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32C-259 (5) BP-2023-0174 25 WILLIAMS ST COMMONWEALTH. OF MASSACHUSETTS Map:Block:Lot: 32C-259-001 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-2023-0174 PERMISSION IS HEREBY GRANT D TO: Project# INSULATION 2023 Contractor: License: Est.Cost: 8000 AMERICAN INSTALLATIONS LLC 106178 Const.Class: Exp.Date: 09/29/2023 Use Group: Owner: LLC 25 WILLIAMS Lot Size (sq.ft.) Zoning: URC Applicant: AMERICAN INSTALLATIONS LLC Applicant Address Phone: Insurance: 130 COLLEGE ST SUITE 100 (413)552-0200 AMWC262555 SOUTH HADLEY, MA 01075 ISSUED ON: 02/14/2023 TO PERFORM THE FOLLOWING WORK: INSULATION/WEATH ERIZATI ON POST THIS CARD SO IT IS VISIBLE FROM THE STREET Inspector of Plumbing Inspector of Wiring U.P.W. Building Inspector Underground: Service: Meter: Footings: Rough: Rough: House# Foundation: Final: Final: Final: Rough Frame: Gas: Fire Department Driveway Final: Fireplace/Chimney: Rough: Oil: Insulation: Smoke: Final: THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIO: ATION OF ANY OF ITS RULES AND REGULATIONS. Signature: f Fees Paid: S65.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Office of the Building Commissioner 23-0046-AB Depi� ?off50 Am•,.y City of Northampton/ --``' 4/C.,r Building Department ,c� 212 Main Stre t 9INSULATION - , #4d ,: Northampton, MA'Cif :,* ►.: phone 413-587-1240 Fax 413 504 / QftJL., Y ,,,3,,,, ,,,,;,:,,,,,c, . /APPLICATION FOR INSULATION FOR A ONE OR TWO FAMILY DWELLING ONLY SECTION 1 -SITE INFORMATION INSULATION PERMIT 1.1 Property Address: This section to be completed by office Map Lot Unit 25 Williams Street Northampton, MA 01060 Zone Overlay District Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: Hawkins, Christian 35 Forbes Ave, Northampton MA 01060 Name(Print) Current Mailing Address: 917-922-6628 See attached Telephone Signature 2.2 Authorized Agent: American Installations 130 College Street Ste. 100, South Hadley, MA 01075 Name(Print) Current Mailing Address: /"A- M— (413)552-0200 Signature Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building 8,000 (a)Building Permit Fee 2. Electrical 0 (b) Estimated Total Cost of Construction from(6) I, 3. Plumbing 0 Building Permit Fee X 4. Mechanical(HVAC) 0 5. Fire Protection 6. Total=(1 +2+3+4+5) 8,000 Check Number 2 /�, This Section For Official Use Only Building Permit Number: r�P- 3 -- 7( ( � Issued: ed: Signature: ./Z___ 2 - 1y - Z023 Building Commissioner/Inspector of Buildings Date permits@AmericanInstallations.com @ EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR) SECTION 4-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder: Wesley K. Couture 106178 License Number 130 College Street Ste. 100, South Hadley MA 01075 9/29/2023 Address , Expiration Date (413)552-0200 Telephone 9.Registered Home Improvement Contractor: Not Applicable 0 American Installations 175982 Company Name Registration Number 130 College Street Ste. 100, South Hadley MA 01075 6/26/2023 Address kV Expiration Date Telephone (413)552-0200 SECTION 5-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 of the building permit. Signed Affidavit Attached Yes . No ❑ Brief Description of Proposed Work NOTE: INSULATION ONL Y Attic and basement insulation and air sealing throughout. I, American Installations - Wesley Couture , as Owner/Authorized Agent hereby declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge and belief. Signed under the pains and penalties of perjury. Wesley K. Couture Print Name 2/4/2023 f ` Date Hawkins, Christian as Owner of the subject property hereby authorize American Installations to act on my behalf, in all matters relative to work authorized by this building permit application. See attached 2/4/2023 Signature of Owner Date City of Northampton 'S!r��.. ���/// Massachusetts fof � 16 . 4V DEPARTMENT OF BUILDING INSPECTIONS o +j c $� 212 Main Street • Municipal Building Northampton, MA 01060 fdjP 3+71.�J AFFIDAVIT Home Improvement Contractor Law Supplement to Permit Application The Office of Consumer Affairs and Business Regulation("OCABR")regulates the registration of contractors and subcontractors performing improvements or renovations on detached one to four family homes. Prior to performing work on such homes,a contractor must be registered as a Home Improvement Contractor("HIC"). M.G.L. Chapter 142A requires that the"reconstruction, alteration, renovation, repair, modernization, conversion, improvement, removal, demolition, or construction of an addition to any pre-existing owner-occupied building containing at least one but not more than four dwelling units....or to structures which are adjacent to such residence or building"be done by registered contractors. Note:If the homeowner has contracted with a corporation or LLC,that entity must be registered. Type of Work: Insulation Est.Cost: 8,000 Address of Work 25 Williams Street, Northampton, MA 0106 Date of Permit Application: 2/4/2023 I hereby certify that: Registration is not required for the following reason(s): Work excluded by law(explain): _Job under$1,000.00 _Owner obtaining own permit(explain): Building not owner-occupied x Other(specify): Contractor pulling permit for homeowner OWNERS OBTAINING THEIR OWN PERMIT OR ENTERING INTO CONTRACTS WITH UNREGISTERED CONTRACTORS OR SUBCONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK ARE NOT ELIGIBLE FOR AND DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER M.G.L.Chapter 142A.SUCH OWNERS ALSO ASSUME THE RESPONSIBILITES FOR ALL WORK PERFORMED UNDER THE BUILDING PERMIT.SEE NEXT PAGE FOR MORE INFORMATION. Signed under the penalties of perjury: I hereby apply for a building permit as the agent of the owner: 2/4/2023 American Installations 175982 Date Contractor Name HIC Registration No. OR: Notwithstanding the above notice, I hereby apply for a building permit as the owner of the above property: Date Owner Name and Signature City of Northampton pR MPe S -r- ^.s. "I Massachusetts mow, _ 'ram x, �: H Id" t DEPARTMENT OF BUILDING INSPECTIONS ?. r ;,x,,' + r./ 212 Main Street •Municipal Building `.),i:,_ p .-r ' Northampton, MA 01060 °st% i^' Debris Disposal Affidavit In accordance of the provisions of MGL c 40, S54, I acknowledge that as a condition of the building permit all debris resulting from the construction activity governed by this Building Permit shall be disposed of in a properly licensed solid waste disposal facility, as defined by MGL c 111, S 150A. The debris from construction work being performed at: 25 Williams Street, Northampton, MA 0106 (Please print house number and street name) Is to be disposed of at: K& W Materials &Recycling, 138 Palmer Ave, West Springfield, MA 01089 (Please print name and location of facility) Or will be disposed of in a dumpster onsite rented or leased from: (Company Name and Address) pim„_ 2/4/2023 Signature of Permit Applicant or Owner Date If, for any reason, the debris will not be disposed of as indicated, the Applicant or Owner shall notify the Building Department as to the location where the debris will be disposed. /TH �; City of Northampton sus /'� 1. z, _ Massachusetts ;�. * �•G .'� sE ;r' "T .. , DEPARTMENT OF BUILDING INSPECTIONS S. ' 212 Main Street •• Municipal Building a`s•. .''SCb Northampton, MA 01060 s �1 MANDATORY FOR HOUSES BUILT BEFORE 1945 Property Address: 25 Williams Street, Northampton, MA 0106 Contractor Name: American Installations Address: 130 College Street Ste. 100 City, State: South Hadley MA Phone: (413)552-0200 Property Owner Name: Hawkins, Christian Address: 35 Forbes Ave City, State: Northampton MA 01060 1, Wesley K. Couture (contractor) attest and affirm that the building I intend to insulate does not have any open air (knob and tube) wiring in the spaces to be insulated and that I have provided the property owner with a copy of this affidavit. Contractor signature ;1 //A Date 2/4/2023 Page 1 of 2 • ticensed&insured A R T N ER mass save MA CSL It:106178 , P MARegostrntidtp175982 American Installations www.Americanlnstallations.com 130 College Street Suite 100,South Hadley,MA 01075• Office:(413)552-0200 fax:(413)552-0202• Email:support@Americanlestallations.com Customer Name: Christian Hawkins Email:Not provided Phone: 917-922-6628 Premise Address:25 Williams St,Northampton,MA 01060 Mailing Address:25 Williams St,Northampton,MA 01060 Project ID:4705741 Date:Jan.9,2023 Job Description Measure Description Location Quantity Unit Total Cost Customer Cost Air Sealing at Estimated 62.5 CFM50 Per Hour Other 1 hr $94.33 $0.00 Door-2"Thermal Barrier Polyiso Other 1 each $90.61 $22.65 Rim Joist-2"Thermal Barrier Polyiso Other 76 SF $370.12 $92.53 Door Sweep(with AS hrs) Other 3 each $78.33 $0.00 Exterior Door Weather Stripping (with AS hrs) Other 2 each $63.62 $0.00 Walls-Wood Sided -4" Dense Pack Cellulose Other 864 SF $2,185.92 $546.48 Project Total $2,882.93 Weatherization incentive ($1,984.99) Air sealing incentive ($236.28) WARRANTY:American Installations,LLC will provide the above stated homeowner with a 1-year workmanship warranty. American Installations,LLC hereby proposes to furnish all material and labor to complete the above scope o'work in accordance with the above specifications and all Kcal and state building regtiatinns for the Total Contract Value as stated herein. ACCEPTANCE OF PROPOSAL: The above prices, specifications and conditions are TOTAL CONTRACT VALUE= S satisfactory and are hereby accepted.You are authorized to do work as specified.Payment Down Payment=5 ❑ will he 1/3 down prior to start of work,and balance due upon Completion. PAID Balance Due Upon Completion= S Signature Date Property Owner(Print) (Sign) Date Representative:(Print) (Sign) Date T XIS AGREEMENT 15 COMPOSED OF THIS PAGE AND THE REVERSE SIDE OF THIS PAGE AND SMALL BE CONSIDERED IRE ENTIRE AGREEMENT IN THE PARTIES INVOLVED IRIS AGREEMENT IS BETWEEN AMERICAN INSTALLATIONS,LLC tRREnsrER REFERRED TO AS-COMPANY', ANCTNE CUSTOMERS)NAMED ABOVE,HERONAFTER REFERRED TO AS`CLIENT'.AND WRL BE SUBJECT TO ALL APPROPRIATE LAWS,REGULATIONS AND ORDINANCES OF THE STATE OF MASSAOIUSETTS OR coeAscTICUT RESPECTIVELY,AS WELL AS ALL LOCAL JURISDICTIONS Page 2 of 2 MA CS1 mass save jcensed&insuredMACS[M:106178 16.4111111. PARTNER MA Reg,52,arion#175982 American Installations vyww.Americaninstallations.com 130 College Sheet Suite 100,South Harley,MA 01075• Office:(413)552-0200 fax:(413)552-0202• Email:supportgaAwericanlnstallations.com Customer Name: Christian Hawkins Email:Not provided Phone: 917-922-6628 Premise Address:25 Williams St,Northampton,MA 01060 Mailing Address:25 Williams St,Northampton,MA 01060 Project ID:4705741 Date:Jan.9,2023 Total Program Incentive -$2,221.27 Customer Total $661.66 WARRANTY:American Installations,L_C will provide the above stated homeowner with a 1-year workmanship warranty. American Installations,LLC hereby proposes to furnish all material and labor to complete the above scope of work in accordance with the above specifications and aN local and state building regulations for the Total Contract Value as stated herein. ACCEPTANCE OF PROPOSAL: The above prices, specifications and conditions are TOTAL CONTRACT VALUE=S satisfactory and are hereby accepted.You are authorized to do work as specified.Payment Down Payment=S ❑ will be 1/3 down prior to start of work,and balance due upon Completion. PAID Balance Due Upon Completion= S CWH SignaturecwH(Jan 27,202311:11 EST) Date Property Owner(Print) (Sign) Date Representative:(Print) (Sign) Date THIS AGREEMENT IS COMPOSED Of THIS PAGE AND THE REVERSE SIDE OF THIS PAGE AND SMALL BE CONSIDERED THE ENTIRE AGREEMENT BY THE PARTIES INVOLVED THIS AGREEMENT IS BETWEEN AMERICAN I INSTALLATIONS,LLC HLAEINA TEI�REf ERRED TO AS'COMPANY, A ND THE CUSTOMER(S)NAMED ABOVE,MEREN AFT ER REFERRED TO AS"CLIENT',AND WILL BE SUBJECT TO ALL APPROPRIATE LAWS,REGULATIONS AND ORDINANCES OF THE STATE Of MASSACHUSETTS OR CONN ECTICUT RESPECT WELT,AS WELL AS ALL LOCAL JURISDICTIONS Page 1 of 2 Licensed&Insured MACSt#:106178 11?.1111111) mass save PARTNER MA Reg,stratFonn 175982 American Installations www.Americanlnstallations.com 130 College Street Suite 100,South Harley,MA 01075 • Office:(413)552-0200 Fax:(413)552-0202• Email:support@Americanlnstallations.com Customer Name: Christian Hawkins Email: Not provided Phone: 917-922-6628 Premise Address:25 Williams St,Northampton,MA 01060 Mailing Address:25 Williams St,Northampton,MA 01060 Project ID:4705868 Date:Jan.9,2023 Job Description Measure Description Location Quantity Unit Total Cost Customer Cost Air Sealing at Estimated 62.5 CFM50 Per Hour Living Space 1 hr $94.33 $0.00 Attic Floor-6" Enclosed Cellulose Living Space 972 SF $1,973.16 $493.29 Attic Floor- 9" Dense Pack Cellulose Living Space 30 SF $90.00 $22.50 Walls - Wood Sided -4" Dense Pack Cellulose Living Space 864 SF $2,185.92 $546.48 Door Sweep (with AS hrs) Living Space 2 each $52.22 $0.00 Exterior Door Weather Stripping(with AS hrs) Living Space 2 each $63.62 $0.00 Project Total p4,459.25 Weatherization incentive ($3,186.81) Air sealing incentive ($210.17) WARRANTY:American Installations,LLC will provide the above stated homeowner with a 1-year workmanship warranty. American nstallations,LLC hereby proposes to furnish all material and labor to complete the above scope of work in accordance with the above specifications and all local and state building regulations for the?Mal Contract Value at stated herein. ACCEPTANCE OF PROPOSAL: The above prices, specifications and conditions are TOTAL CONTRACT VALUE=S satisfactory and are hereby accepted.you are authorized to do work as specified.Payment will be 1/3 down prior to start of work,and balance due upon Completion. Down Payment=S ❑ PAID Balance Due Upon Completion= $ Signature Date Property Owner(Print) (Sign) Date Representative:(Print} (Sign) Date THIS AGREEMENT IS COMPOSED OF THIS PAGE AND TIE REVERSE SIDE Of THIS PAGE AND SHALL BE CONSIDERED THE ENT IRE AGREEMENT 0!THE PARTIES INVOLVED THIS AGREEMENT IS RETWEOI M/ERICAN INSTA:LATIONS,LLC HOIERI AFTq REFERRED TO AS"COMPANY'. ANC-NE CUSTOMERIS)NAMED ABOVE,HEREINAFTER REFERRED TO AS"CLIENT'.AND WILL BE SUBJECT TOAD.APPROPRIATE LAWS,REGULATIONS AND ORDINANCES Of THE STATE Of MASSAUT USETTS OR CONN ECTICUT RESPECTIVELY.AS WELL AS ALL LOCAL JURISDICTIONS Page 2 of 2 • mass save Licensed&insured MA al#:106178 , PARTNER MARegistmtiona175982 American Installations www.Americanlnstallations.com 130 College Street Suite 100,South Hadley,MA 01075• Office:(413)552-0200 Fax:(413)552-0202 • Email support®Americanlnstallations.com Customer Name: Christian Hawkins Email: Not provided Phone: 917-922-6628 Premise Address:25 Williams St,Northampton,MA 01060 Mailing Address:25 Williams St,Northampton,MA 01060 Project ID:4705868 Date:Jan.9,2023 Total Program Incentive -$3,396.98 Customer Total $1,062.27 WARRANTY:American Installations,LLC will provide the above stated homeowner with a 1-year workmanship warranty. American Installations,LLC hereby proposes to furnish all material and labor to complete the above scope of work in accordance with the above specifications and all local and state building regulations for the Total Contract Value as stated herein. ACCEPTANCE OF PROPOSAL: The above prices, specifications and conditions are TOTAL CONTRACT VALUE=S satisfactory and are hereby accepted.You are authorized to do work as specified.Payment Down Payment=S ❑ will be 1/3 down prior to start of work,and balance due upon Completion. PAID Balance Due Upon Completion= S CWH CWH(lan 27,202311:11 EST) Signature Date Property Owner(Print) (Sign) Date Representative:(Print) (Sign) Date THIS AGREEMENT IS COMPOSED Of THIS PAGE AND THE REVERSE SIDE Of THIS PAGE AND SHALL BE CONSIDERED THE ENTIRE AGREEMENT GY THE PARTIES INVOLVED_THIS AGREEMENT IS BETWEEN AMERICAN INSTALLATIONS,LLC HEREINAFTER REFERRED TO AS'COMPANY. ANOTHE CUSTOMERS)ROWED MOVE,HEREINAFTER REFERRED TO AS-curer.AND WILL BE SUBIECT TO ALL APPROPRIATE LAWS,REGULATIONS AND ORDINANCES OF THE STATE Of MASSACH USETTS OR CONNECTICUT RESPECTIVELY,AS WELL AS ALL LOCAL JURISDICTIONS. _ The Commonwealth of Massachusetts ,.r Department of Industrial Accidents ij—; !> ►.:.._ Office of Investigations Srfayette City Center 1'1:►f 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):American Installations LLC Address:130 College St, Suite 100 City/State/Zip:South Hadley, MA 01075 — Phone#:413-552-0200 Are you an employer? Check the appropriate box: Type of project(re uired): 1.❑� I am a employer with 43 4. 0 I am a general contractor and I employees (full and/or part-time).* have hired the sub-contractors 6. El New construe 'on 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition workingfor me in anycapacity. employees and have workers' P tY 9. 0 Building addi 'on [No workers' comp. insurance comp. insurance. required.] 5. 0 We are a corporation and its 10.0 Electrical rep irs or additions 3.0 I am a homeowner doing all work officers have exercised their 11.0 Plumbing rep irs or additions myself. [No workers' comp. right of exemption per MGL 12.0 Roof repairs insurance required.] t c. 152, §1(4),and we have no Insulat on employees. [No workers' 13.❑� 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 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 police and job site information. Insurance Company Name: Berkshire Hathaway GUARD Insurance Policy#or Self-ins. Lic. #:AMWC332951 Expiration Date:09/04/2023 Job Site Address: 25 Williams Street City/State/Zip: Northampton, MA 01060 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 hereby certify under the pains and penalties of perjury that the information provided above is true and correct. -' 2/4/2023 Signature: 9, 1@i�% Date: Phone#: 413-552-0 00 Official use only. 1)o not write in this area, to be completed by city or town official. City or Town: Permit/License# Issuing Authority(check one): 1❑Board of Health 2❑Building Department 3tCity/Town Clerk 4.0 Electrical Inspector 5falumbing Inspector 6.0Other Contact Person: Phone#: „. Commonwealth of Massachusetts Division of Professional Licensure Board of Building Regulations and Standards Const t- ot) bt) • rvisor • CS-106178 ri Expires: 09/29/2023 WESLEY COUtURE 139 PACKARDVILLE 417' 1) PELHAM MA 01002 .04 e )1CS, ICt 0 ,an rk, • Commissioner /:/a, A, A, loi-641ai Ack, Office of Consumer Affairs and Business Regulation 1000 Washington Street - Suite 710 Boston, Massachusetts 02118 Home Improvement Contractor Registration Type: LLC Registration: 175982 AMERICAN INSTALLATIONS,LLC. Expiration: 06/26/2023 130 COLLEGE STREET SUITE 100 SOUTH HADLEY,MA 01075 Update Address and Return Card. Oak*of Consumer Affairs&Business Regulation NOME IMPROVEMENT CONTRACTOR Registration valid for individual use only TYPE:LLC before the expiration date. If found return to. 81giattetiOn ExIUSI211 °Moe of Consumer Affairs and Business Regulation 175982 06/28/2023 1000 Washington Street -Suite 710 AMERICAN INSTALLATIONS,LLC. Boston,MA 02118 WESLEY COUTURE //2,/,‘,..4.- 130 COLLEGE STREET surrE 100 .(0.4gmfe. Not valid without signature SOUl'H HADLEY,MA 01075 Undersecretary A�® CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) 08/30/2022 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Barbara Grynkiewicz Webber&Grinnell PHONE (413)586-0111 FAX (413)586-6481 (A/C,No,Ertl: (A/C,No): 8 North King Street ADDRESS: bgrynkiewicz@webberandgrinnell.corn INSURER(S)AFFORDING COVERAGE NAIC# Northampton MA 01060 INSURER A; Employers Mutual Casualty Company 21415 INSURED INSURER B: AmGUARD/BH GUARD 43290 American Installations,LLC INSURER C: Attn:Wes&Suzanne Couture INSURER D: 130 College Street,Suite 100 INSURER E: South Hadley MA 01075 INSURER F: COVERAGES CERTIFICATE NUMBER: Exp 9/4/23 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 INSD WVD POLICY NUMBER POLICY EFF POLICY EXP LIMITS (MMIDD/YYYY) (MM/DDIYYYY) COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED 500,000 CLAIMS-MADE OCCUR PREMISES(Ea occurrence) $ X Liquor Liability MED EXP(Any one person) $ 10,000 A 5D3535223 09/04/2022 09/04/2023 PERSONAL&ADV INJURY $ 1,000,000 GEN'LAGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY X PECOT- LOC PRODUCTS-COMP/OPAGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 (Ea accident) ANY AUTO BODILY INJURY(Per person) $ A OWNED X SCHEDULED 5Z3535223 09/04/2022 09/04/2023 BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS X HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY X AUTOS ONLY (Per accident) PIP-Basic $ 8,000 X UMBRELLAUAB _ OCCUR EACH OCCURRENCE $ 1,000,000 A EXCESS LIAB CLAIMS-MADE 5J3535223 09/04/2022 09/04/2023 AGGREGATE $ 1,000,000 DED X RETENTION $ 10,000 $ WORKERS COMPENSATION X STATUTE ERH AND EMPLOYERS'LIABILITY Y N B ANY PROPRIETOR/PARTNER/EXECUTIVE Y NIA AMWC332951 09/04/2022 09/04/2023 E.L.EACH ACCIDENT $ 500,000 OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 500,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS I 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 Evidence of Insurance ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD