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24C-100 (5) BP-2021-2106 89 MASSASOIT ST COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 24C-100-001 CITY OF NORTHAMPTON Permit: Exterior Res PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) BUILDING PERMIT Permit# BP-2021-2106 PERMISSIONIS HEREBY GRANTED TO: Project# ROOF Contractor: License: Est. Cost: 9400 SEXTON ROOFING AND SIDING INC Const.Class: Exp.Date: Use Group: Owner: STRAUSS MONICA J TRUSTEE Lot Size (sq.ft.) Zoning: URB Applicant: SEXTON ROOFING AND SIDING INC Applicant Address Phone: Insurance: P O BOX 6327 (413)534-1234 7PJUBOG07898221 HOLYOKE, MA 01041 ISSUED ON:10/28/2021 TO PERFORM THE FOLLOWING WORK: ROOF POST THIS CARD SO IT IS VISIBLE FROM THE STREET Inspector of Plumbing Inspector of Wiring D.P.W. Building Inspector Underground: Service: Meter: Footings: Rough: Rough: House# Foundation: Driveway Final: Final: Final: Rough Frame: Gas: Fire Department Fireplace/Chimney: Rough: Oil: Insulation: Final: Smoke: Final: THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Signature: I a �? 3-s Fees Paid: $40.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Office of the Building Commissioner f _ The Commonwealth of Massachusetts ' Board ofBm7dingRegitlations and Standards :.FOR .). Massachusetts State Building Code,-780 CMR,7th edition ' 'USES � cviliN �-� - a BuiIding Permit Application To Construct,Repair,Renovate Or Demolish a Revised Janet), _i D C i One-:arTwo-Fami'yDwelling 1,2008 c This Section For Official Use Only\t: B naafi Permit Num 4 a 1• Am i t ' SI' / 28 ZOZI • o p '.... Building Commissioner/Inspector of Buildings . Date cr' • SECTION 1:SITE INFORMATION roperty Address: 1.2 Assessors Map&Parcel Numbers 81 to/1 $5, o 1 T. .5/7 ' . 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 T Required - Provided Required Provided Required Provided . - 1.6 Water Supply: (M.O.L c.40.§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Public❑ Private❑ . Zone: - Outside Flood Zone? Municipal❑ On site disposal system 0 Check ifyes0 - SECTION 2: PROPERTY QW NERSHIPr 2.1 Ownert of Record: ' Name(Print) Address for Service: • • 4.11r., 4 id 0..44 • 9/7 - 4, Z o -6 S-S. 7 - - Signature Telephone - SECTION 3:DESCRIPTION OF PROPOSE)WORK2(check all that apply) New Construction O Existing Building 83' -Owner-Occupied l'Repairs(s) 0 Alteration(s)-4 Addition 0 - Demolition 0 Accessory Bldg.0 Number of Units ) Other 0 Specify: Brief Description of Proposed Work: . &01tit.,c 4,1 al le.f.r(u-.c- fX i, -- i - 3A i ^f /.e .4� o -f1 s,�,/ i d • • • SECTION 4:ESTBIATED CONSTRUCTION COSTS Item Estimated Costs; - Official Use Only (Labor and Materials) _ . • 1.Building $ 1, Building Permit Fee:$ Indicate how fee is determined: ❑Standard City/Town Application Fee 2.Electrical 0 Total Project Cost (Item 6)x multiplier x 3.Plumbing $ ' 2. Other Fees: S - 4.Mechanical (HVAC) $ List: ' 5.Mechanical (Fire $ Total All Fees:$ Suppression) �• ' Check N Q� r _reek Amours Cash Amount: !1 6.Total Project Cost: $ a/f`f. ❑Paid to Pull 0 Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES( 5.1 ConstructionSupeervi se E Err tfJ � Frere/-1 je t V/) License Number 'EaCpuanan Date Name of CS t.Holder f� ? � <1JaK List 1-St Type(seebetow) 1�f No.and Street Type Description iption ,0e e .72'7 fJ ) /)LIII 13 Unrestricted(Buildings up to 35,000 cu.S) City(Cbgtd,State Lll� r t/� �J 1J /f R Restricted 1&2 Family Dwelling M Masonry RC Roo5mg Covering WS Window and.Siding SF Solid Fuel Burning Appliances I Insulation =-- .T.._. .. _ Telephone Email address D Demolition 5.2 Registered Home Improvement Contractor(RIC) v.-- p J j PX i7 C'lc-)crl find 0r e incite n'on umber Date ABC C-o Name or egisiraat Name '� NriffeAk 3a ,)�?r(_llog 0 mQ,t /27 Net cKE.,�')"I/9 /LI3' 5/ 4/3 3i L/ E t address State,LIP Telephone SECTTON6: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 ' 'iiir` No II SECTION 7a:OWNtt.tt AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMTT I,as Owner of the subject property,hereby authorize De l�ll} G��tillat to act on my behalf;in all matters relative-to work authorized by this buuidin em cir appli aiion. n tf e 1 G r ' /tt(.re f( /�/2d/'t Print Owner's Name(Electronic Signariue) Date SECTION 7b:OWNERS OR AU11IORIZEI)AGENT DECLARATION By entering my name below,I hereby attest under the pxims 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. d/7 /Z MUSTBE SIGNED by Owner or Authorized Agent Date NOTES: I_ An Owner who obtains a building permit to do his/her own work,or an owner who hires an unregistered contractor (not registered in the Home Improvement Contractor(IBC)Program),will have access to the arbitration program or guaranty fund under M.GL.c.142A_Other important information on the HIC Program can be found at www_t,es,sRovioca Information on the Construction Supervisor License can be found at pw,v_mass_gov/dt?s 2. When substantial work is planned,provide the information blow: Total floor area(sq.ft.) (including garage,finished basement/attics,decks or porch) Gross living area(srk ft.) Habitable room count Number of fireplaces_ Number of bedrooms Number of bathrooms Number of half/baths Type of ht'atiug system Number of decks/porches Type of cooling system Enclosed Open 3_ "Total Project Square Footage"rhay be substituted for"Total Project Cost- ' City of Northampton t Massachusetts , ' :` p 111 4 DEPARTMENT OF BUILDING INSPECTIONS yy} f 212 Main Street • Municipal Building -,j �✓ ?� Northampton, MA 01060 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: ?orzJ17A1/1/ S% itply6�z The debris will be transported by: Name of Hauler: C l 1-(1 (J %7 e c (fit f Signature of Applicant: -- Date: /c/2(i (Z Propc:St, R . , d } rrt144r, ' t1ttID41 )04$ #t11 ttr \44444 4 .0414.1'444, # `. c-A it 1' :€ tO ottititero,to.tot s,t t �s is l�+xt 1 a td a � tk� tl:s � tr rtt � . * Strip 111441 t t 4144444ke s t,4444t of vit prompie:r Ustitilikt r trees roottriiig tirrct sad rrpi: ry ar x r� 41 'fit per smart. imitate two*4W t to r!meit Attol is r t root Pt*iir bruit sr loman Iry er, r Airid 4.101. . ; 'i, *4+14 rt t.,urr 1, (fit-ow:rrA *OW at four 4Art•!i rnv { treesI*II 44 444iiebt to!f saw *nit*low trr it rat. Vista* rfe rr r w ;Ai 4*%r* r rstpt, Xi tail 'KO Arr *r*# rw port m r*iselanrtrr*'tp 4tt tt_ 14) istottall rit rip s 1rr ritio t Softpty rtio tint Liirtimat wt ` *ad s4tt ' ,t at i p**artist:iv.. [d*< x�Ar fat: . M i,4 r* .i r19. .+ " tat . tt.Vitt,t*tt tM tint tilt.s F t a #rr t***r +eaar ►�.ti .+x . tit big 1t t om,.4MM A.* tt. 4 ** ram. Mrt. {>' s '?+' ^ t airs W. t 1'dt► fit if0 Dr A.4 !fit O 0100 tvat 00 CV4e44�Ffit a * , 4410~44* t00#1100 .14* riAlt 1,401.4owlogiSitsmut pri w.�.,.,ir• n.arrn..�...ta. �+.Mrrl+:+.nv+.+w:• t , rm.....•�psMMY•u±:#�'M'n�°'+v�,.ryy.ewxn_vrex+,,* w.•••^Y ..—..,e -.. -.a mHt✓. -. ,.,. g of P po of Iv tit ' ^fit „ Fl s e _ Departrnent ofIndustrialAccidents ' '' ' Office aflrrvestigatians Lafayette City Center 1, -L'C= 2Avenue de Lafayette, Boston,MA 0211.I-1750 fir-` www.mass_gov/dig Workers' Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Buaness/O,rg on/Individual):Sexton Roofing & Siding, Inc Address:P.O. Box 6327 , City/State/Zip:Holyoke, MA 01041 , Phone 4:413-534-1234 • - Are you an employer?Check the appropriate box Type of project(required): 1_❑ I am a employer with 4. M I am a general contractor and I 6_ ❑New construction employees (full and/or part tirne).* have hired the sub-contractors 2_❑ I am a sole proprietor orparhier- listed on the attached sheet 7. ❑Remodeling . ship and have no employees .Theme sub-cow have 8_ ❑Demolion working for me in any capacity. . employees and have workers' • insurance- [No workers' comp.insunce •count_insurance 9. ❑Building addition requited] - 5. ❑ We are a corporation and its ' 10.❑Electical ieyairs or additions • 3.❑ I am a homeowner doing all work oiiiceis have exercised their .11_❑Phmmbing repairs or additions myself- [No workers' c - "right of exemption per MGL comp_ 12_M Roofrcpairs insutance required_]t c_ 152,§1(4),and we have no employees. [No workers' 13.0 Other comp.insurance required_] . *Any aeplic'ntfihnt checks boa P1 must also fill outlhe section helawshowing-heir wader,'campensation policy mfnmrrt±au. I.Homeowners who submit-this a idaviKmdicam,gthey are doing all-work and.then hire outside contractors run sr rebuilt a new a£5davitmdicatingsuch_ ,*Contractors that check this box must am-hed an additional dirt showing the name of the sab-contactors and state whether ar not thole entities have emplu j cra. If the sob-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 - inforrriation_ - _ Insurance Company Name:Travelers Property CAS CO OF AM _ Policy#ar Self-ins-Lin_4:7PJU13000789822, Expiration Date:6/4/gas • Job Site Address: 9/0 4,ro, f ,)/ , City/State/Zip: Ar�A � , iY • /ii/y__ . Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). ' Failure to secure coverage as reed under Section 25A ofMGL c_ 152 can lead to the imposition of Liiiinaal penalties of a fine up to$1,500.00 andlor one-year imgtisonmer<t,as well as civil penalties in the form of a STOP WORK ORDER-and a fine of LT to$250.00 a day a ttamst the violator_ Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA forance coverage verification . Ido hereby certify under " s and penalties-afperjray that the information provided above is true and correct : Sio-natnre: - Date: /i /Zr 4 l . • Phone#: 413-534-1234 . Official use only. Do not write in this area,to be completed by city or town officiaL • City or Town: . • Permit/license it Issuing Authority(check one): • 10Board of Health 2[]BuildingDe_partment 30CitylTown Clerk 4.1=1Electrical Inspector 50Plnmbing 1 Inspector 6_0Other Contact Person: Phone#: • AC Ref CERTIFICATE OF LIAB:UT1f INSURANCE n'TE 11` Y' 4/2021 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 policyties)must be endorsed. if SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain panties may require an endorsement A statement on this cartff"tcate does•not confer rights to the certificate holder in lieu of such endorsementis)_. PRODUCER CONTrowE'er Eric Dembinske ORMSBY INSURANCE AGENCY III (413)737 u300 Nei: AormES.a edembinske .ormsbyins.mm P O BOX 718 INSURER a)AFFORDINGCOVERAGE AMC •WEST SPRINGFIFI 11 MA 01090 INsuRERA: TRAVELERS PROPEtt I Y CAS CO OF AM 25674 INSURED II1.31IRER B: SEXTON ROOFING&SIDING INC INSURER INSURER PO BOX 6327 INSURER E: HOLYOKE MA 01041 ENSURERF: COVERAGES t.LtiiIrICATE 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 INDICA!tu_ NfTCWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH This CERTIFICATE MAY BE ISSUED OR MAY PER i AIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, FXCI_US)ONS AND CONDITIONS OF SUCH POLICIES.UNITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. RISR. ADM SUBR POLICY EFF POt[CYEC, DR TYPE OF NISURANCE *SD wyri POLICY NUMBER IleriDONYrY. (MM1Dn/YYYY1 Lams COINNUCCIALG8IFRae t uBIUTY EACH OCCURRENCE -'$ C ARIS-LADE OCCUR .FIZEWSES(Eaanirtance1 S MED EXP(A+y mependnl N/A ' PfRSCNAL S ACV INJURY "S GEM.AGGREGATE IUD-APPLIES.PER: GENERAL AGGREGATE -.5 POLICYI IJH'. LOC PRODUCTS-COMP/OPAGG $ CITHEL' • - :S AUTONOBILELIABILITY CCIMENNED SINGLE LIMIT S. ■ANYAtrTO BCOILY INJURY*(Pw person) S ■A OS ® SCHEDU5LED /A BCOILY INJURY(Per Accident)" I.HIRED AUTOS ' AU us NON-OWNED 1Per accident) PROPERTY R UMBRELLA LIAH OCCUR EACH'OCCURRENCE S FJCCESSLIA8 CLAIMS-MADE N/A AGGREGATE S DEO RETENTIONS. S. WORKERS COMPENSATION PER 0TH- 13 AND EMPLOYERS"LtABUJ YIN TY X STA I u it ER E% ANYPROPRIE7ORIPARTNER/ ECUTIVE EL EACTf ACCIDENT.S 1,000,000 A OFFICE RM®IBERRECLUDEDI NIA NIA Nut IP.IUB00075.98221 06/04/2021 06/04/2022 b(M nd . ten l EL DISFA E:EAEAI s 1,000,000 IIy��dma;b. der OFS('RIFIIONOE O OP87ATON5treiw EL_tIL4FaSE_POLICY'C]Mrf 1,000,000. N/A DESCRIPTION OF OPERATIONS!LOCATIOIIR(VENICLES(ACOrrD.10t,Additienai Ramatbr Omar be attached if mom space 7c emoted) Workers'Compeisation benefits will be paid tb Massachusetts employe i only_Fursrraritto Endorsement.WC 20 03 06 S,no authorrzation is given to pay claims for bene116.to.employees instates other than Massachusetts.III he insured hires,or has hired those emptaycee 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&'this certificate&insurance)_ The status of this coverage can be monitored daily by accessing the Proof of Coverage-Coverage Verit-a.dliun. Seared tool at www:mass_govAwd/worker...-compensationfinvestigations/_ . CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED-Fan.BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS, ) ALm fi12' 3 REPRESENTATIVE Daniel M.Croy,CPCU,Vice President—Residual Market—WCRIBMA ( 1968;1014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD , /'—I", SEXTO-2 OP ID: KH A�ORO CERTIFICATE OF LIABILITY INSURANCE DATE(MM/D❑YYYfj 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 poiicy(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 FAX 413-737-0617 698 Westfield St PO Box 718 (A/C,No,Ext): (AIC,No): West Springfield,MA 01090 E-mAILss:edembinske@ormsbyins.com Eric Dembinske I INSURER(S)AFFORDING COVERAGE I 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 0: 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 ADOL SUER POLICY NUMBER POLICY EFF POLICY EXP LIMITS LTR INSD WVD IMMIDDIYYYYI (MMID0/YYYYI A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE I X l OCCUR WS45073 06/25/2021 06/25/2022 DAMAGE TO RENTED 100,000 PREMISES IEa occurrence) $ MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY PELT LOC PRODUCTS-COMP/OP AGG $ 2,000,000 _ OTHER: $ B AUTOMOBILE UABILITY - COMBINED SINGLE LIMIT 1,000,000 (Ea accident) $ — ANY AUTO AFV206561 05/15/2021 05/15/2022 BODILY INJURY(Per person) $ OWNED SCHEDULED _ AUTOS ONLY X AUTOS - BODILY INJURY(Per accident) $ X HIRED X NON-OWNED PROPERTY DAMAGE AUTOS ONLY _ AUTOS ONLY (Per accident' $ - $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED Rt I ENTION$ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY STATUTE ER YIN ANY PROPRIETOR/PARTNER/EXECUTIVE TO BE ISSUED SEPARATELY OFFICER/MEMBER EXCLUDED? N/A EL EACH ACCIDENT $ (Mandatory in NH) If yes,describe under E.L DISEASE-EA EMPLOYEE $ DESCRIPTION OF OPERATIONS below _ - E.L DISEASE-POLICY LIMIT_$ DESCRIPTION OF OPERATIONS 1 LOCATIONS I VEHICLES (ACORO 101,Additional Remarks Schedule,may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES SE 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 of Ma�achusetts S.TA F OF CO\\EC"IICLT wealth Common sional Licensure pivision of Prof ulations and Standards H� COS Board of Building R? .�� r Specialty �J S FON SR Constr��� �j f i 1010512023 ]a2 i� empires: f CSSL-099689 _ - CTO. TON ROOFING&SIDING CO Wit. p0BO 2� v} PO 80X 01 ylp YOKE MAt �nP ,�0 � � �C-°605383 ' 12 20- `'` 2I/3Q1202a SIGNED Commissioner 0 Rvuis-r ant �_n RESPONSIBLE REGiSTRATiON ADDRESS EXPIRATION ST, T'. S !NDWIDUAL NFUME, R DATE SEXTON ROOFING& SEXTON,E/ERETT 118239 P.O.BOX 6327 02/14/2023 Current Siding Inc HOLYOKE,MA 01041 112 il till 1 , 41 . . 8 , . 1111111 . , . ::I 11 01 0 t 1 -,-_--, I . 4,4 4 t k ): 00cr.,:0 [1 . 1:1 li• 'i . i I 1', ig : od cil it z1 74 , • ti ,.., 1,11 , z 1 '111 ,11 I 4 , , 1 i ' 1,1 10 ' I :1".-riN 4 11 ,; 1 .., _ () 1 , 1 ,/ , :, gri , ., klog $ ., I, , od 1 , a. ..., ,; N' t; ,tig 4' ' 111; - ,x111,. 4ts, ; 1 Nii .,: r the III i,1 I . 14r! . L'',c. ):: [ t 1 i Pl 11 °14 ' ni • 1 °" 111 lot ,liti •.4., - 41 1 ,fl . %ILI, if. 1 ,,, id td x 1 ". . 1 11 . . , II; 1111 ][111, 14:10'' 1 ,011, 11 1 ! 1 I .:: : . ; ;\,,,, 11 Ilk !Ill t I 1 i 1 , 4! bi, • I'L ir: t , frt I 4 lllit, 411likii:lhi: '..1 ' I . ;t it 1 i; ill i g ' . i 4:411 '--7 ° 1 . •17! l' I ' ihrliow. ti. 1 IN_141' ,., AB A tIN" ill IIM 4 " a Poi ; 4.t. 1 '10 it 11 1 1 ' .. 1"11 111 (Q9 ' 9 Ci kill 1 . 1 g tl 114th F14 6' 4 '4''zi ' A�D® CERTIFICATE OF LIABILITY INSURANCE CAI t''_tL "'' 11/13/2020 THIS CERTIFICATE IS ISSUER}AS A MAI i t1{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 CEItIIHCATE HOLDER. IMPORTANT: If the certificate holder is an ADOInONAL 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). PRODUCERp'CT Edson DeSO1.17a MAYFLOWER INSURANCE GROUP INC PHONEo 1: (7-74)n3-9702 E AI7D RE3S: Edson m owerinsurance.com 299 Court Street INSURERLS)AFFORDING COVERAGE NAICTL Plymouth MA 02360 S SJ RERA: HARTFORD UNDERWRITERS INS CO 30104 2,151.112E0 INSURER B MNP CONSTRUCTION INC ups❑RERC, INSURER D: 45 EXCHANGE ST APT 3E INSURER E MILFORD MA 01757 INSURER F_ COVERAGES CERTIFICATE NUMBER: 595621 REVISION NUMBER THIS IS TO CEKI IFY THAT THE POLICIES OF INSURANCE LIE ED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICAIk.u_ 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 POUCIES_LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS_ LSR TR TYPE OFINSURANCE ADDLSUBR POLICY EFF POLICY P _ MILL wvp— SO POLICY NUMBER _WACONT T TI (MAVDDrYYY) LIMITS COMMERCIAL GEVERAL LIABILITY EACH OCCURRENCE S DAMAGE TO RENTED CLAIMS-MADE OCCUR PREMISES(Fa omrrnence) ; MED EXP(Anyone person) S N/A PERSONAL SADv INJURY $ GEN'L AGGREGATELMITAPPLIES PER: rI 'PROT- r GENERAL AGGREGATE ; POLICY I I JEC I LOC PRODUCTS-COMP/OP AGG S OTHER AUTOMOBILE LIABILITY CC'df81Nm SING]F LIMIT $ (Es accident)" ANY-AUTO BODILY INZ RY(Per person) S- ALL OWNED SCHEDULED AUTOS AUTOS N/A BODILY INJURY(Per amdard) ; NON-OWNED PROHEHTY DAMAGE HIRED AUTOS AUTOS O'er ay;,lent) S UMt3RELLAIIAB OCCUR EACHOCCURfBJCE S ECCESS LAB CLAIMS-MADE N/A AGGREGATE s Ott I RETENTIONS WORKERS COMPENSATION X STATUTE (OTH- E2 AND EMPLOYERS'LIABE ITY Y!N' ANYPROPR1ELOR/PARTNERIEXFLIITIVE EL EACH ACCIDENT $ 1,000,000 A OFFICERlMm4BFRE(C JJOED? NIA WA MA 6S60UB1K70970620 11/16/2020 11/16/2021 (Mandatory in NH) EL➢isaasa-EA ELiPLOYIJ S 1,000,000 if yes,describe under DESCRIPTION OF OPERATIONS()dare EL DISEASE-POLICY LIMIT $ -1,000,000 WA OF‘r'RIPTION OF OPERATIONS/LOCATIONS!VMIICLES(ACORD 101,Adddional Remarks Schedule,may be attached if-mores-pace is required) - Workers'Compensation beneffis will be paid to Massachusetts employees only_Pursuant to Endorsement WC20-03 06 B,no authorLation is given to pay claims for benefits to employees instates other than Massachusetts if the insured hires,or has hired those employees outside of Maosachusetts. This certificate of insurance shows the policy in farce on the date that this certifies was issued(unit the expiration date on the above policy precedes the issue date of this certificate of insurance). The status of this coverage can be monitored daily by ar =cFing the Proof of Coverage-Coverage Verification Search tool at www.mass.goviiwd/workers-compensationfirlyestigations/. " CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCFI I Fr)BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS_ Sexton Roofing & Siding Inc 102 Pine St AUTTRORy_su REPRESENTATIVE • Holyoke MA 01041 j FI C Daniel M.Cr v y,CPCU,Vice PIt ident—Residual Market—WCRIBMA ©1985-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD • CERTIFICATE OF LIABILITY INSURANCE , 1,124120 THIS CERTIFICATE IS ISSUED AS A MA I I tK OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CET-I IHCATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALIBI 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 ADOftIONAL 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 Astatement on this certifiLate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Art Calvillo PE One Family Insurance (Ar�c,Nti,En), 975-403-5_942 FAX N.), 97S-403-5943 1 Main St Suite 15 E-MALL AusREa'S: art1uran .com Y�ra cs Lunenburg,MA 01462 NatC INSURER(S)AFr'OFDT G COVERAGE INSURER A: Evanston Insurance Company INSURED - INSURER B: INNP CONSTRUCTION,INC. INSURER C 45 EXCHANGE ST APT 3E INSURER D MILFORD,MA 01757 INSURER E ENSURER F: COVERAGES C.tRTIFICATE 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 PBX IAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALLTHE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR 1IDLSUBH POLICY El-P POLICY EB' LIMITS LTR I Y1't OF INSURANCE nLSD � WVD POLICY NUMBER {c,LMIDD{YYYY{ D OIYYYYI X COMMERCIAL.SEVERAL LIABII WY EACH OCCURRENCE 5 1,000,000 DAMAGE TO RENTED 100,000 _ CLAIMS-MADE X OCCUR FRE J bb(Eammar oce) S MED EXP(Any one Pe* ) s 5,000 A Y Y 3EIJ385 11120120 11/20/21 PERSONAL&ADVINJURY s 1,000,000 GEM_AGGREGATE LIMIT APPLIES PER: t GENERAL AGGREGATE s 2,000,000 P 2,000,000 POLICY JECT LOC PRODUCTS- NC G OTHER COMBINED S AUTOMOBILE LIABILITY f ramp)WGLE LIMIT ANY AUTO BODILY INJURY(Per person) S OWNED —SCHEDULED BODILY INJURY(Per—:6:Emf') S AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE AU I L' ONLY AUTOS ONLY (Peramderdl S UMBRELLA LEA$ OCCUR EACH OCCURRENCE S Eti.t�LIAB CLAIMS-{MADE AGGREGATE S DED RETENTIONS - WOR1� GTH- PER 5 COMPENSATION STATUTE ER AND EMPLOYERS LIABILITY Y/N ANY PROPRIETORPARI7IERE(ECUTIVE NIA EL EACH ACCIDENT S OFFICER/MEMBER EXCLUDED'? (Myy-aa,rs�..I.,tu j in NH) EL DlsFa1E-EA EMPLOYT.S DESCRIPTION OFFO OPERATIONS Leto, ,EL DISEASE-POLICY LAID- S DESCRIPTION OF OPERATIONS!LOCATIONS I VEHICLES (ACORD 101,AddiEmcl Rrmrarka Sdretile,may Ise a>sached if more space is.required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCEL I Fr)BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. SEXTON ROOFINGS SIDING INC 102 PINE ST P.O.BOX 6327 ALYTHOR7ZED REPRESENrA HOLYOKE,MA01040 ����+ ©1988-2015 ACORD CORPORATION_ All rights reserved. ACORD 25(2016103) The ACORD rime and Togo are registered marks of ACORD