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12C-024 BP-2023-1404 30BURNCOLT RD COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 12C-024-001 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-2023-1404 PERMISSION IS HEREBY GRANTED TO: Project# WINDOWS 2023 Contractor: License: Est.Cost: 4571 HOME DEPOT USA INC 106106 Const.Class: Exp.Date: 09/29/2024 Use Group: Owner: CURRAN JOHNSON BARBARA J&EVAN N Lot Size (sq.ft.) Zoning: RI/WSP Applicant: HOME DEPOT USA INC Applicant Address Phone: Insurance: 2455 PACES FERRY RD NW 860-952-41 12 WLRC50668058 ATLANTA, GA 30339 ISSUED ON: 10/10/2023 TO PERFORM THE FOLLOWING WORK: 5 REPLACEMENT WINDOWS POST THIS CARD SO IT IS VISIBLE FROM THE STREET Inspector of Plumbing Inspector of Wiring D.P.W. Building Inspector Underground: Service: Meter: Footings: Rough: Rough: House# Foundation: Final: Final: Final: Rough Frame: Gas: Fire Department Driveway Final: Fireplace/Chimney: Rough: Oil: Insulation: Smoke: Final: THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Signature: , )9 . 3)15/ Fees Paid: $40.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Office of the Building Commissioner RECEIVED 1 , The Commonwealth of Massachuse OCT Q FO Board of Building Regulations and Stan ards Massachusetts State Building Code, 780 M ICIP ITY ,.., US Building Permit Application To Construct, Repair, Re vatej rvsPF dM r 2011 c �,,MA )1060 One-or Two-Family Dwelling This Section For Official Use Only Building P rmit Number: _3P )--3 " ('I 05 Date Applied: CwL) 6 ), // 0.1D•ZOZ3 Building Official(Print Name) Signature Date SECTION 1: SITE INFORMATION 1.1 Properly Address: 1.2 Assessors Map&Parcel Numbers 30 ' .4-roG0( T ll R0.... el 1.la Is this an accepted street?yes . no Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Area(sq ft) Frontage(ft) 1.5 Building Setbacks(ft) Front Yard Side Yards Rear Yard Required Provided Required Provided Required Provided 1.6 Water Supply: (M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Public❑ Private❑ Zone: _ Outside Flood Zone? Municipal 0 On site disposal system 0 Check if yes❑ SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of Recorll r friwwee o fence 01060 Name(Print) City,State,ZIP 30 Zmfito/t giod qtr. a - 7717 b ►'IGaa.. inZeZe 3wnw;1,44... No.and Street Telephone Email Address SECTION 3: DESCRIPTION OF PROPOSED WORK2(check all that apply) New Construction 0 Existing Building 0 Owner-Occupied 0 Repairs(s) 0 Alteration(s) 0 Addition 0 Demolition 0 Accessory Bldg. 0 Number of Units Other Lilo pecify: edger.gigebseigtiot [' Bri f Description of Proposed Work': SECTION 4: ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1.Building $ i(5-7 CA 1. Building Permit Fee: $ Indicate how fee is determined: ❑ Standard City/Town Application Fee 2.Electrical $ ❑Total Project Cost' (Item 6)x multiplier x 3. Plumbing $ 2. Other Fees: $ 4.Mechanical (HVAC) $ List: 5.Mechanical (Fire ,) Suppression) $ Total All Fee$: ' ) N Check Nogb Check Amount: -v Cash Amount: 6. Total Project Cost: $ fp/ do 0 Paid in Full 0 Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) lt)C AO 6 9/Z?/ZY ecA 1;h Ct ,6 O 4 v..r License Number Expiration Date Name ofCSL Holder Utis' t 3 Be kaw• S List CSL Type(see below) No.and Street Type Description a Unrestricted(Buildings up to 35,000 cu.ft.) el it m ai d 1(01 R Restricted 1&2 Family Dwelling City own,S te,ZIP M Masonry l� Roofing Covering Window and Siding -L SF Solid Fuel Burning Appliances Y//2 pd�p9/rs&q o/f t i I Insulation Telephone Emai a cs D Demolition 5.2 Registered Home Improvement Contractor(HIC) ff#re ARPI (4i J't $ ' r(2 SIS n HIC Registration Number Expiration to HIC Company,,DiameggrHI tegistrantlia e No tree 1:nail dclress Steel/ G4 T2411' SP 45.2- /e z 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 q/eo 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 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 accurate t• the best m knowledge and understanding. ti.1.11e. C,t. 7� � to -s- 2-3 Prmt Owner's or Authorized Agent's Name(Electronic ignature) 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,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 V "�M Tort SAS S, �^ Massachusetts �? ..•.- 'e .I {KW DEPARTMENT OF BUILDING INSPECTIONS �. \ � r � 212 Main Street • Municipal Building Jti CD � Northampton, MA 01060 -sNiy 310‘.-- 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: I- g/4 . Location of Facility: q--Z Sitiker k1 uo, 2 4", ffil CT ©Go F Z The debris will be transported by: Name of Hauler: EX 11/ Afe•ual€(' �t"- Signature of Applicant: ...).-."( g Date: --Z 3 The Commonwealth of Massachusetts a Department of Industrial Accidents REST = Office of Investigations Lafayette City Center 2 Avenue 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): Home Depot USA, Inc. Address:2455 Paces Ferry Road City/State/Zip:Atlanta GA 30339 _ Phone#:1-860-952-4112 Are you an employer?Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. • I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. employees and have workers' 9. ❑Building addition [No workers' comp.insurance comp.insurance? required.] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions 3.❑ I 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.❑Roof repairs insurance required.]t c. 152, §1(4),and we have no 13 NI other Wlndow replacement employees. [No workers' comp.insurance required.] *My applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors 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: Indemnity Insurance Company of North America Policy#or Self-ins. Lic. #:WLRC50668058 Expiration Date:3/1/2024 Job Site Address: 36 Au.CA Coif ADa el City/State/Zip: flak' M 11 O/d ,e 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: -` � � Date: /D' 2� Phone#: 860-952-4112 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): 11:1Board of Health 2❑Building Department 31:City/Town Clerk 4.0 Electrical Inspector 5E:Plumbing Inspector 6.DOther Contact Person: Phone#: Go Permits, LLC 4130 105 Buttonball Lane _ Glastonbury, CT 06033 PERMITS Scott Doughman Phone: 860-952-4112 Fax: 860-430-6719 scottdoughman@gopermits.org Re: Massachusetts Solid Waste Affidavit Good day, Please find attached locations where the installers can bring their debris from the jobs. These are all Home Depot USA, Inc. locations. • 72 Shaker Road, Unit 2 Enfield, CT 06082 • 32 Scotland Boulevard Bridgewater, MA 02324 Gallant Moving & Storage • 375 Airport Drive Worcester, MA 01602 Euro-American Worldwide Logistics • 12 Linscott Road Woburn, MA 01801 Silvas Transport Inc • 50 Maria Ave Johnston, RI 02919 Vito's Express Thank you, Go Permits - -ome •epo - erma v a ue o •ro• uc s ' anu acture• •y imonton Dated: 5/30/201 C' Without Grids With Grids Style Glass Package Glazing Spacer IG U SHGC U SHGC (al!with Argon) Fact Fact 6500 awning 6500 Base ProSolar Supercept 7/8" 0.26 0.23 , o o e 0.26 0.21 • *1 easement 6500 Base ProSolar Supercept 7/8" 0.26 0.24 • • • • 0.26 0.22 • • • • transom 6500 Base ProSolar Supercept 1' 0.27 0.32 • • 0.27 0.29 • • _ )ouble-Hung 6500 Base ProSolar Supercept 7/8" 0.29 0.26 • 0.29 0.24 • • 'icture Casement (NH) 6500 Base ProSolar Supercept 7/8" 0.26 0.28 • • 0.26 0.25 • • • • 'icture 6500 Base ProSolar Supercept 7/8" 0.27 0.29 • • 0.27 0.26 • • ?Panel Slider 6500 Base ProSolar Supercept 7/8" 0.29 0.26 • 0.29 0.23 • • • 3 Panel Sliders 6500 Base(s 21 sgft) Pro Solar Supercept 7/8" 0.29 0.26 a 0.28 0.23 0 e • •500 DOORS 3arden Door(CH) 6500 Energy Star ProSolar SUN Super Spacer 1" 0.30 0.24 I •I •I •I*I 0.30 0.21 1•I •I•I • 'atio Door INOVO 6500 Base Pro Solar Super Spacer 1" 0.28 0.26 • • 0.31 0.23 • • • • •1 00 Homes located everywhere EXCEPT:Arizona,California,Idaho,Nevada,New Mexico,Oregon,Utah,and Washington. kwning(Inc Hopper) 6100 Base Pro Solar Intercept 7/8" 0.27 0.24 • • • • 0.28 0.21 • • • • ;asement 6100 Base Pro Solar Intercept 7/8" 0.27 0.24 • • • • 0.27 0.22 • • • • ' o -Hun 6100 Energy Star Pro Solar Supercept 3/4"(_Q.3d) 0.30 • 0.30 0.27 • • • mini 'icture Casement(No Hinge) 6100 Base Pro Solar Intercept 7/8" 0.27 0.28 • • 0.27 0.25 • • • • 'icture 6100 Base Pro Solar Intercept 3/4" 0.27 0.31 • • 0.27 0.28 • • ?Panel Slider 6100 Base Pro Solar Intercept 3/4" 0.30 0.28 • 0.30 0.27 • 3 Panel Slider 6100 Base Pro Solar Intercept 3/4" 0.30 0.29 • 0.30 0.27 • • 100 Doors Homes located everywhere EXCEPT:Arizona,California,Idaho,Nevada,New Mexico,Oregon,Utah,and Washington. 'atio Door INOVO 6100 Energy Star Pro Solar Super Spacer 1" I 0.28 0.26 0 0 0.28 0.23 • • • • 'atio Door NARROW FRAME 6100(PD05)Base Pro Solar Intercept 3/4" 0.28 0.30 I 0 �0.28 0.26 I •I 0 I I 6200 Homes located only in following markets:Dallas,Denver,Detroit,Phila,Northern NJ,Long Island,NY. kwning 6200 Base Pro Solar SHADE Supercept 3/4" 0.27 0.25 10 •I o • 0.26 0.23 • 0 I 0 I • .lasement 6200 Base Pro Solar SHADE Supercept 3/4" 0.26 0.18 • • • • 0.29 0.17 • • • • 'icture Casement-NH 6200 Base Pro Solar SHADE Supercept 3/4" 0.25 0.21 • • • • 0.25 0.19 • • • • 'icture Window 6200 Base Pro Solar SHADE Supercept 3/4" 0.26 0.24 • • • • 0.26 0.22 • • • • iingie Hung 6200 Base Pro Solar SHADE Supercept 3/4" 0.28 0.23 • • • • 0.28 0.21 • • • Tingle Slider 6200 Base Pro Solar SHADE Supercept 3/4" 0.28 0.23 • • • 0.28 0.21 •_ • • 3 Panel Slider 6200 Base Pro Solar SHADE Supercept 3/4" 0.28 0.23 •_• • 0.28 0.21 _ • • • •tormBreaker Plus 300VL Homes located in coastal areas. Wining SB+300VL Energy Star PS SUN/Lami Supercept 1' 0.26 0.23 • • • • 0.26 0.21 • 0 • • 3asement SB+300VL Base PS/Lami Super Spacer 1" 0.25 0.23 • • • • 0.25 0.21 • • • • )ouble Hung SB+300VL Base PS/Lami Super Spacer 1' 0.29 0.25 • • • • 0.29 0.23 • • • • hider SB+300VL Base PSI Lami Intercept 1" 0.29 0.25 • • • • 0.29 0.23 • • • • 'atio Door SB+300VL ETC 366 PS Shade/Lami Super Spacer 1" 0.30 0.19 • • • • No Grids Allowed 3arden Door(CH) SB+300VL Base PS/Lami Super Spacer 1" 0.30 0.28 • • 0.30 0.25 1• • •I • Dots indicate Energy Star certified for that zone Please Note: Simonton Windows may substitute East&West windows given the requirements of each order. WINDOW SPECIFICATION SHEET - Spec.Sheet#: F37705925 Sheet: 1 of 1 Customer: Barbara Johnson Job#:F37705925 Consultant: Chad Minton Date: 09/22/2023 New Window _ Hinge Locations Existing Window Measurements Grids Product Options Labor Options From outside, Left to Right Bays,Bows Location Color Rough Opening #of bars #of bars Csmnts,1 Pnl, use L,R or S Glass Misc Items Hardware Code Screens For doors use c7 = m 0 m Mull "S"=stationary or an o -i5 r v rL E m o N W o N "X"=operating w Style Wraps m ° m C7 o m 8 d `= 8 ., `o I Room Floor Code (Y/N) Style Code Series Code E _ ui U a > x > x STD,White, GlassPack: WRAP,LSR 1 BED 1st DH- Y DH 6100 WH WH 36 45 81 Standard ALDER STD,White, GlassPack: WRAP,LSR 2 BED 1st DH- Y OH 6100 WH WH 36 45 81 Standard ALDER STD,White, GlassPack: WRAP,LSR 3 LIV 1st DH- Y OH 6100 WH WH 36 45 81 Standard ALDER STD,White, GlassPack: WRAP,LSR 4 KITCH 1st DH- Y DH 6100 WH WH 32 36 68 Standard ALDER STD,White, GlassPack: WRAP,LSR 5 KITCH 1st DH- Y DH 6100 WH WH 36 45 81 Standard ALDER SPECIAL CONSIDERATIONS: 1:White,2:White,3:White,4:White,5:White Wrap Color interior Casing Type Bay or Bow window: Seatboard material(vinyl only-Birch or Oak) Bay Project Angle(30 or 45) Bay Ranker Type(DH,SH,or Csmnt) Top of window to soffit(inches) If tied to soffit,color of soffit material I have reviewed and agree with all the job specifications above and the Construct Roof(Yes or No)' Special Terms and Conditions on the following page Garden Window: Seatboard Material(vinyl only-White Pionite,Birch or Oak) Home Improvement Agreement: Page 1 Home Depot License #'s -For the most current listing visit www.Homedepot.com/LicenseNumbers MA: 107774, 112785 Chad Minton Salesperson Name Registration#(Req. in CA,CT,ME,MD,MI,NJ,DC) Home Depot U.S.A.,Inc.("Home Depot") or Authorized Service Provider named below will furnish, install and/or service the equipment listed below at the price, terms and conditions as outlined on this form. 1. Service Provider Contact Information The Home Depot The Home Depot Service Provider Contact Name Service Provider Company Name (203) 265-7037 customercancellationnortheast@hom MA: 107774, 112785 I Phone# Miiac1 eider Email Address Service Provider License#(s) 2. Customer Information 'Johnson Barbara I New England West F37705925 Customer Last Name Customer First Name Store#/Branch Name Customer Lead/PO# 30 Burncolt Road Florence MA I 01062 Customer Address City State Zip (413) 259-7727 barbarajohnson202@gmail.com Home Phone# Work Phone# Cell Phone# Customer Email Address 3.NOTICE OF RIGHT TO CANCEL YOU MAY CANCEL THIS AGREEMENT WITHOUT PENALTY OR OBLIGATION BY CONTACTING THE SERVICE PROVIDER OR STORE DIRECTLY; EMAILING SERVICE PROVIDER AT: customercancellationnortheast@homedepot.com OR DELIVERING WRITTEN NOTICE TO HOME DEPOT AT: 1070 N. Farms Road, Unit 3 Wallingford Wallingford CT 1 [06492 Address , City State Zip BY MIDNIGHT ON THE THIRD BUSINESS DAY AFTER SIGNING, UNLESS THE STATE SUPPLEMENT PROVIDES A DIFFERENT CANCELLATION PERIOD. THE STATE SUPPLEMENT CONTAINS A FORM TO USE IF ONE IS SPECIFICALLY PRESCRIBED BY LAW IN YOUR STATE. YOUR PAYMENT(S) WILL BE RETURNED WITHIN TEN (10) BUSINESS DAYS AFTER HOME DEPOT'S RECEIPT OF YOUR NOTICE. YOU MUST MAKE AVAILABLE FOR PICKUP BY HOME DEPOT OR SERVICE PROVIDER, AT YOUR SERVICE ADDRESS, AND IN SUBSTANTIALLY THE SAME CONDITION AS WHEN DELIVERED, ANY MERCHANDISE OR MATERIALS DELIVERED TO YOU. OR YOU MAY CONTACT HOME DEPOT FOR INSTRUCTIONS REGARDING RETURN SHIPMENT AT HOME DEPOT'S EXPENSE. THE LAW REQUIRES THAT THE HOME DEPOT GIVE YOU A NOTICE EXPLAINING YOUR RIGHT TO CANCEL. PLEASE SIGN BELOW TO ACKNOWLEDGE THAT YOU HAVE BEEN GIVEN ORAL AND WRITTEN NOTICE OF YO R RIGHT TO CANCEL. Acknowledged by: L---l� 09/22/2023 Custom Signature Date 460 Standard Form HIA(21 Jul.21)(E) Generated Date n Q/?9/9 0 23 Lead/PO# F 3 7 7 059 2 5 V 0.1.12 ` 1 Home Improvement Agreement: Page 2 4. Description of Work to be Performed A detailed description of the work to be performed is included in the paragraph entitled Scope of Work, Specification, Customer Summary Sheet, Quote Form, Estimate, Invoice or Measure which is included in this Agreement. 5. Anticipated Delivery Date/Installation Schedule Approximate Start Date: 03/20/2024 Approximate Finish Date: 04/19/2024 All dates are approximate and subject to change based on unforeseen events including inclement weather, permitting delays, and delays in confirming insurance coverage of Your claim for any repair, if applicable. 6. Electronic Records Authorization You are entitled to a paper copy of this Agreement if you choose. If you consent to an e-mailed copy, your consent applies to this Agreement and all subsequent documents and written communications related to this Agreement. By contacting your Service Provider,you may update your email address,withdraw your consent,or obtain a paper copy of the Agreement or related documents at no charge. By providing your consent and verifying your email address above, you confirm that you have access to a computer that can receive and open emails and PDF documents. 7. Contract Price and Payment Schedule Payment of the Contract Price is due upon signing unless a different payment schedule is required by law, specified below or in a payment addendum. Contract Price: $ 4571.40 Includes all applicable taxes. Excludes finance charges.* Sales Tax: $ 0.00 (If applicable, total amount of taxes included in Contract Price) ".1Iaxiiniii,i deposit ONLY applicable in 1111), IsLI, ME (33%), NJ, WI(99%) Deposit % 25.0 Deposit Amount $ 1142.85 Remaining Balance $ 1__ 428.55 8. Finance Charges Any interest payments or other finance charges will be determined by Customer's separate cardholder or loan agreement, to which Home Depot is NOT a party, and will be in addition to Customer's payment under this Agreement. Customer is subject to the terms and conditions of the cardholder or loan agreement, as applicable. No funds should be made payable to Service Provider; however, Service Provider may collect Customer's payments , made payable to Home Depot. 9. Acceptance and Authorization By signing below, you authorize Home Depot to: (a) arrange for Service Provider to perform any Services or (b) order and arrange for the delivery of special order merchandise, including special order merchandise that may be custom made, as specified in this Agreement. Do not sign if blank or incomplete. (Service Provider's or permitting information may need to be provided to You later.)By signing, you acknowledge that: (i)You have read,understand, and accept this Agreement in its entirety, including the General Conditions and State Supplement, if any; (ii) You are receiving a complete copy of this Agreement; (iii) all rights and interests under this Agreement are solely vested in the person listed as "Customer" above; and (iv) Electronic signatures will be deemed originals for all purposes. X / 09/22/2023 Customer's Sign e Date X /s/The Home Depot 09/22/2023 The Home Depot Digital Signature Date For questions related to your installation, contact Service Provider at (203) For any other concerns, contact The Home Depot at 1-800-466-3337 1b5 iu. ' 460 Standard Form HIA(21 Jul.21)(E) Generated Date 00/27/2023 Lead/PO# C 37705925 v 0.1.12 Scope of Work Johnson Barbara New England West F37705925 Customer Last Name Customer First Name Store #/Branch Name Lead # Job #: (Internal Products: Spec Sheet(s)#: Project Amount Reference) F37705925 Windows Entry Doors F37705925 4571.40 Windows Entry Doors Windows Entry Doors Windows Entry Doors Windows Entry Doors Sales Tax 0.00 Total Contract Amount 4571'40 Notes: Warranty: The warranty on the work identified above is listed in the General Terms and Conditions, or if applicable, specified in the following documents: Simonton 6100 Warranty Name(s): 460 Standard Fc mHlA(21Jul.21)(E) Generated Date 09/27)2023 Lead/PO# F37705925 v 0.1.12 �` The Home Depot General Terms & Conditions 1. DEFINITIONS: "Agreement" means (I) the Home Improvement Agreement between You and Home Depot, (II) the following listed documents, and (III) any documents referenced in or attached to any of the following listed documents: (a) any Change Orders; (b) the State Supplement, if any; (c) these General Terms and Conditions ("General Conditions"); (d) extended installation warranty documents, if any; and (e) the Scope of Work. "Defect" means any Services that are found to be non-compliant with manufacturer's installation instructions. "Home" means the real property, fixtures and any physical improvements where the Services are performed. "Services" means(i)the delivery and furnishing of goods, equipment, materials, and hardware; and (ii)any related labor and services, including without limitation, construction, consultation, fabrication, erection, installation, inspection, maintenance,repair, and testing. "Scope of Work" means a detailed description of work or Services to be performed, including, but not limited to, any quotes, schedules, invoices, specification sheets, proposals, confirmation emails or otherwise. "Service Provider" means an independent contractor, authorized by Home Depot, and its employees, agents, and subcontractors. "Work Area" means any property, buildings, or structures necessary for the staging, temporary storing and performance of the Services. "You"/"Your" means the customer identified in the Agreement 2. HOME DEPOT'S RESPONSIBILITIES: Home Depot or Service Provider will complete the Services in a workmanlike manner and in accordance with applicable law without causing damage to Your Home,provided, however, that Home Depot or Service Provider will not start or continue with any Services upon discovery of any condition at Your Home that Home Depot or Service Provider deems in its sole discretion to be hazardous, unsafe or, materially changes the Scope of Work. Unless specifically contracted to do so, neither Home Depot nor Service Provider is obligated to repair such pre-existing hazardous or unsafe conditions. 3. ASSIGNMENT/SUBCONTRACTING: Home Depot and Service Provider may assign this Agreement, or any right herein, or any monies due or to become due hereunder, and may delegate or subcontract any obligations or Services hereunder without Your consent. This Agreement will not be assigned by You without first receiving Home Depot's written consent, which may be denied in Home Depot's sole discretion. 4. YOUR RESPONSIBILITIES: (a)Payment:You agree to pay Home Depot in full for the Services pursuant to the terms of this Agreement. (b) Safe Access: You agree to provide Home Depot and Service Provider Safe Access to Your Home. Safe Access means safe and complete access to the Work Area, including,without limitation: (1) obtaining in advance of the Services consent,permission, or relief from any covenants,easements,restrictions,or other legal encumbrances affecting the Work Area; (2) providing the location of utilities, whether underground, concealed, overhead or visible, to Home Depot or Service Provider; (3)removing from the Work Area physical impediments, hazards, and building code or zoning violations that affect directly or indirectly the Work Area; (4) removing unsafe working conditions and hazardous materials, including environmental hazards, from the Work Area; (5)providing sanitary facilities to Home Depot or Service Provider convenient to the Work Area(or, alternatively,paying for the rental costs of such facilities);(6)providing all utilities,including without limitation, power,water,ventilation and climate control,in and for the Work Area; (7)removing from and protecting against minors, pets, guests and visitors in the Work Area; (8) keeping permits, if required, visible at all times; (9) disengaging, suspending or terminating any security systems protecting the Work Area; (10)providing adequate temporary storage space as needed for Home Depot's or Service Provider's performance of the Services; and(11) not interfering, impeding, impacting or otherwise disrupting the Work Area at any time during Home Depot's or Service Provider's performance of the Services. (c)No Performance: Services are to be performed by Home Depot or Service Provider. If You attempt to perform or assist with the Services in any way, You assume all risk for property damage and for injury to Yourself and others. 460 Standard Rem H1A(21 Jul.21)(E) Generated Date 0q/27]2073 Lead/PO# Fg7705g25 v 0.1.12 N The Home Depot General Terms & Conditions 5. MODIFICATIONS AND CHANGE ORDERS: Without invalidating this Agreement, You may authorize Home Depot or Service Provider to perform Services beyond the scope of the Agreement("Change Order").A Change Order will be issued by Home Depot or Service Provider on behalf of Home Depot, which You may accept by signing.Upon Your signing of the Change Order,it will become part of this Agreement, subject to all of the terms of the Agreement. Change Order may also result from Home Depot or Service Provider encountering conditions at the Work Area that impact, impede or otherwise interfere with the performance of the Services, requiring an increase in cost,time, or both. Following the discovery of any conditions that impact, impede or otherwise cause the Work Area not to have Safe Access, Home Depot may immediately ask for a Change Order or discontinue the Services without further obligation to You.Home Depot may also ask for a change order in the event of errors or omissions in measurements or quantities used to determine the Contract Price. If You decline a Change Order request, You or Home Depot may terminate this Agreement. 6. TITLE AND RISK OF LOSS: The title to and risk of loss for any materials or goods provided to You that originate from Home Depot will pass to You when paid in full by(1)You or(2)the Service Provider as part of the Services. Title to any other materials or goods provided by Service Provider will pass to You upon completion of the Services. 7. WARRANTY LIMITATION ON WARRANTIES AND DAMAGES: (a) Warranty: Unless otherwise stated in the Agreement, Home Depot warrants for 1 year from the completion date (the "Warranty Period") that all Services will: (i) be performed with good workmanship and (ii) conform to the requirements of the Agreement. During the Warranty Period and within a reasonable time after receiving notice from You of a warranty claim, Home Depot may, at its sole discretion (I) correct or replace each Defect, (II) authorize the correction or replacement of each Defect; or (III) remove each Defect and refund all or a proportional amount of the Contract Price thereof to You;provided, however, that all warranties are voided if(1) anyone other than Home Depot or Service Provider performs work upon or otherwise modifies any materials or Services provided under this Agreement; or (2) You fail to pay Home Depot in full as provided in this Agreement. Any warrantable corrections, replacements or repairs made in accordance with this Agreement will not extend the Warranty Period. (b) Limitation on Warranties: THE WARRANTIES PROVIDED IN THIS AGREEMENT ARE STRICTLY LIMITED TO THE FOREGOING EXPRESS WARRANTIES CONTAINED IN THIS PARAGRAPH IN THE WARRANTY SECTION OF THE AGREEMENT, IF ANY. YOU ACKNOWLEDGE AND AGREE THAT NO OTHER WARRANTIES ARE MADE OR GIVEN BY HOME DEPOT OR SERVICE PROVIDER,INCLUDING ANY WARRANTY FOR FITNESS OF PURPOSE, WARRANTY OF MERCHANTABILITY,OR ANY OTHER ORAL,EXPRESS OR IMPLIED WARRANTIES. HOME DEPOT'S EXPRESS WARRANTIES ARE VOIDED FOR ANY DEFECT CAUSED BY ABUSE, MISUSE, NEGLECT, ACTS OF GOD, LACK OF PRESCRIBED OR STANDARD MAINTENANCE, OR IMPROPER CARE/CLEANING. ANY MANUFACTURER'S WARRANTIES PROVIDED FOR GOODS, MATERIALS, OR EQUIPMENT WILL BE PASSED THROUGH BY HOME DEPOT TO YOU, AND YOU AGREE TO LOOK SOLELY TO SUCH MANUFACTURER FOR REMEDY OF ANY DEFECT IN SUCH GOODS, MATERIALS, AND EQUIPMENT. HOME DEPOT MAY ASSIST YOU WITH WARRANTY CLAIMS AGAINST MANUFACTURERS. (c)Limitation on Damages.Home Depot will not be liable to YOU for indirect, incidental, special, punitive or consequential damages RESULTING FROM PERFORMANCE OF THE SERVICES, including, BUT NOT LIMITED TO, damages for lost opportunities, OR lost profits. 8. TERMINATION: This Agreement may be terminated by Home Depot for its convenience, and by either party for cause if the other party fails to correct a material breach within ten (10)days after receiving notice from the non-breaching party identifying the breach.In the event Home Depot terminates this Agreement because You fail to provide Safe Access to perform the Services, or if either party terminates the Agreement because You decline a Change Order request resulting from unforeseen, hazardous, or unsafe conditions or conditions that materially changes the Scope of Work,then You will pay Home Depot for Services provided through the date of termination plus any costs or expenses incurred by Home Depot or Service Provider as a result of the termination. 460 Standard Fann HIA(21 Jul.21)(E) Generated Date 09/22/7073 Lead/PO# F37705925 v 0112 The Home Depot General Terms & Conditions 9. CHOICE OF LAW; SEVERABILITY: This Agreement will be governed by and interpreted in accordance with the laws of the State where the Project is physically located. The parties intend for the terms and conditions in the Agreement to be complementary, consistent, and enforceable under applicable laws. In the event any term or condition in the Agreement violates applicable law, such term or condition will be severed from the Agreement, but only to the extent necessary to avoid such violation, without invalidating any other terms and conditions of the Agreement. 10. ENTIRE AGREEMENT: This Agreement is the final, integrated, and exclusive expression of the parties' understanding, which supersedes all prior offers, orders, understandings, representations, proposals, confirmations, and negotiations between the parties, whether oral or written. No course of dealing, usage of trade, course of performance, course of conduct, or any other evidence of additional or different terms will be admissible to contradict or vary any term in the Agreement. 11. SECURITY INTERESTS: LIENS: If You make all payments as required under this Agreement, no security interest will be placed against Your property by Home Depot. If a security interest is placed on Your property, it creates a lien, mortgage, or other claim against Your property to secure payment and may cause a loss of Your property if You fail to pay as requested. After paying on any completed phase of the Services and before making any further payments, You should request from Home Depot or Service Provider a signed, unconditional release from, or waiver of, any right to place any claim against Your property applicable to the work then completed. You may ask an attorney about Your rights to discharge security interests. 12. RETURNS: Custom order merchandise (i.e., goods that are custom made, uniquely altered, colormatched, shaped,sized,or otherwise uniquely designed or fitted to the requirements of a particular space)is non-returnable, and its Contract Price cannot be refunded unless Home Depot or Service Provider(1) incorrectly ordered item, or(2) damaged item beyond repair. Special or custom order merchandise may be returned, and a refund for all or part of the Contract Price provided, in the discretion of Home Depot. Please contact The Home Depot for additional details concerning returns. 13. AGREEMENT/SERVICE ORDER COMMUNICATION PREFERENCES: You can visit www.homedepot.com > In-Store Special Orders at any time to access Your account for the following: (1) Update Your Agreement/ Service Order Communication Preferences(email,text,Auto Call);(2)Contact Home Depot for order assistance; (3) View latest order status; or (4) Take action to schedule pickup for Your Service Orders. To stop any of the following communications You may visit www.homedepot.com > In-Store Special Orders to access Your account to update Your Agreement/Service Order Communication Preferences, contact The Home Depot, and take action on orders. If You signed up to receive updates about Your Agreement/Service Order(s) via: (a) Text Message Communications, You may receive multiple messages per order (including current and future orders) via automated technology to the mobile phone number You provided. The total number of messages received depends on the number of orders placed and order activity. Standard message and data rates apply. Not all carriers covered. You can text STOP to 97710 to stop (You will be sent a confirmation message). Call 1-877-467-2581 or 1-800-466-3337 for help; (b) Electronic voice communications (Auto Call), You may receive multiple pre-recorded phone calls per order (including current and future orders) via automated technology to the phone number You provided. The total number of calls received depends on the number of orders placed and order activity. You can press 9 during a call to opt out or call 800-HOME-DEPOT for help; or (c) Email Communications, You may receive multiple Emails per order(including current and future orders) via automated technology to the Email address You provided. The total number of Emails received depends on the number of orders placed and order activity. 14. LEAD PAINT:Homes built prior to 1978 may require additional testing to determine if lead paint is present,and additional precautions if lead paint is present. You will be informed by Your Service Provider of any additional costs resulting from lead paint requirements prior to performing the Work. For additional information, visit www.epa.gov/lead/renovation-repair-and-painting-program. 460 Standard Fain HIA(2I Jul.21)(E) Generated Date 09/29/7023 Lead/PO# F37705925 ° 0.1.12 Go Permits, LLC 105 Buttonball Lane CPO 1111 Glastonbury, CT 06033 ,( PERMITS ', Scott Doughman Phone: 860-952-4112 Fax: 860-430-6719 „;\\*414440.....000) scottdoughman@gopermits.org Re: Building Permit Application - Licenses Good day, Please find attached permit application, licenses and supporting documents. Home Depot USA, Inc. sold the job and is the G.C. HIC 112785 Exp. 4/22/2025. Workers' Comp: Indemnity Insurance Company of North America Policy: WLRC50668058 Expires 3/1/2024 Eugeniu Ciubotaru of Exterior Remodeling is the sub-contractor. CSSL-106106 Exp. 9/29/2024 / HIC 187666 Exp. 5/9/2025 Workers Comp: Associated Employers Ins. Policy WCC-500-5028443-2023A Exp. 1/25/24 All licenses and insurances are attached. Once the permit is ready: • Please fax or e-mail a copy of the permit and receipt to the below address and mail the original to the homeowner: Fax: 860-430-6719 Email: permits@gopermits.org • If you unable to mail the permit to the homeowner please send to the below address and we will ensure the permit is at the home posted at the time of installation: Go Permits, LLC 105 Buttonball Lane Glastonbury, CT 06033 If we are required to pick up the permit in at the building department, please call 860-952- 4112 once it's ready and we will come to get it. Thank you, Go Permits AC Rd CERTIFICATE OF LIABILITY INSURANCE DATE NINCOYYYY, �..� ar21.ri2 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 POUCIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURERS), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: N the certificate holder Is an ADDITIONAL INSURED,the po5cypes)must have ADDITIONAL INSURED provisions or he endorsed. N SUBROGATION IS WANED,suhhect to the temp and conditions of the policy,certain policies mey require en endorsement A statement on this certificate does not confer rights to the certificate holder In tleu of such endorsementls). PRODUCEII CONTACT MARSH USA hC P TWO ALLIANCE CENTER P44H0H ONE I FAX bin FP LA/C.Vol: 3560 LENOX ROAD,SUITE 2411E E ASIONIESI ATUWTA.GA 30326 INSURERS)AFFORDING COVERAGE RA1C II 0410164206411aImaG,AW.,22.25 OWNER A:Old R4putlitIriu*u a Co 24147 IMMURED T)!E Hg1E DEPOT.INC. MSDNER S:IndMlwllt to CD Of Nor tI AMMO 13575 HOME DEPOT USA,INC. 00100 011 C:ACE Amnon,Maitre.Comex ,22667 2455 PACES FERRY ROAD INSURER D BUILDING C-20 ATLANTA GA 30339 NS►MERE: _INSURER F COVERAGES CERTIFICATE NUMBER: AT1.405072225.15 REVISION NUMBER: 7 THIS IS TO CERTIFY THAT THE POLICES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDIT1014 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 CLAMS. LTMR TYPE Of NIEWSOMCE MD WVD POLCY RUINER d1iinO117Yt11fliSCINYTYTI UNITS A X commanc4LOWNENN.UAea.rn' waZY31664E Olt 1,2022 0341112025 EACH OCCURRENCE 1 1,OECD00 +CLAIMS-MADE X OCCUR PREMISES lE.aT'-CWrancsi i 1D00.000 X SR$1 0D5 CO3 MED ESP{Any ono preen' i Fin lElEO _ PERSONAL S ADV INJURY f 1,0:0000 GEM.AGGREGATE WAIT APPLIES PEA. GENERAL AGGREGATE ,i 2,020,000 X PC.ICY C 0LOC PFIODUCT5-COMPFOPAGG $ 2,000,000 OTHER I A AUTDYOSLEIItAaILITY MWTB316649 01121,12022 33+10112':25 WARPED SINGLE LIMIT s 1,1300000 1 X ANY AUTO BODILY INJURY(PIN parson) F —y OWNED SCHEDULED SELF INSURED AUTO PHY DIE BODILY INJURY(Par aot100nty I �{AUTOS eiFIED ONLY AUTOSPROPERTY DAMAGE _ AUTOS ONLY — AUTOS MN ,i� m Sarm i 1 A IISiRELLA LIMB H uR MWZX 316647 O)0 2022 C311)1l2025 EACH OCCURRENCE $ X EXCESS U►E 10,OfA 000 CLANS-MADE AGGREGATE i 10:E20,000 DEo I I RETENTION i t ..B NIORKERS COMPENSATOR SCFC5D66819EE iW1) (DAi 2UZ$ 63912124 x I PER I I OTM- AMDEaPLOYERirUYAJTY STATUTE ER 8153IYT) 0341/7323 03411.21724 5,M0000 AWYP OPRETCR+PARTNER EXECUTIVE E L EACH ACCIDENT $ OFFICER:E�REXCLUDEDT SUEEj lirerYry le NM E L.DIsF ast•EA EMPLOYEE i 5.000900 If y�.�o&o m*21be u11du DESCFUF''TEON OF OPERATIONS Neon GOnatJld co*Mond Psge E L.DISEASE-POLICY LAW 5 5;000.000 I If I f DESCRIPTION OF OPERATIONS:LOCATIONS/VESICLES(ACORD 11M.Aem auW IYmut,StlMAA.,asay ea a1YNNlad I men awe N wmagalO) EVIDENCE OF FSURANCE CERTIFICATE HOLDER CANCELLATION HOME DEPOT USA.NC SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 2466 PACES FERRY ROAD BUILDING C-20 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ATLANTA.GA 30339 ACCORDANCE MTh THE POLICY PROVISIONS. - AUTHORIZED REPRESENTATIVE I -714vra 74fS1�' -/ACC. C 1455-2016 ACORD CORPORATION. AN rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marts of ACORD AdeNCY CUSTOMER lb: CN 10164206g LOC t1: Atlanta — e ACORD ADDITIONAL REMARKS SCHEDULE Page 2 of 3 AGENCY LAMMED MBURED USA.INS THE HCAIE DEPOT.INC HOME DEPOT S A.In: Pout x NUMBER 2455 PACES PERRY Fu'JAD C>t.ALDING C-23 ATLANTA G4 36339 CARRIER NAIL COME EFFECTIVE DATE ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER. 25 FORM TITLE. Certificate o1 Liability InSufante 'Porkers CcrrFcut,m Cairuec. Caner Saf habra Cas:ah Civvaton. Policy Malty-LUS018089A.AMAZFL.0 A,ILKS,KYLAMSJAO.NC,t ,NIAND.CKSC,SD.TN WOW WYi Etkca.e Cate.3331.723 Espriton Dst 314)1 cM24 IELI Let$50x X0 Cantor Safety halms:Cataty Coravakr. Pdcy Nwrbar SPt:00%3SIt iCJ&OR,W.A;ii Mare e Dot 23,312023 Espraaon Dew Y]1224 ELILint s56x SIR fl,Gtt.C60 Caen ACE Amercan r Bice Cminany Pycy N.ntr'NCUC5068113S5 3SI I;GA MI NY OH in Eftecase Cat:Il/a1.2023 Etpraaon Cat 31^21i2t24 iELI tint$4,00C,000 SIR$1,Dx;X0 SIR IGA7-s7540x Garner I4 rr*fay Iresjan:a Ca°PtrY of AAA Moro Pricy Waiter'MR C50668 I58 MI.CO,CT DCDEMI01f,W►QIAIE.IN.NI,NJRY,PARI.YTl Marti Cs*031e12023 Eaprson Oars:0Y3taC24 EL(Lint 550x.XXt Tk Enpgers 11S hdert eta Crne Zurcn Mm an rnurmce Carta-re PalcslAtire*,NSL1138319(7lII Effector Date 334012023 Esprabn Dot 5.1+31i2021 iELJ Let VOX.3QO SIR SSREIDECO ACORD 101(200001) 0 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD THE COMMONWEALTH OF MASSACHUSETTS Office of Consumer Affairs anq Business Regulation 1000 Washingtqiyljruat-Suite 710 Bosto ,•Massachus4ttts_1;118 Home um. • a• traCB r_.o9istration r ; J ==f_,,,_ 17 ; Type: Corporation ViEf zrT 1=2= .•„Ai Winn: 112785 HOME OEYO1 USA INC. to 1"®lion' 04122r2025 P 0 BOX 105451 �. .� ATTN: LICENSE MGMT TEAM � 7 ATL.ANTA,GA 30348 Update Addrese and Return Card. THE COMMONWEALTH OF MASSACHUSETTS OM.ce of Consumer ANa re a Business Regulation RegieLaati n valid for MdIvlduai um,only before the HOME IMPROVEMEACONTRAC TON esplrarion date. lr tound return log ���� ��}y��P��E�� Qrp6rAWt1 Oftce of Consumer Affairs and business Regulation t1PY[s1(aY1t11 0 1000 Washington Street•Sulte 710 1I�t,?tI +.i-,nua2r tp swam,MA 021111 HOME PI:POT USA'OW :� 'i e C THR1NEYA HOWE i 2465 PACES FERRY RE ATIANTA GA 90356 , ttndrtraetretary Not vaNd without signature ,4cc)Ro CERTIFICATE OF LIABILITY INSURANCE DATE 1/312023 �.►-- 31/2 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 INSURERISI,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, stiNect 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 endors mint(s). PRODUCER :pf1 ACT Deborah Merino Canary ebmstrom insurance Agency dPHONE AAICE too Ewa.(413)750-9022 I CAC,Not(413+786-7004 868 Springfield Street Feeding ICUs,MA 01030 1-21261,dmarinoreanaryblomstrom.com N9URE R131 AFFORONO COVEMGE NAIL C INSURER A.NGM Insurance Co. 14788 INSW1EU N,c�IRr5A-Arbella Protection Insurance Company 41360 Exterior Remodeling Group Inc. NSUREstc AIM Mutual Insurance Co. 23 B¢nham St N6Cgp Springfield,MA 01109 RI',y,IRI'R r NSUNIR P 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 ALA THE TERMS. EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHCAMN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INIR TYPE Or INSURANCE AOOls1n POLICY NUMBER POLICY EFF POLICY ERP LIMITS 1TR INFO MR IMIIIDONYPYI IMIi401Y1YYI A X COMMERCIAL GENERAL L.MAILETY 1,000.000 EACH Ur�GURHENL"L I CLair4S-WL1E Q OCCUR MPP3376W 7/27/2022 7/27/2023 DANA^E .RENTED 500,000 PR�MIuSrEA ciu„rrcrmr S _ „MEDEXP1 i arsora 1 10.000 � ,PERSOIIAL a AU'r IN.AARY S 1.000.000 ht AGGREGATE UMWAPI(F"'�5 PER.. GENERAL ACr.RFCATF # 2,000,000 _ PCak;YEl78 Jto'; PR.ODU,,T5-CC'.F' it'ftO 1 2,000,000 X OTHER B AUTOMOBILE LMEIETT C aBr slNrjLL..PAIT € 1,000,000 ar.•Au To 1020110392 6117/2022 8/17/2023 B IUL3INiUH' Itr d"'-,'r' _ wN EoX SCHEDULED ONLY ALTOS FOOL Y € X �Titpp CeLY X Mtirejta fPrE adds 6 LR Tr W it , UMBRELLA Ma OCCUR EACH OCCURRENCE `r EXCESS LIAR Cus1MSJAtir_ AGC.iti_Att �„ DEC ! I RETENTIONS ,€ C WORILERSCOMPEN$ATUq X ;,;lAllll! I ILHH AND EMPLOYERS'MARMOT WCC-500-5028443-2023A 1125:2023 1/2512024 500,000 ANN PROFEIE'C A PARTVERExECLITIVE E.',:.f areH AWOL4T $ yy,,;�r►-�Ea� R nNHI Eke I. DEO, Y N A 500 00B (�" Y"^^r Ea..DISEASE-EA EMPI.OI'EE,€ I 500 000 CfSURIP f ION Of OPERA!MI5,176. T t.L,..1115 ASE-Pr31GYUMiI I DESCRIPTION OF OPERATIONS!LOCATIONS r VEHICLES IACORD 101 Adorn. al Re,arts Schoduia,Am?be JamIo0 It men spool Is roquirsd? Home Depot U.S.A.Inc.is named as Additional Insured with respects to General Liability. Eugenio Ciubotaru Ls excluded from the Workers'Compensation Policy. CERTIFICATE HOLDER _CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Home Depot U.S.A. THE EXPIRATION DATE THEREOF. NOTICE WLL BE DELNERED N 455 PacesDepFerry IncI Cr11 ACCORDANCE WITH THE POLICY PROVISIONS. 2Atlanta,GA 30339 --- AUTHOIe2ED REPRESENTATIVE ACORD 25(2016/03) ©1988.2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo ate registered marks of ACORD lrfrAIR 00114)14% *MP or.tatnio 01.3co fl,.1trozdan P1401.$141,12 Lcanturo artd ttv Nrnon Stairdarlt, ti Public Safety " 0 Mass. Licensee Details Dririplr*Lic jnformation NarreUUIU8OTARU \o-ie ;Cert.(' &Ire.*Information State. MA Zit:Kerte 01109 Country United Stales License Information ,:en5e4o CSSL-106106 L cense Type Construction Supery%sor Spec art, Prole3SkO Budm Licenses Date otIastReaewal 10,112022 Issue Date 4(1212017 Epraton Date 9,29A202.4 L cense Status Active Today's Date 101142022 Secondary Lcerse Type ,Dotng Business As 'Status Change Reason bums.Rene ,L Prerequisite Information L censee TAIDTAALI,euGENtu peaten3nso Maims Of L.:ense No CSS1406106 No"Ayarawe boc,,rrents I w Commonwealth ot Massachusetts Division of Occupational Licensure Board of Building Recrlations and Standards ConstructigittipUr Specialty CSSL-106106 fy „,„ E*pires: 09/29/2024 EUGENIU ClqE30T.it 23 BENHAM fiT- SPRINGFIEL6-m T# ' 1 ,srer 114, # 14A4, vt; Le. • . e. "1-1' II• 160'4000#####11.4.011,6JI 616 Ljp.46.4.4 ), $.4,• Construction Supervisor Specialty Restricted to: CSSL-WS -Windows and Siding Failure to possess a current edition of the Massachusetts State Building Code is cause for revocation of this license. For information about this license Call (6171 727-3200 or visit www.rnass.govtdp1 Of ce of Consumer Affairs and Business Regu411011 1000 Washington Street-State 710 Boston,Massachusetts 02118 Homo 1t'prov(tdn nt Contractor Registration EXTV/I R riEbitocetAIGI,"•:f UP hti Rov40ofkr tares Office of Consumer 23 SIMON 8PH v.IAA 4r 100 F4•rywr .1 Affairs and Business �`"�""`�'`�` NON 41.1401101604,MOW Regulation . WSW :Q6Y$S1a :a MHO*001**rem Rogolohoft 'OW Q'fl/1ONVoi Ousel^SHIM 7111 r'x7EROR 1YACIt7CL1':►$•'ag61{•xP!VC IM19T MA 01111 HIC Registration Complaints 5 l►iT,u o„m ::r-. -g Not valid s 1 iikolure ,noryvevnier Registration u 187666 Registrant EXTERIOR REMODELING GROUP INC Name EUGENIU CIUBOTARU Address 23 BENHAM ST City.State Zip SPRINGFIELD MA 01109 R .� � ^Q ` � _ Expiration Date 05/09/2025 1 e Yl i. lI 1`t. (1G) -t,,(G,C, autnori iro rermits i1.c to pull pertnits using my Complaints Details No complaints found for this registrant l J LiCenSC Ti I O 6 arirJ my HIC Registration# /83 6 6 6 . n Any•^::cctions please call me at: (Li 13) 3 3 S'3?DO\ installer Jii:._.. e - t..ompany Nah.. ...__ X .e.RiP�__. aiS_______G_ItOu p