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29-188 (4) BP-2022-0513 142 DEERFIELD DR COMMONWEALTH OF MASS CHUSETTS Map:Block:Lot: 29-188-001 CITY OF NORTHAMPT N Permit: Exterior Res PERSONS CONTRACTING WITH UNREGISTERED ('ONTRACTORS DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) BUILDING PERMIT Permit # BP-2022-0513 PERMISSION IS HEREBY GRANTED TO: Project# WINDOWS Contractor: License: Est. Cost: 15346 RENEWAL BY ANDERSEN 090125 Const.Class: Exp.Date: 10/06/2022 Use Group: Owner: DRAGON FAQ 1I LY TRUST Lot Size (sq.ft.) Zoning: WSP Applicant: RENEWAL BY ANDERSEN Applicant Address Phone: Insurance: 30 FORBES RD 508-351-227 MWC31415820 NORTHBOROUGH, MA 01532 ISSUED ON:05/12/2022 TO PERFORM THE FOLLOWING WORK: INSTALL 6 REPLACEMENT WINDOWS 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: TIT .52 . Fees Paid: $40.00 212 Main Street, Phonc(413) 587-1240,Fax:(4131587-1272 Office of the Building Commissioner • 4?-•••... 4-.1*.t., 'vf C::: . . i n_...._-.......-___...,„,.. ' , • ! MAY - 9 20 .Z, The Commonwealth of Massachusetts r,.-.,C _.„1(..Ns FOR D; Board of Building Regulations and Standards '',h I',',.", MUNICIPALITY Massachusetts State Building Code,780 CMR USE • Building Permit Application To Construct,Repair,Renovate Or Demolish a Revised Mar 2011 One-or Two-Family Dwelling This Section For Official Use Only Building errnit Number: GP_ .; —Cs..( -a, Date Applied: 5-/2-262.-2. Building Official(Print Name) Signature Date SECTION 1:SITE INFORMATION .1.1 Property Address: 1.2 Assessors Map&Parcel Numbers • • 142 Deerfield Drive 29 188-001 1.1a Is this an accepted street?yes no Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimension= 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 CI Private CI Check if yes!: Municipal 0 On site disposal system 0 SECTION 2: PROPERTY OWNERSHIP1 2.1 Owner1 of Record: Emily&Walter Dragon Northampton,MA 01060 Name(Print) City,State,ZIP 142 Deerfield Dr, 413-584-8841 ewdragon@comcast.net No.and Street Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply) i I New Construction 0 Existing Building)5( Owner-Occupied 0 'Repairs(s) CI I Alteration(s) 0 Addition 0 Demolition 0 Accessory Bldg.0 Number of Units Other R Specify. Replacements Brief Description of Proposed Work2: Replacement of 6 windows. No structural changes. • SECTION 4:ESTIMATED CONSTRUCTION COSTS Estimated Costs: I Item Official Use Only (Labor and Materials) • I.Building $ 15346 1. Building Permit Fee:$ Indicate how fee is determined: CI 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 Fn.,:Sa i Check No. 0-1 Cheek Amoun#S Cash Amount: 6.Total Project Cost: $ 15,346 1 0 Paid in Full 0 Outstanding Balance Due: • . , . (89 . . • • SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) CS-090125 1 O/06/2022 Jaime Morin • License Number Expiration Date • Name of CSL Holder 30 Forbes Rd. List CSL Type(see below) •• U No.and Street Type Description Northborough, MA 01532 U Unrestricted Buildings up to 35,000 cu.ft.) City/Town,State,ZIP R Restricted 1&.2 Family Dwelling • M Masonry RC Roofing Covering • WS Window and Siding • SF Solid Fuel Burning Appliances 508-351-2277 rbabostonpermitting@andersencorp.com 1 Insulation Telephone Email address - D Demolition • 5.2 Registered Home Improvement Contractor(HIC) 170810 12/22/2023 Renewal by Andersen HIC Registration Number Expiration Date HIC Company Name or HIC Registrant Name 30 Forbes Rd. rbabostonpermitting@andersencorp.corn No.and Street Email address Northborough, MA 01532 508-351-2277 City/Town,State,ZIP Telephone SECTION 6:WORKERS' COMPENSATION INSURANCE AFFIDAVIT(NLG.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 . No 0 SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHIN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I,as Owner of the subject property,hereby authorize Jaime Morin to act on my behalf,in all matters relative to work authorized by this building permit application. Emily& Walter Dragon ( See signed contract attached) 5/5/2022 Print Owner's Name(Electronic Signature) Date SECTION 7b:OWNER1 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 in this application is true and accurate e best of my knowledge and understanding. Jaime Morin • 5/5/2022 Print Owner's or Authorized Agent's Name is 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.aov/dps 2. When substantial work is planned,provide the information below: Total floor area(sq.fr.) (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" . • • • • � 1 CITY OF NORTHAMPTON SETBACK PLAN MAP: _ LOT: _ • LOT SIZE: • REAR LOT DIMENSION REAR YARD • • • • SIDE YARD • SIDE YARD • • • • FRONT:SETBACK_ _ 4 • FRONTAGE • I I 1 OP7,' , The City of Northampton ro-y I. fr.t,,,, -i4filt) Building.Department '� '` is 212 Main Street :,i.-->-,,,.,-'' Northampton,Massachusetts 01060 • Phone(413) 529-1402 Fax (413) 529-1433 • CONSTRUCTION DEBRIS AFFIDAVIT • (FOR ALL DEMOLITION AND RENOVATION PROJECTS) In accordance with the provisions of MGL c40, s54, a condition of Building Permit Number is that all debris resulting from this work shall be disposed of in a properly licensed waste disposal facility as defined by MGL c 111, S 150A. The debris will be disposed of in: Location of Facility__30 Forbes Rd.LNorthborou_gh, MA 01532 The debris will be transported by: Name of Hauler Renewal by Andersen • Signature of Applicant:__ _ _ ___ ___ ___ _ Date_5/5/2°22 • The Commonwealth of Massachusetts Department of Industrial Accidents _- _ / 1 Congress Street,Suite 100 • Boston,MA 02114-2017 www.massgov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMTITING AUTHORITY. Applicant Information Please Print Lenibly Name(BusinessiOrganization/Individ„al): Renewal by Andersen Address: 30 Forbes Rd. City/State/Zip: Northborough, MA 01532 Phone#: 508-351-2277 Are you an employer?Check the appropriate box: Type of project(required): 1.®I am a employer with 30 employees(full and/or part-time).' 7. New construction 2.0 I am a sole proprietor or partnership and have no employees working forme is 8. ❑Remodeling any capacity.[No workers'camp.insurance required.) 3.01 am a homeowner doing all work myself[No workers'comp.insurance required.]' • 9 ❑Demolition 4.01 am a homeowner and willbe hiring contractors to conduct all work on my property. I will 10 Building addition ensure that all contractors either have workers'compensation insurance or are sole 11.0 Electrical repairs or additions proprietors with no employees. 12.0 Plumbing repairs or additions 5.1:1 I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13 RODE sits These sub-contractors have employees and have workers'comp.insurance.: ❑ 6.0 We are a corporation and its officers have exercised their right of exemption per MGL c. 14.®Other Replacement 152,§1(4),and we have no employees.(No workers'comp.insurance required.] 'Any applicant that checks box N1 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: Old Republic Insurance Co. Policy#or Self-ins.Lic.#: MWC 31415820 • Expiration Date: 1/15/2021 • • Job Site Address: 142 Deerfield Drive City/State/zip: Northampton, MA 01060. 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•certify under e and penalties of perjury that the information provided above is true and correct • • Signature: • Date: 5/5/2022 Phone#: 508-3 7 Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town CIerk 4.Electrical Inspector 5.Plumbing Inspector • 6.Other Contact Person: Phone#: • City of Northampton. Massachusetts • ��Frye..��'+: 1 `1"- 9'�'i:� DEPARTMENT OF BUILDING INSPECTIONS a oaf 1..;_cs• , f 212 Main Street • Municipal Building VjE. b y s;�a NOYthampton, MA 01060 �h1. HOMEOWNERS'EXEMPTION ELIGIBILITY AFFFI JAVTT • .(insert full legal name), born (insert month, day,year), hereby depose and state the following: • 1. I am seeking a building permit pursuant to the homeowners'exemption to the permit requirements of the Massachusetts State Building Code, codified at 780 ClvIR 110.R5.1.3.1, in connection with a project or work on a parcel of land to which I hold legal title. 2. I am not engaged in, and the project or work for which I am seeking the aforementioned homeowners'. exemption, does not involve the field erection of manufactured.buildings constructed in accordance with 780 CMR IIO.R3. 3. I qualifij under the State Building Code's definition of"homeowner"as defined at 780 CMR 110.R5.1.2: Person(s) who owns a parcel of land on which he/she resides or intends to reside, on which there is, or is intended to be, a one-or two-family dwelling, attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a home owner. 4.. I do not hold a valid Massachusetts construction supervision license and, except to the extent that I qualify for and will abide by the Massachusetts State Building Code's requirements for the supervision of the project or work on my parcel, I am not engaged in construction supervision in connection with any project or work involving construction, reconstruction, alteration, repair, removal or demolition involving any activity regulated by any provision of the Massachusetts State Building Code. 5. If I engage any other person or persons for hire in connection with the aforementioned project or work on my parcel,I acknowledge that Ian/required to and will act as the supervisor for said project or work. • Signed under the pains and penalties of perjury on this day of /14 ,20 .9-- • • (Si re) 4ii Agreement Document and Payment Terms DBA:RENEWAL BY ANDERSEN OF BOSTON Emily&Waller Dragon RENEWAL Legal Name:Renewal by Andersen LLC 142 Deerfield Dr. RENDER A HIC#170810 Florence,MA 01062 by 30 Forbes Road I Northborough,MA 01532 H:(413)584-8841 (MUNK!MOW Phone:(508)351-2200 I Fax:(508)986-7072 I rbaboston@gmail.com Emily&Walter Dragon 03/24/22 BUYER(S)NAME CONTRACT DATE 142 Deerfield Dr., Florence , MA 01062 (413)584-8841 BUYER(S)STREET ADDRESS PRIMARY NUMBER SECONDARY NUMBER ewdragon@comcast.net PRIMARY EMAIL SECONDARY EMAIL Buyer(s)hereby jointly and severally agrees to purchase the products and/or services of Renewal by Andersen LLC d/b/a Renewal By Andersen of Boston("Contractor"),in accordance with the terms and conditions described in this Agreement Document and Payment Terms,any documents listed in the Table of Contents,and any other document attached to this Agreement Document,the terms of which are all agreed to by the parties and incorporated herein by reference(collectively,this "Agreement"). Buyer(s)hereby agrees to sign a completion certificate after Contractor has completed all work under this Agreement. TOTAL JOB AMOUNT: $15,346 By signing this Agreement,you acknowledge that the Balance Due,and the Amount Financed must be made by personal check,bank check,credit card,or cash. DEPOSIT RECEIVED: $5,114 BALANCE DUE: $10,232 Estimated Start: Estimated Completion: 1-2 Days 26 Weeks AMOUNT FINANCED: $0 We schedule installations based on the date of the signed contract and secondarily on the date METHOD OF PAYMENT: Credit Card in which we complete the technical measurements.The installation date that we are providing at this time is only an estimate.We will communicate an official date and time at a later date.Rain and extreme weather are the most common causes for delay. NOTES: 1/3 Deposit; 1/3 Start of Project; 1/3 Substantial Completion Buyer(s)agrees and understands that this Agreement constitutes the entire understandings between the parties and that there are no verbal understandings changing or modifying any of the terms of this Agreement.No alterations to or deviations from this Agreement will be valid without the signed,written consent of both the Buyer(s)and Contractor. Buyer(s)hereby acknowledges that Buyer(s)1)has read this Agreement,understands the terms of this Agreement,and has received a completed,signed,and dated copy of this Agreement,including the two attached Notices of Cancellation,on the date first written above and 2)was orally informed of Buyer's right to cancel this Agreement. NOTICE TO BUYER: Do not sign this contract if blank.You are entitled to a copy of the contract at the time you sign. YOU,THE BUYER, MAY CANCEL THIS TRANSACTION AT ANY TIME NOT LATER THAN MIDNIGHT OF 03/28/2022 OR THE THIRD BUSINESS DAY AFTER THE DATE OF THIS TRANSACTION,,WHICHEVER DATE IS LATER. SEE THE ATTACHED NOTICE OF CANCELLATION FORM FOR AN EXPLANATION OF THIS RIGHT. 1{/4762C-__?› SIGNATURE OF SALES PERSON SIGNATURE SIGNATURE Wayne Gremo Emily Dragon Walter Dragon PRINT NAME OF SALES PERSON PRINT NAME PRINT NAME 03/24/22 Page 2 / 31 //[�/�// Itemized Order Receipt - 'LJ' , DIA:RENEWAL BY ANDERSEN OF BOSTON Emily&Walter Dragon Legal Name:Renewal by Andersen LLC 142 Deerfield Dr. RENEWAL REbyANDERSEL HIC#170810 Florence,MA 01062 MSEMRn OM4DO191111 II 30 Forbes Road I Northborough,MA 01532 H:(413)584-8841 Phone:(508)351-2200 I Fax:(508)986-7072 I rbaboston@gmail.com ID#: ROOM: SIZE: DETAILS: PRICE: 101 Kitchen Window, Gliding, Double, 1:1, Acti e / Passive, Base Frame, Exterior White, Interior White, Perf rmance Calculator, PG Rating: 40 I DP Rating: + 40 / - 4 , Glass, All Sash: High Performance SmartSun Glass, No attern, Hardware, White, Screen, Fiberglass, Half Screen, G ille Style, No Grille, Misc, Full Frame Installation (Standard), Replacement of window frame and sash, includes casing f om standard options. 102 Bathroom Window, Double-Hung (DG). 1:1, S ope Sill, Insert Frame, Traditional Checkrail, Exterior White, Interior White, Performance Calculator, PG Rating: 40 I DP Rating: + 40 / - 40, Glass, All Sash: High Performance SmartSun Glass, No Pattern, Tempered Glass, Hardware, White, Screen, Fiberglass, Half Screen, Grille Stye, No Grille, Misc, Aluminum Wrap - Complete Unit, Ahuminum wrap of exterior casing. 103 The Den Window, Double-Hung (DG), 1:1, lope Sill, Insert Frame, Traditional Checkrail, Exterior While, Interior White, Performance Calculator, PG Ratin•: 40 I DP Rating: + 40 / - 40, Glass, All Sash: High Perform.nce SmartSun Glass, No Pattern, Hardware, White, Screen, Fiberglass, Half Screen, Grille Style, No Grille, Misc, Alum num Wrap - Complete Unit, Aluminum wrap of exterior casing. 03/24/22 Page 3/ 31 A J/-/[L�// Itemized Order Receipt =.J` DBA:RENEWAL BY ANDERSEN OF BOSTON Emily A Walter Dragon RENEWAL Legal Name:Renewal by Andersen LLC 142 Deerfield Dr. RENANEWALSEN HIC#170810 Florence,MA 01062 DER� 30 Forbes Road I Northborough,MA 01532 H:(413)584-8841 Phone:(508)351-2200 I Fax:(508)986-7072 I rbaboston@gmail.com ID#: ROOM: SIZE: DETAILS: PRICE: 104 The Den Window, Double-Hung (DG), 1:1, Sliope Sill, Insert Frame, Traditional Checkrail, Exterior Whit , Interior White, Performance Calculator, PG Ratin : 40 I DP Rating: + 40 / - 40, Glass, All Sash: High Performance SmartSun Glass, No Pattern, Hardware, White, Screen, Fiberglass, Half Screen, Grille Style, No Grille, Misc, Alumi urn Wrap - Complete Unit, Aluminum wrap of exterior casing. 105 Bedroom Window, Double-Hung (DG), 1:1, S ope Sill, Insert Frame, Traditional Checkrail, Exterior White, Interior White, Performance Calculator, PG Rating: 40 I DP Rating: + 40 / - 40, Glass, All Sash: High Performance SmartSun Glass, No Pattern, Hardware, White, Screen, Fiberglass, Half Screen, Grille Style, No Grille, MIsc, Aluminum Wrap - Complete Unit, Aluminum wrap of exterior casing. 106 Bedroom Window, Double-Hung (DG), 1:1, S ope Sill, Insert Frame, Traditional Checkrail, Exterior Whi e, Interior White, Performance Calculator, PG Ratin : 40 I DP Rating: + 40 / - 40. Glass, All Sash: High Performance SmartSun Glass, No Pattern, Hardware, White, Screen,Fiberglass, Half Screen, Grille Style, No Grille, Misc, Alum num Wrap - Complete Unit, Aluminum wrap of exterior casing. WINDOWS: 6 PATIO DOORS: 0 SPECIALTY: 0 MISC: 0 TOTAL $15,346 -v =='ems" - Renewal by Andersen is committed to our customers's' ety by oFRFt. complying with the rules and lead-safe work practices Gcpecified by the EPA. 03/24/22 Page 4/ 31 :r If Using a Builder DBA:RENEWAL BY ANDERSEN OF BOSTON Emily 8 Walter Dragon Legal Name:Renewal by Andersen LLC 142 Deerfield Dr. RENEWAL RE NDERSEN HIC#170810 Florence,MA 01062 byAER 30 Forbes Road I Northborough,MA 01532 H:(413)584-8841 Phone:(508)351-2200 I Fax:(508)986-7072 I rbaboston@gmail.com Property Owner Must Complete & Sign This Section If Using A Builder I, as Owner of the said property, hereby authorize Renewal by Andersen LLC to act on my behalf, in all matters relative to building permit application for the property/address indicated on this agreement. ql7ER,?-- -- a'AP SIGNATURE OF SALES PERSON SIGNATURE SIGNATURE Wayne Gremo Emily Dragon Walter Dragon PRINT NAME OF SALES PERSON PRINT NAME PRINT NAME 03/24/22 Page 17/31 Page 1 of 1 C DATE(MM/DD/YYYY) A C CERTIFICATE OF LIABILITY INSURANCE 09/29/2021 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 Willis Towers Watson Certificate Center NAME: Willis Towers Watson Midwest, Inc. PHONE 1-877-945-7378 FAX 1-888-467-2378 c/o 26 Century Blvd IA/C.No.Ern: (A/C,No): P.O. Box 305191 ADDRESS: certificates@willis.com Nashville, TN 372305191 USA INSURER(8)AFFORDINGCOVERAGE NAIL# INSURERA: Old Republic Insurance Company 24147 INSURED INSURERS: Renewal by Andersen LLC --- --- 30 C Forbes Road INSURER C: Northborouah, MA 01532 INSURERD: INSURER S: INSURER F: COVERAGES CERTIFICATE NUMBER:w22288053 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 C AIMS. INSR TYPE OF INSURANCE ADDL SUER POLICY EFF POD U �) VAS LTR INSD WVD POLICY NUMBER (MM/DD/YYYY) X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 2,000,000 AMAGE TO RENTED CLAIMS-MADE + X i OCCUR PREMISES Ea occurrence) $ 500,000 A MED EXP(Any one person) $ 10,000 MWZY 314161 21 10/01/2021 10/01/2022 PERSONAL SADVINJURY $ 2,000,000 GEN'L AGGREGATE UNIT APPUES PER: GENERAL AGGREGATE $ 4,000,000 X POLICY JECT LOC PRODUCTS-COMP/OP AGG $ 4,000,000 OTHER: $ AUTOMOBILE UABILITY COMBINED SINGLE LIMIT $ 5,000,000 (Ea accident) X ANY AUTO BODILY INJURY(Per person) $ A OWNED SCHEDULED MWTB 314159 21 10/01/2021 10/01/2022 BODILY INJURY(Per accident) $ AUTOS ONL Y AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY (Per accident) _ $ UMBRELLA LIAB _ OCCUR EACH OCCURRENCE $ _ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION X PER OTH- AND EMPLOYERS'LIABILITY STAME ER IN A ANYPROPRIETOR/PARTNER/EXECUTIVE rY--� E.L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? I I NIA MWC 314158 21 10/01/2021 10/0i/2022 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under 1,000,000 DESUHIP PION 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) I 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 C' Evidence of Insurance l W.1- yvlr ©1988-2016 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD SR ID: 21636556 BATCH: 2252220 can.eruat.rt otlprn>rtaa 1 i=2:41.111Miliseilmals ' tt retu d•Moldings of Roy use group which ow�tit't OWN Of Ida* 1 kw,Mart 38,000 cubic foot psi cur*rusting of ondlsard ap•Ca s 18A110125 r • 93141411: . Wit. ' , , r1 h4h LIMN mil y Faunmat to poison I cornet tl01Nt of the frlossaolruM9b t t/ n�//c�. � stab euldkri Codo Its moo ets brood on of this Noonan. �v at o eaa ttp lame**about Mr o0..n i COIT!T•#de1 Of AOAONafJg ns gllM ii , .,, ».a,. 104.00..........—•.••••.. 000...0.00000000* THE COMMONWEALTH OF MASSACHUSETTS Office of Consumer Affairs and Business Regulation 1000 Washington Street-Suite 710 Boston,Massachusetts 02118 Home Improvement Contractor Registration ,� Y Type'. Supplement Card Registration: 170810 RENEWAL BY ANDERSEN LLD Upiration: 12/22/2023 30 FORBES RD NORTHBOROUGH,MA 01532 4 5 /dlM� Update Address end Return Card. THE COMMONWEALTH OF MASSACHUSETTS Registration valid for Mdividual use only before the Office of Consumer Affairs 8 Business Regulation Re espheron date.If found return to: HOME IMPROVEMENT CONTRACTOR Office of Consumer Affairs and Business Regulation TYPE:Supplement Card 1000 Washington Street-Suite 710 Ear{� Boston,MA 02118 iR 7Q 0810� 12/22/2023 RENEWAL BY ANDERSEN L!C JAIME MORIN 30 FORBES RD , idoMe 4.44' �l- .. NORTHBOROUGH,MA 0l5SZ� IId Utl iocrotaty Not v lid without sig Benue G 1 BD nit n .iwe.rN�! arww r. _r r 1 J _ g J 1 asp — - • • cc - tA►_ • e• .';I '1.'ice 5. by` .:: . wmarvnytw • qwl pmth. Bma ESun - Draw rwomulyta Wpm U-Fa or 9War Hest Gin Caaliklart (u.6h P1 t 2astiran ADDITTONA1..}!atf067i1ANCE W . VIsible.Trw mltt*rne • • aana.d wing or reis.04. • • 1 � t si, comm.. �'+;a fie. . 100-0071206 31E gc-.•— .[C.ANA.1 Pia-A,.low '$r aeplgw 41111.l.iw4eei.INllw . D o u b l e H u n g ..• C' . 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