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29-428 (6) BP-2023-0569 78 GOLDEN DR COMMONWEALTH OF MitSSACHUSETTS Map:Block:Lot: 29-428-001 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-2023-0569 PERMISSIO IS HEREBY GRANTED TO: Project# ROOF 2023 Contractor: License: Est.Cost: 9900 SEXTON ROOFING O 99689 Const.Class: Exp.Date: 10/05/202 Use Group: Owner: E. WIT, ING, PAMELA Lot Size (sq.ft.) Zoning: WSP Applicant: SEXTON ROOFING CO Applicant Address Phone: Insurance: P O BOX 6327 (413)534-1234 7pjubog07898222 HOLYOKE, MA 01041 ISSUED ON: 05/04/2023 TO PERFORM THE FOLLOWING WORK: REPLACE 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: Insulation: Smoke: Final: THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Signature: I • • . 72,81a, Fees Paid: $40.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Office of the Building Commiss oner g5, The Commonwealth of Massachusetts Board of Building Regulations and Standards •: FOR 7V. ,Massachusetts State Building Code,-780 CMR,7m edition MUNIOPAL1USE TY Building Permit Application To Construct,Repair,Renovate Or Demolish a Revised Jemmy • One-or Two-Family Dwelling I,2008 . • This Section For Official Use Only . Building Permit Number. .? -5-0 1 Date Applied: Signature. /3. • • . • . 5^3.2OZ3 . izii'o = Bu ding Commissioner/Inspector of Buildings Date • .-1. ` i D C. - ( , SECTION 1:SITE INFORMATION g t I. Pro Address:j 1.2 Assessors Map&Parcel Numbers o., ca j getie,� P� • • • 1:.9 • sa. 1.ie Is • an ac epted street?yes no Map Number 0 1.3 Zoning Information: 1.4 Property Dimensions: PareelNumtier z ____ - Zoning District Proposed Use — Lot Area(sq ft) Frontage(ft) 1.S Building Setbacks(ft) • FrontYard 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 C1 • Zone: _ Outside Flood Zone? Municipal 0 On site disposal system 0 Cheel if yes° • • SECTION 2: PROPERTY QWNERSHIP1 2.1 O •tier'of Reco d: ,(�,�•,-1 •'��t r Gii j ald/CreriJ D,e— A4ie,, .,.vs'l m Na rint) ( ZI ress or Service: ' . peir.,4---4,4441 , r!o/6.7�D-�-�' 2 J4 za 51,.s:-e ....,e, ( cam• • re Telephone • SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply) .New Construction 0 Existing Building Lf Owner-Occupied Repairs(s) ❑' Alteration(s)'❑ Addition ❑ • Demolition 0 Accessory Bldg.❑ NumberofUnits / Other 0 Specify: • . • Brief Descriptiio�onnj of Proposed Wr�• �ork2: /�` ' / C1 L,'P I•'V .p/r'//d{ cX.�r^�'i✓ls� L��7 i' �/ /4sti1' 4 • SECTION 4:ESTIMATED CQNSTRUCTION.COSTS • • Estimated Costs; Item . .• ' Official Use Only . • (Labor and Materials) • I.Building $ I, Building Permit Fee:$Indicate how fee is determined: CI standard City/Town Application Fee 2.Electrical $• ❑Total Project Costl(Item 6)x aiuhiplier•x 3.Plumbing • . $ ' 2. Other Fees: $ • ' 4.Mechanical (HVAC) $ List: • • ' 5.Mechanical (Fire Total All Fees:$ • ' • Suppression) _ ) • ' Check No3/x i Cheek Amount Cash Amount 6. Total Project Cost: $419,z) ❑Paid in Full CI Outstanding 13alance Due: r SE{TFON& CONSTRUCTION SERVICES Si Cate ue tau SupervisorLieense(C SSL) �j j IC fereH Se too I f Nameeof CSL Hoidrr V � (9�1Q` i List t Si Type(=betnw) LL1J- No_and Street Typc Description Ile ice :MA 01D ' -G -►rf„r=m35, $) . ��� R Restricted_I&_2 F»mty mg M Affasomly RC . Roofing;Carcring WS Wmdour and Sailg SF SOTid Fort Burning Apirbam,, I Ins:daion — ---- _" TcicpilanC Email address D De tom _ S? Home pravemeut Contractor([U ) ,o -9 t " .t ‘319x17 goy n4 and`sik',9 _ Zfr f� _ _ . _in _ . ?MC Name or HHv eon..r Name ! a 1U3�'7 .3( nr 'n @] )/rnati j , No_and Street Fzarkii ffi ` fir_/��If-1 p7A d/ )3Q -(f3-o3-I-i V Cl tyldwa,State,ZIP Telephone SECTIONS:WORKERS'COIVIPE?SATION INSURANCE AF};WWAVIT(MI r e.L52 §2SC(6)) Workers Compensation Ir+srvranrr affidavit mast be c m-rpleted and submitted with this application_ failure to provide this affidavit will result in the denial of the Issuance of the building peunit. c r*tAfiidavitAttaritrd? Yes______._: No Ll SECTION 7r OWNER AUTUIORIZAITON TO BE COMPLETED WHEN • OWNER'S AGE/CT OR CONTRACTOR APPEIFS FOR BUILDING PERMIT L as Owner of the subject p.uycity_hereby authorize jel I) ? ii7O a �/J di /fir _ e._ ` to act on my behalf,in all matron relative to work authorized by this buildu tic ap li tioa.�J ?tint Owner's Name(Fla=tmnic Sratmr) Date SECTION 71b OWNER'OR AHTHQRIZED AGENT DECL ARAT;CkN By canning my name below,I hereby attest under the gains and penalties of perjury that all of the information . contained its this liration is true acid accurate to the best of my knowledge and understanding.. �/a.2 _ . MMCST BE SIGNED by Owau or Anthcnized Agent Dare NOTES: I_ An Owner who obtains a bul1d`mg permit to do hislher own w,or an.ownerwho hires an umei-e.ered contractor . (not registered in the Howie Improvement Coutractor WIC)Program).will wit hm'e access in the arintlatltlii program or-guaranty find under bLG_L.c.142I_Other important won on the tint'Program can be found at nvrn_ii ass er fnca Information on the Construction Supervisor License can be found at w w rrriss Qov"'dps Z When substantial wank.is planned,provide the h�aabelow: Total floor area(sgft) Galehading garage, hesi brmnenttratiics,decks orporch) Cruse Trying area(sg L) Habitable room count _ Number offireplaces Number ofbednoot s Number ofbaliarooms Number ofhalfhaths Type of beating system Number of dam!per _ Type of cooling sy.inu Enclosed OP= . 3. "Toed Project Square Footage"ttmybe for"Total Project Coer prCity of Northampton in,P •.' Massachusetts R DEPARTMENT OF BUILDING INSPECTIONS - •. "�� 212 Main Street • Municipal Building ;;„ ..•00, Northampton, MA 01060 Jr?,W A; 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: 04,. , /v4 The debris will be transported by: Name of Hauler: e /1 5cc_i,..�tJ i,., `v✓eCZed 1 Signature of Applicant: Date: 3 Proposal SEXTON ROOFING AND SIDING INC www.sextonroofing.com INO P.O. Box 6327 +•`�"s :111•11..11%. Holyoke, MA 01041 Soling the Standard • p. 413.534.1234 f. 413.539.9906 MA HIC# 118239 sextonroofinhotmaii.com SUBMITTED TO Pam Witting r PHONE 616-260-2820 DATE 412Sn3 -- STREET 78 Golden Dr EMAIL 1azo5052 CITY,STATE,2IP Florence,Ma. roofr SEXTON ROOFING HEREBY SUBMITS SPECIFICATIONS AND ESTIMATES FOR: 1) Strip and remove existing shingles and dispose of in proper landfill. 2) Inspect roofing deck and replace as needed @$75.00 per sheet. ($5,500.00 max) 3) Install new metal edging to rakes and eaves of roof. (white/brown) 4) Install ice and water shield on eaves (6'), vent stacks, in valleys, chimney, at intersecting roofs. 5) Install synthetic roofing underlayment on remainder of roof. 6) Install new flanges over existing vent stacks. 7) Install starter shingles on eaves and rakes of roof. 8) Install IKO Architectural style roofing shingles as per manufacturers'specifications. 9) Install new cap over ridge vent. • 10)Reflash chimney as needed @$400.00 11)Supply manufactures Lifetime warranty and SRC 5 yr.workmanship warranty. ATTENTION HOMEOWNERS:PLEASE COVER ALL PERSONAL BELONGINGS IN THE ATTIC,GARAGE,OR STORAGE AREAS DUE TO POSSIBLE ROOFING DEBRIS OR OUST CONING THROUGH CRACKS OF WOOD DECKING. SEXTON ROOFING SHALL APPLY FOR ALL PERMITS / 1 bib to dbnli aeMttd aa/bier- -• la - midi ore areae — Ibr die a so a/ Arlo -w,,......- doe ku wpm -. M Material is guaranteed to be as specified. Alt work to be completed in . , , ethAAA4.26 - workmanlike manner according to standard practices. Any alteration or , re deviation from above specifications involving extra costs wilt be executed only upon written orders,and will become an extra charge over and above the estimate.DAMAGES TO BUSIES AND OTHER VEGETATION'MARKS ON HOUSE MAY BE UNAVOIDABLE AND WE ARE HEW NNPSS. Not responsible for water Note:This propalsai may be withdrawn by us not accepted damage during construction. Owner to pay responsible legal fees for non- pay ,and applicable interest. within(to days., � Acceptance of Proposal The above prices,specifications and conditions are satisfactory and are Signature akt hereby accepted. You are authorized to the work as / isspecified. Payment will be made as outlined above. Date of Acceptance. Signature • lne l ommonwetatn of inrumacr+ssacasa Department of Industrial Accidents w` Office of Investigations Lafayette City Center iii 2 Avenue de Lafayette,Boston,MA 02111-1750 ✓/j www.mass.gov/dia orkers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers Information Please Print Legibly rplicant me(Business/Organization/Individual).Sexton Roofing&Siding Inc Address:P.O.Box 6327 ::ity/State/Zip:Holyoke,Ma.01041 Phone#:413-5341234 .re you an employer?Check the appropriate box: Type of project(required): D I am a employer with 4. ® I am a general contractor and I 6_ ❑New construction employees(full and/or part-time).* have hired the sub-contractors listed on the attached sheet_ 7. ElRemodeling ❑ I am a sole proprietor or partner- ship and have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. employees and have workers' 9. 0 Building addition [No workers' comp.insurance comp.insurance.t required.] 5_ 0 We are a corporation and its 10.0 Electrical repairs or additions 0 I am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions myself INo workers'comp. right of exemption per MGL l2.Roof repairs insurance required.]t c. 152,§1(4),and we have no employees.[No workers' 13.0 Other comp.insurance required.] ay applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. mtractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have ployees_ If the sub-contractors have employees,they must provide their workers'comp_policy number. 'm an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site rormation. ;trance Company Name:Travelers Property Gas Co Of Am they#or Self-ins.Lie_#:7PJUB0G07898272 Expiration Date:06/4/23 b Site Address: 71- 0 /(J 0 City/State/Zip:✓ /t,s� )/ 2 tach a copy of the worke compensation policy declaration page(showing the policy number and expiration date). ilure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a le 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 up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of vestigations of the DIA for insurance coverage verification_ to hereby certify under the ' ins and penalties of perjury that the information provided a ve is true and correct .7:53 grature: l ' Date: / a 3 ,one#.: sue 7- / z 3 1 !!! Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority(check one): l❑Board of Health 2❑Building Department 3❑City/Town Clerk 4.1D Electrical Inspector 5.11Plumbing Inspector 6.DOther Contact Person: Phone#: rr.-------.......""NPRCTtI SEXTO-2 OP ID:KH �`® CERTIFICATE OF LIABILITY INSURANCE DAE(MM/20D12Y)I-USCERTIFICATEIS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS ERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THISCERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVEOR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: Ifthecertificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed. f SUBROGATIONIS WANED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on his certificatedoesnot confer rights to the certificate holder in lieu of such endorsement(s). ODUCER 413-737-0300 cDNTACT Eric Dembinske OrmsbyInsurance Agency Inc. P1�9(e 698 Wstfield St PO Box 718 PRONE No,Ext):493-737-030D ((A1C,No): West 7 West Springfield,MA 01090 ADDRIESSt edembnnske@ormsbyins.com Eric Dembinske INSURERS}AFFORDING COVERAGE NAIL# INSURER A:Northfield Insurance Company NSUREDon Roofing&Siding,Inc- INSURER B:Progressive 24260 oext PO Box 6327 INSURERC: Holyoke,MA 01041 INSURER D: INSURER S: INSURER F: I COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LIS I EU BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POUCY 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' 'f1DDL RR POLICY EFF I POLICY EXP LTR TYPE OF INSURANCE OW POLICY NUMBER IMM/DD/YYYY) IIMMIODIYYYY) LINK A X COMMERCIAL GENERAL LIABILITY r EACH OCCURRENCE I$ T,000,000 CLAIMS-MADE I X I OCCUR W545073 06/25/2022 06/25/2023 DAMAGE TO RENTED 100,000 _PREMISES(Ea occurrence) S MED EXP(Am/one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GEM_AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE S 2,000,000 X POUCY I JEC0.T I 1 LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: S B AUTOMOBILE LIABILITY I COMBINED SINGLE LIMIT 1,000,000 (Ea accident) S _ ANY AUTO 04434955-0 05/15/2022 05/15/2023 BODILY INJURY(Per person) $ OWNED 7 SCHEDULED AUTOS�p ONLY X AUTOS BODILY INJURY(Per accident)_ $ X AUTOS ONLY X AUUTN'OS ONLY P((ROPER accident)DAMAGE S I S UMBRELLA LIAB OCCUR EACH OCCURRENCE v$ EXCESS LIAB 1 CLAIMS-MADE AGGREGATE S DED I I RETFJJTlON S -L I S WORKERS COMPENSATION I I PER OTH- AND EMPLOYERS'LIABILITY YIN TO BE ISSUED SEPARATELY STATUTE I ER ANY PROPRIETORIPARTNER/EXECUT1VE EL EACH ACCIDENT $ OFFICEROMEMBER EXCLUDED? N/A (Mandatory In NH) EL DISEASE-EA EMPLOYEE$ i If yes.describe under !DESCRIPTION OF OPERATIONS below I E L DISFASE-POLICY LIMIT I$ I I DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) roofing&siding contractor CERTIFICATE HOLDER CANCELLATION NONE-01 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. / yy 41,' vI�;' . AUTHORIZED aEPaESEaramrE 1 ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. ®Rl CERTIFICATE OF LIABILITY l INSURANCE DATE O$/07120Z2 IS CERTIFICATE IS ISSUED AS A MAI ItlH 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 HOLD IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the poTh y(res)roust 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 °+CT K Hutchinsonfume ORMSBY INSURANCE AGENCY , (413)737-0300 Trkkt,No): worms: khutr hinson@onnsbyins.an P O BOX 718 ENSURESISOFFORCINECOVELAGE NAIL* WEST SPRINGFIELD MA 01090 iA: TRAVELERS PROPERTY CAS CO OF AM 25674 INSURED INSURER B: SEXTON ROOFING&SIDING INC mtsuRERc: D: , I PO BOX 6327 INSURERE: I HOLYOKE MA 01041 INSURERF: 1 COVERAGES CERTIFICATE NUMBE 782111 REVIS/ON NUMBER: THIS IS TO Limit i II-Y THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED It)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 I ER MS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY`PAID CLAIMS_ POLICY ESP . LTRTYPE OFMR r‘13 POLICYPynteiraa %trinamerrvrn roaariocorym i31rNiS COMMERCIAL L cIAL GENERAL ABILITY 1 EACH OCCURRENCE S if DAMAGE TO RENTED CLAIMS-MADE OCCURPREMISES(Ea^R"""m) ((S l {rJED EXP(Ant one Pam) 1 5 N/A ix�a r s AINV INJURY j s Galt AGGREGATE LINT APPLIES PER I GENHtALAGGREGATE 5 I PCAJCY ACT LOC I PRffiY CTS-COMPIOPAGG,S OTTER: • 5 AUTOMOBILE LABILITY - COMBINED SINGLE LIMIT S (Ea accident) ANY AUTO BODILY INJURY(Perpason) S {ALL UTOSOWNED -SCHEDAUTOS ID NIA r SCxLYINJURY(Paa�eo4 S NON-OWNEDAUTOS AUTOS _ PROPERTY DAMA HIRED AUTOS .AUTOS (Per accident) GE $ S 1 teasessALuke [ 1 t1CGY7R EACH OCCURRENCE 1 S EXtr-sS LIAR DOE WA AGGREGATE $ DED j RETENTIONS 1 S WORKERS coniP81SAT1ON X A AND EMPLOYERS UABILIi Y YJ N , l TUIE 1 ER AANYPROPRGETORPART fcA7132XECITI E } E�EACH Ammar S 1,000,000 A DFFICERAVEMBERFJGCLUDED2 IA red Nut TRIUBOG07898?n 06/04/2022 I OS 3 • (Mendatoiy in NH) ELDLSFASE_EAERPLOYEE $ 1,000,000 If Byes, ON o OPaR.ATIONS bead Ider L E ��-POLICY Luau s 1,000,000 N/A DMCIUT,TION OF OPE AT IS I LOCATIONS/VEYECLES(ACORD ills.Add Rzaserts S ,e-ay be an2m,Inici Ziraxa spas in required) Workers'Campensatesni berretiils vol be paid to Massachusetts employees only Pursuant in Endorsement WC 20 CO 06 B,no authorization is given to pay claims for benefits to employee;in stares other Than Massachusetts if the insured hires,or has hired those employees outside of Massachusetts. This certificate of insurance shows the policy in hare on the date that this ierlila.ate was issued(bless the r. riration date an the above policy precedes the issue date of this certificate of insurance)_ The stains of this coverage can be monilorect daily by ak.,..tiliy the Proof ed.—Coverage-Coverage Verification Search tool at www mass_gavfiwrYworkers-co . GEN i!MATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE ROi VERFD IN ACCORDANCEWITH TOTE POLICY PROVISIONS_ AUTHORIZED REtIATivE MA ( v rP 01040 �,,j, L.v X- I Daniel Cro CIJ l M. y,CP ,Vice President—Residual Market—WCRIBMA ©1988 Z814ACORD CORPORATION. All rights reserved_ arson 74 r niiurail Tixi Art-um res,,, ,.,a Inns rurr:cl,n,naA,a.srfr nc Arrr% n r,-----.141 0ERTIFICATE OF LIABILITY INSURANCE OATS IMM/ODIYYYY) -' 02/27/2023 ERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS ICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES . THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED SENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. TANT: 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 Jaw, BRUNO ROZEMBARQUE POINT INSURANCE I N C 017)783-11s0 _ _ —__ _. ,,,);_,_.�____._-... _._..- _ADORE$$: bruno@la pointinsure.com ___ 1103 COMMONWEALTH AVE INSURER(SI AFFORDING COVERAGE _ I NAIC1_ BOSTON T MA 0221�l 1 i 1 ENSURER A_AIM MUTUAL INS CO INSUREo '-- —�F_ 33758 ..�.-.__.�... INSURER B= E C A GENERAL CONSTRUCTION INC IN511it C: ,! x--�—, �— RNSURER 03 _._._I__._. 8 OTIS ST APT 1 INSURER E: MILFORD MA 01757 INSURER F `.—.___._...__._. .COVERAGES CERTIFICATE NUMBER: 866002 REVISION-NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE USTED 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 POUCIES.UMITS SHOWN MAY NAVE BEEN REDUCED BY PAID CLAIMS. IWSR I 'IIOOL SUER- �__.� -- POLICY EFI nliOUCY Exp i ' LTR I TYPE OF INSURANCE i INSD:wvD:; POUCY NUMBER 'r(U WDOIYYYY1'MAMA DIYYYY)'. LIMITS I COMMERCIAL GENERALLIABILrrY I f 7 1 OCCURRENCEEACH !S — i_.�-CLAMS-MADE OCCUR i MK �O .^.— i I- ) yMED EXP(Any one orison) {i -.�....._._...___...�._.._ _- -�._1 I 1 N/A ? PERSONAL d ADV INJURY ti s G�ENi AGGREGATE LIMIT APPLIESPER: 5GENERAtAGrStEGATE !.S PRO- .�_._..,._ , ( i POLICY JEcT _ LOC 1 f I I i, I PRODUCTS-COMPOPAGG $ AUTOMOBILE WIBILITY i COMBINEDSNtt,E LIMIT _ x LEa item) ANY AUTO I ! t 1 i BODILY INJURY(Per WW1) !.$ AWNED I SCHEDULED FF -_ — - . ___ AUTOS ONLY { AUTOS # t ( WA - I BODILY INJURY(Par occident)_S I 11 HIRED 1 NON-OWNED + -'" -�-_ ..--.- •--.- -._.,w_, 1! ( IPROPERTY DAMAGE ;S ._y AUTOS ONLY _ ;AUTOS ONLY ) ( ) - Peracntf:M ._._._._ _.,_._. ' S •URELLA UAB i rlrraart 1 • MB 1 EACH OCCURRENCE $ !EXrFciLU\B =:.t CLARASN I ,, NSA I ; ` 1 �—t_ I —I i AGGREGATE ---,s�. _..__....._..... QED ': 1 RETENTION S }{ 't ;- ;S j WORKERS COMPENSATION 1 f - PER ER". ( .,AND EMPLOYERS'UABILITY Y I N I I (STATUTE {{Ht ! -. ANYPROPRIETOWPARTNEREXECUTIVE I j El.EACH ACCIDENT _;$ 1,000000 A ,OFFICERNMEMBEREXCLUDED? MAA WA 1{N►A' VWC10060260282023A 02!11/2023 02J1112024 "" -'--"— "~- (Mandatory in NH) i LE-1..DISEASE-a EMPLOYEE f 1.000 000 If yes.[Iasrnee under I - .. i DESCRIPTION OF OPERATIONS D(30ar 1.E.L DISEASE-POUCYUNIT i$ 1.000.000 • N!A DESCRIPTION OF OPERATIONS/LOCATIONS VEHICLES IACORO 101,Additional Remarks Schoduls,may ba attached if more spars is rugn+ndf Workers'Compensation benefits will be paid to Massachusetts employees only.Pursuant to Endorsement WC 20 03 06 B.no authorization is given to pay claims for benefits to employees in states other than Massachusetts if the insured hires,or has hired those employees outside of Massachusetts. This certificate of insurance shows the policy in force on the date that this certficate was issued(unless Ole expiration date on the above policy precedes the issue date of this certificate of insurance). The status of this coverage can be monitored daily by amassing the Proof of Coverage-Coverage Verification Search tool at www.mass.gov/lwd/workers-campensationlinvestigationsi. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POUCIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN SEXTON ROOFING AND SIDING ACCORDANCE WITH THE POUCY PROVISIONS. 102 PINE ST-PO BOX 6327 AUTHORIZED REPRESENTATIVE HOLYOKE MA 01040 Daniel M.Crowley,CPCU,Vice President-Residual Market-WCRIBMA C31988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD Aco'21 CERTIFICATE OF LIABILITY INSURANCE GA'E`E"`°°"'YY' �--"" 03/27/2023 . 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 POUC1ES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURERS), 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. It 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 endorsementts). PRODUCER rNANIE 7 valdir borba I-INSURANCE GROUP INC s (978)645-6996 I FAX EJII(�. Wig; YtiOrHnbU7afhClgiDUp,net 799 GORHAM ST W TSURERM AFR3RDING COVERAGE _ NAV. LOWELL MA 01852 MUTTER A: TRAVELERS INDEMNITY CO OF AMERICA 25666 INSURED INSURER s: LDG HOME IMPROVEMENT INC INSURER C: INSURER o; 18 SPRING ST 1ST FL INSURER E; MILFORD MA 01757 INSURER F: COVERAGES CERTIFICATE NUMBER: 875092 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. _7pRj' TYPE OF INSURANCE �yy"p{ POLICY NURSER LRAM COLVMERClAL GENERAL IJAEIIJTY ! EACH OCCURRENCE 11$ 1 CLAIMS-►MDE [ 1 OCCUR I ( p r88E5(E5555maice) 1 S ]1 MED EXP IMy ono Person) 1 S � N/A PERSONAL&ADn/WJURY ,s — GENtAGGREGATE LIMIT APPLES PER GENERAL AGGREGATE 1$ _I POUcY OTHER(� 7 LOC PRODUCTS-COMP/OP A[aG $ 1 rAUTo nRgF LIABILITY r CoUBINED SINCLE Vid7 )$ I.. ANY AUTO ( !eoorLY INJURY(Per Peesan) $ OWNED —1 SCHEDULED r J!attr i NIA BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS 1 noN-Dv ONLY .tom Lam_____ I 1 UMBEL^LlAB j_ OCCUR i EACH OCCURRENCE s I EXCESS LUAB I.CLAIMS-MADE ( N/A AGGREGATE $ DED i i F rENTION5 {! 5 i WORKERS COMPENSATION x i PT.T.TE _L it Ili AND EMPLOYERS LIABILITY MIYPROPPoErOSLPAR INERIDCECJnVE rTINl I EL.EACH AGCDB'rr $ 100,000 A /or-FicaumEmBERENauva i 1 NIA Na 6HIIB4N86974323 03/2_6/2023;03/26/2024 (Mandatory In NH) @1.nm-FAsF-EA FalPLOYEE 3 100,000 Ayes,dasa�e under I DESCRIPTION OF OPERATIONS below _ I EL-DISEASE-POUCYLW/1$ 500,000 r � f i . } wA JJ I i 'DESCRIPTION OF OPERATIONS I LOC:COONS I VEHICLES"(^CORD 101,Additional Ramada se..•aule,may be attached if more Apace Is nwhendi Workers'Compensation benefits will be paid to Massachusetts employees only.Pursuant to Endorsement WC 20 03 06 B,no authorization is given to pay claims for benefits to employees in states other than Massachusetts if the Insured hires,or has hired those employees outside of Massachusetts. This certificate of insurance shows the policy in force on the date that this c ertifi,dte was issued(unless the expiration date on The above policy precedes the issue date of this certificate of insurance). The status of this coverage can be monitored daily by accessing the Proof of Coverage-Coverage Verification Search tool at www.mass.gov/iwdiworkers-compensationfinvesligations/. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED ED BEFORE THE EXPIRATION DATE THEREOF. NOTICE WILL BE DELIVERED IN SEXTON ROOFING AND SIDING INC ACCORDANCEWITHTHEPOLICYPROVISIONS, POST OFFICE BOX 6327 AuThloPmEn RIEP ESENTATIVE HOLYOKE MA 01041 Daniel M.Cry y,CPCU,Vice President—Residual Market—WCRIBMA t 1988-2015 ACORD CORPORATION. All rights reserved, . STATE OF CONNECTICUT DEP-4RT.;IEX"T OF CONSUMER PROTECTIO.V oe enassaL c " sure HOME IMPROV 'C<CONTRACFOR Q c o of Prof ° Sand Standards EYEREIT J SEXTON SR 0. t�I Board of among R,eg�f r f Secialty 2 Pmc SY: :. Const uc %fey: Ia0512023 HOEYo ,MA 01040-24n SEXTON ROOFlNG8c SIDING CO CSS1..-099POttop5-8y9 � -� .. .:1 j��a�� YOKE ,044''4 Yy rL - HIC.0605383 S2T01f202I 03I31/2023 Yr.•. n-' -�� SIGNED -LC3r5�-i�t�_ ��oner sNE: g S'3 — EGIS xx�ssATs �z r_ #7 ,rz�`SE . A R TIC- T iS =S 1.�ioic%��??:v �,._+�:''tcr_�t..s'✓ii � i.xvia-S�S cvF-C ts:.3 �� ��._ 3 �s-+�;iTt rS S. c.ry O r: c;A; -Nr.S IS=RI DiE.717.. SEXTON ROOFING& SEXroN,EVERETT 118239 P_O BOX 6327 02I1412023 Cunent Watg Inc HOLYOKE,MA 0I04-1 1.2 4��