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32C-221 (9) BP-2022-1370 97 HAWLEY ST COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 32C-221-001 CITY OF NORTHAMPTON Permit: Acc Structure PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) BUILDING PERMIT Permit # BP-2022-1370 PERMISSION IS HEREBY GRANT D TO: Project# ACC STRUCTURE Contractor: License: Est. Cost: 32752 Const.Class: Exp.Date: HAMPSHIRE EDUCATIONAL COLL•I:ORATIVE Use Group: Owner: INC Lot Size (sq.ft.) HAMPSHIRE EDUCATIONAL COLLA:ORATIVE Zoning: 01 Applicant: INC Applicant Address Phone: Insurance: 97 HAWLEY ST NORTHAMPTON, MA 01060 ISSUED ON: 10/25/2022 TO PERFORM THE FOLLOWING WORK: 14X26 ACCESSORY STRUCTURE TO BE USED AS OFFICE SPACE 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: � , Ifj Fees Paid: S73.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Office of the Building Commissioner RECEIVE—. ) OCT 4 2C22 +he Commonwealth of Massachusetts Office of Public Safety and Inspections Massachusetts State Building Code(780 CMR) DEPT.OF BUIL A& twit Application for any Building other than a One-or Two-Family Dwelling NORTHAMP!Urv.MA --0 (This Section For Official Use Only) Building Permit Number: e /ate. 0 Date Applied: Building Official: SECTION 1:LOCATION 97 Hawley Street Northampton 01060 tr. City/Town Zip Code Name of Building(if applicable) 3J+C-- 41 Assessors Map# Block#and/or Lot # SECTION 2:PROPOSED WORK Edition of MA State Code used If New Construction check here 0 or check all that apply in the two rows below Existing Building 0 Repair 0 Alteration 0 Addition 0 Demolition ❑ (Please fill out and submit Appendix 2) Change of Use 0 Change of Occupancy 0 Other 0 Specify: Are building plans and/or construction documents being supplied as part of this permit application? Yes 0 No 0 Is an Independent Structural Engineering Peer Review required? Yes 0 No 0 Brief Description of Proposed Work To install a pre-made outdoor accessory structure on the property that is 14'x 26'. It will be used as a meeting space.There will not be any plumbing-only electrical. SECTION 3:COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATION,ADDITION,OR CHANGE IN USE OR OCCUPANCY j Check here if an Existing Building Investigation and Evaluation is enclosed(See 780 CMR 34) ❑ Existing Use Group(s): Proposed Use Group(s): _ SECTION 4:BUILDING HEIGHT AND AREA Existing Proposed No.of Floors/Stories(include basement levels)&Area Per Floor(sq.ft.) Total Area(sq.ft.)and Total Height(ft.) SECTION 5:USE GROUP(Check as applicable) A: Assembly A-1 0 A-2 0 Nightclub ❑ A-3 0 A-4 0 A-5 0 B: Business 0 E: Educational 0 F: Factory F-1❑ F2 0 H: High Hazard H-1 0 H-2❑ H-3 0 H-4 0 H-5 0 I: Institutional I-1❑ I-2❑ I-3❑ I-4❑ M: Mercantile 0 R: Residential R-10 R-2 0 R-3 0 R-4 0 S: Storage S-1 0 S-2 0 U: Utility 0 Special Use 0 and please describe below: Special Use Description: SECTION 6:CONSTRUCTION TYPE(Check as applicable) IA 0 IB ❑ IIA ❑ IIB ❑ IIIA ❑ IIIB ❑ IV VA CI VB SECTION 7:SITE INFORMATION(refer to 780 CMR 105.3 for details on each item) Trench Permit. Debris Removal: Water Supply: Flood Zone Information: Sewage Disposal: Licensed Dis sal Site 0 Public El Check if outside Flood Zone 0 Indicate municipal ElA trench will not be po Private 0 or indentify Zone: or on site system 0 required i 0 or trench or specly: permit is enclosed 0 Railroad right-of-way: Hazards to Air Navigation: MA Historic Commission Review Process: Not Applicable 0 Is Structure within airport approach area? Is their review completed? or Consent to Build enclosed 0 Yes 0 or No 0 Yes 0 No 0 SECTION 8:CONTENT OF CERTIFICATE OF OCCUPANCY Edition of Code: Use Group(s): Type of Construction: Does the building contain an Sprinkler System?: Special Stipulations: Design Occupant Load per Floor and Assembly space: City of Northampton ?ogi , or SAS »....._SIC . . Massachusetts ?�' << �;r *.v \c• d. ' DEPARTMENT OF BUILDING INSPECTIONS '. r, !a �l y 212 Main Street • Municipal Building J�;.� C. ••ems' Js•4......... p ��� Northampton, MA 01060 ►� ��'� PROCEDURE FOR OBTAINING A BUILDING PERMIT FOR COMMERCIAL & MULTI-FAMILY NEW CONSTRUCTION/ADDITIONS/ALTERATIONS 1. Building Permit Application signed by legal owner and filled out by owner or authorized agent. 2. One set of plans and specifications of proposed work (Digital & Hard copy). 3. Site Plan with location of proposed structure(s) and setbacks. 4. Construction Debris Affidavit filled out and signed by applicant. 5. Worker's Compensation Insurance Affidavit filled out and signed by applicant. 6. Contractors must supply a copy of CSL and proof of Liability Insurance. 7. Energy Conservation Compliance Certificate (if applicable). 8. Note any Conservation and/or Special Permit requirements (if applicable). 9. Driveway Permit (if applicable). 10. Proof of Water and Sewer entry fees paid (if applicable). 11.Trench Permit (if applicable). 12. Initial Construction Control Documents filled out and signed by the Registered Design Professional in responsible charge. 13. Please provide the appropriate fee in the form of a check made payable to: The City of Northampton SECTION 9: PROPERTY OWNER AUTHORIZATION Name and Address of Property Owner Collaborative for Educational Services 97 Hawley Street Northampton 01060 Name(Print) No.and Street City/Town Zip Property Owner Contact Information: Executive Director 413 _ 586 _ 4900 _ - tgazda@collaborative.org Title Telephone No.(business) Telephone No. (cell) e-mail address If applicable,the property owner hereby authorizes: Todd Gazda 97 Hawley Street Northampton MA 0106 Name Street Address City/Town State Zi to apply for and act on the property owner's behalf,in all matters relative to work authorized by this building permit application SECTION 10:CONSTRUCTION CONTROL(Please fill out Appendix 1) If a building is less than 35,000 cu.ft.of enclosed space and/or not under Construction Control then check here O. Otherwise provide construction control forms(see section 107 in the code)as required. 10.1 Registered Professional Responsible for Construction Control(the professional coordinating document submittals) Name(Registrant) Telephone No. e-mail address Registration Number Street Address City/Town State Zip Discipline Expiration Date 10.2 General Contractor l< Lo-rstr& FFCc Company Name Name of Person Responsible for Construction License No. and Type if Applicable Street Address City/Town State Zip Telephone No.(business) Telephone No.(cell) e-mail address SECTION 11:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.152.§ 25C(6)) A Workers'Compensation Insurance Affidavit from the MA Department of Industrial Accidents must be compleed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the buildifrig permit. Is a signed Affidavit submitted with this application? Yes D No 17 SECTION 12:CONSTRUCTION COSTS AND PERMIT FEE Item Estimated Costs:(Labor and Materials) Total Construction Cost(from Item 6)=$ 1.Building $25,252 Building Permit Fee=Total Construction Cost x (insert here 2.Electrical $7,500 appropriate municipal factor)=$ 3.Plumbing $ r 00 4.Mechanical (HVAC) $ Note:Minimum fee=$ P. (contact municipality) 5.Mechanical (Other) $ Enclose check payable to 6.Total Cost $32,752 (contact municipality)and write check number here I oWAP'9 SECTION 13:SIGNATURE OF BUILDING PERMIT APPLICANT 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 e best of my knowledge and understanding. Todd Gazda `'`/� Executive Director 413 _586 _ 4900 /07A,? Please print and sign name Title Telephone No. Date 97 Hawley Street Northampton MA 01060 tgazda@collaborative.o Street Address City/Town State Zip Email Address Municipal Inspector to fill out this section upon application approval: �: ` a' I 0/aVd Name bate CITY OF NORTHAMPTON SETBACK PLAN MAP: LOT: LOT SIZE: REAR LOT DIMENSION: REAR YARD See attached document SIDE YARD SIDE YARD FRONT SETBACK FRONTAGE :NHA EYSTl T $ l „,,---- M-1u ,••-- \ t + I Ia • G ^O N r d F ill . * I O 4. t‘�s : se I 11 ..• City of Northampton Massachusetts DEPARTMENT OF BUILDING INSPECTIONS c:h4;,.k 212 Main Street • Municipal Building y `l .�, s Northampton, MA 01060 ,'I,} ,.,o 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: Marion Excavating Co. Location of Facility: 749 New Ludlow Rd, South Hadley, MA 01075 _ The debris will be transported by: Name of Hauler: Haber Brothers /2—Applicant: y Date: /.fit , Signature ofpp -- The Commonwealth of Massachusetts 1' ` ;A Department of Industrial Accidents Congress Street,Suite 100 ._;. : __ __ Boston, MA 02114-2017 www.mass.gor/dia 1lpikers'Compensation Insurance Affidavit: Builtiers!ContractorsIEIectriciansfPlumhers. TO BE FILED 11'ITH THE PERMUTING AIrTHORITY. Applicant Information Please Print Lel_�il►lr Name(I3usiness&Organtz.ation lndtvidunll: Collaborative for Educational Services Address: 97 Hawley Street City/State/Zip: Northampton, MA 01060 Phone#: 413-586-4900 _ Are you an employer"t hack the appropriate hoc Type of project(required): it]I am a employer w Lth crtpluys.cs(full and or part-time)_• 7. © New construction 2.El I am a sole prupnetor or partnership and have no employee,working for me in 8. D Remodeling any capacity.[Nu workers'comp.insurance required.] 30 I am a homeowner doing all work.myself.[No workers'comp.insurance required]► 9. ❑Demolition homeowner 40 I am a homeowner and will be hiring contractors to conduct all work on my property. I will 10 El Building addition ensure that all contractors either have workers'ouergiensation insurance or arc sole 114:3 Electrical repairs or additions proprietors a ith no employees. 12.1]Plumbing repairs or additions 1D1 am a general contraciur and 1 have hind the sub-contractors listed un the attaclicd sheet- 13.1DROOf repairs Thee sub-contractors base employees and lease wurkers•comp.insurances h.D We are a melioration and its officers have exercised thou nghl of exemption per ht(iL c. 14.❑Other_ 132,11(4),and we have no cinpluyces.[No a orkers'comp.insurance required.] •Any applicant that checks but al most alai fill out the section below showing their worker'compensation pulley information. Homeowners who submit this affulas it indicating they are doing all work and then hue outside contractors must submit a new atlidas it andieating such. )Contractors that check this box mum attached an additional shirt show Mg the name of the sub-contracture and state a holier ur nut Muse amities hasc employees- If the sub-contractors hale employees.they, mom prusidc their workers-Dump.policy number. 1 am an employer that is providing worlters'compensation insurance for my employees. Below is the policy and Job site information. Insurance Company Name: Policy#or Self-ins.Lic.#: Expiration Date: lob Site Address: CityiState.Zip: Attach a copy of the workers'compensation polky declaration page(showing the policy number and expiration date). Failure to secure coverage es required under MGL c. 152,*25A is a criminal violation punishable by a fine up to$I,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify a tier the I and penalties of perjury'that the information provided above 's true and correct. Signature: / � Phone P: 413-586-4900 Official use only. Do not write in the% area,to be completed by city or town official ('its or Town: Permit/License h Issuing Authority (circle one): I. Board of Ilealth 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector t,. Other Contact Person: Phone#: The Commonwealth of iilassachuselts Print Form Department of industrial Accidents =s two=4.,t Office of Investigations .-z / Congress Street, .Suite lull - Boston, MA 02114-2017 .-f-1,`` ►rt,.w.mass.goi/dia Workers' ('ompensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print 1 e¢ihly A:111te illustn.s.I?rganizahunlndividual):Kloter Farms Inc Address:216 West Rd ('its state 71 .Ellington CT 06029 Phone 4:860-871-1048 Arc you an employer?Check the appropriate box: —1 ✓ 40 4. lam a generalType of project(required) 1.Q I am a employer with ❑ contractor and 1 employees(full and or part-time).* have hired the sub-contractors 6. ❑ New construction 2.❑ 1 am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling shipand have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. employees and have workers' q ❑ Building addition [No workers'comp. insurance comp. insurance.: required.] S. ❑ We arc a corporation and its 10.0 Electrical repairs or additions 3.ElI am a homeowner doing all work officers have exercised their 1 LE Plumbing repairs or additions I myself.[No workers' comp. right of exemption per MGL 17 ❑ Roof repairs insurance required.]' c. 152,§1(4).and we have no 13.❑Other employees.[No workers' comp. insurance required.] 'Any applicant that checks box#1 must also fill nut 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 :Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those.nutlet have employees If the sub-contractors have employees,they must provide their workers'comp.policy number l am an employer that is providing workers'compensation insurance for my employees. Below is the policy and jab site information. Insurance Company Name:Travelers Policy#or Self-ins. Lic.#: 02WECAN5GGW _ Expiration Date:10/24l2022 Job Site Address: --__—.—City'State'Zip: ----- Attach a copy of the workers'compensation policy declaration page(showing the policy number and expirat n date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal pen fries of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDE and a tine of up to S250.00 a day against the violator. Be advised that a copy of this statement may be tons arded to the Otlic of Investigations of the DIA for insurance coverage verification. i do hereby certify u der the pains and penalties r popery that the information provided above is true and.urrtct. Signal re'I a g t/ . katel ./ /1//1Z , Phone#:860$71-1048 41 Official use only. Do not write in this urea,to he completed lit'city or town officiaL City or Town: Permit/License# Issuing Authority(circle one): 1. Board of Health 2. Building Department 3.City/Town Clerk 4. Electrical Inspector S. Plumbing Inspector 6.Other Contact Person: Phone#: 1 (Policy Provisions: WC000000C) INFORMATION PAGE WORKERS COMPENSATION AND EMPLOYERS LIABILITY POLICY INSURER: SEE ATTACHED ENDORSEMENT THE Ao"' NCCI Company Number: 30147 HARTFORD Company Code: 9 Suffix LARS RENEWAL POLICY NUMBER: 02 WEC AN5GGW Previous Policy Number: New 1. Named Insured and Mailing Address: KLOTER FARMS INC (No., Street, Town, State, Zip Code) 216 WEST RD ELLINGTON CT 06029 FEIN Number: 06-1135178 State Identification Number(s): Refer to the EXTENSION OF THE INFORMATION PAGE-WC990365. The Named Insured is: Corporation Business of Named Insured: Furniture Stores Other workplaces not shown above: See Endorsement-WC990366 2. Policy Period: From 10/24/21 To 10/24/22 ANNUAL 12:01 a.m., Standard time at the insured's mailing address. Producer's Name: DOWDING MORIARTY& DIMOCK PO BOX 300 ROCKVILLE CT 06066 Producer's Code: 02020214 Issuing Office: THE HARTFORD BUSINESS SERVICE CENTER 3600 WISEMAN BLVD SAN ANTONIO TX 78251 (877) 853-2582 Total Estimated Annual Premium: $50,834 Deposit Premium: Policy Minimum Premium: $1,620 CT (Includes Increased Limit Min. Prem.) Audit Period: ANNUAL installment Term: Ten Pay(25%Down+9@8.33%) The policy is not binding unless countersigned by our authorized representative. Countersigned by J;-4t9 d' t d2 ra, Q- 10/20/21 Authorized Representative Date Form WC 00 00 01 A (1) Printed in U.S.A. Page 1 (Continued on next page) Process Date: 10/20/21 Policy Expiration Date: 10/24/22 INFORMATION PAGE (Continued) Policy Number: 02 WEC AN5GGW 3.A. Workers Compensation Insurance: Part one of the policy applies to the Workers Compensation Law of the states listed here: CT SEE ENDORSEMENT-WC 99 03 67 B. Employers Liability Insurance: Part Two of the policy applies to work in each state listed in Item 3.A. The limits of our liability under Part Two are: Bodily injury by Accident $1,000,000 each accident Bodily injury by Disease $1,000,000 policy limit Bodily injury by Disease $1,000,000 each employee C. Other States Insurance: Part Three of the policy applies to the states, if any , listed here: ALL STATES EXCEPT NORTH DAKOTA, OHIO, WASHINGTON, WYOMING, U.S.TERRITORIES AND STATES DESIGNATED IN ITEM 3.A, OF THE INFORMATION PAGE. D. This policy includes these endorsements and schedule: SEE ENDORSEMENT-WC 99 03 68 4. The premium for this policy will be determined by our Manuals of Rules, Classifications, Rates and Rating Plans. All information required below is subject to verification and change by audit. Premium Basis Classifications Total Estimated Rates Per Estimated Code Number and Annual $100 of Annual Description Remuneration Remuneration Premium Total Standard Premium $48,958 Premium Discount -$1,518 Expense Constant $160 Terrorism Risk Insurance Program Reauthorization Act Disclosure Endorsement $813 Catastrophe (Other Than Certified Acts Of Terrorism) $325 Other Miscellaneous State Premiums $20 Estimated Annual Premium (before Surcharges) $48,758 Total Estimated Surcharges $2,076 *See the attached Schedule(s) of Operations for Location and State Level Premium Information Total Estimated Annual Premium: $50,834 Deposit Premium: Policy Minimum Premium: $1,620 CT (Includes Increased Limit Min. Prem.) Interstate/Intrastate Identification Number: Refer to Schedule of Operations NAICS: 442110 Labor Contractors Policy Number: SIC: 5712 Form WC 00 00 01 A (1) Printed in U.S.A. Page 2 Process Date: 10/20/21 Policy Expiration Date: 10/24/22 ,_67:4 6/32/740-7W}eadle/ Ilx)-e/Z1- Office of Consumer Affairs and Business Regulation 1000 Washington Street - Suite 710 Boston, Mapsachusetts 02118 Home Improvement optractor Registration Type: Corporation z 4.1 ,G i" �� Registration: 127530 KLOTER FARMS, INC r`,' .--t J4; t t•! ' Expiration: 11/08/2022 PO BOX 440 . ua k' ELLINGTON,CT 06029 v '`."n i i+ .fir' t�_-'--"- 1,,� v.."" Update Address and Return Card. SCA 1 0 200MM-06/1177 �® ,n gix,, ncyzCticial Zdp 6/..il¢e1Jacivet eV4 Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only TY,PLt.\Corporation before the expiration date. If found return to: Registratioi't gxplration Office of Consumer Affairs and Bu iness Regulation 1275,@. 11/08/2022 1000 Washington Street -Suite 0 KLOTER FARI rM Boston,MA 02118 _14 yFs JASON K.KLOT F ,W/ -°k'„! a,( 1. if 216 WEST ROAD`:�+�ti:r,�;j ELLINGTON,CT 0602t9"" Undersecretary of valid without signature KLOT -2 OP ID: JODI ACORO CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 10/25/2021 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 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 Dowding,Moriarty&Dimock Inc NAME: Jodi Sakai 139 Uni Street PHONE N,Eat):860-875-2523 FAX No): 860-875-0921 Rockville,CT 06066 AA DRESS:• jsakal@dmdinsurance.com ED GIZA INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:THE HARTFORD INSURED Kloter Farms, Inc. INSURERa:Central Insurance Company Country Warehouse,LLC ATIMA 216 West Road INSURER C: Ellington, CT 06029 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 ADDL SUBR POLICY EFF POLICY EXP L�MITS LTR INSR WVD POLICY NUMBER (MM/DDIYYYY) (MM/DD/YYYY) GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 B X COMMERCIAL GENERAL LIABILITY 8694976 10/24/2021 10/24/2022 DAMAGE TO RENTED 100,000 PREMISES(Ea occurrence) $ CLAIMS-MADE X OCCUR MED EXP(Any one person, $ 5,000 PERSONAL 8 ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GENII AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 7 POLICY n JECT n LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1000,000 (Ea accident) S + B X ANY AUTO 8694977-10 10/24/2021 10/24/2022 BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOS x SC AUTOS BODILY INJURY(Per accident) $ X HIRED AUTOS X NON-OWNED PROPERTY DAMAGE AUTOS (PER ACCIDENT) UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 5,000,000 B EXCESS LIAB CLAIMS-MADE 8694978-10 10/24/2021 10/24/2022 AGGREGATE $ 5,000,000 DED RETENTION$ $ WORKERS COMPENSATION X WC LIMITS I:R AND EMPLOYERS'LIABILITY A ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N 02WECAN5GGW 10/24/2021 10/24/2022 E.L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED'? N/A (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 B Property 8694976-10 10/24/2021 10/24/2022 Blanket 9,647,000 Property DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks Schedule,If more space Is required) Evidence of Insurance CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Kloter Farms, Inc THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Evidence of Insurance AUTHORIZED REPRESENTATIVE 40//rie:i ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD