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38B-178 (5) BP-2022-1207 11 FORT ST COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 38B-178-001 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-2022-1207 PERMISSION IS HEREBY GRANTED TO: Project# ROOF Contractor: License: Est.Cost: 7800 SEXTON ROOFING CO 99689 Const.Class: Exp.Date: 10/05/2023 Use Group: Owner: ARNY LIBBY C TRUSTEE 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:09/26/2022 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 VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Signature: t Fees Paid: S40.00 212 Main Street, Phone(413)587-1240,Fax:(413)587-1272 Office of the Building Commissioner . A, The Commonwealth of Massachusetts FOR of Building Regulations and Standards { t. Massachusetts State Building Cod;-780 CMR,7b edition MUNICIPALITY OUSE TY j Building Permit Application To Construct,Repair,Renovate Or Demolish a Revised January One-or Two-Family Dwelling 1,1008 om o cn C l This Section For Official Use Only v c_ Buit omit Number: ��' �-� 7 Rim Applied: v f` • z Sign : . ',�C /,; Ll -r o Building Commissioner)Inspector of Buildings Date �"� co g m ti ' • SECTION I:SITE INFORMATION I. n b z 7.1 Propert`y Ad real: 1.2 Assessors Map&Parcel Numbers 4-1 Ida Is this an accented street?yes no p Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Area(sq fl) 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 Q Private 0 . Zone: --- Outside if Flyesood0 Zone? Municipal❑ On site disposal systeM ❑ • SECTION 2: PROPERTY QWNERSHIP' 2.1 Owner'of Record: Name(Print)l I// fJ Address for Service: • ,2,fr - 6cS-SS/(F L-t 4 `l CA S ' t'y ..y'-'l. - : Signature Telephone ' SECTION 3:DESCRIPTION OF PROPOSED WORK2(check ell that apply) New Construction 0 Existing Building 111>--Owner-Occupied @VRepairs(s) 0• Aheration(s)'C3 Addition 0 - Demolition 0 Accessory Bldg.❑ Number of Units / _ Other 0 Specify: _ • Brief Descriptio ofProposed Work2: . /Ze/fl 4d tom-t vi c/e,-7, (:(74 "ice 12. -/` ' . a,v Pm ;a, I-JT tj5--'L - SECTION 4:ESTIMATES 5QNSTRUC11ON COSTS • , Item • Estimated Costs: • Official Use Only . (Labor and Materials) • _ 1.Building $ 1, Building Permit Fee:$ Indicate how fee is determined: ❑Standard City/Town Application Fee 2.Electrical $ 0 Total Project Cost'(Item 6)x multiplier x 3.Plumbing $ ' 2. Other Fees: $ - 4.Mechanical (HVAC) $ List: ,,(, 5.Mechanical (Fire $ Total All Fees:$ �-tfC Suppression) _ • Check No /(( v Cheek Amount. Cash Amount: 6.Total Project Cost: $ '79 c-C,6 l ❑Paid In Full ❑Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) (%? Name �of CSL Holder ?o (LJ0k (/I, 7 Listf'ST Type(seebelow) Lf.) No.and Street G� Type Description t eKe 1 1}/r�4 00 / II Unrestricted(Buildings rip ft.) to 35,O00 c ) R Restricted 1&2 Family DwellingCity/T6w4.State,GIPMaso Mrny RC Roofing Covering \VS Window and Siding SF Solid Fuel Burning Appliances I Insulation — Telephone Email adders D Demolition .� 5.2 Registered Home Improvement Contractor(HIC) ( I 3 , curnQ and s INa39� i_ HIC Corpamj rl ��{ SIP: 1I1cRe �ti��.umbe -:: ,tpnan . asry Name or l- �2egisirant Name .1 ge.eX fo3 '] f l . eePi No.and Street G�fvt� /� �( �l/, 4Ig�fe KC, 727/9 C)/ )-3// 4/3-�3�f--/ 9� F laddr=ss Citylf�wn,State,GIP Telephone SECTION-6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M_G.L c.15Z§25C(6)) Workers Comppn Ution Insurance affidavit most 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 ' 'Er' No D SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S ACFNT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I,as Owner of the subject property,hereby authorize �u (i/ TWI©Q alig /)C. to act on m y behalf,in all matters relative to work authorized by this buiiidit . eumit application.t,-f ecnIT ct r o Print Owner's Name(Electronic Signat re) 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 plication is true and accurate to the best of my knowledge and understanding MUST BE SIGNED by Owner or Authorized Agent Date NOTES: An Owner who obtains a b iildtng permit to do his/her own wok,or an owner who hires art unregistered contractor (not registered in the Home Improvement Contractor(HIC)Program),will IIir1 have access to the miitration program or guaranty fund under M_C I..c.142A Other important information on the HIC Program can be found at www.rnass_uov/oca Information on the Construction Supervisor License can be found at-.1pw v.rnass.gov/dps 2. When stsustantial wok is planned,provide the information below: Total floor area(sq_f.) (including garage,finished basement/attics,decks or porch) Gross living area(sq.f ) Habitable room count Number of fireplaces Number of bedrooms Number of bathrooms Number of half/baths Type of hratitug system Number of decks/porches Type of cooling system • Pnclosed Open 3_ 'Total Project Square Footage may be substituted for"Total Project Cosy' City of Northampton --�L.M - • '� Massachusetts r./ c'� # �1- �. .. . c. DEPARTMENT OF BUILDING INSPECTIONS 7: 212 Main Street • Municipal Building v"•1.., ail \\ Northampton, MA 01060 ''•••• ; .0�C CONSTRUCTION DEBRIS AFFIDAVIT (FOR ALL DEMOLITION AND RENOVATION PROJECTS) In accordance of the provisions of MGL c 40, S54, a condition of Building Permi Number is that all debris resulting from this work shall be d sposed 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: 7a �,�/dl/ Si- lz, y4 b The debris will be transported by: Name of Hauler: 4 S-C 64'.7.C '-} Al ip/ec,6L4 Signature of Applicant: Date: F4/2'1— . firopogat SEXTON ROOFING AN ) SIDING Il�TC www.sextonroofing.com 4IIIKO P.O. Box 6327 _ "�. Holyoke, MA 01041 Setting the Standard ram, """'"„ „ ,, JiZaw' • a p. 413.534.1234 f. 413.539.9906 MA HIC# 118239 sextonroofmg(cLhotmail.com SUBMITTED TO Libby Amy PHONE 695-5916 DATE 9/13/22 STREET 1 Fort St EMAIL libbyca514gmail.com CITY,STATE,ZIP Northampton,Ma. roofr SEXTON ROOFING HEREBY SUBMITS SPECIFICATIONS AND ESTIMATES FOR: Main House roof/Lower attached roof 1) Strip and remove existing shingles and dispose of in proper landfill. 2) Inspect decking and replace as needed C $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 roofs. 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 1KO Architectural style roofing shingles as per manufacturers' specifications. 9) Install new cap over ridge vent. 10)R/R existing skylights @ $350.00 labor plus cost of skylights. 11)Reflash chimney as needed $400.00 12) 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 Upper main roof=5,800.00 lower attached mof=$2,000.00 We Propose hereby to furnish material and labor-complete in accordance with the above specifications,for the sum of Seven Thousand Eight Hundred DOLLARS ($7,800.00) PAYMENTS TO BE MADE AS FOLOWS: due in full upon completion All Material is guaranteed to be as specked 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. f Stxeptante of f ropooal The above prices,specifications // 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 3�) R Lafayette City Center 2 Avenue de Lafayette, Boston,MA 02111-1750 " e 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): I.❑ I am a employer with 4. © I am a general contractor and I employees(full and/or part-time).* have aired the sub-contractors 6. ❑New construction listed on the attached sheet. 7. ❑Remodeling ?.❑ I am a sole proprietor or partner- ship and have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. employees and have workers' [No workers' comp.insurance comp.insurance.: 9. ❑Building addition 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'comp. right of exemption per MGL 12 Roof airs insurance required.]t c. 152,§1(4),and we have no reP employees. [No workers' 13.0 Other comp.insurance required.] kny 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. 1onttactors 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 formation. tsurance Company Name:Travelers Property Cas Co Of Am olicy#or Self-ins.Lie.#:7PJUB0G07898777 Expiration Date:06/4/23 )b Site Address: kit I— r City/State/Zip: ' I 0 4-/P-Z�j]c 447.-) 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 p ins and penalties of perjury that the information provided above is true and correct. anature: Date: 7/1/ 2 "2— hone#: Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority(check one): 11:1Board of Health 20 Building Department 30City/Town Clerk 4.0 Electrical Inspector 50Plumbing Inspector 6.00ther Contact Person: Phone#: r A !�o DATE(NIslDDlYYYY) ® CERTIFICATE OF LlABJUTY INSURANCE 06107/2022 THIS CERTIFICATE IS ISSUED AS A MAI TER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON TIE-CERTWICATE 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 ADD1TTON L INSURED,the prr.,i,y(ies)nwmt 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). 'PRODUCERfutii Katta I- n . ORMSBY INSURANCE AGENCY (PHONE (413)737 w�""c pone khutchinson@ormstryins.com���ncom - P O BOX 718 ACAGE ' IIAIC3t WEST SPRINGFIELD MA 01090 ResuRER A= TRAVELERS PROPERTY CAS CO OF AM 25674 INSURED - INSURER a: SEXTON ROOFING&SIDING INC INSURER C: INSURER 9: PO BOX 6327 INSURER E_ HOLYOKE MA 01041 INSURER E: COVERAGES CERTIFICATE NUMBER 782111 REVISION NUMBER: THIS IS TO CEt- I IFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TD THE INSURE NAMED ABOVE FOR THE POLICY PERIOD INDICA I EU. NOTWITHSTANDING ANY REQUIREMENT TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERIAIN, 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 DUCE!BY PAID CLAIMS_ TYPE OFINSURMn� ADOL 4 R i I I POLICY INOIN LIMITSitisR a SD vivo ,4 'fl ( Yl COMMERCIAL GENERAL LIABILITY rtY EACH OCCURRENCE 5 I DAMAGE TO RENTED C'r_Aisr7.-tstAriE OCCUR j PREi6SE5(Ea ccmace) $ NED EXP(Airy ramper) `S N/A FHSONAL&Anv ecum' 1 5 GEM_AGGREGATE OMIT APPLIES Pttt I GRIERALAGGREGATE I S POLICY f-1. LOC `PRLIDUCTS-COMPTOP AGG 1 S OTHER: I - I AUTOMOBILE LIABILITY I COMBINED SINGLE LIMIT1 S ANY AUTO BODILY INJURY(Perp n) S - ALL OWNED -1 sc nulE j I,IVA aooa oxidant) r NARY(Per a ) S AUTOS HIRED AUTOS NON-OWNED I , Per PROPERTY DAMAGEAUTOS 5 $ _ _ rOC S UMBRELLA Luse OCCUR E r=rrxSS tins CLAIMS-MADE WA AGGREGATE i s 1 I DED RETENTIONS 1 �S I WORKERS COWERS/SIN N Xl P63 atrl- _ STATUTE I� f �r T YI R EL EACH Ac cirri r s 1,000,000 A oFFICERAIEMBuenro unrrn NA ►NA 7P-PUBOG07896722 06/042022 06/04/2023 (Mandatory in NH) ELIxgEASP_Ems,exPLOYEE s 1,000,000 If yes,d cnbe under DESCRIpnON OF OPERATIONS bey. 1 f EL fve rr ASE.-POLICYLY s 1,000,000 rI 1 1 N/A 1. 1 DESCRIPTION OF OPERATIONS ILOCATI JVEoa. (Amon 11:11,AskfilionalRnimaksSthedsia,may be ifaroma spacer isr,quir.d) Workers'Compensation benefits will be paid to Massachusetts employees only_Pursclant to Emitraenun 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 Let titicate of insurance shows the porrryy in force on the date that this ate was issued(rmliess the expiration dale on the above policy precedes the irisle date of this certificate of insurance) The status of this coverage can be IlnaQiurera daily by aging the Proof of Coverage-Coverage Verification Search tooi at www_mass_gov nsl. Chi{I(FICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANC73LED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DFI NEREn IN ACCORDANCE%AKIN THE POLICY PROVISIONS. AAUTHORIZEDRIPrATINE r MA 01040 Daniel M ,CPCU, President—Residual Market—WCRIBMA I 1988-2014ACORD CORPORATION_ All rights reserved. Amon 7A IoMd/alI Th.LinfIRI1.,me..e n..A r.,..,"sa re..Kfa.e.i err 4c,,f Amon SEXTO-2 OP ID: KH A CC)RCY DATE(MMIDDfYYYY) �� CERTIFICATE OF LIABILITY INSURANCE 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(), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. I 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 413-737-0300 I NAME:CONTACT Eric Dembinske Ormsby Insurance Agency Inc. PHONE 413-737-0300 FAx 413-737-0677 698 Westfield St PO Box 718 (ac,No,at): (A/c,No): West Springfield,MA 01090 ADDRESS:edembinske@ormsbyins.com Eric Dembinske 1 INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Northfield Insurance Company ENSURED INSURER B:Progressive 24260 Sexton Roofing&Siding,Inc. PO Box 6327 INSURERC: 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 ADOL SUBR POLICY NUMBER POLICY EFF POLICY EXP L1MR3 LTR JNSD WVD IMMIDDIYYYY) IMMIDD/YYYYI A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE 5 7,000'000 DAMAGE TO RENTED 100,000 CLAIMS-MACE X OCCUR WS45073 06/25/2022.06/25/2023 PREMISES(Ea occvnencel MED EXP(Any one person) 5,000 PERSONAL&ADV INJURY ,$ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY PRO- JECT LOC PRODUCTS-COMP/OP AGG 2,000,000 OTHER: B AUTOMOBILE LIABILITY (Ea accidenllNED SINGLE LIMIT 1,000,000 ANY AUTO _ 04434955-0 05/15/2022 05/15/2023 BODILY INJURY(Per person) OWNED SCHEDULED AUTOS ONLY X AUTOS • BODILY INJURY(Per accident) X HIRTTES ONLY X NON-O ONID PROPERTY DAMAGE (Per accident) S $ 1_.— UMBRELLA UAB — OCCUR EACH OCCURRENCE $ EXCESS LAB CLAIMS-MADE AGGREGATE DED RETENTION$ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE . ER TO BE ISSUED SEPARATELY j ANY PROPRIETORWARTNER/EXECUTIVE E.L EACH ACCIDENT I$ OFFICER/MEMBER EXCLUDED? N I A (Mandatory In NH) EL DISEASE-EA EMPLOYE $ If yes,describe under DESCRIPTION OF OPERATIONS below I E.L DISEASE-POLICY LIMIT 1$ DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) roofing Sr 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 REPRESENTA r1VE I ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. t l ® DATE(MMIODNYYY) ACCORD CERTIFICATE OF LIABILITY INSURANCE `----- 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 B' THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER( ), 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 Pmu HONE too. (774)773-9702 FAX No): ADDRESS: karina@mayflowerinsurance.com . 2 Court St Unit B INSURER(S)AFFORDING COVERAGE MAIC# 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. INSRLTTYPE OF INSURANCEINSOADDL YVYD SUER POLICY NUMBER IMM/DDPOLICY LTRINSD /YYYYI (MMIDO/YYYY) OMITS COMMERCIAL GENERAL LIABILITY I EACH OCCURRENCE $ I DAMAGE TO RENTED CLAIMS-MADE 7 OCCUR PREMISES(Ea occurrence) $ I MED EXP(Any one person) $ N/A PERSONALSAOV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY PECOT- ( i LOC PRODUCTS-COMPIOP AGG $ OTHER: $ AUTOMOBILEL(ABILfrr COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED AUTOS ONLY AUTOS N/A .BODILY INJURY(Per accident) $ HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY ^AUTOS ONLY (Per accident) $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS-MADE N/A 1 AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION X STATUTE - Eft AND EMPLOYERS'LIABILITY A OFFCEOR/MEMBERPEXCLUDED ECUTNE [NIA N/A NIA 6560UB6R43531322 06/08/2022 06/08/2023 EL EACH ACCIDENT $ 1,000,000 ' (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 j DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES(ACCORD 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-compensationllnvestigations/. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. SEXTON ROOFING & SIDING INC 102 PINE ST AUTHORIZED REPRESENTATIVE Holyoke MA 01040 73..E Daniel M.CroWley,CPCU,Vice President—Residual Maridet—WCRIBMA ©1988-2015 ACORD CORPORATION. Au rights reserved. ACORD Clients: DATE CERTIFICATE OF LIABILITY INSURANCE ° 2 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLYAND CONFERS NORIGNTUPON THE LtRi1FICATE HOLDER-THIS • CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGA11Y9_Y AMEN0.lxJSJD OR ALTER 7iE'CWH2AGE AFFORDED BYTiJE POI.ICJES BELOW_THIS CERTIFICAIEOF INSURANCE DOES NOT CONS TTlJIEACONTRACTBEIWEENTHE`ISSUING NSURER(SJ,pJThOI D REPRESENTATIVE OR PRODUCER,AND:THECERfIFICATE HOLDER.:':; IMPORTANT_If the certificate holder is aiACOmONAL INSURED,thepolicy(fes)must be endorsed.If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,canal,policies may requite at endorsement Astaternent on this awe does not confer rights to the certificate holder in lieu of such endor nent(s). PRODUCER CONTACT Gaeterine CatnaesaEo MAW-- PHONE 975:7 9630 • 1-INSURANCE GROUP INC BAWL 799 GORHAM ST ADDRESS: LOWELL,MA 01852 NSLI RE RIS)AFFORDING COVERAGE NAhc INSURED 1NSURER`A G NERAt_STAR INDEMNITY COde INSUREIR B:ARBELLA PROTECTION INSURANCE LDG HOME IMPROVEMENT INC INSURER C::,,.. 18 SPRING ST FLi INSURER:D:TRAVELERS.PROPERTY.CAS CO OF AM MILFORD, MA 01757 INSURER.E:• INSURE?F: COVERAGES CERTIFICATE NUMBER:000015 ...REVISION.NUMBER: INDICATED_NOTWITHSTANDING ANYREQUIREINNENT,TERM OR CONDITION OF ANY CONTRACT.OR Oli$M'DOC1iENL WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE PIC71_ICIES.DESCRIBED HEREIN IS SUBJECT TO TALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES:UNITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS_ i188 1.10dl-SUER POL.=EFF PQLYEW Tit TYPE OF HLSI:RAME NSA wvn 11x:Y xaaDEt ( pJ.yyy1 yyyyl DUDS A GE �.. m E:.Aa�oca 5 elmfm 00 X SAL r lAL UAf�nY DAMAGE So RENTED .REMIXES(Ea mammy* $ 1aa,000.00 IMA3055923A 3/512022 315>2023 r arovmum $ S.Dm.000.00 .(aERALAQSAIMhTE $ 2,000,00am FinadaJs Ca�E�d OP A94�GBrLAGC�iH.AiELsrrAFR6Pat $ J_mrn,_mnm nPROJECT[-PC B COne.eu Unar AUTOMOBILE LMBl1TY (6 $ 1 m mn o wwr AUTOeoo�ysuur�e•o i S 2000nio AU_CYLIOZO - 1tD 1020096012 41132021 4/13/2022 Bo1..tMY ff'tr...4.0 AUTOS Au 5 qa 0aapa AIMS nwaowr ED PROPERLY DAMAGE HIRED NILOS . (Accrue aRm.»n 5 100,00000 C UAB OCCUR EALM OCT,ARMMIT D® tE7DrtI M D WORKERS COMPENSATION WCSTAnrrORY OTH arnarats trAtnarn 'nn trres Eat ANv El-EAW Af�]ir ler.rr..r�na9 EXCLUDED) r>ta 6HUB4N86974322 3252022 326J2023 S t�Jmao EL DISEASE BR1hYg $ imn mom • M ama.,� • DESCRIPTION OF OPERAnOls babe, F1 OffASE-POLr(_'Yt➢eT $ 1,000.000,00 OF OPERARON.S I LOCATIONS)VON C ES(AnachPaiRD fah.AAWGamal Remoras Schedule,d mac space is required) • GENERAL LIABRITY:-far rogue rand ussiphz MCI the cerebrate holder a an a*%Ir a"emceed WUdess'Cornparsa0isr hemdls vibe pad D i45arhlrselts es pbycg c y-P,es ant to Endorsement WC 20 03 06 8,m authorietivr is given to pay • dada for benefits to employees it sus cam rMan Alessachusolts d the laved hies or has hied Base employees'urtside of Afas:aderens_ This certificate of insurance shows the policy in forte m the date trrer tfas certificae was issued(unless the expirahon date on The above pokey 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 Venficaliun • Search tool at weve_massgovihrdhrorkers-comperssatianimestigationst LEHIIFICATE HOLDER CANCELLATION • SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED ED BEFORE THE. • EXPIRATION CATE IT IS THE CUSTOMERS RES'ONSABIUTY TO[NFRRME ANY SEXTON ROOFING&SIDING INC crimpsEs OR CANCELATIONS. 102 PINE ST.,HOLYOKE MA GUILHERME CAMOSSATO • 1/1 019111112010At1'1NDCavOMTIDIL P.1 rights reserved. 1 STATE OF CONNECTICUT DEP.4Rr.trE.vr OF CONSE:VER PROTECTiox ROME IMPRPVEKEIrr„ .,_,. __ CONTRACTOR -- conalonwea" c't wiassairusettsre thymic:al an of Professional d standards igt _ ,Reguiatons 'r'A., j Board of Bu"s'ul f 7' - S ialtY ctipri41PerASTP Pec '- 142 PiriO Con jt:! Stril ......, -I 1101A70.05.Mg:.. ' EXTON ROOFTN4'..*SED/NCH.7111'..co. ' -:' 1 •••,Fnires:1131(3512(323 2411 G581,099639 EVERETT.1 s,:_ ' HIC•0605383 - ,'1,-.y4,1:..".„ /:01H*gecti*I6'1291:-':.i''''''''.':::4^-'''...u.2‘. ExPu2/31/262°023 --:--- ‘41 Abi!,4;z-21,10` SIGNED ( dtael A'_BtntSiga-- — Commissioner ----= -- —___---- ____-- - R...9'.;:-.4.:.-.77,:int\iz.-.-rete RES PC:INS1BLE R.Er4STRATICIN .A.E.frli-"ZEsS, *-21.4.17:1 ATION STAT:'Xi ;.-.1.71TVIU•L'A 3 IIIIMSER , 1..r. .1 1....-.. SEXTON ROOFING& SEXTON.EVERETT 118239 PO_BOX 6327 I pi, • .1,,A{ CiNiErit • Sidng Inc HOLYOKE,MA 01041 finpw.ften•rceszcasteir_mearstiiiermenseertstaspix '. .---;.' la • •