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29-239 (5) BP-2023-0920 212 ACREBROOK DR COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 29-339-001 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-2023-0920 PERMISSION IS HEREBY GRANTED TO: Project# ROOF 2023 Contractor: License: WILDE HSE LLC DBA SEXTON Est.Cost: 11400 ROOFING 106265 Const.Class: Exp.Date: 03/08/2027 Use Group: Owner: R DUF Y PATRICIA A& STEPHEN Lot Size (sq.ft.) Zoning: WSP Applicant: WILDE HSE LLC DBA SEXTON ROOFING Applicant Address Phone: Insurance: 45 OLANDER DR 315-569-7761 6HUBOW55113923 NORTHAMPTON, MA 01060 ISSUED ON: 07/14/2023 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: I II el • I' . yg . (Pi • Fees Paid: $40.00 212 Main Street,Phone(413)587-1240,Fax (413)587-1272 Office of the Building Commiss. ner 1-fEc&,V,- D JUL i 3 , 2023 1, The Commonwealth of Mas , use iqOr--- , o T ',b/w;r FOR Ali ' Board of Building Regulations and Stang . A')TON MS oECripps , ICIPALITY Massachusetts State Building Code, 780 CMR 0 60 USE Building Permit Application To Construct,Repair,Renovate Or Demolish a Revised Mar 2011 One-or Two-Family Dwelling This Section For Official Use Only Building Permit Num : SP- 3` 99.3 Date Applied: I4�IP 055 /& 714tZ025 Building Official(Print Name) Signature Date SECTION 1:SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map&Parcel Numbers 21 X AC..rtrortidt D r I.1 a 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❑ On site disposal system 0 Check if yes❑ SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of Record: —r-r.t1.% '1Duo NI m rkhr:ww ol• M a+t ¢ O'Olp Name(Print) City,State,ZIP' 212 421r rcb R7e14 Dr, '(IvSgs -g 3211 aeLiA4 3 @ cm:A: an No.and Street Telephone Q Email Address SECTION 3: DESCRIPTION OF PROPOSED WORK2(check all that apply) New Construction 0 Existing Building 0 Owner-Occupied 0 Repairs(s) lid Alteration(s) 0 Addition 0 Demolition 0 Accessory Bldg. 0 Number of Units Other 0 Specify: Brief Description of Proposed Work': ct-p 6ea. (bd(r 4n o..ink t‘e Vim. SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1.Building $ (('qC0 1. Building Permit Fee: $ I Indicate how fee is determined: 2.Electrical $ CIStandard City/Town Application Fee ❑Total Project Costa(Item )x multiplier x 3.Plumbing $ 2. Other Fees: $ 4 4.Mechanical (HVAC) $ List: 5.Mechanical (Fire $ Suppression) Total All Fe i I q0 Check N Jv9 f Check Amount: Cash Amount: 6.Total Project Cost: $ ''t lip, ❑Paid in Full 0 Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) ►C i41'5 31%5evaivt Wtote. License Number Expiration Date Name of CSL Holder List CSL Type(see below) 'RC. LIS Nome( pr No.and Street Type Description U Unrestricted(Buildings up to 35,000 cu.ft.) 1•10Nekhe. n M. 0101,0 R Restricted l&2 Family Dwelling City/Town,State,ZIP t M Masonry RC Roofing Covering WS Window and Siding SF Solid Fuel Burning Appliances 3►5-FLDal-1 1 4.0-sho45,e.oenranC"nc4.pam I Insulation Telephone Email address J D Demolition 5.2 Registered Home Improvement Contractor(HIC) 1_'►& ►!� DDA Sc4cE F oiwu► ?1�rW'7a �4 3A�2025 V�� Oct tn c d, HIC Registration Number Expiration Date HIC Company Na or HIC Registrant Name AkC ( (r ( • 6astris, ` �g+ [� � �� No.and Street address MIVAIAAYAOars, (4144 ctuoc' 31S--Svc+-711lJ 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 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 Wade, Ik%tU C MA ce ken Vcciew5 to act on my behalf,in all matters relative to work authorized by this building permit application. 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. LiJ4 (6041isk VJ I tail) Print 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 gel 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.tnass.gov/dps 2. When substantial work is planned,provide the information below: Total floor area(sq.IL) (including garage,finished basement/attics,decks or porch) Gross living area(sq. ft.) Habitable r 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 �i►' ~'>t S•s s,� Massachusetts s� j4' - _A • et t.7 1� l 4 6 DEPARTMENT OF BUILDING INSPECTIONS S :. 212 Main Street • Municipal Building b b., Northampton, MA 01060 "6j? - .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: scab t—i Sk. 1-�� ac� t atoc4 The debris will be transported by: Name of Hauler: Signature of Applicant: A. tsliet Date: 1 113 2023 The Commonwealth of Massachusetts P=� t:=s, i el Department of Industrial Accidents K =_i:B11= 3 1 Congress Street,Suite 100 = 1 t=a Boston,MA 02114-2017 w;:,.,Z,..11 www mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Leeibly Name(Business/Organization/Individual): �*Men ��F� U.L.0 'A c,ex}tr ' ,Y'ts L,e.s.m..,1_ Address: 145 Qlo r 17r' J City/State/Zip: !o, w,pk,n, MA MO oo Phone#: as- -Isq--1-7(01 Are you an employer?Cheek the appropriate box: Type of project(required): 1 am•employer with employees(full and/or part-time).* 7. ew construction 2 am a sole proprietor or partnership and have no employees working for me in $. BRemodeling any capacity.[No workers'comp.insurance required.] 30 am a homeowner doing all work myself.[No workers'comp.insurance required.]t 9. Demolition 10 Building addition 401 am a homeowner and will be hiring contractors to conduct all work on my property. 1 will ensure that all contractors either have workers'compensation insurance or are sole 11.0Electrical repairs or additions proprietors with no employees. 12.0Plumbing repairs or additions 52I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13. Roof repairs These sub-contractors have employees and have workers'comp.insurance) P 60 We are a co oration and its ofcers have exercised their ri t of ex 14. Other rp gh emption per MdL c. 152,§1(4),and we have no employees.[No workers'comp.insurance required.] 'Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors 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 subcontractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: -tilde gs_. taNit4 ( 4. Amer'tcc... Policy#or Self-ins.Lic.#:, (a NU'MNnlSSAte2a Expiration Date: (o it ( ?p 7 N Job Site Address: ala AcrtloCre)t, p,( IJ9f11,•anvten tIP. City/State/Zip: CSIblco 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 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 certify under the pains and penalties of pedury that the information provided above is true and correct. Signature: C. aeff-- iDi,j4_.__ Date: —I i 13/232s Phone#: 31 S-Sloi—77(a1 Official use only. Do not write in this area,to be completed by 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 Contact Person: Phone#: � . A CERTIFICATE OF LIABILITY INSURANCE DATE /2"�20 3"''06/09THIS 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 poilcy(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 en endorsement A statement on this certificate does not confer rights to the certificate holder In lieu of such endorserrwnt(s). PRODUCER woe: Eric Dembinske ORMSBY INSURANCE AGENCY E,ti; (413)737-0300 FAX INC.Not ADOREss: edembinske@ormebyine.com P 0 BOX 718 INSURER(a)AFFORDING COVERAGE NAK:e WEST SPRINGFIELD MA 01090 INSURER A: TRAVELERS INDEMNITY CO OF AMERICA 25666 INSURED INSURER B: WILDE HSE LLC INSURERC: DBA SEXTON ROOFING&SIDING INSURED: 45 OLANDER DRIVE INSURER E: _ NORTHAMPTON MA 01060 INSURER F: COVERAGES CERTIFICATE NUMBER: 901203 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED T 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. LIR TYPE OF INSURANCE INSD W VD POLICY NUMBER ( �YYYYYI IM fl!OrYYYYYY) UNITS COMMERCIAL.GENERAL UABIUTY EACH OCCURRENCE f CLAIMS-MADE OCCUR PREMISES(Be ocourtvros) $ _ MEO EXP(My one person) S N/A PERSONAL i ADv INJURY $ GERI AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY[ l c LOC PRODUCTS-COMPX)P AGO $ OTHER: 5 COMBINED SINGLE LIMIT AUTOMOBILELIAea rrr me occident) s ANY AUTO BODILY INJURY(Per person) $ OWNED T—-SCHEDULED N/A AUTOS ONLY I AUTOS BODILY INJURY(Per occident) $ AUTOS ONLY AUT��NEDONLY (Per PROPERTY DAMAGE $ $ OCCUR EACH OCCURRENCE f EXCESS(JAB I CLMM.Cmanr N/A AGGREGATE $ DIM RETENTION; I f WORKERS COMPENSATION x PER 0TH- AND EMPLOYERS' YIN LIABILITY STATUTE ER ANYPROPRIETORIPARTNER/EXECUTIVE E.L EACH ACCIDENT $ 1,000,000 A OFRCER/MEMBEREXCLUDED? N/A NIA wA 6HUBOW55113923 06/01/2023 06/01/2024 (Myyaeenssdatary In NH) E.L DISEASE-EA EMPLOYEE $ 1,000,000 under DESCRIPd escribe 1ONN OF OPERATIONS below E.L DISEASE-POLICY LIMIT $ 1,000,000 N/A DESCRIPTION OF OPERATIONS/LOCATIONS f VEHICLES(ACORD 101,Addlbonel Remarks Schedule,may be eNarhed II mare specs Is required) 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 certificate 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.govAwd/workers-compensation/investigationsl. 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 POUCY PROVISIONS. a AUTNORRED REPRESENTATNE Daniel M.Cm y,CPCU,Vice President—Residual Market—WCRIBMA I 01B88.2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD ACORD Client#: DATE CERTIFICATE OF LIABILITY INSURANCE OS/01/2023 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHT 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 pollcy(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 Guilhenne Camossato MASAC• PHONE 978 726.9830 I-INSURANCE GROUP INC (NC,No,EXt): EMAIL gcamossato(itHnsuraneegroup.net 799 GORHAM ST ADDRESS: LOWELL,MA 01852 INSURER(S)AFFORDING COVERAGE NAIC INSURED INSURER A:GENERAL STAR INDEMNITY COM INSURER B:ARBELLA PROTECTION INSURANCE LDG HOME IMPROVEMENT INC INSURER C: 18 SPRING ST FL1 INSURER D:TRAVELERS PROPERTY CAS CO OF AM MILFORD, MA 01757 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:000015 REVISION NUMBER: 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 TALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSRL ADDLI SUBR POLICY EFF POLICY EXP TR TYPE OF INSURANCE NSR WVD POLICY NUMBER (MMIDD/YYYY) (MM/DDNYYY) LIMITS A GENERAL uABIuTY EACH OCCURRENCE $ 1,000,000.00 DAMAGE TO RENTED X COMMERCIAL GENERAL LIABILITY PREMISES(Ea ocurrence) $ 100,000.00 CLAIMS-MADE IX I OCCUR MEDERP(My Ma person) $ 5,000.00 IMA395923A 8/25/2022 6/25/2023 PERSONAL a AOV INJURY $ 1,000,000.00 GENERAL AGGREGATE $ 2,000,000.00 GENT.AGGREGATEILIMIT APPLIES PER: PrProductsrn Cpieted Or.Aggregate $ 2,000,000.00 7 POLICY I 't 1 PROJECT I ILOC COMBINED SINGLE LIMIT B AUTOMOBILE LIABILITY I (En.wJdea) $ 100,000.00 ANY AUTO BODILY INJURY(Pr person) $ 20,000.00 ALL OWNED -SCHEDULED 1020096012 4/13/2023 4/13/2024 BODILY INJURY(Per=Wad) AUTOS AUTOS $ 40,000.00 .ter NON-OWNED PROPERTY DAMAGE HIRED AUTOS AUTOS (Prebcdrd) $ 100,000.00 UMBRELLA LIAR OCCUR EACH OCCURRENCE EXCESS LIAB CLAIMS-MADE AGGREGATE PEP RETENTIONS D WORKERS COMPENSATION WC STATUTORY OTH AND EMPLOYERS' ABILITY YM LI LIMITS ER ANY PROPRIETOR/PARTNEWEXECUITVE OFFICER/MEMBER EXCLUDED? n/8 E.L.EACH ACCIDENT $ 1,000,000.00 (Mandatory ln NH) 6HUB4N86974323 3/26/2023 3/26/2024 E.L.DISEASE•EA EMPLOYEE $ 1,000,000.00 R yes,describe under DESCRIPTION OF OPERATIONS below EL.DISEASE-POLICY LIMIT $ 1000 000.00 GENERAL LIABILITY'for regular and usual jobs and the certificate holder is an additional insured. Workers'Compensation:benefits will be paid to Massachusetts employees only.Pursuant to Endorsement WC 20 03 06 8,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 certificate 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/Iwd/Workers-compensation/lnvestigations/ CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE WILDE HSE,LLC EXPIRATION DATE IT IS THE CUSTOMER'S RESPONSABILITY TO INFORME ANY 45 OLANDER DR. CHANGES ORCANCELATIONS. NORTHAMPTON,MA 01060 GUILHERME CAMOSSATO 1/1 0 1988-2010 ACORD CORPORATION.All rights reserved. AcoR CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYYY) 05/31/2023 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 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 NONE: BRUNO ROZEMBARQUE POINT INSURANCE INC PHONE NN C o.Eet); (617)783-1160 FAX (AI (A/C,No): ADDRESS: brurlo@pointlnsure.com 1103 COMMONWEALTH AVE INsuRER(s)AFFORDING COVERAGE NAICA BOSTON MA 022151111 INSURERA: AIM MUTUAL INS CO 33758 INSURED INSURER B E C A GENERAL CONSTRUCTION INC INSURER C: INSURER D 8 OTIS ST APT 1 INSURER E MILFORD MA 01757 INSURER F: COVERAGES CERTIFICATE NUMBER: 897535 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 INBR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LTR USD VINO POLICY NUMBER IMWDDIYYYY) (MM/DDIVYYY) LIMITS COMMERCIAL GENERALUABIL1Y EACH OCCURRENCE $ CLAIMS-MADE OCCUR. DAMAGE TO RENTED PREMISES(Ea occurrence) $ MED EXP(Any one person) $ N/A PERSONAL&ADV INJURY $ GEN'L AGGREGATE OMIT APPLIES PER: GENERAL AGGREGATE $ POUCY JPERO LOC PRODUCTS-COMP/OP AGG $ OTHER $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMB $ (Ea accident) ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED AUTOS ONLY AUTOS N/A BODILY INJURY(Per accident) $ FIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY (Per accident) $ UMBRELLA LIAO OCCUR EACH OCCURRENCE $ EXCESS UAB CLAIMS-MADE N/A AGGREGATE $ DED I RETENTIONS $ WORKERS COMPENSATOR X PER OTh- AND EMPLOYERS'LIABILITY ANYSTATUTE ER A OFFICER/MEMBER EXCLUDED'ECUTIVE N/A N/A N/A VWC10060260282023A 02/11/2023.. 0211112024 EL.EACH ACCIDENT $ 1,000,000 (Mandatory In NH) EL DISEASE-EA EMPLOYEE $ 1,000,000 It yes describe under DESCRIPTION OF OPERATIONS beiow EL DISEASE-POLICY LIMIT $ 1,000,000 N/A DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES IACORD 101,Additional Remarks Schedule,may be attached If more space Is required) Workers'Compensation benefits will be paid to Massachusetts employees only.Pursuant to Endorsement WC 20 03 06 B,no authorization is given to pay clams 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 certificate 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/)wd/workers-compensation/investigationsl. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Wilde HSE LLC ACCORDANCE WITH THE POLICY PROVISIONS. 45 Olander Dr AUTHORED REPRESENTATIVE Northampton MA 01060 Daniel M.Cn y,CPCU,Vice President—Resioual Market—WCRIBMA ©1988-2015 ACORD CORPORATION, All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD THE COMMONWEALTH OF MASSACHUSETTS Office of Consumer Affairs and Business Regulation 100€.1 Washington Street•Suite 710 Boston,Massachusetts 0211B Nome Improvemeeat Contractor Reglstratbn -Typa :Lc 174 "Riptitttatlon, 224470 W't.OE tisE.,LC Eaplrattan; 441302025 OSA SEXTON ROOFING&StDtIO 4°LANDER DR htORTMAMPTON NA 031a4 tl'PdMa Addnsa and Raton Card. Tine COnamOimwf.ALTt4 OP MASSACNV#ETTS Ortu of CanSumsr Attafn S Sutniaa Ragui+dan Ra01a1ratiOn valid fat individual uaa only baton ta. HOME IMPROVEMENT CONTRACTOR 4a414Neon date.flfauna mum 1a° TYPES LLC Oaflea at COMIUMIIT Attain and easiness Ragutatoo 1000 WaMM06on Sava•Sulta 710 2+4T0 Ci47402S Soatan,VA 02114 W*.04 vOlE,LLC OJSA SEXTON RQoAMRi 4&WN3 OOER DR rd:[ ,rKv��1 tvWf rlplaT4i 4rw'a+.,1AA 01104 ry Not YMMt without* natut, Licensee Details Demographic Information [Full Name: SASHA MARIE WILDE wner Name: License Address Information City: NORTHAMPTON State: MA Zipcode: 01060 Country: United States License Information (License No: CSSL-106265 License Type: Construction Supervisor Specialty (Profession: Building Licenses Date of Last Renewal: Issue Date: 7/6/2023 Expiration Date: 3/8/2027 License Status: Active Today's Date: 7/7/2023 Secondary License Type: Doing Business As: Status Change Reason: License Issuance _ Prerequisite Information __ .. No Prerequisite Information No Available Documents WILDE HSE,LLC SEXTON ROOFING AND SIDING www.sextollroofi g.cold 45 Olander Dr. � �gam 11111. Northampton, Ma. ••" 01060 ...sr ate.. .�....... p. 413,534.1234 MA HIC#208470 inf@sextonrooling.com SUBMITTED TO PHONE ,03 .5:1 8 te_. ,1.1 1 DATE STREET 212 Accrehraok Dr EMAIL Ff 3 e rg CITY,STATE,ZIP Ziortbampton,Ma. roofr SEXTON ROOFING HEREBY SUBMITS SPECIFICATIONS AND ESTIMATES FOR: 1) Strip and remove existing shingles and plywood,dispose of in proper landfill. 2) Install neW 'h"plywood.($3,600.000 is for plywood and is inducted in price) 3) Install new metal edging to rakes and eaves of roof.(white) 4) Install ice and water shield on eaves(6'),vent stacks,in valleys,chimney,at intersecting roofs. 5) Install synthetic roofing u nderiayment on remainder of roof. 6) Install new flanges over existing vent stacks. 7) Install starter shingles on eaves and rakes of roof. 8) Install MO Architectural style roofing shingles as per manufacturers'specifications. 9) Install new cap over ridge vent. IC)Reflash chimney. 11)Supply manufactures Lifetime warranty and SRC 5 yr.workmanship warranty. ATTENTION HOMEOWNERS:PL EA=COVER ALL PERSONAL SEL ONGINGS IN THE ATTIC,GARAGE,01 STORAGE AREAS DUE TO POSSIBLE ROOFING DEBRIS OR DUST COMING THROUGH CRACLS OF WOOD DECKING. SEXTON ROOFING SHALL APPLY FOt ALL PERMITS lS "MOOR OOR lounrir-Aa—Irr otor>rilAcad lokor-Azoloaikifto b,accord _=atA.idiom storofflootkoo.Aw t*.wow of Storms homas%IAxe-ifrowford DOLLARS l$11.400.001 PAYMENTS TO HENAPEEAS rows* due In full upon completion Allo Materkmanial k is guaranteednrcto bn as sni d. All work to be completed rn a sat_ N JCS workmanlike manner according to standard pracdoa. Any alteration or Signature deviation from above specifications involving extra costs will be executed only upon written orders.and Will become an extra charge over and above the estimate.DAMAGES TO BUSHES ANDOr71ER VEGETATION'MARKS ONHOUSE WE Note:This proposal may be withdrawn by us if not accepted within BE UNAVOIDABLE AND WE ARE HELD HARMLESS Not responsible for water (14)days. damage during construction. Owaa to pay tespo legal fees for non- payment.and applicable interest. _talltallet et leopoa�al The above prig,specifications Ik&ui' ,�" v i C!CA and conditions are satisfactory and are hereby accepted. You Sure sU"'c'� are authorized to the work as specified. Payment will be made as outlined above. / / Signature Date of Acceptance.; '�L[d/a13