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30B-048 (2) BP- 022-1224 7 HINCKLEY ST COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 30B-048-001 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-2022-1224 PERMISSIONIS HEREBY GRANTEA TO: Project# ROOF Contractor: License: Est. Cost: 7350 THOMAS MORIN 112460 Const.Class: Exp.Date:07/23/2024 SIMMONS, LINDA A(L/E) &DALE R.RANDALL G Use Group: Owner: JR Lot Size (sq.ft.) Zoning: URB Applicant: VALLEY ROOFING AND RESTORATI IN Applicant Address Phone: Insurance: 162 PENDLETON AVE (413)230-8076 7PJUB6R27625422 CHICOPEE, MA 01020 ISSUED ON:09/27/2022 TO PERFORM THE FOLLOWING WORK: STRIP AND RE-SHINGLE 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 VIO ATION OF ANY OF ITS RULES AND REGULATIONS. Signature: , ' • )2 . Tit • Fees Paid: $40.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Office of the Buildinc Commissioner REcP ` The Commonwealth of Massachus•tts SEP Board of Building Regulations and S :ndar 2 / Dn FO Massachusetts State Building Code, :0 cue? ICIPALITY aTn U Building Permit Application To Construct,Repair,Ren R ised ar 2011 One-or Two-Family Dwelling ',T°t' q o( Ns This Sec!iiin For Official Use Only Build,inf.Permit Number: 9,,„4,1' / tZ Date Applied: get,I > Z-5S /(1.°Z 9-Z7-Zozz Building Official(Print Name) Signature Date SECTION 1: SITE INFORMATION 1.1 Property Address: 1.2 Asse Map&Parcel Numbers eit 7 Hinkley St. Florence, MA 01062 (� � 1.1 a Is this an accepted street?yes no Map Number Parcel Number 1.3 Zoning Information: ' 1.4 Property Dimensions: 1 Zoning District Proposed Use Lot Area(sq ft) Frontage(fl) 1.5 Building Setbacks(ft) Front Yard Side Yards Rear Yard Required Provided Required Provided Required Provided 1 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 0 On site disposal system Check if yes❑ SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of Record: Dale Simmons Florence MA 01062 Name(Print) City,State,ZIP 7 Hinkley St. 413-579-2380 No.and Street Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply) New Construction❑ Existing Building 0 Owner-Occupied 0 Repairs(s) 0 Alteration(s) 0 Addition,0 Demolition 0 Accessory Bldg.0 Number of Units Other Specify: Roof replacement Brief Description of Proposed Work': Remove and replace asphalt shingles, see attached estimate if further detail is needed SECTION 4:ESTIMATED CONSTRUCTION COSTS Estimated Costs: Item (Labor and Materials) Official Use Only 1.Building $ 7,350.00 1. Building Permit Fee: $ Indicate how fee is determii ed: 2.Electrical $ ❑Standard City/Town Application Fee ❑Total Project Cost (Item 6)x multiplier x 3.Plumbing $ 2. Other Fees: $ 4.Mechanical (HVAC) $ List: 5. Mechanical (Fire $ Suppression) Total All Firm 17 to 4 Check No. ky Check Amount: Cash Amount: 6.Total Project Cost: $ 7,350.00 0 Paid in Full 0 Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) CS-112460 07/23/2024 Thomas Morin License Number Expiration Date Name of CSL Holder List CSL Type(see below) U 143 Parker Lane No.and Street Type Description Ludlow, MA 01056 U Unrestricted(Buildings up to 35,000 Cu.ft.) R Restricted 1&2 Family Dwelling City/Town,State,ZIP M Masonry RC Roofing Covering WS Window and Siding SF Solid Fuel Burning Appliances 413-230-8076 valleyroofingandrestoration@gmail.com I Insulation Telephone Email address D Demolition 5.2 Registered Home Improvement Contractor(HIC) 185148 08/08/2024 Torn Morin D/B/A Valley Roofing and Restoration HIC Registration Number Expiration Date HIC Company Name or HIC Registrant Name 143 Parker Lane valleyroofingandrestorationcgmail.com No.and Street Email address Ludlow, MA 01056 413-230-8076 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 Issuance of the building permit. Signed Affidavit Attached? Yes lit' 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 Tom Morin D/B/A Valley Roofing and Restoration to act on my behalf,in all matters relative to work authorized by this building permit application. Dale Simmons 9/22/22 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 in this application is true and accurate to the best of my knowledge and understanding. Tom Morin D/B/A Valley Roofing and Restoration 9/22/22 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.) $7,350.00 (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 4.�� Y &M S`\ . ..sic (iir .>/` �' Massachusetts &? '< m: l.� _ � DEPARTMENT OF BUILDING INSPECTIONS a` \ �. �'. 212 Main Street • Municipal Building Jx. C. 'y'�- Northampton, MA 01060 ,. ,' CONSTRUCTION DEBRIS AFHI)AVIT (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: Casella Waste Systems 700 Main St. Holyoke, MA 01040 413-306-3929 The debris will be transported by: Name of Hauler: The Barnish Companies Signature of Applicant: Date: 9/22/22 `�� The Commonwealth of.11assachusetts Department of Industrial Accidents � "� ''J' 1 Congress Street,Suite 100 '{ ...:_i _ Boston, AL-f 02114-2017 - www.mass.got/dia 11 ui kern'("ompensation Insurance:Midas it:Builders/('ontractorstElrctricianu"Plumbers. '11)BE E1l.E1)%%1111 1 IIE PER\111"17% ;Al 1I10R111. Applicant Information Please Print l-reibl% Name i Business Organs atioa Individual): Tom Morin D/B/A Valley Roofing and Restoration Address: 143 Parker Lane City/State/Zip: Ludlow, MA 01056 phone#: 413-230-8076 Ant yaa ar awl"er!(beck the appropriate hut: Typruf project(required): 1.0 1 am a ctnrim,cr with empkrices(cult and or part-boa I• 7. CI Neu construction -'Q I am a sue pruprklu or par[i rship and hate nu employees rurlang for nw in 8. O Remodeling any capacity_(No rwhen'coot".uisuraoeC n.-qun1:d.I 9. ❑Demolition 10 1 am a luinlcosnet tieing all swill myself(No rdNists'cusp.arnuraatee nyurr.d.)' 4.0 i am a home tnet and v.all be hiringe don co a i ra iti nduct all roil on my property. 1 rill 1 U a Building additionu .nsurc that all evrueaton either hate rurien'compensation insurance or are sole 1 1.a Electrical repairs or additions pr .sus ts "�th nu rlptu„". 12.0 Plumbing repairs or additions 5 I am a eencral contractor and 1 list a hired the subcontractors listed on the attached sheet Thcac subcontractors lute employees and 111t1:woi►m'comp insurance. 130 Root reputes It Dace, Roof replacement 6.0 We ate a cwpeiraelon officers and its ocers has a caaeisd they mildof exemption per Mk&c. 151...114i.and re hate no etlipluyees.[No reacts'comp.insurance required.] •Any applicant that ehecks boa=1 rota/the fill.rat the section helms slims tog their%micas'compensation policy information. lionio mints s hp submit thus aftiaitriit asdkatanr they arc doing all ruri and then hire outside eontraatus mug subnut a ncr at-films it lnlicasigseek :Contractors that check this hot moo attached an additional sheet shuts any the name of the sub-contraetunarwt stale sherher or not those adibtshove anpkayecs_ If the sub-contractors hate employees.they must pros idc their % i te&eump.puhcy number. t am an employer that is providing worLers'compensation insurance for my employees. Below is the policyeat lab sloe information. Insurance Company Name:__ Policy#or Self-ins.Lie.#: Expiration Date: Job Site Address: City State Zip: Attach a copy of the workers'compensation police declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL c. 152.§25A is a criminal v tulatton punishable by a tine up to$1,500.00 an d or one-year imprisonment,as well as civil penalties in the tilnn of a STOP WORK ORDER and a line of up to S250.00 a day against the s iolator.A copy of this statement may be berm arded to the Office of Investigations of the DIA for insurance coverage verdication. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct. ti Signature: , Date: 9/22/22 Phone a: 413-230-8076 Official use only. Do not write in ibis area.to be completed br city or town official City or"Fown: Permitil.icense# Issuing.tuthorits (circle one): I. Board of Ilealth 2.Building Department 3.City(limn Clerk 4.Electrical Inspector 5. Plumbing Inspector 6.Other ('untact Person: Phone#: ESTIMATE Valley Roofing and Restoraton,LLC Sales Representative 162 Pendleton Ave Tom Morin Chicopee,MA 01020 (413)230-8076 (413)230-8076 valleyroofingandrestoration@gmail.com CSL#CS-112460•HIC#185148 Dale Simmons 7 Hinckley St. Estimate# 1366 Florence, MA 01062 Date 8/10/2022 Item Description Price Amount Asphalt •Strip all layers of roofing on the house-dispose of all $7,350.00 $7,350.00 debris •Furnish and install synthetic underlayment •Furnish and install starter strip •Change existing bath hood vent if needed •Furnish and install 6'ice and water barrier at all eaves, valleys,and all roof penetrations to meet MA code •Furnish and install new aluminum drip edge—Color: White •Furnish and install low profile ridge vent •Replace stack pipe collars •Furnish and install new lead flashing on chimney •Furnish and install new GAF Timberline HDZ Lifetime Shingle(color to be determined) Sub Total $7,350.00 When Paying by Cash or Check Total $7,350.00 When Paying by Credit Card Surcharge $213.44 Balance Due* $7,563.44 *Credit card payments includ a surcharge of 2.9%+.29¢�per transaction. SPECIAL INSTRUCTIONS ***The prices in this estimate are valid for 3 weeks*** *All installations include a lifetime workmanship warranty *The prices in this estimate include labor,materials,dump fees and permits for work at address listed above. *AII measurements are based on aerial photos.There may be some discrepancy. *Any needed 1x6-1x10 pine boards will be installed at$11 per linear foot. *Any needed plywood will be installed at the following: 1/2"at$90.00 per sheet 5/8"at$110.00 per sheet 3/4"at$130.00 per sheet Document ID: B210AC1 B-7AC4-4DBC-BA46-C3B9A0DBCE2D Page 1 of 2 DATE(MM/DWYYY) ACRE® CERTIFICATE OF LIABILITY INSURANCE �./ 02/24/2022 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT LEANDRO GUIMARAES NAME: POINT INSURANCE INC (A/C NE Ext): (508)552-8066 I No: (508)552-8065 424 BELMONT ST E-MAIL Iguimaraes@pointinsure.com ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# WORCESTER MA 01604 INSURER A: ATLANTIC CASUALTY INS CO INSURED INSURER B CT HOME EVOLUTION LLC INSURER C: PO BOX 81328 INSURER D: INSURER E: SPRINGFIELD MA 01108 INSURER F: COVERAGES CERTIFICATE NUMBER: Master Cert 2022 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 INSD WVD POLICY NUMBER (MM/DD/YYYY) (MM/DO/YYYY) LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCEDAMAGE T $ 1,000,000 CLAIMS-MADE XI OCCUR PREMISESO(EaENTE occur ence) $ 100,000 MED EXP(Any one person) $ 5.000 A L307001666 02/16/2022 02/16/2023 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY JECT PRO LOC PRODUCTS-COMP/OPAGG $ 2,O00,000 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 LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? N/A 1 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached H more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN Valley Roofing and Restoration LLC ACCORDANCE WITH THE POLICY PROVISIONS. 162 Pendleton Ave AUTHORIZED REPRESENTATIVE Chicopee MA 01020 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD ACO DATE(MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 02r24r2022 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 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: LEANDRO GUIMARAES POINT INSURANCE INC mac No.Ext); (617)78311so FAX (A/C, ADDRESS: bn/no@pointinsure.com 1103 COMMONWEALTH AVE INSURER(S)AFFORDING COVERAGE NAIC C BOSTON MA 022151111 INSURER A: TRAVELERS PROPERTY CAS CO OF AM 25674 INSURED INSURER B: CT HOME EVOLUTION LLC INSURERC: INSURER D: PO BOX 81328 393 BELMONT AVE INSURER E: SPRINGFIELD MA 01108 INSURERF: COVERAGES CERTIFICATE NUMBER: 748131 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 TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXPO LTR INSD WVD POLICY NUMBER (MM/DD/YYYY) (MMIDD/YYYY) COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE DAMAGE TO RENTED CLAIMS-MADE L OCCUR PREMISES(Ea occurrence) $ MED EXP(Any one person) $ N/A PERSONAL&ADV INJURY $ GENT AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE 4$ POLICY PRO- JECT LOC PRODUCTS-COMP/OP AGG $ OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS N/A BODILY INJURY(Per accident) $ NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS (Per accident) UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE N/A AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION AND EMPLOYERS'LIABILITY X STATUTE Y I N ANOTH- ER _. A OFF C OER/M MBEREXC UDEDXECUTIVE N/A N/A N/A 7PJUB6R27625422 02/16/2022 02/16/2023 E.L.EACH ACCIDENT $ 1,000,000 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 N/A DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Workers'Compensation benefits will be paid to Massachusetts employees only.Pursuant to Endorsement WC 20 03 06 B,no authorization is given to pay claims for benefits to employees in states other than Massachusetts if the insured hires,or has hired those employees outside of Massachusetts. This certificate of insurance shows the policy in force on the date that this certificate was issued(unless the expiration date on the above policy precedes the issue date of this certificate of insurance). The status of this coverage can be monitored daily by accessing the Proof of Coverage-Coverage Verification Search tool at www.mass.gov/Iwd/workers-compensation/investigations/. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN VALLEY ROOFING AND RESTORATION LLC ACCORDANCE WITH THE POLICY PROVISIONS. 162 PENDLETON AVE AUTHORIZED REPRESENTATIVE CHICOPEE MA 01020 rni M C 'COX Daniel M.Crowley,CPCU,Vice President—Residual Market—WCRIBMA ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD Commonwealth of Massachusetts i.® Division of Occupational Licensure Board of Building Regqulations and Standards `II T' Constion rvisor CS-112460 rti. , ec�pires:07/23/2024 THOMAS D IYORIN, � 162 PENDLETON AVE CHICOPEE M 01020 !t t��IJ,t'd'.1�� THE COMMONWEALTH OF MASSACHUSETTS Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR TYPE:Individual Registration Expiration 185148 08/08/2024 TOM MORIN D/B/A VALLEY ROOFING AND RESTORATION THOMAS MORIN 162 PENDLETON AVE. CHICOPEE,MA 01020 Undersecretary Aco CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) �./ 09/30/2021 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 Chris Hess NAME: Southwick Insurance Agency PHONE (413)746-2822 FAX (413)413 746-2901 (AIC,No,EAD: (A/C,No): 562 College Hwy ADDaIESs: chess@southwickinsagency.com INSURERS)AFFORDING COVERAGE NAIC# Southwick MA 01077 INSURERA: Crum&Forster Specialty Insurance Company 44520 INSURED INSURER B Thomas Morin,DBA Valley Roofing&Restoration INSURER C: 162 Pendleton Ave INSURER D INSURER E: Chicopee MA 01020 INSURER F COVERAGES CERTIFICATE NUMBER: CL2193003712 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 LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER LIBIC POLICY EFF POLICY EXP (MMIDDIYYYY) (MM/DDIYYYY) LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S 1,000,000 DAMAGE TO RENTED CLAIMS-MADE OCCUR PREMISES(Ea occurrence) S 100,000 MED EXP(Any one person) S 5,000 A BAK-69939-2 09/25/2021 09/25/2022 PERSONAL BADVNJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE S 2,000,000 X POLICY PRO- JECT LOC PRODUCTS-COMP/OP AGG S 2.000,000 OTHER. S AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea awdent) ANY AUTO BODILY INJURY(Per person) S OWNED SCHEDULED BODILY INJURY(Per accident) S AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE AUTOS ONLY AUTOS ONLY (Per accident) _ S UMBRELLA LIAB OCCUR EACH OCCURRENCE S EXCESS LIAB CLAIMS-MADE AGGREGATE S DED RETENTION S . S WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY YIN STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICERIMEMBER EXCLUDED'/ N I A E L.EACH ACCIDENT S (Mandatory in NH) E L DISEASE-EA EMPLOYEE $ II yes.descnbe under DESCRIPTION OF OPERATIONS below E L DISEASE-POLICY LIMIT S DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space Is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN City of Northampton Department of Building Inspections ACCORDANCE WITH THE POLICY PROVISIONS. 212 Main St,Municipal Bldg AUTHORIZED REPRESENTATIVE Northampton MA 01060 I ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD Valley Roofing & Restoration CSL#CS-112460 HIC# 185148 Please mail permit to: 143 Parker Lane Ludlow MA 01056 or Email to: valleyroofingandrestoration@gmail.com *If you cannot do either of these can you call 413-230-8076 so that we know permit has been issued Thank you ! Tom Morin 162 Pendleton Ave • Chicopee MA 01020 • (413) 230-8076 valleyroofingandrestoration@gmail.com