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29-446 (5) BP-2023-1474 34 ELLINGTON RD COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 29-446-001 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-2023-1474 PERMISSION IS HEREBY GRANTED TO: Project# roof 2023 Contractor: License: WILDE HSE LLC DBA SEXTON Est. Cost: 11475 ROOFING 106265 Const.Class: Exp.Date: 03/08/2027 SCHLOESSER WOLFGANG L & MARITA Use Group: Owner: TRUSTEES Lot Size (sq.ft.) Zoning: FFR/WSP Applicant: WILDE HSE LLC DBA SEXTON ROOFING Applicant Address Phone: Insurance: 45 OLANDER DR 315-569-7761 6HUB0W551 13923 NORTHAMPTON, MA 01060 ISSUED ON: 10/20/2023 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• , ,'• Q1-' 1 • ! ' f Fees Paid: $40.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Office of the Building Commissioner The Commonwealth of Massachuy ACT �0 Board of Building Regulations and StT 9�O C OR rr�t :C )• Massachusetts State Building Code, 780gry U�� US Building Permit Application To Construct,Repair,Renovate Or ���� R ised ar 2011 • One-or Two-Family Dwelling �'4 o o�oi N, This Section For Official Use Only Buildingpermit Number: 30-).3-- I—1 79 Date Applied: l Nu,,o g-35 // id.ZD-ZO2 Building Official(Print Name) Signature Date SECTION 1:SITE INFORMATION 1.1 Property Address:34 OW 1, t k) RD.1.2 Assessors Map&Parcel Numbers t\ 0(0(9ot 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 I Private❑ Municipal 12r6n site disposal system 0 Check if yeser SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of Record: J r-- _— ame(Print) City,Stale,ZIP f,—VtkNV477)ki V\kk 0/0(0a (1/44/2C1 fN, No.and Street I Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply) New Construction 0 Existing Building Owner-Occupied Repairs(s) TrAlteration(s) ❑ Addition 0 Demolition 0 Accessory Bldg. 0 Number of Units Other 0 Specify: Brief Description of Proposed Work2.tj er n t/'E r[�c.t M I NJG 1 OAS O4- Sid►t.Y3 L-F S; (L. ' c-9. 14 c A 1 ,., l Ns7 Zt rs' g l�uI' -i S. �, — — L bl t3GIL. r I wo'► u , GLE 1 1 RUCTION e% L.Ys 4 C E4 1 id. SECTION 4:ESTIMATED CONS RUC ON COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1.Building $ /// 767 00 1. Building Permit Fee: $ Indicate how fee is determined: 2.Electrical $< ` 9 ❑Standard City/Town Application Fee ❑Total Project Cost'(Item 6)x multiplier x 3. Plumbing $ 2. Other Fees: $ 4.Mechanical (HVAC) $ List: 5. Mechanical (Fire $ Suppression) Total All Fees: $ /�l Check No.Airt 1Xheck Amount: Cash Amount: 6.Total Project Cost: $/l V. U v 0 Paid in Full 0 Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) P C_C2 -_, / / y ',1 1-k-t\ 1s l U3 1,0, License Number Expiration Date Name of CSL Holder List CSL Type(see below) K No.and Street Type Description �I v 11(C`"' _��)i ,(\i 01 b U Unrestricted(Buildings up to 35,000 cu.ft.) 1�.t� R Restricted 1&2 Family Dwelling City/Town,State,ZIP \ M Masonry RC Roofing Covering WS Window and Siding SF Solid Fuel Burning Appliances f _` 4-1 11 1 C I Insulation Telephone Email address 6i �A/Lraivtn Demolition 5.2 RegisteredHome Improvement Contr ctor(HIC) &OG J /!�D q/ioj&.s- ZXVO1 ) �� • } l�� HIC Registration Number Expiration Date HIC Company Name or HIC Registrant Name �\ Q.- Sty--7a t�q10S'c I k\C- T �)CY .and Street Email address A)L oh\ 0 / ii C3 City/Town,State,ZIP elephone SECTION 6:WORKERS' COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c. 152.§ 25C(6)) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the Issuance of the building permit. Signed Affidavit Attached? Yes No ❑ 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 `Q')1 , R� ' 11�� �f 1 J�/AICj f to act on my behalf,in all matters relative to work authorized by this building permit application. Print Owner's Name(Electronic Signature) Date SECTION 7b:OWNER'OR AUTHORIZED AGENT DECLARATION By entering my name below,I hereby attest under the pains and penalties of perjury that all of the information contained in this application is true and acc ate to the best of my knowledge and understanding. i d)�j 6)//Q _ Cci-L I /7%3 Print Owner's or Authorized Agent's Name Ironic 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. 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,fmished 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 �S�S. Massachusetts ��' L * DEPARTMENT OF BUILDING INSPECTIONS f .. `.� 212 Main Street • Municipal Building �.. - o Northampton, MA 01060 f• . `^.o 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: x4 Location of Facility: 3-Co2 AtbAitt ST •SpV2-j ,) iKA QMA The debris will be transported by: Name of Hauler:AE(.1C//6 4i(i)/A/ / (/:st Signature of Applicant:VaA/,///11 Date: The Commonwealth of Massachusetts l=? ' Rt Department of Industrial Accidents -1111..... 1 Congress Street,Suite 100 Boston, AMA 02114-2017 www mass.gov/dia ....., - Winters'Compensation insurance AMdasit:Builders/Contractors/Electricians/Plumbers. TO HE FILED WITH THE PERMI'rfist;AUTHORil't'. Annlicant Information Please Print Leeibts t Name 113usincssi anuatioa lndiv�tdual l: ��D Zj{� F j a ,!C.& Address:_, DU.A,6 . -,)(2.. City/State/Zip: one#• t/i 3 —fogy/ .%re you an enyttaer!Cheek the appropriate bo>,: Ty pe of project(required): 1.01 am a employer uith employees(full and'or part-time).• 7. 0 New construction 20 I am a role proprietor or partnership and have no employes%larkins; for me in S. O Remodeling any capacity.[Nu sorters'comp.insurance required.) 9. ❑ Demolition 3.❑I am a humour.n^r doing all rust myself.(No workers'comp.insursince morn i.)s i0 CI Building addition 4❑I am a honor nrr and mill be hiring evntracturs to conduct all work on my property. I will �7 ensue that all contra ton n L either has srorke 'cYrnpcn atrcm insurance or are sole 1 1 Electrical repairs or additions prupriet.'r,i ith no employee,_ 12.0 Plumbing repairs or additions 3 am a gcrwra1 contractor and 1 have hind the orb-cuntractun listed un the auac4101 slxri The sub-contractors base employees and has lc%utters'comp.of wars e. I3❑y'Iaof repairs 14.❑Other 6.❑11'e an:a corporation and its officer%have cxcniscd thou nght of c.tcmption pa Ati.L c.132,,1141.and u c lta c no employers.(No is urkcn'rump.insurance required.] 'Any applicant that ch cis tit a 1 must aLsu 1111 out the section belui shoo ins their renders'compensation poI&}information. Romeo%nen u ho submit tlus atlala%it urinating they are doing all u irk and then hue outside contractors must submit a new affidavit indicating such :Contractor that check thia box must attached an.additional shot shot ing the name of the sub-contractors and state u hither or not thaw entities hair employee,. tithe sub-cuntractos Lass:c rpluycgs.they must rru,rde their uorkcrs'comp policy number am an employer that is providing n'urAers'compensation insurance for my employees. Below is the policy and job site Information. Insurance Company Nance: Policy#or Self-ins.Lie.#: Expiration Date: Job Site Address3q P '�Li'V K0, City/State/Zip' Oje6g Attach a copy of the workers'compensation policy declaration page(showing the policy number an expo flan ate). `� Failure to secure coverage as required under MGL c. 152, §25A is a criminal violation punishable by a fine up to Sl.SUOAU an door one-year imprisonment,as well as civil penalties in the fomc 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 DR for insurance coverage verification. I do hereby certify under the pains and penalties 41)erjurt•that the information provided a/ ve is rue and correct ::: Al,/ ��� j Date:/ /7�- J ,i/ L , / 7 Official use only. Do not write In this area.to be completed h} till. or town official ('ity or Town: l'erntiti license a Issuing Authority(circle one): I. Board of Health 2.Building Department 3.Citylrown Clerk 4.Electrical Inspector 5. Plumbing Inspector 6.Other Contact Person: Phone#: DATE(MM/DD/YYYY) ACORO® CERTIFICATE OF LIABILITY INSURANCE 09/12/2023 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 Kathi Hutchinson NAME: ORMSBY INSURANCE AGENCY PHONE H ila Ed): (413)737-0300 FAX WC,No): -NAIL khutchinson@ormsbyins.com P 0 BOX 718 INSURER(S)AFFORDING COVERAGE NAIC Y WEST SPRINGFIELD _ MA 01090 INSURER A; TRAVELERS INDEMNITY CO OF AMERICA 25666 _ INSURED INSURER B: W ILDE HSE LLC INSURER C: INSURER D: 45 OLANDER DRIVE INSURER E: NORTHAMPTON MA 01060 INSURER F: COVERAGES CERTIFICATE NUMBER: 929774 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 POLICY EXP LTR TYPE OF INSURANCE INSD VND POLICY NUMBER JMMIDDIYYYY) (MMIDD/YYYY) LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS MADE i OCCUR DAMAGE TO RENTED PREMISES Ea occurrence) $ MED EXP(Any one person) $ _ N/A PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY E T LOC PRODUCTS-COMP/OP AGG $ OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED N/A BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY _ AUTOS ONLY (Per accident) $ UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE N/A AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION X STATUTEPER OTH- • ER AND EMPLOYERS'LIABILITY ANYPROPRIETOR/PARTNER/EXECUTIVE Y/N E.L.EACH ACCIDENT $ 1,000,000 A OFFICER/MEMBEREXCLUDED? N/A N/A N/A 6HUBOW55113923 06/01/2023 06/01/2024 1,000,000 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT S N/A DESCRIPTION OF OPERATIONS I 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- compensatioNinvestigations/. Continuation of above Named Insured:DBA SEXTON ROOFING&SIDING CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Northampton ACCORDANCE WITH THE POLICY PROVISIONS. 210 Main Street AUTHORIZED REPRESENTATIVE Northampton MA 01060 Daniel M.Cro y,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 WILDE-1 OP ID: KH ACORO CERTIFICATE OF LIABILITY INSURANCE DA09/12/2023TE Y) 09/12/2023 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 413-737-0300 : CONTACT Ormsb Insurance Agency Inc. NAME` 698 Westfield St PO Box 718 NC,No,Ext):413-737-0300 ��413-737-0617 West Springfield,MA 01090 E-MAIL Eric Dembinske ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC S INSURER A:Northfield Insurance Company INSURED HSELLC dba INSURER B:The Travelers of MA 10647 WilSexton Roofing&Siding INSURER C:Commerce Insurance Co. 34754 48 Olander Drive Northampton,MA 01060 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 SUER POLICY EFF POLICY EXP LTR TYPE OF INSURANCE DASD INVD POLICY NUMBER IMM/UD/YYYYI /MM/DD/YYYYt LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE I $ 1,000,000 CLAIMS-MADE [X OCCUR 100,000 WS556514 05/30/2023 05/30/2024 DAMAGE TO RENTED PREMISES fEa occurrence)_ _$ MED EXP(Any one person) $ 5,000 PERSONAL 8 ADV INJURY S 1,000,000 GEM_AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE S 2,000,000 X POLICY JECT LOC PRODUCTS-COMP/OP AGG 3 2,000,000 OTHER: S C AUTOMOBILE LIABILITY ( aaccident) COMBINED SINGLE LIMIT S 1,000,000 ANY AUTO L11219 06/30/2023 06/30/2024 BODILY INJURY(Per person) $ OWNED SCHEDULED — AUTOS ONLY X AUTOS BODILY INJURY(Per accident) S X HIRED X NON-OWNED PROPERTY AMAGE _ AUTOS ONLY AUTOS ONLY (Per accident4 S UMBRELLA IJAB _ OCCUR EACH OCCURRENCE S EXCESS LIAR CLAIMS-MADE AGGREGATE S DED RETENTIONS S A WORKERS COMPENSATION EOTH- AND EMPLOYERS'LIABILITY x STATUTE ER AANNYPROPRIIETOR/PARTNER/EXECUTIVE Y/N ISSUED SEPARATELY E.L.EACH ACCIDENT S OFF(Mandatory in BER EXCLUDED?NH) N/A E.L.DISEASE-EA EMPLOYEE S If yes,describe under DESCRIPTION OF OPERATIONS below E_L.DISEASE-POLICY LIMIT S DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Roofing&Siding Contractor CERTIFICATE HOLDER CANCELLATION NONE-01 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Northampton ACCORDANCE WITH THE POLICY PROVISIONS. 210 Main Street Northampton, MA 01060 AUTHORIZED REPRESENTATIVE ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD ACORD Client#: DATE CERTIFICATE OF LIABILITY INSURANCE 05/01/2023 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHT UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT:If the certificate holder is an ADDITIONAL INSURED,the 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 NAME PHONE 978 726-9830 I-INSURANCE GROUP INC (A/C,No,Ell): EMAIL gcamossalo@i-insurancegroup.net 799 GORHAM ST ADDRESS: LOWELL, MA 01852 INSURER(S)AFFORDING COVERAGE NAIL 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 ‘AND POUCY NUMBER (MM/DD/YYYY) (MM/DDIYYYY) LIMITS A GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000.00 DAMAGE TO RENTED X COMMERCIAL GENERAL LIABILITY PREMISES(Ea eminence) $ 100,000.00 EX we person) CIN AIMS-MADE IXI MEDP(Any OCCUR S 5,000.00 IMA395923A 8/25/2022 6/25/2023 PERSONAL AADV INJURY $ 1,000,000.00 GENERAL AGGREGATE $ 2,000,000.00 GFFNT AGGREGA IF I IMI I APPI TES PER: Products Completed Ops AggregoIe $ 2,000,000.00 POLICY El PROJECT II.00 B COMBINED SINGLE LIM AUTOMOBILE IJABIUTY IT (Ea accident) $ 100,000.00 ANY AUTO BODILY INJURY(Per person) $ 20,000.00 ALL OWNED —SCHEDULE 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 C UMBRELLA L.IAB OCCUR EACH OCCURRENCE EXCESS LIAR CLS-MADE AGGREGATE MI DED I RETENTION S D WORKERS COMPENSATION Y N WC STATUTORY OH I AND EMPLOYERS'LIABILITY LIMITS ER ANY PROPRIETOR/PAR I NEU/EXECUTIVE EL FACT I ACCIDENT OFFICER/MEMBER EXCLUDED? n/e $ 1,000,000.00 6HUB4N86974323 3/26/2023 3/26/2024 (Mandatory In NH) E.L DISEASE-EA EMPLOYEE $ 1,000,000.00 11 yes,describe uncle, 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 10 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/lwd/wortcers-compensatiorr/investgationsr CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE WILDE HSE,LLC EXPIRATION DATE IT IS THE CUSTOMER'S RESPONSABILITY TO INFORME ANY 45 OLANDER DR. CHANGES OR CANCELATIONS. NORTHAMPTON, MA 01060 GUILHERME CAMOSSATO 1/1 ©1988-2010 ACORD CORPORATION.All rights reserved. ACo OR CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYYY) `ram./ 05/31/2023 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT BRUNO ROZEMBARQUE POINT INSURANCE INC PHONE 617 7 FAI( (A(C No.Ez4: ( ) 83-1160 WC Nol: s-voalL ADDRESS: brunoCPOintinsure.corn 1103 COMMONWEALTH AVE INSURER(S)AFFORDING COVERAGE NAICAr BOSTON MA 022151111 INSURER A: AIM MUTUAL INS CO 33758 INSURED INSURER B E C A GENERAL CONSTRUCTION INC INSURER C: INSURER D: B OTIS ST APT 1 INSURER E: MILFORD MA 01757 INSURER F COVERAGES CERTIFICATE NUMBER: 897535 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADOTYPE OF INSURANCE D y�VJ POUCY NUMBER IMWDDIY POUCY YYY) (MMIUDDIYYYYY) UNITS LTR COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE •$ __ CLAims-MADE OCCURDAMAGE TO RENTED PREMISES(Ea occurrence) $ MED DU,(Any one person) $ N/A PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY JERO LOC PRODUCTS-COMP/OP AGG $ OTHER AUTOMOBILEUABILITY 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(JAB CLAIMS-MADE N/A AGGREGATE $ DED RETENTIONS $ WORKERS COMPENSATION X PER OTH- ERAND EMPLOYERS'UABIUTY STATUTE _. ____ ANYPROPRIETOR/PARTNERIEXECUTIVE YJN E.L.EACH ACCIDENT $ 1,000,000 A OFFICERIMEMBEREXCLUDED? NIA N/A VWC10060260282023A 02/11/2023 02/11/2024 (Mandatory In NH) EL DISEASE-EA EMPLOYEE $ 1,000,000 it yes,describe under DESCRIPTION OF OPERATIONS below EL DISEASE-POLICY LIMIT $ 1,000,000 N/A DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES IACORD 101,Additional Remarks Schedule,may be attached it 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 Wilde HSE LLC ACCORDANCE WITH THE POLICY PROVISIONS. 45 Olander Dr AUTHORIZED REPRESENTATIVE Northampton MA 01060 Daniel M. Crnwy,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 ipcode: 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 I No Prerequisite Information No Available Documents THE COMMONWEALTH OF MASSACHUSETTS Office of Consumer Affairs and Business Regulation 1000 Washington Street - Suite 710 Boston, Massachusetts 02118 Home Improvement Contractor Registration r ,,, , ""� i-f# (fi ''" =:.... t _': Type LC ., z Regstrabor 2:+547C NrkELDE KBE.LLC 4 «« Exp+ratct 04 31i:25 OVA SEXTON ROOFING&SONG _ . aS WADER DR 4 Oi , + P ORTNAMPTON..10A 03104 y i.wrt...7.*. 1.1104ats Address and Return Cs d. •TMt COIIIIOKv IALTN OF MASIAC$VSETTS Ofrtci M Csmawnsr Affairs&BusInsse Rapulanon Raplatration read for IndIYMuai use only Wore tea NONE IMPROVEMENT CONTRACTOR aspiration data. If fo.0 d mum to TYPE-:!C Oftlos of Conatewer Affairs and Buiuuss Repulaton ltnus/alba Eiultattan I 000 Waahhpton Street •Suite 710 2".4104 3G425 Boston,MA 0211$ w'U*NEC.L1.0 CIIVASEx7Of ROCSt9Oi6ONO SASS4S°LA DERE '� S'I/`—L Ste' 44 OLANJE R OR ,j,..,t '..Kr•+t•• C- fi.� .__ ffORsflAAarTOfr'fAA 0310 Unders.rr tsry Not valid without signature 10/14/23,3:08 PM 34 Ellington Rd Signed Contract.jpg WILDE HSE, LLC SEXTON ROOFING AND SIDING www.sextonroofing.com r'r�• p. 413.534.1234 Vat) i-a,,.im�� info@sextonroofing.com ��t,� ,Z,�i�■t�► 45 Olander Dr. Setting the Standard Northampton, MA 01060 MA HIC#208470 SUBMITTED TO j' 0 I i PHONE 2 22 c8 5_ 5 DATE /6 — j 3 -2.1 / .y^ ' STREET Lf L 'l 1 t c-C4 0 VI N EMAIL CITY,STATE,ZIP 4)0 Irl „t.'I 1 D t (/v Special Requirements: SEXTON ROOFING HEREBY SUBMITS SPECIFICATIONS AND ESTIMATES FOR: iv/ r A) , tG v ltrip and remove existing shingles and dispose of in proper landfill. ['I-inspect roofing deck and replace as needed @$ per sheet. v v .I- vo t,, -- To° "nstall new metal I edging to rakes and eaves of roof. Color: 1 i,)'i ice[ 5 in 0 8 in L Install ice and water shield on eaves(6'),vent stacks,in valleys, chimney,at intersecting roofs. E'1nstall synthetic roofing underlayment on remainder of roof. enstall new flanges over existing vent stacks. Llnstall starter shingles on eaves and rakes of roof. "Install IKO Architectural style roofing shingles as per manufacturers' specifications. Install new ridge vent cap over ridge vent. C-1 Reflash chimney E-Supply manufactures warranty. IB Supply SRC 10-year workmanship warranty. &Sexton Roofing shall apply for all permits. Shingle: Oa✓vi br I dit Color: /'(Ir Vej r ( S (_..'G 4C We propose hereby to furnish material and labor-/complete iin s or¢l yv�t��abo_r spe cif,Atior3, lee um of Total Due$ /) Li 7 5 1/3 Down Payment$ 6 006 (J Balance due upon completion$ Acceptance of Proposal The above prices,specifications and conditions are satisfactory and are hereby accepted. You are authorized to do the work as specified. Payment will be made as outlined above.Unpaid balances shall accrue interest at 18%per annum.Purchaser(s)will pay for all costs, expenses and reasonable �attorney'sy's fees incurred by Wilde HSE,LLC DBA Sexton Roofing&Siding to recover any sums due under this contract. • Customer Signature: ..., `� G� �'��'�' �--- Date: Authorized Signature: / i' Date: — /3 1- 3 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.All Material is guaranteed to be as specified. All work to be completed in a workmanlike manner according to standard practices. Any alteration or deviation from above specifications involving extra costs will be executed only upon written orders,and will become an extra charge over and above the estimate. DAMAGES TO BUSHES AND OTHER VEGETATION'MARKS ON HOUSE MAY BE UNAVOIDABLE AND WE ARE HELD HARMLESS. Not responsible for Water damage during construction. --), _ , -7)- 0) SU, https://drive.google.com/drive/folders/1 bMHWdomQiCOvgpw_S02u30E0yWG-kHIG 1/1