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38B-195 (9) BP-2022-1188 50 MANHAN ST COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 38B-195-001 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-2022-1188 PERMISSION IS HEREBY GRANTED TO: Project# ROOF Contractor: License: Est. Cost: 8800 SEXTON ROOFING CO 99689 Const.Class: Exp.Date: 10/05/2023 ALBRO-FISHER BENJAMIN & BETH NN ALBRO- Use Group: Owner: FISHER Lot Size (sq.ft.) Zoning: URB Applicant: SEXTON ROOFING CO Applicant Address Phone: Insurance: P O BOX 6327 (413)534-1234 7pjubog07898222 HOLYOKE, MA 01041 ISSUED ON:09/23/2022 TO PERFORM THE FOLLOWING WORK: STRIP AND RE-SHINGLE POST THIS CARD SO IT IS VISIBLE FROM THE STREET Inspector of Plumbing Inspector of 11 iring 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: I ' 0 • , � 3-0 • , • Fees Paid: S40.00 212 Main Street, Phone(413)587-1240,Fax:(413)587-1272 Office of the Building Commissioner - Z. - The Commonwealth of Massachusetts PO -. - Board of Building Regulations and Standards .FOR JMassachusetts State Building Code,-780 CMR,7b edition A4lJNlUCISPE IY Building Permit Application To Construct,Repair,Renovate Or Demolish a RevisedJanuar), o One-ar 7wo-Fam4Dwelling 1,2008 o-+ 11 This Section For Official Use Only �0 -'" -mo Bu, Permit Numbez a-a?" /./ 8� Date Applied: DQ T J C 8° • Sigt at / - . - ' q 2/--2OZ2 z . L7 0 " Building Commissioned Inspector of Buildings . Date c z r.) . c - - a s*"as,•, 'o m a„ _• SECTION I:SITE INFORMATION ru 1.1 Property Address. 1.2 Ass or,I Map&Parcel Numbers ' 1.1b$,is anaccepstreet/yes r no Map�Number ParcelNumber • 1.3 Zoning ng Information: 1.4 Property Dimensions: Zoning District Proposed Use _ Lot Area(sq ft) Frontage(it) 1.5 Building Setbacks(ft) . Front Yard Side Yards Rear-Yard Required Provided Required Provided Required • Provided 1.6 Water Supply: (M.O.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Public❑ Private 0 Zone: , Outside Flood Zone? Municipal 0 On site disposal system 0 Check if yes❑ - SECTION 2: PROPERTY QWIERSHIP' 2. Own er'of ecord: /Lb i f7 S ILX` l y� 5) /l!e f�jJ, iL,./ ) Sr :e-// 7-ii.-}94-6 - acne(Print) Address for Service: ' Il '-Slab'? • Signature Telephone SECTION 3: DESCRIPTION OF PROPOSE)WORK2(check all that apply) New Construction 0 Existing Building Owner-Occupied la`'Repairs(s) Cl Alteration(s) 0 Addition 0 Demolition 0 Accessory Bldg.0 Number of Units / _ Other ❑ Specify: _ • Brief Descrip jo of Proposed Workl: Pi ,s4•• f ob- /I''L/ , 9g/Ar 10:4'e- • - . r" ,S/.'.✓/ZL3G"el,1 • • SECTION 4:ESTIhIA.TED CONSTRUCTION COSTS Item • Estimated Costs; Official Use Only (Labor and Materials) . • 1.Building $ 1. Building Permit Fee:$ Indicate how fee is determined: O Standard City/Town Application Fee 2.Electrical $ O Total Project Costl(Item 6)x multiplier . x 3.Plumbing S ' • 2. Other Fees: S 4.Mechanical (HVAC) $ List: 5.Mechanical (Fire $ Total All Fees:$ Suppression) _ C � (,��l Check No. Check Amo • Cash Amount: 6. Total Project Cost: $ . ! It i v° ❑Paid in Full ❑Outstanding Balance Due: SECIION CONSTRUCTION SEBVRCES 5.1 License(CSC) WO? /v15-/a3 er-e ,. g t too .1:icp 'ssiiiiart rime . - Name/�afL(M.Fiddrr/-5��}} List LSL Type(e below) 64kb teX �s f leffe ,"2 7A DIO L} U >�a an m3s..©oo en-ft) R ifr2 UityfrState,ZIP Id Masonry NIS WmdaorandSitlmg SF Solid End Doming Appiainczs 1 beadationTelephone Email adds D Denman=. /MC-Oacniannw Name or Name No.and Street town address mg a/1)3Q 4/ :534-4,,:23 State:.ZEE' Tedep6mc SECIION6c WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M C ..c.152-§25C(6)) . Workers C.n ao.I m e affidavit Est be completed and sued with this application- rack to paw-AO this affidavit will result in the denial of the1ssaanee offbuilding permit &gnerlAffidavitAnacheer Fes ..: ' No • •t1 SECTION 7=OWNER AUTHORIZAT IITOSECOMPLE'TEDWHEN • OWNER'S AGENT OR CONIRACTOiR Al FOR RUI DYNG PERMIT • rl _ j �^ Las Owner of the sabject prop�Y_hereby anri>� j( fI ! J(,(!l `e to act on my hdolf,in all matters relative to wog authorized by this Ent. application. , C'D orehp ?_ Print Owners Nam=(FCC SEC 7b OWNER'OR AUTHORIZED AGENT DECLARATION I • By mitering.ray name below,I hereby attest under the pains and penalties ofperjury that all of the information contained in this pb1-nion is trae and accurate to the best of my knowledge and 1 wSI NED try AuthorizedAgent Dan NOTES_ • 1_ An Owner who obtains a in*kiting permit tan do his/her aeon wank,or an owner Who]Hors arronsegistered ennttadct' , (ant registered in the Horne Improvement C (MC)Pi a,n.),wifigps have ass to the arbitration • programs orgitarauty fond tmderM.G.L.a 142A_Other important inframatiarn on the SIC Pram can be ford at www_rnass.nrwInca lurnntation eel the Cc tnxt on Sopetvisor License can be frond at www.uos ovidps 2 When substauthdwot>cispisu protatiethe iuformationbelovw Total floe area(sq.ft.) Cog garage,finishedbasement/attics,decks or porch) Gross living area(sg fa`) fat itab*room count Nutter of fireplaces Number of bedrooms • Number of-bathrooms Nuodaa ullsol/baEhs Type ofheasing system Number ofdecks/porches • Type of cooling system Enclosed _OPen . 3_ -Total Project Squdi‘..Footage"roay be aded.for'ToUdProject Cost' City of Northampton • -, Massachusetts •��5� 'fe DEPARTMENT OF BUILDING INSPECTIONS J. 212 Main Street • Municipal Building ;• �-• Northampton, NA 01060 CONSTRUCTION DEBRIS AFFIDAVIT (FOR ALL DEMOLITION AND RENOVATION PROJECTS) In accordance of the provisions of MGL c 40, 554, 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: j / /¢//1 3 > I2c4' The debris will be transported by: Name of Hauler: Asa,14y5 ►,6-'t /J(/,t &1/ C/1L- Signaturey of Applicant: Date: 41/) /Z� Propol5ar SEXTON ROOFING AND SIDING INC www.s extonro ofing.coal VINO teaP.O. Box 6327 Setting the Standard � ' Holyoke, MA 01041 4111 _1__ �� p. 413.534.1234 f. 413.539.9906 MA HIC# 118239 sextonroofing@hotmail.com SUBMITTED TO Jamie Fisher PHONE 386-5909 DATE 9/10/22 STREET 50 Manhan St EMAIL jami.albro.fisher@gmail.com CITY,STATE,ZIP Northampton,Ma. roofr SEXTON ROOFING HEREBY SUBMITS SPECIFICATIONS AND ESTIMATES FOR: MIAN ROOF AND LEFT SIDE SUN ROOM 1) Strip and remove existing shingles and dispose of in proper landfill. 2) Inspect decking and replace as needed @ $105.00 per sheet.. 3) Install new metal edging to rakes and eaves of roof. (white) 4) Install ice and water shield on eaves(6'), vent stacks, in valleys, chimney, and at intersecting fs. 5) Install synthetic roofing underlayment on remainder of roof. 6) Install new flanges over existing vent stacks. 7) Install starter shingles on eaves and rakes of roof. 8) Install IKO Architectural style roofing shingles as per manufacturers' specifications. 9) Install new cap over ridge vent. 10)Reflash chimney as needed(it $400.00 Sexton Roofing will remove chimney to below the roofline instead of rehashing. II) Supply manufactures Lifetime warranty and SRC 5 yr. workmanship warranty. ATTENTION HOMEOWNERS:PLEASE COVER ALL PERSONAL BELONGINGS IN THE ATTIC,GARAGE,OR STORAGE AREAS DUE TO POSSIBLE ROOFING DEBRIS OR DUST COMING THROUGH CRACKS OF WOOD DECKING. SEXTON ROOFING SHALL APPLY FOR ALL PERMITS FOR PROJECT We Propose hereby to furnish material and labor-complete in accordance with the above specifications,for the sum of Eight Thousand Eight Hundred DOLLARS ($8,800.00)PAYMENTS TO SE MADE AS FOLOWS: due in full upon completion _ All Material is guaranteed to be as specified. All work to be completed in a Authorized workmanlike manner according to standard practices. Any alteration or Signature deviation from above specifications involving extra costs will be executed only upon written orders,and will become an extra charge over and above the estimate.DAMAGES TO BUSHES AND OTHER VEGETATION'MARKS ON HOUSE MAY Note:This proposal may be withdrawn by us if not accepted within BE UNAVOIDABLE AND WE ARE HELD HARMLESS. Not responsible for water (14)days. damage during construction. Owner to pay responsible legal fees for non- payment,and applicable interest. acceptance of 13ropoccat The above prices,specifications __ ���_� � 911512022 and conditions are satisfactory and are hereby accepted. You Signature are authorized to the work as specified. Payment will be made as outlined above. Signature Date of Acceptance. - Department of Industrial Accidents ( Office of Investigations . Lafayette City Center 2 Avenue de Lafayette,Boston,MA 02111-1750 www.mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organiration/Individual):Sexton Roofing &Siding Inc Address:P.O. Box 6327 City/State/Zip:Holyoke, Ma. 01041 Phone#:413-534-1234 Are you an employer?Check the appropriate box: Type of project(required): 1.0 I am a employer with 4. © I am a general contractor and I 6. New construction employees(full and/or part-time).* have hired the sub-contractors listed on the attached sheet 7. El Remodeling El I am a sole proprietor or partner- ship and have no employees These sub-contractors have g_ ❑Demolition workingfor me in anycapacity. employees and have workers' P ty $ 9. ❑Building addition [No workers' comp.insurance comp.msltrance. required.] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions myself. [No workers'comy right of exemption per MGL 12 e Roof repairs insurance required.]t c. 152,§1(4),and we have no employees. [No workers' 13.0 Other comp_insurance required.] .ny applicant that checks box#1 must also fill out the section below showing their 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 such. :ontractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have nployees. If the sub-contractors have employees,they must provide their workers'comp.policy number. am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site tformation. tsurance Company Name:Travelers Property Cas Co Of Am olicy#or Self-ins.Lic.#:7PJUB0G07898272 Expiration Date:06/4/23 ib Site Address: City/State/Zip: ttach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). ailure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a ne 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 f up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of tvestigations of the DIA for insurance coverage verification. do hereby certify under the ins and penalties of perjury that the information provided above is true and correct gnature: Date: hone#: / z y Official use only. Do not write in this area,to be completed by city or town official. City or Town: PermitlLicense# Issuing Authority(check one): I❑Board of Health 20 Building Department 30City/Town Clerk 4.0 Electrical Inspector 50Plumbing Inspector 6.DOther Contact Person: Phone#: A�LED CERTIFICATE OF LIABILITY INSURANCE DATE(NMIDDrrrYY) O6/07/2022 THIS CERTIFICATE IS ISSUED AS A MAI ttit OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE Ctttite-u.ATE 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 pdrey(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 muse l(aite Hutchinson ORMSBY INSURANCE AGENCY ( (4?3) FAX NO►: ADDR kttutCttlns0n ns.GGm - aDDrzEss: Y� P O BOX 718 A t6 L MAIC4- WEST SPRINGFIELD MA 01090 IAA: TRAVELERS PROPERTY CAS CO OF AM I 25674 INSURED INSURER B: SEXTON ROOFING&SIDING INC INSURSER C_ PO BOX 6327 INSURER E_ HOLYOKE MA 01041 INSURER F_ COVERAGES CERTIFICATE N 7132111 REVISION NUMBER_ - THIS IS TO CEH IVY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TD THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICAILL/ 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 f5 SUBJECT TO ALL THE TERMS, . EXCLUSIONS AND CONDITIONS OF SUCH POLICIES_LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. leSR I An1111{'4' R POLICY ffF POLICY OcR LTR TYPE OF1NSURANCf —D I i yo POLICY MIS tRrYYn 1( ITYY) LIMITS COMMERCIAL GENERAL LIABILITY I 1 EACH OCCURRENCE S DAMAGE TO RENTED CLAIMS MADE I OCCUR I PISiISES a Dame®) S ®SG.'Wry am pence) S N/A PSimONAL&AUY INJURY i S GEN'LAGGREGATE LIMITAHJE5 PER i GENERALAG&GREGATE S POLICY I .1ECT LOC PR IS-COUPIOPIGG S IOTHER- s . AUTOMOBILE LIABILITY C.OMBINED SING-,LE LIMIT $(Ea accident) . . ANY AUTO BODILY INJURY(Per person) 5 —ALL OWNER SCHEDULED N/A BU4tLY 1N55tY(Per acres) 5 ,AUTOS AUTOS HIREDAUTOS A W� PROPERTY DAMAGE S (Per S MOREIJ ALIAS OCCUR EACHOC S c CCESS LIAR CLAIMS-MADE, - WA AGGREGATE S DEO RETENTIONS :S I WORKERS COMPENSATION NSATION x I OTH- I EFt AND ELIPLOYERS"LABILITY ANYPROP »iRARTt DIVE Y 7 fi neat,.cco r 5 1,000,000 A oFFICER/MEMBME(CLUDED? N/A��► ►+ 7P lUBOG07896222 06/D4/2022 06/04/2023 • (Undatn,y.a NH) ELPEA¢-EA EMPLOYEE 5 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS ne!w I EL.fItc. .SE-POLICY UNIT I s 1,000,000 i WA DESCRIPTION OF OPERATIONS!LOCATIaNSJVENCLE5 UN,Additional Remies Schedule.=ay he=ladled iime space is Workers'Compensation benefits Ira be paid to Massachusetts employees only_Pursuant to Endo' errrent WC 20 33 06 B_no auks given to pay claims for benefits to empioycc in states other than Massachusetts if the insured hires,or has hired those employees outside of Massachusetts. This certificate of insurance shows the policy si force an the date that this certificate was steed(unless the ex ation dale on the above policy precedes the issue date of this cer fficzte of insurance The slstr r of this coverage can be it Mil i1 ecf daily by accessing the Proof of Coverage-Coverage Verification Search tool at www_mass. i e fsl. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BEI CANCaiI D BEFORE THE EXPIRATION DATE THEREOF, NOI10E WIfLLI HE DELIVERED IN ' ACCORI3ANCE WITH THE POLICY PROVISIONS_ S AUTHORIZED R», IATNE , %-ram MA 01040 DiinielM.Crowley,CPCU,Vice President-Residual Market-WCRIBMA ©1988-2014 ACORD CORPORATION Ail rights reserved. Arrnari'74 rwm.tun» Tb Ar'r%Ofl.,3...0><,.I I,,...,».er.:e:3..mA.n-,.-4<r,F erssvn �—...N SEXTO-2 OP ID: KH A� )Ro CERTIFICATE OF LIABILITY INSURANCE DATE(MM/OD1YYrY) 06/30/2022 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). 413-737-0300 CONTACT Eric Dembinske PRODUCER NAME: Ormsby Insurance Agency Inc. J PHONE 413-737-03D0 F 413-737-0617 698 Westfield St PO Box 718 (A/c,No,Ext): (ac,No): West Springfield,MA 01090 E-MAIL edembinske@ormsbyins.com Eric Dembinske ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Northfield Insurance Company INSURED INSURER B:Progressive 24260 Sexton Roofing 8 Siding,Inc. PO Box 6327 INSURER C: Holyoke,MA 01041 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 TYPE OF INSURANCE ADD_DUBR POLICY NUMBER MI POLICY EFF POLICY EXP LIMITS LTRINSR IWYOIMMIODITTTY1 IMDD/YYYYI A ' X`COMMERCIAL GENERAL LIABILITY ? EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE 1 X i OCCUR WS45073 DAMAGE occurrence) $ 100,000 MED EXP(Any one person) $ 5'000 i 1,000,000 PERSONAL&AM INJURY I$ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY JECT LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: I $ B ' COMBINED SINGLE LIMIT 1,000,000 AUTOMOBILE LIABILITY (Ea accident) $ ANY AUTO 04434955-0 05/15/2022 05/15/2023 BODILY INJURY(Per person) S - OWNED AUTOS ONLY X AU SCHEDTOS ULED BODILY INJURY(Per accident) $ -X HIRED X NON-OWNED �PReOPPE�RdTYDAMAGE $ - AUTOS ONLY AUTOS ONLY I, $ UMBRELLA[JAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ _ $ i WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY STATUTE . ER Y/N TO BE ISSUED SEPARATELY ANY PROPRIETOR/PARTNER/EXECUTIVE EL EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? N/A (Mandatory In NH) EL DISFARE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below ' E.L DISEASE-POLICY LIMIT $ I DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORO 101,Additional Remarks Schedule,may be attached if more space is required) roofing&siding contractor CERTIFICATE HOLDER CANCELLATION NONE-01 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 REPRESENTAn E ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. ACOREP CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYYY) `----- 06/17/2022 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 NAME: Karina Silva MAYFLOWER INSURANCE GROUP INC (PHHO" Exit: (774)773-9702 �u�Not ADDRESS: karina@mayflowerinsurance.com 2 Court St Unit B INSURER(S)AFFORDING COVERAGE NAIC O Plymouth MA 02360 INSURER A: HARTFORD UNDERWRITERS INS CO 30104 INSURED INSURER B MNP CONSTRUCTION INC INSURER C: INSURER D: 76 GROVE ST APT 1 INSURER E: MILFORD MA 01757 INSURER F: COVERAGES CERTIFICATE NUMBER: 785876 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. I EFF ' POLICY tap LT R TYPE OF INSURANCE 'tNsD JSUBRI POLICY NUMBER (MM(DDPOUCIYYYY) (MMIDDIYYYY) OMITS LTR INSD I � COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE , $ DAMAGE TO RENTED CLAIMS-MADE OCCUR i PREMISES(Ea occurrence) $ 11 MED EXP(Any one person) $ N/A PERSONAL 3 ACV INJURY $ GEN'L AGGREGATE LIMIT APPUES PER: GENERAL AGGREGATE $ RO- POLICY JECT ! I LOC PRODUCTS-COMP/OP AGG $ OTHER: $ AUTOMOBILELIAeIr-!TY I COMBINED SINGLE LIMIT (Ea acadent) $ ANY AUTO BODILY INJURY(Per person) $ ' OWNED SCHEDULED N/A i AUTOS ONLY AUTOS �i.BODILY INJURY(Per accident) $ HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY (Per accident) $ UMBRELLA LIAB — OCCUR EACH OCCURRENCE $ EXCESS UAB CLAIMS-MADE N/A AGGREGATE $ DED RETENTION S $ WORKERS COMPENSATION X STATUTE I I ER AND EMPLOYERS'LIABILITY Y I N ANYPROPRIETOR/PARTNER/IXECUTIVE EL EACH ACCIDENT $ 1,000,000 A OFFICERJMEMBEREXCLUDED7 NIA NIA WA 6S60UB6R43531322 06/08/2022 06/08/2023 ' (Mandatory in NH) EL DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below EL DISEASE-POLICY LIMIT -$ 1,000,000 N/A i DESCRIPTION OF OPERATIONS 1 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 SEXTON ROOFING & SIDING INC ACCORDANCE WITH THE POLICY PROVISIONS. 102 PINE ST AUTHORIZED REPRESENTATIVE Hol oke MA 01040 an i � Y Daniee l M.Crowllby,CPCU,Vice President—Residual Market—WCRIBMA i ©1988-2015 ACORD CORPORATION. All rights reserved. • ACORD (Mena': DATE CERTIFICATE OF LIABILITY INSURANCE ° Q22 `THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHT UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMIATIVELY OR NEGATIVELYAMEND,EX713iD ORAL-TER THE COVERAGE AFFORDED BYTHEPOLICES BELOW-THIS CERTIFICATE OF INSURANCE DOES NOTCONSTITUTEACONTRACT BEIVABENTHE ISSUING INSURER(S),AUTHOR® REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER IMPORTANT:It the certificate holder is an ADDITIONAL INSURED,thepoliey(tes)must.bur endorsed.If SUBROGATION IS WAIVED,subject to the terms and condbo ns of the require an etedarsetnerrc Astairiiiiiron this certificate does not confer rights to the certificate holder in nett of such ldorsesnenl s} PRODUCER CONTACT G1a>eme Camossato PHONE •97e 725-3830 I-INSURANCE GROUP INC tAlc.No EUr 9UL 799 GORHAM ST ADDRESS: LOWELL,MA 01852 atwrErtsl AFFORDING COVERAGE N 1C INSURED INSURERS:GENERAL STAR INDEMNITY COM INSURER B:ARBELLA PROTECTION INSURANCE LDG HOME IMPROVEMENT INC INSURER C: . 18 SPRING ST FL1 INSURER D:TRAVELERS PROPERT(CAS CO OF AM MILFORD, MA 01757 INSURER E INSURER F: COVERAGES CERTIFICATE NUMBER:000015 REVISION.NUMBER: INDICA I EU-NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDTITON OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CER I IFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE PO JCIES.DESCRIBED HEREIN IS SUBJECT TO TALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES_UNITS SHOWN MAY HAVE BE3 N REDUCED BY PAID CLAIMS. INS L AOCII POLICY EFF POLICY ESP ' TR TYPE OF INSURANCE NSA v_n PCUCY N[8CE2 parrryT. ,..QeAX00Y1rYVY) LAIRS A _ „LAMM EAOr oavamw� S Lam!rcn m Lwa NTED X SAL GENERAL Rm- PRELIMS(Ea aaaNa l $ Sna,00D no _ ..._ IX I Dine ,®FDPtr�ra.�r $ 5,000,00 NA395923A 3./5/2022 3/512023 macaw_s Ayr maw S I,1300,000A0 GEEFAL AC[ ATE S 2.000.00ODO GOO_AGL .ATELaaT APPLE PER htd'aCaddad 01,NA93 S 2,000PDODD POUCT n PROJECY I ILOC IDDLIONEED B AUrorae.ELY1®fY (Ea y)�EuelT S 100,00000 !ANT A RO 9ODNLY UMW W Pmr>oN $ 7Lla0..W ALL GYnen -SCHEDULED AUTOS Autos 1020096012 4/122021 4/13/2022 aoDiLY NARY(rtr.�* S 4OA00 00 MENUO NEO PRBBtrY DAMAGE INED AUTOS ,Autos {P.r»n S 103,000.00 C ULEIREIIA LOH OCCUR EACH a(. JER EJR�LAB nAes+uloE N-a-.03'dOE [Da' PIEDENTONS D WORKERS COWENIA ION 'WCSnATUfORY OM PO EPLOTHOr I./AMITYYIN - LIMITS ER ANY El EACUACCEERr rmo r,xn_m OFFT.Hi16ffREg1lAn�r 6HUB4N86974.'0TJ 3�0222 326J2023 $ > El_r> -EA9P+.orEE S 1A00A00.00 'Ter deob order OFSCRIPr70N OF OPERATIONS below EL DISEASE Poucr OUT $ 1.000.000.00 DESCRIPTION OF OPERATIONS I LOCATIONS I VENIC LE5(ACad1Iialo'IO7.AddBvol Beasts Schelde,A nose Apo a respired) GENERAL LIAB1LfrittarerpAarand vest jobs aai Er certificate trader is an additional insured Ms'Compeasat r bereft we be paid to Massachusetts employees only_Plasmatic Sithaserneet WC20 GB 06 8,no authorization u given to pay claims for benefits to employees it slates other than Massachusetts 1tle iLsaed hiss,is'tia5 hied tale castle of tie This ORKLICCIte ofnsurancrshows the p_ticy in formai the date that this certificate was issrasd(teifea thiaexprafon date on the above policy precedes the issue date of this certificate ofisuance).The ste6iiufthsa coverage can bemrJEledd it*accessing thePmafd Coverage-Coverage Verification Search fodii• ... . a CERTIFICATE HOLDER CANCELLATION SHOULD ANY OFTHE ABOVE I3SCRI8ED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE IT IS THE CUSTOMERS RESPONSASIUIY TO INFORMEANY SEXTON ROOFING&SIDING INC CHANCES OR CANCELAT1ONs. 102 PINE ST.,HOLYOKE MA • GUILHERME CAMOSSATO 1/1 0 iss3-2olo AaNtocalirouTiort.AS 1irjas reserved_ STATE OF CON ECTICUT DEPARTMENT OF CONSUMER PROTECTJO.V cosnmonwealm oass"r'us ren�re HOME I PR.O NT,.rC 1gTRAC rOR p Dcvs+on of P ationS DalaRegulnd Starvdards 4EHE 'j SEX1 SR Board at Bisilnk"gt f - r Spediaity U HOEY v �ires: 1U105IZ Z3 D :01Lj 2411 .• CS8L-099689 a "y j SExTON BAOkIN4&sibittiin CO 6yER�T P, -� F PO X Y o1oa 1'11? L HIC.0605383 wt /a1;/24) �at�.' ,i` 1 :r . 03I31I2023 •.OiSS-1"-) SIGNED Coassnissionet at.r-iat as:211 G�aP. R�SPONS"EL GIS T fl NCHt " rl!"/E �+ E 3+g TIGN STATUS 5 !�1 ��tis�"�icr2t Y:J.'� �C--.+.7 ��1c. 3L SEXTON ROOFING& SEXTON,EVERETT 119239• P_O_BOX 6327 Ctaent Sidng Inc HOLYOKE MA 01041 to