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18C-159 (2)
BP-2023-1076 37 WARBURTON WAY COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 18C-159-001 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-2023-1076 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: CAIN ADELAIDE Lot Size (sq.ft.) Zoning: URB Applicant: WILDE HSE LLC DBA SEXTON ROOFING Applicant Address Phone: Insurance: 45 OLANDER DR 315-569-7761 6HUBOW55113923 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: i yQ / • Fees Paid: $40.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Office of the Building Commissioner _ VD 1s.. The Commonwealth of Mass chus tts AU qd/14L: Board of Building Regulations 4nd S 'ndards 7 4 ?0 iC PALITY Massachusetts State Building Code, RFOR USE Building Permit Application To Construct, Repair, �' �� 'i ^o Re ised Mar 2011 One-or Two-Family Dwelling MAo'o6n°^IS This Section For Official Use Only Building 4tils..) ermit Number: --�j -� ro 70 Date Applied: �� 8-/D-7.oz3 Building Official(Print Name) Signature Date SECTION 1: SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map& Parcel Numbers 31 uior6u44se, ' 1414.0awelel MA 4300 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(II) 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: Aaede. 'C_l n (gy en N a0100 Name(Print) City,State,Z 31 Wl2rbUa-tor. wen13.1_,..NN::_utitw N No.and Street Telephone [mail Address SECTION 3: DESCRIPTION OF PROPOSED WORK=(check all that apply) New Construction 0 Existing Building 0 Owner-Occupied 0 Repairs(s) M Alteration(s) 0 Addition ❑ Demolition 0 Accessory Bldg. 0 Number of Units Other 0 Specify: Brief Description of Proposed Work'-: (tnC yt; coeJtANAt."4 4n e.Mert. hern.sl... SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1. Building $ ,3SS I. 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 F Check Nola, I Check Amount: Cash Amount: 6. Total Project Cost: S 16 0 Paid in Full 0 Outstanding Balance Due: • SECTION 5: CONSTRUCTION SERVICES Construction supervisor License ILSL) `_' 10(0 ►S 3(A1m2} gs�ro S . Vv t dP. j License Number Expiration Date "DC List t.5t. type tree beio t �li S etko�MkG' Noo.and Street Type Description { t.' i t au >.0 g*acted i Buildin .up to 35.000 cu.tt-} Nitsci‘Nompken i MA at au.C j R ' Restricted I&?Family Dwelling City,Town,State,LIP M 1 Masonry RC Roofing Co%ering ------- — WS } Window and Baling SF Solid Fuel Burning Appliance; 3t5—S(oq--nut ilcfth.Qsea.;esm1rAoci.corn i insulation Telephone Email addr ss y D Demolition 5.2 Registered Home improvement Contractor(HIC) '_J 2oeo f y 134 (2e25 Y`tAck V$J LPL' lnn di?elciCn f faeL MC Registration Number Expiration Date iJIC Corp�an�.\amc or 1{tC Rcri irani Name Y br No. and Street Email addre, t4.0,04fti NM mow 3t5-crept--mot City`Town,State.ZIP Telephone SECTION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c. 152. § 25C(6)) Workers Compensation insurance affidavit must he 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 \SActt, HSt ►, 'DgA Stst}v%'9,11"yy i�jldn to act on my behalf,in all matters relative to work authorized by this building permit application. it•Adlit. Gat►n $(9(241a._ 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. � . Vriside, 94,12023 Print Owner's or Authorized Agent's Name(Electronic Signature) Date NOTES: 1. An Owner who obtains a building permit to do hisiher 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 \1wW.111a S.eo%ula Information on the Construction Supervisor License can be found at p w.mass.eovidps 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 tm V 3 DEPARTMENT OF BUILDING INSPECTIONS �. z 212 Main Street • Municipal Building F Cam Northampton, MA 01060 srbw (r`� 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: lo�LI t-icAirt gv Nsvec` OA o The debris will be transported by: Name of Hauler: AS�ocao,x,,, WAS Signature of Applicant: ar,,,A,„ O1J,:et,-. Date: eia J2oo'i.3 The Commonwealth oftilassay?`__= - r. ,. Department of Industrial Accidents I* I Congress Street, Suite 100 7-117. t_ Roston. MA 02114-2017 www.rass gov/dia ink ers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WiTH THE PERLiITTING At'THORiTY. Applicant Information Please Print I.etribi f; Name (Business Organi7ation-lndividuai): AckQ, i cstYEuty (Su3s46 Address: yS ntr�s,r Dr J City/State/Zip: 14viv,Ach,r9on MA atctao Phone#: 315-Sto9--i1(Q1 Are yam an employer:a neeli the appropriate Wm: ] Type of project(required): ICI am a employer with employes(full andior part-time).* 7, ❑New construction 2.DIama sole proprietor orpartnership and have no employees working for mein 8. El Remodeling any capacity.[No workers`comp.insurance required.] 9. ❑Demolition 3.01 am a homeowner doingall work myself:[No workers'comp.insurance required.]' 10❑Building addition .t.12Iamabomcownerarxiwithbe hiring ec.ntractrns to conduct all workonrn properly. I will en.urc that all craaactir,cithtrhavc."% ti;ers'roatpzn.alinki irsacr or arc sok 11.0Electrical repairs or additions proprietors with no employees. 12.r3 Plumbing repairs or additions 5. i am a general contractor and I have hired the;ub-contractors listed on the attached sheet. These sub-conractors have employees and have workers'comp.insurance. 1.3.®Roof repairs 6.0 We arc a corporation and its officers have exercised their right of exemption per MGL c. l Other 152.,cs i(4),and we have no employees.[No workers'comp.insurance required.] 'Any applicant that checks box ` moat also till our the section below showing their n rkinv. 3 r+ ;sir rpolicy information. Homo AIMS who submitth isatidav it indicating they are doingall work and then hire outside contractors must submit.t new aftidav itindicatingsuch. tConttactan that check thishoxmustattachedanadditionalsheetshowingthenameofthesuh-contractors and state whether or not those entities have employees. If the sub-contractors 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 polity and job,site information. Insurance Company Name: "tateutlalers -ltnglanwni%y 4 C.o t. A+MWiie o. Policy #or Self-ins. Lie.N:___ViNkantsi!MS 1.13c0.2 Expiration Date: CAD Lb%(20't14 Job Site Address: Si WGw17ttfkrk.Wad City/State:'Zip: N6444e. i 13(co 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,,sy25A is a criminal violation punishable by a fine up to$1,500.00 andior 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. Jdo hereby certify under the pains and penalties of perjury that the information provided above is true and correct. Signature; 64,41,---iVeh.--- Date: 8 jq(zA2A Phone=: 31s-614-7' 0( 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 16.Other Contact Person: Phone #: A`C� CERTIFICATE OF LIABILITY MIS IODIYYYY) TY INSURANCE 1/2023 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFER 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 NSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the polfcy(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 tier of such endorsemenI(s). PaooucEa COWIACT Ram BRUNO ROZEI11BAROUE POINT INSURANCE INC PHONEeriAt,,Eze., (617)783-1160 FAXUVC.Ran ADelESL cum 1103 COMMONWEALTH AVE Rls,rs 8818AFFORonmcCOVERAGE RAW* BOSTON MA 022151111 ggiunciA; ,AIM MUTUAL INS CO 33758 INSURED ED ISURER B: E C A GENERAL CONSTRUCTION INC MOSUREseC: TIED: 8 OTIS ST APT 1 MBE: MILFORD MA 01757 M'LEURER F: COVERAGES CERTIFICATE NUR: 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,TIE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS fit as IFGT TO ALL.THE TERMS, OCCLUSIONS AA'D CONDITIONS OF SUCH POLICIES.MOTS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS MR POOL SUM POLICYEFF I POUCYEXP UNITS LTR TYPE OE INSURANCE RIM,WM POLICYNtMBER g4eDOIYYYYI AMMCOIYY)YV {{ C' ML C SIDER/LLLIMILA i r EACH OOCU RREraCE $ DAMAGE I 0 RENTED CIAMISMADE fl OCCUR I PREMISES occurrence} S LIED Earthward person) $ N/A PERSONAL.SAW INJURY $ GBILAN IEGATE UNIT APPLESPER G13830LAGGREGATE $ POLICY n I LOG 'PRODUCTS-COMPA7PAGG $ _ OTHER S AUTOM08LEUABUTY COWSHED SINGLE LIMIT : I�acrid** ANrALTO It BOM SUM swr LYe an} S AUTOS Y d1I NIA SOCILYPROPS YfH URY(Per DAMAGE accident) $ HONEDr panes curt, AUTOS ONLY i IPur aceieentt, ; $ onMlltLutlAa r feria P EACH OCCtJ MEE $ MESS UMC[ARa3 fIADE NIA 1 AGGREGATE S DM u REDWOOD1 t }} {{ $ uumcrosco eesATIOM OTH- XI STATUTE II ER ANO EMPLOYER,LAMOUTY YIN A AropRoprestivisanwnsprEcuntEoFficatweeemcwourNat+WA VWC10360260282023A 02/11/2023'02111/2024 ELTlICBiArtT $ 1,000.000 (YandatovyinNH) , ELOsEti¢ EA EMPLO EE $ 1,000,000 p P7IpaWa=Mr d'OFOPERATIONSbekler EL DISEASE-FDLYA6i S 1,000,000 1 NIA orsci PUONOFontrin orwrLOCATIONSIVENICSES 4400118 TM AddlIkagaRammksseiMefaadIMarsMii}neoeapssiaatNuitar9 Workers'ConTper allon benefits will be paid to Massachusetts employees only.Pursuant to Endorsement WC 20 03 06 B,no authorization is given to pay dawns for benefits to employees(re states other than Massachusetts if the insured tomes,or has hired those employees outside of Massachusetts. This certificate of insurance shows the pdficy in force on the date that this certNicate 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 foci at www.mass . CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE cANcELI fin BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN lde HSE LLC ACCORDANCE MT3TH THE POLICY PROVISIONS- Wi 45 Olander Dr AUTHORIZED ii rrAwYE Northampton MA 01060 vl 4 Daniel IA Grcwwley,CPCU,Vice President—Residual Market—WCRIBMA CI 1968-2015 ACORD CORPORATION. AN rights reserved. ACORD 25(2016 03) The ACORD name and logo are registered marks of ACORD ACORD Client#- DATE TM 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 Gartherme Camossato NAME- PHONE 978 726-9830 I-INSURANCE GROUP INC (A/C,No,Ext), EMAIL gcamossatoaHnsurancegroup.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 (MM/DONYYY) (MM/DO/YYYY) LIMITS A GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000.00 DAMAGE TO RENTED X COMMERCIAL GENERAL LIABILITY PREMISES(Es ocurrencal $ 100,000.00 CLAIMS-MADE Ix I OCCUR MED EXP(Any one persons $ 5,000.00 IMA395923A 8/25/2022 8/25/2023 PERSONAL&ADV INJURY $ 1,000,000.00 GENERAL AGGREGATE $ 2,000,000.00 'GE�N'LI AGGREGATE LIMIT APPLIES PER' Products Completed Ops Aggregate $ 2,000,000.00 f POLICY []PROJECT' ILOC B COMBINED SINGLE UMIT AUTOMOBILE LIABILITY (Ea accident) $ 100,000.00 BODILY INJURY(Per person) ANY AUTO $ 20,000.00 "` ALL OWNED —°—"SCHEOULED AUTOS AUTOS AUTOS 1020096012 4/13/2023 4/13/2024 BODILY INJURY Per coident, $ 40,000.00 NON-OWNED PROPERTY DAMAGE HIRED AUTOS AUTOS IPer accident) $ 100,000.00 Ce UMBRELLA LIRE OCCUR EACH OCCURRENCE EXCESS LAB CLAIMS-MADE AGGREGATE DEO RETENTION$ D WORKERS COMPENSATION YIN WC STATUTORY OTH AND EMPLOYERS'UABIUTY LIMITS ER ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? n/a E.L.EACH ACCIDENT $ 1,000,000.00 (Mandatory In Nis6HUB4N86974323 3/26/2023 3/26/2024 E.L DISEASE-EA EMPLOYEE $ 1,000,000.00 11 yes,describe under DESCRIPTION OF OPERATIONS below E 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 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-compensatiorunvestigations/ 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 ©1988-2010 ACORD CORPORATION.All rights reserved. DATE(MM/DD/YYYY) ACURD CERTIFICATE OF LIABILITY INSURANCE 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 ORMSBY INSURANCE AGENCY iA/c°NPo.Eut): (413)7370300 A/C, No): E-MAIL ADDRESS: edembinske@ormsbyins.COm P 0 BOX 718 INSURER(S)AFFORDING COVERAGE NAICat WEST SPRINGFIELD MA 01090 ,INSURER A: TRAVELERS INDEMNITY CO OF AMERICA 25666 INSURED INSURER 13: WILDE HSE LLC INSURER C: DBA SEXTON ROOFING &SIDING INSURER D: 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. ILTR TYPE OF INSURANCE NSD SWV. POLICY NUMBER (MM (MMIDD/YYYY)IDDIYYYY)I EXP LIMITS IDD/ COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ --1 DAMAGE TO RENTED CLAIMS-MADE I OCCUR PREMISES(Ea occurrence) $ MED EXP(My one person) $ N/A PERSONAL&ADV INJURY $ GENL AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLY FT PRO-L JECT LOC PRODUCTS-COMP/OP AGO $ -- _.. _ _._--.--- OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ .�Ea acc 4 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 accident)_ $ UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESS LU1B CLAIMS-MADE N/A AGGREGATE $ DED RETENTION$ —_- $ WORKERS COMPENSATION X RTUTE H- TR STATUTE AND EMPLOYERS'LIABILITY ANYPROPRIETORIPARTNER/EXECUTIVE YIN E.L.EACH ACCIDENT $ 1,000,000 A OFFICER/MEMBER EXCLUDED? N/A N/A NIA 6HUBOW55113923 06/01/2023 06/01/2024 -- (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/LOCATIONS I 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 �"I y Daniel M.Croy,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 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 Q21 t 8 Home Improvement Contractor Registration Tyre t.LC Jt:[ !�tS1g.+..LC Reipttrabar MUD O$A SEXTON ROOFING d SIDAIGa E>tRir.btfts 04451025 c.6 OtdSOER DR NORTHAMPTON UA 43T64 - VcodeSi Adr r l...ne lt,Myrn THE COPOWNWULTrr OP tuASSAC►osETTS O$ ..et Consumer Arrows 4 business Regutaton RealstrIMan used tar fndtvldust use only inter'.rrH HOVE IMP CYEelEWT CCA-TRACTOP ecplletl.n M. tttb5md return w TYPE . C Oats 6r CoMumN AWWs and Basimis Plidgulidwort SIStit a1iwt Eutimus TWO W.rrmaton Some =Sults ITt: 3544r:; at.'024i1 awban,t1tA 03t14 to 3E µ#E.L.L. 011.44 SEXTTOfiI*DO i>iO 4 6C,N SASHA Vst.DE 46 tXNHf3ER DR .r;.++t' e,s — pigirriimaPron MA OVA Undersecretary FM valid W1theVt signature WWI l4 . ttt SEXTON ROOFING AND SIDING muy,sextuiiivoril c.uiu I 411W41101 45°Linder Dr � .rot Northampton, MA 01060 %dims Oit Iftimised saina�a~+liall► p. 411.534 1234 at. rim +teeer+ x infoOsextionroofing.com .ELIMITIMIP110 1 kkx:02. cx...1.1 TIM= 1 c,k‘ _sbq _wag Don ridisiziki art soup miertufapink,eI Mae ai.fk t glad 11001011110001•116MINEW10111111111531111CINCIIIMINEANDEMISCIES FOE q Sirrrt,t arttf resseert resinirrranagfes 410060410orforals potP+e+rlror it taw" ursperyiosa 1) isrr"ai sr*settai Waft sa rakes and+erwesaYner .(runic} 4 e.eei ire mei saw Ibrahim awn t fa stases stain.a stibisk.ehintininewitheiguisis. 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AS wart ie r canpirred &sum oed IWO awasidbagiprommidiaatrassima Amy 3411.011* ‘,32a11-4A- 9 dm al nal or nnssrrisad"w vas a s immix ovine+.aria wit bra r men m ersni % r rprerinew rasor -e�ieir woos+red a l�ei'r atio a***aimar dorcomedre a+rrr+ts 1 1 a Airmsesoinno WO t tea,/'. afr OAahowsscariea 1Msw sspawrlb r"lrr rraw�I-*aeu a gelatana flr mulls Trip g raorrd»e Ir Ores fur non nn papaw*And with/at r►on rat x The above n vs,iperdwatxrtls �eaearf a*a See signature below next to address are ayg gyred to der the work As spirited afhsreiaineeir •`_ilk. _......reams _'____u.e.r Address Cost Notes 162 Prospect. Unit 1 $5,150 162 Prospect.Unit 2 $5,150 162 Prospect.Unit 3 $5,150 162 Prospect, Unit 4 $5,150 +�+ I 162 Prospect,Unit 5 $5.1.50 162 Prospect,Unit 7 $5.150 F � 20 Warburton Way $7,350 includes garage c � `22 Warburton Way $7,900 includes garage and back porch 34 Warburton Way $7,350 Includes garage 36 Warburton Way $7.350 Includes garage 39 Warburton Way $7,350 c � 43 Warburton Way $5,150 45 Warburton Way $5,150 47 Warburton Way $5,150 [ , 53 Warburton Way $5.150 WWb 7 Aso \f_q c1,� I. As stated in the request for proposal,if selected.Sexton Roofing will provide a certifica insurance showing Prospect Woods Homeowners Association as additional insured.Color samples of the matching color will also be submitted to Sabrina Bardwell. Please accept this proposal on behalf of Sexton Rung,we look forward to working with you on this project. Sincerely. Sasha Wilde Sexton Roofing 413.534.1234 info@@sextonroofmg.com www.sextonroofing.com