main Level DEB_LOHMEYER 7/7/2021 Page: 11 Exterior • Gab" . • `` 1 In+•� �12'4"� '+ Il'S"� IS'8iYA� •r�19'3"—� HII'6"y/ ,`\'. 73• i y. i T •t t i 111 2 [ i'ty7:1"i, lA=rr Ott .,I n•". "y ���sl: d•"5 Fr• `"l:r 'ul � �� 'i.,, a Ir2 1" , ; I ; 3�:�' `rr; IN .�''I * r• 1 25,8• u,8" • 2" I 6" 1-37'8" m I--.15'6' I PA 01 ;5 8. 9 FI(A�. c> 7 Roo' I . p ` I-1 '11' — •--� 1-14'4"•--• E I "fi". Exterior DEB_LOHMEYER 7/7/2021 Page: 12 21• RESPOND•REMEDIATE•REBUILD 24 Restore NE LLC 9 Corporate Ridge Road, Hamden CT 06514 PH: 1.475.655.7800 Fax: 203.553.7963 HOME IMPROVEMENT CONTRACT Service Start Date: TBD Service completion Date: TBD Contractor/Salesperson Name: Dave Worthington Home Improvement Contractor Reg.Number: HIC#0660478 Property Owner: Deb Lohmeyer Authorized By: Deb Lohmeyer Address: 51 Gleason Road,Northampton,MA 01060 Relationship: Insured Phone: 413-626-4581 Insurance Co: Mapfre Claim TYVP01 Scope: (A)Specific work and associated work schedules are described and attached hereto as Exhibit 1 and are subject to change at any time by written agreement between Owner and Contractor(the "Parties"). All work performed by the Contractor shall be done in a workmanlike manner and conforming to required building codes and industry building practices. Any city,town or state mandated code upgrades and/or approved supplements will be in addition to contract. (B) Estimated payments are set forth below. The dollar amounts and timing of payments are subject to change at any time by written agreement between the Parties. Owner shall provide Contractor with a Final Punch List of remaining work items to be completed before final payment is made. This punch list is to be provided prior to completion of project to ensure efficient completion of the project. Owner shall pay contractor final payment of additional fees for change orders,code upgrades or supplements when they are signed. Contracted amount is due upon completion of the work. Doc ID:0e6c7881cae072d8187979124fbf2f73e7b55442 24 Restore NE LLC Work to be performed in accordance with estimate named"DEB_LOHMEYER" written by Dave Worthington on June 21,2021 with a total value of$28,429.69. Total Contract Price: $28,429.69 Payment Terms: To be paid by Mapfre upon Certificate of Satisfaction $28,429.69 If the construction scope of work is changed in any way,whether it is an addition or subtraction to the scope of work,a change order will be issued. Change orders consist of the definition of the change in the scope of work or type of material to be used(including fixtures or soft costs)and the cost associated with these changes. The change order will be presented to the Owner and asked to be signed to acknowledge the cost and definition of the work to be changed. Any change of work requiring a Change Order will not be started until all parties have agreed on the change order and have signed off for acceptance. Because Change Orders can affect the time of the project length, an estimated time to complete the change order will be provided. All parties must sign off on the Change Orders in a timely manner. Construction work on the change order will not proceed until all parties have agreed and signed off,therefore the contractor is not responsible for down time associated with waiting for approval signatures on any changes and that downtime will extend the substantial completion date. Electronic signatures or Email acceptances of change orders are acceptable provided they include all information pertaining to the change order. Change order costs will be estimated and payment is due in full upon the approval of the change. Change orders are estimated and may result in client credits or additional charges. These will be detailed upon completion of the change order. Hidden and Unanticipated items: • These are any items whose scope of work are hidden until construction has allowed them to be discovered. Hazardous wiring or hidden plumbing are the most common items to be discovered upon opening walls with construction. Significant rot and mold are common discoveries. These items will be shown and explained to homeowner,but any additional labor or materials for these items will be billed to the owner/and or insurance carrier on a time and materials basis. Pictures and email may be used to help expedite a decision if the discovery were to cause any delays to construction: Permits: The following permits are required for this contract: It shall be the obligation of the contractor to obtain the permits. Provisions re timely payment of contractors,subcontractors,and suppliers: The owner shall pay any amounts due to any contractor in a direct contractual relationship with the owner, or due to any subcontractor/or supplier in a direct contractual relationship with the contractor, whether for labor performed or materials furnished,not later than thirty days after the date any written request for such payment has been made to the owner by such contractor, subcontractor or supplier; The contractor shall pay any amounts due any subcontractor or supplier,whether for labor performed or materials furnished,not later than twenty-five days after the date the contractor receives payment from the owner which encompasses labor performed or materials furnished by such subcontractor or supplier. The 2 Doc ID:0e6c7881cae072d8187979124fbf2f73e7b55442 24 Restore NE LLC contractor shall include in each of its subcontracts a provision requiring each subcontractor and supplier to pay any amounts due any of its subcontractors or suppliers,whether for labor performed or materials furnished,not later than twenty-five days after the date such subcontractor or supplier receives a payment from the contractor which encompasses labor performed or materials furnished by such subcontractor or supplier. Dispute Resolution: If a dispute arises from or relates to this contract or the breach thereof, and if the dispute cannot be settled through direct discussions,the parties agree to endeavor first to settle the dispute by mediation administered by the American Arbitration Association under its Construction Industry Mediation Procedures before resorting to arbitration.The parties further agree that any unresolved controversy or claim arising out of or relating to this contract,or breach thereof,shall be settled by arbitration administered by the American Arbitration Association in accordance with its Construction Industry Arbitration Rules and judgment on the award rendered by the arbitrator(s)may be entered in any court having jurisdiction thereof. The arbitration shall be governed by the laws of the State of Connecticut.Notwithstanding any language to the contrary in the contract documents,the parties hereby agree:that the Underlying Award may be appealed pursuant to the AAA's Optional Appellate Arbitration Rules("Appellate Rules");that the Underlying Award rendered by the arbitrator(s)shall, at a minimum,be a reasoned award; and that the Underlying Award shall not be considered final until after the time for filing the notice of appeal pursuant to the Appellate Rules has expired. Appeals must be initiated within thirty(30)days of receipt of an Underlying Award,as defined by Rule A-3 of the Appellate Rules,by filing a Notice of Appeal with any AAA office. Following the appeal process the decision rendered by the appeal tribunal may be entered in any court having jurisdiction thereof. Cost of Collection: If 24 Restore is required to engage outside representatives for the purpose of collecting payment hereunder,I agree to pay all costs of collection, including attorney's fees and 24 Restores legal expenses incurred with the collection of amounts due them;whether or not a lawsuit is filed. Interest/finance charges will be charged at a rate of 18%per annum on all delinquent accounts;the maximum rate permitted by applicable law. Warranty: Without limiting any provision of this agreement and notwithstanding anything to the contrary contained herein,the Contractor covenants and agrees as follows: The repair of the following items is specifically excluded from Contractor's warranty: • Damages resulting from lack of Owner maintenance • Damages resulting from Owner abuse or ordinary wear and tear Subcontractors: 3 Doc ID:0e6c7881cae072d8187979124fbf2f73e7b55442 24 Restore NE LLC The Contractor agrees to be solely responsible for completion of the work described regardless of the actions of any third party/subcontractor utilized by the contractor. The Contractor further agrees to be solely responsible for all payments to all subcontractors for materials and labor under this agreement. Contract Acceptance Upon signing,this document becomes a binding contract under law. Unless otherwise noted within this document,the contract shall not imply that any lien or other security interest has been placed on the residence. • Access I hereby employ and authorize the Contractor and its employees and agents to enter and exit the premises described above as necessary to provide the reconstruction services. I understand that I am responsible for securing the premises both during and after the performance of the Contractor's improvements. Contractor shall not be responsible for any loss and/or damage to the premises or any personal property located therein caused by failure to secure the premises. Payment I agree to pay for all materials and labor approved by my insurance company expended by Contractor in connection with the work they perform as described above. Authority I hereby affirm that I possess the authority to authorize the completion of the above improvements. I agree I am personally responsible for any and all charges relating to the services provided by the Contractor pursuant to this agreement, if in fact,I do not possess such authority. YOU, THE BUYER, MAY CANCEL THIS TRANSACTION AT ANY TIME PRIOR TO MIDNIGHT OF THE THIRD BUSINESS DAY AFTER THE DATE OF THIS TRANSACTION. SEE THE ATTACHED NOTICE OF CANCELLATION FORM FOR AN EXPLANATION OF THIS RIGHT. Do not sign this contract if there are blank spaces. 4'd 0C9A0 e1 2 06/30/2021 `- 06/30/2021 Signature and Date Signature and Date Deb Lohmeyer Gina Murray Printed Name Printed Name • 4 Doc ID:0e6c7881cae072d8187979124fbf2f73e7b55442 24 Restore NE LLC - NOTICE OF CANCELLATION YOU MAY CANCEL THIS TRANSACTION, WITHOUT ANY PENALTY OR OBLIGATION, WITHIN THREE BUSINESS DAYS FROM THE ABOVE DATE. IF YOU CANCEL,ANY PROPERTY TRADED IN, ANY PAYMENTS MADE BY YOU UNDER THE CONTRACT OR SALE, AND ANY NEGOTIABLE INSTRUMENT EXECUTED BY YOU WILL BE RETURNED WITHIN TEN BUSINESS DAYS FOLLOWING RECEIPT BY THE SELLER OF YOUR CANCELLATION NOTICE, AND ANY SECURITY INTEREST ARISING OUT OF THE TRANSACTION WILL BE CANCELLED. IF YOU CANCEL,YOU MUST MAKE AVAILABLE TO THE SELLER AT YOUR RESIDENCE, IN SUBSTANTIALLY AS GOOD CONDITION AS WHEN RECEIVED, ANY GOODS DELIVERED TO YOU UNDER THIS CONTRACT OR SALE; OR YOU MAY, IF YOU WISH, COMPLY WITH THE INSTRUCTIONS OF THE SELLER REGARDING THE RETURN SHIPMENT OF THE GOODS AT THE SELLER'S EXPENSE AND RISK. IF YOU DO MAKE THE GOODS AVAILABLE TO THE SELLER AND THE SELLER DOES NOT PICK THEM UP WITHIN TWENTY DAYS OF THE DATE OF CANCELLATION, YOU MAY RETAIN OR DISPOSE OF THE GOODS WITHOUT ANY FURTHER OBLIGATION. IF YOU FAIL TO MAKE THE GOODS AVAILABLE TO THE SELLER, OR IF YOU AGREE TO RETURN THE GOODS TO THE SELLER AND FAIL TO DO SO,THEN YOU REMAIN LIABLE FOR PERFORMANCE OF ALL OBLIGATIONS UNDER THE CONTRACT. TO CANCEL THIS TRANSACTION, MAIL OR DELIVER A SIGNED AND DATED COPY OF THIS CANCELLATION NOTICE OR ANY OTHER WRITTEN NOTICE, OR SEND A TELEGRAM TO .... (Name of Seller) AT .... (Address of Seller's Place of Business) NOT LATER THAN MIDNIGHT OF....(Date) I HEREBY CANCEL THIS TRANSACTION. .... (Date) .... (Buyer's Signature) 5 Doc ID:0e6c7881cae072d8187979124fbf2f73e7b55442 VHELLOSIGN ` Audit Trail TITLE Revised contract for repairs FILE NAME Lohmeyer Contract.docx DOCUMENT ID 0e6c7881 cae072d8187979124fbf2f73e7b55442 AUDIT TRAIL DATE FORMAT MM/DD/YYYY STATUS •Completed Document History 06 1 30/2021 Sent for signature to Deb Lohmeyer(dlohme@gmail.com)from SENT 17:07:20 UTC gmurray@24restorene.com IP: 50.212.123.241 0 06/30/2021 Viewed by Deb Lohmeyer(dlohme@gmail.com) VIEWED 17:15:36 UTC IP: 71.192.26.214 06/30/2021 Signed by Deb Lohmeyer(dlohme@gmail.com) SIGNED 17:18:17 UTC IP: 71.192.26.214 06/30/2021 The document has been completed. COMPLETED 17:18:17 UTC Powered by V HELLOSIGN