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42-135 (6) BP-2023-0451 878 WESTHAMPTON RD COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 42-135-001 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-2023-0451 PERMISSION IS HEREBY GRANTED TO: Project# ROOF 2023 Contractor: License: SAMBRICO LLC/VISTA HOME Est. Cost: 29987 IMPROVEMENT 111478 Const.Class: Exp.Date: 01/21/2025 Use Group: Owner: GOULET SNAPE BRIAN& SUSAN Lot Size (sq.ft.) Zoning: WSP Applicant: SAMBRICO LLC/VISTA HOME IMPROVEMENT Applicant Address Phone: Insurance: 2097 RIVERDALE ST 413-382-0249 UB-2E072183-23 W SPRINGFIELD, MA 01089 ISSUED ON: 04/13/2023 TO PERFORM THE FOLLOWING WORK: STRIP AND REROOF 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: 0 • • j2 1 QTr • Fees Paid: $40.00 212 Main Street,Phone(413)587-1240,Fax (413)587-1272 Office of the Building Commissioner 1 The Commonwealth of Massachusetts ' `I W Board of Building Regulations and Standards APR 13 F R Massachusetts State Building Code, 7$'0 CMR MLNIC PAL ITY U E t� r�"�Building Permit Application To Construct, Repair,Rgnova � ised ar 2011 Ec- l One-or Two-Family Dwelling -- _ ^O9THAMPTON.MAo1o6o __ This Section For Official Use Only Buildiinf Permit Number: 3 95 1 D A lied: /�`��� !1Co� /777 ---� I1- 13-zoz Building Official(Print Name) Signature Date SECTION 1:SITE INFORMATION 1 1.1 Property Address: 1.2 Assessors Map&Parcel Numbers $l k LilL xn(i-sn 12d favvy-D Mg- 1.la Is this an accepted street?yes no Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Area(sq ft) Frontage(ft) 1.5 Building Setbacks(ft) Front Yard Side Yards Rear Yard Required Provided Required Provided Required Provided 1.6 Water Supply: (M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Public❑ Private 0 Zone: _ Outside Flood Zone'? Municipal 0 On site disposal system ❑ Check if yes❑ SECTION 2: PROPERTY OWNERSHIP' 2 Owngr'of Recor Y,Ian J(tbo. )c1 Exu(a-P -ta/'enc e., /v Olotool Name(Print) City,State,ZIP g'l k W S Ani n n d . 413-5a-zofte No.and Street Telephone Email Address SECTION 3: DESCRIPTION OF PROPOSED WORK2(check all that apply) New Construction 0 Existing Building 0 Owner-Occupied 0 RepairsO 0 Alteration(s)t 0 Addition ❑ Demolition 0 Accessory Bldg. El Number of Units Other a'Specify: /�.Q,—f2 Brief Description of Proposed Work': S-fr1p ( (Ye r?i i 4" k et.G(_ n etd aset'Y f Shi .es — lvo 3 i&c: x� ( SECTION 4: ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1. Building $ )cl R g 3, ae7 1. Building Permit Fee: $ Indicate how fee is determined: / 0 Standard City/Town Application Fee 2. Electrical $ 0 Total Project Costa (Item 6)x multiplier x 3. Plumbing $ 2. Other Fees: $ 1 4. Mechanical (HVAC) $ List: 5. Mechanical (Fire $ Suppression) Total All Fees: $ Check NogI Check Amount: 1 Cash Amount: 6.Total Project Cost: $079�6 p i . O. 0 Paid in Full 0 Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) \\\Vn 1,a6S ,Q.f\ ,()cNc4 License Number Expiration Date Name of CSL Holder �� List CSL Type(see below) No.and Street Cs- Type Description „,�`' , \�,1`S \ ,\n o1„�0 U unrestricted(Buildings up to 35,000 c t.ft.) 1(�LSJ� Cl \ VV l� �J R estricted 1&2 Family Dwelling ity/Town,St�[t$,ZIP M vlasonry RC Roofing Covering WS Window and Siding ^r p, SF ,Solid Fuel Burning Appliances Lin' 1a 4 ,►1SU�C'v)�rV/ld(VtQ,tK )SLMpAi-.41 1 I nsulation Telephone Email address D raemolition 5. Registered Home Improvement Contractor(HIC) -� egistras� `I,.1, v\cra `u _. H tiion Number Expiration Date HIC Comp Nam or HIC Re strant Name Zb Y Ief&1L . Vn tangle Tomo ,MpmJa,A kOti— N .and Street Email address .Coat& \, 5* W61, . wk-oko89 a13 To-4s--A.0 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 Issuanc the building permit. Signed Affidavit Attached? Yes No . 0 SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR/ APPPLIES FOR BUILDING PERMIT I,as Owner of the subject property,hereby authorize S ` O C,C0 � ' to act on my behalf,in all matters relative to work authorized by this building p@rmit application. C.13 WeVi 1 q W/7 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. (( ,n,I l Prin er's or Authorized Agent's Name(Electronic Signature) Date NOTES: 1. An Owner who obtains a building permit to do his/her own work,or an owner who hires an unregistered contractor (not registered in the Home Improvement Contractor(HIC)Program),will not have access to the arbitration program or guaranty fund under M.G.L.c. 142A. Other important information on the HIC Program can be found at www.mass.gov/oca Information on the Construction Supervisor License can be found at www.mass.gov/dps 2. When substantial work is planned,provide the information below: Total floor area(sq. ft.) (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' City of Northampton 0.i. •,-` Massachusetts it/ �_ ;r (: . '1/4al; w t c! ; . ' DEPARTMENT OF BUILDING INSPECTIONS Sk x ro'* ` 212 Main Street • Municipal Building yv6;., .a� Northampton, MA 01060 J'' ''O'' 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: \`') Vj\\ .i\ 'i?),\, &cm.9-\6‘• CC- The debris will be transported by: Name of Hauler: 3S \ Nk(i L\n ` Signature of Applicant: CkV ,i)0..._ Q-VCI.1^'---- Date: 1 == The Commonwealth of Massachusetts 110 Department of Industrial Accidents -----tirr1 1 Congress Street,Suite 100 . ,:1;.—, Boston, MA 02114-2017 `- www.mass.gov/dia %%takers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO RE FILED N ITH"IRE PERMUTING AUTHORITY. Applicant Information r � ` ` Please Print Legibly Name(Business'Organization/lndividual): S C a�"� �s\ - l�`.Q._ Address: OCA-1 `-\\\1 Q1 �.� City/State/Zip:V s c Q C Phone#: k-l\T"3---)a— `--\ -- 0 Are you an employer?('heck the appropriate bon: Type of project(required): 1.D 1 am a csoployer with employees(lull and or part-time).• 7. 0 New construction 20 1 am a sole proprietor or partnership and have no employers working for nor m 8. 0 Remodeling any capacity.[No workers'coup.insurance requited.) 9. ❑ Demolition 30 I am a homeowner doing all work myself.[No workers'comp.rnwrance required]' 10 0 Building addition 40 1 am a homeowner and will be hiring contradurs to conduct all work on my property. 1 will ensure that all contraclurr either have workers'compensation insurance or are ode 1 1.Q Electrical repairs or additions pr 12.0 Plumbing repairs or additions tors with no employees. S am a general contractor and I have hired the suba'ontraclon hated on the attached sheet. These sub-contractors have employees and have worker;comp.insurance.t 13❑Root'repairs 14.�Othet li/,- (!;c)60 We area corporation and its officers have exercised their right of exemption per tail c_ 152,41(1),and we have no employees.[No worker'cutup.insurance requicsil •Any applicant that checks box#1 must also fill out the section below showing their workers;compensation policy information. 'Homeowners wile submit this affddavit indicating they arc doing all work and then hire out.ndc contractors mini submit a new affidavit indicattisjaa k :C untrat lore that check this Nov must attached an additional shoot showing the name of the sub-contractor and state w heftier or not those mutiet have crmpluyers. If the sub- i,tractors hate cn>ployecs.they must provide their worker"comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and fob site information. Insurance Company Name: Policy x or Silt-ins.Lie.#: Expiration Date: Job Site Address. SOS/ (\ M.• City/State/Zip: A 1JZ c csL a 6 \6 L.D., 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 they be forwarded to the Office of Investigations of the DIA for insurance coo cratme%ertficanon. I do hereby c ify under the pains and penalties of petjury that the information provided above b owe end correct a Signature: )\ -r"j�r � � ()-k "" Date: (—A\I (I1 a Phone#: V\M'5'�-fir--- lJ+\}- a-0 Official use only. Do not write in this area,to be completed by city or town official ('it), or Town: Permit/License# Issuing,authority (circle one): 1. Board or Health 2. Building Department 3.City/lown Clerk 4. Electrical Inspector 5. Plumbing Inspector 6.Other Contact Person: Phone#: Page 1 of 7 2097 Riverdale Street MA Lic# 162058 West Springfield, MA 01089 CT Lic#0621848 v1Sta 4IP' vistahomeimprovement.com Phone: 888.597.2323 HOME IMPROVEMENT p c .NI.,•e PREFERRED CONTRACTOR Fax: 413.382.0241 Nor'Easter Roofing Contract 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 02116 Phone: 617.973.8700 Customer Information Brian Snape (413)588-2086 Date: 04/04/2023 Susan Goulet (413)585-8331 Rep: John Devine 878 Westhampton Rd susangoulet@comcast.net Florence MA 01062 Roof Specifications Nor'Easter Roof Systems Platinum Roof System Color D/C Storm Cloud Drip Edge Color white Number of Layers 2 Attic plywood Tear Off/Shingle Over tear off Location Full house and garage Underlayment Nor' Easter Deck Defense Ice &Water Shield 6feet Supply and Install Ridge Vent yes Vista Home Improvements agrees to do the following: Supply Dumpster Included Dumpster location Driveway Skylight Rework Flashing Included Inspect Decking for damage Yes Replacement decking price per sq ft 4.50 Replacement decking price per sq ft OPE' Ice and Water all valleys, penetrations, eaves and chimneys Yes Supply and install pipe boot flashing Yes Total Job Clean-Up Yes Frame In Or Close Off Gable Vent(s) 2 12" Chimney Relead 1 This space intentionally left blank Page 3 of 7 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 04/15/2023 Barring delay caused by circumstances beyond Contractors control, the work will be completed by 04/28/2023 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 50 Year Measure Section Measure Set With -- Call To Confirm with customer Total Contract Amount (All Discounts Applied) $29,987.00 Payment Deposit $5,000.00 Amount Financed $24,987.00 Form of Payment Upon Signing Check Check# 6128 Check Date 04/04/2023 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. NOTICE OF CANCELLATION 1 inns space intentionally left bl nx Page 7 of 7 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. ku0A-Ruppie- Brian Snape Susan Goulet 04/04/2023 04/04/2023 Date Date John Devine Authorized Representative 04/04/2023 Date This space intentionally left PI nk immon Commonwealth of Massachusetts Division of Occupational Licensure Board of Building Requ Nations and Standards Const�i'iilS visor CS-111478 a, F*pires:01/21/2025 BRIAN RUDDI 7' i '' ,p 2097 RIVERDALE.S.• • O WEST SPRIN0I' l t.4f:. 'a. .,o.ztmi�iararr ,. ....,zc...a. • • THE COMMONWEALTH OF MASSACHUSETTS Office of Consumer Affairs and Business Regulation 1000 Washington Street - Suite 710 Boston, Massachusetts 02118 Home Improvement Contractor Registration ' r» ir, _ ._ _._.t 1` Type. LLC es 14egistration: 1612058 SAMBRICO LLC tot r Expiration: 01/02/2025 D/B/A VISTA HOME IMPROVEMENT :+ J. 2097 RIVERDALE ST WEST SPRINGFIELD,MA 01089 �1.1— {"` 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 Washington Street -Suite 710 162058 01/02/2025 Boston,MA 02118 AMBRICO LLC /B/A VISTA HOME IMPROVEMENT f r1 RIAN RUDD , ( 1 ----._._ 097 RIVERDALE ST _,...,,,. ,,';,,r; ��� ( L /EST SPRINGFIELD,MA 01089 Undersecretary Not valid without sianature DATE IMM/DDIVYYY) AC R CERTIFICATE OF LIABILITY INSURANCE 5,42022 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 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 CON IACI - NAME: Certificate Department A-Costa Insurance Agency Inc (A/C PHONE,Ext): 508-875-3488 FAX No): 508-875-9388 mAIL 1 FRANKLIN COMMONS ADDRESS: SS: coi@a-cOstains.com INSURER(S)AFFORDING COVERAGE NAIC N FRAMINGHAM MA 01702 INSURER A: Atlantic Casualty Ins Co 42846 INSURED INSURER B: PROGRESSIVE 24252 GOLDEN CREW CONSTRUCTION CORP INSURER C: Hartford Underwriters Ins.Co. 30104 20 Timrod Dr INSURER D: UNIT A INSURER E: Worcester MA 01603-1246 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 QR 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 ADDL SUER —-- I POLICY EhF PUMA'!XI, I LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MMIDDIYYY`() IMMIDDIYYYY) LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 UAMAGt IU Rth/ItU CLAIMS-MADE X OCCUR PREMISES(Ea occurrence) $ 50,000 MED EXP(Any one person) $ 1,000 A AC14778750PC 5/4/2022 5/4/2023 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY JET LOC PRODUCTS-COMP/OP AGG $ 1,000,000 OTHER: $ AUTOMOBILE LIABILITY LAMBINEU SINGLE LIMI I $ 40 000 (Ea accident) ANY AUTO BODILY INJURY(Per person) $ 20,000 ALL B AUTO OWNED SCHEDX AUTOSULED 04409910 4/26/2022 4/26/2023 BODILY INJURY(Per accident) $ 100000 HIRED AUTOS — NON-OWNED PROPER I Y DAMAGE $ 5 000 AUTOS (Per accident) $ UMBRELLA LIAB OCCUR EACH OCCURRENCE S EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION X I STATUTE I WAN - AND EMPLOYERS'LIABILITY Y/N ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 1,000,000 C OFFICER/MEMBER EXCLUDED? piNIA 1326760 5/4/2022 5/4/2023 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN VISTA HOME IMPROVEMENT ACCORDANCE WITH THE POLICY PROVISIONS. 2097 Riverdale St AUTHORIZED REPRESENTATIVE West Springfield MA 01089-1025 j �.949Z!7- ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD CERTIFICATE OF LIABILITY INSURANCE [DATE(MM/DD/YYYY) Atl7C IRC l 03/23/2023 T TIFICATE 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: SOU HWICK INS AGENCY INC PHONE FAX P 0 BOX 100 (A/C,No,Ext): (A/C,No): E-MAIL SOUIHWICK. MA 01077 ADDRESS: 28TKC INSURER(S)AFFORDING COVERAGE NAIC# INSURED INSURER A: TRAVELERS PROPERTY CAST \l.FY COMPANY 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 4DDL POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER (MMIDDIYYYY) (MMIDDIYYYY) LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS MADE n OCCUR. DAMAGE TO RENTED $ PREMISES(Ea occurrence) i MED EXP(Any one person) $ PERSONAL&ADV INJURY $ �GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL $ AGGREGATEPROJECT EILOC E POLICY PRODUCTS-COMP/OP AGG $ IS AUTOMOBILE LIABILITY COMBINED SINGLE $ ANY AUTO LIMIT(Ea accident) BODILY INJURY $ OWNED SCHEDULE AUTOS (Per person) AUTOS ONLY BODILY INJURY $ HIRED --' NON-OWNED (Per accident) AUTOS ONLY AUTOS ONLY PROPERTY DAMAGE (Per accident) $ _ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED uRETENTION $ $ WORKER'S COMPENSATION AND PER OTHER EMPLOYER'S LIABILITY STATUTE UB-2E072183-23 03/12/2023 03/12/2024 ANY PROPERITOR/PARTNER/EXECUTIVE Y/N E.L.EACH ACCIDENT $ 500,000 OFFICER/MEMBER EXCLUDED? (Mandatory in NH) n N/A E.L.DISEASE-EA EMPLOYEE $ 500,000 f yes,describe under E.L.DISEASE-POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERAT)ONSILOCATIONSNEHICLES(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. CERTIFICATE HOLDER CANCELLATION SAMBRICO ETC DBA VISTA HOME IMPROVEMENT SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED 2097 RIVERDALE STREET l IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE WEST SPRINGFIELD, MA 01089 ACORD 25(2016/03)(Rev.09-18) The ACORD name and logo are registered marks of ACORD 1988- 5 A OR ORATION. gaits reserved.