Loading...
38B-031 (4) BP-2023-1722 15 LASELL AVE COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 38B-031-001 CITY OF NORTHAMPTON Permit: Alts Renovations Repair PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) BUILDING PERMIT Permit# BP-2023-1722 PERMISSION IS HEREBY GRANTED TO: INSULATION 2023 I Alts Project# Renovations Repair 110/11/2023 Contractor: License: INSULATION AND FIREBLOCK SOLUTIONS ABA INSULATION AND Est. Cost: 2590 ENERGY SOLUTIONS INC 113737 Const.Class: Exp.Date: 06/18/2025 Use Group: Owner: DEVON MOORE, THOMAS Lot Size (sq.ft.) INSULATION AND FIREBLOCK SOLUTIONS ABA Zoning: URB Applicant: INSULATION AND ENERGY SOLUTIONS INC Applicant Address Phone: Insurance: 260 CENTRE ST UNIT B (781)204-3019 65626B6R39538423 HOLBROOK, MA 02343 ISSUED ON:12/07/2023 TO PERFORM THE FOLLOWING WORK: INSULATION/W EATH ER I Z AT I ON 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: Fees Paid: $65.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Office of the Building Commissioner tiLT )`)24 F Deppo raY�+ - , y ofon - City Northampton Building Department,::(; / ; 212 Main Street ` 7 20 INSULATION i- ` .. �` Room 100 � � Northampton, MA 01060 ;cam, �- y phpne 413-587-1240 Fax 413-587-1272; sro QJ\(j _ Y APPLICATION FOR INSULATION FOR A ONE OR TWO FAMILY DWELLING ONLY SECTION 1 -SITE INFORMATION INSULATION PERMIT i 1.1 Property Address This section to be completed by office f5 ketSSQ/ Ac;Or)u.e_ Map Lot Unit P0i4h frt p+Gh� 14/l- b t,OuO Zone Overlay District Elm St.District CS District SECTION 2-PROPERTY(OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: Name(Print) i Current Mailing Address: Telephone Signature 11�� 2.2 rA}uthorized Agent' 'f151t IC.1 4 l(�� �iCe\ . 1,11.t}-;ors. dtbc 1 ri cIct�-�CM cod E1rtpr�'a✓, /n/� �/ . I SUlu,F,0,c, Iir l� c"t•'l�. ' �QLi (LID Co1� Cf e j eiT ( cf/irC 6 1 Name din ,. Current Mailing Address: 1 {& e— /Y 7n A C?3`S • 1uti �? C .PA AA. I- 0 o U- 3z-1 i Sig Telephone SECTION 31-ESTIMATE[ CONSTRUCTION COSTS . Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building (a) Building Permit Fee 2. Electrical i (b)Estimated Total Cost of Cccstructiori from (6) 3, Plumbing Building Permit Fee 4. Mechanical(HVAC) • 4/16 5. Fire Protection 6. Total=(1 + 2+3+4+5) 1,3 590 ` AI) Check Number 0- 16 1 2 /� This Section For Official Use Only Building Permit Number: 6 P- oi 3^/7„)0- f Date Issued: Signature: ,�17 l2-7-20z3 Building Commissioner/Inspector of Buildings Date EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR) i 0 i ti 1 SECTION 4-CONST4U4TION SERVICES 8.1 Licensed ConstructioPi'. naySupervisor: Not Applicable ❑ Name of License Holder: 1 1 ,� VI0 f%.a Ca SV) ( t 1 --) ?-7 License Number 1d3 Pcil1 V a Q C f bOft LO I rd 3c Address I ' I i u 1 Expiration Date �..._, —_i•� l --..)Ca i—9i j j-- Z ) 1 Signature Telephone ` JIJ 9.Rea eid e4 ,rwvsmentContracto� -. - Not Applicable 0 ( iInc,,ilii-tivf`all Gle luk Sb)t ,0tis di% rukkffvs,0ndCIrs 511jtoi6'iriS/j O' S15 l Company Name Registration Number n,2b y !! 4 is oajcloac �t�� �� i..,� Cii r?r � f ddress s I Expiration Date • fG!' ' )�t�( = �%�� ��0LI- Telephone c�Di" I . i r SECTION 5-WORKERS I COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c 152,§25C(6)) Workers Compensation Inurance affidavit must be completed and submitted with this application.Failure to provide this affidavit will result in the denial of the issuinoe of the building permit. Signed Affidavit Attached Yes IT No Cl �`/� Brief Description of Proposed Work NOTE:TE: INS ULA TION ONLY njr 1flS llJh,�-in Cr.Itut tom i in mil) (r1 9" = c' tcP-r ,fie c41 CY' CLb''','t bQ,-hr\rCC ry 'i i I ' i i 1, i `f� as Owner/Authorized Agent he by dare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge and belief. ` I Signed u er the pains anti penaltie oftt perjury. i is Print Nam i LitAn..; CGS tip%/ �a- Signature of Ovyner/Agent e I f ( , i 1 ! Thomas Devon Moore ,as Owner of the subject property' I Insulation and Fireblock Solutions, Inc. dba Insulation and Energy Solutions, Inc. hereby authorize I' to act n my behalf in all matters relative to w rk au* rized by this building permit application. �,�.,� I I a7 23 Sign a e of Owner-� Date i I City of Northampton Massachusetts �� •N'cc� r~: DEPARTMENT OF BUILDING INSPECTIONS =: 212 Main Street ',Municipal Building il rCa llorthampton, MA 01060 Debris Disposal Affidavit In apcordance of the provisions of MGL c 40, S54, I acknowledge that as a condition of the building permit all debris rbsulting from the construction activity governed by this Building Permit shall be disposed of in a properly licensed solid waste disposal facility, as defined by MGL c 111, S 150A. I i The debris from construction work being performed at: 15 (Please print house number and street name) Is to be disposed of at: Jc (Please print name an location of facility) Or will be disposed of in a dumpster onsite rented or leased from: (Company Name and Address) 014 " `i ate iof ermit Applicanf"or Owner Date If, for any reason, the debris will not be,disposed of as indicated, the Applicant or Owner shall notify the Building Department as to the location where the debris will be disposed. 4 ± 4 l c I 1 r ` I 1 x The Commonwealth of Massachusetts n=: fl. Department of Industrial Accidents ' -iel= ! 1 Congress Street,Suite 100 _y4E_9.' ! Boston,MA 02114-2017 j� I www.mass.gov/dia Workers'Compensation Insurane Affidavit:Builders/Contractors/Electricians/Plumbers. 1 TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information I Please Print Legibly I Name (Burliness/Organization/Individual):I119.4 1.(Alan 1:41rebib1�.36iLi io'vIS Lime r Mid Cd-Curl a Oa' �it,71- /,xji�.41 ,S I�ih fit, Lf rn ' Q O Address: )U 6 ( DTI e l)1� /LC-�' l `!lI- fij) Inc, City/State/Zip: )1Y Y). I lor Oa4'4 Phone#: Si-3 j j -,--77f 7 Are you n employer"Check the appropriate box: Type of project(required): 1. am a empl4yerlwith 2 employees(full and/or part-time).* 7. 0 New construction i 2.01 am a sole F/ropciytor or partnership and have no employees working for me in 8. El Remodeling any capacity.[Nc workers'comp.insurance required.] 3.0 I am a homeowner doing all work myself.[No workers'comp.insurance required.]t 9. ❑Demolition 10 Building addition 4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. 1 will ensure that all contractors either have workers'compensation insurance or are sole 11.E Electrical repairs or additions riroprietors with 1 employees. 12.0 Plumbing repairs or additions 5.0 I am a general co4tractor and I have hired the sub-contractors listed on the attached sheet. 13.❑Roof repairs These sub-contra rs have employees and have workers'comp.insurance. , � f at 6.0 We are a corporation and its officers have exercised their right of exemption per MGL c. I4. Other frisk IK/�� 152,§1(4),and wqI have no employees.[No workers'comp.insurance required.] *Any applicant that chec box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners*bo submi 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 pr$vide their workers'comp.policy number. I am an employer thdt is providing workers'compensation insurance for my employees. Below is the policy and job site information. f Insurance Cothpany Name: iC54er , I]Ajar] IasutrC/1G gir ev- ip t . Policy#or Self-ini Lic.#: aLtrs.p 39 38(/a3 Expiration Date: b/6--/dLc Li Job Site Address: j S L cc Sic I LP ��w,_ City/State/Zip: Pa CLA-0—e k. 14 616 is a Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure]coverage as required under MGL c. 152,§25A is a criminal violation punishable by 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 viol or.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I I do hereby c. under the pains and en • s of perjury that the information provided above is true and correct Sib atuie: lit A4.t t,'t 0 ' Date: l i 7 04) Phone#: A j —9(, L -1j 5. Official use only. :Do not write in this area,to be completed by city or town official City or Town: i Permit/License# Issuing Authority(circle one): 1.Board df Health 2.Building Department 3,City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: ! i Phone#: 1 t I 1 t City of Northampton Massachusetts r tiw Y1; DEPARTMENT OF BUILDING INSPECTIONS 5 Dt a,y ,yH'c 1 212 Main Street • Municipal Building 3`J•. N Northampton, MA 01060 �h' � MANDATORY FOR HOUSES BUILT BEFORE 1945 Property Address: 15 lC Pf Qc C� L'()c/ Ut5Z-/-haic,LFte, � �/ri ; O/6tp I I, Contractor , Name: r) li1/4-(14i(A,1 Q.1, A ir-77(0 blta (%)G4i0 C cihe 1/7:stt.eiLy-1C'ek C Address: �0 C-�IA Q ,S)-r 0J2 C 6t,t0( -b6) ourc,0 City, State: 0' broA K. OgeN2, Phofe: i i ,1 _D•O'`1� 3()1 C) • 1 Property Owner Name: Di.lnal J fSY), N)(� Address: I- I. ass,e .I lon,,,I . City, State: I Ivb`( eV.X.w\3 k/1c MA- 6 j/�I ct) I,, p1-/c_t2)---^-4- rc..<, S.,c (contractor) attest and affirm that the building I intend to insulate does not have any open air (knob and tube) wiring in the spaces to be insulated and that I have provided the property owner with a copy of this affidavit. f i Contractor signature kr Date i kiDil-) i 1 i 9 r, Insulation&Fireblock Solutions,Inc.,dba Insulation&Energy Solutions,Inc Work Authorization Contract \\,::45:e...„)! Customer Name'Morn a•s l2Oon f 1cGC-e_, s Devon Mbore I Insulation&Fireblock Solutions,Inc. I dba Insulation&Energy Solutions,Inc. Street Address(not Post Office Box) 260 Centre Street Unit B 15 Lassel Avenue I Holbrook, MA 02343 579 Weeden Street Unit 1 City/Town State Zip Pawtucket, RI 02860 Northampton M I 01060 (781)-926-3030 Daytime'Phone Fvening Phone Internal Project Manager: Stephanie Calise 413-896-2687 ' Phone:(781) 204 -3019 i Email: scalisePinsulationfs.com Mailing Address(If different from above) i 1 i Home Improvement Contractor Registration FEIN 87-3321100 I MA 203851 Expires 12/02/2023 RI GC-48515 Expires 03/29/2024 The Contractor agree to I o the following work: Refer to the estimate proded by Insulation&Energy Solutions,Inc - I In additions to the listed items and product recommendations referenced on the estimate provided by Insulation&Energy Solutions, the customer agrees the following list including but not limited to; Keep children and pets away from work areas while the job is in progress,and before the work begins, remove all indoor and outdoor furniture decorations,and/or moveable objects from the work area. You may also want o temporarily store anything of value to you that is in high-traffic areas to prevent breakage and/or injury. To provide adequate clearlance and parking space for work trucks and other equipment. In addition to items men Toned above,please refer to the Informed Consent Waiver for Contract,and any additional information specific to work to be peOormed. Proposed Start and Completion Schedule-The following schedule will be secured by the contractor as the customer's agent be adhered to unless circumstances beyond the contractor's control arise. 12/8/2023 Dte when contractor will begin contracted work. 12/8/2023 Date when contracted work will be substantially completed. Total Contract Price and Payment Schedule -$2590.80 $2590.80 Due when the p Jject is complete. "Check,Money order or sh is accepted. Please make checks payable to Insulation&Energy Solutions,Inc 1 , *LATE CHARGE:Subject to applicable legislation, if any amount, including any termination liability, remains Unpaid after its due date, you will pay per diekn interest on the unpaid amount at the interest rate of 18%per annum 'i ii i 1 Subcontractors-The contractor agrees to be solely responsible for completion of the work described regardless of the actions of any third party/subcontractor!itilized by the contractor.The contractor further agrees to be solely responsible for all payments to all subcontractors for materials and labor under this agreement. Contract Acceptance-Ulpcin signing,this document becomes a binding contract under law. Unless otherwise noted within this document,the contract shall not imply that any lien or other security interest has been placed on the residence. Review the following cautions and noticEis carefully before signing this contract. • Don't be pressured into signing the contract.Take time to read and fully understand it.Ask questions if something is unclear. • Make surethe contactor has a valid Home Improvement Contractor Registration.The law requires most home improvement contractors and subcdntractors to be registered with the Director of Home Improvement Contractor Registration. You may inquire about contractor registration by writing to the Director at 10 Park Plaza, Room 5170, Boston, MA 02116 or by calling 617-973-8787 or 888-283-3757. •Your security and the security of our technicians is paramount to the success of any project.As a matter of practical job necessity, we cannot be responsible for any damage caused by any containment related installations required during the project(tape,glue, staples,plastic,etc).This includes any type of siding on the dwelling that may be damaged during the installation of the insulation. • Does the contractor hav insurance?Ask the Contractor for his insurance company information so that you can confirm coverage or ask to see a copy of a"proof of insurance"document. • Know your rights an0 responsibilities. Read the Consumer Guide to the Home Improvement Contractor Law. Office of Consumer Affairs and Bisiness Regulation -Guide to Home Improvement Contractor Program I You may cancel this agreement if it has been signed at a place other than the contractor's normal place of business, provided you notify the contractor in writing at his/her main office orl branch office by ordinary mail posted, by telegram sent or by delivery,no later than midnight of the third business day following tithe signing of this agreement.See the attached notice of cancellation form for an explanation of this right. DO NOT SIGN THIS CONTRACT IF THERE ARE ANY RELEVANT BLANK SPACESI I I Two identical copies of thelcontract must be completed and signed.One copy should go to the homeowner.The other copy should be kept by the contractor. Customer's signature j Date Contractor's Signature Date I f z 7/�3 11/27/2023 II 1 i 1t 1 i I imig r.41' Ltift:,61Whi. 1 iviiii w Commonwealth of Massachusetts Division of Occupational Lice nsure Board of Bui#using Regulations and Standards Consta:E> 'of S ,rvisor .+ CS113737 4cpires: 06/18/2025 1 MELINDA L CASHMAN 123 PLEASANT VALLEY R D �: AMESBURY itA 019. „F. f Jxftit Commissioner • '! --4!/ e , if T Q 1 , 1 • i i i ACORN® CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDIYYYI) kii.------ 05/08/2023 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NO,T 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 l NAME: Christian Taylor FOSTER SULLIVAN INSURANCE GROUP /a/co_No Ext): (978)686-2266 j ac,No): E-MAIL -- _- ADDRESS: ctaylord@fostersullivangroup.com 163 MAIN STREET INSURER(S)AFFORDING COVERAGE NAIC# NORTH ANDOVER MA 01845 INSURER A: ACE AMERICAN INSURANCE CO 22667 INSURED INSURER B: INSULATION & FIREBLOCK SOLUTIONS INC INSURER C: INSURER D: 260 CENTRE ST ' INSURER E: HOLBROOK _MA 02343 INSURER F: COVERAGES CERTIFICATE NUMBER: 889797 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. INSRR TYPE OF INSURANCE ADDL SUER POLICY EFF POLICY EXP INSD WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ DAMAGE TO RENTED 1 CLAIMS-MADE IpCCUR PREMISES(Ea occurrence) $ MED EXP(Any one person) $ N/A PERSONAL&ADVINJURY S GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $ POLICY I jECOT- L,_i LOC PRODUCTS-COMP/OP AGG $ OTHER: ' t^ I $ 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) $ it $ II UMBRELLA UM OCCUR EACH OCCURRENCE $ EXCESS LIAB C4IMS-MADE N/A AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION X STATUTE ERH AND EMPLOYERS'LIABILITY Y/N ANA OFF CER/EMBEREXCLUDED?E0��i N/A N/A N/A 6S62UB6R39538423 05/05/2023 05/05/2024 E.L.EACH ACCIDENT $ 500,000 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 500,000 If yes,describe under DESCRIPTION OF OPERATIONS below I E.L.DISEASE-POLICY LIMIT $ 500,000 I I N/A DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space is required) Workers'Compensation benefits will be paid to Massachusetts employees only.Pursuant to Endorsement WC 20 03 06 B,no authorization is given to pay claims for benefits to employees in states other than Massachusetts if the insured hires,or has hired those employees outside of Massachusetts. This certificate of insurance shoWs the policy in force on the date that this certificate was issued(unless the expiration date on the above policy precedes the issue date of this certificate of insurance). The status of this coverage can be monitored daily by accessing the Proof of Coverage-Coverage Verification Search tool at www.mass.gov/Iwd/workers-compensation/investigations/. CERTIFICATE HOLDER `• CANCELLATION ) SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN For Evidence Only ACCORDANCE WITH THE POLICY PROVISIONS. For Evidence Only AUTHORIZED REPRESENTATIVE i n n Holbrook '1 MA 02343 �-')"'n C� Daniel M I M.Cro v y,CPCU,Vice President Residual Market WCRIBMA 1 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) 1. The ACORD name and logo are registered marks of ACORD I ! ____..""1 I INSUAND-0t CTAYLOR ACO I CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 8/21/2023 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 CERTIFICA OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PROD CER,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 WAIVEQ, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not conifer rights to the certificate holder in lieu of such endorsement(s). PRODUCER 1 I CONTACT NAME: Foster Sullivan Insurance Group PHONE pqX 163 Main Street (ac,No,EX1):(978)686-2266 I(ac,No):(978)686-6410 North Andover,MA 01845 I E-MAIL ADDRESS: I INSURER(S)AFFORDING COVERAGE NAIC# I INSURER A:Kinsale Insurance Company 38920 INSURED INSURER B:Central Mutual Insurance Company 20230 Insulation And Fir block Solutions Inc INSURER C:Westchester Surplus Lines Insurance Company 10172 DBA Insulation a Energy Solutions,Inc. 260 Centre StreetUnit B INSURER D: I Holbrook,MA 02343 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT TH POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTP$NDIr G 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 CONDITION F SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDL SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MM/DDIYYYYI (MM/DD/YYYY) , LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE X OCCUR 0100190073-1 5/6/2023 5/6/2024 DAMAGE TO RENTED 100,000 PREMISES(Ea occurrence) $ I MED EXP(Any one person) $ Excluded PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIEc-tPER: GENERAL AGGREGATE $ 2,000,000 X POLICY PRO- JECT LOC i PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: B $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000,000 I (Ea accident) $ ANY AUTO i ' BAP 8946825 2/23/2023 2/23/2024 BODILY INJURY(Per person) $ 20,000 AUTOS NLY AU SULED 40,000 — ������ BODILY INJURY(Per accident)_ $ X AIUTOS ONLY X NON-OWNED PROPERTY DAMAGE AUTOS (Per accident) $ $ A X UMBRELLA UAB X OCCUR I EACH OCCURRENCE $ 2,000,000 EXCESS LIAB i CLAIMS-MADE 0100238659-0 5/6/2023 5/6/2024 AGGREGATE $ 2,000,000 DED X 1RETENTIONI$ 10,000 $ WORKERS COMPENSATION ' I i l PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTF ER ANY PROPRIETOR/PARTNER/EXE UTIVE E.L.EACH/k CIDENT $ OFFICER/MEMBER EXCLUDED? N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below _ E.L.DISEASE-POLICY LIMIT $ C Pollution Liability G73556351 002 5/F'2023 5/6/2024 Per Occurrence 1,000,000 C Pollution Liability G73556351 002 5/6/2023 5/6/2624 Aggregate 2,000,000 DESCRIPTION OF OPERATIONS I LOCATI(7NS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) rt ( 1 i I CERTIFICATE HOLDER CANCELLATION j SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE For Evidence On15 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN j ACCORDANCE WITH THE POLICY PROVISIONS. , I AUTHORIZED REPRESENTATIVE i I ACORD 25(2016/03) + ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD