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35-145 (8) BP-2023-1308 17 WESTWOOD TERR COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 35-145-001 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-2023-1308 PERMISSION IS HEREBY GRANTED TO: Project# roof 2023 Contractor: License: Est. Cost: 4000 • GREATER BOSTON ROOFING CSL113557 Const.Class: Exp.Date: 10/06/2024 Use Group: Owner: SAGE CAMPBELL, Lot Size (sq.ft.) Zoning: WSP Applicant: GREATER BOSTON ROOFING Applicant Address Phone: Insurance: 27 JACKSON ST#123 (978)905-5045 VWC-100-6022848 LOWELL, MA 01852 ISSUED ON: 09/20/2023 TO PERFORM THE FOLLOWING WORK: STRIP AND REROOF 9SQ 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: . f. deC.il 51-''1 • Fees Paid: $65.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Office of the Building Commissioner The Commonwealth of Ma:sach etts Sep /9 �� Board of Building Regulatio and 70. ds Massachusetts State Building C•I 4QR 0 CIPA USE LITY Building Permit Application To Construct,Repair,Reno': ( ish a Re,ised Mar 2011 One-or Two-Family Dwelling Ma ,7noti This Section For Official Use Only au 8 Building Permit Number: :J►' •. 3"/ F/ Date Applied: 9./q3,3 Building Official(Print Name) Signature Date SECTION 1:SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map&Parcel Numbers 17 Westwood Terrace Northampton,MA 01062 1.1 a Is this an accepted street?yes x no Map Number Parcel Number 13 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 O er'of Record: Northampton, MA 01062 Sage Campbell Name(Print) City,State,ZIP 17 Westwood Terrace (602)329-0511 No.and Street Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply) New Construction 0 Existing Building❑ Owner-Occupied ❑ Repairs(s) 0 Alteration(s) 0 Addition ❑ Demolition 0 Accessory Bldg.0 Number of Units Other Cl Specify: Brief Description of Proposed Work': Strip and Re-Roof 9SQ SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1.Building $4 000 1. Building Permit Fee:$ Indicate how fee is determined: 2.Electrical $ ❑Standard City/Town Application Fee ❑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. 11 eck Amount: V Cash Amount: 6.Total Project Cost: $ 4,000 0 Paid in Full 0 Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) CS-113557 10/6/24 Enda Garry License Number Expiration Date Name of CSL Holder List CSL Type(see below) U 10 Stevens St. #481 No.and Street Type Description Andover, MA 01810 U Unrestricted(Buildings up to 35,000 Cu.ft.)R Restricted 1&2 Family Dwelling City/Town,State,ZIP M Masonry RC Roofing Covering WS Window and Siding SF Solid Fuel Burning Appliances 617-908-0242 permits@greaterbostonroofing.com I Insulation Telephone Email address D Demolition 5.2 Registered Home Improvement Contractor(HIC) 191498 4/23/24 Greater Boston Roofing HIC Registration Number Expiration Date HIC Company Name or HIC Registrant Name 10 Stevens St. #481 permits©greaterbostonroofing.com No.and Street Email address Andover, MA 01810 617-908-0242 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 0 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 Enda Garry to act on my behalt',in all matters relative to work authorized by this building permit application. q Print Owner's am lectronic 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. Print Owner's or Authorized Agent's Name(Electronic Signature) ate 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. 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.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 ° .,0 Massachusetts Z ... '��. � t G ga rr j(�j-� k DEPARTMENT OF BUILDING INSPECTIONS yUt �S" .*. /' 212 Main Street • Municipal Building JtiCD N..rs Northampton, MA 01060 �Sfr �7%^` CONSTRUCTION DEBRIS AFFIDAVIT (FOR ALL DEMOLITION AND RENOVATION PROJECTS) In accordance of the provisions of MGL c 40, S.54, 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: nearest location The debris will be transported by: Name of Hauler: Republic Services Signature of Applicant: Date: ci hEA3 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations ' - Lafayette City Center 2Avenue de Lafayette, Boston,MA 02111-1750 www.mass.gov/dia Workers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): Greater Boston Roofing Address: 10 Stevens St. #481 City/State/Zip: Andover, MA 01810 Phone#:978-905-5045 Are you an employer?Check the appropriate box: Type of project(required): I I am a employer with 4. ® I am a general contractor and 1 employees(full and/or part-time).* have hired the sub-contractors b. ❑New construction 2.❑ 1 am a sole proprietor or partner- listed on the attached sheet. 7. Remodeling ship and have no employees These sub-contractors have g. El Demolition workingfor me in anycapacity. employees and have workers' ty 9. ❑Building addition [No workers' comp.insurance comp.insurance.: 10. Electrical repairs or additions required.] 5. ❑ We are a corporation and its ❑ 3.❑ 1 am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.011 Roof repairs insurance required.]t c. 152,§1(4),and we have no i 3 Other 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. Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. :Contractors 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 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 policy and job site information. Insurance Company Name: AIM Mutual Policy#or Self-ins. Lic.#. VWC-100-6022848-2021A Expiration Date: 1/24/24 Job Site Address: 17 Westwood Terrace City/State/Zip:Northampton, MA 01062 Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of 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. Be advised that 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 perjury that the information provided above is true and correct signature: Lar L Date: 9/11/23 Phone#: 617-908-0242 Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority(check one): 10Board of Health 20 Building Department 3❑City/Town Clerk 413 Electrical Inspector 51:Plumbing Inspector 6.0Other Contact Person: Phone#: 9/13/23,6:20 PM Estimate Print Preview Greater Boston Roofing Corp 09/13/2023 Greater Boston Roofing Claim Information i 10 Stevens St1f481 Andover,MA 01810 GREATER BOSTON Phone:617-744-9690 ROOFINGFax:978-418-0233 �O Company Representative Lisa Zonfrillo Phone: (978)761-9202 lisa.zonfrillo@g reaterbostonroofing.corn Sage Campbell Job:Sage Campbell Sunrun Solar 17 Westwood Terrace Northampton, MA 01062 (602)329-0511 Roofing: Shingles Section Roofing Section -Remove existing shingles down to the deck. - Renail any loose wood. If bad or rotten wood is discovered, it will be replaced and the homeowner notified of the change order. - Install 6'of ice and water shield at eaves,3'in all valleys&cheek walls, and around all protrusions. - Install synthetic underlayment to keep the roof dry. - Install drip edge along eaves and rakes edges. - Install GAF ProStart Starter Shingles along eaves and rake edges. - Install GAF Timberline HDZ Lifetime Dimensional Shingles per specifications using 1 %"roofing nails. - Install GAF Seal-A-Ridge Hip&Ridge Shingles. - Install new Snow Country ridge vent(when applicable) - Install new pipe and chimney fleshings. - Clean up all job-related debris. - Provide workmanship warranty and manufacturer transferrable LIFETIME WARRANTY. - Our Crews are licensed and insured. - Crews will maintain safety requirements at all times during the construction process. Qty Unit Materials Roofing Materials Labor Roofing Labor Permits, Dumpster and Other Costs Tax $106.11 TOTAL $4,000.00 about:blank 1/2 9/13/23,6:20 PM Estimate Print Preview -Any work related to structural deficiencies or work required to complete the project to Massachusetts Building Code not covered in this estimate will require a Change Order.Roof decking replacement cost will be billed at$90 per sheet of plywood or$5 per linear foot of ledger board. -Estimate includes single layer strip and replaces unless specifically noted in the contract.Additional preexisting layers of shingles to be removed will require a Change Order.Strip and removal for additional layers of shingles will be billed at$.25 per square foot per layer. -In the event that the customer becomes past due and is referred by Greater Boston Roofing to an outside collection agency or attorney,the customer will be responsible for the cost of the collection services at the rate of 20%of the balance due along with reasonable attorney fees and court cost incurred by Greater Boston Roofing. -Roofing,siding&exterior renovation jobs may involve major demolition and minor disturbances may occur.Greater Boston Roofing will NOT be responsible for any interior damages and advises the client to remove all wall hangings,light glass fixtures,and other fragile items prior to the start of work.Any items in the attic should be covered for protection from falling debris and dust.Greater Boston Roofing shall not be responsible for interior drywall cracks,nail pops,or any damage to the interior of the home not caused by contractor negligence.Additionally,Greater Boston Roofing will not be liable for damages to shrubbery,outside plants,landscaping,yard fumiture,decking,sprinkler systems,or driveways during the process of the work.Upon request from the client,Greater Boston Roofing will assist in covering or removing these items.Upon completion of the work,the property will be swept with a metal magnet and all debris associated with the work will be removed. Company Authorized Signature Date /1,-4%/1 Customer Signat t4 Date q-10 Customer Signature Date about:blank 2/2 DATE(MM/DDIYYYY) ACORD CERTIFICATE OF LIABILITY INSURANCE 01/24/2023 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: Ginette Preto FAX G.Preto Insurance,LLC Pa"c°.No.ExU: (781)746-7873 j vc.No): (781)746-7875 PO Box 001 A gpreto@gpretoinsurance.com ADDDRDRESS; INSURER(S)AFFORDING COVERAGE NAIC# Medfield MA 02052 INSURER A: LANDMARK AMERICAN INSURANCE COMPANY 33138 INSURED INSURER B: Greater Boston Roofing Co INSURER C: 10 Stevens St#481 INSURER D INSURER E Andover MA 01810 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 TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP W MI LIMITS LTR INSD VD POLICY NUMBER (MDD/YYYY) (MM/DDIYYYY) X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO CLAIMS-MADE _ OCCUR PREMISES Ea occTED urrence) $ 100,000 MED EXP(Any one person) $ 5,000 A LHA113684 01/25/2023 01/25/2024 PERSONAL BADVINJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY X PEa LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED AUTOS ONLY AUTOS See Other COI BODILY INJURY(Per accident) $ HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY - AUTOS ONLY (Per accident) UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE See Other COI AGGREGATE $ _ DED RETENTION$ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y IN STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? N I A See Other COI (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ It yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached 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. AUTHORIZED REPRESENTATIVE ,I )_ ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD r v COfnfnoesweaR?of ttlassactur..11. Orvttuon of Occup4t.onal Lar.nsuf. BOW d of 8 uticnn4 R.liutattrwtr and Standards C trvetan 9losegvt$CM CS t'355' Eres 10 06:202` ENDA S GARRY 4Sifw 221 CHANDLER ROAD ANDOVER MA 011110 Commissioner THE COMMONWEALTH OF MASSACHUSETTS Office of Consumer Affairs and Business Regulation 1000 Washington Street-Suite 710 Boston,Massachusetts 02118 Home Improvement Contractor Registration T/pe: Corporation Reglstralon: 191498 GREATER BOSTON ROOFING CORP Exptra:ion: 04/23/2024 10 STEVENS ST#481 ANDOVER,MA 01810 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. It found return to: TYPE:Corporation Office of Consumer Affairs and Business Regulation ReiffItEdiRli Exaltation 1000 Washington Street-Suite 710 191498 0423/2024 Boston,MA 02118 GREATER BOSTON ROOFING CORP ENOA S GARRY 27 JACKSON ST APT 123 „d„? '.140.4' UNIT 2 LOWELL.MA 01852 Undersecretary Not valid without signature ' 7 ACORE) CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 11/04/2022 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 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: Fausto Pina ACE INSURANCE SERVICES INC IA/C.No.ExtI: (508)584-5900 _ FAX (A/C, ADDRESS: aceinsuranceservices ADDRESS: GYahoo.com 675 WARREN AVE INSURER(S)AFFORDING COVERAGE NAIC# BROCKTON MA 02301 INSURER A: ACE AMERICAN INSURANCE CO 22667 INSURED INSURER B: LOJA GENERAL CONSTRUCTION INC INSURERC: INSURERD: 100 MENLO ST UNIT 1 INSURERE: BROCKTON MA 02301 _INSURER F: COVERAGES CERTIFICATE NUMBER: 832297 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 ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR _ INSDJNVD POUCY NUMBER (MM/DD/YYYY) IMM/DDIYYYYI 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 POLICY PRO- JECT 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 accident) UMBRELLA LIAB OCCUR EACH OCCURRENCE $ _ EXCESS LIAB CLAIMS-MADE N/A AGGREGATE $ DED ,RETENTION$ $ WORKERS COMPENSATION X I STATUTE I I ER AND EMPLOYERS'LIABILITY ANA OFFCERMEMBEREXC UDED?ECUTIVE N/A N/A N/A 6S62UB6R11000822 10/11/2022 10/11/2023 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/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 certi icate 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 GREATER BOSTON ROOFING CORP ACCORDANCE WITH THE POLICY PROVISIONS. 10 STEVENS ST#481 AUTHORIZED REPRESENTATIVE � �ANDOVER MA 01810 Daniel el M M.Crowley,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