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17A-047 (2) BP-2023-0043 168 BRIDGE RD COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 17A-047-001 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-2023-0043 PERMISSION IS HEREBY GRANTED TO: Project# DOOR 2023 Contractor: License: Est. Cost: 2596 LOWES HOME CENTERS INC 117055 Const.Class: Exp.Date: 08/02/2025 Use Group: Owner: FLEGENHEIMER JEAN Lot Size (sq.ft.) Zoning: RI/URA Applicant: LOWES HOME CENTERS INC Applicant Address Phone: Insurance: 1000 LOWES BLVD 860-505-9314 WC035901712AOS MOORESVILLE, NC 28117 ISSUED ON: D1/19/2023 TO PERFORM THE FOLLOWING WORK: REPLACEMENT DOOR 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: I 2 . CIPS Fees Paid: $40.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Office of the Building Commissioner V ' The Commonwealth of Massachusetts Board of Building Regulations and Standards MUN1 PAD iT1'The State Building Code, 780 CMR F USE Building Permit Application To Construct,Repair,Renovate Or Demolish a Revised Mar 2011 One-or Two-Family Dwelling This Section For Official Use Only Building Permit Number: f3 P" 01. 3, 41,.3 Date Applied: /t,,1,��Ss , -- 1-19.2az3 Building Official(Print Name) Signature t*e SECTION 1:SITE INFORMATION 1.1 Proper J ,�ddress ` 1.2 Assessors Map&Pared Numbers l.la is this an accepted street?yes no Map Number Parcel Number 13 Zoning information: 1-4 Property Dimensions: Zoning District Proposed Use tot Area(sq t) Frontage(ft) 1.5 Building Setbacks(ft) Front Yard Side Yards Rear Yard Required Provided Required Provided Required Provided 1.6 Water Supply:(M.G.L c.90,§54) 1,7 Flood Zone information: 1.$Sewage Disposal System: Public 0 Private❑ Zone: — Outside Flood Zone? Municipal 0 on site dispel system 0 Check if yes° SECTION 2: PROPERTY OWNERSHiP' 4 ,2.1 ��G►,1 Roorct e n/U rXl � D,, , A./4 UlO(�� trt) C ,ZIP S l - 13—3c/0 3c050 No.and Street Telephone t:inail Address SECTION 3:DESCRIPTION OF PROPOSED WORK;(check all that apply) New Construction Cl Existing Building 0 Owner-Occupied A Repairs(s) Alteration($) 0 Addition ❑ Demolition 0 Accessory Bldg.0 Number of Units Other 0 Specify: Brief Description of Proposed Work2: r rg1e g �� Il('jLl Y SECTION 4:ESTIMATED CONSTRUCTION COSTS Estimated Costs: Item (Labor and Materials) Offal Use Only 1,Building $ )9i r&) I. Building Permit Fee: $ Indicate how fee is determined: 2 Electrical $ ❑Standard City/Town Application Fee ❑Total Project Cost}(Item 6)x multiplier x 3,Plumbing S 2. Other Fees: $ 4.Mechanical (11VAC) S List: 5_Mechanical (Fire — Total All Fees: Suppression) Check No.31 " ..eek Amount: 40 Cash Amount: 6.Total Project Cost: S (7,206 p Paid in Full 0 Outstanding Balance Due: - RECEIVE.D J A N 1 3 2023 DEPT.OF nun.DING INSPECTIONS 1 ^NORTHAMPToN.MA 01060 SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License License Number i:x pi ation mate Name of S (0: e. stib/ea e poem 0/��,� Q / ListcSt_7yTc(seebelow) No.asid tr• /�Q� Type Description ,/,4 eX 41,1 1,1Ag U Unrestricted(Buildings up to 35,000 cu 1i,) Citylfown,State, (i/ (J(Y R Restricted 1&2 Family Dwelling M Masonry RC Rooting Covering WS Window and nd Siding S Solid Fuel Burning Appliances ppliances 00)70'4 elinr1 �eG� � iv,L Insulation ephone Email address 1) Demolition 5.2 Registered Home I �/ G e�nent Contractor(HIC) / soy /0p I 5 u).1/J g'd t,--i iJ/_.S MC Registration lumber Expiration Date IBC C Nom a 1�D-tee aK/t 0. itogh 2&9 e, — No.and_ .64 /re, Ali Email address City/Town,State,ZIP Tel SECTION 6:WORKERS'COMPENSATION INSURANCE A_FFIDAViT(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 of the building permit. Signed Affidavit Attached? Yes I/ No...........O SECTION 7a:OWNER AUTIIORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT .I,as Owned'of the subject property,hereby authorize L�-"k(/f11-9 0 to act on my behalf,in all matters relative to work authorized by this building permit application, rLiii0L/111/0V. --001.)-((t(r' ) i3JL2-, ,kwanc ' (Efictronic Signature) griatur ) 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' this applicati is true and accurate to the best of my knowledge and understanding. Print Owner's or Authorized Agent's Name(Electronic Signature) Date NOTES: 1. All 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(IUC)Program),will 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.) (including garage,finished basement/attics,decks or porch) Gross living area(sq. ft.) 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" V ) Store 1916 LOWE'S OF HADLEY, MA 282 RUSSELL STREET HADLEY, Massachusetts 01035 Lai w Ells® Contract Prepared for: Jean Flegenheimer 168 Bridge Road Florence, Massachusetts 01062 (413) 320-3250 Prepared by: Steven Lockwood (413)588-0270 steven.lockwood@lowes.com Store 1916 LOWE_S OF HADLEY_MA-Contract-819655-Page 1 of 28 LOWE'S MASSACHUSETTS SERVICES SOLUTIONS INSTALLED SALES CONTRACT LOWE'S AUTHORIZED REPRESENTATIVE SALES ID DATE CUSTOMER NAME Steven Lockwood 3070929 01/04/2023 Jean Flegenheimer STORE NO. S I REE I ADDRESS STREET ADDRESS 1916 282 RUSSELL STREET 168 Bridge Road CITY STATE ZIP CITY STATE P HADLEY MASSACHUSETTS 01035 Florence Massachusetts 1062 TELEPHONE TELEPHONE (413)588-0270 (413)320-3250 EMAIL EMAIL steven.lockwood@lowes.com mudfish49@gmail.com LOWE'S CONTRACTOR LICENSE s LOWE'S REPRESENTATIVE LICENSE z CREDIT/DEBIT CHECK LCC CARD SIFT CARD 4CSL-081810;HIC#148688; 3070929 This is only a quote for the merchandise and services printed below. Lowe's does not offer services to paint,seal or stain fences. This becomes an agreement upon payment and issuance of a Lowe's receipt, upon pay-ment,the entire agreement,including the specifically completed pages of this document,the Terms and Conditions included with this document and any other addenda and attachments hereto,shall be referred to herein as this"Contract."PLEASE READ THIS ENTIRE DOCUMENT, INCLUDIrG THE "NOTICES,""TERMS AND CONDITIONS,"AND"ADDENDUM"CONTAINED WITHIN THIS CONTRACT ON THE FOLLOWING PAGES BEFORE SIGNING. INSTALLATION STREE I ADDRESS CITY STATE ZIP 168 Bridge Road Florence Massachusetts 01062 MERCHANDISE AND INSTALLATION SUMMARY:(I.E. ITEM NUMBERS,COLORS, DIMENSIONS,CONSIDERATION ): Entry Doors Product Store 1916 LOWE_S OF HADLEY MA-Contract-819655-Page 2 of 28 Entry Doors Project Installation of a replacement door from kitchen to porch. Door will be Therma-Tru Steel Single Door 32-in x 80-in Profiles TM Steel Inswing Left Hand Style Option = 206HD-LE Overall: 33 5/8-in x 82-in Profiles TM Steel Half Lite 2 Panel Flush Glass Style = Clear 1 Lite No Grid Caming = None Slabs Unfinished Jambs Unfinished 4 9/16 On-Guard Primed - Smooth Jamb Mill Composite Adjustable Sill and Light Wood Door will be primed. Customer responsibility to paint. Proposal and pricing dependent on installer second measure to ensure suitability, sizing, and estimated installation costs. Project Preparation Process o Dedicated project support staff keeps you up-to-date through every process o Installer conducts Pre-Installation Inspection o Provides appropriate protection to home during installation o Obtain & post any necessary permits o Perform Lead Assessment (if applicable) Installation Process o Remove&haul away existing doors o Check existing door(s) for leaks and evidence of pest infestation o Install new doors&accessories, including handle set, caulk, stops, and fasteners o Follow Lead Safe Practices (if required) o Follow Health and Safety Guidelines Clean-up/Final Inspection o Complete final clean-up and haul away all job-related debris o Test product&perform complete inspection with customer o Review warranty information Work is to commence upon reasonable availability of Contractor and/or any special order or customer made Good(s)which is anticipated to be 02103/2023.Estimated completion date is 02/25/2023. COVID-19 has affected manufacturers and labor markets, with the production of fence, deck and generator material experiencing significant delays and installation start dates that are at least four(4)months away in most cases. Please also note that weather can delay start dates for these and other exterior categories,particularly in colder climates. CONTRACT TOTAL ,596.00 Paid upon signature of Installed Sales Contract(33%) 23.68 Paid upon or after commencement of work(67%) 1,672.32 Store 1916 LOWE_S OF HADLEY_MA-Contract-819655-Page 3 of 28 Paid upon completion of Installed Services to both parties satisfaction *100.00 Store 1916 LOWE_S OF HADLEY_MA-Contract-819655-Page 4 of 28 ,ppAD SAFE INFORMATION. Federal and applicable state laws require that You be provided with a lead''hazard information pamphlet such as the Renovate Right: Important Lead Hazard Information for Families, Child Care Providers and Schools. By signing this Contract, You acknowledge having received a copy of this information pamphlet before work began igforming You of the potential risk of the lead hazard exposure from renovation activity performed in Your dwelling unit or facility. A copy of the pamphlet is available at the following website: www.lowes.com/EPARRP, For more information see: https://www.epa.gov/lead/lead-renovation-repair-and-painting-proqram. NOTICE OF ARBITRATION AGREEMENT: This Contract provides that all claims by Customer or Lowe's will be resolved by BINDING ARBITRATION. Customer and Lowe's GIVE UP THE RIGHT TO GO TO COURT to enforce this Contract (EXCEPT for matters that may be taken to SMALL CLAIMS COURT). Lowe's and Customer's rights will be determined by a NEUTRAL ARBITRATOR and NOT a judge or jury. Lowe's and Customer are entitled to a FAIR HEARING. But the arbitration procedures are SIMPLER AND MORE LIMITED THAN RULES APPLICABLE IN COURT. Arbitrator decisions are as enforceable as any court order and are subject to VERY LIMITED REVIEW BY A COURT. FOR MORE DETAILS: Review the section titled ARBITRATION AGREEMENT, WAIVER OF JURY TRIAL AND WAIVER OIr CLASS ACTION ADJUDICATION found in the Terms and Conditions of this Contract. NOTICE REGARDING ARBITRATION AGREEMENT FOR CLAIMS COVERED BY M.G.L. c. 142A: LOV1�E'S AND OWNER HEREBY MUTUALLY AGREE IN ADVANCE THAT IN THE EVENT LOWE'S HAS A DISPUTE CONCERNINGITHIS CONTRACT, THAT LOWE'S MAY SUBMIT SUCH DISPUTE TO A PRIVATE ARBITRATION SERVICE WHICH HAS BEEN APPROVED BY THE SECRETARY OF THE EXECUTIVE OFFICE OF CONSUMER AFFAIRS AND BUSINESS REGULATIONS AND THE OWNER SHALL BE REQUIRED TO SUBMIT TO SUCH ARBITRATION AS PROVIDED IN M.G.L. c.142A. THE SIGNATURES OF THE PARTIES BELOW APPLY ONLY TO THE AGREEMENT OF THE PARTIES TO ALTERNATIVE DISPUTE RESOLUTION INITIATED BY LOWES, PURSUANT TO M.G.L. c. 142A. THE OWNER MAY BE PERMITTED TO INITIATE ALTERNATIVE DISPUTE RESOLUTION EVEN WHERE THIS SECTION IS NOT SEPARATELY SIGNED BY THE PARTIESl11 If customer has a complaint which cannot be resolved informally, the home Improvement Contractor Law(M.G.L. c. 142A) may provide Customer with the right to request arbitration through a private arbitration program approved by the Director of the Office of Cgnsumer Affairs and Business Regulation, as an alternative to court action. The same right is not afforded to Lowe's unless this Notice is signed and dated by Lowe's and Customer. All claims by Customer or Lowe's concerning this Contract which cannot be resolved informally, and which are not covered by M.G.L. c142A or subject to the jurisdiction of a small claims court, shall be resolved by binding arbitration as set forth in the Terms and Conditions. By: fit, cro-ck.uro-o-d. Date: Lowe's Authorized Representative By: ``6 ` Date: 01/03/23 Customer PRICE CALCULATIONS. If this Contract includes Goods and related Installation Services sold by unit of measuriement, such as per square foot, the Price may include more Goods than the actual measurements of Your project area. The Prig includes the total amount of Goods required by Lowe's to fulfill the Contract (including surplus materials and overages) (together the "Estimated Product")and the Installation Services required based upon this total amount of Goods. For instance, a 120 square foot room may require 140 square feet of carpet to properly match the carpet seams, pattern, or unique room characteristics, ,nd the Price would include Installation Services based upon the 140 square feet of carpet. The total amount of Estimated Product is based upon the total Goods recommended by the Installer, based on the Installer's assessment of unique characteristics of `'our project. If any usable Goods are left over, Lowe's may, at its discretion, initiate a Price adjustment. Lowe's will not adjust the Contract Price for the related Installation Services. By signing this Contract, You acknowledge You are aware of Your project area measurements and the amount of Estimated Product, and that the Estimated Product may exceed Your actual project area. If Your project includes the installation of flooring materials, by signing this Contract You further acknowledge having received a completed Flooring Detail Diagram (the "Diagram") prior to execution of this Contract. Upon request, Lowe's can provide You with additional copies of the Diagram,which identifies the square footage of Your project area and the square footage of the Estimated Goods. PHOTO RELEASE. By signing this Contract, You grant to Lowe's, its representatives, and Installer the right to take and use photographs, videos, or other representations of the Premises before and after the Installation Services and all'I work performed at the Premises related to this Contract (the "Content"). Lowe's irrevocably keeps all rights (including the copyright), title, and interest in the Content for use in all markets and media, worldwide, in perpetuity. Lowe's can use the Content, in ani form or medium, internally for any purpose (e.g., customer service, planning, and claims. NOTICE REGARDING PAYMENT SCHEDULE. If the Contract Price is$1,000 or less, payment of the Price by ustomer to Lowe's is due in full upon execution of this Contract. If the Contract Price exceeds $1,000, Customer shall use the following payment schedule: (1) Deposit of $ 823.68 [enter 1/3 of the contract Price] to be paid upon signing this Contact. ny deposit collected at the time this Contract is signed will not exceed one-third (1/3)of the Contract Price; Store 1916 LOWE_S OF HADLEY MA-Contract-819655-Page 5 of 28 Rev.03/02/2021 , (2) Payment of $ 1672.32 [enter 2/3 of the contract Price minus $100] to be collected upon or after the commencement of work. Customer authorizes Lowe's to charge Customer's credit card, or deposit Customer's check, for the amount of the payment indicated in this section anytime upon or after the commencement of the work; and (3) Final payment of$100 to be paid upon completion of the Installation Services to both parties' satisfaction. NOTICE OF CUSTOMER'S RIGHT TO CANCEL. If this is a "door-to-door sale" as defined by 16 C.F.R. § 429.0(a), or if this Contract is signed by Customer at a place other than the address of the seller as set forth in M.G.L. c. 93 § 48, You, the Customer, may cancel this Contract at any time prior to midnight of the third business day after the date of this transaction. See the notice of cancellation form sent as an attachment to this Contract for an explanation of this right. By executing this Contract, Customer acknowledges receipt of two (2) completed copies of the Notice of Right to Cancel form and certifies Lowe's has informed Customer orally of his or her right to cancel. NOTICE TO CUSTOMER. DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES. Lowe's Home Centers, LLC EXECUTION DATE: 01/03/23 LOWE'S AUTHORIZED REPRESENTATIVE SIGNATURE OWNER'S SIGNATURE CO-OWNER SIGNATURE OrCrC kuro-od. j-"" t.2.44,ve" Customer acknowledges receipt of a true copy of this contract which was completely filled in prior to Customer's execution hereof. Store 1916 LOWE_S OF HADLEY_MA-Contract-819655-Page 6 of 28 Rev.03/02/2021 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations Lafayette City Center r 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/Organization/Individual): LOWES HOME CENTERS Address: 1000 LOWES BLVD City/State/Zip: MOORESVILLE,NC 28117 Phone #: 860-505-9314 Are you an employer?Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. ®I am a general contractor and I employees(full and/or part-time).'` have hired the sub-contractors 6. ❑New construction 2.❑ 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 working for me in any capacity. employees and have workers' 9. ❑Building addition [No workers' comp.insurance comp. insurance. required.] 5. El We are a corporation and its 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions myself [No workers' comp. right of exemption per MOL 12.❑Roof repairs insurance required.]I c. 152,§1(4),and we have no employees. [No workers' 13.0 Other comp. insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and that hire outside contractors must submit a new affidavit indicating such. :Contractors that check this box must attached an additional street showing the name of the Rib-contractors and state whether ar not those entities have employees. If the sub-contractors have employees,they mud provide their workers'comp policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: AIU INSURANCE COMPANY Policy#or Self-ins. Lic. #: WC035901712/ AOOS,( Expiration Date: 4/1/2023 /,n Job Site Address: )L l)([ d j C `' • City/State/Zip: 1'/O(JV)U, -'''1 H 0/0( e Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties 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 ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereb fv under the enalties of perjury that the information provided bove is true and correct Signature: -)1 4 -� � Date: � eq. 3 Phone#: 860-505-9314 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): 1L]Board of Health 20 Building Department 3❑City/Town Clerk 4.0 Electrical Inspector 5.EIPlumbing Inspector 6.0Other Contact Person: Phone#: THE£I1 O, IEJ LTh£ �of CarSS on 1 Wa -Sta 710 8 ... -.3.- _. ;_ ._. WINES LW�n+ .-gam- Y*_'r.T v , �j a148593 �i!liisP i ssm Lmf3 l cm L1tiYC+Ej = = r :sue -. Y-'- GFfM Y 3? I . -mot Z.-i- <I OillbtoMorauserMivils&euslatasalguilioss flielikulhavelldiorindbildwiumkesigholuattbe ffflE �iOt _ ti � �rfNor Olikadltars/MEdisatilibil s 1�re t-�slls7lt a OJ ES HOME CORERS.lie. - - NEXEDES SW3'O _ rf&d44- -SERVICES COMPLIANCE `• , _�.- 43 eIB! rid 8 FiOfl�.�C 281i7 - t IP A`oRL? CERTIFICATE OF LIABILITY INSURANCE DA/23/20IDOfYYYY) o3123rzo22 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. JJ IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the pollcy(ies)must have ADDITIONAL INSURED prowls ons or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsem nt. A statement on this certificate does not confer rights to the certificate holder In lieu of such endorsement(s). PRODUCER CONTACT Marsh USA Inc. .NAME: 100 North Tryon Street Suite 3600 (N.NNo.Exn: FAX Rol; NC ADDRESS: 28202 ADDRESS: INSURER(S)AFFORDING COVERAGE NAIL s CN102776519LowesSI.22-23 INSURER A:National Union Fire Ins Co.of Pittsburgh PA 19445 INSURED INSURER s:Interstate Fire 8 Co 22829 Lcwe's Companies,Inc. Casualty and subsidiaries INSURER C:AIU Insurance Co 19399 1003 Lowe's Boulevard INSURER D Mooresville,NC 28117 INSURER E: INSURER F: i COVERAGES CERTIFICATE NUMBER: ATL-004976909-11 REVISION NUMBER: 10 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. POLICY EXP *MR TYPE OF INSURANCE SO y�pyp POLICY NUMBER (PMM POLICY YYYEFY) ( IDWYYYY) UNITS COMMERCIAL GENERAL LIABILITY EACH SCE $ CLAIMS-MADE OCCUR Self Insured-See below DAMAGE TO RENTED PREMISES(Ea occurrence) S RED EXP(Any person) $ PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLES PER GENERAL AGGREGATE S PRO- POLICY jEcy LOC PRODUCTS-CO$PAOP AGG $ i OTHER: $ A AUTOMOBILELIABILM CA7030892 (ADS) 04/01/2022 04/01/2023 � M�GLELV T s 5000 ,000 C x ANY AUTO CA7030891 (MA) 04/01/2022 04/0112023 BODILY INJURY(Per person 1 $ A _ OWNED SCHEDULED CA7030893 (VA) 04/01/2022 04/01/2023 BODILY INJURY(Peraccident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY (Per accident) S B X LMMMBRELLALIAB x `OccuR USZ00024220 04/01/2022 04101/2023 5,000,000 — _ EACH OCCURRENCE s EXCESS UPS CLAMMS4r111DE AGGREGATE f 5,000,000 DED RETENTIONS S C woRNERs conwENsAT1oN WC035901712 (AOS) 04/01/2022 04/01/2023 X AND PER OTH- C 2. ANYPROPRI TiYEAR RAF CU VE YIN WC035901713 (ND.WA.WI,WY) 04/01/2022 04101/2023 STATUTE ER OFFICERMEMBEREXCLUDED? N NIA EL S �� (Mandatory In NH) EL DISEASE-EA EMPLOYEE.$ 2.000,000 M yes,cesrnbe under , 2,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LSIIr $ A Excess Workers'Compensation xWC1647325 (FL) 04/01/2022 04/01/2023 (WC per statute) 3,000,000 A Excess Workers'Compensation XWC1647324 (AOS) 04/01/2022 04/01/2023 (WC per statute) 3,000,000 DESCRIPTION Of OPERATIONS I LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Commercial General Liability poky is Self-Insured,effed ive 4/1/2022 to 4/1/2023. CERTIFICATE HOLDER CANCELLATION Lowe's Companies,Inc,and Subsidiaries SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 1000 Lowe's Blvd' THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Mooresville,NC 28117 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE �y�,� Vt. "2 ®1988-2016 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD rM►. i AGENCY CUSTOMER ID: CN102776519 LOC#: Charlotte AC tJ RD ADDITIONAL REMARKS SCHEDULE Page 2 of 2 AGENCY NAMED INSURED Marsh USA Inc. Lowe's Companies.Inc. and subsidiaries POLICY NUMBER 1000 Lowe's Boulevard Mooresville,NC 28117 CARRIER NAIL CODE EFFECTIVE DATE: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: Certificate of Liability Insurance Workers Compensation and Excess Workers Compensation poides induce a self-insured retention of$2.000,000. General L abity Tie insured is self insured for$10.000.000 each occurrence for the period of 4/1/2022 to 41112023. The Automobile Liabily poky evdenced above is subject to addrt anal self-insured retentions excess of units shown for various perils covered. ACORD 101 (2008/01) ©2008 ACORD CORPORATION. M rights reserved. The ACORD name and logo are registered marks of ACORD ACORO® DATE(riNDD!YYYY) `� CERTIFICATE OF LIABILITY INSURANCE a,,,,,,pn 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 Diane Gendreau,CISR NAME: Nicholson Associates,Inc. PHONE (203)203)877-2741 FAX (203)877-9004 kW o.EMI. INC,No): 395 New Haven Ave. A p)SS: d.gendreau@nicholsonassoc.com P.O.Box 5189 INSURER(S)AFFORDING COVERAGE NAIC S Milford CT 06460 INSURER A: Selective Insurance Co of S.C. 19259 INSURED INSURER B EAST COAST MILLWORK,LLC INSURER C: 14R PEACH ORCHARD RD INSURER D: INSURER E: PROSPECT CT 06712-6001 INSIURER F: COVERAGES CERTIFICATE NUMBER: 9/22-23 GL Auto Umb 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 POLICES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POUCIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADOLSUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INS° VIVO POLICY NUMBER (MM/DD/YYYY) (MWDD/YYYY) WITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1.000,000 DAMAGE-10 RENTED S CLAIMS-MADE a OCCUR PREMISES(Ea ocrrenos) 500.000 M MED EXP(Any one person) $ 15,000 A Y S 2040386 09/22/2022 09/22/2023 PERSONAL a ADV INJURY $ 1,000,000 GENI_AGGREGATE LIMIT APPLES PER: GENERAL AGGREGATE S 3,000,000 POLICY n J CT n LOC PRODUCTS-COMP/OPAG[ $ 3.000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 (Ea accident) X ANY AUTO BODILY INJURY(Per person) $ A — OWNED —SCHEDULED Y S 2040386 09/22/2022 09/22/2023 BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS— HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY _ AUTOS ONLY (Per accident) Medical payments S 5,000 X UMBRELLA L.IAB — OCCUR EACH OCCURRENCE S 2.000,000 A Excess LIAa CLNMS-MADE S 2040386 09/22/2022 09/22/2023 AGGREGATE S 2,000,000 DED I I RETENTION$ $ WORKERS COMPENSATION XI PER OTH- AND EMPLOYERS'LIABILITY YIN STATURE ER ANY PROPRIETORIPARTNER/EXECUTIVE EL.EACH ACCIDENT ,100,000 A OFFICER MEMBER EXCLUDED? n NIA WC 9084546 06/04/2022 06/04/2023 (Mandatory In NH) EL DISEASE-EA EMPLOYEE $ 500, If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY UMIT $ 500,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Lowe's Companies,Inc.and Lowe's Home Centers,LLC are named as additional insureds as respects general liability and auto liability. This insurance is primary over any other available insurance coverage.10 Day Notice of Cancellation for Non-Payment of Premium. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELNERED IN Lowe's Companies,Inc.and any and all subsidiaries ACCORDANCE WITH THE POLICY PROVISIONS. 1000 Lowe's Blvd AUTHORIZED REPRESENTATIVE Mooresville NC 28117 i jc vas au� ©1988-2015 ACORD CORPORATION. Al rights reserved. AMMO ZN(gfUtllfU/ 111tffi AMMO maw mit limp awe r rinaAit6 tiff ATOM %mkt- Commonwealth of Massachusetts Division of Occupational Licensure Board of Building Regulations and Standards Constonr Svisor CS-117055 E pires: 08/02/2025 KYLE R SEARLES 14R PEACH ORCHARD ROAD PROSPECT CT 06712 0t,11,1,1, Commissioner u . A. e.vr7