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23B-004 (5)
BP-2023-0543 14 STRAW AVE COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 23B-004-001 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-2023-0543 PERMISSION IS HEREBY GRANTED TO: Project# ROOF 2023 Contractor: License: SAMBRICO LLC/VISTA HOME Est. Cost: 22721 IMPROVEMENT 1 1 1478 Const.Class: Exp.Date:01/21/202 Use Group: Owner: C CAR TON LAURA E&EVAN Lot Size (sq.ft.) Zoning: URB Applicant: SAME ICO LLC/VISTA HOME IMPROVEMENT Applicant Address Phone: Insurance: 2097 RIVERDALE ST 413-382-0249 UB-2E072 1 83-23 W SPRINGFIELD, MA 01089 ISSUED ON: 05/01/2023 TO PERFORM THE FOLLOWING WORK: STRIP AND RE-ROOF 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: 1 Insulation: Smoke: Final: THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Signature: Q 1:2tretiv1/4_, . (pi 6 ` ' ! Fees Paid: $40.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Office of the Building Commissi ner The Commonwealth of Massachusetts W Board of Building Regulations and Standaads ' FOR Massachusetts State Building Code, 780 C\IRApR 2 8 2023 1 UNIUSE LITY Building Permit Application To Construct, Repair, Renovate Or Demolish a kevised Mar 2011 One- or Two-Family Dwelling ,,L T OF BUILDING INSPEG IO This Section For Official Use Only r""�T"A�49T_Oh_�."Ao'o--o Building Permit Number: bi- s 3 Date Applied: 4 ttJ ` Kass /17:///:7--- 5-1-z6Z3 Building Official(Print Name) Signature Date SECTION 1: SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map&Parcel Numbers 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 0 Private 0 Zone: Outside Flood Zone? _ Municipal 0 On site disposal system 0 Check if yes❑ SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of Record: t(a3te, . k l,G,vcr,.\�cica J CG Aron CQ/1CQ.- O\'Lta. Name(Print) City ZIP \ 4 S"\C q,LA Q. -1S )-a .-\‘.kS F1' 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 Repairs(s) ❑l Alteration(s) 0 Addition 0 Demolition 0 Accessory Bldg. 0 Number of Units Other 'd Specify: �.( Brief Description of Proposed Work': S<Sp Cam - V- .� \r ctA-A-- c� C;� ? \n 'r 0, SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1. Building $ Da—) a\, 1. Building Permit Fee: $ , Indicate how fee is determined: 2.Electrical $ ❑ Standard City/Town A lication Fee ❑Total Project Cost3(It 6)x multiplier x 3. Plumbing $ 2. Other Fees: $ 4. Mechanical (HVAC) $ List: 5. Mechanical (Fire $ Suppression) Total All Fees: Check No.gq 0 Check`' ount: I- Cash Amount: 6. Total Project Cost: $ 014. T\ -" 0 Paid in Full 0 Outstanding Balance Due: I SECTION 5: CONSTRUCTION SERVI I ES 5.1 Construction Supervisor License(CSL) M • 1 le:A a3 v\ .OV\ 6 License Num.-r Expiration Date Name of CSL Holder \1S COvNoSet.. ist CSL Typ (see below) No.and Street CrV1 Type Description n^�\ t ! U i nrestricted(Buildings up to 35,000 Cu.ft.) XY�U S \ ��b� R ;estricted 1&2 Family Dwelling City/Town, te, IP M asonry RC oofing Covering WS indow and Siding SF olid Fuel Burning Appliances WS- -g59D \(\(b@ isN- br&scosCDJDlti1v1 I 1 sulation Telephone Email address Co N D I emolition 5.2 Re istered Home Improvement Contractor(HIC) ` ,,atir I a cl3 amv3o'\.d \_\-L HIC 'egistration Number Expiration Date HIC Comp Any Name or HIC Registrant Name Ql .v/& J.., Sc. \( @._ 4‘sk-o� 'M9c0v42.n„0,..4, No.and Street SQAd `,^ 0 (() �`.1-31a.NS cUto Email address _ C-o"„\ 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 Issuance of the building permit. Signed Affidavit Attached? Yes ll/ No .0 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 0\0 n C O \\, to act on my behalf,in all matters relative to work authorized by this building permit application. C_c OUr- 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 per-ury that all of the information contain d in this application is true and accurate to the best of my knowledge and understanding. GSA rud•9. �1a�1 a Print 0 is 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 lot 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 riL Massachusetts �4.� - DEPARTMENT OF BUILDING INSPECTIONS 212 Main Street • Municipal Building r J ,a • ,.._-' ►'' Northampton, MA 01060 1's:-h, 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. The debris will be disposed of in: Location of Facility: - �I WkiA k, • £ ►C 0 d The debris will be transported by: Name of Hauler: V ``� Signature of Applicant: cli — Date: The Commonwealth of Massachusetts • T--1f Department of Industrial Accidents 1 Congress Street,Suite 100 Boston, MA 02114-2017 www.ntass.gov/dia 11urkers' Compensation Insurance:lfftda%it: Builders/Coatracto timber. to BF: F-ILF:1)N%fl ll I IIF: NF:R�IICClltlG�ILP1INORITY. Applicant Information Please Print Legibly Name(Buytnes.s,Or-s.1111/dt,0t, individual): j,jj\(`NNjC, c Address: Q 7) Q�J 9rCf OjQ City'State/Zip: 0\01 Phone#: (13 • 3-a' 1/4-k5c) c) are you an employer?Cheek the appropriate boy. Typeof project(required): I snn a cluplover with emplosccs(full and or part-bone).' 7. Q New construction ?-a I am a sole proprietor or partnership and have nu employees working for me in 8. Q Remodeling any capacity.[No worker'comp.insurance required.) 9. p Demolition 3�I am a homeowner doing all work myself-[No worker:comp-insurance require[.)' 0❑Building addition 4.0 I am a homeowner and will be hiring contractors to conduct all work on my property. 1 will l croon that all contractors either have workers'compensation insurance or are sole i La Electrical repairs or additions proprietor with nu employees. 12.0 Plumbing repairs or additions 561 am a general contractor and I have hired the sub-contractors listed on the attached sheet- 130 Roof repo: These sub-contractor have employees and have workers'comp.insurance. 14. er oC- 6.o We are a corporation and its officers have exanised their right of exemption per MGL c. 152.5114),and we have no employees-[No worker'comp.insurance rcquitn_r11 •Any applicant that checks box NI must also till 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 affidas it indicating such. :Contractor 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 Nub-contractors hose employees.they must pros de their workers'comp polies numer. I am an employer that is providing workers'compensation insurance for etc employees. Below is the policy and job site information. Insurance Company Name: Puhcy #or Self-ins. Lie. #: Expiration Date: Job Site Address:` Q. . CityIState/Zip:.\O91\(Q 0\Q(.9c) Attach a copy of the workers'compensation policy deearadoa 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 S 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 S250.00 a day against the violator. A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby c ,tinder the pains and penalties of perjurythat the information provided above is correct.true and Signature: W" Date: mil,c t ` :.: Phone#: � 31 .4' --4v Official use only. Do not write in this area.to be completed hi 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 1 Contact Person: Phone 4: Page 1 of 18 2097 Riverdale Street MA Lic# 162058 West Springfield, MA 01089 CT Lic#0621848 VistaLATINUM! Phone: 888.597.2323 HOME IMPROVEMENT vistahomeimprovement.com yx,,QPRFFERREO«,N1RA TUk 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 Evan - Laura Carlton Lareau Evan Cell: (413)222-1458 Date: 04/15/2023 14 Straw Ave elareaul l @gmail.com Rep: Michael Mastroianni Florence MA 01062 Roof Specifications Nor'Easter Roof Systems Preferred Roof System Color Estate Grey Drip Edge Color white Number of Layers 1 Attic Can't get into attic Location Just Main house 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 Inspect Decking for damage Yes Replacement decking price per sq ft � 5 j�/ Replacement decking price per sq ft O Ice and Water all valleys, penetrations, eaves and chimneys Yes Supply and install pipe boot flashing Yes Total Job Clean-Up Yes Cut In New Ridge Vent Included Frame In Or Close Off Gable Vent(s) 2 Replace Existing Braun Vents 1 12" Chimney Relead 1 Additional Details Do Not Do (We do not do any painting or staining) Page 2 of 18 I, Evan - Laura Carlton Lareau, 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. Roof Sketch / Photos 1, • Michael Mastroianni,Authorized Representative Evan-Laura Carlton Lareau 04/15/2023 04/15/2023 Date Date This space intentionally left bl.nk Page 3 of 18 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 05/01/2023 Barring delay caused by circumstances beyond Contractors control, the work will be completed by 05/03/2023 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 -- Kevin Date Measure Is set for 04/17/2023 2 hour window Measure is set for 9-10 Total Contract Amount (All Discounts Applied) $22,721 .00 Payment Deposit $6,500.00 Amount Financed $16,221.00 Form of Payment Upon Signing Check Check# 4217 Check Date 04/15/2023 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 This space intentionally left PI nk Page 7 of 18 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. /*:===" Evan - Laura Carlton Lareau 04/15/2023 Date Michael Mastroianni Authorized Representative 04/15/2023 Date This space intentionally left bt nk ° CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 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: SOUTHWICK INS AGENCY INC' PHONE FAX P O BOX 100 (A/C,No,Ext): (A/C,No): E-MAIL SOUTHWICK,MA 01077 ADDRESS: 28TKC INSURER(S)AFFORDING COVERAGE NAIC# INSURED 'INSURER A: TRAVELERS PROPERTY CASUALTY 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. INSRI 4DDL3UBR POLICYEFF POLICY EXP LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER (MM/DDIYYYY) (NM\DDIYYYY) LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS MADE OCCUR. PDAMAGE REMISES RENTED Ea NT ence) MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER GENERAL $ AGGREGATEPROJECT nLOC E POLICY PRODUCTS-COMP/OP AGG $ 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 I $ (Per accident) UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED LIRETENTION $ $ 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 S 500.000 OFFICER/MEMBER EXCLUDED? (Mandatory In NH) Ti N/A E.L.DISEASE-EA EMPLOYEE $ 500.000 If yes,describe under E.L.DISEASE-POLICY LIMIT $ 1.000,000 DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(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 LLC DBA VISTA HOME IMPROVEMENT SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED 2097 RIVERDALE STREET BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED 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 1988-2 15 A ORD RPORATION.fights reserved. - ACORO CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYYY) `r.----- 08/01/2022 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 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: WM J IS WILLIAM MISS INSURANCE AGENT (PAHI/CN u Eur1:- (413 568-6111 FAX No) (413)572-9191 156 ELM STREET E-MAIL ADDRESS. BILL ILLMISINSURANCE.COM .__ WESTFIELD, MA 01085 INSURER(S)AFFORDING COVERAGE NAIC# _ INSURER A: NAUTILAS INS 66915 INSURED INSURER B: SAMBRICONISTA HOME IMPROVEMENT INSURER C: INSURER D 2097 RIVERDALE RD 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 TYPE OF INSURANCE UBR POLICY EFF POLICY EXP LT INSR LTR MD POLICY NUMBER (MMIDOIYYYY) (MM/OD/YYVY) LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY PREMISES(CEccurrrence) $NTED 1OO,000 CLAIMS-MADE X,OCCUR MED EXP(Any one person) $ 5,000 X G3679203 08/02/2022 08/02/2023 PERSONAL a ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 OR P POLICY X LOC $ PR T AUTOMOBILE UABILITY COMBINED SINGLE LIMIT LEa accident) .S._ ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS _ AUTOS NON-OWNED PROPERTY-EAMAGE' I HIRED AUTOS AUTOS (Per accident) b $ UMBRELLA UAB OCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS-MADE AGGREGATE $ DED RETENTIONS I $ WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS'LIABIUTY Y/N --.__;,SQRY UMIT_S. �ER_ ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? N I A E.L.EACH ACCIDENT $ (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under _--- DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS 1 LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks Schedule,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 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE 4/4.0'/� 0 .0., ....3"...-9 1c.:. . ACORD 25(2010/05) ©1988-2010 ACORD CORPORATION. All rights reserwtd. The ACORD name and logo are registered marks of ACORD Commonwealth of Massachusetts latDivision of Occupational Licensure Board of Building Rel ulationsIT and Standards Constctiaion Svisor CS-111478 AM.„ EMC.pires:01/21/2025 BRIAN RUDCF Aft ., 2097 RIVERDALE=S"'`0 ..' '" WEST SPRINGIER.' ' O r ;. 1 eolrui 4'0IJ.V(VP.- n ..I.. • r 1 THE COMMONWEALTH OF MASSACHUSETTS Office of Consumer Affairs and Business Regulation 1000 Washington Street - Suite 710 Boston, Massachusetts 02118 Home Improvement Contractor Registration "` • ` Type. LLC SAMBRICO LLC '! ON kegistration: 162058 D/B/A VISTA HOME IMPROVEMENT '" Expiration: 01/02/2025 2097 RIVERDALE ST WEST SPRINGFIELD,MA 01089 =111M.' 43 Nf o° Update Address and Return Card. THE COMMONWEALTH OF MASSACHUSETTS Office of Consumer Affairs 8 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 , '") J1n I RIAN RUDD I /)97 RIVERDALE ST .r.,i. ,.;,.• l '' (1— ! L v -- /EST SPRINGFIELD, MA 01089 Undersecretary f i Not valid without sianature Awn CERTIFICATE OF LIABILITY INSURANCE DATE IMM/DDIYYYY) 5/4/2022 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 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 GUN IACr NAME: Certificate Department A-Costa Insurance Agency Inc (A/CC,,NNo,Ext): 5084175-3488 A C,No): 508-875-9388 L 1 FRANKLIN COMMONS ADD DRE ADRE SS: coi@a-costains.com NSURER(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: Hartfo'd Underwriters Ins.Co. 30104 20TimrodDr INSURERD: _ UNIT A INSURER E: Worcester MA 01603-1246 INSURERF: 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 - - POLICY EFF- I POLICY EXP INSD WVD POLICY NUMBER (MM/DDIYYYY) (MM/DDIYYYY) LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE X OCCUR PREMISES(EatNT occurrence) $ 50,000 MED EXP(My 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 PRO- JECT LOC PRODUCTS-COMP/OP AGG $ 1,000,000 OTHER: $ AUTOMOBILE UABIUTY WMBINED SINGLE LIMI I (Ea accident) $ �.� ANY AUTO BODILY INJURY(Per person) $ 20,000 8 ALL OWNED SCHEDULED AUTOS X AUTOS 04409910 4/26/2022 4/26/2023BODILY INJURY(Per accident) $ 100,000 HIRED AUTOS NON-OWNED PROPERlY DAMAGE AUTOS (Per accident) $ 5,000 UMBRELLA UAB OCCUR EACH OCCURRENCE $ EXCESS UAB CLAIMS-MADE AGGREGATE $ DED I RETENTION$ $ WORKERS COMPENSATION X STATUTE ERH AND EMPLOYERS'LIABILITY Y/N ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 1,000,000 C OFFICER/MEMBER EXCLUDED? pi E.L.I A 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 [ a/Oiritaillik- ©1988-2014 ACORD CORPORATION. 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