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25C-058 (6) 25 LINCOLN AVE COMMONWEALTH OF MASSACHUSETTS BP-2021-1959 Map:Block:Lot:25C-058- 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-2021-1959 PERMISSION'S HEREBY GRANTED TO: Project# AIR SEALING Contractor: License: Est. Cost: 766 GEE INSULATION 115036 Const.Class: Exp.Date:01/02/2024 Use Group: Owner: LAWLOR, ANDREA &MELLIS BERNARDINE A Lot Size (sq.ft.) Zoning: URB Applicant: GEE INSULATION Applicant Address Phone: Insurance: 398 BURNCOAT ST (508)665-8685 6ZZUB-5R8 1 822-2-2 1 WORCESTER, MA 01606 ISSUED ON:09/29/2021 TO PERFORM THE FOLLOWING WORK: AIR SEALING 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: ) Fees Paid: $65.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Office of the Building Commissioner /1/ - .- Commonwealth of Massachusetts IcS :a o ilding Regulations and Standards FOR �p c ? Ma achu•.etts State Building Code, 780 CMR MUNICIPALITY USE Nog7.elm uilding Permit ppli One-or Two-Family Dwellin To Construct, Repair, g Or Demolish a Revised Mar 2011 qMn '1' g Tv1 MAoFero pis cti For Official Use Only Building P rmit Nu o'. ros �—�'� ` S WO-) 725c- Date Applied: .// q Z$-ZZ 1 Building Official(Print Name) Signature Date SECTION 1:SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map& Parcel Numbers Z6- Lincoln A,rc.,Ncx1lncum plan,MA olo bo 1.1 a Is this an accepted street?yes x 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: rv*e Cl Lc t or N.larklarnp - ( M A O►o Co O Name(Print) City,State,ZIP Z-S' l.:n(01n I°ric. y13 - q23 -8`8SG No.and Street Telephone Email Address SECTION 3: DESCRIPTION OF PROPOSED WORK2(check all that apply) New Construction ❑ Existing Building 0 Owner-Occupied 0 Repairs(s) 0 Alteration(s) 0 Addition 0 Demolition 0 Accessory Bldg. 0 Number of Units Other 1st Specify:_-T_A53\a•lit Brief Description of Proposed Work': ps-c sew kW13 SECTION 4: ESTIMATED CONSTRUCTION COSTS _ Item Estimated Costs: Official Use Only (Labor and Materials) 1. Building $ -AA .8-6 1. Building Permit Fee: $ Indicate how fee is determined: 0 Standard City/Town Application Fee 2. Electrical _ $ 0 Total Project Cost3 (Item 6)x multiplier x 3. Plumbing $ 2. Other Fees: $ 4. Mechanical (HVAC) $ List: 5.Mechanical (Fire $ Total All Fees: $ Suppression) �, ij Check No.j030 Check Amount: Cash Amount: 6. Total Project Cost: $ _ bk, ,g(:„ 0 Paid in Full 0 Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) CS-115036 c Ic L 2O21 CA-NY) (e-'co(Y) License Number Expiration Date Name of CSL Holder List CSL Type(see below) V 3C $ 6.M.nCava' SI- No.and Street �Type Description �� IAO 1fo 6 ` % Unrestricted(Buildings up to 35,000 Cu. ft.) Restricted 1&2 Family Dwelling City/Town,State,ZIP M Masonry RC Roofing Covering WS Window and Siding SF Solid Fuel Burning Appliances 5o8 6 8681S 9` n .(upon(qP �5%1L4+"'�() + I Insulation Telephone Erna-if address D Demolition 5.2 Registered Home Improvement Contractor(HIC) CrWi I(4.CAen ( CsEe =6SOk4?an) HIC e O�-on It Ex it t �.D to HIC Company Name or HIC Registrant Name Registration Number Expiration Date 3cl8 12)0coCflcak 5.;al •fGcxY1 also kw-4- • tom No.and Street Emai"I'address Wor'c—es.4Q-C MA- otbob 5oS 665-$6$S 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 'I 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 hereby attest under the pains and penalties of perjury that all of the information contained in this appli do i tr ccurate to the best of my knowledge and understanding. twim R.CO WI pg,t q l -kV 21 Print Owner's or Aut orize Age ame(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 Massachusetts �w` - ' s 41 DEPARTMENT OF BUILDING INSPECTIONS , ' ;4.4 212 Main Street • Municipal Building Northampton, MA 010601.sky -)\� 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: SeAck. v.Wos're-- SerJi s Location of Facility: 'v SvJ I S'r• A-Jb'rn M A o 5 o ► _ The debris will be transported by: Name of Hauler: k()nk. o s3\c*A ) Signature of Applicant: Date: cc( iq���24 The COMM on wealth of Massachusetts Department of Industrial Accidents I congress Street,Suite 100 Boston, MA 02114-2017 WW W.mass.goildia I 40'kers'Compensation Insurance Affida%it: BuildersiContrsuaorsalectriciansiPlumhers. TO 111.FILED%VIII! flIF.PE Witt HIM;At ITIORITV. Antliicatil In forttiAtital Please Print Legibly, .Name 413tisiniOranization:Indkvictuni): („al,tyt O.c..c)An Addres : 348 €1,Jr 0 c_,c1/4..Ar City/State/Zip: liJo(c...e.4e4-- enct o_s6 9,t) Phone#: sog 665— 13beci_5 _ Are yam an entlIITI rr?Chi he a pp RIpliiiif INA: Type of project(required): 1111 4111 a employer with 1.4 x.-mpluysie.s tfull ariihm part-Lintel.* 7. 0 New construction 20 1 Mil a sole proprietor or partnership and have nu employees working lift me in 8. a Remodeling any capacity.[No workers'comp.i ce nsuran my moll] 9. [J Demolition i am a hurnrvssiLL1 doing all%suck myself.(No WArrken'cutup.insurance requared.1' 100 Building addition .4.0 I am a lionsivassuirt and oill be hiring ramlniours to eunduct all work on my property. I will ensure that all corm:mum either lust:markers'e,Jeirpzitsaiiian insurance ur Luc sole i i C Electrical repairs or additions pn,prietors v,ith nu employees, i 2.0 Plumbing repairs or additions 5 1 am a general contractor and 1 have hired the sub-contractors listed on the attached sheet 130 Roof repairs These Nub-worm:cum have employees and have wurkers'comp.insurance.% ei x_05.1\ook-71,C1 6.0 we are a L-orporation and its officers have ekertimcd their right of exemption per Ps4GL c. 14. othet 152,¢44),and we liaise no employees.[No workers comp.insurance required.] 'Any applicant that elio.ls bay ul must also till out the section below showing their workers'compensation policy information. 'lio1111.13**CM who submit this affidavit insheamse they are doing all vvork and then lii re outside commove,must s utinut a new affidavit indicating such. %Contractun,that rhea this lxx.must attached an additional sheet%box ing the name of the suh-euntmetors anal state ssItether or nut those caulks have employees.. It the sub-contractors base employ'et:N.tires 111EITI prus kit:their sitters omit,.polies'nuiriber. lam an employer that is providing ivorAers'compensation insurance for ary employees. Below is the policy and job site information. Insurance Company Narnc:___efmgx--,-Cos-0 -2.04-C...VI a-in S JC.0x0C.Q.... CUrn iXA-11.. . Policy 4 or Self-ins.Lie.#: G— sgglg 2,2,- '2.--'2-k - Expiration Date: °Oil cl-\SO 27-- Job Site Address: '2-5 Li Loln Pie... Noli410JAVIr00 CityiStateZip: Na(Prta1/4rocr)-1,-cN rn A ()lobo i __ Attach a copy of the viorkers'compensation policy declaration page Ishowing 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 S1,500.00 and!or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a tine of up to 5250.00 a day against the violator copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby c tf it r the pains and penalties olpesfitry that the information provided above is true and correct l Signature -_____ 1/atc. 0 c1\ %ck \ 2-0 Phone#: So8 LS- —8 685 Official use only. Do not write in this area,to he completed by city or town official city or Town: Per initil.icense 4 Issuing Authorit% (circle one): 1. Board of Health 2. Building Department 3.City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6.Other Contact Person: Phone#: ����y� City of Northampton Massachusetts frs DEPARTMENT OF BUILDING INSPECTIONS 212 Main Street • Municipal Building Northampton, MA 01060 MANDATORY FOR HOUSES BUILT BEFORE 1945 Property Address: 2S L.; (ILO 0 (�-�2 for lc,,wle-i-on 1 on cA06 D Contractor Name: Corr Address: act$ e)oro C ck Sr City, State: or 'se-c- vA A C\b 0 b Phone: 5 0 8 6 6S Property Owner Name: Pnolceck L.a J I chr Address: 2-S L;n ca\n cJQ_ City, State: ('3c>e o\w10-}o,C1 rf\A 0\ObO I, CA- rn I --Corn (contractor) attest and affirm that the building I intend to insulate does not have any open air (knob and tube) wiring in the spaces to be insulated and that I have provided the property owner wi hra copy of this affidavit. I Contractor signature ! — CY Date oq�tq �202\ CLEAResuft CONTRACT CLEAResult 50 Washington Street, Customer Name:ANDREA LAWLOR Westborough,MA,01581 Email:Not provided Phone:413-923-8856 Premise Address:25 Lincoln Ave,Northampton,MA 01060 WAadiAcz, 6&- ?c( S C) Mailing Address:25 LINCOLN AVE,Northampton,MA 01060 Project ID:4267796 Date:July 1,2021 Job Description Contractor will perform or cause to be performed the following work on these"Premises"in a professional manner and in accordance with the terms of this Contract, including the attached recommendations/work order describing the work in detail (the"Work")which are incorporated herein by reference. Measure Description Location Quantity Unit Total Cost Customer Cost Air Sealing at Estimated 62.5 CFM50 Per Hour 1 hr $92.58 $0.00 Exterior Door Weather Stripping (with AS hrs) 2 each $60.14 $0.00 Door Sweep(with AS hrs) 2 each $50.62 $0.00 Rim Joist-6" Fiberglass Batting 60 SF $162.00 $0.00 Rim Joist-2"Thermal Barrier Polyiso 84 SF $401.52 $0.00 Total: $766.86 Program Incentive: -$766.86 Customer Total: $0.00 Payment Customer agrees to pay Contractor for the Work, the Customer Share of the Contract Price as follows: Payment#1:$0.00 as a Deposit payable to CLEAResult upon signing the Contract(not to exceed 1/3 of the total retail costs). Mail check&contract to CLEAResult,50 Washington Street, ,Westborough, MA, 01581. Final Payment:$0.00 as the final payment for the Work shall be payable to the Home Performance Contractor(HPC) or Independent Installation Contractor(IIC) upon satisfactory completion of the Work.Customer understands that he/she will not be required to pay the Utility Incentive Share of the Contract price in the amount of$766.86. Changes to individual line items and/or previous incentives may increase or decrease the size of the Utility Incentive Share. Dispute Resolution The IIC and Customer hereby mutually agree in advance that in the event that the IIC has a dispute concerning this Contract,the IIC may submit such dispute to a private arbitration service which has been approved by the Office of Consumer Affairs and Business Regulation and Customer shall be required to submit to such arbitration as provided in M.G.L.c 142A. Page 1 of 4 Document Ref J7 `•ECRAG=953CU-RREtii+. Page 1 ot 6 You may cancel this agreement if it has been signed by a party at a place other than an address of the seller,provided you notify the seller in writing by ordinary mail posted, by telegram sent or by delivery, not later than midnight of the third business day following the signing of this agreement. DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES. ANDREA LQGILDR O9/02... Customer Signature Date Indicate your selected IIC here, if applicable Initial here if you want the Program to assign a Participating .6tAutito colt/ Contractor Kevin Cote CLEAResult Signature Date Name of CLEAResult Representative Page 2 of 4 Document Ref.J7EYT-ECRBG•953CU.RGEHF Page 2 of 8 TERMS AND CONDITIONS ASSIGNMENT OF CONTRACT BY CLEAResult Customer acknowledges that CLEAResult will,and Customer hereby requdsts CLEAResult to,assign this Contract to the IIC to undertake the Work on the terms set forth in the Contract.After such assignment:(a)CLEAResult shall no longer be a party to this Contract;and(b)Customer shall have no recourse against CLEAResult for any of the performance,non-performance or deficient performance of the Work or any obligations under this Contract performed by,or on behalf of,the IIC.Notwithstanding the foregoing,Customer shall provide CLEAResult with(i)such information regarding the IIC's performance as CLEAResult may reasonably request;and(ii)reasonable access to the Premises as CLEAResult may request to permit CLEAResult to inspect IIC's work;and(c)Furthermore,Customer agrees that he/she/they(i)shall notify CLEAResult of any dispute between Customer and the IIC concerning the Contract;(ii)shall provide CLEAResult with such information regarding the dispute as CLEAResult may reasonably request;and(iii) consent to CLEAResult's participation,at its sole election,in any arbitration or other dispute resolution proceeding between Customer and the IIC. LIMITED TIME OFFER The terms,prices,and any incentive offered in this Contract are valid for only thirty(30)days from the date of CLEAResult's presentation of this Contract to the Customer.In the event that Customer does not execute this Contract and return it to CLEAResult within such thirty(30)day period,the terms,prices and any incentive offered by CLEAResult is NULL and VOID. COMMENCEMENT AND COMPLETION The IIC will not begin the Work or order the materials before the sixth(6th)day after the execution of this Contract by CLEAResult and Customer, whichever signs later(the"Contract Execution Date").Subject to the availability of subcontractors/materials and to delays attributable to the weather or "acts of God",the IIC shall begin performing the Work as soon as practical after the Contract Execution Date,and the IIC shall substantially complete the Work no later than sixty(60)days after that Contract Execution Date,barring delay caused by circumstances beyond the IIC's control,including but not limited to any delay resulting from Customer's decision to wait for a particular IIC. Each of CLEAResult and the IIC reserve the right to advise the Customer of changes in the projected start and completion dates,based upon availability of materials and subcontractors.Upon completion of the Work,the IIC will leave the Premises in a neat and orderly condition but shall not be responsible to correct conditions outside the scope of its Work. MODIFICATION Prior to CLEAResult's assignment of this Contract to the IIC set forth in Section IV(above),this Contract cannot be changed except by a writing signed by CLEAResult and the Customer.After CLEAResult's assignment of this Contract to the IIC set forth in Section IV(above),this Contract cannot be changed except by a writing signed by the IIC and the Customer that has been approved in writing by CLEAResult. PERMITS In connection with the Work to be performed at the Premises by the IIC Under Contract,the following permits may be required for this project depending upon the judgment of local inspectors:Electrical,Plumbing/Gas,Mechanical,Building.The IIC shall be responsible to,and shall,obtain any and all permits required for performance of the Work.The IIC shall inform the Customer of the permits required and any Customer co-pay or cost of the required permit acquisitions. If Customer chooses to secure her/his own work-related permits,and/or deal with an unregistered contractor, Customer will be excluded from the Guaranty Fund provisions of M.G.L.c. 142A. CUSTOMER'S DUTY Customer must prepare the Premises for the Work.Objects which obstruct areas of Work must be moved before the Work is to commence.Customer affirms that they have received no incentives(from the above-named Utility)during the last calendar year. DISCLAIMER OF LIABILITY OF CLEAResult AND UTILITY Customer understands and acknowledges that the IIC is not an agent,vendor or sub-vendor of the Utility or CLEAResult with respect to the installation of any energy efficiency measures. In the event of the failure of any energy conservation device to perform as expected,Customer agrees that Customer's sole recourse is to the IIC and not to CLEAResult or the Utility.The Utility and its operating companies shall not maintain,remove or perform any work whatsoever on the energy conservation measures installed.Customer understands and acknowledges that its participation in the Mass Save Home Energy Services Program is voluntary and that it has consented for the IIC to install the proposed energy conservation measures. Customer agrees that it shall not hold CLEAResult,the Utility,their affiliates or operating companies liable for the IIC's failure to perform its obligations under this Contract,for failure of the energy conservation measures to function,for any damage to Customer's Premises caused by the IIC or for any and all damages to property or injury to persons caused by the energy conservation measures. ENERGY BENEFITS The local sponsoring Utility is entitled to 100%of the energy benefits associated with all energy conservation measures,excluding the value of energy cost savings by the Customer,but including all rights to all associated ISO-NE Energy,Capacity and Reserves Products(as defined by ISO New England),and the IIC agrees to provide the Utility with such further documentation as the Utility may request to confirm the Utility's ownership of such benefits and Products. IIC REGISTRATION The IIC and any subcontractors must be registered by the director and any inquiries about the IIC or any subcontractor relating to a registration should be directed to:Office of Consumer Affairs and Business Regulation,Home Improvement Contractor Registration, 10 Park Plaza, Room 5170,Boston, Massachusetts 02116,617-973-8700. Page 3 of 4 Document Ref:J7EYT-ECRBG-953CU46GEHF Page 3 of 6 IIC WARRANTIES The IIC warrants as follows: A. Materials and workmanship will meet or exceed the specifications in CLEAResult's Materials and Installation Standards. B. The Work and the materials furnished by the IIC will conform to the requirements of this Contract. If there be a defect in workmanship or materials,or any damage caused by its subcontractors or employees is discovered within one year after completion of the Work(including cleanup),the IIC will,at its own expense,at its option,remedy,repair,correct,replace,or cause to be remedied,repaired,corrected or replaced such defect or damage. CUSTOMER RIGHTS UNDER M.G.L.C 142A Customer has the following rights under M.G.L.c. 142A: A. At the time of signing this Contract,the Customer shall be furnished with a copy of it. No Work shall begin prior to the signing of this Contract by the Customer and CLEAResult. B. Any party may bring an action to enforce any provisions of Mass.G.L.c. 142A or to seek damages or the Customer may request that a dispute be decided under the terms of a private arbitration program approved by the Secretary of the Executive Office of Consumer Affairs and Business Regulations. C. Customer may have the right to be compensated from the Residential Contractor's Guaranty Fund for actual losses incurred as a result of a registered contractor's or subcontractor's conduct found by a court to be work performed in a poor or unworkmanlike manner or which violates certain laws for the protection of consumers within 6 months after the Customer has obtained a judgment or arbitration award and has exhausted customary reasonable efforts to collect the judgment or award. Page 4 of 4 Document Ret J7EYT-ECRBG-953CU-RGEHF Paps 4 of.6 Permit Authorization mass save Form Site ID: 4267796 Customer: ANDREA LAWLOR I, Andrea Lawlor , owner of the property located at: (Owner's Name,printed) 25 Lincoln Ave Northampton, MA 01060 (Property Street Address) (City) hereby authorize the Mass Save Home Energy Services Program assigned Participating Contractor listed below to act on my behalf and obtain a building permit to perform insulation and/or weatherization work on my property. 41VDRE4 144/!AR Owner's Signature: Date: 09 / 02... fMM•••••'••••••i••••••••••••••••••l•••ii•••••si•*iti••••A/S*i*f•••••••• FOR OFFICE USE ONLY We have assigned the following Mass Save Home Energy Services Participating Contractor to the above referenced project: Participating Contractor Date Name: CLEAResult Phone: 800-480-7472 Email: Page 1 of 1 For Office Use Only K AC._-c ./R6 CERTIFICATE OF LIABI LITY INSURANCE DATE(MM/DDPYYYY) �--' 04/19/2021 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 CONTACT NAME: RIPPLE EFFECT INSURANCE PHONE FAX PO BOX 1242 (A/C,No,Ext): (A/C,No): EMAIL ADDRESS: DOUGLAS MA 01516 78SAL INSURER(S)AFFORDING COVERAGE NAIC# INSURERAAMERICAN ZURICH INSURANCE COMPANY INSURED INSURER 8: G E E INSULATION LLC INSURERC: 20 KENWOOD AVE WORCESTER MA 01605 INSURERD: 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 ADDL SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MMIDD/YYYY) (MM/DD/YYYY) LIMITS —�COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ DAMAGE TO RENTED CLAIMS-MADE OCCUR PREMISES(Ea cccurrence) $ MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GEN'RRLCCgq AGGREGATEGG LIMIT APPLIES PER: GENERAL $ ��POLIC PROJECT n LOC PRODUCTS—COMP/OP AGG $ AUTOMOBILE LIABILITY r COMBINED SINGLE LIMIT (Ea accident) $ ANY AUTO BODILY INJURY(Per person) $ OWNED AUTOS SCHEDULED BODILY INJURY(Per accident) $ ONLY AUTOS PROPERTY DAMAGE HIRED AUTOS NON-OWNED ONLY AUTOS ONLY (Per accident) $ _^ $ UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS-MADE AGGREGATE $ DED RETENTION $ $ WORKERS COMPENSATION PER 0TH- A X STATUTE ER AND EMPLOYERS'LIABILITY (6ZZUB-5R81822-2-21) 04-02-21 04-02-22 ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? Y/N E.L.EACH ACCIDENT $ 1,000,000 (Mandatory in NH) Y N/A n 1,000,000 E.L,DISFI�SE—EA EMPLOYEE$ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE—POLICY UMfT $ 1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) WOS IN FAVOR OF CLEARESULT CONSULTING INC AND PARTIES AS REQUIRED BY CON TRACT 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 CLEARESULT CONSULTING INC POLICY PROVISIONS. 4301 WESTBANK DR. , BLDG A SUITE 300 AUTHORIZED REPRESENTATIVErf ch 7} /J p AUSTIN TX 78746 / ©1988-2015 ACORD CORPORATION.All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD (Rev.09-18) DATE(MM/DD/YYYY) A�''� CERTIFICATE OF LIABILITY INSURANCE 4/19/2021 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 Jamie Karrat NAME: Ripple Effect Insurance Inc PHONo.Ext): 508-283-3250 [TA XX,NoL. 5083069702 PO Box 1242 E-MAIL ADDRESS: Douglas,MA 01516 INSURER(S)AFFORDING COVERAGE NAIC# INSURERA: Scottsdale Insurance Company INSURED INSURER B: Arbella Insurance G.E.E.Insulation LLC INSURERC: 20 Kenwood Drive INSURER D Worcester MA 01605 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 ADDL SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MMIDD/YYYY) (MM/DD(YYYY) LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1000000 CLAIMS-MADE �XJ OCCUR DAMAGE TO RENTED 100,000 PREMISES(Ea occurrence) $ MED EXP(Any one person) $ 5,000 A X CPS7338423 4/2/2021 4/2/2022 PERSONAL&ADVINJURY $ 1000000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2000000 POLICY PE� LOC 2000000 PRODUCTS-COMP/OP AGG $ OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1000000 (Ea accident) ANY AUTO BODILY INJURY(Per person) $ B ALL OWNED SCHEDULED X 102015413 3/3/2021 3/3/2022 BODILY INJURY(Per accident) $ AUTOS X AUTOS HIRED AUTOS X NON-OWNED PROPERTY DAMAGE AUTOS (Per accident) UMBRELLA LIAB OCCUR EACH OCCURRENCE $ 1000000 A X EXCESS LIAB CLAIMS-MADE XBS0132293 4/13/2021 4/13/2022 AGGREGATE $ 1000000 DEO RETENTION$ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANYPROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ OFFICER/MEMBEREXCLUDED? NIA (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E,L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) CLEAResult and Utilities is additional insured for General Liability and Auto liability when required by written contract. Policies are primary and non-contributory and waiver of subrogation applies per written contract. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN CLEARESULT CONSULTING INC ACCORDANCE WITH THE POLICY PROVISIONS. 4301 WESTBANK DR,Bldg A Suite 300 AUTHORIZED REPRESENTATIVE AUSTIN TX 78746 Jamie Karrat ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD Commonwealth of Massachusetts �` DiviSion of Professional Licensure Board of Building Regulations and Standards • 'C o nstryuGtTilotYSikp$.rvisor CS-115036 Expires: 01/02/2024 GIM S R'COM 398 BURNCOAT ST • %� WORCESTER MA 01606 vOiSViltikW Commissioner &eat K70/22/2'40-/W)-eCail 61-/ eze,i4-excieeedie/4- Office of Consumer Affairs and Business Regulation 1000 Washington Street - Suite 710 Boston, Massachusetts 02118 Home Improvement Contractor Registration Type: Individual GIM RCOM try ' ,,. Registration: 200024 398 BURNCOAT ST Expiration: 11/02/2022 —_ WORCESTER, MA 01606 tn 4 =-; 1 .' Update Address and Return Card, SCA 1 0 20M-05/17 KGvn/rrnirureag/fty< aJ kW/keMea./ Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only TYPE: Individual before the expiration date. If found return to: Registration Expiration Office of Consumer Affairs and Business Regulation 200024 11/02/2022 1000 Wa ngton Street -Suite 710 GIM RCOM Boston, 02118 GIM R'COM 398 BURNCOAT ST 4,,/714'0(a `jOk' • . WORCESTER,MA 01606 Undersecretary Not valid without signature