36-180 (8) BP-2022-0578
103 DUNPHY DR COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
36-180-001 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-2022-0578 PERMISSION IS HEREBY GRANTED TO:
Project# WINDOWS Contractor: License:
Est. Cost: 6978 116396
Const.Class: Exp.Date:05/20/2025
Use Group: Owner: MAHESH PATEL SONIYA M&
Lot Size (sq.ft.)
Zoning: WSP Applicant: WINDOW NATION LLC
Applicant Address Eh ne: Insurance:
575 UNIVERSITY AVE (866)217-9582 WC9064617
NORWOOD, MA
ISSUED ON:05/23/2022
TO PERFORM THE FOLLOWING WORK:
2 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/Chimne':
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:
' , ' •
.; . v . ,2
Fees Paid: $40.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Office of the Building Commissioner
The Commonwealth of Massachusetts
Board of Building Regulations and Standards FOR
.0): Massachusetts State Building Code,780 CMR MUNICIPALITY
USE
Building Permit Application To Construct,Repair,Renovate Or Demolish a Revised Mar 2011
One-or Two-Family Dwelling I J
This Section For Official Use Only
Building Permit Number: (,P- P.'x"b?1 Date Applied: V
_____k_viA) 0 •
Building Official(Print Name) Signature Date --
SECTION 1:SITE INFORMATION ,
1.1 Property Ad s3� ipvvl no fix r 1.2 Assessors Map&Parcel Numbers
ibi1.1a Is this an accepted street?yes�'/ 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❑ Private❑ Zone: _ Outside Flood Zone? Municipal❑ On site disposal system ❑
Check if yes❑
SECTION 2: PROPERTY OWNERSHIP'
2.1 wne o ior�l: 7L r if/Ge-ZdV m9" �1- Z'
Name/A P ✓P/7/ bIt r(Print) City,0t te,ZIP 4 -0 /
No.and Street / Telephone Email Address
SECTION 3:DESCRIPTION OF PROPOSED WORK(check that apply)
New Construction❑ Existing Building❑ Owner-Occupied ❑ Repairs(s) Alteration(s) ❑ Addition 0
Demolition 0 Accessory Bldg.0 Numb of Unit Other ❑ Spec'
Brief Description of Proposed Work': , �--�}!— //�:F� C
LC),�11�, " A ./�l�' �J2.44 Z r
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(La and Materials)
1.Building $ >9'4.0 I. Building Permit Fee:$ Indicate how fee is determined:
0 Standard City/Town Application Fee
2.Electrical $ ❑Total Project Cost;(Item 6)x multiplier x
3.Plumbing $ 2. Other Fees: $
4.Mechanical (HVAC) $ List:
5.Mechanical (Fire $ j
Suppression) Total All Fees:$1 i_.f
Check No. Check Amount: —/V Cash Amount:
6.Total Project Cost: $ ). 7 jJ 0 Paid in Full 0 Outstanding Balance Due:
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL) ) /I /1� 4r�
&Hold2 � /f lLLiic%nse Number Expiration Date
Name of /'` AfE [J/ 2_ XI)/)f��/ � List CSL Type(see below)
No. d Street T� Description
i3c0,2z07‘2 )
� m�d 4Pf Unrestricted(Buildings up to 35,000 cu.ft.)
siy)Ctty/Town,State,ZIP / M MasonryRestricte 1&2 Family Dwelling
RC Roofing Covering
WS Window and Siding
40id —279�� — ST TnF su ation id Fuel Burning
Appliances
Telephone Email address D Demolition
5.2,,R--eg�ister Home I ove e t Contras r ) j%7q ,,�/2 D7� /
�,d'p p, MC Registration Number Expiration "�s
Hpsl//Mje) �
City/N D2-a ,( '11 21 Email address
State,�TP ' Telephone
SECTION 6:WORKERS'COMPENSATION INSURANCE AI I+WAVIT(M.G.L.c.152.§ 25C(6))
Workers Compensation insurance affidavit must be c mpleted and submitted with this application. Failure to provide
this affidavit will result in the denial of the Iss of the building permit.
Signed Affidavit Attached? Yes No .❑
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 ng app`Gdion� t
to act on my behalf,in all matters relative to work authorized by this permitbuildi .
/1?,9,ih 47-/- i-- (. ,,,p),.ey--
-----/p-2,22_
Print Owner's Name(Electronic Signature) Date
SECTION 7b:OWNER'OR AUTHORIZED AGENT DECLARATION
By entering my name below,T hereby attest under the pains and penalties of perjury that all of the information
contained in this application is true and accurat to the best o y know e and understanding.
h-4 ,71)_,_p
Print Owner's or Au ' N onic Signatur 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(IBC)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
�' ' Massachusetts �wt'r �- ''<<G
wi
r t )f DEPARTMENT OF BUILDING INSPECTIONS D�. �"
" 212 Main Street • Municipal Building yve k ��
Northampton, MA 01060 �'^�j 0
...,...)
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.
The debris will be disposed of in:
Location of Facility: A(/) /
211
The debris will be transported by:
Name of Hauler: 6.--img,../ ----xiir,,--,,,,,z
Signature of Applican : Date: ,. /Z1.--.2.10 _ _
1070 North Farms RoadVSAPV Date of Agreement:
Wallingford,CT 06492 April20,2022
W I N DOW NATION Sales: 866-446-2846
License#: 197968 WINDOWS • SIDING • DOORS Service: 866-217-9582
PRODUCT SPECIFICATIONS
Buyer's Information and Buyer Contact Information: Buyer Email Information:
Description of Property: (413)306-8439 Landline soniyapate11414@gmail.com
Soniya Patel (413)306-8437 Primary Mobile
Mahesh Patel
103 Dunphy Dr
Florence,MA 01062
Buyer(s) listed above hereby jointly and severally agrees to purchase the goods and/or services
listed on the accompanying specification sheets, in accordance with the prices and terms
described in the Custom Remodeling and Improvement and the Product Specifications
(collectively,this"Agreement").
Windows-Belle Vue inclusions:Beveled exterior frame with drip-cap,Fusion welded frame and sashes,Limit lock
on double hung windows, Multi-Layer weatherstripping , Defense-Tek Cam-action lock, Special formula uPVC,
Constant force balance system on double hung window,Integral lift rail, Super Spacer,CoreFX reinforced meeting
rail, Forecaster sloped sill, Gatekeeper sash-to-sill interlock, exterior custom capping, installation by factory
certified crew,clean up and haul away of all job related debris.
DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES.
It is agreed and understood by and between parties that the Product Specifications, along with the
Custom Remodeling and Improvement Agreement,constitutes the entire understanding between
the parties,and replaces any and all prior negotiations,representations,or agreements,either
written or oral. The Product Specifications may not be changed,modified,or varied in any way
(with exception that installation materials may be substituted with similar products when
inventory shortages exist)unless such changes are in writing and signed by both Buyer(s)and
Window Nation, LLC. Buyer(s)hereby acknowledge that Buyer(s)has read the Product
Specifications.
I have read and received each page of this 2 page Product Specification.
Window Nation Buyer(s)
7/1 � 1.
it
Signature of Exterior Design Consultant Signature
Paul Cangialosi-License#On File
YOU,THE BUYER(S),MAY CANCEL THIS TRANSACTION AT ANY TIME PRIOR TO MIDNIGHT OF THE THIRD BUSINESS DAY
AFTER THE DATE OF THIS TRANSACTION. SEE THE ATTACHED NOTICE OF CANCELLATION FORM FOR AN EXPLANATION
OF THIS RIGHT.
April 20,2022 www.windownation.com Page 1 of 2
•
1070 North Farms Road VW
Date of Agreement:
Wallingford,CT 06492 April 20,2022
WI N DOW NATION Sales: 866-446-2846
License#: 197968 WINDOWS • SIDING • DOORS Service: 866-217-9582
PRODUCT SPECIFICATIONS
Buyer's Information and Buyer Contact Information: Buyer Email Information:
Description of Property: (413)306-8439 Landline soniyapate11414@gmail.com
Soniya Patel (413) 306-8437 Primary Mobile
Mahesh Patel
103 Dunphy Dr
Florence,MA 01062
Work Order Details:
Model:Belle Vue W:108"H:46" Location:Level 2,Living Room "
1 Quantity:2
• Style:3 Part Slider • Configuration:1/4-1/2-1/4
• Grids:None • Screen:Full •
• Glass:Extreme 2 Pane/Low-E&Argon • Color:Interior White/Exterior White
Additional Items
6-EPA Lead Containment Install-Window(Per Opening)
Special instructions:
Told to remove blinds
Installation Details:
Window Removal Type:Wood Additional products needed in the future:No
Exterior Trim:G8
Exterior Trim Color:White Customer agrees to allow Window Nation to post a yard
Sealant:OSI Quad Max sign until 30 days after install:Yes
Insulation Around Window:OSI Quad Foam Year house was built: 1976
Clean Up and Haul Away:Yes EPA Lead Containment Required:Yes
EPA Lead Testing Required:Yes
HOA Approval Required:No
•
April 20,2022 www.windownation.com Page 2 of 2
1070 North Farms RoadV%i‘f Date of Agreement:
Wallingford,CT 06492 April 20,2022
WINDOW NATION Sales: 866-446-2846
License#: 197968 WINDOWS • SIDING • DOORS Service: 866-217-9582
CUSTOM REMODELING AND IMPROVEMENT AGREEMENT
Buyer's Information and Buyer Contact Information: Buyer Email Information:
Description of Property: (413)306-8439 Landline soniyapate11414@gmail.com
Soniya Patel (413)306-8437 Primary Mobile
Mahesh Patel
103 Dunphy Dr
Florence, MA 01062
All home improvement contractors and subcontractors shall be registered. Inquiries about a
registered home improvement contractor should be directed to the Office of Consumer Affairs and
Business Regulation Home Improvement Contractor Program, 1000 Washington Street, Suite 710,
Boston, MA, 02118, 617-973-8787
Buyer(s)listed above hereby jointly and severally agrees to purchase the goods and/or services of Window Nation,LLC.
("Contractor")in accordance with the prices and terms described in this 6 page document and the Product Specifications,which
are incorporated as part of the Agreement(collectively,this"Agreement"). This Agreement represents a cash sale of goods and
services. Buyer(s)agrees to pay the cost of the goods and services purchased as described herein,regardless of timing or
approval of any financing Buyer(s)may seek for their purchase.
Sale Total $6,729.00
Setup&Disposal Fee $249.00 Estimate Project Start:14-16 weeks
Permit Fee $0.00
Total Sale Price $6,978.00 Estimate Project Finish:1 to 3 days after start
Sales Tax(0%) $0.00
Total Amount Due $6,978.00 Buyer(s)acknowledge that definite start and completion
Down payment-Charge $2,220.00 dates are NOT of the essence. Delays beyond Contractor's
Balance Due $4,758.00 control not included in calculating timeframes. See
COD(Payable at time of install) $4,758.00 Section 5 of the Terms and Conditions.
Amount Financed $0.00
This Agreement constitutes the entire agreement and understanding between the parties,and this Agreement replaces any and all
prior negotiations,representations,or agreements,either written or oral. No amendment,modification or waiver of this
Agreement shall be valid or effective unless in writing and signed by both parties. Buyer(s)hereby acknowledge that Buyer(s)
1)has read the entire Agreement and has received a completed,signed,and dated copy of this Agreement,including the two
accompanying Notice of Cancellation forms,on the date fast written above and 2)was orally informed of his/her right to cancel
this transaction.
Buyer(s)also agrees and understands that if Buyer(s)finance the work with a third-party,the terms of that financing will be
contained on separate documents,including any finance charge.
Price includes all discounts and promotions.
I have read and received each page of this 5 page Agreement.
Window Nation Buyer(s)
771/ i4/1
Signature of Exterior Design Consultant Signature
Paul Cangialosi-License#On File
YOU,THE BUYER(S),MAY CANCEL THIS TRANSACTION AT ANY TIME PRIOR TO MIDNIGHT OF THE THIRD BUSINESS DAY
AFTER THE DATE OF THIS TRANSACTION. SEE THE ATTACHED NOTICE OF CANCELLATION FORM FOR AN EXPLANATION
OF THIS RIGHT.
April 20,2022 www.windownation.com Page 1 of 5
•
1070 North Farms Road Vrt
Date of Agreement:
Wallingford,CT 06492 April 20,2022
WI N DOW NATION Sales: 866-446-2846
License#: 197968 WINDOWS • SIDING - DOORS Service: 866-217-9582
PRODUCT SPECIFICATIONS
Buyer's Information and Buyer Contact Information: Buyer Email Information:
Description of Property: (413)306-8439 Landline soniyapatel1414@gmail.com
Soniya Patel (413)306-8437 Primary Mobile
Mahesh Patel
103 Dunphy Dr
Florence, MA 01062
Order Summary:
Belle Vue
2 3 Part Slider
Configuration: 1/4-1/2-1/4
Grids:None
Glass:Extreme 2 Pane/Low-E&Argon
Screen:Full
Color:Interior White/Exterior White
Total Order Summary of Units 2
Additional Items
6-EPA Lead Containment Install-Window(Per Opening)
Special instructions:
Told to remove blinds
Installation Details:
Window Removal Type:Wood Additional products needed in the future:No
Exterior Trim:G8
Exterior Trim Color:White Customer agrees to allow Window Nation to post a yard
Sealant:OSI Quad Max sign until 30 days after install:Yes
Insulation Around Window:OSI Quad Foam Year house was built: 1976
Clean Up and Haul Away:Yes EPA Lead Containment Required:Yes
EPA Lead Testing Required:Yes
HOA Approval Required:No
April 20,2022 www.windownation.com Page 1 of 1
The Commonwealth of Massachusetts
`—" -, I Department of Industrial Accidents
E?�� 1 Congress Street, Suite 100
�'1� ? Boston, MA 02114-2017
www.mass.gov/dia
Workers' Compensation Insurannce Affidavit:Builders/Contractors/Electricians/Plumbers.
TO BE PILED WITH THE PERMITTING AUTHORITY.
Applicant Information / / Please Print Legibly
• Name(Business/Organization/Individual): //(�///U/� �. /'r� //0/V /t
-----7"-,---
^ i i'�-
�ddress: .,�� (.)/G/� ✓5 //4/ `/ /I-—
City/State/Zip: t/,�� G !��t r/I%/T /� tG�-Piione#: ` 1 /—5 3 — / 2A
. r� •
Are you an employer?Check the appropriate box: Type of project(required):
AIL am a employer with U employees(full and/or pan-time). 7. 0 New conSl action
,'2..' v0 I mn a sole proprietor or partnership and have no employees working forme in 8. Ei Remodeling •
.• any capacity.(No workers'comp.insurance required.]
3.0 I am a homeowner doing all work myself.[No workers'comp.insurance required.)r
9. El Demolition
4.0 I ant a homeowner and will be hiring contractots to conduct all work on my property. 1 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.Q Plumbing repairs or additions
s.❑I am a general contractor end I have hired the sub-contractors listed on the attached sheer.
13.0
f repairs
These sub-contractors have employees and have workers'comp.insurance.{
6.0Itnr
We are a corporation and its officers have exercised their right of exemption per MOL c. 14.
Other' I�f/�0"!//I�Y�
152,1i1(4),and we have no employees.[No workers'coma.insurance required.)
"Any applicant that checks box gl must also till out the section below showing their workers'compensation policy infonnatioe.
,Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have
_-.01,1ployees. If the sub-contractors have employees,they must provide their workers'comp.policy number.
t,.
I am an employer that is providing workers'compensation insure for my employees. Below is the policy and job site
information. 5 e / C,/i 7/t p`r ,%]l .e. 1�
Insurance Company Name: f .___LA) , cG' J l /' —_
Policy-It or Self-ins.Lic.#: l'/1� q����%) f Expiration Date: =�,r G'c 2
n�
Job Site Address: /® 2) 11107,4y _Piz r City/State/Zip: CLIZI-A/L `-'-� � -/1/ /
Attach a copy of the workers'compensation policy laration page(showing the policy number and expiration d'ate), 0 104-2-
Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by a tine up to S1,500.00
and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a
day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance
coverage verification. . .
I do herebynder th'e pit•ns and penalties of perjury t/urt the information provided above is true and correct.
Sienature.� '. _ ' Date: /4 —�2 02-Z-
Phone#:
`t':_� - j -� b —1 / .ei
Official use only. Do not write in this area,to be completed by city or town official.
City or Town: Permit/License#
Issuing Authority(circle one):
1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
6. Other
Contact Person: Phone#: d
THE COMMONWEALTH OF MASSACHUSETTS
Office of Consumer Affairs and Business Regulation
1000 Washingtaq Street-Suite 710
Boston,Massachusetts 02118
Home Im royement sr. tractorRegistration
•./'
Alit
.-- '
' Type: Supplement Card
Rgistration: 197968
WINDOW NATION LLC rn z
8110 MAPLE LAWN BLVD,#335 r= E t�ifation: 02112/2024
FULTON,MD 20759
Update Address and Return Card.
THE COMMONWEALTH OF MASSACHUSETTS
Office of Consumer Affalla&Business Regulation Registration valid for individual use only before the
HOME IMPROVEMENT CONTRACTOR expiration date. If found return to:
TYPE:Supp(ernent Card Office of Consumer Affairs and Business Regulation
Registration Expiration 1000 Washington Street -Suite 710
197988 02/12/2024 Boston,MA 02118
WINDOW NATION LLC
BRANDON BOYLE
575 UNIVERSITY AVE { .cay„(/ -.y-L
NORWOOD,MA 02062
Undersecretary Not valid without signature
Division of Occupational Licensure
Board of Building., Regi Iations and Standards
ant.tj toA S rv►sor
CS-116396 - qpires:05/20/2025
142 RHODE
BRANDON LIrillill
142 ISLAND q1( -
CUMBERLA4 RI 02
igialf
'-Cl/.LVda J
Commissioner diw?t IC' 'ilitrnh&.
`,—"---`v NIND0-' �P'^: J-.?.
CERTIFICATE OF LIABILITY INSURANCE V 0$;0S;2031 1
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFI.CATE 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
I this certificate does not confer rights to the certificate holder in lieu of such andorsement(s).
PRooucER 4{0-461.1101 I CONTACT Tim Fitzpatrick
Todd Associates,Inc. 174o�IE 440-461-1101 I FAX
4-40�k!"o•0182
23825 Commerce Park;Suite A IA;c.No.BATE :tA,c.>1o1:
Beachwood,OH 44122 1 3ooRss:Irusso@toddassociateS.com
Timothy P.Fitzpatrick INSURER(S)AFFORDING COVERAGE i V.UC:
I s,I CEa,,:Selective Ins.Co.of America 125T2
INSURED I INSURERa:selective Ins.Co.of the SE 39926
Yndow Nation Holding,LLC
"mdo:v?!atop LLC TI$uRER c:
irikla'Minr{ow!!all n,lncy),
a t la .,lao a Lat•1n!align,
-.:5 I INSURER 0:
r=alten.:,ID±0T59
,INSURER=:
_COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED SELZW-A•/E SEEN ISSUED TO THE INSURED NAMED ABO1/E FOR THE POLICY FERICD
INDICATED. NOTWITHSTANDING ANY REQUIREMENT TERM DR CCa1017!CN OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO'Yi1 IC- -CIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN.THE INSURANCE AFFORDED 3Y THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL HE TERMS
EXCLUSIONS.AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
r1SRI IA0014 SUBRl i POLICY EPF • POLICYEXP '
i,�. TYPE OF INSURANCE IIAISDI?PM POLICY NUMBER ,i ,1100MM!I I I.`Min WWII LIMITS
A 1 X I COMMERCIAL GENERAL LIABILITY I i ti j c co P—VICE - 1,000.000
I 1 1 CLAIMS-MACE 1�OCCUR •• I i o 08/04/2021 08/04/2022 go=ius z?�sna ercei II a 500,000
I S_423578 j j
1 I I 1..UCD :CP.:.nv ono oer;am i 3 15,400
I I j 1 1 ?ERS0NAL3 ACV!P1.1UR'! i i 1,900.000
I+ I I I _ 2.000.000
r_;aCR =_Di1T.�`P ;_C j I I 1 .,alE:.,c7s-.,C7.1P'CP;w j 3
I
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A i AUTOMOBILE LEA-o1LITY :Calge 0 3INCLC_...0 !3 1,000,000
,a 9 0C"h I
.771 a.N V AGTC i 's213+573 t 32359973 108/04/2021 08/04/20221 SOC!_•.,•I,LR'' Per:arson, 1 3 +
AUTOS ONLY (_� AUTOS I EOCIL°aL.l:?' Per ageer;:!
I aI,Y.� I 1 NC4 Yr`_?FD ! I.?sr at_Uei t PRCPERTY �ad3c
Ii:IU,t5'S ONLY I'05'J 5 l+
1 10,000.000
A X j UMBRELLA LIAR i X I OCCUR 1 I i �;cH Oct aeEa:c=
! i EXCESS(JAB I CLAWS-MACE I 1 S2423578 I.08/04/2021!08/04/20221 AGOR_,OOATS 5 10.000.000
i
I DEO I X I RETENTIONS 01 1 I
';a
B WORKERS COMPENSATION i I X I'> ;T•_:T` I I=3•
ANDe:1PLOYERS'L!Aes.mr I ( i 2 _ _ 1,000,000
r,1i 08/04/_021 08/04/202_ 1 3
A ANY PROPRI=TORrP;e�l'PIEPJc:t_CUnVE j X ,4`IC90aJ517(dOS) I_:_=;C!i�CCtCiAtT
IOFRC RIME eERBXCLUOEO° 1 I+! 7IA) 08104/2021.08/04/2022 - 1,000.000
((Mandator/In HI =�i !'lC903JSli(NJ) , I IS2-��- S1PL�Y°o 5
! 1.000.000
t•sc ,PTIOe under i j I o OIg"c.-5'c-=CL:C:':i.LII'
�OC_SCRhTr10AlCF OPER.Ii,ONS below
-'-
1 1
I I
? i I )
DESCRIPTION OF OPERATIONS!LOCATIONS I1VEHICLES(ACORD 101.Additional Remarks Schedule,may ha attached if more space is required)
DVaiver of Subrogation is provided where required by written contract and as
permitted by law.
CERTIFICATE HOLDER CANCELLATION
BOSTB04
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
.AUTHORIIZZ-0 REPRESENTATIVE
I
ACORD 25(2016/03) 1988-2015 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORO
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