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25C-015 (5) 168NORTH ST COMMONWEALTH OF MASSACHUSETTS BP-2021-1773 Map:Block:Lot:25C-015- 001 CITY OF NORTHAMPTON Permit: Alts Renovations Repair PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) BUILDING PERMIT Permit# BP-2021-1773 PERMISSION IS HEREBY GRANTED TO: Project# Contractor: License: SEXTON ROOFING AND SIDING Est.Cost: $13800 INCSEXTON ROOFING CO Const.Class: Exp.Date: Use Group: Owner: SANDRI, LISA L Lot Size (sq.ft.) Zoning: URB Applicant: SEXTON ROOFING AND SIDING INC Applicant Address Phone: Insurance: P O BOX 6327 (413)534-1234 HOLYOKE, MA 01041 TO PERFORM THE FOLLOWING WORK: ISSUED ON:08/23/2021 STRIP AND SHINGLE 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. Signature: • ri. y9 . TAIT Fees Paid: $40.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Office of the Building Commissioner 1 fL, The Commonwealth of Massachusetts w • Board of Building Regulations and Standards FOR Massachusetts State Building Code,780 CMR,7th edition MUNICIPALITY USE „, �`i Building Permit Application To Construct,Repair,Renovate Or Demolish a Revised January G Tr f j' _ One-or Two-Family Dwelling 1,1008 C_ 7 c �' 0_ - This Section For Official Use Only o ' Bui ck Permit Number: ___GP.-ZJ.-J Z Z?7 Date Applied: v ry SisrlBititre: - /Z. • • CJ �Q "Zd z m m Building Commissioner!Inspector of Buildings Date • o a _ a_Aiz SECTION 1:SITE INFORMATION Co 1.1 Pr//((jj��perty Addressy�/ 1.2 Assessors Map&Parcel Numbers 1.1a 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 BuiIding Setbacks(ft) FrontYard - - Side Yards Rear•Yard Required V 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 yes0 - SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of Record: , L-i 5 , _5<I IliOi'�) r , Si % LicLett.„, m Nae rint) - Address r ►� ���Service: , - ice•4.1 eLc,1" 4# S ri 'S-- C 7y Li- P 3Am.z, Zt„ e c044=J Signature Telephone - - SECTION 3: DESCRIPTION OR PROPOSEDWORK2(check all that apply) -New Construction 0 Existing Building CV'Owner-Occupied MI Repairs(s) O J Alteration(s) 0 Addition 0 - Demolition ❑ Accessory Bldg.Cl Number of Units I Other 0 Specify: - Brief Description ogroposed Work2: - Wit;i • :1.VV 1�0Y1Qe. ,x e vt < _ Lsr V p,IN` • - O✓J IA Gt,c2 • ' SECTION 4:EST11tL4TED CONSTRUCTION COSTS • • Estimated Costs: - Item V - • 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: $ - - - 4.Mechanical (HVAC) $ List: 5.Mechanical (Fire $ Total All Fees:$ Suppression) 4 Check No.3/ Check Amount: `P-'Cash Amount: 6. Total Project Cost: $ g (,,C't GI Paid in Full 0 Outstanding Balance Due: • • • • • • • • • • • -ten.... Crfn Il�,to; s .,R f lhiTi4 L + �- _ * {' .. _ _. : ice "" '+ J_: ,, E t y_�: - t tfc dj' > 4-.ir _. ' ------ . _,_ , ' � # 1 4y �`!V �5 � —`x� } ,Lfi .1 a tG _ /: Gir t- 77 _• --131"14 i _.._f _ J L i 7; 3 i M..i. •:6:u a x . r,j ;3;!s: - • '�?r+'ttq `: -- - --�:_-..._.a C,c+°r•:rr c,Ry;1-‘ .•a. •_,-L,bi,,in,,r. gq ` ._ ri : i' Bu!,{ties•cYjTlr ,E tr'S� }w 1 . e 4LF��y��yy " . } i LY ,F f - t .. • • 7 lu,. E L) j"xt,: r r r i fix.;C. r-- — f t� 4 t_ luui 4 pf ?S r _.... �-.-..._ .._ tit' x . • 1 — _ ( , Li: .1.7,CAN:ij : • • S 21ltf �t,, ,;ta.� ?: � • - •• K - t� 1A,.• ' jn : ,};n 0 rx2-n cN yet}:-:!: 0 I • 7 ( • • • "14 11 jyidbi f,Ar i4 2tLG. •• afxt1ltcgur•:L;;t„ , ;wcjt = ; •� --- Y I 3 ! btu} -4r YQ4.a(e; — i r""` 1 -1-,,C71.. - - .. a c gay to Lc r; , vi e, ti I , . t. L. T1$,1;,3 _ .• _._ <�.� -- ; �•- r..y'+- yC'�2271�11z L,C ter. , ..v t 1 - 1 V , _ ts: J� I r �jC{ a• - t _t- .. _ • .rti L'iD2�. r� • 4jC �,° 7�a"fit !: fa.. / c`l Bit#I ?L�1` ..5 Lt1rGs`:,� tk; t":'c ' 9 kfr',isex x 0$#j IDU2 :N1 � �� i I' 1 .#CIINTLLi SECTION 5: CONSTRUCTION SERVICES — 5.1 Construction Supervisor License(CSL)gre// 3e,t 1 )/') License eY Name of CSL Holder//�Q �l� f 'PO iLJC.�k W,30' ! List CSL Type(see below) r id No.and Street G� Type Description k) ), eAre —)2 i4 /}�/� 9 II Unrestricted(Buildings to 3ing000 cu.ft) !'U/�(.(,{� l j/ Cl R Restricted 1&2 Family CityTT State,ZIP M Masonry RC Roofing Covering WS Window and Siding SF Solid Fact Burning Appliances I Insulation - Telephone Email address D Demolition ll ! a2 Registered Home Improvement Contractor(HIC) rJl 1 / ' 3 \ x n /�otA/7 anal sihi -n 11�s3 9-.nnber - ��.1 �-j �- HIC Re�suatiaa Number Ezperation I}atc HIC Com any Name or llegistrant Name �J eeX fo302 7 �3Pk G�TdJ q-01)(l olt "I No.and Street adder Heko"a, P7A 61/6)31/ 4/3 53i71-1. 3q City State,GIP Telephone SECTIONS: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 ' 't ' No 0 SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I,as Owner of the subject property,hereby authorize DeYI)�}�Jc OI?C� > i JJ, I1�' z _ to act on my behalf;in all matters relative to work authorized by this btuildittst ertnit application. C �Itr� r 0f (hPr/ rc"�r Print Owner's Name(Electronic Signature) Date SECTION 7b:OWNER'OR AUTHORIZED AGENT DECLARATION By entering my name below,I hereby attest under the pains and penalties of perjury that all of the information contained in this plication is true and accurate to the best of my knowledge and understanding./ MUST BE SIGNED by Owner or Authorized Agent Date NOTES: 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 aid 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 w.unass_govioca Information on the Construction Supervisor License can be found at iworty_mass.,ov.%cltis 2. When substantial work is planned,provide the information below_ Total floor area(sq.ft.) (including garage,finiched 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 Fnelosed Open 3. "Total Project Square Footage"may be substituted for"Total Project Cost" • City of Northampton Massachusetts ='•s rlAr ,��<<c g6`w i DEPARTMENT OF BDILDIXG INSPECTIONS 212 Main Strait • M nicipal Building Northampton, MA 01060 C{1� 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:-�_�r_� 1 ,� ,��� (� C . , The debris will be transported by: Name of Hauler: 1S6( t1L- du Signature of Applicant: Date: / 1( l I Proposal SEXTON ROOFING AND SIDING INC w w w,sc x ton roo fing.co m 411/111r0 P.U.Box 6327 Setting the Swndanl £„ 'Holyoke,MA 01041 swnoiss Aar r p.413.534.1234 1.413.539.9906 MA111Ca1111239 sex ton roofingnhotmailrco® s1 BSttTTEDTO LisaStndri PHONE 2t.'I46 1 D.x1F. 19/21 S'tRF'ET 16[INurM s1 Ituudrl76apodium (11N.5IA1L,'LIP Northampton.Ma. mere SEXTON ROOFING II1.kE81 SUBMITS SPECIFICATIONS 5ND ESTIMATES FOIL'Ifou..mod 1)Strip and remits existing shingles and dispose of in proper landfill. 2)Inspect roofing deck and replace as needed a SIIK.INI iwr sheet.(Add S7,AI10.110 for all new IJ2"1 3)Install nets metal edging to rakes and eaN'es of roof.(white) 4)Install ice and water shield on cases(6').lcnt stacks,in tallest,chimney, and at intcnectin!C roofs. 5)Install synthetic roofing underlay meat on remainder of roof. 6)Install new flanges user existing sent stacks. 7)Install starter shingles on eases and rakes of roof. 8)Install IKO Architectural style roofing shingles as per manufacturers'specifications. 9)Install nen cap user ridge sent. IR)Reflash chimney. II)Supph manufactures Lifetime warranty and SRC 5 yr.workmanship warranty. .ITINTIO\IlOMEOi\U M1.11..I\E(OVER Ar.t PLJ0O%U.n0l41\t.r,1 s1\1111. (1TN.l:(R.U:E,ORS'fl IR,U:f AREAS DUE TOpossral.a worm(. M IItI%OR IX ST row\(.nat(N CM(-RAGA N OF(WOO Oki Ilnt. Rr"welt Anct.rJJarauirr.rtrytatcmrrlcrle_em u.ri the elo"tJaeeJ&/aew+Iw fkr nun nl Tltntrar llwrae.1 L At IIre.tcd DOlIIR.S ILI,DMPe/pIS If/1T.5IOD£(1IDf. ISFOIn1R:S due in full upon completion sn Neural u guava/toed b•be as.pe,16cd 111.A.to be eomplrled is a Authorized u.rlr.snidc manner accords,I,,,fae 0 1 pm,trce, And.hmbon er do rY +p r.s from.bole aal.. '1n.»W nor.,e eh rot .111 be cx.eued anis - g'nature up...n omen orders,and w111 beam.na corm dope•.,cr and.here arc e.umatc 2.1.20,14fIES TO @ 1Im AM)011117.h 1xe eeu-..Y 1t4..1..,,n..IF MA+rt' Note I hi,pioposal may be withdrawn by us if net accepted within +.:.alr+etr 4et!WI!AM owl n5aarual Aid rapoeablc for water dam.gc downs cu nabuctien Owner(op.y roopnwrble legal fen for nonp.rmenl.and (141 dais Acceptanceopploothk enot "\,ti.'iC. of Proposal The above prrccs,specifications and conditions are sausfact r,and arc hereby accepted. You arc Signature authorized to the work as specified. Payment will be made as outlined above /7. ti�Date of Acegxanuc 7r2 /7 I Day crtrileizt.of Industridl.AecideniS . . . . c ' , • . . rt*:- • , . . ,. Office of InTestigations • : . . • . . •I.. Lafaye&e.City cenSer • . . • "t ,-,•, -•=4• . • -2 Aven rze de iceayetie, Bostot, 402111-11750 . • . • -- - .:7-7 ,./ . www. -Lass-goy/dia. • • . - . Workers CompgitsztioniliguramilAfffday.-11-:Rders/CoulTaitors/Electridans111.1mbers •• • Ap'plicant Infonnation -' ' • • . ' ' Please Prild LeeilAY. . ' - . • • .... ' • . Nalile(Bu.,sis' essiOrgatip4aniladirif4noly.SOkton Railing&Siding, Inc ' . , _, • . • • 1/4 " . . • AddieSs:°-°. Ec.cc 637 , : • • .. : . . ._ • .• • , • . ' • • • . . City/State/Zip:Holyoke,MA 01041. ' phone#..413-534,1234 . - • . Are poll an.emPIoyer?Checit the appropriate 1;t:m • ' . • _ Type of proj ect fre.quirec1):. - i I.b I am a+=nit-layer with. • 4. kl ant a general Cathie-tar-and-I . , ,—,.s, _• . .•• have lair'-ed the sub-:contractors. • °- LJ 1‘1.6W cOnkr.P-CtitM . . employees:(MP end/or part7tinae),*- 2-0 ram a.sale proptietor•orpartier- ' Bite&on.the ottnalled Sheet. : 7. 0 R.eotorielli"4: . ' •. ' .. • !. sl.01). gLaliiire 11-0 erciPaYeit8 . ••.'Iliese-snbcatttraztoraha-ve • .8. 0 ljempuifou warag,for me in may capacity - ,. - ':e.c•FE[Pl*e micl-lixteN.v05' - 9. 0•Rtairiag-...aMitiP32 • [No:woriters' comp,if:us-mance - tam 0 p.instranc • • , __required.] •• ' ' . . . Weake corporation.#01±(23. , 10..0 EleOttiCal repairs or additions 3• .LJ.I am a homeowner ttfinz,all work . ' aacell have eiercisedtheir • 11.0 ilnan13-in lapolis or additions. . .,, - . .• . • • - .uiybelf [No workers' eplap. . Fight of e..s.6114,op.p.er.MGI .. • .124E.Rjoof Tell, . ' .• . frisarauce requiredl t • i , • c•152,&1(4),atakwe have no . . .• . . . etaptOyees. No wt:Am's': . ;lip Other • .. -. , clamp.in#Erapoe recuiredj • . • - • • . • I'Likiry apialicantthat ohocio ho;r#1 nrasta]sola ontilie-seetionhelovislanwhag-tileir worlad compensation policy tti=a•tion.. ' . tHanietavoicra who anbinittirie alt dav#:_indicitto. ktliel are&big all Nverk and.tlic°inside ctattinctorszaustaiiear zifEdayitincliicating such_ -• • ,t!Ccarbaciars that clieckftdo bozo:nisi at:edified.an additional altert slioWiagtlienrroseof the sub-cordractors and Apt c villein=°snot tlapie entities hart , cinployees.Mite ab-caatra‘;;tai-4Jm*easp19yeL.-;the-ymithtptaride-their vicoi*!'ciipil.poliginanbFr. • - • _rot gri employ - hatthatisprovEzzg worker,cemperzsatiP 2.:fri,syretn.eijoi• y etaye!= 171 elir:i*is thud ricy•and job si* • information • ' . . • • • • • • • ,T=e carppany liamie:Trattele.rs Properly CAS CO OF AM ' . . " •. . - . • •, • . • ' polick4,-,,r 5edf_ins.1_, ..i....7P,1.1.1430G0789.8220 . , . : '7.3t1.1-41.lotinate6141.2 . . ' i • • _ A L a. .i ... • lob Rte.:Address: I 6;. t AI OC A 1. S .1 • .City/StaietTap: PP if—AA-et,,174-(/ 4;44, . Attach a copy of the workers'colnpemsatian.policy declaration page(sh.o-wing-the policy nronlper and expiration dLte). ' Failure to'secar:e coverage as regared ander-Section 2.5A ciiVi3i,c,„152 canleadto the itupoeiflottpf 6:intinal•penaltits of a - oe up to$1,500.0133x1/ar one-Year isopdsonmest,as well as civil penalties in the faUca.of a.STOP WORK IDER.ancl a flue '.*•' of-up to$256..00::4 day agaiustthe•-vialator. Be advised that,a copy of tflok statemeatm.w be forwarded to ite Office of . . ... Investigatiom ofthe DIA for p.Forancit coverage vetificetion • . : , , . . . . . . • .- ..1.do Ai-Eby cergi zuzircrandpen.gti•A;75,ofpojsr4 that tAe.frig.Ccinprrrvirled aye is trzte tql:t1 current • .. ., • . • SimaaErre: • . . . - • • • .' Dmie: se it 1-24. . . _ • . • • Phone#: 4.1-3.-53 4,-1.2.34 . • .. ... •. • . • • ; • . . 00441 use pply. 1)9 not-ril .17#171 015 trrea;L.2 be compieefi b y city or tP-p-n official .. . .. .. . . .. . .. . ' ' • • ' . .City oi town: • • .• • • •iermitri4cenee# • • • • • • • • t• • ' • ' Issuing:Authority(check one): • .. • . . 1033oard of Health 20 B-aadingD epartment 3.1=1Ciiyflown Clerk 4.0Xlectrical Inspector J_,_taIninbing • • Inspector 6,04ther ' • • • • . ' . . . • • - • . • Contact Person:. . . • Phone ,: .*_ • • • , . • . . . , . ' . • . . • - . •. . • . - . , • • •.. . • . . • • . • . I . • . . •, . A o® CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 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 PHONE (413)737-0300 FAX No); ADDRESS:• edembinske@orrnsbyins.com 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 • INSURER C: 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. INTE TYPE OF INSURANCE ADDL SUER POLICY EFF POLICY EXP INSD WVO_ POLICY NUMBER (MM/DD/YYYY) (MMIDD/YYYY) LIMITS COMMERCIAL.GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS-MADE OCCUR DAMAGE TO RENTED PREMISES(Ea occurrence) .$ MED EXP(Any one person) $ N/A PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $ POLICY PET • LOC PRODUCTS-COMP/OP AGG $ OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) _ ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOS . AUTOS N/A BODILY INJURY(Per accident) $ HIRED AUTOS NON-OWNED PROPERTY DAMAGE $ • AUTOS (Per accident) UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE N/A AGGREGATE $ DED RETENTION$ _ $ WORKERS COMPENSATION X PER H PERTUTE ER AND EMPLOYERS'LIABILITY A OF CER/M BEREXC UDED7�CUTNE N/A N/A N/A 7PJUBOG07898221 06/04/2021 06/04/2022 EL EACH ACCIDENT $ 1,000,000 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below EL DISEASE-POLICY LIMIT $ 1,000,000 • N/A DESCRIPTION-OF OPERATIONS I 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 ofinsurance). 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.Crg4� y,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 SEXTO-2 OP ID:KH "��REE CERTIFICATE OF LIABILITY INSURANCE DATE(MMI00/YYYY) 07/07/2021 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 413-737-0300 CONTACT Eric Dembinske Ormsby Insurance Agency,Inc. PHONE 413-737-0300 l Fax 413-737-0617 698 Westfield St PO Box 718 (A/c,No,Ext): (A/C,No): West Springfield,MA 01090 E-MAIL edembnnske@ormsbyins.com Eric Dembinske INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Northfield Insurance Company INSURED INSURER B:Quincy Mutual Fire Insurance 15067 Sexton Roofing&Siding,Inc. PO Box 6327 INSURER C: Holyoke,MA 01041 INSURER D: 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 AWL SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD_WVD POLICY NUMBER (MM!DD1YYYY) IMMIDD/YYYY1 LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE X OCCUR WS45073 06/25/2021 06/25/2022 pRE I SEs(Ea occvrrDencel $ 100,000 MED EXP(Any one person) $ 5,000 PERSONAL&ADVINJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POUCY JECT LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: B $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000,000 (Ea accident) ANY AUTO AFV206561 05/15/2021 05/15/2022 BODILYINJURY(Perperson) $ OWNED X SCHEDULED AUTOSONLY AUTOS BODILY INJURY(Per accident! $ X AUTOS ONLY X NON-OWNEDUUTS (Fern acEofaenc�AMAGE UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ - WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y!N _STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE TO BE ISSUED SEPARATELY EL EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? N I A (Mandatary in NH) EL DISEASE-EA EMPLOYEE $ If yes,describe under • DESCRIPTION OF OPERATIONS below E.L DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORP 101,Additional Remarks Schedule,may be attached If more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. • AUTHORIZED REPRESENTATIVE ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD L l 1 ' [ ' ' itl ' 1 ! I ' .:-,i I 1 41 ' , . . ' .v c— iii. .2 .1114 l' ' 1 ci: g glf 1 ' lic Q 1 ...1 ' 1 , . 41 ' Lii ' ii.: 1 11$ F i 1 11 i ,t"-I i'Ci ,4ro �� : . l kr:ILIEI � � Cl ii �, � 1 1; , i_ , ' - , i 1 IL ' -- 641 .,i, 1 ii 4-- tti, 1 . tcti ' r4 t‘' - 1 , Fli il , ii t apd ° ' . I :11 "; 1 i .,*11 I . ti . • ca '0 il, l & 11 , A' 44 i I ii ' � � / �► 1 � ii g .. .fq , + to 1 . :I Jr q . 11 VI ' 1,1111 al ',1111 .8 ,i . . lilt I FL' • • I , t 11 It 0 . fill 41' ' ' lilt I t "' . I ri ! i 1fl1 * F' 10 I' 4 Il1i.i...ii.i,14t,-..N.):.11.1 ;.:,i) Ig � f1,. 1 1 4iiti rp,,ils: 141'-.:,':''t'6gii14 4' --t''1,c,-' '-i,4—._..[cI I.., ,,;um;.rl�1) tl r� �' �, N U r; 1-i :-' 1tl t i M '4 i t: ' i. .zpi' .Clt,44. ACOJ?II CERTIFICATE OF LIABILITY INSURANCE I11/13l2020 THIS CERTW ICATE 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 CONSUME A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CEK I IHCATE 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 - °'m Edson DeSo,I7a MAYFLOWER INSURANCE GROUP INC No• l_ (774)773-9702 FA"• (A11:,Tlej: DuR Edson@ mayfi owerinsurance.c ADDRESS: am A 299 Court Street INSURER(5)AFFORDING COVERAGE NAM* • Plymouth MA 02360 INSl1RERA: HARTFORD UNDERWRITERS INS CO 30104 INSURED ENSURER B MNP CONSTRUCTION INC INSURER C: • • INSURER D: 45 EXCHANGE ST APT 3E INSURER E: • MILFORD MA 01757 INSURER F: COVERAGES • CERTIFICATE NUMBER: 595621 REVISION NUMBER: . • THIS IS TO CEx1IFY THAT THE POLICIES OF INSURANCE US 1 i u BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POUCY 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 PtRiAIN,THE INSURANCE AFFORDED BY THE POUCIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POUCIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS_ INSR TYPE OFINSURANCE ADDL SUER POLICY E'FF POLICY Er.P LTR _ MQ MD POLICY-uesse wjov Y1 (i YYYrMiDDNYYYY) LIMITS COMMERCIAL GENERAL LIABI ITY EACH OCCURRENCE' S CLAIMS-MADE OCCUR DAMAGE TO RENTED PREMISES(Fa occurrence) S • MED EXP(Anyone person) S N/A PERSONAL SADVINJURY $ Gan.AGGREGATELIMITAPPLlESPEfZ GENERAL AGGREGATE S POLICY ,EcT LOC • PRODUCTS-COMPIOP AGO S _ OTHER • S AUTOMOBILE LIABILITY -COMB/NED SINGLEUMIr S (Ea accident)* ANY-AUTO • BODILY INJURY(Perpe�n) S —ALL OWNED SCHEDULED AUTOS AUTOS WA • BODILY INJURY(Per amdeal) S _ - HIRED AUTOS NON-OWNED - PROPERTY DAMAGE 5 AUTOS (Per amdent) S UMBRELLA UAB OCCUR - EACH OCCURRENCE S • • J ECESSLIAB CLAIMS-MADE N/A AGGREGATE S CEO (RETENTIONS S WORKERS COMPENSATION v/• PER STATUTE OTH- AND EMPLOYERS'LIABILITY , ANYPROA OFFIC RIM�EMB CJDDED? �� WA WA NIA 6S60UB1K70970620 11/16/2020 11/16/202.1 EL EACH Dram " $ 1.040'000 (Mandatory in NH) , EL OISEP SE-EA EMPLOYEE S 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E L.DISEASE-POLICY LIMIT S "1,000,000 N/A DESCRIPTION OF OPERATIONS)LOCATIONS)VEHICLES(ACORD 101,Addirrtiortal Remarks Schedule,may be attached ifmoresp ce is required) Workers'Compensation benefits will be paid to Massachusetts employees only.Pursuant to Endorsement WC 20 fl3 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 theexpiration 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 atwww.mass.gov/Iwd/workers-compensationiinvestigations/ CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED FOUL-ES BE CANCFI I FT)BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN • Sexton Roofing &Siding Inc ACCORDANCE WITH THE POUCYPROVISIONS. 102 Pine St - AUUTRORIZED REPRESENTATIVE ' C Daanint Holyoke MA 01041 el M_C1 r y,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 '`{CQE)- CERTIFICATE OF LIABILITY INSURANCE 1 ---- 11/24/20 THIS CERTIFICATE IS ISSUED AS A MA I I tit OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER THIS l CERTIFICATE DOES NOT AFFIRMATIVELY CR NEGATIVELY AMEND,EXTEND OR ALI tit 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 cert:i holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorse& If SUBROGATION IS WANED,subject to the terms and conditions of the policy,certain policies may require an endorsement Astatement on this certificate does not confer rights to the certificate holder in lieu of such endorsemnent(s). PRODUCER CONTACT N Art Cabrillo One Family Insurance oic,"N o,Fj �1- 973-5942 we ,No): 9T3-403-5943 i Main 5t Suite 15 Dan ems: art@lfamilyinsuratice.com Lunenburg,MA 01462 yplC INSSURER)S)IIFFDRDING COVERAGE it INSURER A: Evanston Insurance Company INSURED INSURER B: MNP CONSTRUCTION,INC. INSURER C: 45 EXCHANGE ST APT 3E INSURER D MILFORD,MA 01757 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER= THIS IS TO CERTIFY THAT THE POLICES 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 PEK I AIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALLTHE TERMS, EXCLUSIONS AND CONDmONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS_ INSR ADOL aUBk POLICY BFF POLICY EIP LIMITSr LTR 1 THE OF INSURANCE I1SD VIVO POLICY NUMBER (NWD!DYYYY) {MIUDOI YYYI X co► eRcIALGBl62ALL1AE1LTY EACH OCCURRENCE S 1,000,000 mmai DAMAGE TO REN I ED 100,000 CLAIMS-MADE 1 X OCCUR PREMISES(Ea oce) S MID ISCP(Any one person) S 5,000 A Y Y 3E19385 11120/20 11/20/21 PERSONAL wADv1N.1uRY $ 1,000,000 GENLAREGATH TAPPLJES PER: t C-G LlA GENERAL Ar.aREGATE S 2,000,000 POLICY 1 JECi I 1 LOC PRODUL IS-COMPIOP AGG S 2,000,000 5 OTHER AUTOMOBI F LIABILIIY CnMHINEDS SINGLE LIMITS (Ea accident) ANY AUTO -BODILY INJURY(Per person) S —OWNED —SCHEDULED BODILY-INJURY(Per e der') S AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE S All I W ONLY AUTOS ONLY (Peracader t) S UMBRELLA LIAR OCCUR EACH OCCURRENCE S IXGESS LIAB CLAIMS-,MADE AGGREGATE S CEO RETENTIONS S - - WORKERS COMPENSATION PER OT}-1- STATUTE ER AND EMPLOYERS'LIABILITY Y/N ANY PROPRIETORIPARNERJEECUTNEI I NIA EL EACH ACCIDENT S OFFICERJMEMEER EXCLUDED? ` (Mandatory in NH) EL DISEASE-EA EMPLOT E.L $ If yes,describe under ,E1.OISF_A_,E-POLCY LIMIT S DESCRIPTION OF OPERATIONS berm, DESCRIPTION OF OPERATIONS/LOCATIONS!YH-B ES (ACORD 101,Additional Re aik,Sdte loIe,may be.JL J—.i it more space is required) CERTIFICATE HOLDER - CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCFI I Fll BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. SEXTON ROOFING&SIDING INC 102 PINE ST P.O_BOX 6327 ALJTHO RIZED REPRESENTA ar/4HOLYO KE,NIA 01040 •kr, I • C 1988-2015ACORD CORPORATION_ All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD