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10B-065 (5) BP-2023-0272 35 WATER ST COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 10B-065-001 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-2023-0272 PERMISSION IS HEREBY GRANTED TO: Project# TUB REPLACEMENT 2023 Contractor: License: SAMBRICO LLC/VISTA HOME Est. Cost: 15439 IMPROVEMENT 107644 Const.Class: Exp.Date: 08/19/2023 Use Group: Owner: THOMAS MATTHEW DAVID Lot Size (sq.ft.) Zoning: URB Applicant: SAMBRICO LLC/VISTA HOME IMPR VEMENT Applicant Address Phone: Insurance: 2097 RIVERDALE ST 413-382-0249 UB-2E072183-22 W SPRINGFIELD, MA 01089 ISSUED ON: 03/07/2023 TO PERFORM THE FOLLOWING WORK: TUB REPLACEMENT 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: loll& .)2 � U Fees Paid: $104.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Office of the Building Commissioner The Commonwealth of Massachus tts Board of Building Regulations and St a radar•s MAR _ 6 M I PALITY Vy Massachusetts State Building Code, 7 C R 20 E Building Permit Application To Construct, Repair, R nova ' 1-mu. ' h a 4ise# filar 2011 One-or Two-Family Dwelling _ ^r;°F N,;rurtpI INSPE. IONS ?AA 0 .0 This Section For Official Use Only - ... Buildi g Permit Num ber: �jf7 ,— �� Date Applied: ���,s �� ,Z' 3-7-Zo z3 Building Official(Print Name) Signature 1 Date SECTION 1:SITE INFORMATION 1.1 Property Address: � � 1.2 Assessors Map& Parcel Numbers 35 LA QS- 3\ LQO_c� `"`•c-c.. 1.1a Is this an accepted street?yes no Map Number Parcel Number 1 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 ❑ Check if yes❑ SECTION 2: PROPERTY OWNERSHIP' Owner' f Re rd: Name(Print City,State,ZIP 5 L s J S's-. LiI3 -31(0c 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 lEr Specify:lab ( ilk jz Itiw1-1- Brief Description of Proposed Work': v U -1-1) - S in tr (t it/Ai_ uceLfd, instat1 acr 4i4 --fib b ' rkIill b -fa ou ii ' + . /VV g{QC-In' SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1. Building $ i i/39, coo 1. Building Permit Fee: $ Indicate how fee is determined: 2.Electrical $ ❑ Standard City/Town Application Fee ❑Total Project Cost3 (Item 6)x multiplier x 3. Plumbing $ 2. Other Fees: $ 4. Mechanical (HVAC) $ List: 5. Mechanical (Fire $ Suppression) Total All Fee : $ Check Noll Dif Check Amount: I U`I 6. Total Project Cost: $ /5- y39 a° ❑Paid in Full 0 Outstanding Balance Due:_ II SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) Iv.) Y 4 8J?/a? 0 >7 4 e-- License Number Expiration Date Name of CSL Holder „' ) ^^ List CSL Type(see below) No.and Street ')( ' Type Description With/al/an, f_ / ,,,M //\ U Unrestricted(Buildings up to 35,000 Cu.ft.) t h/al/ l V II �% v�J R Restricted l&2 FamilyDwelling City/Town,State,ZIP M Masonry RC Roofing Covering WS Window and Siding /�/// SF Solid Fuel Burning Appliances `-//3'3 �'c, i I•��U V/5��'lor rilrilPak/Y ¢/1+.ea-(,(, I Insulation Telephone Email address D Demolition 5.2 Registered Home Improvement Contractor(HIC) !I(0d6 S'i 1/a/ac hi CO LA,L HIC Registration Number Exp ration Date HIC Compakky Name or HIC Re istrant Name i tuv li s+-a.ho rheiri preVQ Y) A+-co.-, No.and Street Email address �t le.u- Scnigf'Ua - a City/Town,Stacy,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 of 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 u n C b L L L to act on my behalf,in all matters relative to work authorized by this building permit application. . ,e Cow Ct Print Owner's Name(Electronic Signature) Date SECTION 7b: OWNER1 OR AUTHORIZED AGENT DECLARATION By entering my name below, I hereby attest under the pains and penalties of perjury that all of the information containe in this application is true and accurate to the best of my knowledge and understanding. Srj DUazl�-- understanding. J/a3 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 a 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 ,orch) 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" The Commonwealth of Massachusetts 14 1 1� Department of Industrial Accidents �� 1 Congress Street,Suite 100 ' Boston, MA 02114-2017 www.mass.govfdia 11 otters' ('ompensation Insurance Affidavit:Builders/Contractors/Electricians/Plumber. Tt)BE FILED WITH THE PERMITTING AUTHORITY. Annlicant Information Please Print ledht b Name I Huamnes.r)rganizationiIndividual):J1c.i I btl Address: (Pi-) QL Vi2Ic City/Statc7ip:14 . ,Q . ( d loy5 Phone#: q/3 -3 a tis aL�a .Are yuu an employer:'Cheek the appropriate Ions: Type of project(required): I.Q I am a employer with employees(full anitor part-tim cl.' 7. CI New construction ?.ti LJ'I am a sole proprietor or partnership and hate nu employees working for me in $. Q Remodeling any.capacity.[No workers'comp.insurance n-quirel.] 9. ❑Demolition 30 l am a homeowner doing all work myself.[No workers comp.insurance Required.]' 4.0 I am a homeowner and will be hiring contractors to conduct all work on my property. I will 10 0 Building addition ensure that all contractors either have workers•currpsnaatwn insurance or are sole 11.0 Electrical repairs or additions proprietors with no employees. 12.0 Plumbing repairs or additions 5 am a general contractor and I have hind the sub-contractors listed on the attached sheet 13.EI Roof repairs These sub-contractors have employees and brie workers'comp.usurariec.l. 6.0 We are a corporation and its officers hate exectheir ised right of exemption per M(iL C. 14. other r 152,§1(4).and we have nu employees.[No workers'comp.insurance required_[ 'Any applicant that checks box al must also till out the section below showing their workers'compensation polies. information. Homeowners who submit this afidat it indicating they are doing all work and then hire outside contractors must submit a new attidat it indicating such. .t'untractors that cheek this box niu,t attached an additional sheet showing the name of the sub-contractors and state whether or nut those entities hate employees_ If the sub-contractors hate employees.they must pro%idc their workers-sump.policy number. I am an employer that is providing workers'compensation insurance fur my employees. Below is the policy and job site information. Insurance Company Name: Policy IS or Self-ins.Lic.#: Expiration Date: lob Site Address:`7 (41-11 J h City/State/Zip: Leeds .O/Drj Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL c. 152. §25A is a criminal violation punishable by 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.A copy of this statement may be forwarded to the Office of investigations of the DiA for insurance coot eras c r eritication. I do hereby certif t,{tnder the pains an penalties of perjure dune lire information provided above is true and correct Sta_natttre: � / Date_ `2Ia34 Phone v: L,/_i y Official use only_ Do not write in this area,to be completed by city or town official a its or pow n: Pernik/License# Ivsuitt<2 .'kutltority(circle one): 1. It,t;trd Of Health 2.Building Department 3.('it/Town Clerk 4.Electrical Inspector 5, Plumbing Inspector 6.Oilier Contact Person: Phone#: City of Northampton ,, O S �'� Massachusetts ma` s` ,._ cfc * ,t DEPARTMENT OF BUILDING INSPECTIONS r r ` 212 Main Street lb Municipal Building :04 r -411.7. Northampton, MA 01060 ss),y�, �yVy 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: P6 V./VW- S-F. �.. f- Spy^-,Gie(ae Ao 4 ba Lap G,ns'ar} dLbri s bCk__ - (Air ,c;.e .- po --el. cam- J‘i A 75v4116u The debris will be transported by: Name of Hauler: 301t/11(10 It L Signature of Applicant: (7(Vid/(.e' Date: Page 1 of 8 2097 Riverdale Street MA Lic# 162058 West Springfield, MA 01089 CT Lic#0621848 Phone: 888.597.2323 vista vistahomeimprovement.com Fax: 413.382.0241 BATHS BATHROOM CONTRACT Customer Information Matthew Thomas (413)539-3165 Date: 01/27/2023 35 Water St inthehouse123@comcast.net Rep: Amy Smith Leeds MA 01053 All home improvement contractors and subcontractors must be registered and any inquiries about a contractor or subcontractor relating to a registration should be directed to: Office of Consumer Affairs and Business Regulation Ten Park Plaza, Suite 5170 Boston, MA 02116Phone: 617.973.8700 Wet Area Item: Tub to Tub Solid colors Left or Right Hand Drain Right Hand Size of Tub 60x30x15 Style on front of tub straight Color of Tub White Wall Color Arctic Ice Hardware Color Brushed Nickel Qty 1 Pulse Showerheads and Spa Item Lanai Shower System CH Notes —"`Brushed nickel "" LANAI Qty 1 a.... ®.. (NEW) ANS ,U 111 Soap dish and Caddy's Item 3 shelf caddy Qty 1 Color Arctic Ice Shower Accessories Item curved shower rod Length of Shower rod 5' Qty 1 This space intentionally left blank Page 2 of 8 Other Work to be performed Additional Details Do Not Do (We do not do any painting or staining) Bathroom Sketch 4 I, Matthew Thomas, have read the terms stated herein, they have been explained to (me/us), and (I/We)find them to be satisfactory and hereby accept them. Amy Smith,Authorized Representative 01/27/2023 Date Mstoteov.lsww() Matthew Thomas 01/27/2023 Date Page 4 of 8 Homeowner's Association NO WORK SCHEDULE Contractor will not begin the work or order the materials before the third day following the signing of this Agreement, unless specified herein. Contractor will begin the work on or about 03/27/2023 Barring delay caused by circumstances beyond Contractors control, the work will be completed by 04/27/2023 WARRANTY The Contractor warrants that the work furnished hereunder shall be free from defects in materials and workmanship for the period stated below following completion and shall comply with the requirements of this Agreement. In the event any defect in workmanship or materials, or damage caused by the Contractor, its subcontractors, employees or agents, is discovered after completion of any job, Including cleanup, the Contractor shall, at its own expense, forthwith remedy, repair, correct, replace, or cause to be remedied, repaired or replaced, such damage or such defect in materials and workmanship. The foregoing warranties shall survive any inspection performed in connection with the agreed-upon work. Warranty Period Lifetime Measure Section Measure Set With -- Call To Confirm with customer Total Contract Amount (All Discounts Applied) $15,439.35 Payment Deposit $2,000.00 Amount Financed $13,439.35 Form of Payment Upon Signing Credit Card Credit card XXXX-XXXX-XXXX-8343 Acceptance of Proposal I have read both sides of this document and accept the prices, specifications and conditions stated. I understand that upon signing,this proposal becomes a binding contract. You are authorized to do the work as specified. Payment will be made as outlined above. You may cancel this agreement if it has been signed by a party thereto at a place other than an address of the Seller, which may be his main office or branch thereof, provided you notify the Seller in writing at his main office or branch by ordinary mail posted, by telegram sent or by delivery, not later than midnight of the third business day following the signing of this agreement. Please refer to the Notice of Cancellation below contents of which are referred to above and incorporated herein by reference. DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES. this space intentionally left blank Page 8 of 8 Contractor, under provisions of Chapter 142A of the Massachusetts General Laws, is required to apply for and obtain all construction related permits. Contractor shall not be deemed responsible for delays in the work described in this agreement caused by regulator, permit granting or inspectional agencies, authorities or individuals. NOTICE: If Owner obtains his/her own construction related-permits for the work described under this Agreement, Owner is hereby advised that in the event of a dispute,judgment and non payment of Contractor, Owner will not be entitled to make claim to or collection from the guaranty fund established in M.G.L. c. 142A. Modification: This Agreement, except as to concealed conditions or delays occasioned thereby or by restarts, cannot be changed except by a written statement signed by both Contractor and Owner. However, cancellation by Owner is allowed in accordance with the Notice of Cancellation. Owner hereby grants Contractor a limited Power of Attorney to complete incomplete documents on Owners behalf. Completeness of Contract for Execution: Owner is hereby advised not to sign this Agreement unless and until all blank sections have been filled in or marked as void, deleted or not applicable, and until all exhibits and related or referenced documents that are incorporated herein are attached hereto. Attorney's Fees/Costs Owner agrees to pay all costs of collection, including reasonable attorney's fees, cost and expenses. Furthermore, interest shall be charged at the highest lawful rate of interest on any and all overdue payments. Copy of Agreement to be given to Owner: This Agreement is governed by the laws of the Commonwealth of Massachusetts. It must be executed in duplicate, and an original, signed copy hereof given to the Owner at the time of execution. No work under the Agreement shall begin prior to the signing of the Agreement and transmittal to the Owner of a copy therefor. 4c45144,4) Matthew Thomas 01/27/2023 Date Amy Smith Authorized Representative 01/27/2023 Date This space intentionally left blank i-...4N A&TCHER-01 JDION ACORO CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYYY) � '' 12/7/2022 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 AXIA Insurance Services . PHONE FAX 84 Myron Street (a/o No,Ext):(413)788-9000 (A/C,No);(413)886-0190 Suite A ADDRESS:info©axiagroup.net West Springfield,MA 01089 INSURERS)AFFORDING COVERAGE NAI N INSURER A:MSA Main Street America Assurance Company 29939 INSURED INSURER B:Pilgrim Insurance Co. 21750 A&T Cherry Contractors,Inc INSURERC:A.I.M.Mutual Insurance Co. 17 Herman St INSURERD: West Springfield,MA 01089 - INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUER POUCY NUMBER POUCY EFF POUCY EXP LIMITS LTR INSD WVD (MMIDDIYYYY) (MMIDD/YYYY) A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE X OCCUR MPP3447Z 12/8/2022 12/8/2023 DAMAGE TO RENTED 50,000 PREMISES(Ea occurrence) $ MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY isref LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: $ B AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000,000 (Ea accident) $ _ ANY AUTO CSC00001009834 12/31/2021 12/31/2022 BODILY INJURY(Per person). $ OWNED ONLY X AUUTNOSSWULNEEDp BODILY INJURY(Per accident) $ ALTOS ONLY _ AUTOS ONLY (Per ant)Y DAMAGE $ $ UMBRELLA UAB OCCUR EACH OCCURRENCE $ EXCESS UAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ C WORKERS COMPENSATION I PPR EATUTE ERH AND EMPLOYERS'uaewTY YIN WCC-500-5023856-2022A 12/8/2022 12/8/2023 1,000,000ARTNER/ECUTIVE E.LEACHACCIDENT $ OFFICER/MEMBEREX , NIA (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE,$ 1'000,000 If yes,describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS I 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 Vista Home Improvement THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN p ACCORDANCE WITH THE POLICY PROVISIONS. 2097 Riverdale St West Springfield,MA 01089 AUTHORIZED REPRESENTATIVE ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD THE COMMONWEALTH OF MASSACHUSETTS Office of Consumer Affairs and Business Regulation 1000 Washington Street - Suite 710 Boston, Massachusetts 02118 Home Improvement Contractor Registration r t i. ,' ; iv.____i I_t '"° 17 Type. LLC n.� , Registration: 162058 SAMBRICO LLC 4 Expiration: 01/02/2025 D/B/A VISTA HOME IMPROVEMENT - ° 2097 RIVERDALE ST °, '", WEST SPRINGFIELD, MA 01089 Update Address and Return Card. THE COMMONWEALTH OF MASSACHUSETTS Office of Consumer Affairs&Business Regulation Registration valid for individual use only before the HOME IMPROVEMENT CONTRACTOR expiration date. If found return to: TYPE:LLC Office of Consumer Affairs and Business Regulation Registration Expiration 1000 Washigton Street -Suite 710 162058 01/02/2025 Boston,MA 02118 AMBRICO LLCc) /B/A VISTA HOME IMPROVEMENT j/ RIAN RUDD D97 RIVERDALE ST _,-0-4,,,,,,r, 4<4fr< J ( '/ V...*.***."------ /EST SPRINGFIELD, MA 01089 Undersecretary Not valid without sianature Commonwealth of Massachusetts Division of Professional Licensure Board of Building Regulations and Standards ConstruCtiOn Supervisor CS-107644 Expires:08/19/2023 RICK A LAJEUNE B COOLEY DRIVE WILBRAHAM_CIA Ik„ 00, Commissioner W &n ,,' A Af-tr�Rn CERTIFICATE OF LIABILITY INSURANCE 'DATE IMM/DD/YYYY)03/22//02 TMLSGERTIFICATE 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 NAME: SOUTHWICK INS AGENCY INC PHONE FAX P 0 BOX 100 (A/C,No,Ext): (AIC No): E-MAIL SOUTHWICK.MA 01(177 ADDRESS: 28TKC INSURER(S)AFFORDING COVERAGE NAIC# INSURED INSURER A: TRAVELERS PRtIPFR-Pv CAS! ALTV CO\1PAN N OF AMERICA SAMBRICO LLC DBA VISTA HOME IMPROVEMENT INSURER B: INSURER C: INSURER D: 2097 RIVERDALE STREET INSURER E: WEST SPRINGFIELD.MA 01089 INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: ' THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADOLnUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER (MMIDDIYYYY) (MMIODIYYYY) LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS MADE n OCCUR DAMAGE TO RENTED $ PREMISES(Ea occurrence) MED EXP(Any one person) $ PERSONAL 8 ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER. GENERAL $ - AGGREGATEPROJECT [JLOC E POLICY PRODUCTS-COMPIOP AGG $ _ $ AUTOMOBILE LIABILITY COMBINED SINGLE $ LIMIT(Ea accident) - ANY AUTO BODILY INJURY $ OWNED SCHEDULE AUTOS (Per person) _y AUTOS ONLY HIRED .� BODILY INJURY $ NON-OWNED {Per acc tl AUTOS ONLY AUTOS ONLY --� PROPERTY DAMAGE $ (Per accident) S UMBRELLA LIAB OCCUR EACH OCCURRENCE $ ilIMMII MEPEXCESS LIAB CLAIMS-MADE AGGREGATE 1 r.... DED uRETENTION $ WOR- KER'S COMPENSATION AND PEP OTHER EMPLOYER'S LIABILITY STATUTE ANY PROPERITORIPARTNERIEXECUTIVE YIN UB 2E072183-22 03112/2022 03/12/2023 E L EACH ACCIDENT $ 500.000 OFFICER/MEMBER EXCLUDED? (Mandatory in NH) a N/A E L DISEASE-EA EMPLOYEE $ 500.000 It yes,describe under E L DISEASE-POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) THIS REPLACES ANY PRIOR CERTIFICATE ISSUED TO THE CERTIFICATE HOLDER AFFECTING WORKERS COMP COVERAGE THE INSURED'S MA WORKERS COMPENSATION POLICY AND ITS LIMITED OTHER STATES ENDORSEMENT AUTHORIZES THE PAYMENT OF BENEFITS FOR CLAIMS MADE BY THE INSUREDS MA EMPLOYEES IN STATES OTHER THAN MA NO AUTHORIZATION IS GIVEN TO PAY CLAIMS FOR BENEFITS IN STATES OTHER THAN MA IF THE INSUsED HIRES.OR HAS HIRED EMPLOYEES OUTSIDE OF VIA THIS POLICY DOES NOT PROVIDE COVERAGE FOR ANY STATE OTHER THAN NIA CERTIFICATE HOLDER CANCELLATION VISTA HOME IMPROVEMENT SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED 2097 Riverdale St BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. t AUTHORIZED REPRESENTATIVE West Springfield MA 01 089-1 0 2 5 I 1 ACORD 25(2015103)(Rev.09-18) The ACORD name and logo are registered marks of ACORD 1988- 5 A ORD ORATION. Ig reserved.