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43-047 (2)
BP-2022-0488 81 AUTUMN DR COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 43-047-001 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-2022-0488 PERMISSION IS HEREBY GRANTED TO: Project# Contractor: License: SAMBRICO LLC DBA VISTA HOME Est. Cost: IMPROVEMENT 111478 Const.Class: Exp.Date:01/21/2023 Use Group: Owner: SALLY WARCHUT WALTER & Lot Size (sq.ft.) SAMBRICO LLC DBA VISTA HOME Zoning: WSP Applicant: IMPROVEMENT Applicant Address Phone: Insurance: 2097 RIVERDALE ST 413-382-0249 UB-2E072183-22 W SPRINGFIELD, MA 01089 ISSUED ON:05/05/2022 TO PERFORM THE FOLLOWING WORK: NEW DOOR 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: 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: o Fees Paid: $40.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Office of the Building Commissioner 11-11-Ez Div J he Commonwealth of Massachusetts MAY - 4 Bo rd oflBuilding Regulations and Standards FOR 2022 MUNICIPALITY Ma sachtsetts State Building Code, 780 CMR USE DEFT o �r plication To Construct, Repair, Renovate Or Demolish a Revised Mar 2011 mcm_ 4,,,p.,� ! 1 PFCT10 0 ,fit. MA o,oAc One-or Two-Family Dwelling This Section For Official Use Only Building Permit Number: 6 P a 1.— 41 aDate Applied: / 2 5-6-Z6Z a Building Official(Print Name) Signature Date SECTION 1: SITE INFORMATION 1.1 Property Address: 1.2 ors Map& Parcel Numbe s a'1 v'rur �( . , A.1301\k.Q l N`A, Y j `f 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 Required Provided Required Provided Required Provided 1.6 Water Supply: (M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Public 0 Private 0 Zone: _ Outside Flood Zone? Municipal❑ On site disposal system 0 Check if yes❑ SECTION 2: PROPERTY OWNERSHIP' W OiLk%k N CIASL Vi Ck C14-NnA AA(xina ws--. okoucz Name(Print) City, State,ZIP g 1 (\)f 1(`(V\ D( . v\3-5t19-tra.G U 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) 0 Alteration(s) 0 Addition 0 Demolition 0 Accessory Bldg. ❑ Number of Units Other iSpecify:q\x,(51C,I(Q, IQA{t i4)0(S Brief Descri tion of Proposed Work'-: k U\l1. 1 t vrcaI\?r 040 ( (/�t CW. \ �Q , + (*DO( ,)v1 \ s-Vrrti -wv r . SECTION 4: ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1. Building $ 1 I o� Do 1. Building Permit Fee: $ Indicate how fee is determined: 2. Electrical $ 0 Standard City/Town Application Fee 0 Total Project Cost3(Item 6)x multiplier x 3. Plumbing $ 2. Other Fees: $ 4. Mechanical (HVAC) $ List: 5. Mechanical (Fire $ Suppression) Total All Fees:,�rj /, ` r; Check NoqO of 0 Check Amount:`4_Cash Amount: v 6. Total Project Cost: $ is2 l\a. 0 Paid in Full 0 Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) 1 1 aA1 ku f- License Number Expiration Date Name o L Holder List CSL Type(see below) U No.and Street Type Description a.1 \\1 r\ ,�^ ` ,\ U Unrestricted(Buildings up to 35,000 Cu.ft.) 11�k1 i lv V� V R Restricted 1&2 Family Dwelling City/Town,State,Z M Masonry RC Roofing Covering WS Window and Siding SF Solid Fuel Burning Appliances (AG'3'9 j(^&v 1sAa'Or i V I Insulation Telephone Email address .LploV D Demolition 5. Registered Home Improvement Contractor(HIC) is al c�3 tc1 co '-t- HIC Registration Number Ex iration Date H CompanyiName or HIC Reg.istrant Name _r 1 Y\v Q1`CL S]I Gaols\-G,1v"0'M Q4,M p n)vann QAAf No and Street Email address . Lo City/Town,State,ZIP Telephone SECTION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c. 152.§ 25c(6)) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure do provide this affidavit will result in the denial of the Issuannce of the building permit. Signed Affidavit Attached? Yes Isa' No 0 SECTION 7a: OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIESFOR BUILDING PERMIT I,as Owner of the subject property,hereby authorize 3C)1V' O1 ` to act on my behalf, nlf in all matters relative to work authorized by this building permit application. ts ( 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 contain in this application is true and accurate to the best of my knowledge and understanding. Print Owne s or Authorized Agent's Name(Electronic ignature) Date NOTES: 1. An Owner who obtains a building permit to do his/her own work,or an owner who hires an unregistered contractor (not registered in the Home Improvement Contractor(HIC)Program),will not have access to the arbitration program or guaranty fund under M.G.L.c. 142A.Other important information on the HIC Program can be found at www.mass.gov/oca Information on the Construction Supervisor License can be found at www.mass.gov/dps 2. When substantial work is planned,provide the information below: Total floor area(sq.ft.) (including garage,finished basement/attics,decks or porch) Gross living area(sq. ft.) Habitable room count Number of fireplaces Number of bedrooms Number of bathrooms _ Number of half/baths Type of heating system Number of decks/porches Type of cooling system Enclosed Open 3. "Total Project Square Footage"may be substituted for"Total Project Cost" City of Northampton ow' 1�•�' Massachusetts ��5 _ c;. ,c, ll *Jo { a v DEPARTMENT OF BUILDING INSPECTIONS E r 212 Main Street • Municipal Building ,ate Northampton, MA 01060 .rrt- ��‘�\ iv 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. Nc `nss�,\\9SS w\A (rwc C k_ Va.l t �` US —OU,KQS S Or` The debris will be disposed of in: Location of Facility: aOc11 4.\'„,\)(ifdoca NA 0 \UV� The debris will be transported by: Name of Hauler: \c V\1)( 0—_ `(\(\QS-1\1o1n(1. -k . Signature of Applicant: U w`L Date: �-. The Commonwealth of.%lassachusetts it — Department of Industrial Accidents c 1 Congress Street,Suite 100 'w Boston, .t1.4 02114-2017 t. www.mass.gor/dia - - '0 or kers' Compensation Insurance Affiidas it: Builders/('ontractorsfEiectricians/I'lumhers. It)ni: FILED Nl WI IDE PE:RMIII-Ilr(:Al 7.HORI lI. applicant Infurmat- �` Please Print t. ibiy Name(Busmessdorganastion/tndividual): :�� \ `�C\L 0 \ -(_ Address: 62Cf \ \ \f\'.JQSa,,C3 ., City/State/Zip: ) • SQ'k\. 0\OSC7 Phone #: \\' `3-)a - Are yur as eagdoyer?Check Ike appropriate box: Type of project(required): t.❑I am a employer with employees(full and or part-tinwl-• 7. CI New construction 20 I am a sole proprietor or partnership and have no employees working fur me in 8. 0 Remodeling any capacity.[No workers"comp.insurance required" 30 I am a homeowner doing all work myself_[Nu workers'comp.assurance required"' 9. ❑ Demolition 10 0 Building addition .1.0 I am a homeowner and will be hiring contractors to conduct all work on my property. I will cnsu that all contractors either have wurken'compensation insurance or are sole 1 ILO Electrical repairs or additions 07 caws with nu employees. 12.0 Plumbing repairs or additions am a general contractor and I have hired the subcuntracton listed on the attached sheet. These subcontractors have employees and have workers'comp.insurance.: 1 ❑Roof repairs 6.0 Wean_a corporation and its officers have exercised their nghi of exemption per ACE C. 14. 'Other lid i 152.,1114).and we have no employees.[No workers'comp_insurance required.' •Any applicant that checks box#1 must also till out the section below showing their workers'compensation policy information. *Homeowners who subnnt this affidavit ind.catug they arc doing all work and then hire outside contractors must submit a new affidavit mdicaimg such_ :contracture that check this box must ana:led an additional sheet showing the name of the sub-coruiactors and state whether or not those entities have employees. It the sub-contractors have employees,they must provide their warkcn"comp.policy number. I um an employee that is providing workers'compensation insurance fir my employees. Below is the policy and job site information. Insurance Company Name: — Policy 4 or Self ins.Lie.#: Expiration Date: (� Job Site Address: T \,v M� )c City/state/zip: . 0(, I\u..t "' 0 \0 LO a_ Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL c. 152.§25A is a criminal violation punishable by a fine up to$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.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby Er,under the pains peg\, f perjury that the information provided above i'true and correct � � Inn Signature: j , S� ,t Q i Dalc: DJ P-. .., Phone#: 11,\ "1 —LAS—0 Official use only. Do not write in this urea,to he a vunp/etetl hl city or town official i i ('its or loss n: Permit/License# Issuing authorits (circle one): I. Board of Itcalth 2. Building Department 3.('it./Tossn Clerk 4. Electrical Inspector 5. Plumbing Inspector h. Other Contact Person: Phone#: 2097 Riverdale Street MA License# 162058 West Springfield, MA 01089 CT License# 0621848 Phone: 888.597.2323 V1Staji ; PLATINUM Fax: 413.382.0241 HOME IMPROVEMENT c r''.•i IRhl ERREI1l ON FRAI"I OR vistahomeimprovement.com ENTRY DOOR CONTRACT Customer Information Walter Warchut (413)586-6206 Date:03/17/2022 81 Autumn Dr walterwarchut@outlook.com Rep: David Lauzon Florence MA 01062 All home improvement contractors and subcontractors must be registered and any inquiries about a contractor or subcontractor relating to a registration should be directed to: Office of Consumer Affairs and Business Regulation Ten Park Plaza, Suite 5170 Boston, MA 02116Phone: 617.973.8700 ProVia Entry Doors Legacy Single Entry Door in FrameSaver Frame e.IPA -36"x 80" Nominal Size Quantity -Unit Size:37 9/16"x 81 11/16" -Frame Depth:4 9/16" -2"Standard Brickmold -With Storm Door-Sized to Fit on Brickmold -Right Hand Inswing-Inside Looking Out -Entry Door -4 Panel 400 Style 20-Gauge Woodgrain Textured Steel Door 8416119 -ComforTech DC -Sunburst Contoured Internal Grid o -Mountain Berry Red Grids -Oak Inside/Mountain Berry Red Outside -Hardware -All Hardware in Lifetime Bright Brass Finish -Georgian Lockset -Thumbturn Deadbolt -Frame -Oak Inside Frame(Painted) -Mill Finish ZAC Auto-Adjusting Threshold(5 5/8"Depth) -Zinc Chromate Ball Bearing Hinges(Complements Bright and Antique Brass) -Security Plate Inside View Outside View Door Location Front door This space intentionally left blank Deluxe 398 Hi-Lite . -36"x 80" Standard Size Quantity -Mountain Berry Red -Standard Z-Bar -Pre-Hung -Color Matched Leaf Hinge -Hinge on Right(Viewed from Outside) -1"Color Matched Bottom Expander • -Pebble Grain Kick Panel 8416119 -White Contemporary Curve Handleset(DH226) -Assign a Random Key Number -Color Matched Heavy Duty Closer(DH219-20) 1 g -Standard Sash -Clear Glass -Top Screen with BetterVue Screen Mesh Inside View Outside View Door Location Front door Door Fees Lead Fee 1 1 Time Disposal Fee 1 Additional Details Homeowner's Association NO WORK SCHEDULE Contractor will not begin the work or order the materials before the third day following the signing of this Agreement, unless specified herein. Contractor will begin the work on or about 06/17/2022 Barring delay caused by circumstances beyond Contractors control, the work will be completed by 07/17/2022 WARRANTY The Contractor warrants that the work furnished hereunder shall be free from defects in materials and workmanship for the period stated below following completion and shall comply with the requirements of this Agreement. In the event any defect in workmanship or materials, or damage caused by the Contractor, its subcontractors, employees or agents, is discovered after completion of any job, Including cleanup,the Contractor shall, at its own expense, forthwith remedy, repair, correct, replace, or cause to be remedied, repaired or replaced, such damage or such defect in materials and workmanship. The foregoing warranties shall survive any inspection performed in connection with the agreed-upon work. Warranty Period Lifetime Measure Section Measure Set With -- Call To Confirm with customer Total Contract Amount (All Discounts Applied) $6,412.00 Payment Deposit $641.00 Amount Financed $5,771.00 Form of Payment Upon Signing Credit Card Credit card XXXX-XXXX-XXXX-0300 Acceptance of Proposal I have read both sides of this document and accept the prices, specifications and conditions stated. I understand that upon signing,this proposal becomes a binding contract. You are authorized to do the work as specified. Payment will be made as outlined above. You may cancel this agreement if it has been signed by a party thereto at a place other than an address of the Seller, which may be his main office or branch thereof, provided you notify the Seller in writing at his main office or branch by ordinary mail posted, by telegram sent or by delivery, not later than midnight of the third business day following the signing of this agreement. Please refer to the Notice of Cancellation below contents of which are referred to above and incorporated herein by reference. DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES. This space intentionally left blank Contractor, under provisions of Chapter 142A of the Massachusetts General Laws, is required to apply for and obtain all construction related permits. Contractor shall not be deemed responsible for delays in the work described in this agreement caused by regulator, permit granting or inspectional agencies, authorities or individuals. NOTICE: If Owner obtains his/her own construction related-permits for the work described under this Agreement, Owner is hereby advised that in the event of a dispute, judgment and non payment of Contractor, Owner will not be entitled to make claim to or collection from the guaranty fund established in M.G.L. c. 142A. Modification: This Agreement, except as to concealed conditions or delays occasioned thereby or by restarts, cannot be changed except by a written statement signed by both Contractor and Owner. However, cancellation by Owner is allowed in accordance with the Notice of Cancellation. Owner hereby grants Contractor a limited Power of Attorney to complete incomplete documents on Owners behalf. Completeness of Contract for Execution: Owner is hereby advised not to sign this Agreement unless and until all blank sections have been filled in or marked as void, deleted or not applicable, and until all exhibits and related or referenced documents that are incorporated herein are attached hereto. Attorney's Fees/Costs Owner agrees to pay all costs of collection, including reasonable attorney's fees, cost and expenses. Furthermore, interest shall be charged at the highest lawful rate of interest on any and all overdue payments. Copy of Agreement to be given to Owner: This Agreement is governed by the laws of the Commonwealth of Massachusetts. It must be executed in duplicate, and an original, signed copy hereof given to the Owner at the time of execution. No work under the Agreement shall begin prior to the signing of the Agreement and transmittal to the Owner of a copy therefor. Walter Warchut 03/17/2022 Date David Lauzon Authorized Representative 03/17/2022 Date This space intentionally left blank NOM= cotilmoilweaith ot Massachusetts A, DIV IS144)(1 Of Professional Licensure 5,4:Nru o' Building Regulations and Standards -1 r... t / /4 1§ C 0 nstrutlibil Opgrvisor I _ - "RIP 'ilk ,14.* 6pires : 01 /:21 /2023 4 i. ... - t 4 4-0 BRIAN RUDO t , ....... 475 COYOTE CIRCLE EfECX1413 HILLS MA 01030 --s, b..... /II \ { ..,, ,.... , rss sirier ,..7,/. /.4.'0:-' f 1 . r, 4 0 100 .4 * Office of Consumer Affairs and Business Regulation 1000 Washington Street - Suite 710 Boston, Massachusetts 02118 Home Improvement Contractor Registration Type. LLC Registration: 162058 SAMBRICO LLC D/B/A VISTA HOME IMPROVEMENT Expiration: 01/02/2023 2097 RIVERDALE ST WEST SPRINGFIELD, MA 01089 Update Address and Return Card. Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only TYPE:LLC before the expiration date. If found return to: Registration Expiration Office of Consumer Affairs and Business Regulation 162058 01/02/2023 1000 Washington Street -Suite 710 SAMBRICO LLC Boston,MA 02118 D/B/A VISTA HOME IMPROVEMENT BRIAN RUDD 2097 RIVERDALE ST �,, ,rt'CG-,1 • WEST SPRINGFIELD,MA 01089 Undersecretary Not valid without signature `� CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYYY) �R!) 03/1 5/2021 ThIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: SOUTHWICK INS AGENCY INC PHONE FAX P O BOX 100 (A/C,No,Ext): (A/C,No): E-MAIL SOUTHWICK,MA 01077 ADDRESS: 28TKC INSURER(S)AFFORDING COVERAGE NAIC P INSURED INSURER A: I R\\ELERS PROPERTY CASUALTY COMPANY OF AMERICA SAMI3RICO LLC DBA VISTA HOME IMPROVEMENT INSURER B: INSURER C: INSURER D: 2097 RIVERDALE STREET INSURER E: WEST SPRINGFIELD,MA 01(189 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 SDDLOUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER (VIM\DDIYYYY) (MMIDD\YYYY) LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ "..''.--1 CLAIMS MADE n OCCUR DAMAGE TO RENTED $ PREMISES(Ea occurrence) 11 MED EXP(Any one person) $ PERSONAL 8 ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER. GENERAL 1$ AGGREGATFIPROJECT nLOC E POLICY PRODUCTS-COMP/OP AGG $ AUTOMOBILE LIABILITY COMBINED SINGLE I$ ANY AUTO LIMIT(Ea accident) BODILY INJURY r$ OWNED SCHEDULE AUTOS (Per person) _.— AUTOS ONLY BODILY INJURY $ HIRED — NON-OWNED AUTOS ONLY (Per accident) �r AUTOS ONLY — PROPERTY DAMAGE $ (Per accident) UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ 11 DED I.RETENTION $ $ WOR- KER'S COMPENSATION AND PER OTHER EMPLOYER'S LIABILITY STATUTE U B-2E072183-21 03/12/2021 03/12/2022 ANY PROPERITOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT 1$ 500,000 OFFICER/MEMBER EXCLUDED YIN (Mandatory in NH) n N/A E L DISEASE-EA EMPLOYEE $ 500,000 f yes,describe under E L DISEASE-POLICY LIMIT ,$ 1,000.000 DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) I I ITS REPLACES ANY PRIOR CERIIFIC:CFE ISSLED I'O FHE CERTIFICATE HOLDER AFFECTING WORKERS COMP COVER:\GI CERTIFICATE HOLDER CANCELLATION TOWN OF WEST SPRINGFIELDS SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED 26 CENTRAL ST BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE WEST SPRINGFIELDS.MA 01089 ACORD 25(2016/03)(Rev.09-18) The ACORD name and logo are registered marks of ACORD 1988- 5 A 0 D PORATION.fights reserved. ACORO® DATE(MMIDDIYYYY) CO CERTIFICATE OF LIABILITY INSURANCE 05/28/2021 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT David R Jarry Neill&Neill Insurance Agency Inc Pry ONE FAx 662 Riverdale Street (WC.No.ENO: 413 732 4137 (A/C,No);413-731-6629 West Springfield,MA 01089 E-MAIL dj@neillandneill.com INSURER(S)AFFORDING COVERAGE NAIC N INSURER A: Western World Insurance Co. 13196 INSURED New England Home Improvement INSURER B: Chubb Insurance Co I CHU 43 Booth Road Enfield,CT 06082 INSURER C: 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 EFF POLICY EXP T I TYPE OF INSURANCE INSD SUERWVD POLICY NUMBER (MM/DDY RIYYYY) fMM/DD/YYYYI LIMITS • A J COMMERCIAL GENERAL LIABILITY NPP8745978 05(26/2021 05/26/2022 EACH OCCURRENCE $ 300,000 DAMAGE TO RENTED CLAIMS-MADE \A OCCUR PREMISES(Ea occurrence) $ 1 00,000 MED EXP(Any one person) $ 5,000 PERSONAL 8 ADV INJURY $ 300,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 600,000 J POLICY PRO LOC PRODUCTS-COMP/OP AGG $ 300,000 JECT OTHER: — $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO BODILY INJURY(Per person) $ - OWNED SCHEDULED BODILY INJURY(Per accident) $ _ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ _ AUTOS ONLY AUTOS ONLY (Per accident) UMBRELLA LIAR OCCUR EACH OCCURRENCE $ - EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ - n $ B WORKERS COMPENSATION 6S62UB-9F68699-6 05/06/2021 05/06/2022 V I PER STATUTE ERH AND EMPLOYERS'LIABILITY ANY PROPRIETORIPARTNERIEXECUTIVE YIN E.L.EACH ACCIDENT $ 100,000 OFFICER/MEMBER EXCLUDED? n N I A I (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 100,000 If yes,describe under 500,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) Emailed to:cassied©vistahomeimprovement.com CERTIFICATE HOLDER CANCELLATION VISTA HOME IMPROVEMENT SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 2097 RIVERDALE STREET THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN WEST SPRINGFIELD,MA 01089 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRES TAtIVE e - a 8 0� OFt A rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD ..,^ CERTIFICATE OF LIABILITY INSURANCE 1DATEYY) {lc`t7►rfii'/� 03/22/2022 TS.,GERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: SOUTHWICK INS AGENCY INC PHONE FAX P O 130X 100 (A/C,No,Ext): (A/C,No): E-MAIL SOUT'HWICK,MA 01077 ADDRESS: 25 T K( INSURER(S)AFFORDING COVERAGE NAIC# INSURED INSURER A: I RAVI LIRS PROPER]11]1 (,ASILO ll (OMI'ANY OF ASH RI(A SAMBRICO LEC DBA VISTA HOME IMPROVI:MLN I `INSURER B: INSURER C: INSURER D: 2097 RIVLRDALI`.Sl'RELI INSURER E: WEST SPRINGFIELD, MA 01089 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 4DDL3UBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER (MM1DD\YYYY) (MM\DD\YYYY) LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ .- CLAIMS MADE n OCCUR. DAMAGE TO RENTED $ . PREMISES(Ea occurrence) MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL $ . POLICY ATnPROJECT nLOC E PRODUCTS-COMP/OP AGG $ E POLIC AUTOMOBILE LIABILITY COMBINED SINGLE $ ANY AUTO LIMIT(Ea accident) BODILY INJURY $ ■ OWNED SCHEDULE AUTOS (Per person) AUTOS ONLY BODILY INJURY HIRED — AUTOSNON-OWNEDLY AUTOS ONLY AUTOS ONLY (Per accident) PROPERTY DAMAGE $ (Per accident) UMBRELLA LIAB I OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ . DED JRETENTION $ $ WORKER'S COMPENSATION AND PER OTHER EMPLOYER'S LIABILITY STATUTE UB-2E072183-22 03/12/2022 03/12/2023 ANY PROPERITOR/PARTNER/EXECUTIVE Y/N E.L.EACH ACCIDENT $ 500,000 OFFICER/MEMBER EXCLUDED? (Mandatory in NH) n N/A E.L.DISEASE-EA EMPLOYEE $ 500,000 If yes,describe under E.L.DISEASE-POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONSILOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Tl Its REPLACES ANY PRIOR CIiRTTITCATF ISSUED TO lift CERTIFICATE IIOLDER AFFECTING WORKERS COMP COVERAGE. HIE INSURED'S MA WORKERS COMPI:NSA I]ON POLICY AND ITS LIMITED OTHER Sl ATES ENDORSEMENT AtTT1ORI/FS'HIE PAYMENT OF 13FNEITI'S FOR CLAIMS MADE BY TIIF INSURF.D'S MA EMPLOYEES IN STATES OTHER'Tl1AN MA NO AUTHORIZATION IS GIVEN TO PAY CLAIMS FOR BENEFITS IN STATES OTHER THAN MA IF THE INSURED I IIRLS,OR I IAS!BRED EMPLOYEES OUTSIDE OF MA. THIS POLICY DOES NOT PROVIDE COVERAGE FOR ANY STATE OTHER THAN MA. CERTIFICATE HOLDER CANCELLATION w 'I HL WAIN DI.POT USA INS SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED COMPLIANCE C-i 1-2455 PA('l,S LARRY ROAD IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ATLANTA,GA 30339 ACORD 25(2016/03)(Rev.09-18) The ACORD name and logo are registered marks of ACORD 1988- 15 ACORD ORPORATION. rights reserved.