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11-018 (2) BP-2021-2328 31 RUSTLEWOOD RIDGE COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 11-018-001 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-2021-2328 PERMISSION IS HEREBY GRANTED TO: Project# ROOF Contractor: License: Est. Cost: 38800 SEXTON ROOFING AND SIDING INC 99689 Const.Class: Exp.Date: 10/05/2023 Use Group: Owner: HELMS ZACHARY N&MICHLLE W Lot Size (sq.ft.) Zoning: WSP Applicant: SEXTON ROOFING AND SIDING INC Applicant Address Phone: Insurance: P 0 BOX 6327 (413)534-1234 6s60ub5r90632621 HOLYOKE, MA 01041 ISSUED ON:12/22/2021 TO PERFORM THE FOLLO WING WORK: NEW 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 w 5 Fees Paid: $40.00 212 Main Street,Phone(413) 587-1240,Fax:(413)587-1272 Office of the Building Commissioner .� The Commonwealth of Massachusetts - Board of Building Regulations and Standards . FOR \.1Massachusetts State Building Code,780 CMR,7'a edition MUNICIPALITY USE ---• Building Permit Application To Construct,Repair,Renovate Or Demolish a Revisediamiary j One-or Two-FamilyDwelling 1,2008 i T r n- This Section For Official Use Only o li a Bi thing Permit Number C/Z' 41r 3,.g- Date Applied: fi ��/� zD • c s. ,' ' /� - • /Z- ZJ:ZOZI o° , + Building Commissioner/Inspector of Buildings Date � , z� co ,�, SECTION 1:SITE INFORMATION g m 1.1 roperty Add 1.2 Assessors Map&Parcel Numbers c o 6-^-�"- "1 1aIs this an accepted street?yes (no MapNumbcr Parcei1 Number\ 51.3 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 Pear-Yard • Required Provided Required Provided Required Provided 1.6 Water Supply: (MAL 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 Ch ect if yes❑ • SECTION 2: PROPERTY QWlRSHIP1 2.1 Owner'of Record: � I ,� c C ytCteti � . (wi--5 • 3 r�C - • Name(Print) Address for Service: X Signature Telephone • SECTION 3:DESCRIPTIONIO OF PROPOSED WORK2(check all that apply) New Construction CI Existing Building/d' Owner-Occupied 11- Repairs(s) 0 Alteration(s) to Addition 0 Demolition 0 Accessory Bldg.0 Number of Units / _ Other 0 Specify: _ • Brief Descripti ofProposed Work: ' pfrkii.4r__. {�' P L 4 r f , • . - SECTION 4:ESTIMATED CQNSTROCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) _ - 1.Building $ 1. Building Permit Fee:S Indicate how fee is determined: Standard City/Town Application Fee 2.Electrical $ 0 Total Project Costa(Item 6)x multiplier . x 3.Plumbing . . S • • 2. Other Fees: S 4.Mechanical (HVAC) $ List: 5. Mechanical (Fire $ Total All Fees:$ Suppression) t �- Check No.%`-' ' Check Amount: ' Cash Amount: 6. Total Project Cost: S3 ('Sz%, o Paid In Full ❑Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) �F /�i() 16/5-'2 & 'erebLSe mil^ License fNluL'mberf Y�iraRain)D�,ate Name of CSL Holder /(�' 1 } i��/L�CJ ?6 /1OK 0 ry T set CSL Type(seebelow No.and Street J Type Description !1 U I /l f(DL `-MA 016511 U Unrestricted(Buildings up to 35,000 cut ft.)) 4f/tR Restricted 1&2 Family Dwelling City/C State,ZIP M _ Masonry RC _Roofing Covering WS Window and Siding SF Solid Fuel Burning Appliances I Insulation — - Telephone Fntail address D Demolition 5.2 Registered Home improvement Contractor(HIC) /` 19 3 3Px � &i� f and 3,d� T--nP I 1 Re 3 �j HIC Regsuation Number £atpiratian Da`tc HIC Co arty Name or egistrant Name .J No. Street ,)e -onf In 0ah0M0//6 i7) F�il address l/4Ca4?KC4 rnA G-/ )-4(/ q13-53 / j 1 Cityfrawn,State,LIP 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 ' 'fi}'` No ❑ SECTION 7a:OWNER AUTHORIZATION TO BE COMPLE1k,D WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT 1,as Owner of the subject property,hereby authorize 3e dVl) 17 wit-ea Ol7d f/ The- to act on my behalf,in all matters relative to work authorized by this bul1dibg.?ermit application Print Owner's Name(Electronic Signature) Date SECTION 7b:OWNER'OR AUTHORIZED AGENT DECLARATION By entering my name below,I hereby attest under the pains and penalties ofpezjury that all of the information contained in this plication is true and accurate to the best ofmy knowledge and understanding_ / MUST BE SIGNED by Owner or Authorized Agent ` Date NOTES: I_ An Owner who obtains a building permit to do his/her own wodc,or an owner who hires an unregistered contractor (not registered in the Home Improvement Contractor(HIC)Program), ma have access to the arbitration program or guaranty fund under M_G_L-c.I42A Other important information on the HIC Program can be found at www_mass_govloca Information on the Construction Supervisor License can be found at}r utiy_mass_gov%dns 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.fL) Habitable room count Number of fireplaces Number of bedrooms Number of bathrooms Number of hatf/hath,c 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 << t 4. `y t, g s DEPARTMENT OF BUILDING INSPECTIONS "- b 212 Main Street • Municipal Building Northampton, MA 01060 CONSTRUCTION DEBRIS AFFIDAVIT (FOR ALL DEMOLITION AND RENOVATION PROJECTS) In accordance of the provisions of MGL c 40, 554, 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: 7601 C4414/ 'J r / t/ C 1-� t MA-- The debris will be transported by: r , Name of Hauler: e 4'5'ct ,-- vt Signature of Applicant: Date:It! Z G'I a __ _____..43tropaigat .„.........,... ..___ ..,......_________ .. SEXTON ROOFING AN') SIDING INC w•i TR.se tQt•mofin,'Lo 3 l ,,, ,, ,, .:� ,-,,,,,:.t, ,.; ,-,,,,, , ,-, ,,btsK4� VANir0 - P.O. Box 6327 .. Itwil'. Setting the+taticarcl -.. Holyoke, MA 01041 p. 413.534.1234 f. 413.539.9906 MA IIUC # 118239 s xt 1, � 9l, of riail.cpm SUBMITTED TO Michelle Hums_ 1 PHONE 732-394-8894 .�- CITY,Sfi , ZIP Northampton,Ma. ' ........_ mrarlulituW il.tom SEXTON ROOFING HEREBY SUS..TI'S SPECIFICATIONS AND ESTIMAThS TC7R: ' I) Strip and remove existing shingles and dispose of in proper landfill. 2) Inspect roofing deck and replace as needed* $95.00 per sheet. 3) Install new metal edging to rakes and eaves of roof. (white/brown) 4) install ice and water shield on treys (6'), vent stacks, in valleys,chimney, and at intersecting roofs. 5) .Install synthetic roofing underiayment on remainder of roof. I 6) Install new flanges over existing vent stacks. ?) install starter shingles on eaves and rakes of roof. 8) Install Ike)Architectural style roofing shingles as per manufacturers' specifications. 9) Install new cap over ridge vent. 10) Reflash chimney as needed- 5300.00 11)Supply manufactures Lifetime warranty and SRC 5 yr. workmanship warranty. ArrENT1oNHCk LOWt5;;pr.FAsrCOVERAle PERSONAL IR#l:DtcitiGSt\Tiff' ATTIC,GARAGE,Ire STottAGF AREAS DUE To POSSIBLE ROOFING DEBRIS OR Mtn CUSUPIO THROUGH CLACKS OF WOOD PFiCU O. i rare P vpofo hef by to furnish matrrtJta/#nPd f1abO -Pasplatil IA acoonnance wfr tbe above s_peciAcafion:i,, !or the sum ell 3'0 T_►1_ + 1Eht Theue dflue h*mdrsd IPOUbRA 08,800.00) Pi AyBE $:1 113 payment schedule .o...',..-; •- .-..... e-� - , AIl svistecat b gutreeterd w be as spctztbcd All work to be completed to a Authorized ,--"�, ,�}" _"' -. straw=Anna according to standard pia Any aJeratur.�Or `s Si/Mat/in1 - de iatluta from alone specifications Einfolving atm onus will be execute,...1 only upon written orders,and will brxonse an over and above Me z '•tom", - } ,�-t .1- estimate.DAMAGES raw €sx*�ra�rzur vrceTar Aatc r.Y Note.This proposal may be withdrawn by t if ncot aCceptecl ISE UNAvt MAlLE ANi WE ARE HELD fia,1sd1ESS NO am •amble for water within (14)days ti. . Owner us pair was lrte legal flax for non- . •<,I and +�•t.- .' inrreui — Ilaeptante at ixsposal The above prices,specifications and conditions are satisfactory and are hereby accepted.. You Signature are authorized to the work as vecified. Payment will be made as outlined above. Signature ».. I Date of• it . .nee. g :f r '' "+ txy'tP a .. ....... :"F,„ . _c.. r*., b. ` per S.t6K'. `. --...Nti' . nfa.. ..�+K3'S'h."S , 1 C,W---- 0 Department a,fIndustrialAccidents Office o Irry ations .1Lafayette City Center —�,� Avenue de Lafayette, Boston,MA02IZ1-1750 www.mass_gov/dig • Workers' Compensation Insurance Athdavit:Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name /Org zation/lndividual):Sexton Roofing & Siding, Inc Address:P.O. Box 6327 , City/State/Zip:Holyoke, MA 01041. Phone#:413-534-.1234 Are you an employer?Check the appropriate boa: 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-time).*' have hired the sub-contractors 2_❑ I am a sole proprietor orpartaer- listed on the attached sheet 7. ❑Remodeling ship and have no employees -These sub-contractor have 8_ ❑Demolition working for me in any capacity. . .employees and have workers' 9. ❑Building addition - [No workers' comp.inst rance, comp.ins anc $ required.] • 5. ❑ We are a corpoidiion and its ' 10.0 Electrical iejiairs or additions 3.❑ I am a homeowner doing all work officers have exercised their -11.0 Plumbing i pairs or additions myself-sel£ [No worker' c • right of exemption per MGL °�P 12_a Roofrepairs insurance leg-aired]t c_ 152, §1(4),and we have no • - employees_ [No workers' li.0 Other comp.insurance required] 'Any dpplican±Thnrt checks boxf1 must also fill out-die section&lowshowingtheirworkars'compensation policyinfamat?cm_ t Homeowners who snbarittlri s a5davrmdir-mrg they are doing all work and then hire outside contractors must snbniit a new affidavitindicating such_ :7-Contractors that check-his hex must attached an additional sheet showing the name of the sob-contractors and state whether ar not those entitieshere . employees. If the sob-contractors have employees,they m ustpruvide their workers'comp.policy numb= • I um an employer that is providing workers'compensation issuance for my employers Below is the policy and job site - information. - . Insurance Company Name:Travelers Property CAS CO OF AM Policy#or Self ins_Lin_4:7PJU80O0789P,911 - Expiration Date_6/4129, ' Job Site Address: 1/4:-. - I 12(.s'1 le UOLC1.1-- 't tl l'2 CityiState/Zrp: 1K--T i Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). ' Failure to secure coverage as required under'Section 25A ofMGL c. 152 can lead to the imposition of criminal penalties of 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 iv to$250.00 a day against the violator. Be advised the a copy of this statemcut may be forwarded to the Office of Investigations of the DIA forsiminancle coverage verification_ I do hereby certify under</� s and penahies-ofpejwr that the information provided above is true and correct Sio-na we: - Date: `dt/Z-'I Z/ • 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# . • Issuing Authority(check one): 1--� 10Board of Health 211 Building Department 3❑City/Town Clerk 4.0Flectrical Inspector 5 • trinmbing Inspector 6.0Other • Contact Person: Phone#: M E{M�MrDMYYYI'YI { A`ELT) CERTIFICATE OF LIABILITY INSURANCE DATeaire2D21 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 INSURERIS), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER IMPORTANT: tf the certificate holder Is an ADDITIONAL INSURED,the policy(iesj must be endorsed. If SUBROGATION IS WAIVED,subject to • the tarns and conditions of the policy,certain policies may require an endorsement A statement on this certificate does not confer rights to the certificabs holder In lieu of such endorsement(s). PRODUCER CONTACT Eric Dembinske ORMSBY INSURANCE AGENCY Erik 1413)737-0300 Nol_ E-MAIL edembin on„s rxs_cam P O BOX 718 ReRa/S)AFFORowG COVERAGE NAIC* • WEST SPRINGFIELD MA 01090 vasueeeA, TRAVELERS PROPERTY CAS CO OF AM 25674 INSURED INSURER B: SEXTON ROOFING&SIDING INC INSURER INSURER n_ PO BOX 7 RMBURIERE: HOLYOKE MA 0:1041 INSURER F- COVERAGES C L-KI IHCATE NUMBER: 665015 REVISION NUMBER: THIS IS:TO LLXIIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICAI I_U_ 'NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY Pttt I AIN,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 ADOLSIBRI I POLICY EFF POLICY FX LTR' TYPE OF N5LRANC>= MD AIM . POLICY NUMBER MMIDDtYYYY)' rMFNDD/YYYYI - UNITS COMMERCIAL GENERALLAee.JTY EACH OCCURR5FCCPALLAC TO ASIS E311 MADE I I OCCUR PRLs5(Faamrrn Q. ncel 3 MED ECP(Any ace semen) 5 N/A " PERSCNAL&AOV INJURY -5 GEM.AGGREGATE LIMIT APPLIES.PER: - GENERAL AGGREGATE S POLICY I,ErrT I LOC PRODUCTS-COMP/OP AGG S OTHER: S COMBINED SINGLE LIMIT AtrroMMCBSEIJAeILrrY - 11 calico!) s ANY AUTO BODILY INJURY(Pei Peman) S ■ WN®ALL OWN® —SCHEDULED' N/A BODILY INJURY(Pei'accident) S ■H .AUTOS AU _AUTOS AUTOS I.. HIRED. UMBRELLA LIAR _.00CUR EACH OCCURRENCE. S EXCESS LIAR CLAIMS MADE NIA AGGREGATE S DM3 RET MJT1CN 5. 5- WORKERS CORPENSATION OTH- ER STAI rt ER AND EMPLOYERS LILau_rrr ANYPROPRIETDR/PARTNERIECUTNE Y f„IX EL EACH ACCIDENT PLDYF I S 1.000,000 A OFFICE RMEMEI RE<CLIpEO? I.RAI NfA IN!‘ 7R1UB000789822'1 06/04/2021 06/04/2022 siI (Imo. b L ey it NH) EDISEAE_EAERA s 1,000,000 II yes.dmenib r wider DESCRIPTION OF OPERATIONS below EL.DISA F-POUCrUMTT I's 1,000,D00. N/A DESCRIPTION OF OPERATIONS!LOCATIOIS VE NCLS(ACDim 1Rt,Additional Remarks-Schedule,may be attached if more space a menaced) Workers'Compensation benefits will be paid to Massachusetts empio only_Pursuant Endorsement WC 20 03 06 B,no authorization is given to pay claims-for benef"ib,th-employees instates other than Massachusetts. 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-nets 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 at Coverage-Coverage Veril-n.atiun. Search tool at www:mass.govINaliworkers-compensationIInvestigationsf. 1 CERTIFICATE HOLDER . CANCELLATION SHOULD AMY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED-FIT_BEFORE • 1e THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS: AUTHOR®REPRESENTATIVE I I Daniel M.Croy,CPCU,Vice President-Residual Market-WCRIBMA 1988.2014 ACORD CORPORATION. AR rights reserved ACORD 25.(2014101) The ACORD.name and logo are registered marks of ACORD SEXTO-2 OP ID: KH W RE:r CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DO/Y(YY) 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 NAME CT Eric Dembinske Ormsby Insurance Agency,Inc. PHONE 413-737-0300 FAx 413-737-0617 698 Westfield St PO Box 718 (A/c,No,Ext): I(Avc,No): West Springfield,MA 01090 E-MAIL edembinske@ormsbyins.com Eric Dembinske ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Northfield Insurance Company _INSURED INSURER B:Quincy Mutual Fire Insurance 15067 exton 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 TYPE OF INSURANCE ADOL SUER POLICY NUMBER POLICY EFF POLICY EXP LIMITS ISO WVD (MMIDD/YYrr) (MMIDD/YYYY) A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE X OCCUR WS45073 06/25/2021 06/25/2022 PREM ss rEa ooD ce) $ 100,000 MED EXP(Any one person) $ 5,000 • PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE UMIT APPUES PER: GENERAL AGGREGATE $ 2,000,000 POLICY j LOC PRODUCTS-COMP/OPAGG $ 2,000,000 OTHER: B AUTOMOBILE LIABILITY jEa B Nccid SINGLE LIMIT $ 1,000,000 ANY AUTO AFV206561 05/15/2021 05/15/2022 BODILY INJURY(Per person) $ OWNED AUTOS ONLY X AUTOS BODILY INJURYp (Per accident), $ X AUTOS ONLY X AUTOS ONLY Perr ecEadent)AMAGE $ • UMBRELLALIAB _ OCCUR EACH OCCURRENCE $ EXCESS L1AB i CLAIMS-MADE AGGREGATE $ DED RETENTION$ _$ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y/N - STATUTE ER ANY PROPRIETOR/PART TO BE ISSUED SEPARATELY . EL EACH ACCIDENT OFFICER/MEMBER EXCLUDED? I N I A $ (Mandatory in NH) _ Eyes,descdhe under EL DISEASE-EA EMPLOYEE $ DESCRIPTION OF OPERATIONS below EL DISEASE-POUCY 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 REPRESENTATIVE ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD STATE OF CO\\EC-TICLT o:1st Ma�achusetts •-.' onweatth Ucensure .;.•.; !,', Comm ional dStandardsDivisionofrolgp r BoardofBuidingRec3ations an ecialtyR SaP rd+�r 5p J SEXTON SR Construct�!iQ :6:pires:10105f2023 •_upset HOLYO M ' � 1 CSSL-099689 ?` S "6 ���yy`` TO SEXTON ROOFING Sc SIDING CO EVERT d� � �k `�r HOL Box HOLYOKE M 101Mti • , HIC_0605383 12 24tig ll! 30/2020 '1'OI4 j�L3 SIGNED a A.��zyrrc9 Commissioner Ornor Reaist an Nerne RESPONSIBLE REGISTRATION ADDRESS EXPIRATION S .',TU IND1VIDL€AL NUMBER DATE SEXTON ROOFING& SEXTON,EVERE7T 118239 P_0_BOX 6327 02/1412023 Current Siding Inc HOLYOKE,MA 01041 http r 1/2 1 i : , 1 k ' 01,11 ' 1 g ' , , 1 , -,--6- t:„ 1 , 1 ::: 1 -1• F Ili li ' . i i ! : ICU 1 • ' 1 1 c!. r .11:10[210Eirl c] 11 i ii 11 , ''' 'kEN: ccicti $ 1:-.70 ,141 ' ' 1 ' f411. - 11 , 1 'I : 1-111A ' i 1 44 ' ,., '; 1 ,, • i t i'd C-- :glio, 1 i 1 i :1 dic,. 1 114 1 .4 11:1 , ‘ `J 11 — t •Itgl 11 ,.1 ; 4 . 111) . Zr # 1 ill litili ,-,;-.. ' ill; lit r I ii.g. - ,). di 111 Ili lilt ' ,so° Il I 11111 fl 4 III: i : 11 2 , , I 102 1 ' " ' I \,r) i :;11 b IA I . 1 , '' 4'1° ;.;. ' . IN, ) I :-.: : 4 's: 1 . . H1111 6 1 Itliti 1 41* x i t 4 1111j10%j:i I N8 11114iii :7'1 ° t }7( I 1 ' 1 il 4 II III lit. II ' 6.11:1)0/7 8 gi ,gt ., Au A 00 liri 1 m 44.-, ef a 1 I J . 1 thvil • - 1 ACORO CERTIFICATE OF LIABILITY INSURANCE DATE(MMAIDDNYYY) ;a..-�"--- 11/24/2021 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: Marina Silva MAYFLOWER INSURANCE GROUP INC PHONE wExs). a 773 s7oz FAx � _ I We No) ADOREss: karina(9maytlowerinsurance.com 2 Court St Unit B INSURERISI AFFORDING COVERAGE NAIC it Plymouttl — MA 02360 INSURER A: HARTFORD UNDERWRITERS INS CO 30104 INSURED INSURER B MNP CONSTRUCTION INC INSURER C: INSURER D: 45 EXCHANGE ST APT 3E INSURERE: MILFORD MA 01757 INSURER F: COVERAGES CERTIFICATE NUMBER: 720120 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 u_... . r_� ADDLr'SUBR' POLICY EFF POLICY EXP LTR TYPE OF INSURANCE WSD I W VD POLICY NUMBER tMINDD/TYYY) (MN DDIYYYY► LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ J CLAIMS-MADE E OCCUR DAMAGE TO RENTED PREMISES(Fa occurrence') .�$_ MED EXP(Any one person) $ N/A PERSONAL&ADV INJURY $ GEN"L-AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $ _-�POLICY_-,PECOT- L_�.1 LOC . PRODUCTS-COMP/OP AGG $ l 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) $ _. ---- NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS ______ AUTOS ( $ 1 UMBRELLA L.IAB OCCUR EACH OCCURRENCE $ EXCESS ELAB CLAIMS-MADE N/A AGGREGATE $ DEP I I RETENTIONS $ WORKERS COMPENSITTION 'v. .PERTTUTE I OTH- ER AND EMPLOYERS*LIABILITY ANYPROPRIETOR/PARTNER/EXECUTIVE YIN E.L.EACH ACCIDENT $.._,_1,000,000 IA �_..___.. A OFFICER/MEMBEREXCLUDED? N WA WA 6S60UB5R90632621 06/07/2021 06/07/2022 - _—_- _-- (Mandatory in NH) El.DISFASF-EA EMPLO $ 1,000,000 If describe under DEyes,SCRIPTION OF OPERATIONS below ,EL DISEASE-POUCY LIMIT , S 1,000,000 N/A DESCRIPTION OF OPERATIONS I LOCATIONS 1 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(han 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 of insurance)_ The status of this coverage can be monitored daily by accessing the Proof of Coverage-Coverage Verification Search tool at www.mass.gov/lwd/workers-compensatian/nvestigations/_ CERTIFICATE HOLDER CANCELLATION • SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN SEXTON ROOFING & SIDING INC ACCORDANCE WITH THE POLICY PROVISIONS. 102 PINE STREET AUTHORQED REPRESENTATIVE HOLYOKE MA 01041 Daniel M.Crowley,CPCU,Vice President-Residual Market-WCRIBMA 1 01988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD