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17C-194 (12) BP-2023-1787 20 WILDER PL COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 17C-194-001 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-2023-1787 PERMISSION IS HEREBY GRANTED TO: Project# INSULATION 2023 Contractor: License: Est. Cost: 2990 GEE INSULATION 115036 Const.Class: Exp.Date: 01/02/2024 Use Group: Owner: KROTKOV NORRIS SCOTT A&SONIA Lot Size (sq.ft.) Zoning: URB Applicant: GEE INSULATION Applicant Address Phone: Insurance: 20 KENWOOD DR UB-0W729432 WORCESTER, MA 01605 ISSUED ON: 12/26/2023 TO PERFORM THE FOLLOWING WORK: INSULATION/WEATH ERI ZATI 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: bi Fees Paid: $65.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Office of the Building Commissioner / a Dep �Nr = >� Cityof Northam to y OR 4P0.°fib` r- , Building Departmt� lFC 212 Main Stre 4- 1 , Room 109�tio owe � INS ULA TI ON Northampton, MA 0?t�`Q 0/4 -.= phone 413-587-1240 Fax 413-5$7-12i pF ONLY APPLICATION FOR INSULATION FOR A ONE OR TWO FAMILY DWELLING ONLY SECTION 1 -SITE INFORMATION INSULATION PERMIT 1.1 Property Address: This section to be completed by office 2-0 wit Agee' P Map Lot Unit N Oi T a.r-p , ma- b 166 y, Zone Overlay District Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: co4+ A- Marr;.S ZO 'Wt1C P\-, aaceora-i on 0- O1062 Name(Print) Current Mailing Address. LIl3—qnl —qoS Telephone Signature 2.2 Authorized Agent: 6 wi (.CUM 39 R (61-x-n cocci-- S'r• VLcto MO" 01 606 Name(Print) Current Mailing Address: t . 50g—6b.S-86Rs" Signature Telephone SECTION 3-E TIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building (a) Building Permit Fee ?A9O . 22- 2. Electrical (b) Estimated Total Cost of 0 Construction from (6) 3. Plumbing O Building Permit Fee 4. Mechanical(HVAC) kt 4 5. Fire Protection 0 6. Total= (1 +2+ 3+4+ 5) 2C(90 • 22 Check Number .i/ / This Section For Official Use Only Building Permit Number 4p- of b - '1 e l Date Issued: �' I Wsignature: OW �' • I XO/a3 Building Commissioner/Inspector of Buildings Date g;nn • ccom @ ,gee, s‘nso1al-on _ corn EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR) SECTION 4-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable 0 Name of License Holder: (x--,m '(Z,cc r1 C-S 1 1 SO 3 G License Number 1 R f�(xnc d- S-1--• kit)acc.e-s (V A U\bob OI1o21-i Z1 Address Expiration D to cc -665-8bg5- Signatu Telephone 9.Registered Home Improvement Contractor: Not Applicable 0 G1-i Rc..c)'<Y1 Z•oc o 2 Lf Company Name Registration Number 3c a 8 of c.coz-v . k)accam , rv- la o\bo (0 k i 0 o ,2- 1 z-y Address Expiration Date Telephone 50g-0:35-gbgS SECTION 5-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 0 Brief Description of Proposed Work NOTE: INSULATION ONL Y IN--";( Sec4v aylc ',Y�U\- a-F 4-1AR___cA -F( • I, (.1-tiW) -9-f-C1 ncl . as Owner/Authorized Agent hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and belief. Signed under the pains and penalties of perjury. (A-1 OA. Q.-. C U m/l Print Name Signature of gent Date ______________7 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. Signature of Owner Date City of Northampton Massachusetts DEPARTMENT OF BUILDING INSPECTIONS r. 212 Main Street •Municipal Building �f Northampton, MA 01060 ,c�.y .-1 , Debris Disposal Affidavit In accordance of the provisions of MGL c 40, S54, I acknowledge that as a condition of the building permit all debris resulting 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. The debris from construction work being performed at: 2-o rN 11�� el N oc Avv, r) ( M'M O l D 6 2 (Please print house number and street name) Is to be disposed of at: W,r) fie- �nnw�-'-;15N s �3� S�V doff M;11b� , Mf'� a1S27 (Please print name and location of facility) Or will be disposed of in a dumpster onsite rented or leased from: (Company Name and Address) 121151 1-02Z Signature of P r it Appl. ant 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. The Commonwealth of Massachusetts M= G,illi 1. Department of Industrial Accidents ESsit I Congress Street,Suite 100 i;l r Boston, MA 02114-2017 .�_ri� www mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legibly Name(Business/Organization/Individual): (.. i-n 12-'_c M Address: 3q% &,x n cs. o.-4--- City/State/Zip: Wtx c,e ert MA- cl 16 0 6 Phone#: Sc -b6S -$6& Are you an employer?Check the appropriate box: Tyke of project(required): I. I am a employer with employees(full and/or part-time).* 7. New construction 2. I am a sole proprietor or partnership and have no employees working for me in 8. 0 Remodeling any capacity.[No workers'comp.insurance required.] 3.0I am a homeowner doing all work myself.[No workers'comp.insurance required.]' 9. ❑Demolition 4.0 I am a homeowner and will be hiring contractors to conduct all work on my property. i will 10 [J Building addition ensure that all contractors either have workers'compensation insurance or are sole 11.EI Electrical repairs or additions proprietors with no employees. 12.❑Plumbing repairs or additions 5.0 I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.❑Roof repairs These sub-contractors have employees and have workers'comp.insurance.% 6.0 We are a corporation and its officers have exercised their right of exemption per MI.c. 14. Other v.r -�{/la r( -V+v✓1 152,§1(4),and we have no employees.[No workers'comp.insurance required.] JJ *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy infonnation. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Ptm¢,r;Lwn ^Z...1,c h S k.Prowl(�_ CO,r rt • Policy#or Self-ins.Lic.#: V(g_o W-7 214 3 2_ Expiration Date: t o t I y( -Lp Job Site Address: 2-0 10;141.o.Ar P\ City/State/Zip: (lJocSharnp0 tell IV 0106 '2- 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 violator.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 ins and penalties of perjury that the information provided above is true and correct Signature: Date: t 51 7.0 Phone#: Scf's-6b5'-$68-5- Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): I.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: Ay '• City of Northampton Massachusetts W _ �� ,111 # i• . DEPARTMENT OF BUILDING INSPECTIONS gi‘ ipa� � � 212 Main Street • Municipal Building Northampton, MA 01060 MANDATORY FOR HOUSES BUILT BEFORE 1945 Property Address: 2 dax- Pt IVv0-1,10,01 on , ,vvl A U1t '- Contractor Name: Wen R.C..cyc Address: 3q8 (3,)rn co City, State: moo« }e- fv\A- 0 b o C� Phone: 50g -66.5-$b&S Property Owner Name: S0'-4- Pt (Vor Address: -0 y,1; \ p\ MC)4440 4.1010- �0 , ('A0- 01062_ City, State: I, &y- RLalr (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. Contractor signature Date 1 i S I2o7..- 3 Permit Authorization mass save Form Site ID: 5054259 Customer: SCOTT A NORRIS Scott Norris 1, , owner of the property located at: (Owner's Name,printed) 20 Wilder PI Northampton, MA 01062 (Property Street Address) (City) hereby authorize the Mass Save Home Energy Services Program assigned Participating Contractor listed below to act on my behalf and obtain a building permit to perform insulation and/or weatherization work on my property. 4ealfttt. Monti) Owner's Signature: Date: 11 / 19 / 2023 FOR OFFICE USE ONLY We have assigned the following Mass Save Home Energy Services Participating Contractor to the above referenced project: Participating Contractor Date Name: CLEAResult Phone: 800-480-7472 Email: Page 1 of 1 For Office Use Only CLEAResult CONTRACT CLEAResult 41 Brigham St., Customer Name:SCOTT A NORRIS Marlborough,MA,01752 Email:Not provided Phone:413-977-9053 Premise Address:20 Wilder PI,Northampton,MA 01062 Mailing Address:20 WILDER PL,Florence,MA 01062 Project ID:5054259 Date:Nov.17,2023 Applicable Customer Required Actions: Notes: • Storage Removal Customer must remove flooring (or seek contractor help • Flooring Removal ahead of time)and storage from attic before contractors arrive to air seal and insulate that space. 10'x18' storage area can be re-floored once work is complete. Job Description Contractor will perform or cause to be performed the following work on these"Premises"in a professional manner and in accordance with the terms of this Contract, including the attached recommendations/work order describing the work in detail(the"Work")which are incorporated herein by reference. g'g , pp Air Sealing at Estimated 62.5 CFM50 Per Hour 6 hr $639.54 $0.00 Roof Vent- 12" 2 each $350.34 $87.58 Damming 57 each $158.46 $39.61 Propavent 32 each $149.76 $37.44 Attic Floor- 14"Open Blow Cellulose 426 SF $1,180.02 $295.02 Attic Floor-5"Open Blow Cellulose 168 SF $314.16 $78.54 Door Sweep(with AS hrs) 3 each $88.98 $0.00 Exterior Door Weather Stripping (with AS hrs) 3 each $108.96 $0.00 Total: $2,990.22 Program Incentive: -$2,452.03 Customer Total: $538.19 Payment Customer agrees to pay Contractor for the Work,the Customer Share of the Contract Price as follows:Payment#1:$119.39 as a Deposit payable to CLEAResult upon signing the Contract(not to exceed 1/3 of the total retail costs). Mail check&contract to CLEAResult,41 Brigham St., , Marlborough, MA, 01752. Final Payment:$358.80 as the final payment for the Work shall be payable to the Home Performance Contractor(HPC)or Independent Installation Contractor(IIC) upon satisfactory completion of the Work. Page 1 of 4 Customer understands that he/she will not be required to pay the Utility Incentive Share of the Contract price in the amount of $2,452-43. Changes to individual line items and/or previous incentives may increase or decrease the size of the Utility Incentive Share. Dispute Resolution The IIC and Customer hereby mutually agree in advance that in the event that the IIC has a dispute concerning this Contract,the IIC may submit such dispute to a private arbitration service which has been approved by the Office of Consumer Affairs and Business Regulation and Customer shall be required to submit to such arbitration as provided in M.G.L.c 142A. You may cancel this agreement if it has been signed by a party at a place other than an address of the seller, provided you notify the seller in writing by ordinary mail posted, by telegram sent or by delivery, not later than midnight of the third business day following the s nmg o isAgree t. DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES. _� ([`` AI/in. �� 11 / 19 / 2023 please assign for us V• . Customer Signature Date Indicate your selected IIC here, if applicable Initial here if you want the Program to assign a kitiva OA, 11/17/23 Kevin Cote Participating Contractor CLEAResult Signature Date Name of CLEAResult Representative Page 2 of 4 TERMS AND CONDITIONS ASSIGNMENT OF CONTRACT BY CLEAResult Customer acknowledges that CLEAResult will,and Customer hereby requests CLEAResult to,assign this Contract to the IIC to undertake the Work on the terms set forth in the Contract.After such assignment:(a)CLEAResult shall no longer be a party to this Contract;and(b)Customer shall have no recourse against CLEAResult for any of the performance,non-performance or deficient performance of the Work or any obligations under this Contract performed by,or on behalf of,the IIC.Notwithstanding the foregoing,Customer shall provide CLEAResult with(i)such information regarding the IIC's performance as CLEAResult may reasonably request;and(ii)reasonable access to the Premises as CLEAResult may request to permit CLEAResult to inspect IIC's work;and(c)Furthermore,Customer agrees that he/she/they(i)shall notify CLEAResult of any dispute between Customer and the IIC concerning the Contract;(ii)shall provide CLEAResult with such information regarding the dispute as CLEAResult may reasonably request;and(iii) consent to CLEAResult's participation,at its sole election,in any arbitration or other dispute resolution proceeding between Customer and the IIC. LIMITED TIME OFFER The terms,prices,and any incentive offered in this Contract are valid for only thirty(30)days from the date of CLEAResult's presentation of this Contract to the Customer. In the event that Customer does not execute this Contract and return it to CLEAResult within such thirty(30)day period,the terms,prices and any incentive offered by CLEAResult is NULL and VOID. COMMENCEMENT AND COMPLETION The IIC will not begin the Work or order the materials before the sixth(6th)day after the execution of this Contract by CLEAResult and Customer, whichever signs later(the"Contract Execution Date").Subject to the availability of subcontractors/materials and to delays attributable to the weather or "acts of God",the IIC shall begin performing the Work as soon as practical after the Contract Execution Date,and the IIC shall substantially complete the Work no later than sixty(60)days after that Contract Execution Date,barring delay caused by circumstances beyond the IIC's control,including but not limited to any delay resulting from Customer's decision to wait for a particular IIC. Each of CLEAResult and the IIC reserve the right to advise the Customer of changes in the projected start and completion dates,based upon availability of materials and subcontractors.Upon completion of the Work,the IIC will leave the Premises in a neat and orderly condition but shall not be responsible to correct conditions outside the scope of its Work. MODIFICATION Prior to CLEAResult's assignment of this Contract to the IIC set forth in Section IV(above),this Contract cannot be changed except by a writing signed by CLEAResult and the Customer.After CLEAResult's assignment of this Contract to the IIC set forth in Section IV(above),this Contract cannot be changed except by a writing signed by the IIC and the Customer that has been approved in writing by CLEAResult. PERMITS In connection with the Work to be performed at the Premises by the IIC Under Contract,the following permits may be required for this project depending upon the judgment of local inspectors:Electrical,Plumbing/Gas,Mechanical,Building.The IIC shall be responsible to,and shall,obtain any and all permits required for performance of the Work.The IIC shall inform the Customer of the permits required and any Customer co-pay or cost of the required permit acquisitions. If Customer chooses to secure her/his own work-related permits,and/or deal with an unregistered contractor, Customer will be excluded from the Guaranty Fund provisions of M.G.L.c. 142A. CUSTOMER'S DUTY Customer must prepare the Premises for the Work.Objects which obstruct areas of Work must be moved before the Work is to commence.Customer affirms that they have received no incentives(from the above-named Utility)during the last calendar year. DISCLAIMER OF LIABILITY OF CLEAResult AND UTILITY Customer understands and acknowledges that the IIC is not an agent,vendor or sub-vendor of the Utility or CLEAResult with respect to the installation of any energy efficiency measures. In the event of the failure of any energy conservation device to perform as expected,Customer agrees that Customer's sole recourse is to the IIC and not to CLEAResult or the Utility.The Utility and its operating companies shall not maintain,remove or perform any work whatsoever on the energy conservation measures installed.Customer understands and acknowledges that its participation in the Mass Save Home Energy Services Program is voluntary and that it has consented for the IIC to install the proposed energy conservation measures. Customer agrees that it shall not hold CLEAResult,the Utility,their affiliates or operating companies liable for the IIC's failure to perform its obligations under this Contract,for failure of the energy conservation measures to function,for any damage to Customer's Premises caused by the IIC or for any and all damages to property or injury to persons caused by the energy conservation measures. ENERGY BENEFITS The local sponsoring Utility is entitled to 100%of the energy benefits associated with all energy conservation measures,excluding the value of energy cost savings by the Customer,but including all rights to all associated ISO-NE Energy,Capacity and Reserves Products(as defined by ISO New England),and the IIC agrees to provide the Utility with such further documentation as the Utility may request to confirm the Utility's ownership of such benefits and Products. IIC REGISTRATION The IIC and any subcontractors must be registered by the director and any inquiries about the IIC or any subcontractor relating to a registration should be directed to:Office of Consumer Affairs and Business Regulation,Home Improvement Contractor Registration, 10 Park Plaza, Room 5170,Boston, Massachusetts 02116,617-973-8700. Page 3 of 4 IIC WARRANTIES The IIC warrants as follows: A. Materials and workmanship will meet or exceed the specifications in CLEAResult's Materials and Installation Standards. B. The Work and the materials furnished by the IIC will conform to the requirements of this Contract.If there be a defect in workmanship or materials,or any damage caused by its subcontractors or employees is discovered within one year after completion of the Work(including cleanup),the IIC will,at its own expense,at its option,remedy,repair,correct,replace,or cause to be remedied,repaired,corrected or replaced such defect or damage. CUSTOMER RIGHTS UNDER M.G.L.C 142A Customer has the following rights under M.G.L.c. 142A: A. At the time of signing this Contract,the Customer shall be furnished with a copy of it.No Work shall begin prior to the signing of this Contract by the Customer and CLEAResult. B. Any party may bring an action to enforce any provisions of Mass.G.L.c. 142A or to seek damages or the Customer may request that a dispute be decided under the terms of a private arbitration program approved by the Secretary of the Executive Office of Consumer Affairs and Business Regulations. C. Customer may have the right to be compensated from the Residential Contractor's Guaranty Fund for actual losses incurred as a result of a registered contractor's or subcontractor's conduct found by a court to be work performed in a poor or unworkmanlike manner or which violates certain laws fol the protection of consumers within 6 months after the Customer has obtained a judgment or arbitration award and has exhausted customary reasonable efforts to collect the judgment or award. Page 4 of 4 V IT hiLvik it-it" RCS PLANVIEW DIAGRAM Customer: 'CC-4 4 I Ph r`(t Home Phone: ( 14-13 )- el 17 _ r o s3" Address: 1-0 ut(ic,/ 1 p 1 Work Phone: ( )- - Town• f"I v re°ri.t.K. Cell Phone: ( )- Any Iimaatrorts for access by large truck? No f( Yes it yes,destobe: 1 Arty spec,rit d'rect ons or landmarks) No Yes if yes,describe. Site ID: 5-0 S1115-9 I Energy Specialist: rf,, , 1 1"4, 1!I, Reviewed by: 0 G kis ,his 1, 5-.1114 >+ ,t, P( if if 4I00-0. P6- l- 15, hfWI 32 pm)pvJh (t.( , 134 tn„ c 7 14- CI„r A N J 644/ G't/I k v p i- p ry e°t -f 5 k e brit,..., �` (4\ V l 1 t•‘(4 k �i ,4--c jG if ve--. 1,4 ik . _ __ __ cal/ (4 e 04 — f‘ y o fir c tI 4.) ).---kf,I c1/2 ft_ ii-ti-,c pr /4 /q ark f cef(t.r(ore bg — 42_646, IA 1 b I (it 3 - iG;ft- I I , r- A--4%L UG I k u P Iic (2,;) 6 (i....) .6) I 11) E I �.,}3 t..-c. 11 S w crt Z' (0 _, ' ( n.fi4(rt(-e..P . f p to — t=L' T r 4GCesi, 0 r t--3—1 1......_...._— VS - If Bushes Ladder Neighbor Proximity Pocket Doors I Insert Radiators Fence(s) ~ Existing Conditions X=Access ❑=Vents Note Inside Square R=Roof S=Soffit G=Gable RV=Ridge Vent CS=Continuous Soffit CDE=Continuous Drip Edge I=Triangle Install 0=New Access Note in Circle C=Ceiling W=Wall S=Sheathing Temp Unless Noted Otherwise d=Vents Note in Triangle R=8"Roof S=Soffit G=Gable M=12"Mushroom For Access Rev 1/14 t AREA SUPPORTING MATH TOTAL __•3 r 14--41L F( (2.k4x-t() — ( /oxiit) — (3ir) 11Z6is F by WI1.1 j (�+'2f-'Lf-2) ( icio ' � �� � S rs)t krc-. 60 K1 S) " ( 3 % C 166.4. __ t'A Is y V F � 1-c1" — 6 fop ve-, = , 3G tt/ s - g 2'i ;3 — 2-. o l' ji-cco pl w,c.wi A,J i-wo 12 a,.A frvAr Recommended Ventilation Calculation P c ,-, t -3 2- ( (.44r- p c.,I) ve"4-3- rt. Recommended r � Ventilation Calculation 11d�1 i u,- r Ct.K" VA 1 IC �p c r n t,J Y, ti ,.AIR SlALING WORK HOW*S• , :w x .�. Air Sealing Work Hour Calculation ''Zt} a 2-4 "( _ �/K to� Sq�t Work Hours 4 6 8 10 12 14 16 (+2) Attic Sq.Footage < 500 501-800 801-1100 1101-1400 1401-1700 1701-2000 2001-2300 Every 300' Exceptional AFL Hours Primarily Floored Attics Chimney or BF=1 Hour Multiple Chimney/BF=2 Hours Prefab/Modular Hours No Chimney=4 Hours Chimney=6 Hours Exceptional KW Hours X<20 feet=1 Hour 20 ft<X<40 ft=2 Hours X>40 ft=4 Hours Rim Joist Only Hours RJ<150 ft=1 Hour RJ>150 ft=2 Hours BMT Ceiling Only Hours Ceiling Area<2,000 sq ft=1 Hour Ceiling Area>2,000 sq ft=2 Hours ***NOTE:You MUST be INSULATING RJ or Basement Ceiling to specify RJ or SPIT Ceiling ONLY Air Sealing Hours*" Q >6"Loose Insulation Cross Batt insulation Multipliers ?6"Mix Batt&Loose Insulation Truss Construction • For Office Use Only AC RD® CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) `e••••---- 10/16/2023 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 Daniel Pomfret NAME: Ripple Effect Insurance Inc. PHONE (508)283-3250 FAX (508)306-9702 (A/C,No,Ext): (A/C,No): 15 North Street EMAIL dpomfret@ripFX.net ADDRESS: PO Box 1242 INSURER(S)AFFORDING COVERAGE NAIC# _ Douglas MA 01516 INSURERA: Scottsdale Insurance Company INSURED INSURER B: Arbella G.E.E Insulation INSURER c: American Zurich Ins Co 20 Kenwood Dr INSURER D: INSURER E: Worcester MA 01605 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 SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MMIDD/YYYY) (MM/DD/YYYY) LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED 100,000 fl CLAIMS-MADE 1 X OCCUR PREMISES(Ea occurrence) $ mu)EXP(Any one person) $ 5,000 A CPS7765841 04/02/2023 04/02/2024 PERSONAL&ADV INJURY $ 1,000,000 ( GEN'L AGGREGATE LIMIT A0PLIES PER: GENERAL AGGREGATE $ 2.000,000 X POLICY JECT LOG 2,000,000 PRODUCTS $ I OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 I (Ea accident) ANY AUTO BODILY INJURY(Per person) $ B OWNED X SCHEDULED 1020105413 03/03/2023 03/03/2024 BODILY INJURY(Per accident) $ AUTOS ONLY " AUTOS XHIRED X NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY (Per accident) $ 1 UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 1,000,000 A X EXCESSLIAB I CLAIMS-MADE XBS0183767 04/02/2023 04/02/2024 AGGREGATE $ 1,000,000 I DED RETENTION$ $_ WORKERS COMPENSATION X STATUTE ERH AND EMPLOYERS'LIABILITY C ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N E.L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? N/A UB-OW729432 10/14/2023 10/14/2024 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 II yes,describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) i CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN Clearesult ACCORDANCE WITH THE POLICY PROVISIONS. 112 Turnpike Rd Westborough,MA 01581 AUTHORIZED REPRESENTATIVE I ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD r Commonwealth of Massachusetts • Division of Professional Licensure • , Board of Building Regulations and Standards • 'Constr h higiipprvi<sor CS-115036 Ecpires: 01/02/2024 GIM S R'COM 398 BURNCOAT ST WORCESTER-MA 01606 Commissioner (Yeti? K. Bccriiii&. THE COMMONWEALTH OF MASSACHUSETTS Office of Consumer Affairs and Business Regulation 1000 Washington Street - Suite 710 Boston, Massachusetts 02118 Home Improvement Contractor Registration Type: Individual GIM RCOM Registration: 200024 398 BURNCOAT ST Expiration: 11/02/2024 WORCESTER, MA 01606 Update Address and Return Card. THE COMMONWEALTH OF MASSACHUSETTS Office of Consumer Affairs&Business Regulation Registration valid for individual use only before the HOME IMPROVEMENT CONTRACTOR expiration date. If found return to: TYPE: Indivuival Office of Cons mer Affairs and Business Regulation Registration Expiration 1000 Washi to Street -Suite 710 200024 ''"02•'2024 Boston, M 021 8 QIM RCOM GIM R'COM 398 BURNCOAT ST WORCESTER, MA 01606 Undersecretary Not valid without signature