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11C-032 (6) BP-2022-0693 9 STOWELL ST COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 1 1 C-032-001 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-2022-0693 PERMISSION IS HEREBY GRANTED TO: Project# DOOR Contractor: License: SAMBRICO LLC DBA VISTA HOME Est. Cost: 8561 IMPROVEMENT 111478 Const.Class: Exp.Date:01/21/2023 ELLIOTT DOROTHY L& PAULA L ELLIOTT& Use Group: Owner: TERRI L BUCKLEY Lot Size (sq.ft.) SAMBRICO LLC DBA VISTA HOME Zoning: URA Applicant: IMPROVEMENT Applicant Address Phone: Insurance: 2097 RIVERDALE ST 413-382-0249 UB-2E072183-22 W SPRINGFIELD, MA 01089 ISSUED ON:06/13/2022 TO PERFORM THE FOLLOWING WORK: ENTRY DOOR POST THIS CARD SO IT IS VISIBLE FROM THE STREET Inspector of Plumbing Inspector of Wiring D.P.VV. 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: 590.457 • • >9 • Fees Paid: $40.00 212 Main Street, Phone(413) 587-1240,Fax:(413)587-1272 Office of the Building Commissioner r i pip The Commonwealth of Massachuse s �c�/ c� Board of Building Regulations and Sta dard ��� FOR Massachusetts State Building Code, 7 C " ��`!�"IC LITY z' JU US Building Permit Application To Construct, Repair, enov:to Or DemoI slp Re ised i ar 2011 One-or Two-Family Dwelli� n,_a This Section For Official Use Onl )/i Non,M„A Building Permit Number: P7'� -,32,. 3 Date Applied: °N•041q pr oMs ,�i. v,,..) IZs / *-2 L-►3-ZO zz Building Official(Print Name) Signature Date SECTION 1: SITE INFORMATION 1.1 Property Address: ��"(�T' 1.2 Assessors Map& Parcel Numbers ciSkoka � 1.1a Is this anaa`cccepJted street?yes �lno Map Number Parcel'Ju"mber 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 yes❑ Municipal 0 On site disposal system 0 SECTION 2: PROPERTY OWNERSHIP' 2 Owner'of e�rd: '1 C. \-SQ-d A O v) 3 Name(Print) City.State,ZIP 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) ❑ Alteration(s) 0 Addition 0 Demolition 0 Accessory Bldg. 0 Number of Units Other I�pecify: Q1 )\Cite,,, `c Brief Description of Proposed Work': _, \ GUf(Q,k/r 9'11 k Cis )c-\,u,(.t 1 c Q�'\a 1\,t - Q ckx)r- ) 1,-) c�-N,-.3 C k\cir . SECTION 4: CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1. Building $ $'aQ\ . Goo 1. Building Permit Fee: $ Indicate how fee is determined: 2. Electrical $ ` 0 Standard City/Town Application Fee 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: $ Q Check Noo((I j Check Amount: 9 O Cash Amount: 6. Total Project Cost: $Ca c u.\. Gil 0 Paid in Full 0 Outstanding Balance Due: i SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Su ervisor License(CSL)) `��-1 /ILL ' bc1 Qr\ License Number Expiration Date Name of CSL Holder \T ^ _\r List CSL Type(see below) U and Street 1•, ` Type Description c- 1; ``„\. !`^''s C`bT U Unrestricted(Buildings up to 35,000 Cu.ft.) �( �'( l \ / 1 �.J R Restricted 1&2 Family Dwelling City/Town,Sit,ZIP M _ Masonr y RC Roofing Covering WS Window and Siding �✓� �y( SF Solid Fuel Burning Appliances �V `tC tl41 4i _(S O(vAll"LpCOVO PARAA I Insulation Telephone Email address .(04 D Demolition 5. egistered Home Improvement Contractor(HIC) I Q005S /a a3 a(�b1 n► HIC Registration Number Expiration Date HIC Company Name orJEC Registrant Name _ No.and Street Email address W MI Ololj Ut13,3 P-Lisa o coy\ 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 to provide this affidavit will result in the denial of the Issuancce of the building permit. Signed Affidavit Attached? Yes ID/ 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 ,SCAM\nC t Ca L .x to act on my behalf,in all matters relative to work authorized by this building permit application. ¶-PQ/ Cy CIA 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' this application is true and accurate to the best of my knowledge and understanding. a CO\00..\, - U1 0 C)-1 Print Owner's or Authorized Agent's Name(Electronic Signature) 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 co.SH. T,. 1S S! ` Massachusetts �''' e'cr i F. `Si DEPARTMENT OF BUILDING INSPECTIONS :j,', r y 212 Main Street • Municipal Building yvy �'+' + Northampton, MA 01060 s$ - ' 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: Roc() chu on -)", Ga A- 0 t685\ The debris will be transported by: Name of Hauler: \I , cl` \-\1A\A-Z_ .r\M) (VQ ,Q, / V Signature of Applicant: 100 )./L Date: (01G I &. . The Commonwealth of Massachusetts I* ---al Department of industrial Accidents • _:� i Congress Street,Suite 100 —'� �'e, Boston, MA 02114-2017 _,, www mass.gov/dia -- 'v VIkers' ('umpensation Insurance Affidavit: Builders/('ontractors/Ekctricians/Plumbers. 1't)BE FILED V.ti ll THE PER%IITTING Al'IIH)RITI'Y. Applicant Information Please Print Legibly Name(Business Organization Individual): OW \E")` I, (b U.,(..... Adds :6X)C.—) \JeGV G & S 1. City/StatelZip: • 59 /td MA 6V)Si Phone #: 3 - --1,4 - LASS Are ytta ars employer?Check the appropriate bin: Type of project(required): LEI I am a employer with employees(fill(and or part-time(-' 7. 0 New construction 20 i am a sok proprietor or partnership and have nu employees working for me in 8. Q Remodeling any capacity.(Ivo workers'comp.insurance requued:I 30 I am a homeowner doing all work myself_(No workers'comp.msra urre required.(' 9. ❑Demolition 4.0 I am a homeowner and will be hiring contractors to conduct all work on my property. I will 10 Q Building addition ensure that all contra tors either have workers'compensation insurance or are sole 110 Electrical repairs or additions etors with nu employees. 12.0 Plumbing repairs or additions 5 l am a general contractor and I have hired the subcontractors listed on the attached sheet. I ❑R f ails These sub-contractor have employees and have workers'comp.insurance. 6.0 We are a corporation and its officers have exercised their right of exempuun per MGL c. 14. et � 152.$1(4).and we have no employees_[No workers'comp.insurance required_] -NDQ I •Any applicant that checks box al must also fill out the section below slowing then workers'compensation policy information. *Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating suck :Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or nut those entities have employees. If the sub-contractors lime employees.they must protirdc than workers'comp.policy number. I am an employer that is providing workers'compensation insurance for m)•employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self ins. Liic.#: Expiration Date: Job Site ( Address: "` J'C��)Q,.�. S� City/State/Zip: sA,,S W 0 I Qs--3 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 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 S250.00 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 cer y under the pains and aides of perjury that the in formation provided abope is true and correct Signature: Q [)ate. L�, 0. ' d-a__ Phone Pt: \-� " )1 a,''L'l c--a-'o , Official ow twill-. Do not write In lla area,to be completed by city or town official • ( itv or I own: Permit/License# I..uinig.authority(circle one): I. Board of Health 2. Building Department 3.City/Town Clerk 4.Electrical Inspector 5. Plumbing Inspector fi. Other ( ontact Person: Phone#: 2097 Riverdale Street MA License # 162058 West Springfield, MA 01089 CT License# 0621848 •_1 Phone: 888.597.2323OW Vista Fax: 413.382.0241 HOME IMPROVEMENT ti, .y vistahomeimprovement.com ENTRY DOOR CONTRACT Customer Information Terri Buckley (413)336-2447 Date: 05/05/2022 Paula Elliott (413)230-6064 Rep: David Lauzon 9 Stowell St yellowturtle21@gmail.com Leeds MA 01053 buggles1960@outlook.com 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 02116 Phone: 617.973.8700 ProVia Entry Doors Heritage Single Entry Door in FrameSaver Frame n ijP -36"x 80"Nominal Size Quantity aft � -Unit Size:37 4 9/ x 81 11/16" -Frame Depth:4 9/16" -2"Standard Brickmold A� -Left Hand Inswing-Inside Looking Out -2 Panel 439 Style Heritage Woodgrain Textured Fiberglass Door IsII -Esmond Decorative Glass with Patina Laming(ESM) -Light Oak Inside and Outside 8624159 iiiil -Aardwdre -All Hardware in Lifetime Bright Brass Finish mmio -Georgian Lockset -Thumbturn Deadbolt •. -Frame -Textured Oak Aluminum Frame Cladding-In Separate Box -Light 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 Door Fees Lead Fee 1 1 Time Disposal Fee 1 Additional Details • This space intentionally left 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 07/05/2022 Barring delay caused by circumstances beyond Contractors control, the work will be completed by 08/05/2022 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) $8,561 .00 Payment Deposit $1 00.00 Amount Financed $8,461.00 Form of Payment Upon Signing Check Check# 212 Check Date 05/05/2022 Acceptance of Proposal I have read both sides of this document and accept the prices, specifications and conditions stated. 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. f U Terri Buckley Paula Elliott 05/05/2022 05/05/2022 Date Date zp,141 David Lauzon Authorized Representative 05/05/2022 Date This space intentionally left blank OEM= L''‘' N.illtitonweatth ot Massachusetts Ditsictil of Professional Licensure 134>arct of Building Regulations and Standards Co nstr4letfilOhtStprvisor .4. 41.. . 4 • we .... rtxpires : 01 /21 /2023 4 BRIAN RUOCrop , la ..... 7 5 CO YO TE-011n LE -4 14 'A-144k 4 , t .......- _.,,,:. FEEDING H ---A,4 MA . Alf C4its,s1 ‘,10 ‘‘ Pt f &,.. Lb* ..a rintegiSiOne r . )., (--/:(, ., ,....) a ,.... , ..,,, J 1 . .., -,247 Office of Consumer Affairs and Business Regulation 1000 Washington Street - Suite 710 Boston, Massachusetts 02118 Home Improvement Contractor Registration Type. LLC SAMBRICO LLC Registration: 162058 Expiration. 01/02/2023 D/B/A VISTA HOME IMPROVEMENT 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 ,',;,e6 i WEST SPRINGFIELD,MA 01089 Undersecretary Not valid without signature IMMD DATE / OIYYYY) CERTIFICATE OF LIABILITY INSURANCE Tllii&GE-RTIFICATE 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# INSURED INSURER A. TRAYEI FRS PROPERTY CASt_.HLTY COMPANY OF AMERR- SAMBRICO LLC DBA VISTA HOME IMPROVEMENT INSURER B: INSURER C: INSURER D: 2097 RIVERDALE STREET 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 ADDL$UBR POLICY EFF POLICY EXP LTR TYPE OF INSR WVD POLICY NUMBER IMMIDDIYYYY) (MMIDDIYYYY) LIMITS COMMEPCI L GENERINSURANCE AL LIAB LITY EACH OCCURRENCE S CLAIMS MADE n OCCUR DAMAGE TO RENTED $ PREMISES(Ea occurrence) MED EXP(Any one person). $ PERSONAL 8 ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER. GENERAL AGGPEGATEPROJECT ELOC $ E POJc, PRODUCTS-CLOMP/OP AGG $ AUTOMOBILE LIABILITY COMB NED SINGLE S ANY AUTO LIMIT(Ea accident) BODILY INJURY S OWNED SCHEDULE AUTOS (Per person) AUTOS ONLY HIRED ^ NON-OWNED BODILY INJURY AUTOS ONLY rPer accident) AUTOS ONLY ^� PFOPEPTr DAMAGE $ I Per accident, $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE S DEL) uRETENTION $ WORKER'S COMPENSATION AND PEP OTHER EMPLOYER'S LIABILITY STATUTE UB-2E072183-22 33/12'2022 03,'12/2023 ANY PROPERITORIPARTNERJEXECUTIVE YINE L EACH ACCIDENT $ 500.000 OFFICER/MEMBER EXCLUDED? Li (Mandatory in NH) N/A E L DISEASE-EA EMPLOYEE 500.000 If yes describe under DESCRIPTION OF OPERATIONS below E L DISEASE-POLICY LIMIT $ 1 000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) THIS REPLACES ANY PRIOR CERTIFICATE ISSUED TO THE CERTIFICATE HOLDER AFFECTING WORKERS COMP COVERAGE. THE INSURED'S MA WORKERS COMPENSATION POLICY AND ITS LIMITED OTHER STATES ENDORSEMENT AUTHORIZES THE PAYMENT OF BENEFITS FOR CLAIMS MADE BY THE INSUREDS MA EMPLOYEES IN STATES OTHER THAN MA NO AUTHORIZATION IS GIVEN TO PAY CLAIMS FOR BENEFITS IN STATES OTHER THAN MA IF THE INSURED HIRES.OR HAS HIRED EMPLOYEES OUTSIDE OF MA. THIS POLICY DOES NOT PROVIDE COVERAGE FOR ANY STATE OTHER THAN MA. CERTIFICATE HOLDER CANCELLATION VISTA HOME IMPROVEMENT SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED 2097 Riverdale St BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE l � West Springfield MA 01089-1025 C�'ff ACORD 25(2016/03)(Rev.09-18) The ACORD name and logo are registered marks of ACORD 1988- 15 A D PORATION reserved. A`ORD CERTIFICATE OF LIABILITY INSURANCE DATE 4/11/2022 Y) 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 PHONE 413-7324137 FAX 413-7316629 662 Riverdale Street (A/C.No.Esti' (A/C.No): West Springfield,MA 01089 ADDRess: dj©neillandneill.com INSURER(S)AFFORDING COVERAGE NAIC# _ INSURER A: Western World Insurance Co. _ 13196 INSURED Vladimir Duducal INSURER a: Chubb chu V&D Home Improvement INSURER C 776 North West Street Feeding Hills,MA 01030 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 ADDL SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE DASD yyvD POLICY NUMBER IMMIDD/YYYY) (MM/DD/YYYY) UMITS A J COMMERCIAL GENERAL UABILITY NPP8747203 10/10/2021 10/10/2022 EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE OCCUR DAMAGE TO RENTED 100,000 PREMISES(Ea occurrence) $ MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY S 1,000,000 GEN'L AGGREGATE UMIT APPUES PER: GENERAL AGGREGATE $ 2,000,000 POUCY JECOT- LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE OMIT $ (Ea acadent) ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per acadent) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY _ AUTOS ONLY (Per accident) UMBRELLA LIAB _ OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ B WORKERS COMPENSATION 6S62UB-1K95803 04/11/2022 04/11/2023 ,n PER oTH- AND EMPLOYERS'LIABILITY Y I STATUTE ER Y/N ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? 1-1 E.L./A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) cassied@vistahomeimprovement.com CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN VISTA HOME IMPROVEMENT ACCORDANCE WITH THE POLICY PROVISIONS. 1346 ELM STREET WEST SPRINGFIELD, MA 01089 AUTHORIZED REPRESENTATIVE ba4.0j R ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD