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24A-068 (4)
BP-2023-0021 63 RIDGEWOOD TERR COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 24A-068-001 CITY OF NORTHAMPTON Permit: Alts Renovations Repair PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) BUILDING PERMIT Permit # BP-2023-0021 PERMISSION IS HEREBY GRANTED TO: Project# CHIMNEY LINER 2023 Contractor: License: Est. Cost: 2824 ACE CHIMNEY SWEEPS 113698 Const.Class: Exp.Date: 01/21/2023 BERNECHE-STILES JENNIFER L & MICHAEL D Use Group: Owner: STILES Lot Size (sq.ft.) Zoning: URB Applicant: ACE CHIMNEY SWEEPS Applicant Address Phone: Insurance: 115 MAIN BLVD (413)547-8500 AWC-400-7027806 LUDLOW, MA 01056 ISSUED ON: 01/06/2023 TO PERFORM THE FOLLOWING WORK: CHIMNEY LINER 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: , ) IT Fees Paid: $65.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Office of the Building Commissioner RECEI :. . . , _ . The Commonwealth of Massachusetts,lot ` _ ._. FOR Board of Building Regulations and Standards!FaT OF rULD N IN. �ii41!7NPGIPALITY Massachusetts State Building Code, 780'CMR ^onrHamnToN MA 0190 USE Building Permit Application To Construct, Repair,Renovate Or Demolish a Revised Mar 2011 One-or Two-Family Dwelling gnn This Section For Official Use Onl J Building ermit Number: 6? O�3 d/ Date Applied: 1 � 0 � j/.2 i- 1-Z625 Building Official(Print Name) Signature Date SECTION 1:SITE INFORMATION 1.1 Pxoper Address: / ��rr 1.2 Assessors Map&Parcel Numbers !!OO 33 rr 9e wand 1.1a Is this an accepted street?yes �o 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❑ On site disposal system 0 Check if yes❑ SECTION 2: PROPERTY OWNERSHIP' 2.1 fri i ner1 S , )/1LS flT r Ql,�I'► /f 1 , % G/ '�d Name(Print) ,4 1/ �/ City,State,ZIP G3 Xi ailowAI T2tc. Y/3 - c-P-70z- No.and Street Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply) New Construction 0 Existing Building Er-Owner-Occupied EK-Repairs(s) 1E1 Alteration(s) 0 Addition Cl Demolition 0 Accessory Bldg. 0 Number of Units / Other lai-pecify: 64�/)i/7 e,4i# Lfr Brief Description of Proposed Work': /n 5 5141 &L /i S 71'6.1 5 g %A le 5 S 5/'e G Mint thus- I t) G,)cts A/1 mAS llhr ' Mom , fir/ m S 1 7rN e i 5 Oil, �/IL-/ s*ve • SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1.Building $a J'L,T- 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 $ Total All Fe Suppression) 6 �/ 6 , Check No�til� Check Amount. Cash Amount: 6.Total Project Cost: $ A 6 a,`T , 0 Paid in Full 0 Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES (' 5.1 Construction Supervisor License(CSL) I 45 /l 34 9 0/ 4l/zlLD2-3 Xi1 �/��5 License Number Expirat on Date Name of CSL/Holder J! �/ 7 /1 fn �?/,t/ List CSL Type(see below) No.and Street /, ( G/(// /J �1 Type Description I � _ /D� M A /h l o C‘ U Unrestricted(Buildings up to 35,000 Cu.ft.) �W / l/ R Restricted 1&2 Family Dwelling City/Town,State,ZIP . M Masonry RC Roofing Covering / WS Window and Siding '7'/3— SF Solid Fuel Burning Appliances ri?,- 4>SD,4 Ize ino5 9 A) I Insulation Telephone Em it address f97GlJ , D Demolition 5.2 egistered Home Improvement Contractor(11IIC) i'rn SlirJ /1 f 3 SS 03 of loz3 It- �i HIC egistration Number xp ation Date HIC Company e or HIC Re strant N4tne / N and St a "I/3 - /� Email address and St f) /YI/f D/OS 4 S'47- S>SUa e-As" 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 Issuanccee of the building permit. Signed Affidavit Attached? Yes Et No 0 SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMITI,as Owner of the subject property,hereby authorize i -tr(i Z-4 f 07 �I t 1 to act on my behalf,in all matters relative to work authorized by this building permit a6plication. � i -e/ s 5�'/M i es /O1- 3/-07-W 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. it//// m, gAt%i1d s /�-3/- Print Owner'yor Authorized Agent' Name(Electronic Signature) Date NOTES: I. 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.) (including garage,fmished 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" Page No. of Pages Proposal • CHMNEY SVVEFPS CSL *113698 HIC.NI4#11.8355 '15 Main Blvd ottV MA 61 6-788 • 547•-4500 PROPOSAL SUBMITTED TO PHONE DATE Ntchael Stile- 589-7682 80-24 -22 STREET JOB NAME klidgew ow lett CITY,STATE and ZIP CODE JOB LOCATION thanipton, MA 01060 Satre ARCHITECT DATE OF PLANS JOB PHONE Kelly Kapirios ° 1-lame We hereby submit specifications and estimates for: UL Listed Pre-Instdated Stainless Steel Chimney Liner with Lifetime Wdrranty( ;-30 Foot Coil 1,70 0.0 0 1—.Appliance ( nrectpr 64.00 1-13 x 13 Crown Mount Deluxe Cap 275.00 ,—tvlige Materials 95 do 2,134:00 SUBTOTAL -110.00 Demur* PreP,'d 200.00 Permit 600.00 LABOR $ 2,824,00 TOTAL "c propose hereby to furnish material and labor — complete in accordance with above specifications, for the sum of: Thous ht Hunoced Tixit ehi -Four and dollars($ 24324 00 ). Payment to be made as follows: • - prkrt 1s with hatance oft 1 4S6,00 clue on oompletton. Oepmit is non-fetunclable All material is guaranteed to be as specified. All work to be completed in a workmanlike manner according to standard practices.Any alteration or deviation from above specifications Authorized • - • ;, involving extra costs will be executed only upon written orders, and will become an extra Signature charge over and above the estimate. All agreements contingent upon strikes,accidents or delays beyond our control.Owner to carry fire,tornado and other necessary insurance.Our Note:This proposal may be withdrawn by us if not accepted within 60 days. \workers are fully covered by Workman's Compensation Insurance. \‘' Arreptancr of proposal _The above prices,specifications and conditions are satisfactory and are hereby accepted. You are authorized Signature to do the work as specified. Payment will be made as outlined above. Date of Acceptance: 11 11;4 Signature City of Northampton '"° : 1 '11 Massachusetts �4. ce` DEPARTMENT OF BUILDING INSPECTIONSJetV. 212 Main Street • Municipal Building yeti CDC Northampton, MA 01060 N 3��1`� 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. 2:)The debris will be disposed of in: ///: � /'/^S Location of Facility: The debris will be transported by: Name of Hauler: Signature of Applicant: Date: Commonwealth of Massachusetts ® Division of Professional Licensure Board of Building Regulations and Standards ConstruCtion'Supervisor • CS-113698 + * ,pires:01/21/2023 KELLY M KAPINOS .o1 4. 5 115 MAIN BLVD LUDLOW MA 01056 Commissioner -- t9-4 Office of Consumer Affairs and Business Regulation 1000 Washington Street - Suite 710 Boston, Massachusetts 02118 Home Improvement Contractor Registration Type: Supplement Card Registration: 118355 JOHN KAPINOS Expiration: 03/01/2023 D/B/A ACE CHIMNEY SWEEPS 115 MAIN BLVD LUDLOW,MA 01056 Update Address and R turn Card. scA, 0 29M-05/17 Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only TYPE: Supplement Card before the expiration date. If found return to: fiegistration Expiration Office of Consumer Affairs and Business Regulation 118355 03/01/2023 1000 Washington Street •Suite 710 JOHN KAPINOS Boston,MA 02118 D/B/A ACE CHIMNEY SWEEPS 04/1/ 4x/ KELLY KAPINOS . 115 MAIN BLVD ,.5r4 �-'�'f` LUDLOW,MA 01056 Undersecretary of valid ithout signature Product Information • General Product Information The quality and workmanship of Forever FIeXTM/Pre-Insulated Forever Flex"'and ArmorFlex/Hybrid Liner"is reflected in the recognition Underwriters Laboratories has given these products. The rigorous UL testing and listing requirements,is your assurance of consistent quality in materials and manufacturing standards used for these lining systems.In addition,the industry leading Forever Warranty on Forever Flex"'/Pre-Insulated Forever FlexT"and ArmorFlex/Hybrid LinerTM is a further indication of our confidence in the quality of these products. Thank you for choosing Forever Flex"'and ArmorFlex/Hybrid LinerTM! The Forev Fl TM/Pre-insulated Forever Flex"'and ArmorFlex/Hybrid Liner"stainless steel lining systems are L 1777 and ULC S635 listed in 3"(7.6cm)to 12"(30.5cm)diameters. The lining system must be installed by a qualified chimney or venting professional. The criteria for installation must be in conformance with the specifications in the NFPA 211 (Standards for Chimneys, Fireplaces,Vents and Solid Fuel Burning Appliances),National Building Code of Canada and local or state building codes,whichever has jurisdiction. Contact local building or fire officials about restrictions and installation inspection in your area. it may be necessary to obtain permits before installing the chimney liner. Contact the local building authority for permit information. • Product Applications The Forever Flex'"/Fre-Insulated Forever Flex'and ArmorFlex/Hybrid Liner"I.i' •system is intended',for Ze--c-virhTherfiiirappliances burning home heating oil,natural or LP gas and solid fue . (pellet ood and coal)vented through a masonry chimney. Use 304 type stainless steel ArmorFlex/Hybrid Liner"and 304 type stainless steel orevF`�e-Flex'"for wood pellet stoves,wood burning stoves and fireplaces. Use 316 type stainless steel Forever Flex'"'and ArmorFlex/Hybrid LinerT"for wood burning appliances,coal burning appliances,oil burning appliances, gas burning appliances,and solid fuel burning appliances.Use AL 29-4C type stainless steel Forever Flex" for high efficiency appliances.(Forever Flex'in AL 29-4C should Alj be used with wood burning appliances). Use of experimental fuels is not permitted and voids the warranty. This lining system is not intended for use with high efficiency appliances that require type BH gas venting systems,or that create positive pressures in the chimney. The Forever Flex"'/Pre-Insulated Forever Flex"and ArmorFlex/Hybrid Liner"'system is intended for use in (I) new masonry chimneys, lined or unlined, with at least (a nominal) 4"(10cm) of masonry all around, (2) an existing, properly built masonry chimney with cracked clay tile liner.The lining system is intended to provide a properly-Sized flue for a heating appliance installed in a masonry chimney that otherwise meets existing codes. The Forever FlexT"/Pre-Insulated Forever Flex"and ArmorFlex/Hybrid Liner"'liner may also be used as a flue for a fireplace. The liner must be connected to the top of the smoke chamber by means of a bottom plate or other means, which provides an air-tight and drip-free termination. Chimney Inspection and Cleaning Prior to installation of the lining system thoroughly inspect and clean the chimney. All creosote(including tar gl ze creosote),soot,dirt and debris must be removed before the installation of the liner. Thorough cleaning of the chimney is a warranty prerequisite. The chimney must be inspected for cracked,loose or missing-stones,bricks or mortar joints. A chimney that is not structurally sound should not be relined. Make any repairs necessary before proceeding with the installation of the liner. As a precaution it is recommended that a short piece of lining material of the diameter to be installed is connected to a pulling cone and is drawn through the masonry chimney. This will ensure that no obstructions exist that should be removed and will result in a smoother installation of the system; 3 The Commonwealth of Massachusetts Print Form Department of Industrial Accidents ' 1 Office of Investigations - ? 1,1 1 Congress Street,Suite 100 Boston, MA 02114-2017 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): Kelly M Kapinos dba Ace Chimney Sweeps Address: 115 Main Blvd City/State/Zip: Ludlow, MA 01056 Phone #: 413-547-8500 Are you an employer?Check the appropriate box: Type of project(required): 1. ✓0 I am a employer with 4 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 workingfor me in anycapacity. employees and have workers' p ty 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.❑ Plumbing repairs or additions myself [No workers' comp. right of exemption per MGL 12.0 Roof re,�a/irs insurance required.]t c. 152, §1(4),and we have no 13.0 Other(�/1//)')n�/ �I cr employees. [No workers' comp. insurance required.] *My 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 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 entities have employees. If the sub-contractors have employees,they must 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: A.I.M.Mutual Insurance Company Policy#or Self-ins.Lic.#: AW JC-400-7027806-2022A Expiration Date: 10/08/2023 / Job Site Address: G 3 t2I Q�� Lk C1�/ Toff• City/State/Zip: /�D itin/h` /1 // G Attach a copyof the workers' compensation policydeclaration page(showingthe policynumber 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 hereby certify under the pains and penalties of perjury that the information provided above is true and correct. Signature: K%1Il Date /—� Phone#: 413-547-8500 Official use only. Do not write in this area,to be completed by 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 5.Plumbing Inspector 6.Other Contact Person: Phone#: ,acoRD� CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYYY) 10/07/2022 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 AMBtW, 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 00404-001 _NAMEACT D Dykes White Jubinville Ins Agcy Inc Pti8q FppX (gAµqI`o.Ext): IAIC.No.: P O Box789 ADDRESS: dorothyd@jubinville.com South Hadley,MA 01075-0789 N NSLRFwr�r�tFFOROING COVEReGE NAICR RE INSURERA: A.I.M.Mutual Insurance Company 33758 INSURED INSURER B: Kelly M Kapinos Ace Chimney Sweeps !INSURERC: 115 Main Blvd Ludlow, MA 01056 INSURERD: -- 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. I`SR TYPE OF INSURANCE AIMSR VWD W POLICY NUMBER I1 h W t Y+ i LIMITS_ — TR GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ PREMISES1Ea occurfencel -- i CLAMS-MADE rl OCCUR MED EXP(My one person) $ PERSONAL&ADV INJURY $ GENERAL AGGREGATE $ GEM_AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGO $ POLICY JEC;: LOC — - AUTOMOBILECOMBINEDSINGLELIMIT LIABILITY , $ (Ea accidentl ANY AUTO BODILY INJURY(Per person) $ ALL OPINED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE HIRED AUTOS AUTOS (Per accident! UMBRELLA LIAB I OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAMS MADE AGGREGATE $ DED I RETENTION$ $ SKryy� 7 H -- AND EMRREPAS'LIABILITY X TORY LANDS S"WgaP .�VE /N E.L.EACH ACCIDENT $ 100 000.00 q c N/A AWC-d00-7027808-2022A 10/8/2022 10/8/2023 E.L.DISEASE-EA EMPLOYEE $ (Mandatoryd in NH) EL. 100000.00 UrCf 1ON V OPERATIONS below E.L.DISFacP.POLICY LIMB $ 600,000.00 • DESCRIPTION OF OPERATIONS!LOCATIONS J VEHICLES(Attach ACORD 101,Additional Remarks Schedule,If more space Is required) PROOF OF COVERAGE Worker's Compensation Coverage Applies to Massachusetts Employees Only The workers compensation policy does not provide coverage for Kelly M Kapinos CERTIFICATE HOLDER CANCELLATION Kelly Kapinos dba Ace Chimney Sweeps 116 Main Blvd SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Ludlow,MA 01056 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ©1988-2010 ACORD CORPORATION.All rights reserved. ACORD 26(2010/05) The ACORD name and logo are registered marks of ACORD i_~....s ACECH-1 OP ID:AC ACORO' DATE(MM/ODIYYYY) 14.--- CERTIFICATE OF LIABILITY INSURANCE 11/28/2022 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 Ileu of suchpendorsement(s). CO PRODUCER 413-589-0901CONTACT Ideal Insurance Agency,Inc. PHONE 413-589-0901 FAX 413-583-6511 187 East St. (Arc,No,Extl: (uc�No): Ludlow,MA 01056 E-MAIL ADDRESS; INSURER(S)AFFORDING COVERAGE NAIC$ _ INSURER A:Arbeila Protection Ins Co 41360 INSURED INSURER S:Nautilus Insurance Company Ace Chimney Sweeps 115 Main Boulevard I INSURER C Ludlow,MA 01056 INSURER 0: i INSURER E: INSURER F: I 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 I ADDL"ADSUB R` POLICY EFF POLICY EXP I LIMITS LTR TYPE OF INSURANCE ) D wV 1 M/ POLICY NUMBER JMnn!YYYYL IMMIOD/YYYY1 f B X COMMERCIAL GENERLIABILITY, - I EACH OCCURRENCE S 1'000'00C CLAIMS-MADE X OCCUR NN1340149 11/24/2022 11/24/2023 RREMtSESO(EI ENoccI?ence) s 50,00C MED EXP(Any one person) $ 1,00C PERSONAL&ADV INJURY .$ 1,000,00( •GEM.AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE S 2,000,00( X POLICY PEiJT LOC PRODUCTS-COMP/OPAGO $ 2,000,00( OTHER' I S A AUTOMOBILE UABIUTY i COMBINED SINGLE LIMIT I$ iEa.accldent) ANY AUTO 1020007902 11/03/2022I 11/03/2023 BODILY INJURY(Per person) !$ 100,00( — SCHEDULEDO _X so 300,00( AUTOS NLY I BODILY INJURY(Par accident),$ _X AOS ONLY X pO Op I , PO5i npAMAGE 100,00 S i $ UMBRELLA LIAB _ OCCUR EACH OCCURRENCE $ EXCESS UAB I CLAIMS-MADE I AGGREGATE 1 $ DED I RETENTION$ s WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTNE Y/N E.L.EACH ACCIDENT i $ KFCRryEiMBNR EXCLUDED? N/A E.L.DISEASE-EA EMPLOYEE s Ifyes,D , E.L.DISEASE-POLICYJJMIT $ DESCRIPTION OF OPERATIONS below 1 I DESCRIPTION OF OPERATIONS I LOCATIONS r VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) CHIMNEY CLEANING&REPAIR, MASONRY CERTIFICATE HOLDER CANCELLATION INSRECD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN FOR INSURED'S RECORD ACCORDANCE WITH THE POLICY PROVISIONS. . AUTHORIZED REPRESENTATIVE ACORD 25(2016/03) 01988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD