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24A-008 (5) BP-2022-0460 55 TERRACE LN COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 24A-008-001 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-2022-0460 PERMISSIONISHEREBYGRANTED TO: Project# DOOR Contractor: License: Est. Cost: 1836 LOWES HOME CENTERS INC 103003 Const.Class: Exp.Date:09/08/2022 Use Group: Owner: MARVIN MICHAEL F& HEATHER L HOLMQUIST Lot Size (sq.ft.) Zoning: URB Applicant: LOWES HOME CENTERS INC Applicant Address Phone: Insurance: 1000 LOWES BLVD (413)272-8931 0 WC016393105 MOORESVILLE, NC 28117 ISSUED ON:04/29/2022 TO PERFORM THE FOLLO WING WORK: REPLACE FRONT DOOR POST THIS CARD SO IT IS VISIBLE FROM THE STREET Inspector of Plumbing Inspector of Wiring D.P.W. Buirding Inspector Underground: Service: Meter: Footings: Rough: Rough: House # Foundation: Final: Final: Final: Rough Frame: Gas: Fire Department Driveway Final: Fireplace/Chimney: Rough: Oil: Insulation: Smoke: Final: THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Signature: Fees Paid: $40.00 212 Main Street, Phone(413)587-1240,Fax:(413)587-1272 Office of the Building Commissioner --------- 470t/ r _ . . ......... ^ The Commonwealth of Massachusetts 1 1 R /8 2022 ! 1: FOR Board of Building Regulations and Standar& lkil ) Massachusetts State Building Code, 780 CMR MUNICIPALITY USE Building Permit Application To Construct,Repair,Renowate4ajjeMpli*- ,c Revised Mar 2011 One-or Two-Family Dwelling This Section For Official Use Only Building Permit Number: 3P" 2 2-' '/(j 0 Date Applied: eu 4....1 42.s.s 1/(72 II'2q-20Z-Z. Building Official(Print Name) Signature Date SECTION 1:SITE INFORMATION 1.1 ProAddrIsA 1.2 Assessors Map&Parcel Numbers --r," i a., 1.1432— ( 2-0(4 co I 1.1a 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 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: Zone: Outside Flood Zone? Public 0 Private 0 Check if yes0 Municipal 0 On site disposal system 0 SECTION 2: PROPERTY OWNERSHIP' 2.1Tr1 of Rilecord: I i /'A if Uela A—) City, 0/COO Name(Pri5)... tate,ZIP ___/Z-2frati ( i) --• ji/L3'0 0';g37 No.and Street Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply) New Construction 0 Existing Building 0 Owner-Occupied 0 Repairs(s)...lp Alteration(s) 0 Addition 0 Demolition 0 Accessory Bldg.0 Number of Units Other 0 Specify: Brief Description of oposed Wor1c2:i.„.) 1/resiki ayeZei cquAl2/4/64- 412if) SECTION 4:4:ESTIMATED CONSTRUCTION COSTS Estimated Costs: Item Official Use Only (Labor and Materials) 1.Building $ 1 c(36, 26 I. Building Permit Fee:$ Indicate how fee is determined: 0 Standard City/Town Application Fee 2.Electrical $ 0 Total Project Costa(Item 6)x multiplier x 3. Plumbing $ 2. Other Fees: $ 4.Mechanical (HVAC) $ List: 5. Mechanical (Fire Suppression) $ Total All Fees:§ 83 Check No.5- 4"i Check Amount: Cash Amount: 6.Total Project Cost: $ )g3(i , 0 Paid in Full 0 Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) )b.gD n 2 A'EA-),u L W 8 Jr' amwi License Number xptration Date Name of CS IIotdcr ^� r tm o vW List CSL Type(see below) O.and{ Stre Y Type Description C„„ //L,�) l / /P- 6 ) • n U Unrestricted(Buildings up to 35,000 Cu.ft.) ti �Y�1 J� �N /U / R Restricted I&2 Family Dwelling City/Town,State,ZIP M Masonry RC Roofing Covering WS Window and Siding '/� y p / ,,,,�^ SF Solid Fuel Burning Appliances �)3 .01aa'032 614 �) )1 f7.ern? I Insulation Telephone I Email address D Demolitionti �i 5.2 R '' t Ho rne proveContractor(HIC) J'�CJ lPr3 X/n �S�C1 HIC Registration Number I?xptrauo Date WC Cor�tpµry m r f R,e4, ant me �� A No. UStre t �J , y 1 �) l x v Street, / o 1/') 94' -� 5941 Fnta— City/Town,State,ZIP Telephone SECTION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.152.§ 2.5C(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 Issuanc of the building penult. Signed Affidavit Attached? Yes No 0 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 .. /\1 e,V 0) �a to act � on my behalf,in all matters relative to work authorized by this building permit application. LA vi,hat /4?2___ Print Owner's Name(Electronic Signature) Date SECTION 7b: OWNER'OR AUTHORIZED AGENT DECLARATION By entering my name below,I hereby attest under the pains and penalties of perjury that all of the information contained i this applicatio 's true and accurate to the best of my knowledge and understanding. LA Print Owner's of Authorized Agent's Name(Electronic Signature) 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(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.,stov/tips 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" .a STORE COPY INSTALLATION SERVICES CUSTOMER CONTRACT-MWORK-INT/EXT/PATIO DOOR LOWE'S OF HADLEY,MA,STORE a 1916 STORE PHONE.(413)588-0270 LOWE'S 282 RUSSELL STREET SALESPERSON:BRUCE HUNTER HADLEY. MA 01035-0000 SALESPERSON ID:1508948 Document Print Date:04/20/2022 This is only a Ouote for the merchandise and services printed below.This becomes an agreement upon payment and issuance of a Lowe's receipt,upon which the entire agree- ment,including the specifically completed pages of this document,the Terms and Conditions included with this document.the applicable portion(s)of Lowe's receipt.and any other addenda or attachments hereto,shall be referred to herein as this'Contract PLEASE READ THIS ENTIRE PQ VMEtlLJN L UDING THE"TEf3M ND CONDITIONS,"BEFORE SIGNING, Lowe's Registration or Contractor License Number/Lowe's Contractor Name Lowe's Home Centers,LLC's MA HIC NO.: 148688 Lowe's Home Centers,LLC's FEIN:56-0748358 Customer Name Home Phone S MICHAEL MARVIN 413-210-2437 O Customer Address Other Phone 55 TERRACE LN L City State Province Zip,Postal Code D NORTHAMPTON MA 01060 Installation Address T 55 TERRACE LN O Installation City Installation State/Province Installation Zip/Postal Code NORTHAMPTON MA 01060 MERCHANDISE AND INSTALLATION SUMMARY MERCHANDISE SUMMARY 58593:SIEXICL3075M:SOS:SOS BMTT PRESTAINED FBGLSS TEXTUR:3/4in mill sill extention:TRU LOGISTICS INCORPORATED-QTY 1 15634:230612:STK: 120Z DOOR AND WINDOW FOAM: 120Z DOOR AND WINDOW FOAM:DDP SPECLTY ELECT MATERIALS US-QTY 1 238348:2828:STK: 1INX8INX8 FT PVC BOARD: 11NX8INX8 FT PVC BOARD:METRIE INDUSTRIES INC-QTY 1 310630:02709:STK:5-13/16-INX8-FT PVC UTLTY TRM WHT:5-13/16-INX8-FT PVC UTLTY TRM WHT:EAST COAST MILLWORK DISTRIBUTI-QTY 1 737896:ART10002096:STK: 1-2-8 AZEK TRADIT PVC BOARD: 1-2-8 AZEK TRADIT PVC BOARD:PARKSITE INC-QTY 1 833539:BMTT626371 :STK:36 TTBM UNF SHKR 6L RH:36 TTBM UNF SHKR 6L RH:TRU LOGISTICS INCORPORATED•QTY 1 1798654: FE285 G PLY 622:STK:SCH MB FRNT HNDL PLYMOUTH:SCH MB FRNT HNDL PLYMOUTH:SCHLAGE LOCK-QTY 1 1798660:B60 N G PLY 622:STK:SCH MB PLYMOUTH DEADBOLT SGL:SCH MB PLYMOUTH DEADBOLT SGL:SCHLAGE LOCK-QTY 1 Store 1916 Project No.727584009 for MICHAEL MARVIN Page 1 of 8 STORE COPY 913245:5800032E:SOS:WTS ROLSCREEN STORM DOORS:38 x 80.5 Aluminum Storm Door:LARSON MANUFACTURING CO INC-OTY 1 913292:9138305:SOS:PELLA SELECT HARDWARE:Matte Black Handle Kit:LARSON MANUFACTURING CO INC-QTY 1 1 Materials Price I $1057.33 INSTALLATION DESCRIPTION Door type:Exterior Location of new door(s):Front Door Select new door:Single Pre-Hung Hardwood door:No Sidelights or transoms:No Number of additional holes bored for accessories:None Install specialized mortise hardware:No Install storm door:Install new storm,screen or security door Select storm door:Storm Door Lead safe practices:No Total linear feet of custom trim to be Installed:0 Deliver door:Yes Customer understands scope of the project:Yes Permit Fee:Yes Additional Mileage:0 Access fee:None Dump entry Fee:Yes Additional Work:Cut back vinyl siding.buiold jamb.PVC trim ande channel. Additional Work Charge:Yes Comments:Door trim may present problem. Labor Charges S 814.50 Detail Deduction -S 35.00 Additional Specifications: Notation:Lowe's will not make structural modifications,remove cabinetry to accommodate new appliance,or upgrade electrical service. Additional Specifications: LEAD SAFE INFORMATION:Federal and applicable state laws require that You be provided with a lead hazard information pamphlet such as the Renovate Right:Important Lead Hazard Information theor lead Families.Child a Care Providers and Schools By signing this Contract,You acknowledge having received a copy of this information pamphlet before work bean informing You of the potential risk of exposure from renovation activity to be performed in Your dwelling unit or facility.A copy of the pamphlet is also available at the following websde: tIfl /iwww.eoa,gov/sites/oroductionIfilesrdocuments/renovaterjghtbrochure odl.For more information see:httos'//wow eoa.gov/teadllead-renovation-reoair-and-painting-program. PHOTO RELEASE:Customer grants to Lowe's and Lowe's employees and independent contractors the right to take photograghs of the Premises where Installation Services will be performed and all work performed at the Premises related to this Contract.and irrevocably grants to Lowe's all right,title,interest in and to the photographs for use in all markets and media,worldwide,in perpetuity. Customer authorizes Lowe's to copyright.use and publish the photographs in print and/or electronically.and agrees that Lowe's may uses tographs for any lawful purpose,including.but not limited to,marketing advertising publicity,illustration,training and Web content.By initialing here.Customer agrees to the foregoing. •( [Customer to initial to the left). NOTICE TO CUSTOMER-PRICE CALCULATIONS:In order to properly perform the installation of certain Goods,the Contract Price may"' ude more Goods than actually will be installed based on the measured square footage of the Project Area.As a result.the parties agree that the lump-sum Price slated in this Contract is calculated upon both the value of the estimated Goods required to fut. fill the Contract(including waste).which may exceed the actual square footage of the Project Area.and the labor which may be estimated based on the amount of Goods required to fulfill the contract (including waste).By signing this Contract below.Customer acknowledges receipt of this notice and agrees and understands that the Price includes these costs which may not be refunded once the Installation Services are performed.. NOTICE OF ARBITRATION AGREEMENT This Contract provides that all claims by Customer or Lowe's will be resolved by BINDING ARBITRATION.Customer and Lowe's GIVE UP THE RIGHT TO GO TO COURT to enforce this Contract (EXCEPT for matters that may be taken to SMALL CLAIMS COURT).Lowe's and Customer's rights will be determined by a NEUTRAL ARBITRATOR and NOT a judge or jury.Lowe's and Customer are entitled to a FAIR HEARING.But the arbitration procedures are SIMPLER AND MORE LIMITED THAN RULES APPLICABLE IN COURT.Arbitrator decisions are as enforceable as any court or- der and are subject to VERY LIMITED REVIEW BY A COURT.FOR MORE DETAILS:Review the section titled ARBITRATION AGREEMENT,WAIVER OF JURY TRIAL AND WAIVER OF CLASS Store 1916 Project No.727584009 for MICHAEL MARVIN Page 2 of 8 STORE COPY ACTION ADJUDICATION found in the Terms and Conditions of this Contract TOTAL CHARGES OF ALL MERCHANDISE AND SERVICES •where applicable SUB-TOTAL $1836.83 'TAX $ 0.00 DELIVERY $ 0.00 ORDER TOTAL S 1836.83 BALANCE DUE Work is to commence upon reasonable availablity of Contractor which is anticipated to be �� (fill in date] Estimated completion date is s C' ✓ '< ' -(fill in date). NOTICE TO CUSTOMER All items listed in this contract and specification sheet(s)are to be installed under conditions agreed upon at time of purchase and at the price appearing on this contract form.This assumes sound existing substructures,superstructure and points of attachments. Extra labor or material incident to installation necessitated by defective substructures,superstructure,points of attachment.or the moving of fixtures or appliances to be billed at extra cost to custom- er. IF THE CONTRACT TOTAL IS$1.000.00 OR LESS.Customer must pay in full. COMPLETE THIS SECTION ONLY WHEN THE CONTRACT TOTAL.EXCEEDS$1 000.00: (.?j Customer to use the following payment schedule: J ,S (1)Deposit of$ �/� to be paid upon signing contract.Any deposit collected at the time this Contract is signed will not exceed one-third(1/3) of the contract price:and (2)Payment of$ / / to be collected upon or after the commencement of work. I,NUe authorize Lowe's to do one of the following(check ap- propriate box below): [-[Charge my/our credit card for the amount of the payment indicated above upon or after the commencement of work:or ( )Deposit my/our check for the amount of the payment indicated above anytime upon or after the commencement of work:and (3)Final payment of$100.00,to be paid upon completion of the installation to both parties'satisfaction. Store 1916 Project No.727584009 for MICHAEL MARVIN Page 3 of 8 STORE COPY DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES AND UNTIL YOU HAVE READ THE TERMS AND CONDITIONS CON- TAINED IN THIS CONTRACT AND WHICH FOLLOW THE SIGNATURE PAGE(s). BY SIGNING BELOW.YOU ARE ACKNOWLEDGING THAT YOU HAVE READ,UNDERSTAND AND AGREE TO THE TERMS AND CONDITIONS SET FORTH IN THIS CONTRACT.YOU ARE ENTITLED TO A COPY OF THIS CONTRACT AT THE TIME OF SIGNATURE. NOTICE REGARDING ARBITRATION AGREEMENT FOR CLAIMS COVERED BY M.G.L.c.142A LOWE'S AND OWNER HEREBY MUTUALLY AGREE IN ADVANCE THAT IN THE EVENT LOWE'S HAS A DISPUTE CONCERNING THIS CON- TRACT,THAT LOWE'S MAY SUBMIT SUCH DISPUTE TO A PRIVATE ARBITRATION SERVICE WHICH HAS BEEN APPROVED BY THE SECRET- ARY OF THE EXECUTIVE OFFICE OF CONSUMER AFFAIRS AND BUSINESS REGULATIONS AND THE OWNER SHALL BE REQUIRED TO SUB- MIT TO SUCH ARBITRATION AS-P ED IN M.G.L.c.142A. By: "f Date: /2 .r/ ,2 �, y:Lowe's Home Centers.LLC Lo `6 t t��/L2 Y Date: y I°`° h ----.__. Dim By: _Date: _ Co-owner or Witness THE SIGNATURES OF THE PARTIES ABOVE APPLY ONLY TO THE AGREEMENT OF THE PARTIES TO ALTERNATIVE DISPUTE RESOLUTION JNITIATED BY LOWE'S PURSUANT TO M.G.L. c.142A. THE OWNER MAY BE PERMITTED TO INITIATE ALTERNATIVE DISPUTE RESOLUTION EVEN WHERE THE SECTION ABOVE IS NOT SEPERATELY SIGNED BY THE ARTIES. WITNESS OUR HAND(S)AND SEAL(S)BELOW THIS .2 t'\_DAY OF !'.I/ , 2., Lowe's Home-Centers.LLC By: '/----_/ i —.# ' (Seal) Print Name: V r` r e -7'A' ( ‘9-/ s s f // -i 7- }l -- J'(,,!i'(� (Seal) Address// / owner` City State/Province Zip/Postal Code Print Name (Seal) Store 1916 Project No.727584009 for MICHAEL MARVIN Page 4 of 8 STORE COPY Co-Owner or Witness Print Name Customer acknowledges receipt of a true copy which was completely filled in prior to Customer's execution hereof.You the customer may cancel this transaction at any time prior to midnight on the third business day after the date of this transaction.See the attached Notice of Right to Cancel for an explanation of this right. Store 1916 Project No.727584009 for MICHAEL MARVIN Page 5 of 8 sir Commonwealth or Massachusetts Division of Professional Licensure Board of Building Regulations and Standards C onst►ucWbn'Supervisor CS-103003 F.*plres 09/08/2022 MICHAEL W BURGAMASTER,T 22 GRANVILLE ROAD SOUTHWICK MA 01011 J� Commissioner gial2A /Cbiro,am- THE COMMONWEALTH OF MASSACHUSETTS Office of Consumer Affairs and Business Regulation 1000 Washington Street-Suite 710 Boston,Massachusetts 02118 Home Improvement Contractor Registration Type: Supplement Card ro =Y Registration: 148688 LOWE'S HOME CENTERS,LLC Expiration 10/17/2023 1000 LOWES BLVD ■ SERVICES COMPLIANCE j MOORESVILLE,NC 28117 7 — ti Update Address and Return Card. THE COMMONWEALTH OF MASSACHUSETTS Office of Consumer Affairs 8 Business Regulation Registration valid for Individual use only before the HOME IMPROVEMENT CONTRACTOR expiration date. If found return to: TYPE:Supplement Card Office of Consumer Affairs and Business Regulation Registration Expiration 1000 Washington Street -Suite 710 148688 10/17/2023 Boston,MA 02118 LOWE'S HOME CENTERS,LLC -• NEXEDES SOTO aY 1000 LOWES BLVD .a. ife,04. /fAidat.ff, 5kfa SERVICES COMPLIANCE MOORESVILLE,NC 28117 Undersecretary Not valid without signature The Commonwealth of Massachusetts —'-- Department of Industrial Accidents i,-3*,_ Office of Invea[iguliuns ,_ Lafayette City Center " ii (t. -y'r�`J 2 Avenue de Lafayette, Boston,M4 02111-1750 "-c ) www.mass.gov/dia Workers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): LOWES HOME CENTERS Address: 1000 LOWES BLVD City/State/Zip: MOORESVILLE,NC 28117 Phone #: 860-SOS-9314 Are you an employer?Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. [j) I am a general contractor and I employees(full and/or part-tithe)." have hired the sub-contractors 6. ❑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. ❑Demolition working for me in anycapacity. employees and have workers' t 9. El Building addition [No workers' comp.insurance comp. insurance. required.] 5. [J We are a corporation and its 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions myself [No workers' right of exemption per MGL ys comp. 12.❑Roof repairs insurance required.]t c. 152,§1(4),and we have no employees. [No workers' 13.0 Other comp. insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. I 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: AIU INSURANCE COMPANY Policy#or Self-ins. Lic. #: WC035901712 AOS Expiration Date: 4/"1�/2023 // Job Site Address: 6 Vrt& L Q T City/State/Zi A1M4Th/� `-" ) �/-f 1)111 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 pa' , pe hies of perjury that the information provided above is true and correct Signature: Date: 424112.2__— Phone#: 860-505-9314 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 3❑City/Town Clerk 4.0 Electrical Inspector 5CPlumbing Inspector 6.0Other Contact Person: Phone#: qrp o� � CERTIFICATE OF LIABILITY INSURANCE CERTIFICATE °ATE(MMroonrvr/ DOES NOT AFFIRMATIVELY INFORMATION ONLY AND CD ORNFERS NO TIGHTS UPON E A FORD IDATE HOLDER. THIS BELOW, OR NEGATIVELY AMEND, EXTEND TR ALTER THE COVERAGE AFFORDED BY THE POLICIES THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER, IMPORTANT; If the COrtIflCate holder is an ADDITIONAL INSURED,the policy(ies) (S). AUTHORIZED If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain must have ADDITIONAL INSURED provisions or be endorsed. this Certificate does not confer rights to the certificate holder in lieu of such endorsements)Ircies may require an endorsement. A statement on PRODUCER Marsh USA Inc. CONTACT 100 North Tryon Street,Suite 3600 PHOE: PHONE FAX Charblle,NC 28202 (A/C.No.Est):E-MAIL 1(A/C,No). ADDRESS: CN102776519 LDwes SI Z2-23 INSURER(S)AFFORDING COVERAGE NAIC p INSURER A:National Union Fire Ins Co.of Piltsbtl h PA 19445 INSURED Lowe's Companies,Inc. INSURER B:Interstate Fire 8 Casualty Co 22829 and sAisidiaries INSURER C:AIU Insurance Co 19399 1000 Lowe's Boulevard Mooresville,NC 28117 INSURER D INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: ATL-004976909-11 REVISION NUMBER: 10 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 LLTRR TYPE OF INSURANCE �� M POLICY EFF POLICY fc7IP — — INSD yY1ID POLICY NUMBER ( yD/y pYYY) (NEyppryyyy) UMRE COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS-MADE , _ OCCUR Self Insured-See below -DAMAGE (Ea tee) S MED EXP(My one person) $ . PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE S POLICY JECT LOC PRODUCTS-COMP/OPAGG $ OTHER: S A AUTOMOBILECO UARIUTY CA7030892 (AOS) 04/01/2022 04/01/2023 MBINEaccident)D SINGLE LIMIT a 5,000,000 (Ea __ C X ANY AUTO CA7030891 (MA) 04/01/2022 04/01/2023 BODILY INJURY(Par person) S A OWNED —I SCHEDULED CA7030893 (VA) 04101/2022 04/01/2023 BODILY INJURY(Per accident) $ AUTOS ONLY __j AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY `AUTOS ONLY (Per accident) B $ X UMBRELLA X O�� USZ00024220 04/0112022 04/01/2023 EACH OCCURRENCE $ 5,000,000 EXCESS LIAR CLAIMS-MADE AGGREGATE $ 5,000,000 r— DED I RETENTIONS I $ C WORKERS COMPENSATION WC035901712 (AOS) 04/01/2022 04/0112023 x PER NTH- AND EMPLOYERS'LIABILITY STATUTE , ER ____ CY/N WC035901713 (ND.WA,WI.WY) 04/01/2022 04/01/2023 EL.EACH ACCIDENT i ANYPROPRIETOR!PARTNER/EXECUTIVE 2,000,000 OFFICER:MEMBER EXCLUDED? II N/A (Mandatory In NH) EL.DISEASE-EA EMPLOYEES 2,000,000 If yes describe under - -2,000,000 DESCRIPTION OF OPERATIONS belowE.L.DISEASE-POLICY LIMIT S A 'Excess Workers'Compensation XWC1647325 (FL) 04/01/2022 I 04/01/2023 (WC per statute) 3,000,000 A Excess Workers'Compensation XWC1647324 (AOS) 04/01/2022 r 04/01/2023 (WC per statute) 3,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(ACORD 101,Adational Remarks Schedule,may be attached if more space is required) Commercial General Liability policy is Self-Insured,effective 4/1/2022 to 4/112023. CERTIFICATE HOLDER CANCELLATION Lowe's Companies,Inc.and Subsidiaries SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 1000 Lowe's Blvd. THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Mooresville,NC 28117 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Vie / DI-Sr/� !7 1988-2016 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD / L � DATE(MMIDDrYYYY) ® CERTIFICATE OF LIABILITY INSURANCE 03/23/2022 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 Marsh USA Inc. NAME: PHONE FAX 100 North Tryon Street,Suite 3600 (A/C.No.Ext); (ANC,No): Charlotte,NC 28202 E-MAIL ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC It CN102776519-LowesSI-22 23 INSURER A:National Union Fire Ins Co.of Pittsburgh PA 19445 INSURED INSURER B:Interstate Fire&Casualty Co 22829 Lowe's Companies,Inc. and subsidiaries INSURER C:AIU Insurance Co 19399 1000 Lowe's Boulevard Mooresville,NC 28117 INSURER D:INSURER E: I INSURER F COVERAGES CERTIFICATE NUMBER: ATL-004976909-11 REVISION NUMBER: 10 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. INIILLIRR TYPE OF INSURANCE MIST).WVO POLICY NUMBER ISuart POLICY EFF POLICY EXP LIMITS UNIIDDIYYYY, (MMIDD/YY COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE I$ Self Insured-See below —DAMAGE TO RENTED CLAIMS-MADE OCCUR PREMISES(Ea occurrence) $ —, MED EXP(Any one person) $ PERSONAL 6 ADV INJURY $ GEN'L AGGREGATE MIT APPLES PER: GENERAL AGGREGATE $ POLICY JECOT- LOC PRODUCTS-COMP/OP AGG $ OTHER: $ A AUTOMOBLELIABILRY CA7030892 (AOS) 04/01/2022 04101/2023 COMBINED SINGLE Lear $ 5,000,000 (Ea eocidenn C X ANY Auto CA7030891 (MA) 04/01/2022 04/01/2023 BODILY INJURY(Per person) $ A UT SCHEDULED CA7030893 (VA) 04/01/2022 04/0112023 BODLYINJURY(Peraccident) $ AOSONLY SHED HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY (Per accident, $ B X UMBRELLA LIAB X OCCUR USZ00024220 04/01/2022 04/01/2023 5,000,000 FAr HOCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ 5,000,000 f DED 1 RETENTIONS $ C WORKERS COMPENSATION WC035901712 (AOS) 04/01/2022 .04101/2023 X PER OTH- AND EMPLOYERS'LIABILITY STATUTE ER C Y/N WC035901713 (ND.WA,WI,WY) 04/01/2022 04/01/2023 2,000,000 ANYPROPRIETORPARTNER/EXECUTIVE EL.EACH ACCIDENT $ 1 OFFICER'MEMBEREXCLUDED? N N r A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 2,000,000 If yes eescribe under 2,000,0()0 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ A Excess Workers'Compensation XWC1647325 (FL) 04101/2022 04/01/2023 (WC per statute) 3,000,000 A Excess Workers'Compensation XWC1647324 (ADS) 04101/2022 04/01/2023 (WC per statute) 3,000,000 1 DESCRIPTION OF OPERATIONS 1 LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Comrreraal General Liability policy is Self-Insured,effective 4/1/2022 to 41112023. CERTIFICATE HOLDER CANCELLATION Lowe's Companies,Inc.and Subsidiaries SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 1000 Lowe's Blvd. THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Mooresville,NC 28117 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE wla7„2.4 2457,4 'l ete. ©1988-2016 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: CN1 027765 1 9 LOC#: Charlotte ACORO ADDITIONAL REMARKS SCHEDULE Page 2 of 2 AGENCY NAMED INSURED Marsh USA Inc. Lowe's Companies,Inc. and subsidiaries POLICY NUMBER 1000 Lowe's Boulevard Mooresville,NC 28117 CARRER NAIC CODE EFFECTIVE DATE; ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: Certificate of Liability Insurance Workers'Compensation and Excess Workers'Compensation potpies include a self-insured retention of$2,000,000. General L abkty:Tie insured is sett insured for$10.000.000 each occurrence for the period of 4/1/2022 to 41112023. The Automobile Liability policy evidenced above is subject to addit onal self-insured retentions excess of limits shown for various perils covered. ACORD 101 (2008/01) ©2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD �� AMRa CERTIFICATE OF LIABILITY INSURANCE DATE(MMfDD;YYYY) 10/12/21 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 CONT NAME ACT Keri Rusciano,CISR Rejean J.Remillard Ins Agency PHO No.Exec: 413-789-3070 (NC,No): 413-786-0193 1040 Springfield Street Feeding Hills,MA 01030 ADDRESS: Keri@RejeanRemillard.com INSURER(S)AFFORDING COVERAGE NAIC A INSURER A: Main Street American Assurance INSURED INSURER B: National Grange Mutual Burgers Home Improvements INSURER C: Ace American-Travelers Ins Co. 22 Granville Rd INSURER D: Southwick,MA 01077 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 ADDLBUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD Vyvo POUCY NUMBER (MM/DDIYYYY) (MM/DD/YYYY) LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED CLAIMS-MADE X OCCUR PREMISES(Ea occurrence). $ 500,000 MED EXP(My one person) $ 10,000 A Y Y MPK6213N 06/08/21 06/08/22 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY JET LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO BODILY INJURY(Per person) $ 100,000 B AWNED x SCHEDULED AUTOS ONLY AUTOS Y Y M1T3385E 06/10/21 06/10/22 BODILY INJURY(Per accident) $ 300,000 x HIRED X NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY _ AUTOS ONLY (Per accident) $ UMBRELLA LIAR OCCUR EACH OCCURRENCE _$ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY STATUTE ER C OFFICER/MEMBER EXCLUDED?ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N NIA 6R09227AUB 10/02/21 10/02/22 E.L.EACH ACCIDENT $ 100,000 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 100,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES IACORD 101,Additional Remarks Schedule,may be attached it more space is required) Lowe's Companies,Inc.and Lowe's Home Centers LLC are named as Additional Insured with respect to General Liability and Automobile Liability Coverage. 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. Lowe's Companies,Inc. and any and all Subsidiaries Mail Code:MI / 1000 Lowe's BLVD AUTHORIZED REPRESENTATIVE Mooresville,NC 28117 ©180c5 AC PORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD