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29-299 (7) 315ACREBROOK CR COMMONWEALTH OF MASSACHUSETTS BP-2021-1766 Map:Block:Lot:29-299-001 Permit: Exterior Res CITY OF NORTHAMPTON PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) BUILDING PERMIT Permit# B P-2021-1766 PERMISSION IS HEREBY GRANTED TO: Project# Contractor: License: Est.Cost: $16708 JAIME MORIN 090125 Const.Class: Exp.Date: 10/06/2022 Use Group: Owner: COTE THOMAS M&MELISSA M ROBERTS-COTE Lot Size (sq.ft.) Zoning: WSP Applicant: RENEWAL BY ANDERSEN Applicant Address Phone: Insurance: 30 FORBES RD NORTHBOROUGH, MA 01532 TO PERFORM THE FOLLOWING WORK: ISSUED ON:08/20/2021 7 REPLACEMENT WINDOWS 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: �► Tie * I II Fees Paid: $40.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Office of the Building Commissioner / . • • ill ' G Z. The Commonwealth of Massac e 1 6 • WBoard of Building Regulations an S <tic� . FOR Massachusetts State Building Code, �' r gUrlorNr, UIP Building Permit Application To Construct,Repair,Renovate c y1#4.c7., ised ar 2011 One-or Two-Family Dwelling 0706o NS - This Section For Official Use Only • Buildin Permit Number: Date A plied: • vo.) < Ross 8-17-ZDZ) Building Official(Print Name) Signature Date SECTION 1:SITE INFORMATION 1.1 Property Address: • 1.2 Assessors Map&Parcel Numbers • 315 Acrebrook Dr., Florence, MA 01062 29 299-001 , 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(11) 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.40,554) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: , Public❑ Private❑ Zone: i Outside Flood Zone? Municipal❑ On site disposal system ❑ Check if yes❑ SECTION 2: PROPERTY OWNERSIIIP1 • • 2.1 Owner'of Record: Melissa Roberts-Cote&Tom Cote Florence, MA 01062 Name(Print) City,State,DI' 315 Acebrook Dr. 413-588-1628 , mroberscote@gmail.com No.and Street Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORK1(check all that apply) • New Construction❑ Existing Building NI Owner-Occupied ❑ 'Repairs(s) ❑ Alteration(s) ❑ Addition 0 Demolition ❑ Accessory Bldg.0 Number of Units Other rg Specify. Replacements Brief Description of Proposed Work2: Replacement of 7 windows. No structural changes. • SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) . . 1.Building $ 16,708 1. Building Permit Fee:$ Indicate how fee is determined: 2.Electrical $ 0 Standard City/Town Application Fee - ❑Total Project Cost3(Item 6)x multiplier x 3.Plumbing S -2. Other Fees: S . .4.Mechanical (HVAC) S . Last: • . 5.Mechanical (Fire Suppression) $ Total All Feel:. Alf v • Check No�"1 Check Amount (/ Cash Amount 6.Total Project Cost: S 16,708 V 0 Paid in Full 0 Outstanding Balance Due: . ‘ • • • 'SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) CS-090125 10/6/2022 • Jaime Morin • License Number Expiration Date • Name of CSL Holder • List CSL Type(see below) •' U 86 Gardiner St. • No.and Street Type Description Lynn, MA 01905' • U Unrestricted(Buildings up to 35,000 Cu.ft.) R Restricted•1&2 Family Dwelling City/Town,State,ZIP M Masonry RC Roofing Covering WS Window and Siding SF Solid Fuel.Burning Appliances 508-351-2277 rbabostonpermitting@andersencorp.com I Insulation Telephone Email address D Demolition 5.2 Registered Home Improvement Contractor(HIC) 170810 12/22/2021 Renewal by Andersen HIC Registration Number Expiration Date RIC Company Name or HIC RegistrantName • 30 Forbes Rd. rbabostonpermitting@andersencorp.com No.and Street • Email address Northborough.MA 01532 • 508-35,1-2277 . 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 )5( • No ❑ • SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WREN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I,as Owner of the subject property,hereby authorize Jaime Morin to acr on my behalf,in all matters relative to work authorized by this building permit application. . Melissa Roberts-Cote&Tom Cote(See signed contract attached) 8/12/2021 • 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 applicatio curate to the best of my knowledge and understanding. Jaime Morin • 8/12/2021 Print Owner's or Authorize _ it's Name(Electronic Signature) • Date • • NOTES: 1. An Owner who o.tains 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 fluid under M.G.L.c. 142A.Other important information on the HIC Program can be found at www.ntass.gov/oca Information on the Construction Supervisor License can be found at www.mass.trov/dos 2. When substantial work is planned,provide the information below: Total floor area(sq.fr.) • (including garage,finished basement/attics,decks or porch) • • Gross living area(sq.it.) ' 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" • I • CITY OF NORTHAMPTON • SETBACK PLAN • MAP: LOT: LOT SIZE:,_ REAR LOT DIMENSION REAR YARD • • • SIDE YARD SIDE YARD_ _• • • I a • FRONT:SETBACK_ _ 4 FRONTAGE • • • 1 i O `{w "P Tb�, The City of Northampton . ,1 .. Building Department 3 �� i3;. �,.. f 212 Main Street Northampton,Massachusetts 01060 Phone(413) 529-1402 Fax (413) 529-1433 CONSTRUCTION DEBRIS AFFIDAVIT (FOR ALL DEMOLITION AND RENOVATION PROJECTS) In accordance with the provisions of MGL c40, 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__30 Forbes Rd.,Northborough,MA 01532 The debris will be transported by: , Name of Hauler Renewal by Andersen Signature of Applicant:__ _ ___ ___ ___ _Date:_8/12I2021 • • • • • • __ The Commonwealth of Massachusetts E —=—` • „I. Department oflndustrialAccidents = � _ I Congress Street;Suite 100 • '1:, Boston,MA O�XX4-20X 7 y-zx ,ct www.mass.gov/dia • Workers'Compensation.Insurance Affidavit:Builders/ContractorsiElectricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legibly. • Name(Business/Organization/Individual): Renewal by Andersen Address: 30 Forbes Rd. City/State/Zip:Northborough, MA 01532 Phone#: 508-351-2277 Are you an employer?Check the appropriate box: Type of project(required): LEI I am a employer with 30 employees(full and/or part-time).* 7. New construction 2.0 I am a sole proprietor or partnership and have no employees working forme in 8. Remodeling any capacity.[No workers'comp.insurance required.]. 3.01 am a homeowner doing all work myseI£[No workers'comp.insurance required.]+ 9 "El Demolition 4.01 am a homeowner and will be biting contractors to conduct all work on my property. I will10 0 Building addition ensure that all contractors either have workers'compensation insurance or are sole 11.0 Electrical repairs or additions proprietors with no employees. 12.0 Plumbing repairs or additions 5.01 am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.0 Roo{repairs These sub-contractors have employees and have workers'comp.insurance.; 6.0 We are a corporation and its officers have exercised their right of exemption per MGL c. 14.®Other Replacement 152,§I(4),and we have no employees.[No workers'comp.insurance required.] 'Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. Homeowners who submit this affidavit indicating they are doing all work and then hue outside contractors must submit a new affidavit indicating such. " :Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Old Republic Insurance Co. • Policy#or Self-ins.Lic.#: MWC 31415820 ,• Expiration Date: 1/15/2021 Job Site Address: 315 Acrebrook Drive city/state/zip: Florence, MA 01602 Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by a fine up to$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.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification.• _ I do hereby certify under pal d penalties of perjury that the information provided above is true and correct • Signature: Date: 8/12/2021 Phone#: 508-351-2 77 Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town CIerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: • • City of Northampton • f �. M‹as •a. �57t7 cam. �'?� : $, ,� .5 DEPARTMENT OF BUILDING INSPECTIONS `?? �fl+° l 'f 212 Main Street • Municipal Building aj:., * Northampton, MA 01060 HOMEOWNERS'EXEMPTION ELIGIBILITY AFFIDAVIT • I, • ,(insert full legal name), born (insert month,day,year),hereby depose and state the following: • 1. I am seeking a building permit pursuant to the homeowners'exemption to the permit requirements of the • Massachusetts State Building Code, codified at 780 CMR 110.R5.1.3.1, in connection with a project or • work on a parcel of land to which I hold legal title. 2. I am not engaged in, and the project or work for which I am seeking the aforementioned homeowners'. exemption, does not involve the field erection of manufactured,buildings constructed in accordance with 780 CMR 110.R3. 3. I qualifi,I under the State Building Code's definition of"homeowner"as defined at 780 CMR 110.R5.1.2: Person(s) who owns a parcel of land on which he/she resides or intends to reside, on which there is, or is intended to.be, a one-or two-family,dwelling, attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a home owner. • 4.. I do not hold a valid Massachusetts construction supervision license and, except to the extent that I qualify for and will abide by the Massachusetts State Building Code's requirements for the supervision of the project or work on my parcel, I am not engaged in construction supervision in connection with any project or work involving construction, reconstruction, alteration, repair, removal or demolition involving any activity regulated by any provision of the Massachusetts State Building Code. 5. If I engage any other person or persons for hire in connection with the aforementioned project or work on my parcel,I acknowledge that I am required to and will act as the supervisor for said project or work. Signed under the pains and penalties of perjury on this day of (Signature) City of Northampton 212 Main Street,Northampton,MA 01060 Solid Waste Disposal Affidavit In accordance of the provisions of MGL c 40, S54, I acknowledge that as a condition of the building permit all debris resulting from the construction activity governed by this Building Permit shall be disposed of in a properly licensed solid waste disposal facility, as defined by MGL c 111, S 150A. Address of the work: 315 Acrebrook Dr.,Florence, MA 01062 The debris will be transported by: Renewal by Andersen The debris will be received by: Renewal by Andersen Building J: ng permit number: Name of Permit Applicant Jaime Morin 8/12/2021 Date Signature of Permit Applicant DocuSign Envelope ID:F8903C80-42AF-435F-8AB6-F8D5D5DA560D Agreement Document and Payment Terms dba:Renewal by Andersen of Boston Melissa Roberts-Cote&Tom Cote Legal Name. Renewal by Andersen LLC 315 Acebrook Drive RENEWAL HIC#170810 Florence, MA 01062 'UM NDERSEN 30 Forbes Road I Northborough,MA 01532 C.(413)588-1628 1ULL SFMIt NOON 0001 MOM Phone:508-351-2200 I Fax:(508)986-7072 I rbabostonbookingaandersencorp.com Melissa Roberts-Cote & Tom Cote 06/26/21 Buyer(s)Name Contract Date 315 Acebrook Drive, Florence, MA 01062 (413)588-1628 Buyer(s) Street Address Primary Telephone Number Secondary Telephone Number mrobertscote@gmail.com Primary Email Secondary Email Buyer(s) hereby jointly and severally agrees to purchase the products and/or services of Renewal by Andersen LLC d/b/a Renewal by Andersen of Boston("Contractor"),in accordance with the terms and conditions described in this Agreement Document and Payment Terms,any documents listed in the Table of Contents,and any other document attached to this Agreement Document,the terms of which are all agreed to by the parties and incorporated herein by reference(collectively,this"Agreement").Buyer(s)hereby agrees to sign a completion certificate after Contractor has completed all work under this Agreement. Total Job Amount: $16,708 By signing this Agreement,you acknowledge that the Balance Due,and the Amount Financed must be made by personal check,bank check,credit card,or cash. Deposit Received: $0 Balance Due: S16,708 Estimated Start: Estimated Completion: Amount Financed: 12-14 weeks 1-2 days 516,708 Method of Payment: Financing We schedule installations based on the date of the signed contract and secondarily on the date in which we complete the technical measurements.The installation date that we are providing at this time is only an estimate.We will communicate an official date and time at a later date. Rain and extreme weather are the most common causes for delay. Notes: Buyer(s)agrees and understands that this Agreement constitutes the entire understandings between the parties and that there are no verbal understandings changing or modifying any of the terms of this Agreement.No alterations to or deviations from this Agreement will be valid without the signed,written consent of both the Buyer(s) and Contractor.Buyer(s)hereby acknowledges that Buyer(s) 1)has read this Agreement,understands the terms of this Agreement,and has received a completed,signed,and dated copy of this Agreement,including the two attached Notices of Cancellation,on the date first written above and 2)was orally informed of Buyer's right to cancel this Agreement. NOTICE TO BUYER: Do not sign this contract if blank.You arc entitled to a copy of the contract at the time you sign. YOU,THE BUYER, MAY CANCEL THIS TRANSACTION AT ANY TIME NOT LATER THAN MIDNIGHT OF 06/30/2021 OR THE THIRD BUSINESS DAY AFTER THE DATE OF THIS TRANSACTION, WHICHEVER DATE IS LATER. SEE THE ATTACHED NOTICE OF CANCELLATION FORM FOR AN EXPLANATION OF THIS RIGHT. DocuSigned by: P5V- �DocuSlyned by: X l��� 1vk.t sstt 1... 6441, `7837F73CC98B471... '-7837F73CC98B471... Signature of Sales Person Signature Signature Vinson Derek Melissa Roberts-Cote Tom Cote Print Name of Sales Person Print Name Print Name UPDATED: 06/26/21 Page 2 / 27 DocuSign Envelope ID:F8903C80-42AF-435F-8AB6-F8D5D5DA560D Itemized Order Receipt /r/ dba:Renewal by Andersen of Boston Melissa Roberts-Cote&Tom Cote Legal Name:Renewal by Andersen LLC 315 Acebrook Drive RENEWAL HIC#170810 Florence,MA 01062 rAN Dfi o^RSEE N� allall 30 Forbes Road I Northborough, MA 01532 C:(413)588-1628 Phone:508-351-2200 I Fax:(508)986-7072 I rbabostonbooking@andersencorp.com ID#: ROOM: DETAILS: 101 Living Room Window: Gliding, Triple, 1:2:1, EJ Frame, Exterior White, Interior White, Glass: All Sash: High Performance SmartSun Glass, No Pattern, Hardware: White, Screen: TruScene, Full Screen, Grille Style: No Grille, Misc: None 103 bath Window: Double-Hung (DG), 1:1, Slope Sill, Insert Frame, Traditional Checkrail, Exterior White, Interior White, Glass: All Sash: High Performance SmartSun Glass, No Pattern, Tempered Glass, Hardware: White, Screen: TruScene, Full Screen, Grille Style: No Grille, Misc: Aluminum Wrap, Aluminum wrap of exterior trim. 104 hang out Window: Double-Hung (DG), 1:1, Slope Sill, Insert Frame, Traditional Checkrail, Exterior White, Interior White, Glass: All Sash: High Performance SmartSun Glass, No Pattern, Hardware: White, Screen: TruScene, Full Screen, Grille Style: No Grille, Misc: Aluminum Wrap, Aluminum wrap of exterior trim. 105 master bed Window: Double-Hung (DG), 1:1, Slope Sill, Insert Frame, Traditional Checkrail, Exterior White, Interior White, Glass: All Sash: High Performance SmartSun Glass, No Pattern, Hardware: White, Screen: TruScene, Full Screen, Grille Style: No Grille, Misc: Aluminum Wrap, Aluminum wrap of exterior trim. UPDATED: 06/26/21 Page 3 / 27 DocuSign Envelope ID:F8903C80-42AF-435F-SAB6-F8D5D5DA560D „ Itemized Order Receipt 416 dba:Renewal by Andersen of Boston Melissa Roberts-Cote&Tom Cote Legal Name:Renewal by Andersen LLC 315 Acebrook Drive RENEWAL HIC#170810 Florence,MA 01062 bsYNEaRSEN 30 Forbes Road I Northborough, MA 01532 C:(413)588-1628 Phone:508-351-2200 I Fax:(508)986-7072 I rbabostonbooking@andersencorp.com ID#: ROOM: DETAILS: 106 master bed Window: Double-Hung (DG), 1:1, Slope Sill, Insert Frame, Traditional Checkrail, Exterior White, Interior White, Glass: All Sash: High Performance SmartSun Glass, No Pattern, Hardware: White, Screen: TruScene, Full Screen, Grille Style: No Grille, Misc: Aluminum Wrap, Aluminum wrap of exterior trim. 107 hang out Window: Double-Hung (DG), 1:1, Slope Sill, Insert Frame, Traditional Checkrail, Exterior White, Interior White, Glass: All Sash: High Performance SmartSun Glass, No Pattern, Hardware: White, Screen: TruScene, Full Screen, Grille Style: No Grille, Misc: Aluminum Wrap, Aluminum wrap of exterior trim. 108 office Window: Double-Hung (DG), 1:1, Slope Sill, Insert Frame, Traditional Checkrail, Exterior White, Interior White, Glass: All Sash: High Performance SmartSun Glass, No Pattern, Hardware: White, Screen: TruScene, Full Screen, Grille Style: No Grille, Misc: Aluminum Wrap, Aluminum wrap of exterior trim. WINDOWS:7 PATIO DOORS:0 SPECIALTY:0 MISC:0 TOTAL S16,708 �rnn-sasF _..,,.�---�_ Renewal by Andersen is committed to our customers'safety by ;r ^F 10 complying with the rules and lead-safe work practices specified by the EPA. UPDATED: 06/26/21 Page 4 / 27 DocuSign Envelope ID:F8903C80-42AF-435F-8AB6-F8D5D5DA560D If Using a Builder � dba:Renewal by Andersen of Boston Melissa Roberts-Cote&Tom Cote Legal Name:Renewal by Andersen LLC 315 Acebrook Drive RENEWAL HIC#170810 Florence, MA 01062 bN,DERs 30 Forbes Road I Northborough,MA 01532 C:(413)588-1628 MI-WUPhone:508-351-2200 I Fax:(508)986-7072 I rbabostonbookingOandersencorp.com Property Owner Must Complete & Sign This Section If Using A Builder I,as Owner of the said property,hereby authorize Renewal by Andersen LLC to act on my behalf,in all matters relative to building permit application for the property/address indicated on this agreement. DocuSigned by: LDocuSnedbY: rhtliSSA, Plitxfs—Cett, 7837F73CC98B471... X Th% coti, 7837F73CC988471... Signature'of Sales Person Signature Signature Vinson Derek Melissa Roberts-Cote Tom Cote Print Name of Sales Person Print Name Print Name UPDATED: 06/26/21 Page 16 / 27 ' . . t Cerainonwinatt of Maas+darrelts Division of t,icsrrpue Construction Mrpvt►MorI . 1 Unrestricted-tannings of arty use group which remain Board of Building Rogutalions rand**Wards s less than a0.000 cubic teat(M1 stela roisters)of enclosed r`s �r`1!'" 1 Mims- CS O00'(25 i ! , Ices:10/03/2022 JaME 1.. . 44, , $ . = fl Lei 31111 Fallurs to possess a currant gallon of the Massaewueetts e,� Stets Beading gods Is cause for revocation of nds M Manse. Ca0prmisaigner it ts4nilr+w For Infonrsaion about ado Neer= - Caw pinT27a wurr200 or visit w mass govfdirl .; — _ _ ......_ .. ._._ i � Q f600 ae/latie(4 Office of Consumer Affairs and Business Regulation 1000 Washington Street-Suite 710 Boston, Massachusetts 02118 Home Improved Contractor Registr on RENEWAL BY ANDER8EN LLC ` 1 .'',:.`_____• r Types ement Card 90 FORBEB RD 4 '" ti 12/22/2021 NORTHBOROUGH,MA 01532 !I41 .5 . 1 _ tie '"� a `':._ 'fir,,, ,"-?rift,' -zNi Madam Address and Return Card. SCA 1 'A 2014C1/17 Ltr C '''t,4d'71�j 4Iuditaotai Moo et L1om ater Masers&htrelows Ina sa HOME a1PRGvlEMENT CONt11A17f01t Registration weld for IndivIdusl use only TYPE:Sutztament tad before the wiplrsgon data. If found return to: RaObetral an alikalbin 08ke of Consumer Attatra and Business Regulation 17 031 o 12/22/2021 1000 Washington Strad -Salts 710 RENEW IL BY ANDERSEN Lt C: Boston,MA 02110 n JAIME MORIN (— 1) ---11/ 30 FORBES RD NORTHBOROUGH,MA o1532 t '4 Not valid tthout signature Page 1 of 1 ACCORD C O® DATD/YYYY) `./ A CERTIFICATE OF LIABILITY INSURANCE o9/21/9/21/Zo2o 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 CONTACT Willis Towers Watson Certificate Center NAME: Willis Towers Watson Midwest, Inc. c/o 26 Century Blvd (A/C.No.Eat): 1-877-945-7378 FAX No): 1-888-467-2378 P.O. Box 305191 ADDRESS: certificates@willis.com Nashville, TN 372305191 USA INSURER(S)AFFORDING COVERAGE NAICti INSURERA: Old Republic Insurance Company 24147 INSURED INSURER B: Renewal by Andersen LLC 30 C Forbes Road INSURER C: Northborough, MA 01532 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:W17904932 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 EFF POLICY EXP LIMITS LTRINSD WVD POLICY NUMBER (MMIDD/YYYY) IMM/DD/YYYYI X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE I X OCCUR PREMISES(Ea occurrence) $ 500,000 A MED EXP(Any one person) $ 10,000 MWZY 314161 20 10/01/2020 10/01/2021 PERSONAL 8 ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 4,000,000 X I POLICY! E LOC PRODUCTS-COMP/OP AGG $ 4,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 5,000,000 (Ea accident) X ANY AUTO BODILY INJURY(Per person) $ A OWNED 7 SCHEDULED MWTH 314159 20 10/01/2020 10/01/2021 BODILY INJURY(Peraccident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY (Per accident) UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION X AND EMPLOYERS'LIABILITY STATUTE ERA Y/N 1,000,000 A ANYPROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ OFFICER/MEMBEREXCLUDED? No NIA MWC 314158 20 10/01/2020 10/01/2021 (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 $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 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 REPRREESENTATIVE Evidence of Insurance %' ��~ ©1988-2016 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD SR ID: 20103273 BATCH: 1820957 Doub t e H u n g t.,, , ,;.�,, , igt 4 ' 'Andersen. ,�, r" ± •#Aidielf wirdoW. aRPLACEMENT .nArtden.nCowpAeq Wood/Vinyl Composite IF o f oubl Dual tritoosat D Neon Low E4 Stn 1Sun 100-004735518-010 E!IEHCY PERFORMANCE RATINGS U-Factor(U.S)/I-P Solar Heat Gain Coefficient IL29......... ADDITIONAL PERFORMANCE RAVINGS Visible Transmittance 0 ., 42 . • . HMO akararse.NEM raw re dataasird kw a Ord sr el M.. noeyr.a ..rF+...r.l.o.AkF.e.w.%re� saI ere. •wP.0aattndoarw1tt+n...ta..aarkMlyafaro�•etbrr.gepMer e. Orme a..kterark wrr.eo Maratha pedant primer*.rd.,..tae. > 'f1d t % a.t nrr e . ` + Tea• ke .away m.rla <- �;! ''' . . � god " Y" . ; , ;afy .a ` .r.ril.4 . Ry as.. ti ter,? 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