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23C-002 (2) BP-2023-1033 619 RIVERSIDE DR COMMONWEALTH OF M SSACHUSETTS Map:Block:Lot: 23C-002-001 CITY OF NORTHA PTON Permit: Alts Renovations Repair PERSONS CONTRACTING WITH UNREGIS RED CONTRACTORS DO NOT HAVE ACCESS TO THE GUARA TY FUND (MGL c.142A) BUILDING PERMIT Permit# BP-2023-1033 PERMISSION, S HEREBY GRANTED TO: Project# INSULATION 2023 Contractor: License: SAMBRICO LLC/VI A HOME Est. Cost: 26238 IMPROVEMENT 1 1 1478 Const.Class: Exp.Date: 01/21/202 Use Group: Owner: MILAG OS RODRIGUEZ Lot Size (sq.ft.) Zoning: URB Applicant: SAMBR CO LLC/VISTA HOME IMPROVEMENT Applicant Address Phone: Insurance: 2097 RIVERDALE ST 413-382-0249 UB-2E072183-23 W SPRINGFIELD, MA 01089 ISSUED ON: 08/08/2023 TO PERFORM THE FOLLOWING WORK: 15 REPLACEMENT WINDOWS 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 NO HAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Signature: Iv f� � � 7-1i . I Ii Fees Paid: $40.00 212 Main Street,Phone(413)587-1240,Fa :(413)587-1272 Office of the Building Commis oner IJcWU 0-crAc T o 4-5 \C --�V The Commonwealth of Massachus: s 'BUG �40 FOR Board of Building Regulations and St ndar s W Massachusetts State Building Code, 80 MU ICIP LITY U . Building Permit Application To Construct, Repair, Renov.N-''t,. ' h a R ised ar 2011 One- or Two-Family Dwelling I N ,MSpFCT iakis This Section For Official Use Only 40'060 Building Permit Number: f •)) '" 10' ?? Date Applied: 410 J 015 ///7 8-8-2oz3 Building Official(Print Name) Signature Date SECTION 1: SITE INFORMATION 111Proprty Address: �r �� 1.2 Assessors Map&Parcel Numbers �vtrs►&9 1.1a Is this an accepted street?yes no Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Area(sq ft) Frontage(ft) 1.5 Building Setbacks(ft) Front Yard Side Yards Rear Yard Required Provided Required Provided Required Provided 1.6 Water Supply: (M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Public❑ Private 0 Zone: _ Outside Flood Zone? Municipal 0 On site disposal system 0 Check if yes❑ SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of Record: 1\\ PPO -v c_t Vk0 c1 . 0\ �a Na\ `1 e(Print) City,State,ZIP (.IL\Ci �- v Qt--'‘ c - 1 .c . 'Av c 6'$ •M&u 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) 0 Alteration(s) 0 Addition 0 Demolition 0 Accessory Bldg. ElNumber of Units Other l /Specify: ,a(FMJJ14 V(10 Brief Description of Proposed Work': MUi.9— \% C ) rwr W:r d 4r ` c -a_tk l ce4\Qw(Q:IkOJos- Wkni Ot-J — Np ,..zs jG )rc_.%) Ur)cAn0 SECTION 4: ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1. Building $ eD, / ,23 B 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: $ 4. Mechanical (HVAC) $ List: 5. Mechanical (Fire $ TJ Suppression) Total All Fees: ti 1heck I Check No.itl Amount: Cash Amount: 6.Total Project Cost: $ a IQ . t — ❑Paid in Full 0 Outstanding Balance Due: I SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) \\\k-n \ �a f (`A License Number Expiration Date Name of CSL Holder U \ Y' CCuko C 1 C List CSL Type see below) No.and Street Type Description \� Q U Unrestricted(Buildings up to 35,000 Cu.ft.) �l 'C` `�\S �w � 'U3� R Restricted I&2 Family Dwelling City/Town,Stat , IP M Masonry RC Roofing Covering WS Window and Siding [ 115-S1,\a� w @q \ �Qrov NSF S Aid Fuel Burning Appliances V\ V q \ ``.° C����,v !L i Insulation Telephone Email address •COM D Demolition 5.2 Registered_ Home Improvement Contractor(HIC) \J ales f>1reliCk HIC egistration Number Expiration Date C Company N44neeor HIC Registrant Name (Yi V ��lQj? 1Q f S� . � MkM OkVet _\ t `N No.and t t 1 Email address 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 f 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 501/4((00 nc) to act on my behalf,in all matters relative to work authorized by this building permit application. C-� 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 contained in this application is true and accurate to the best of my knowledge and understanding. Print Owner's or Authorized Agent's Name(Electronic Signature) Date NOTES: 1. An Owner who obtains a building permit to do his/her own work,or an owner who hires an unregistered contractor (not registered in the Home Improvement Contractor(HIC)Program),will not have access to the arbitration program or guaranty fund under M.G.L.c. I42A. 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 00.H M �..-___....e' rb' _ 1, \4 Massachusetts * 1 , DEPARTMENT OF BUILDING INSPECTIONS ;',►+�tly,: � 212 Main Street • Municipal Building Northampton, MA 01060 S4w 3,')C\ 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: M 0\\1I S 0\3 . O C� The debris will be transported by: Name of Hauler: V �� Signature of Applicant: Date: The Commonwealth of Massachusetts "Mr= Department of Industrial Accidents 21"1111 �= 1 Congress Street,Suite 100 �' Boston, MA 02114-2017 ?''' wwiv massgov/dia %%orkers'Compensation Insurance Affidavit:Builders!Contractors/Electricians/Plutnbers. '10 BE FILED 14 till THE PERMITI'ING AIJT'HOR1T1. Applicant Information \^ LA— Address: Please Print Legibly Name. i Busin ss Organization individual): �`J C1 CC) C ( ()�-,1 \V trO j Sk • Citv'State'Zip:\ k,\- 11� V ) Phone #: mac\ 3 31 a-`-'\ ,re you an employee!Clerk the appropriate bat: Type at project(required): l.0 1 sin a employer with employees(till andiorpart-tines►.• 7. 0New construction 2.01 am a sole proprietor or Isuinership and have no employees working tier owe in $. Q Remodeling any capacity_[No worker'romp.insurance required.] 301 am a homeowner Jong all work myself.[No workers'comp insurance required)' 9. 0 Demolition 4.0 lam a homeowner and will be hiring contractors to conduct all work on my property. I w ill 10 Q Building addition mmue dial all contractors either hats:workers'compensation insurance or are sole 11.0 Electrical repairs or additions tors with no employees. 12.0 Plumbing repairs or additions 5Jne a general contractor and I hate hired the sub-contractors listed Lin the attached sheet. 130 Roof repairs These sub-contractors hate employees and have workers'comp.insurance.; ,,,/ 6.0 We are a corporation and its officers have exercised their right of exemption per M(;L c. 14.L3 Ether \OS-1;1 Gl-MQA'c 152,i 1(4),and we have no employees.[No workers'coup.insurance required.] W w C\ *Any applicant that checks boa#1 must also fill out the saetioe below showing their workers'compensation policy information. ' Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors mint submit a new affidavit indicating such ;Contractors that check this box must attached an additional sheet show tort the name of the sub-contractors and state whether or not those entities have employees. It the sub-contractors hate employees.they mast proside their workers comp.policy number. s I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site Information. Insurance Company Name: Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address: �'\Ck "(X.-NI QC S`i - --)\ ' ; City/State/Zip:r\ON (Q A, Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL c. 152,*25A is a criminal violation punishable by a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coy crags verification. I do hereby rtlfy under the pains nd penalties of perjury that the information provided abo e is true and correct Signature: Date:`� -� Date: v.e I z Phone#: i.\ 3 - 3 `� -qS a----A t Official use only. Do not write in this urcu. to be completed by city or town official City or Town: Permit/license# Issuing Authority(circle one): I. Board of Health 2. Building Department 3.('its Turn Clerk 4. Electrical Inspector 5. Plumbing Inspector 6.Other i Contact Person: Phone#: i co DATE(MMID ACORO DIYYYY) CERTIFICATE OF LIABILITY INSURANCE 06/14/D/YY 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 David R Jarry NAMENeill&Neill Insurance Agency Inc PHONE 413-7;2-4137 FAX 413-731-6629 662 Riverdale Street IA/C.No.Extl: (A/C,No): West Springfield,MA 01089 ADDRESS: dj(dlneillandneill.com IN SURER(S)AFFORDING COVERAGE NAIC A INSURERA: Western World Insurance Co. 13196 INSURED New England Home Improvement INSURER B: Chubb nsurance Co CHU 43 Booth Road Enfield,CT 06082 INSURER C: INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDL SUBR POLICY EFF I POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MMIDD/YYYY) (MM/DD/YYYY) LIMITS A V COMMERCIAL GENERAL UABIUTY NPP8877610 05/26/2023 05/26/2024 EACH OCCURRENCE s 300,000 CLAIMS-MADE OCCUR DAMAGE TO RENTED 100,000 PREMISES(Ea occurrence) $ MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 300,000 GE///��N'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE S 600,000 '/I POLICY PRO- JECTLOC PRODUCTS-COMP/OP AGG S 300,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE - S AUTOS ONLY AUTOS ONLY ' (Per accident) S UMBRELLA LIAB OCCUR EACH OCCURRENCE S EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED I RETENTION$ S B WORKERS COMPENSATION I 6S62UB-9F68699-6 05/06/2023 05/06/2024 V I PER OTH- AND EMPLOYERS'LIABILITY STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE YIN - E.L.EACH ACCIDENT S 100,000 OFFICER/MEMBER EXCLUDED? 1-7N/A --- - --- (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 100,000 If yes,describe under 500,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ I I I I 1 I DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more;space is required) Emailed to:cassied©vistahomeimprovement.com CERTIFICATE HOLDER CANCELLATION VISTA HOME IMPROVEMENT SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 2097 RIVERDALE STREET THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN WEST SPRINGFIELD. MA 01089 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE a...4.0.6.0?Avezo ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD Page 1 of 10 2097 Riverdale Street MA Lic# 162058 ` West Springfield, MA 01089 CT Lic#0621848 Vista 0 = i l , llt �, Phone: 888.597.2323 HOME IMPROVEMENT vistahomeimprovement.com , ,¢,,RFFFRREDCONTRACTOR Fax: 413.382.0241 Nor'Easter Window Contract Customer Information Milly Rodriguez (413)588-7786 Date: 07/07/2023 619 Riverside Dr Mrod413@yahoo.com Rep: Angelo Passerini Florence MA 01062 All home improvement contractors and subcontractors must be registered and any inquiries about a contractor or subcontractor relating to a registration should be directed to: Office of Consumer Affairs and Business Regulation Ten Park Plaza, Suite 5170 Boston, MA 02116Phone: 617.973.8700 The following windows will be installed by Vista Home Improvement Total number of windows in the home 15 Total number of windows being installed 15 Total number of patio doors being installed 0 Nor'Easter Windows Nor'Easter Double Hung - Triple Pane ilLocation Bathroom 1 Window Number 101 Size 20 x 35 Hardware White Locks Interior White Exterior White Screen Half Screen Color of Wrap aspen white Nor'Easter Double Hung - Triple Pane Location Living Room Window Number 102 IF Size 27 x 47 Hardware White Locks Interior White Exterior White Screen Half Screen Color of Wrap aspen white Nor'Easter Double Hung - Triple Pane Location Living Room Window Number 103 1 1 Size 27 x 47 Hardware White Locks _ Interior White Exterior White 11 Screen Half Screen Color of Wrap aspen white i IL Nor'Easter Double Hung - Triple Pane Location Living Room Window Number 101 Size 27 x 47 Hardware White Locks �_ Interior White Exterior White Screen Half Screen Color of Wrap aspen white This space intentionally left blar„a, Page 2 of 10 Nor'Easter Awning Window - Triple Pane Location Kitchen Window Number 101 y Size 21 x 30 Interior White Exterior White Screen Full Screen ''-iiiimmumor Color of Wrap aspen white Nor'Easter Awning Window - Triple Pane Location Kitchen Window Number 102 Size 21 x 30 Interior White i,! ' Exterior White Screen Full Screen i i Color of Wrap aspen white Nor'Easter Double Hung - Triple Pane 1 Location Bedroom 1 Window Number 101 Size 25 x 26 Hardware White Locks Interior White Exterior White l 1 Screen Half Screen Color of Wrap aspen white i f - - Nor'Easter Double Hung - Triple Pane it II Location Bedroom 1 Window Number 102 Size 27 x 39 Hardware White Locks __ Interior White Exterior White Screen Half Screen Color of Wrap aspen white - Nor'Easter Double Hung - Triple Pane i , 1 Location Bedroom 2 Window Number 101 Size 27 x 30 Hardware White Locks Interior White Exterior White i Screen Half Screen Color of Wrap aspen white Nor'Easter Double Hung - Triple Pane Location Bedroom 3 Window Number 101 Size 27 x 47 Hardware White Locks i Interior White Exterior White i44 Screen Half Screen Color of Wrap aspen white Nor'Easter Double Hung - Triple Pane ii Location Bedroom 3 Window Number 102 [L_____ 27 x 47 Hardware White Locks Interior White Exterior White Screen Half Screen Color of Wrap aspen white I Nor'Easter Single Casement - Triple Pane Location Bedroom 3 Window Number 103 Size 28 x 19 Interior White Exterior White Screen Half Screen Viewed From Exterior L Color of Wrap aspen white Ilij Page 3 of 10 Nor'Easter Double Hung - Triple Pane 7 Location Bedroom 4 Window Number 101 S ulze terior 1 White dware White Locks Exterior White Screen Half Screen Color of Wrap aspen white Nor'Easter Double Hung - Triple Pane I1 I Location Bedroom 4 Window Number 102 Size 37 x 30 Hardware White Locks Interior White Exterior White Screen Half Screen Color of Wrap aspen white Nor'Easter Double Hung - Triple Pane 11 Location Bedroom 4 Window Number 101 Size 37 x 30 Hardware White Locks Interior White Exterior White Screen Half Screen Color of Wrap aspen white Additional Information Do Not Do (We do not do any painting or staining) Is this house in a Historical District? No Did we sticker the windows ? NO This space intentionally left blank Page 6 of 10 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 09/04/2023 Barring delay caused by circumstances beyond Contractors control, the work will be completed by 09/07/2023 WARRANTY The Contractor warrants that the work furnished hereunder shall be free from defects in materials and workmanship for the period stated below following completion and shall comply with the requirements of this Agreement. In the event any defect in workmanship or materials, or damage caused by the Contractor, its subcontractors, employees or agents, is discovered after completion of any job, Including cleanup, the Contractor shall, at its own expense, forthwith remedy, repair, correct, replace, or cause to be remedied, repaired or replaced, such damage or such defect in materials and workmanship. The foregoing warranties shall survive any inspection performed in connection with the agreed-upon work. Warranty Period Lifetime Measure Section Measure Set With -- Cassie Date Measure Is set for 07/17/2023 2 hour window Measure is set for 10-12 Total Contract Amount (All Discounts Applied) $26,238.00 Payment Deposit $3,500.00 Amount Financed $22,738.00 Form of Payment Upon Signing Check Check# 120 Check Date 07/08/2023 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 bl nk Page 10 of 10 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. Milly Rodriguez 07/07/2023 Date Angelo Passerini Authorized Representative 07/07/2023 Date This space intentionally left bl.nk Commonwealth of Massachusetts Division of Occupational Licensure Board of Building Regulations and Standards Cons t Ion Srvisor CS-111478 : .. I cpires: 01/21/2025 BRIAN RUD(1, . y tr 2097 RIVERDALE: I , WEST SPRINO,FI ' "I8s� l 4+w ?/-1AN140,33 • t.LV d41 Commissioner dta., 4- THE COMMONWEALTH OF MASSACHUSETTS Office of Consumer Affairs and Business Regulation 1000 Washington Street - Suite 710 Boston, Massachusetts 02118 Home Improvement Contractor Registration h' ' Type. LLC ro t Registration: 162058 SAMBRICO LLC Expiration: 01/02/2025 D/B/A VISTA HOME IMPROVEMENT ' T 2097 RIVERDALE ST m WEST SPRINGFIELD,MA 01089 :, l- 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 RIAN RUDD D97 RIVERDALE ST ,,, ;,.;; ✓ }� I i ( ll// /EST SPRINGFIELD, MA 01089 Undersecretary Not valid without signature ---,1 ACC)Ro. CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYYY) �� DB/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 blel 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 Wti1)MIS NAME: WILLIAM MISS INSURANCE AGENT PHONE (413)568-6'1 1 FAx 413j$ 2-9191 ANC,No.ExtL: ,-(AIC No, 156 ELM STREET E-MAIL s •BILL G7 BiLLMISINSURANCE.COM ADDREWESTFIELD, MA 01085 INSURER(S?AFFORDING COVERAGE NAIC a# INSURER A: NAUTILAS INS 66915 INSURED INSURER 8: _ SAMBRICONISTA HOME IMPROVEMENT INSURER C: INSURER D 2097 RIVERDALE RD ( _J INSURER E WEST SPRINGFIELD,MA 01089 INSURERF: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: -HIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LIS-ED 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 .ADOLISUBR' -_-. - - -- POLICY EFF ' POLICY EXP -- - --- LTR TYPE OF INSURANCE INSR'WVO POLICY NUMBER (MMIDD/YYYY)'(MMIDDIYYYY) LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 -DAMAGE TO RENTED X COMMERCIAL GENERAL LIABILITY PREMISES(Es occurrence) g 100,000 CLAIMS-MADE !, !OCCUR MED EXP(My one person) $ 5,000 X G3679203 08/02/2022 '08/02/2023 PERSONAL s ADV INJURY $ 1,000,000 ' 1 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: I PRODUCTS-COMPIOP AGG $ 2,000,000 ' POLICY Is LOG ( $ AUTOMOBILE LIABILITY t I COMBINED SINGLE LIMIT _LEn accident) L$ 1-7 ANY AUTO BODILY INJURY(Per person) $ r—i ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ L_*AUTOS AUTOS I NON-OWNED I. I PROPERTY DAMAGE' j HIRED AUTOS I AUTOS (Per accident]_ b $ UMBRELLA LIAB OCCUR EACH OCCURRENCE _ $ EXCESS LIAB - - - CLAIMS-MADE AGGREGATE _$ _ DED RETENTION$ S WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS'LIABILITY Y/N .- TORY LIMITS ANY PROPRIETOR/PARTNERIEXECUTIVE NIA !E.L.EACH ACCIDENT S OFFICERIMEMBER EXCLUDED? - - - - (MandatoryinNH) E.L.DISEASE-EA EMPLOYEE $ _ Ifyes, under D E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 1D1,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.OI AUTHORIZED REPRESENTATIVE id�" �� 7 ACORD 25(2010/05) ©1988-2010 ACORD CORPORATION. All rights resew.d.- The ACORD name and logo are registered marks of ACORD ® 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 SOUTHWIC K. MA 01077 ADDRESS: 28TKC INSURER(S)AFFORDING COVERAGE NAIC# INSURED INSURER A: FR.\\I[I.FRS PROPERTY C:\SI :\I TY COMP:\\V OF:\\IF:RIC;\ 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 4DDLiUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER (MM\DDIYYYY) (MMIDD\YYYY) LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ =CLAIMS MADE a OCCUR. DAMAGE TO RENTED $ PREMISES(Ea occurrence) MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: $ AGGREGATfPROJECT DLOC GENERAL E POLICY PRODUCTS-COMP/OP AGG $ AUTOMOBILE LIABILITY COMBINED SINGLE $ -- LIMIT(Ea accident) ANY AUTO 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 $ I $ WOR- KER'S COMPENSATION AND PER OTHER EMPLOYER'S LIABILITY STATUTE UB-2E072183-23 03/12/2023 03/12/2024 ANY PROPERITOR/PARTNER/EXECUTIVE YIN E.L.EACH ACCIDENT $ 500,000 OFFICER/MEMBER EXCLUDED? (Mandatory in NH) O 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 OPERATIONS/LOCATIONSNEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) FHIS REPLACES ANY PRIOR CERTIFICATE ISSUED TO THE CERTIFICATE HOLDER AFFECTING WORKERS COMP COVERAGE, CERTIFICATE HOLDER CANCELLATION SAM BRICO 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 SPRINGIIELD. MA 01089 1]�(c/J� NOW ACORD 25(2016/03)(Rev.09-18) The ACORD name and logo are registered marks of ACORD 1988- 5 A%RD PORATION.71II tights reserved. T Vista Home Improvement ORDER: 148040 • y iSta, 2097 Riverdale Street ORDER DATE: 7/20/2023 HOME IMPN°VEMENP W. Springfield, MA 01089 PH:413-382-0249 EST. DELIVERY DATE: 8/30/2023 http://vistahomeimprovement.com ORDER CONTACT: ORDER ACKNOWLEDGEMENT INVOICE INFORMATION SHIPPING INFORMATION Vista Home Improvement Cost Quote Vista Home Improvement Cost Quote Vista Home Improvement Vista Home Improvement 2097 Riverdale Street 2097 Riverdale Street W. Springfield, MA 01089 W. Springfield, MA 01089 PH:413-382-0249 PH:413-382-0249 SHIP VIA: ORDER I ORDER DATE I PO NUMBER I CUSTOMER REF I TERMS 148040 7/20/2023 Rodriguez 6302 Rodriguez 6302 ITEM DESCRIPTION QTY SIZE PRICE TOTAL 1 UltraWeld 8420 Double Hung 1 19 1/4 WX 35 3/4 H Private Label N4VYC WG: Hold To Size Head Expander Standard Sill Trim(456) White Alum. Screen Frame(Std) Half Screen Fiberglass Screen Mesh Ultimate(2) Tempered Stainless Spacer Single Lock Innergy Reinforcement Foam Fill Bathroom OF SHGC VT AL Zone 0.19 0.23 0.41 s 0.3 ALL ZONES 2 UltraWeld 8420 Double Hung 2 26 3/4 W X 48 3/4 H Private Label Hold To Size Head Expander Standard Sill Trim (456) White Alum. Screen Frame(Std) Half Screen Fiberglass Screen Mesh Ultimate(2) Stainless Spacer Single Lock Innergy Reinforcement Foam Fill Living Room OF SHGC VT AL Zone 0.18 0.23 0.41 5 0.3 ALL ZONES 8/8/2023 9:03:37 AM 1 of 5 ORDER I ORDER DATE I PO NUMBER I CUSTOMER REF I TERMS 148040 7/20/2023 Rodriguez 6302 Rodri I,uez 6302 ITEM DESCRIPTION QTY SIZE ', PRICE TOTAL 3 UltraWeld 8420 Double Hung 1 27 1/4 W X 48 3/4 H Private Label Hold To Size Head Expander Standard Sill Trim (456) White Alum. Screen Frame(Std) Half Screen Fiberglass Screen Mesh Ultimate(2) Stainless Spacer Single Lock Innergy Reinforcement Foam Fill Living Room UF SHGC VT AL Zone 0.18 0.23 0.41 s 0.3 ALL ZONES 4 UltraWeld 8460 Awning 1 30 W X 22 H Private Label ,'�\ Pf,IVATE LA41. Hold To Size White Fiberglass Screen Mesh Ultimate(2) Stainless Spacer Foam Fill Standard Sill Trim (456) Kitchen s _ UF SHGC VT AL Zone 0.16 0.19 0.33 s 0.3 ALL ZONES 5 UltraWeld 8460 Awning 1 32 1/2 W X 23 1/2 H Private Label Hold To Size *ATE White Fiberglass Screen Mesh Ultimate(2) Stainless Spacer Foam Fill Standard Sill Trim (456) Kitchen OF SHGC VT AL Zone 0.16 0.19 0.33 s 0.3 ALL ZONES 8/8/2023 9:03:37 AM 2 of 5 ORDER I ORDER DATE I PO NUMBER I CUSTOMER REF I TERMS 148040 7/20/2023 Rodriguez 6302 Rodri uez 6302 ITEM DESCRIPTION CITY SIZE PRICE TOTAL 6 UltraWeld 8420 Double Hung 1 27 1/4 W X 40 1/4 H Private Label `"IV" Hold To Size Head Expander Standard Sill Trim (456) White Alum. Screen Frame(Std) Half Screen Fiberglass Screen Mesh Ultimate(2) Stainless Spacer Single Lock Innergy Reinforcement Foam Fill Bedroom 1 UF SHGC VT AL Zone 0.18 0.23 0.41 5 0.3 ALL ZONES 7 UltraWeld 8420 Double Hung 2 24 3/4 W X 25 1/4 H Private Label PRIVATE LABEL Hold To Size Head Expander Standard Sill Trim (456) White Alum. Screen Frame (Std) Half Screen Fiberglass Screen Mesh Ultimate(2) Stainless Spacer Single Lock Innergy Reinforcement Foam Fill UF SHGC VT AL Zone 0.18 0.23 0.41 5 0.3 ALL ZONES 8 UltraWeld 8420 Double Hung 2 31 3/4 W X 37 3/4 H Private Label PRIVATE"`"' Hold To Size Head Expander Standard Sill Trim (456) White Alum. Screen Frame(Std) Half Screen Fiberglass Screen Mesh Ultimate(2) Stainless Spacer Double Locks Innergy Reinforcement Foam Fill Bedroom 3 UF SHGC VT AL Zone 0.18 0.23 0.41 5 0.3 ALL ZONES 8/8/2023 9:03:37 AM 3 of 5 ORDER I ORDER DATE I PO NUMBER I CUSTOMER REF I TERMS 148040 7/20/2023 Rodriguez 6302 Rodri!uez 6302 ITEM DESCRIPTION QTY SIZE PRICE TOTAL 9 UltraWeld 8450 Casement 1 18 W X 25 H Private Label PRIVATE LABEL Hold To Size Direction{Right} White Fiberglass Screen Mesh Ultimate(2) Stainless Spacer Foam Fill Standard Sill Trim (456) Bedroom 3 UF SHGC VT AL Zone 0.16 0.19 0.33 5 0.3 ALL ZONES 10 UltraWeld 8420 Double Hung 1 19 1/4 W X 27 1/4 H Private Label PRIVATE LABEL Hold To Size Head Expander Standard Sill Trim (456) White Alum. Screen Frame(Std) Half Screen Fiberglass Screen Mesh Ultimate(2) Stainless Spacer Single Lock Innergy Reinforcement Foam Fill Bedroom 4 UF SHGC VT AL Zone 0.18 0.23 0.41 S 0.3 ALL ZONES 11 UltraWeld 8420 Double Hung 1 26 3/4 W X 48 1/4 H Private Label Hold To Size Head Expander Standard Sill Trim (456) White Alum. Screen Frame(Std) Half Screen Fiberglass Screen Mesh Ultimate(2) Stainless Spacer Single Lock Innergy Reinforcement Foam Fill Bedroom 4 UF SHGC VT AL Zone 0.18 0.23 0.41 5 0.3 ALL '.. ZONES ....... ........ . __._. 8/8/2023 9:03:37 AM 4 of 5 ORDER I ORDER DATE I :,,,,f0,14thiliefEWitit TERMS 148040 7/20/2023 Rodriguez 6302 Rodriguez 6302 DESCRIPTION t � . �, PRICETOTA .. 12 UltraWeld 8420 Double Hung 1 24 3/4 W X 25 1/4 H Private Label PRIVATE LABEL Hold To Size Head Expander Standard Sill Trim (456) White Alum. Screen Frame(Std) Half Screen Fiberglass Screen Mesh Ultimate(2) Stainless Spacer Single Lock Innergy Reinforcement Foam Fill Bedroom 2 OF SHGC VT AL Zone 0.18 0.23 0.41 E 0.3 ALL ZONES TOTALS: 15 SUBTOTAL: $5,061.67 MA SALES TAX 6.25%: $316.35 TOTAL: $5,378.02 CUSTOMER SIGNATURE REQUIRED: COMMENT: 8/8/2023 9:03:37 AM 5 of 5