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23B-022 (7)
BP-2022-0292 204 NORTH ELM ST COMMONWEALTH OF MASSACHUSETTS Map Map:BIOBlock:Lot: 23B-022-00I 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-2022-0292 PERMISSIONIS HEREBY GRANTED TO: Project# INSULATION Contractor: License: Est. Cost: 6000 AMERICAN INSTALLATIONS LLC 106178 Const.Class: Exp.Date:09/29/2023 Use Group: Owner: CO-TRUSTEES WEST, STEVEN A & AMY S. WEST Lot Size (sq.ft.) Zoning: URB Applicant: AMERICAN INSTALLATIONS LLC Applicant Address Phone: Insurance: 130 COLLEGE ST SUITE 100 (413)552-0200 AMWC262555 SOUTH HADLEY, MA 01075 ISSUED ON:03/24/2022 TO PERFORM THE FOLLO WING WORK: INSULATION/WEATH ER I ZATT ON 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: Gas: Final: Final: Rough Frame: Rough: Fire Department Driveway Final: Fireplace/Chimney: Final: Oil: Insulation: Smoke: Final: THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Signature: I . • Fees Paid: $65.00 212 Main Street, Phone(413) 587-1240,Fax:(413)587-1272 Office of the Building Commissioner ,o"ra �,,n + City of Northampton - ,�� '` ' Building Department '' 212 Main Street f�.,INSULA TION N Room 100 a 4a;=fir,' Northampton, MA 01060 ; ,�.— phone 413-587-1240 Fax 413-587-1272 �. ., QJtJf , f,`� ,;=r,� APPLICATION FOR INSULATION FOR A ONE OR TWO FAMILY DWELLING ONLY SECTION 1 -SITE INFORMATION INSULATION PERMIT 1.1 Property Address: This section to be completed by office (326// i/0r' )-1,1 St Map Lot Unit N o(-`rj �j, `Q � /jj_ Zone Overlay District Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: 40/1Y WEsT daq A/a. On') 5/. i1/�r amP . Name(Print) Current Mail/g6—c: 9/ /7 t!N See attached Telephone 7 Signature 2.2 Authorized Agent: American Installations 130 College Street Ste. 100, South Hadley, MA 01075 Name(Print) (::: Current Mailing Address: (413) 552-0200 Signature Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building // (a) Building Permit Fee 2. Electrical (b) Estimated Total Cost of Construction from (6) 3. Plumbing Building Permit Fee �] , 4. Mechanical(HVAC) ({•r�/Thv 5. Fire Protection 0 6. Total=(1 +2+3+4+5) lo, 6 O 0 Check Number 19`47 This Section For Official Use Only Building Permit Number: 60- P -..)}1 Date Issued: Signature: //42 3- Zy- Z&G Z Building Commissioner/Inspector of Buildings Date permits@AmericanInstallations.com @ EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR) SECTION 4-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable 0 Name of License Holder: Wesley K. Couture 106178 License Number 130 College Street Ste. 100, South Hadley MA 01075 9/29/2023 Address"0/04 Expiration Date (413)552-0200 1.1 nature Telephone 9.Registered Home Improvement Contractor: Not Applicable 0 American Installations 175982 Company Name Registration Number 130 College Street Ste. 100, South Hadley MA 01075 6/26/2023 Address Expiration Date Telephone (413)552-0200 SECTION 5-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 JET No 0 Brief Description of Proposed Work NOTE: INSULATION ONL Y Attic and basement insulation and air sealing throughout. American Installations - Wesley Couture , as Owner/Authorized Agent hereby declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge and belief. Signed under the pains and penalties of perjury. Wesley K. Couture Print Name 3—aV—a ignature of Agent Date /4ply p/es / ,as Owner of the subject property hereby authorize American Installations to act on my behalf, in all matters relative to work authorized by this building permit application. See attached /2./a. Signature of Owner Date City of Northampton ,I ( Massachusetts * er ' , h, $. . DEPARTMENT OF BUIZDING INSPECTIONS lti: 212 Main Street • Municipal Building Jb 'Ca Northampton, MA 01060 AFFIDAVIT Home Improvement Contractor Law Supplement to Permit Application The Office of Consumer Affairs and Business Regulation("OCABR")regulates the registration of contractors and subcontractors performing improvements or renovations on detached one to four family homes. Prior to performing work on such homes,a contractor must be registered as a Home Improvement Contractor("HIC"). M.G.L.Chapter 142A requires that the"reconstruction, alteration, renovation,repair, modernization, conversion, improvement,removal, demolition, or construction of an addition to any pre-existing owner-occupied building containing at least one but not more than four dwelling units....or to structures which are adjacent to such residence or building"be done by registered contractors. Note:If the homeowner has contracted with a corporation or LLC,that entity must be registered. Type of Work: Insulation / Est.Cost: 6, 666 .[J Address of Work: / q /ti . �i!iY1 s. ,4' ?/ &iV1�71-t, Date of Permit Application: 3-Z I hereby certify that: Registration is not required for the following reason(s): _Work excluded by law(explain): Job under$1,000.00 Owner obtaining own permit(explain): Building not owner-occupied x Other(specify): Contractor pulling permit for homeowner OWNERS OBTAINING THEIR OWN PERMIT OR ENTERING INTO CONTRACTS WITH UNREGISTERED CONTRACTORS OR SUBCONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK ARE NOT ELIGIBLE FOR AND DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER M.G.L.Chapter 142A.SUCH OWNERS ALSO ASSUME THE RESPONSIBILITES FOR ALL WORK PERFORMED UNDER THE BUILDING PERMIT.SEE NEXT PAGE FOR MORE INFORMATION. Signed under the penalties of perjury: I hereby apply for a building permit as the agent of the owner: -,/,e American Installations 175982 Contractor Name HIC Registration No. OR: Notwithstanding the above notice, I hereby apply for a building permit as the owner of the above property: Date Owner Name and Signature City of Northampton AMassachusetts �?:s 1.13 x, t L DEPARTMENT OF BUILDING INSPECTIONS 4,9 1 1. 212 Main Street •Municipal Building Northampton, MA 01060 sJN�y ;7�tir� Debris 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. The debris from construction work being performed at: a0 y /1/0. i/rn S f (Please print house number and street name) Is to be disposed of at: K er W Materials er Recycling, 138 Palmer Ave, West Springfield, MA 01089 (Please print name and location of facility) Or will be disposed of in a dumpster onsite rented or leased from: (Company Name and Address) ignature of ermit Applicant or Owner Date If, for any reason, the debris will not be disposed of as indicated, the Applicant or Owner shall notify the Building Department as to the location where the debris will be disposed. City of Northampton S,s•• s'c, ! Massachusetts F�?' $ ' a DEPARTMENT OF BUILDING INSPECTIONS �L'. m ."fit "i 212 Main Street • Municipal Building Ob .,, Northampton, MA 01060 ..4Y : '1, MANDATORY FOR HOUSES BUILT BEFORE 1945 Property Address: ao 9 /t4 . F/m S f Contractor Name: American Installations Address: 130 College Street Ste. 100 City, State: South Hadley MA Phone: (413)552-0200 Property Owner Name: Amy ',//We,,s 7 Address: any AL. G/In St- City, State: //1 d1�/ry1 f 1 ASS 1, Wesley K. Couture (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 with a copy of this affidavit. Contractor signature G ,=- ,LS Date (2 / ^2, American Installations Home Performance Contractor American Installations 130 College Street,South Hadley,MA 01075 CONTRACT - J Z 413-552-0200 FAX 413-552-0202 Page 1 PROGRAM CMA-HPC CUSTOMER PHONE DATE CLIENT# WORK ORDER Amy West (616) 291-1742 03/02/2022 342202 68603 SERVICE S IRE*I BILLING a I NEE I PROPOSED BY: 204 North Elm Street 204 North Elm Street American Installations SERVICE CITY SIArE,ZIP BILLING CITY,STAIE,ZIP Northampton, MA 01060 Northampton, MA 01060 DESCRIPTION QTY COST INCENTIVE TOTAL INCENTIVE 75% For eligible weatherization measures, Eversource is offering an incentive of 75%for insulation measures and 100%for the air sealing measures, both with no limit.You are eligible to apply for the 0% Heat Loan to finance your co-pay, applications must be submitted before the weatherization work begins. HOME AIR SEALING 12 $1,020.00 $1,020.00 Provide labor and materials to seal areas of your home against wasteful, excess air leakage. Materials to be used to seal your home can include caulks, foams and other products. Primary areas for sealing include air leakage to attics, basements, attached garages and other unheated areas(windows are not generally addressed.) WEATHERSTRIP DOOR 3 $174.00 $174.00 Provide labor and materials to install Q-lon weatherstripping to door(s)to restrict air leakage. DOORSWEEP 3 $75.00 $75.00 Provide labor and materials to install a doorsweep to restrict air leakage. ATTIC DAMMING-R-38 FIBERGLASS 108 $221.40 $166.05 $55.35 Provide labor and materials to install a 12"layer of R-38 unfaced fiberglass batts for damming purposes. ATTIC FLAT- 12"OPEN R-42 CELLULOSE 1,040 $1,747.20 $1,310.40 $436.80 Provide labor and materials to install a 12"layer of R-42 Class I Cellulose to open attic space. ATTIC DOOR- INSULATE&WS 1 $110.00 $82.50 $27.50 Provide labor and materials to insulate the back of the attic door with 2"rigid insulation board and seal the door's edge with weatherstripping to restrict air leakage. WHOLE HOUSE FAN COVER 1 $209.21 $156.91 $52.30 Provide labor and materials to fabricate and install a rigid foam insulating cover for the whole house fan. BASEMENT SILLS R19 FIBERGLASS BATT 99 $193.05 $144.79 $48.26 Provide labor and materials to install R-19 unfaced fiberglass insulation to the perimeter of the basement ceiling at the house sill. c a, 6ga / American Installations Home Performance Contractor L1.111°1,111 American Installations 130 College Street,South Hadley,MA 01075 CONTRACT - WZ 413-552-0200 FAX 413-552-0202 Page 2 PROGRAM CMA-HPC CUSTOMER PHONE DATE CLIENT 8 WORK ORDER Amy West (616) 291-1742 03/02/2022 342202 68603 SERVICE S THEE! BILLING El MEE1 PROPOSED BY: 204 North Elm Street 204 North Elm Street American Installations !ERVICE CITY.STATE.-ZIP BILLING CITY,STATE,ZIP Northampton, MA 01060 Northampton, MA 01060 DESCRIPTION QTY COST INCENTIVE TOTAL VENTILATION CHUTES 64 $160.00 $120.00 $40.00 Provide labor and materials to install ventilation chutes in the rafter bays to maintain air flow. Total: $3,909.8E Program Incentive: $3,249.6! Customer Total: $660.2' WE AGREE HEREBY TO FURNISH SERVICES-COMPLETE IN ACCORDANCE WITH ABOVE SPECIFICATIONS.FOR THE SUM OF ***Six Hundred Sixty & 21/100 Dollars $660.21 Steve west(Mar7,ZtT22 08706 EST) COMPANY REPRESENTATIVE CUSTOMER SIGNATURE Mar 7, 2022 NOTE:THIS CONTRACT MAY BE WITHDRAWN BY US IF NOT EXECUTED WITHIN DATE OF ACCEPTANCE SIGN DATE DAYS. A+ www.Americanlnstallations.com BBB Licensed&Insured atrITED rating mass save MA CSL k:106178 American installations PARTNER MA Registration#175982 130 College Street Suite 100,South Hadley,MA 01075 •Office:(413)552-0200 Fax:(413)552-0202 • Email:support@AmerIcanlnstallatlons.com Stephen Watson 3/3/2022 (Fiat last( (Date) 218 Elm st Northhampton MA 01060 (Address) (Lay) (Stale) (TIP) 470252 22-0429 (Ste ID) Um a) Quantity Unit Unit Cost Total Air Sealing AIR SEALING 6 man hour $ 85.00 $ 510.00 WEATHERSTRIP DOOR 3 each $ 58.00 $ 174.00 DOOR SWEEP 3 each $ 25.00 $ 75.00 Total Air Sealing Value $ 759.00 Utility Air Sealing Incentive $ (759.00) Weatherization ATTIC FLAT-4"OPEN R-14 CELLULOSE 660 sqft $ 1.20 $ 792.00 ATTIC DAMMING-R-38 FIBERGLASS 50 sqft $ 2.05 $ 102.50 BASEMENT-INSULATE BULKHEAD DOOR&INSULATE 1 each $ 110.00 $ 110.00 Total Weatherization Value $ 1,004.50 Utility Weatherization Incentive $ (753.38) Total Project Value $ 1,763.50 Utility Weatherization/Air Sealing Incentive $ (1,512.38) Weatherization Balance $ 251.13 Total Customer Contribution $ 251.13 WARRANTY:American Installations,LLC will provide the above stated homeowner with a 1 year workmanship warranty. American Installations,LLC hereby proposes to furnish all material and labor to complete the above scope of work in accordance with the above specifications and all local and state building regulations for the Total Contract Value as stated herein. ACCEPTANCE OF PROPOSAL:The above prices,specifications and TOTAL CONTRACT VALUE= $ 251.13 conditions are satisfactory and are hereby accepted.You are authorized to do work as specified.Payment will be 1/3 down prior to Down Payment= 80.00 l 3/3/2022 start of work,and balance due upon Completion. PAID Balance Due Upon Completion= $ •1 171.13 Client Signature Date Lukasz Socha Al Representative Al Rep Signature Date THIS AGREEMENT IS COMPOSED OF THIS PAGE AND THE REVERSE SIDE OF THIS PAGE AND SHALL BE CONSIDERED THE ENTIRE AGREEMENT BY THE PARTIES INVOLVED.THIS AGREEMENT IS BETWEEN AMERICAN INSTALLATIONS,LLC HEREINAFTER REFERRED TO AS'COMPANY-,AND THE CUSTOMER'S)NAMED ABOVE,HEREINAFTER REFERRED TO AS'CLIENT',AND WILL BE SUBJECT TO ALL APPROPRIATE LAWS,REGULATIONS AND ORDINANCES OF THE STATE OF MASSACHUSETTS OR CONNECTICUT RESPECTIVELY,AS WELL AS ALL LOCAL JURISDICTIONS. The Commonwealth of Massachusetts ^f Department of Industrial Accidents Office of Investigations ' Lafayette City Center � 2 Avenue de Lafayette, Boston, MA 02111-1750 .. 4 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual):American Installations LLC _ Address:130 College St, Suite 100 City/State/Zip:South Hadley, MA 01075 Phone #:413-552-0200 Are you an employer? Check the appropriate box: Type of project(required): l. I am a employer with 43 4. 0 I am a general contractor and I employees (full and/or part-time).* have hired the sub-contractors 6. El New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have 8. 0 Demolition workingfor me in anycapacity. employees and have workers' P h 9. ❑ Building addition [No workers' comp. insurance comp. insurance.: required.] 5. 0 We are a corporation and its 10.111 Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑ Roof repairs insurance required.] t c. 152, §1(4),and we have no Insulation employees. [No workers' 13.© Other comp. insurance required.] *My applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire 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: Berkshire Hathaway GUARD Insurance Policy#or Self-ins. Lic. #:AMWC262555 - Expiration Date: 09/04/2022 Job Site Address: may iV 4 f! m 5.�,/�c�� City/State/Zip:/ o'•i` 41"1:15/ (Di OLQ 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 of MGL 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 up to$250.00 a day against the violator. Be advised that 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 the pains and penalties of perjury that the information provided above is true and correct. Signature: 9, :)1j Date: 3' / 7 - Phone#: 413-552-0 00 4 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): 10Board of Health 20 Building Department 30City/Town Clerk 4.0 Electrical Inspector 5Elumbing Inspector 6.0Other Contact Person: Phone#: Commonwealth of Massachusetts Division of Professional Licensure Board of Building Regulations and Standards Carte "" isor .. y CS-106178 Tres: 0912912023 WESLEY COUTUR 139 PACKAROVILL PELHAM MA 01002 -*t§' • v;1 1 Commissioner da,e121 Office of Consumer Affairs and Business Regulation 1000 Washington Street - Suite 710 Boston, Massachusetts 02118 Home Improvement Contractor Registration Type: LLC Registration: 175982 AMERICAN INSTALLATIONS,LLC. Expiration: 06/26/2023 130 COLLEGE STREET SUITE 100 SOUTH HADLEY,MA 01075 Update Address and Return Card. Office of Consumer Affairs it Business Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only TYPE:LLC before the expiration date. If found return to: Enlaindlm Eudrailan Office of Consumer Affairs and Business Regulation 175982 06/26/2023 1000 Washington Street -Suite 710 AMERICAN INSTALLATIONS,LLC. Boston,MA 02118 WESLEY COUTURE / 130 COLLEGE STREET SUITE 100 Not valid w thout signature SOUTH HADLEY,MA 01075 Undersecretary _AC CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDIYYYY) 08/23/2021 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 endorsoment(s). PRODUCER CONTACT Barbara Grynkiewicz NAME: Webber&Grinnell PHONE (413)586-0111 FAX (413)586-6481 (A/C No.Ext): (A/C,No): 8 North King Street E-MAIL Ss: bgrynkiewicz(r©webberandgrinnell.corn ADDRE INSURER(S)AFFORDING COVERAGE NAIC# Northampton MA 01060 INSURER A: Employers Mutual Casualty Company 21415 INSURED INSURER B: AmGUARD/BH GUARD 43290 American Installations,LLC INSURER C: Attn:Wes&Suzanne Couture INSURER D: 130 College Street,Suite 100 INSURER E: South Hadley MA 01075 INSURER F: COVERAGES CERTIFICATE NUMBER: Exp 9/4/22 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. I EFF POLICY EXP LTR TYPE OF INSURANCE INSDW VD POLICY NUMBER (MMIDDYIYYYY) (MM/DD/YYYY) LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1.000,000 JDAMAGE1 0 RENTED CLAIMS-MADE X OCCUR PREMISES(Ea occurrence) $ 500,000 MED EXP(Any one person) $ 10,000 A 5D3535221 09/04/2021 09/04/2022 PERSONAL&ADV INJURY $ 1,000,000 GEN-'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY n PEo- n LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER. E AUTOMOBILE LIABILITY COMBINED SINGLE OMIT $ 1,000,000 _ (Ea accident) ANY AUTO BODILY INJURY(Per person) $ A OWNED X SCHEDULED 5Z3535221 09/04/2021 09/04/2022 BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS — HIRED �/ NON-OWNED er PROPERTY DAMAGE $ AUTOS ONLY /� AUTOS ONLY PIP-Basic $ 8,000 X UMBRELLA LIAR I OCCUR EACH OCCURRENCE $ 1,000,000 A - EXCESS LIAB CLAIMS-MADE 5J3535221 09/04/2021 09/04/2022 AGGREGATE $ 1,000,000 DED X RETENTION$ 10,000 $ WORKERS COMPENSATION X STATUTE ERH AND EMPLOYERS'LIABILITY YIN 500,000 B ANY PROPRIETOR/PARTNER/EXECUTIVE ri N/A AMWC262555 09/04/2021 09/04/2022 E.L.EACH ACCIDENT E OFFICER/MEMBER EXCLUDED? 500,000 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under 500,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POUCY LIMIT E DESCRIPTION OF OPERATIONS/LOCATIONS I 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 Evidence of Insurance ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD