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36-137 (7) BP-2022-1478 20 LONGVIEW DR COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 36-137-001 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-2022-1478 PERMISSION IS HEREBY GRANTED TO: Project# ROOF Contractor: License: Est. Cost: 6600 THOMAS MORIN 112460 Const.Class: Exp.Date: 07/23/2024 Use Group: Owner: REARDON, JAMES P. &FARRELL, JI LLIAN E. Lot Size (sq.ft.) Zoning: URA/WSP Applicant: VALLEY ROOFING AND RESTORATION Applicant Address Phone: Insurance: 143 PARKER LANE (413)230-8076 7PJUB6R27625422 LUDLOW, MA 01056 ISSUED ON: 11/15/2022 TO PERFORM THE FOLLOWING WORK: STRIP AND RE-ROOF 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: tcft4&_, y9 . 'v Fees Paid: $40.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Office of the Building Commissioner RECE_ gM 1 _ I NOV 1 4 2022 I he C mmonwealth of Massachusetts Boa I of uilding Regulations and Standards 1 ar. FOR hus tts State Building 'Code 780 CMR MUNICIPALITY r)FPT.OF run_D N( INSP .0,0+ USE _ NAB plicat1 n To Construct,Repair,Renovate Or Demolish a Revised Mar 2011 One-or Two-Family Dwelling This ection For Official Use Only Building Permit Number: 42r' Date Applied: J/.)00 45, 1- 15-2ozZ Building Official(Print Name) Signature Date SECTION 1:SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map&Parcel Numbe 20 Longview Dr. Florence, MA 01062 1.1a 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(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 0 Private 0 Zone: _ Outside Flood Zone? Municipal 0 On site disposal system 0 Check ifyes❑ SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of Record: Jillian Farrell &James Reardon Florence, MA 01062 Name(Print) City,State,ZIP 20 Longview Dr. 860-294-6346 jillianfarrell@gmail.com No.and Street Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORK'(check all that apply) New Construction 0 Existing Building 0 Owner-Occupied 0 Repairs(s) 0 Alteration(s) 0 Addition 0 Demolition 0 Accessory Bldg. 0 Number of Units Other Specify: Roof replacement Brief Description of Proposed Work': Remove and replace asphalt shingles, see attached estimate if further detail is needed SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1.Building $ 6,600.00 1. Building Permit Fee: $ Indicate how fee is determined: 2.Electrical $ ❑Standard City/Town Application Fee ❑Total Project Costa(Item 6)x multiplier x 3. Plumbing $ 2. Other Fees: $ 4.Mechanical (HVAC) $ List: 5.Mechanical (Fire Suppression) Total All Fgeilj4 O Check No. /J"i Check Amo t: I Cash Amount: 6.Total Project Cost: $ 6,600.00 0 Paid in Full 0 Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) CS-112460 07/23/2024 Thomas Morin License Number Expiration Date Name of CSL Holder List CSL Type(see below) U 143 Parker Lane No.and Street Type Description Ludlow, MA 01056 U Unrestricted(Buildings up to 35,000 cu.IL) R Restricted 1&2 Family Dwelling City/Town,State,ZIP M Masonry RC Roofing Covering WS Window and Siding SF Solid Fuel Burning Appliances 413-230-8076 valleyroofingandrestoration@gmail.com I Insulation Telephone Email address D Demolition 5.2 Registered Home Improvement Contractor(HIC) 185148 08/08/2024 Tom Morin D/B/A Valley Roofing and Restoration HIC Registration Number Expiration Date HIC Company Name or HIC Registrant Name 143 Parker Lane valleyroofingandrestoration@gmail.00m No.and Street Email address Ludlow, MA 01056 413-230-8076 City/Town,State,ZIP Telephone SECTION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.152.§ 25C(6)) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the Issuance f the building permit. Signed Affidavit Attached? Yes No ❑ SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I,as Owner of the subject property,hereby authorize Tom Morin D/B/A Valley Roofing and Restoration to act on my behalf,in all matters relative to work authorized by this building permit application. Jillian Farrell & James Reardon 11/11/22 Print Owner's Name(Electronic Signature) Date SECTION 7b:OWNER'OR AUTHORIZED AGENT DECLARATION By entering my name below,I hereby attest under the pains and penalties of perjury that all of the information contained in this application is true and accurate to the best of my knowledge and understanding. Tom Morin D/B/A Valley Roofing and Restoration 11/11/22 Print Owner's or Authorized Agent's Name(Electronic Signature) Date NOTES: 1. An Owner who obtains a building permit to do his/her own work,or an owner who hires an unregistered contractor (not registered in the Home Improvement Contractor(HIC)Program),will not have access to the arbitration program or guaranty fund under M.G.L.c. 142A.Other important information on the HIC Program can be found at www.mass.gov/oca Information on the Construction Supervisor License can be found at www.mass.gov/dps 2. When substantial work is planned,provide the information below: Total floor area(sq.ft.) $6,600.00 (including garage,finished basement/attics,decks or porch) Gross living area(sq.fL) Habitable room count Number of fireplaces Number of bedrooms Number of bathrooms Number of half/baths Type of heating system Number of decks/porches Type of cooling system Enclosed Open 3. "Total Project Square Footage"may be substituted for"Total Project Cost" City of Northampton ?°a1 N o.t. ,S •• s, /�•�� S .• Massachusetts �,„ x_ 'c. H 1�.-� �.$ e DEPARTMENT OF BUILDING INSPECTIONS ts dr 212 Main Street • Municipal Building� J' C� „4'' Northampton, MA 01060 ssfh 3,'�%^� 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: Casella Waste Systems 700 Main St. Holyoke, MA 01040 413-306-3929 The debris will be transported by: Name of Hauler: The Barnish Companies C 4 Signature of Applicant: Date: 11/11/22 The Commonwealth of Massachusetts =T•"� Department of Industrial Accidents I Congress Street.Suite 100 t. 11== Boston. MA 02114-2017 tvuiw.mass.go)/dia Wuakers'Compensation Insurance Affidavit:Builders/ContractarsltlectriciansfPlumbers. It)BF FILED V.till'I IIE PERMIYTING AIfTHOW'IV. Applicant Information Please Print Legibly Name Mousiness Organization India.!dual►: Tom Morin D/B/A Valley Roofing and Restoration Address: 143 Parker Lane City/State/Zip: Ludlow, MA 01056 phone#: 413-230-8076 Are ton an emplaned(heck the appropriate but: Type of project(required): I 1 sin a simian er w all employees(lull and or pat-tune l-• 7. 0 New construction 20 I am a sole proprietor or gums nu sip and hate e enriplotecs workingnu:n in K. Q Remodeling t--+an earned!,(No awaken coup.insurance require(.] 9_ 0 Demolition 3 j I am a hor nowner doing all+hurl myself.(No t otels'comp.insurance n-gwnd.]' 10 0 Building addition 4.01 am a homeowner and w ill he huurg contractors to conduct all+hurl on my property. I will ernun that all contractors either hate workers'com si.matrtwt insurance or are sole II. Electrical repairs or additions put 12.0 Plumbing repairs or additions tors w ith nu employees. 5 i am a cameral contractor and I has c hued the sub-contractors listed on the attached she!,_ 13�R repairs[@pai These sub-contractors hate e7nplu o.cc5 and tut e w inters'en(.insurance.: 6.0 a a at re a eorprurun and its officers hat e etcci rsed their right of exemption per IK.L e. 1.3. them Roof replacement 151104.1k and w c hate no tirrfsluyees.INC.V.taken'coop.insurance required.] •Any applicant that checks has=I mini also till out the section below show ing their wolas'compensation puke"udunnatiun. 'Ihrinwwnets u ho submit this affidavit indicating thcr are doing all wink and then hire outside contractors mini subnut a new affida%it nwlieaIng soh :Contractors that check this but must attached an additional sheet sbott ing the name oldie sub-contractors and state wfurther or not those entrtie{hate empluy-ees. If the sub-contractors bate eu iluyecs-they must protide their uorlers"comp.policy number_ i am an employer that is providing woolen'compensation insurance for my employees. Below is the policy andiob site information. Insurance Conipanr Name: — Policy#or Self its.Lie.#: Expiration Date: Job Site Address: 20 Longview Dr. Ctrs State Zip: Florence, MA 01062 Attach a cups of the workers'compensation policy declaration page tshawing the policy number and espies' 'on date). Failure to secure cot erage as required under MGL c_ 152.§25A is a criminal t iolation punishable by a tine up to SI.500.00 and/or one-year imprisonment,as well as civil penalties in the form ola STOP WORK ORDER and a tine of up to S250.00 a day against the violator.A copy of this statement may be forwarded to the 0111cc of investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties oferuy that the information prorided above is true and correct 62.---1 Signature: \ Date_ 11/11/22 Phone t: 413-230-8076 Official use only. Do not write in this area,to be completed by city or town ofcial ('it) or fow n: Permit/License 11t Issuing Authority(circle one): I.Board of Health 2.Building Department 3.(-it)frost n Clerk 4.Electrical Inspector 5. Plumbing Inspector 6.Other Contact Person: Phone#: ESTIMATE Valley Roofing and Restoraton,LLC Sales Representative ROotFIN 143 Parker Lane Tom Morin Ludlow, MA 01056 (413)230-8076 (413)230-8076 valleyroofingandrestoration@gmail.com CSL#CS-112460 HIC#185148 Jillian Farrell Estimate# 1486 20 Longview Dr. Florence, MA 01062 Date 10/25/2022 Item Description Price Amount Asphalt •Strip all layers of roofing on the house-dispose of all $6,600.00 $6,600.00 debris •Furnish and install synthetic underlayment •Furnish and install starter strip •Change existing bath hood vent if needed • Furnish and install 6'ice and water barrier at all eaves, valleys,and all roof penetrations to meet MA code •Furnish and install new aluminum drip edge—Color: White •Furnish and install low profile ridge vent •Replace stack pipe collars •Furnish and install new GAF Timberline HDZ Lifetime Shingle(color to be determined) Sub Total $6,600.00 When Paying . Cash or Check Total $6,600.00 When Paying by Credit Card Surcharge $191.69 Balance Due* ) $6,791.69 *Credit card payments include a surcharge of 2.9%+29¢per transaction. SPECIAL INSTRUCTIONS ***The prices in this estimate are valid for 3 weeks*** *All installations include a lifetime workmanship warranty *The prices in this estimate include labor,materials,dump fees and permits for work at address listed above. *All measurements are based on aerial photos.There may be some discrepancy. *Any needed 1x6-1x10 pine boards will be installed at$11 per linear foot. *Any needed plywood will be installed at the following: 1/2"at$90.00 per sheet 5/8"at$110.00 per sheet 3/4"at$130.00 per sheet Document ID: C671123D-8CF0-449A-9F0A-DDD99E8CCB9E Page 1 of 2 • <f; • Jt��. .Ja;v ` P. •' .yr i. ;. ..`.. s; td rb •• ,guy �+ ` 1 O DATE(MM/DD/YYYY) ACORO CERTIFICATE OF LIABILITY INSURANCE 02/24/2022 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed. if SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT LEANDRO GUIMARAES NAME: POINT INSURANCE INC PHONE (508)552-8066 FAX (508)552-8065 (A/C,No,Ext): (NC,No) 424 BELMONT ST E-MAIL Iguimaraes@pointinsure.com ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# WORCESTER MA 01604 INSURER A: ATLANTIC CASUALTY INS CO INSURED INSURER B: CT HOME EVOLUTION LLC INSURER C: PO BOX 81328 INSURER D INSURER E: SPRINGFIELD MA 01108 INSURER F COVERAGES CERTIFICATE NUMBER: Master Cert 2022 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. IFF POLICY EXP NSR ADDLTYPE OF INSURANCE INSD wvoUBR POLICY NUMBER MM DD/YPOLICY EYYY MM/DD//YYYY LIMITS LTR INSD WVD ( ) ( ) X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED 100,000 CLAIMS-MADE X OCCUR PREMISES(Ea occurrence) $ MED EXP(Any one person) $ 5,000 A L307001666 02/16/2022 02/16/2023 PERSONAL dADVINJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,0I)l7 X POLICY PRO LOC PRODUCTS-COMP/OP AGG $ 2,000,000 JECT OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY (Per accident) UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY STATUTE ER YIN • ANY PROPRIETOR/PARTNER/EXECUTIVE N/A E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN Valley Roofing and Restoration LLC ACCORDANCE WITH THE POLICY PROVISIONS. 162 Pendleton Ave AUTHORIZED REPRESENTATIVE // ()ajar',ols Chicopee MA 01020 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD Ac� DATE(MMIDDIYYYY) CERTIFICATE OF LIABILITY INSURANCE 02/24/2022 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICA—E 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 CONTNAME: LEANDRO LEANDRO GUIMARAES POINT INSURANCE INC NHO,N ): (617)783-1160 WC,No) E-MAIL runo ntinsure.com ADDRESS: b CAPoi 1103 COMMONWEALTH AVE INSURER(S)AFFORDING COVERAGE NAIC BOSTON MA 022151111 INSURER A: TRAVELERS PROPERTY CAS CO OF AM 25674 INSURED INSURER B: CT HOME EVOLUTION LLC INSURERC: INSURER D: PO BOX 81328 393 BELMONT AVE INSURER E: SPRINGFIELD MA 01108 INSURER F: COVERAGES CERTIFICATE NUMBER: 748131 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUBR POLJCY EFF POLICY EXP LIMITS LTR INSD WVD POLICY NUMBER (MWDDJYYYY) IMMIDD/YYYYt COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ TO RENTED CLAIMS-MADE OCCUR PREMISES(Ea occurrence) $ MED EXP(Any one person) $ _ N/A PERSONAL&ADV INJURY $ GEM_AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATEPO- , $ POLICY JET LOC PRODUCTS-COMP/OP AGG $ OTHER: -- - $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS N/A BODILY INJURY(Per accident) $ NON-OWNED PROPERTY DAMAGE HIRED AUTOS AUTOS (Per accident) UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE N/A AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION Ne' PER XOT STATUTE AND EMPLOYERS'LIABILITY ANYPROPRIETOR/PARTNER/EXECUTIVE YIN E.L EACH ACCIDENT $ 1,000,000 A OFFICER/MEMBEREXCLUDED? FN/711 WA WA 7PJUB6R27625422 02/16/2022 02/16/2023 (Mandatory in NH) E.L DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 N/A DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Workers'Compensation benefits will be paid to Massachusetts employees only.Pursuant to Endorsement WC 20 03 06 B,no authorization is given to pay claims for benefits to employees in states other than Massachusetts if the insured hires,or has hired those employees outside of Massachusetts. This certificate of insurance shows the policy in force on the date that this certificate was issued(unless the expiration date on the above policy precedes the issue date of this certificate of insurance). The status of this coverage can be monitored daily by accessing the Proof of Coverage-Coverage Verification Search tool at www.mass.gov/Iwd/workers-compensation/investigations/. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN VALLEY ROOFING AND RESTORATION LLC ACCORDANCE WITH THE POLICY PROVISIONS. 162 PENDLETON AVE AUTHORIZED REPRESENTATIVE CHICOPEE MA 01020 Daniel M.Crowley,CPCU,Vice President—Residual Market—WCRIBMA ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD A CERTIFICATE OF LIABILITY INSURANCE °ATEt"tu°°YYY" 09/29/2072 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 Jennifer Hamel NAME: Southwick Insurance Agency PHONE (413)569-5541 I FAX No): (413)569-6530 4A(yNo Ert: ( 562 College Hwy ADDRESS: jhamel(3southwickinsagency corn INSURERISIAFFOROING COVERAGE 1 NAIC a Southwick MA 01077 INSURER A: Crum&Forster Specialty Insurance Company 44520 INSURED INSURER 8: Thomas Mcnn,DBA Valley Roofing&Restoration INSURER C: I 143 Parker Lane INSURER D: INSURERE: , ._ Ludlow MA 01055 INSURER F` t COVERAGES CERTIFICATE NUMBER: Ct.2292904057 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 WTH 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. ` ADOI.SUER POLICY EFF - POLICY EXP LTR TYPE OF INSURANCE tINSO wvo POLICY NUMBER (MM/DOIYYYY) (MMJDDIYYYY) UM TS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S 1,000,000 � DAMAZE TO RENTED 100,000 l CLAIMS-MADE �/'!CCCUR PREMISES(Fa occurrence) 5 MED EXP(Any one personf 5 5,000 A BAK-69939-2 09125/2022 09125/2023 PERSONAL s AD/INJURY 5 1,C0p,000 GEN'LAGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE _S 2,000,000 X POLICY 1 RO- P CC PRODUCTS-CCMP:CPAGG S 2.000,000 PRO-ECT S OTHER COMBINED LIMIT AUTOMOBILE LIABILITY 5 ( F ANY AUTO BODILY INJURY(Per person) S OWNED --'SCHEDULED;LED BODILY INJURY(Per accident) S A AUTOS ONLY AUTOS HIRED f4ON-0vwED PROPERTY DAMAGE 5 AUTOS ONLY AUTOS ONLY (Per are•Cect) 5 I I 1 UMBRELLA LIAR /OCCUR EACH OCCURRENCE 5 - EXCESS LIAR CLAIMS-MACE AGGREGATE S CEO al RETENTION 5 , PER OTH- S -i WORKERS COMPENSATION STATUTE ER AND EMPLOYERS'LIABILITY Y I N ANY PROPRIETOR/PARTNERIEXECUTIVE NIA E L EACH ACCIDENT S OFFICERIMEMBER EXCLUDED (Mandatory In NH) E L DISEASE-EA EMPLOYEE 5 If yes.describe under DESCRIPTION OF OPERATIONS team _ E L O:SEASE-POLICY LIMIT S T DESCRIPTION OF OPERATIONS r LOCATIONS 1 VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN City of Northampton Dept of Building Inspections ACCORDANCE WITH THE POLICY PROVISIONS. 212 Main Street AUTHORIZED REPRESENTATIVE , Municipal Building ' \ / f?� -S \ Northampton MA 01060 Rat / lV . -\ , ; 1 I r j ©1988-2015'ACORD CORPORATION. All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD Commonwealth of Massachusetts lirDivision of Occupational Licensure Board of Building Reqqulations and Standards `fIi Const.Li on S rvisor �' -r CS-112460 s�pires:07/23/2024 THOMAS D Ni1ORIN j, 162 PENDLETON AVE CHICOPEE M13 01020 *...- ::i",;' , '' q. ti0/.LVdl33 ,� l.---;--;......_ AI. I/ .4,7 7417.ii THE COMMONWEALTH OF MASSACHUSETTS Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR TYPE:Individual Registration Expiration 185148 08/08/2024 TOM MORIN D/B/A VALLEY ROOFING AND RESTORATION THOMAS MORIN ' 162 PENDLETON AVE. r./c4/r-s*iC?. " ` CHICOPEE,MA 01020 Undersecretary Valley Roofing & Restoration CSL#CS-112460 HIC# 185148 Please mail permit to: 143 Parker Lane Ludlow MA 01056 or Email to: valleyroofingandrestoration@gmail.com *If you cannot do either of these can you call 413-230-8076 so that we know permit has been issued Thank you ! Tom Morin 162 Pendleton Ave • Chicopee MA 01020 • (413) 230-8076 valleyroofingandrestoration@gmail.com