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18C-157 (3) BP-2023-1073 34 WARBURTON WAY COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 18C-157-001 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-2023-1073 PERMISSION IS HEREBY GRANTED TO: Project# ROOF 2023 Contractor: License: WILDE HSE LLC DBA SEXTON Est. Cost: 7350 ROOFING 106265 Const.Class: Exp.Date: 03/08/2027 Use Group: Owner: C HARRIS EDWARD S&FAYE Lot Size (sq.ft.) Zoning: URB Applicant: WILDE HSE LLC DBA SEXTON ROOFING Applicant Address Phone: Insurance: 45 OLANDER DR 315-569-7761 6HUB0W551 13923 NORTHAMPTON, MA 01060 ISSUED ON: 08/10/2023 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: V II Fees Paid: $40.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Office of the Building Commissioner ,CIS The Commonwealth of Massachusetts o�4 FOR �� 9:!"‘c2.4it° Board of Building Regulations and Standards ' ' Massachusetts State Buildingu Code, 780 CMR ��"�`yq �ALITY Building Permit Application To Construct,Repair,Renovate Or Demolish a Reins•. &�'Oda . One-or Two-Family Dwelling �,/� This Section For Official Use Only Buildin i Permit Number'v •••3' i07_ Date Applied: i eii1A-/ari, ///.7 8-0-2623 Building Official(Print Name) Signature Date SECTION 1:SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map& Parcel Numbers 34 \c„ft.AY4o\ ‘Aoy w^ ,s4A 1.1 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: Zone: _ Outside Flood Zone'? Public 0 Private 0 Check if ves❑ Municipal 0 On site disposal system ❑ SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of Record: I 'A cr \-1.04 <S jVVYActr ice+1 1_14A ok040 Name(Print) City,State,ZIP SA Waxu a Vial 413-614—bsSS_ NIIfl No.and Street Telephone Email Address SECTION 3: DESCRIPTION OF PROPOSED WORK (check all that apply) New Construction 0 Existing Building 0 Owner-Occupied 0 Repairs(s)51 Alteration(s) 0 Addition ❑ Demolition 0 Accessory Bldg. 0 Number of Units Other 0 Specify: Brief Description of Proposed Work': CDtc Ytiaccitnestk ork eater., V10M . SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1. Building $ 1M•O 1. Building Permit Fee: $ Indicate how fee is determined: ❑ Standard City/Town Application Fee 2. Electrical $ ❑Total Project Costa(Item 6)x multiplier x 3. Plumbing $ 2. Other Fees: $ 4. Mechanical (HVAC) $ List: 5. Mechanical (Fire $ Suppression) Total All Fees- Check No. WI Check Amount: V° Cash Amount: 6. Total Project Cost: $ itE,0 0 Paid in Full 0 Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.I Construction Supervisor License(CSL) `_r locoa+vS Si RI�-{- ' S0 ' W t lde, License Number Expiration Date ' y 5 U�ot►�trr l� List(Si_ type(see t�elou) RC. No. and Street I Type Description ( L nre, ictcd i n nldino,up to 35.inpu cu.ft.) ty601aWl KA Otace C) R i Restricted 1&2 Family Dwelling City/Town,State,ZIP M Masonry RC ; Roofing Covering WS Window and Siding SF Solid Fuel Burning Appliances 26's(n l=1lko� 3n51rtit►Q5tAdre.t,rim .coM 1 Insulation T.:l Email address D i Demolition 5.2 Registered Home Improvement Contractor(HIC) �1 $� I4 #(RA fititkon RCIOCVS 4 445 BIC Registration Number Expiration Date I IIC Company tame or MC Registrant Name No.and Street Email addre 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!valance of the building permit. Signed Affidavit Attached'? Yes ,* • No .❑ SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BLILDLNG PERMIT 1.as Owner of the subject property.hereby authorize \t►v . NSt, tAng, 't*A '9,406 Oct to act on my behalf,in all matters relative to work authorized by this building permit application. Print 1) .Signature) SECTION 7b:OWNER'OR AUTHORIZED AGENT DECLARATION By entering:ay 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. Print Owner's or Authorized Agent's Name(Electronic Signature) Date • NOTES: I. 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 w 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 \1 g i\_oca information on the Construction Supervisor License can be found at\\Vt. 1113 u\'tips 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 halfbaths 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 Massachusetts h4 ` DEPARTMENT OF BUILDING INSPECTIONS S. ` 212 Main Street • Municipal Building Uj Northampton, MA 01060 fs'ty� 31C1 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: Flo g- �4s\�iYe 1 m°L° _ The debris will be transported by: Name of Hauler: 4ytocicke,ck '� ;���j WK, c.rc Signature of Applicant: Date: Qjlg12 1 The Commonwealth pi Massachusetts "` Department of Industrial Accidents I 1 Congress Street, Suite 100 zietszi s Boston, MA 02114-2017 WWW.mass.gov/dia gd'mkers'Compensation insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING th'THORiTY. Apulicant Information Please Print I.egihly Name tBusiness Organization Individual): t.itittaN1 t Slav Address: LIS Oka/Alex br City/State/Zip: 140,41s,r►p6n MA o16too Phone#: 3l5-stet--17u1 ' .ore yen an esiipkwer'Cber1 the appropriate box: Typeof project(required): 1.0t am a employer with employees(full andiorpart-tune)." 7. [New construction 2.01ama sole proprietor or partnership andhavenocnlo working for me in 8. El Remodeling any capacity.[No workers"comp.insurance required.] 9. ❑Demolition 3.0Jam a homeownerdoingall work myself:[No workers'comp.insurance required.)' 10 0 Building addition .40/amal=avmcowner and will beharmgconaacsns to conduct ail nod onrry property_ 1 will csiure that all cc manna catbter havi workIN.:ngsptns,a<s+ra;b;.-saLc or are sok I i.0 Electrical repairs or additions proprietors with no employees. 12.0 Plumbing repairs or additions 5 lip am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.®Roof repairs These snb-contractors have employees and have workers'comp.insurance.: 6.0 We arc a corporation and its officers have exercised their right of exemption per MGL c. 13.0 Other 152.§1(4),aid we have noeng loyees.[No workers'comp.insurance rewired., "Aray:applicant that checks box w a must also fill Oral tale section below showing rhelr wee •:<,s a.7e,zaak n policy information. Heimann cot who submit thisattidavit indicating they are doingall work and then hire outside contractors must submit a new affidavit indicating such. :Contractors that check thishos must attwhed an additional sheet showing the name cif 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. t am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: !fraa/I itII -rr.4..... ki j c trC Anwi Policy #or Self-ins. lie. #: l0 Nkle(jW iStSkkailAR Expiration Date: Cho(01(2at{ Job Site Address: 3ut Weutia.rAtevx Citv'State'Zip: ► oxx tMA Gloh,0 Attach a copy of the workers"compensati n policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL c. 152,j25A is a criminal violation punishable by a fine up to S 1,500.00 and drone-year imprisonment,as well as civil penalties in the form ofa STOP WORK ORDER anda 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 certil'1'under the pains and penalties ofperjury that the information provided above is true and correct. Si nature; Bird---1iLa.. Date; ciHI/QV Phone. -: 3l5-— —null 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): I.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5. Plumbing Inspector 6.Other l Contact Person: Phone#: ACORD Client# DATE ,M CERTIFICATE OF LIABILITY INSURANCE 07/25/2023 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 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 Guilherme Camossato NANIF PHONE 978 726-9830 I-INSURANCE GROUP INC (A/C,No.E><). EMAIL gcamossatoai-insurancegroup net 799 GORHAM ST ADDRESS LOVVELL, 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 SUER POLICY EFF POLICY EXP TR TYPE OF INSURANCE NSR WVD POLICY NUMBER (MM/DOIYYYY) (MM/DD/YYYY) LIMITS A GENERAL UABILITY EACH OCCURRENCE $ 1,000,000.00 DAMAGE TO RENTED X COMMERCIAL GENERAL LIABILITY PREMISES(Ea ocurrence) $ 100,000.00 CLAIMS-MADE IX I OCCUR MED EXP(Any one person) $ 5,000,00 IMA395923A 8/25.2022 8/25/2023 PERSONAL a ADV INJURY $ 1,000,000.00 GENERAL AGGREGATE $ 2,000,000.00 GEN'L-AGGREGATE LIMIT APPLIES PER' Products Completed Ops Aggregate $ 2,000,000.00 POLICY PROJECT 1 ILOC CB AUTOMOBILE UABIUTY ( SINGLE LIMIT rot) $ 100,000.00 BODILY INJURY(Per person) ANY AUTO $ 20,000.00 ALL OWNED SCHEDULED 1020096012 4/13/2023 4/13/2024 BODILY INJURY(Per accident) AUTOS AUTOS $ 40,000.00 NON-OWNED PROPERTY DAMAGE HIRED AUTOS AUTOS (Per accident/ $ 100,000.00 UMBRELLA LIAR OCCUR EACH OCCURRENCE EXCESS LIAR CLAIMS-MADE AGGREGATE DED RETENTION$ D WORKERS COMPENSATION WC STATUTORY GTH AND EMPLOYERS'UAIILITY YM LIMITS ER ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED, n/a E.L.EACH ACCIDENT $ 1,000,000.00 Mandatory In NM 6HUB4N86974323 3/26/2023 3/26/2024 E L DISEASE-EA EMPLOYEE $ 1,000,000.00 If yes,describe under DESCRIPTION OF OPERATIONS below £L.DISEASE-POLICY LIMIT $ 1,000,000.00 GENERAL LIABILITY:for regular and usual jobs and the certificate holder is an additional insured. Workers'Compensation benefits wit!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 Venfication Search tool at www.mass.gov4wd/workers-compensationAinvestigations/ CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE IT IS THE CUSTOMER'S RESPONSABILITY TO INFORME ANY SEXTON ROOFING CHANGES OR CANCELATIONS. 45 Olander Dr., Northampton, MA GUILHERME CAMOSSATO 1/1 m 1988-2010 ACORD CORPORATION.All rights reserved. ------"41 . AC ORD" CERTIFICATE OF USIIIIILITY INSURANCE I }, GATE onsvacirrm mes CERTIFICATE EII MIST AS A NATTER OF INFORMATION CELT AM CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFIRRIVATIVELY CR NEGATIVELY MEAN EXTENO OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. MS CERTIFICATE OF INSURANCE DOES NOT CONSTMITE A CONTRACT BETWEEN THE MINI.MIG INSURER'S), AUTHORIZED somasietwaree cut PRODUCERL NM TIE CERTIFICATE HOLZER., IMPORTANT: If be certificate nuIdier is an ADDITIONAL INSURED,The poricycies)must haw ADOPTIONAL INSURED purvisions or be endorsed. *NURRTIIRATIMIN IS WAIVED Aitiptct to the terms and=Mainns.at de policy;cartaIn policies may reuttlississimadlaissiment. A statinvenit on this carildnabt dims net center rights so die certificate*Niter in Feu of seek seraisis ipsomoasa coma= Awe, SIMItia3 FICATEMEAROUE PONT INSURANCE.INC r 7:4.i f.,_ : ROAM AL Cr—.---MIL r414 1111011$8$016$110MIXWIT I -N TTO:1 CAL -1 AVE NOLSOMIMINPMION.MCIMEMIME I Mat* BOSTON VA W.21 VI f-1` arimaim:raiitillterelle J*5 CO --4 33758 savassa 111111111111110:. EC A GENERAL CONSTRUCTION INC lielmmez ifteusseraT. S 07IS ST AFT I 'imitatews- MILFORD MA 01757 COINERAMES GERTIFICATE NUMEIER: 197535 REVISION NUMBER: THU%iS r ClItkowr 114a THEIRILIDES a INSLRANCE LISTED SELO*. -Ira,VE SE-t4= -ISSUED Tir.T:IE.itiESURED NAME-O.AEME FOR THE IPOLICY PERIM , iftATER INTWIINSTAPPLING PaFf PEQUIREMEN1, TEFas OFt COMMON OF Ma COVIRACT OR OTAER DOCIAMIAT Vlifti RESPECT IT,WHICH THIS CERVPICATE IOW RE MUM OW INV.'PERTAIN, DIE hisiTRAttrE AffrAGEn ff.4' THE POLICIES .3ESCRIRED HEROIC IS'SUBJECT TO,ALL THE TERMS, Eltt:LuSIONZ_ANL)CONENIMIS OF Skint POLICIES.LIMITS SHOWN MAY HAVE SUN/Waif:ED BY PMEI CLAMS Tow) oirotROBIR i POUCYBAr , POUCTEMP LTA MMEOFRMLIMAKE ?NM$1411i, POLICY NUMBEFt IIMPCKPIPMS OMMIMMANPOLI swims , cOmEROALAWORKJAANA.irt, h ,, • scH,x.CAREMCE * i i afintgavvar)e i waltz f ,' 1 'VARIAGE TGREATED !t 1 IPMEMKESRA Inrawywriasit /- 1( 1 4 killt ARGILATritamyr APPSESIPER: II ) POLLAY) LOC ,I affam. i i ' V 11 1 11 ,usa .1,',,kir,,one fawsonp i 1 REASON&tADVINJORY $ ic*G*GRAL W.GREGATE $ ,PRCIDUCFS-CCAVPOP AGG S. --- * i t i c.OLIKOMOSMGVJELNEL $ 1 AUTOMYLEUIPtardrY li 1 1 ;ilEpsoOdersrt MP*At. ji` ',NOMLY NAM LIPMLwroont $ i OSP,IEO: , ri 5w- , mem AMOS ' 'tilOWMPLEDI 1 I / Mlik i k BOXY'AWRY War amid(*) I 1 ligitiVervilnalmE S 1 1 Mbemadtart $ ,IMMISIMMISME :.:=AL -' 'it ! I liVOPOEMIRRE $ . i i ! WA AGGREGATE '7S --,. —11 IMEINIM11/ i i CLOMMMICE1 1 1 I 1 'JUDO fEHENOLOAV , ,1 , 1 *aulaserczaweincieg i V X;stATIRE I i ER i .mo*-EoPYLOPM$PLIMMIMno: Wer‘ t (1 1 1 , ,,Fair,v0,-Ittf-roAPIVIVIEVENFrJ.0,* ; , .!isti.lakcitiAcOneer J T,CIGGIENT A IEFRV2.4MEME3.11-Zzr..LJEer INK ,Mk iNIVIIIIIIIMISIMMEK 'ORIVIP2MB illIMMIMMI toitossery ss ger, i;i 1, i et.vissiiss-eA EMPLOYEE(5 10)0000 I r 1 il irEILDI IE S T,DDEICI : tilltrOi.,14-,7$14601:Ne.,:affem,gir....04 lc 4 I liffik vcscarnownrwrAmws•LORAMOYM:NESMCISE$?olkCORO 1f-0.StitiMimdMilmmOsIbilMakmelhiallizenterhannpspuwy.ipteeyszmadt Wafters-Cznipensetori benefits Mil ON:paid fa NVZI4F.,,1&4:130415.evildispestsvic.risgesomt.Uni Err atinent WC 21105 Di El,no autnonzaliaa is griri to pay claims far beastfas?a empic,ees r•Vales offv/r tit arr MeesactuspAsafbeisswedkines,rr has hired Moose eursiswaa=We of Massachusetts_ This cattiest&of ineurarese snows depellity in tome ex the czeue or-at OW alliKaile was waved(Unless I ex iratea GM&(SS die abuve pciIc' precedes the issue date a jr,itt aertifire,,firisorencel. The stati.a,of this,to.;,-,esae careeemenattred daffy by'theFtoof of r...atierage-Coverage Verification Searcrt Ed i avweo_mawa.,gavittilecItivorkeTs-ezripmnatimirtvesitgattaml., CERTIFICATE 1431.13ER CAACELLATI011 MOMS rat•DFTRE ALLOW 0$110$EFED,FouaES BE r Atitc-F LI ED BEFORE THE ECIRRAHON DATE THEREOF, NOTICE WRI BE DELIVERED IN ACCORDWWEVIIITH,THEPOLICT rolt OVUM& Wide HSE Li.c 45°fancier Dr , MIMIIMMEMIELMEMMEMMIE hiarihampron MA OMR! Conte Mi.CmeAsiv..CPCU.,Vire President-Re...40'ml"Market-INCREMA CIONII-2105ADZIRD CORPORATIOM. MI risaks,reserves!. ACORC 25(21,6/931 llbrACiallaimmeamdbripareassinemiamilbsetICOREt ' R Accoarit CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) keis,,,,. 06/09/2023 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 NAME: Eric Dembinske FAX ORMSBY INSURANCE AGENCY �acO°Nr ,E:tt (413)737-0300 ( ,No): E-MAIL ADDREss: edembinske@ormsbyins.com P 0 BOX 718 INSURERMAFFORDINGCOVERAGE NAIC# WEST SPRINGFIELD MA 01090 INSURER A: TRAVELERS INDEMNITY CO OF AMERICA 25666 INSURED INSURER B: WILDE HSE LLC INSURERC: DBA SEXTON ROOFING & SIDING INSURERD: 45 OLANDER DRIVE INSURERE: NORTHAMPTON MA 01060 INSURERF: COVERAGES CERTIFICATE NUMBER: 901203 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 ADDLISUER POLICY EFF POLICY EXP W LIMITS LTRINSD VD POLICY NUMBER (MM(DD/YYYY) (MMIDD/YYYY) COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ DAMAGE TO RENTED CLAIMS-MADE OCCUR PREMISES(Ea occurrence) $ MED EXP(Any one person) $ N/A PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ I JET° LOC PRODUCTS-COMP/OP AGG $ OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED AUTOS ONLY AUTOS N/A BODILY INJURY(Per accident) $ HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY (Per accidents UMBRELLA UAB OCCUR EACH OCCURRENCE $ EXCESS UAB CLAIMS-MADE N/A AGGREGATE $ DED j RETENTION$ �/ $ WORKERS COMPENSATION X STATUTE ER AND EMPLOYERS'LIABILITY ANYPROPRIETOR/PARTNER/EXA OFFICER/MEMBEREXCLUDED?ECUTIVE N/A NtA N/A 6HUB0W55113923 06/01/2023 06/01/2024 E.L.EACH ACCIDENT $ 1,000,000 (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 N/A DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (ACORD 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 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/investigations/. 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. Sexton Roofing and Siding Inc PO Box 6327 AUTHORIZED REPRESENTATIVE Holyoke MA 01040 Daniel M.Cro4by,CPCU,Vice President—Residual Market—WCRIBMA ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD Licensee Details Demographic Information Full Name: SASHA MARIE WILDE Owner Name: license Address Information City: NORTHAMPTON 1 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 THE COMMONWEALTH OF MASSACHUSETTS Office of Consumer Affairs and Business Regulation 1000 Washington Street-Suite 710 Boston, Massachusetts 021 I B Home Improvement Contractor Registration Tyrpa .LC J:c.GE SE..t G Raptsiraaor 2 t7 C.SASEXTON RGOFth{3 6 SIDING Expiration flt U25 AS Cri-ASCEA CA kORTnisMMPTON MA 03184 tReon r Addt>tnr and Return C sG 'tit C13iPM4KWtM iM OP MASIACHUIETT3 Cara or Consumer• ar.6 Rurrryrr Rrauaatram Registration rated for tndtsfd4N see*Ma bpiare C•a HOVE IMPROVEMENT CONTRA Vow **moral deer. irrovnd wlunt to- TYPE t Oft*ed Cenauwyr Affairs'rod business Milli'Oar fiS2AItaltao Eaairciall tb®8 WaaMngttn Sheet o Sotto no 1'min `4.1c,,-.-„;i, Bolton.iikk.02111 wL E's''st.LLt OS A SE]rfOri alriCA NG 4 at. OLA WILDE _ S CXirMifltER DA „e«r w:..rt.r C .ci 4 wpt► $MPxOr:.MA 90iC4 UndereaKrwarr Nut*Mid nrtll+teut signaling WILDE HSE. LLC SEXTON ROOFING AND SIDING www.sextonroofing.com grifirtro �- 45(tinder Dr � ' �•�■�SW Northampton,MA 01060 Ilia MIS MilkIIIN.101. MA HIC 4 208470 p.413.534.1234 info@sextonroofing.com Sitcl:Ea Prospect Ase&WarburtonWay 1 EMAIL 1 davidhersh22@gmail.com amsrArEar 4 'c ,dn'et r,„NIA.IN-Obn i:rfield SEXTON ROOFING HEREBY SUBMITS SPECIFICATIONS AND ESTIMATES FOR: 1) Strip aria remove existing shingles and dispose of in proper Land►ill. • kmigbe,m nactiont s;tza any,"militaze 710121210641.MOB per skims_ 3) Install new metal edging ix rakes and eaves of roof.(whitel 4) S" ,,c;in:aaare.-. zAr. 'Ira fir.;rij ' Pa?rTsti►. ar:', S%. 'aII Az-vize' viigr4:-Acita. 5) install ssithetic underlayment cm winder of rook 7) fit'' sumer slinetes eaves and rakes ciMAE • Instag B03 Architectural style roofmg shingles OR Manufacturer Match as per manufacturers"specifications. 10) RetlaSti anuttrng chimneys. ri y minakinuresilfietome. acao as..3 and SRC 34:.morinainatittip it '_ ATTENTION HOMEOWNERS:Please cover all personal belongings in the attic,garage,or storage areas due to possible roofing debris or dust coming through cracks of wood decking. Sexton Roofing shall apply for all permits. We propose hereby to furnish material and labor-complete in accordance with the above specifications,broken out on the page below Cap red einfiagacompldit: AU Material is guaranteed to be as specified.All work to be completed Atidaanted briNiiraillta tram anoie ipecincamors muthit>ragrora costs will be executed only upon written orders.and wsll became an extra Note:This proposal maybe withdrawn by us if not accepted within charge over and above the estimate.n.uacss 70 NAMES AND omra e4071:t W v.sty*de A�0a44 w3u:. ' +rr&-AtE2016011%111.1EILL Not responsible for xattrdamage dmg consumer.Diener to pay responsible legal fees for non-pa}seem,and applicable interest Accepunceafitoposai ThiE above prices,.specifications satisfactory and conditions are and are hereby accepted. You Sighatur are authorized to do the work as specified. Payment will be made as outlined above. Signatur6.6:74 e "� IpateafAcceptinom �� l�"