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24D-090 BP-' 022-1313 68 NORTH ST COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 24D-090-001 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-2022-1313 PERMISSION IS HEREBY GRANT, D TO: Project# ROOF Contractor: License: Est. Cost: 35600 SEXTON ROOFING CO 99689 Const.Class: Exp.Date: 10/05/2023 WOLFRAM JEANNINE M & BARBA•A E 317 WEST Use Group: Owner: ST Lot Size (sq.ft.) Zoning: URC Applicant: SEXTON ROOFING CO Applicant Address Phone: Insurance: P O BOX 6327 (413)534-1234 7pjubog07898222 HOLYOKE, MA 01041 ISSUED ON: 10/13/2022 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: CP 1 • •• Fees Paid: $40.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Office of the Building Commissioner &. _ The Commonwealth of Massachusetts - Board of Building Regulations and Standards . FOR Massachusetts State Building Code,-780 CMR,7e edition M US TY Building Permit Application To Construct,Repair,Renovate Or Demolish a Rerisedfamrary i+--� One or Two-Family Dwelling 1,2008 '.z1 This Section For Official Use Only 4 � Building Permit Nu . t?"s?- f 31 3 1 Date Applied: i N1. �/ l(1- I 3-ZVZZ o m signature: . / Z �,- o h �' 11 ' '1, Building Commissioner/Inspector of Buildings Date * . 6,,, t I''j - SECTION 1:SITE INFORMATION . 1.1 Pr perty Address: 1.2 Assessors Map&Parcel Numbers 1.1 a Is this an accepted street?yes no Map Number Parcel Number • 1.3 Zoning 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 0 Private❑ Zone; : Outside Flood Zone? Municipal❑ On site disposal system ❑ (b eck,if yes❑ - SECTION 2: PROPERTY QWNERSHIP' 2.1 Owner'of Records j .5 / `, i/li S--, /L' 4-4- ' N (Print) / Address for Service: / . 24 `/`4- 3 0/- ,o) - )Y's(G -t)C:L1 I/,r 55 3 4 Frs-C,, Signature Telephone . SECTION 3:DESCRIPTION OR PROPOSED WORK'(check all that apply) New Construction❑ Existing Building E wner-Occupied u)- Repai s(s) El Alteration(s)-LI Addition ❑ Demolition 0 Accessory Bldg.❑ Number of Units .)--_ Other 0 Specify: Brief Description of Proposed Wor : 1L-7� 1 ,r • � \ _- . ��[i �G:� � `J -'T /G(.'� �rrC� r-] J 4 !."Z,i - ,�01-7/--- SECTION 4:ESTIMATE()CONSTRUCTION COSTS j Item • Estimated Costs: Official Use Only (Labor and Materials) . I.Building $ 1, Building Permit Fee:$ Indicate how fee is determined: . 0 Standard City/Town Application Fee 2.Electrical $ 0 Total Project Costl(Item 6)x multiplier . x 3.Plumbing : . S " 2. Other Fees: $ 4.Mechanical (HVAC) S List: . 5.Mechanical (Fire $ Total All Fees:S Suppression) - • • d Check No.��) t Gfeck Amount; ►"Cash Amount: 6.Total Project Cost: ` $3)/ AV) 0 Paid in Full El Outstanding Balance Due: • SECTION 5: CONSTRUCTION SERVICES tio Si. Construcn Supervisor License(CST) / W 05 , erer-e f/ ie,ttaf) License Number Name afCSL Holder Type(seebelaw) �C=���.i 'P0 (60)( ( 7 List CST T No.and Street Type Description (,." ''' f 11 n I j Li Unrestricted(Buildings up to 35,0O0 cu.f) a ram( / v 1 R Restricted 1&2 Family Dwelling ' Cityrr. State,LIP M MasDtuy RC Roofing Covering _ WS Window and Siding SF Solid Furl Burning Appliances I Insulation Telephone Email addres D Demolition . J 7 5� Registered HomeImprovement Contractor(HIC) i ?{) p�(T C PXmn �� n gni mil T-�7� i�lC1 Rena? 7on_Number -r.{ tp19#F,In; • HIC Co•..any Registrant Name No and Sired F .{1 midns hH4/�4 e P'')/ d/Lf / L/3-53h1��3 f� Cityn,State,Lit' Telephone SECTION.6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M_G.L c-I52-§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 ' 'ii(' No________-D SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES�tF�OR'ABIDING�PERMIT I,as Owner of the subject property_hereby authorize e �f) (X r.06"Q �,.1/afr/Q,r to act on my behalf,in all matters relative too work authorized by this building ermit application. t •'n1rC k + ' ( et `fd /U/)/O 2. Prim Owner's Name(Electronic Siptanne) 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 tame and accurate to the best of my knowledge and understandin / /G Sf7Z MUST BE SIGNED by Owner or Authorized Agent Date NOTES: s_ An Owner who obtains a btuilriing 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 rad 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 Wuw_ura,s,?m"oca Information on the Construction Supervisor License can be found at z4•nlv.mass.aovfdps 2_ When substantial wok is planned,provide the information below: Total floor area(sq.ft.) (including garage,famished basement/attics,decks or porch) Gross living area(s4 ft.) Habitable room count Number of fireplaces_ Number of bedrooms Number of bathrooms Number of halThati>_s 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 Cosf' City of Northampton �°t M-.TO\`�,' SAS '''- s� 4••' Massachusetts ,A.„z_ L °'e # $ •'4' DEPARTMENT OF BUILDING INSPECTIONS ? ° M • ' 212 Main Street • Municipal Building ,Ix. C1: � ✓^.>. Northampton, MA 01060 s' ,, i) ' 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: ? Q R74 4/ S71-- 7 l L�/ The debris will be transported by: Name of Hauler: 45-3'0 cox} './ ' , 4-6 ai.7,-' e $ Signature of Applicant: ,...„ Date: /e/S ?e- Proposal SEXTON ROOFING AND SiDING INC www.sextonroofinq.com VNO P.O. BOX 632 toe Srttrng thr Standard " main. Holyoke, MA 01141 444164111mPaeI�►'ilt■►s. p. 413.534.1234 f. 413.539.9906 MA KC#'18239 SUBMITTED TO Jonathan DeYbiss piiONt!sextonr oofjng(hotmajl.com STREET 68 North St DATE 0422 CITY, STATE.ZIP Northampton,Ma EMAIL Ittetraiss39rrtaiede— i. p roafr SEXTON ROOFING HEREBY SUBMITS SPECIFICATIONS AND ESTIMATES FOR: Mam.addition.and Garage 1) Strip and remove existing shingles and dispose of in proper landfill. 2) Install 1t2" plywood on main roof, inspect decking o remainder roofs and replace as needed d S105.00 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 IKO Architectural style roofing shingles as per manufacturers' specifications. 9) Install new cap over ridge vent. 10)Reflash chimney and intersecting walls with new lead. 11)Supply manufactures Lifetime warranty and SRC 5 yr_ workmanship warranty. ATTENTION HOM£OwNERS PLEASE:OVER ALL PERSONAL BELONOINGs th THE Am: GARAGE OR STORAGE AREAS Du ROSS4.E R•v IRO OEMS oR DUST COMING THROUGH CRACKS cF*Oob DECRa G s£i7QN ROOF AG StIA,.L APPo,FCR ALL.PERK s OR PR0.,[ We Propose hereby to furnish material antilw/6 ofospkialit Mt aptjeardimisaLmotaithree• ems cif Fire Thousand! Six Music'DOLLAIdi 01414111104101 PA Aril ( " duo Ira till epee completion At1 Matenat es guarani to be as sees:`et! Al'*04 rs*€rNnaie'Y'::M a AL thorned Aorkmanike manner acrnrdmg to str$' ,I a*acbces Ary$fer~Or ceviatiOn t'bm above spevrKaw,'s trvoivm.)e.lra costs we oe etec.atelt signature Halt-jpon arrrtten orders.and we became an e.'..i cnartle aver we above _ the esbrnate.OAwcEs'001.S+4s VC O1.Na Jt.N3.'A•*)N NUNS ON 4.0I+St damage during cone NI/D RE rt. n Owner un v:F s` Not resper,sttie fc►cater Note, This propose may he*Indrawn by t s if not . -.tom F'airr'ent and au1:==cater interest PayesPonsibc'e tees rx r- within(14)ciao Acceptance of Proposal The above prices. specifications and conditions are sat;sfactory and are Sigrature i._ r_ hereby accepted. You are authcnzed to the work as spec'lred Payment will be made as outlined above Srgratsre Date of Acceptance Department of Industrial Accidents 9 Office of Investigations it4) 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/orgoni7ation/Individual):Sexton Roofing&Siding Inc Address:P.O. Box 6327 City/State/Zip:Holyoke, Ma.01041 Phone#:413-5341234 T Are you an employer?Check the appropriate box: Type of project(required): • l.❑ 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 subcontractors ?.El I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have g. ❑Demolition workingfor me in anycapacity. employees and have workers' P ty t 9. ❑Building addition [No workers' comp.insurance comp.insurance. 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 I2 Roof repairs insurance required.]t c. 152,§1(4),and we have no employees. [No workers' 13.0 Other comp.insurance required.] tiny applicant that checks box#1 must also 511 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. 'onnactors 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. isurance Company Name:Travelers Property Cas Co Of Am olicy#or Self-ins.Lic.#:7PJUB0G07898297 Expiration Date:06/4/23 rb 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 [up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of ivestigations 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 Lenature: 1 Date: `cone#: S.--3 7 / Z y 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): 10Board of Health 20 Building Department 31:1City/Town Clerk 4.0 Electrical Inspector 50Plumbing Inspector 6.0Other Contact Person: Phone#: r • A�D® CERTIFICATE OF LIABILITY INSURANCE DATE(AIMLDD/YYY`() 06,61712022 THIS CERTIFICATE IS ISSUED AS A MA1 Itft OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON TF 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 CE RTIFfCATE HOLDER IMPORTANT: If the certificate holder is an ADDMONAL INSURED, the pii,y(ies)nest be darsed_ If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsemenL A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT mune Kathi Hutchinson ORMSBY INSURANCE AGENCY , r (413) I IFAX c,Nol: ADDRE kttutchinson aDn�ss: gtonnsilyins.cnm P 0 BOX 718 stasunE3AspwRaiRimeiscoweRAGE NA,c WEST SPRINGFIFI D MA 01090 ENSURER A, TRAVELERS PROPERTY CAS CO OF AM 25674 IlNSURZED - INSURER s: SEXTON ROOFING&SIDING INC INSURER C7 PO BOX 6327 INSURER E: HOLYOKE MA 01041 INSURER F. l COVERAGES CERTIFICATE NUS 7ffi111 REVS NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BE$1 IKCI IF7?TO THE INSURE NAMED ABOVE FOR THE POLICY PERIOD INDICA I Ui. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PER IAIN,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 CLAMS_ MISR ,..,.,.5MR POLICY f POLICY BCP LTR TYPE OFDISUR NCE MD WVD POLICY rt1H� t fAIIIIHHYrrYfl I f TTY)i LE5 ! COMMERCIAL GENERAL LIABILITY - I EACH OCCURRENCE 5 DAMAGE TO ReITED CLAIMS-MADEOCCUR PREMISES comma®) S 1 MED EXP(Any ve Pam) {S N/A PERSONAL&AUV INI RY 15 GENLAGGREGATEUMITAPPLIESPsit GE4ERALAGGREGATE 5 I ��, f PRODUCTS-CfH�IOPAGG S _ �S I OTHER: AUTOMOBILE COMBINED SINGLE LIMIT (Ea .".-,It) 15 ANY AUTO BODILY Ittior'(Pere) S ALL owNEn ril SCHEDULED N/A mbar INAIRY(Per a a) 5 Arttas PROPERTY DAMAGE HI4rU AUTOS AUTOS . (Per accident) I S S f _ UrBRtT I a L IM I h OCCUR EACH K:E [S 1 EamssLIAB 1j cI PSMs-rACE N/A AGGREGATE I s I D® I RETENTIONS MITE S WORKERS COMPENSATXS1 I XI SYATUTE I I E'2_ B AND EMPLOYERS UTABM'r Y f ft - A OFFICERMEMBH2 ANYPROPRIETURIPARTN E71''UTTVE nA pfA tgA ]Q.jUB{}GI17 Q22 fl 2.3 El_ I SENT S 1,000,000 (Mandatoryin NH) EL DISEASE-EA EMPLOYEE S 1,000,000 If yes,disc be under D, r_RLP ION OF OPERATIONS below EL .-POLICY UNIT s 1,000,000 1 ' NIA DESCRIPTION OF OPERATIONS;LOCATIONS INS-OGLES iAcczas UM,Addiremai Ram arks Schmhdre,ate=ladled 4me space 6 nAwirv.) Workers'COMLA a isdli i benefits will be paid to Massachusetts emplayecrC oily_Pursuant to Endorsement WC 20 03,06 B,n0 authorization is given to pay claims for benefits to employees in states other than Massachusetts if the insured hires,or has tired those employees outside of Massachusetts. This certificate of insurance shows the policy in truce on the date that this certificate was issued(unless the expiration dam on the abo ie policy precedes the issue date of this certificate ofinsurance)_ The status of this coverage can be touoiluil.li dfalyby.,.,n• ,it ry the Proof of Coverage-CoI age Verification Search toot at www_mass_ ns Chit I IFICATE HOLDER • CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCFR I Fri BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. a IUITHOR=REPRESENTATIVE MA 01040 ,--i:u I -' Daniel M.C Sy,C3'CUU, President-Residual Market-WCRIBMA ©19888-2014 ACORD CORPORATION. Ail rights reserved_ ernrari at r,O1Sin-rh Tha errionre-seem=asci t.,.... .orriela.s.+—.--=- ...lei Ali !- SEXTO-2 OP ID: KH AWIZLY DATE(MM/DD/YYYY) 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(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. PHONE 413-737-0300 FAX 413-737-0617 698 Westfield St PO Box 718 (AIC,No,Eat): (ac,No): West Springfield,MA 01090 Ao RESS:eeembinske@ormsbyins.com Eric Dembinske INSURERS)AFFORDING COVERAGE NAIC# _ INSURER A:Northfield Insurance Company SURED INSURER B:Progressive 24260 SlNexton Roofing&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 IAOOL xUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE IIINSO iWYD POLICY NUMBER IMM/OD/YYYYI fMMIDDIYYYYI LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S 1,000'000 CLAIMS-MADE I OCCUR WS45073 06/25/2022 06/25/2023 DAEMISES(MAGE TOEa RENoccuTEnDence) S 100,000 PR MED EXP(Any one personi $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 Galt AGGREGATE OMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY Ter- LOC PRODUCTS-COMPIOP AGG $ 2,000,000 OTHER: I$ B AUTOMOBILE LIABILITY (Ea accident) OMBINED SINGLE LIMIT $ 1,000,000 ANY AUTO 04434955-0 05/1 512022 05/15/2023 BODILY INJURY(Per person) $_ OWNED X SCHEDULED _ AUTOS ONLY AUTOS BODILY INJURY Per accident) $ X HIRED X NON�J WNED (PerOadentDAMAGE $ AUTOS ONLY _ AUTOS ONLY UMBRELLA LIAB _ OCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS-MACE AGGREGATE �$ DED RETENTION$ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY ,r/N STATUTE I ER ANY PROPRIETOR/PARTNER/EXECUTIVE TO BE ISSUED SEPARATELY E.L EACH ACCIDENT $ OFFICERIMEMBER EXCLUDED? N/A (Mandatory In NH) EL DISFASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below EL DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (ACORD 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. AUTF(GRTZET7 REPRESENTATIVE ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. ► AcoR CERTIFICATE OF LIABILITY INSURANCE °ATE(MMf°°`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 PHONEr Ex@c (774)773 9702 FAX /A4C,Ns!: ADDRESS, Karina@mayflowerinsurance.com 2 Court St Unit B INSURER(S)AFFORDING COVERAGE NAM A Plymouth MA 02360 INSURER A: HARTFORD UNDERWRITERS INS CO 30104 INSURED INSURER B: MNP CONSTRUCTION INC INSURERC: INSURER D 76 GROVE ST APT 1 INSURER E: MILFORD MA 01757 INSURERF: 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. INSR ADDL POLICY NUMBER (MMIDD EFF POLICY EXP LTR TYPE OF INSURANCEINSO NVI NIVE1 POUCY/YYYYI (MMIDDIIYYYY) LIMITS LT COMMERCIAL GENERAL UABI11TY ' I EACH OCCURRENCE $ DAMAGE TO RENTED CLAIMS-MADE I OCCUR PREMISES(Ea occurrence) $ MED EXP(Any one person) $ N/A PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: • GENERAL AGGREGATE $ POLICY PRO JECT LOC PRODUCTS-COMPIOP AGG $ OTHER: AUTOMOBILE LIABILITY COMBINED SINr i F UNIT $ (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 J AUTOS ONLY (Per accident) $ UMBRELLA UAB _ OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE N/A AGGREGATE $ DED RETENTION$ WORKERS COMPENSATION - X STATUTE ER AND EMPLOYERS'LIABILITY ANYPROPRIETOR/PARTNER/EXECUTIVE YIN EL EACH ACCIDENT $ 1,000,000 A OFFICER/MEMBEREXCLUDED7 WA WA 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 I LOCATIONS I 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 ACCORDANCE WITH THE POLICY PROVISIONS. SEXTON ROOFING & SIDING INC 102 PINE ST AUTHORIZED REPRESENTATIVE Holyoke MA 01040 Daniel M.Cro L� ..r1 y,CPCU,Vice President—Residual Market—WCRIBMA ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD Ong • DATE ti CERTIFICATE OF LIABILITY INSURANCE 03/21/2022 THIS CERTIFICATE IS ISSUED AS A MATTER:OP MFORMATION.ONLY AND CONFERS NORIGH.UPON.THE CERTIFICATE HOLDER_THIS • CERTIFICATE DOES NOT AFFTRHATIVELYORTEGATIVELYA ,EA7Hp ORALTER TIE COVERAGE AFFORpm BYTHE POLICES BELOW_THIS CERTIFICATE OF INSURANCE DOES NOT'CONSTITUTEACONTRACT BETWEEN:TIE`ESUING INSURERS),AUTHOR® SASS.. 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 condiboes of the policy,ce taor policies may require an endorsement Astatementon f/Tte ceOTe.ade does not confer rights to the certificate holder in lieu of such endorsemenks). PRODUCER CONTACT GuihemaCamcoasto nte�� PHONE 970 726;9830• I-INSURANCE GROUP INC uur;No s:t ari grancErsalopiiLinsormpoopiret 799 GORHAM ST ADDRESS: LOWELL,MA 01852 i AFNO1NceOVERAGE NA INSURED INSURERAl-G8R9iALSTAR.MDEAH,IRTY COM INSURER'B ARBELLAPROTECIIONINSURANCE LDG HOME IMPROVEMENT INC INSURER C..:.`•. ••• : 18 SPRING ST FL1 INSURER 0_:TRAVFJ$2S•PROPERTY CAS CO OF AM MILFORD, MA 01757 INSURER E INSURER F: COVERAGES CERTIFICATE.NUMBER.000015. .. REVISION.NUMB6R.• INDICATED_NOTWITHSTANDING ANY REQUIREMENT;TERM OR CONDITION OF ANY CONTRACT OR OTF$R DOCII.attIT.WITH RESPECT TO WHICH THIS Chi I IFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLIC ES.DESLRIBED HEREIN IS SUBJECT TO TALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES LIMITS SHOWN MAY HAVE BEE REDUCE BY PAID CLAIMS. INSRL ADaI SLIER Po JCY sE PCI CY EW • TR TYPE OF INS/MANSE NSa p POILY MIDABEi (6ACOMYY}. (11 Y YY) LENTS A GENERALUAm17T eaoramsll $ 1,000,000.03 X SAL et?eERAL LUB:RY DNMGEIDRENIID vREeSES(Ea csamence) S 100000.00 . CLAWS-RAM Jx J oeeee I R®EwlAgewPA..h S MOWN IMA395923A 3/5121= 3/612023 PERMNAL atArty S 'mammon JGREW/AAZGR ATE S 2,000,000-00 GEfLAG(7EI'.AIE Lacer APPLES PER Rama oapiehd Op.A S 2,022,000.00 POOR n PRCUECT' llOC- B f.OMINE0 SEM3LE BNr V O .EtL18r1rY (Ea arnmau $ 1 AC1 Ann AUTO BODILY suhtr War Pry $ 20,000.170 NI.OWNIED AUTOS AUTOS 1020095012 4N32021 4/13/2022 OLYNnur(ctr.m,.n H $ 40A0000 - -NONd7A,Nm PROPERTY DAMAGE —HhemNAOS _ AUTOS IPraccaftoll S 100,000m LLeBi�lU L]AH OCCUREACH OCCURRENCE ESC=WO uN6eAiE I�GGeTEGeTIE nm TFTDrroes D vtOmcElscompewAnON IINCSTATUTORY OTR AND BiPi 5 Ue JTY YIN LaaTS Eat our peopmEmeeARTHERtExEctirTvE LhDra7h nEa EAcu Acc ENr 1r003 m • 6HUB4NBS9742 77 3/260022 3/26/2023 • $ mch .EL atE/Lg-EAO L0 r£ $ 1.om.11r1•r DEYTnPTION OF 0PERATI0NS baba EL INS $ 1. DESCRPTION OF OPERATIONS!L OCATEOKS I VEHICLES{Attach*CORD 101,AddAor &Rrn,ele Schedule,II note spec.is reapeanhl GENERAL SAND/TY:for Jegularaced=cal jars and the ceanc to holder is an addiiorhal insured. NhRters'Ce parrseer benefits ail he paid e7 Aitassocbusells employees only Pursuant lo Endorsement wC 20 03 06$rvi audianatiin is gvee Ivory darts for lanais m employees in stater odherthan Maaa husetts d the jawed hies,or has tied than employees rartsirb a/N This cectiTicate of insurance shows the polo/in farce a1 ins date that the rye was weed(unless the eel:t oton date an Me above policy precedes the issue date oftrrs certificate of insurance).The sta=oft,*.mverage can bnmoracted daily try accessing the Proof of Coverage-Coverage Verification Sancti tocN imiNtnhass • CERTIFICATE HOLDER CANCELLATION • SHOULD ANY OF THE ABOVE ABED POLICIES BE CANCELLED BEFORE THE EXPIRATION BATE IT IS THE CUSTOMERS RESt'ONSASUJT(TO INFORME ANY SEXTON ROOFING&SIDING INC CHANGES OR CANcaATIONS 102 PINE ST.,HOLYOKE MA GUILHERME CAMOSSATO 1/1 ®1483-m10Ao011DO NPOIMMINLM tighLCleered. STATE OF CONNECTICUT DEPARTNEvr OF CO:VR:31'ER PROTECT1O.V a5szettisetts HOME ird:PROI‘TF.,11T-CONTRACTOR pnweattil " censure cornm pr3fessionat.u anc_towsards VARETTJ SEXT , SR Regutatiads oare, suo•-41" /,Tr - r specialty AgEr PzxieSt Cons— _10,0512023 HO .YãKE,,MA iè4.z4ii cssL-099689 t- sEXTON ROOFING. 8cSIDiNG CO EVERErrpoBox„,--evi - HIRisIminC.060;3834 3ExPixa/31/63:023 tt000kcE mA?"1" -40WS" :••=0;,'` , oissAikk.. SIGNED 7:147"-lea Commissioner _ - aistrantili RES'Pir..13(tSJ ELE RECE-TTRATION AianRESS EXL -TIGN 7NDIVIDUAL iiiTakiBER OA SEXTON ROOFING& SEXTON,EVERETT 118239 P_O_BOX 6327 se-+ Cunent Siding Inc HOLYOKE.MA 01041 • 4;7. ii2 https-fiservicets.ccastatesnausfricifi . - • • • • •