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18-032 32 EMILY LN BP-2016-1423 GIS 4: COMMONWEALTH OF MASSACHUSETTS Map:Block: 18-032 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: ROOF BUILDING PERMIT Permit# BP-2016-1423 Project 4 JS-2016-002448 Est.Cost: S4500.00 Fee: $40.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: PATRIOT ROOFING & REMODELING INC - MARK KELLEY 157863 Lot Size(so. ft.): 14461.92 Owner: MAGINNIS KATHERINE E&BRIAN F BEGLEY Zoning: Applicant: PATRIOT ROOFING & REMODELING INC - MARK KELLEY AT: 32 EMILY LN Applicant Address: Phone: Insurance: 88 ARCADIA BLVD (413) 363-1276 WC SPRINGFIELDMA01118 ISSUED ON:6/1/2016 0:00:00 TO PERFORM THE FOLLOWING WORK:REMOVE EXISTING ROOF AND RESHINGLE 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: Driveway Final: Final: Final: Rough Frame: Gas: Fire Department Fireplace/Chimney: Rough: Oil: Insulation: Final: Smoke: Final: THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Certificate of Occupancy Signature: FeeType: Date Paid: Amount: Building 6'1!2016 0:00:00 $40.00 212 Main Street,Phone(413)1587-1240,Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner 4 Department use only. REC 'IVCD City of Northampton Status of Permit: fl :uiiding Department Curb Cut/Driveway Permit • 3 �n 212 Main Street Sewer/Septic Availability MAY Room 100 WaterNVell Availability No hampton, MA 01060 Two Sets of Structural Plans DEPT oirn oiNe'ron 4 .87-1240 Fax 413-587-1272 Plot/Site Plans NORTHAMPTON. Other Specify APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION 1.1 Property Address This section to be completed by office 3 7)i, i-e Map Lot Unit gib/ 1) )14A $f Zone Overlay District Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: 3ct C .3"•_ KP,9f, a (kit/ Pr' X1AllIta .,,,L in1A Name(Print) II Current Mailing AddrO: Si{ C. /�T,� T Telephone Signature 2.2 Authorized Agent: Name(Print) Current Mailing Address: Signature Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building (a) Building Permit Fee 2. Electrical (b)Estimated Total Cost of Construction from(6) 3. Plumbing Building Permit Fee 4. Mechanical(HVAC) 5. Fire Protection 6. Total=(1 +2+3+4+5) ,Check Number f .3-5` This Section For Official Use Only Building Permit Number: Date Issued: Signature: Building Commissioner/Inspector of Buildings Date i qie Section 4. ZONING All Information Must Be Completed.Permit Can Be Denied Due To Incomplete Information Existing Proposed Required by Zoning This column to be filled in by Building Department Lot Size i Frontage ..__._..._.___ ___ _.._..----------- _ Setbacks Front [ Side L: RL......_.] L:_ R: Rear . I Building Height -'-i -"" Bldg. Square Footage i------ ...._ % __----.... _--_-•_.3 Open Space Footage % (Lot area minus bldg&paved L_-_.J i._., 1-.. .1 parking) it of Parking Spaces I. -- t-- Fill: ---- Fill: (-_ _ _ _ (volume&Location) i-_ € .___-__ ......._„._. A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO 0 DONT KNOW 0.. YES Q .......... . .. .............. ....... IF YES, date issued:' IF YES: Was the permit recorded at the Registry of Deeds? NO Q DONT KNOW `�� YES Q IF YES: enter Book Page` 1 and/or Document#, B. Does the site contain a brook, body of water or wetlands? NO Q DONT KNOW 0 YES Q IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained Q Obtained Q , Date Issued: C. Do any signs exist on the property? YES Q NO 0 IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property? YES 0 NO � IF YES, describe size, type and location: I E. Will the construction activity disturb(clearing, grading,excavation, or filling)over 1 acre or is it part of a common plan that will disturb over 1 acre? YES Q NO IF YES,then a Northampton Storm Water Management Permit from the DPW is required. SECTION 5-DESCRIPTION OF PROPOSED WORK(check all appliicable) New House ❑ Addition ❑ Replacement Windows Alteration(s) i ! Roofing Or Doors 0 Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [Q Siding[O] Other[01 Brief Description of Proposed • ctica-Work: Tc vt. dye e J1�wy �'ai i 4�s/Ql/ /tA.cu Ta . asuk.1 f 61 w/ C.e Alteration of existingbedroom Yes o new bedroom Yes <- No ,{ SJ C Nick�� Adding 7 Attached Narrative Renovating unfinished basement Yes a( No Plans Attached Roll -Sheet 6a. If New house and or addition to existing housing, complete the following: a. Use of building: One Family Two Family Other b. Number of rooms in each family unit: Number of Bathrooms c. Is there a garage attached? d. Proposed Square footage of new construction. Dimensions e. Number of stories? f. Method of heating? Fireplaces or Woodstoves Number of each g. Energy Conservation Compliance. Masscheck Energy Compliance form attached? h. Type of construction i. Is construction within 100 ft. of wetlands? Yes No. Is construction within 100 yr. floodplain Yes No j. Depth of basement or cellar floor below finished grade k. Will building conform to the Building and Zoning regulations? Yes No. I. Septic Tank City Sewer Private well City water Supply SECTION 7a-OWNER AUTHORIZATION-TO BE COMPLETED WHEN OWNERS 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. Signature of Owner Date , 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. Print Name Signature of Owner/Agent Date SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable_ £ Name of License Holder: M.N.Ae€ /4.I/.17 4_f// . f e/l,1/ License Number ` ?ltd 51? ;iI tdwd oft( I og q/drila Address Expiratio Date Si u Telephone 9. Registered Home Improvement Contractor Not Applicable £ 8"6 Company NameRegistration Number n C Address' / Expirati n to yr /I�Cu-Q(Q_QUIIVs _cola AI- F (D.� Telephone(II 37) / SECTION 10-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 £ 11. Home Owner Exemption The current exemption for"homeowners"was extended to include Owner-occupied Dwellings of one(I) or two(2)families and to allow such homeowner to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor.CMR 780. Sixth Edition Section 103.3.5.1. Definition of Homeowner:Person(s)who own a parcel of land on which he/she resides or intends to reside, on which there is,or is intended to be,a one or two family dwelling,attached or detached structures accessory to such use and/or farm structures.A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such"homeowner"shall submit to the Building Official,on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit. As acting Construction Supervisor your presence on the job site will be required from time to time,during and upon completion of the work for which this permit is issued. Also be advised that with reference to Chapter 152(Workers' Compensation) and Chapter 153(Liability of Employers to Employees for injuries not resulting in Death)of the Massachusetts General Laws Annotated,you may be liable for person(s) you hire to perform work for you under this permit. The undersigned"homeowner"certifies and assumes responsibility for compliance with the State Building Code,City of Northampton Ordinances,State and Local Zoning Laws and State of Massachusetts General Laws Annotated. Homeowner Signature The Commonwealth of Massachusetts Department of Industrial Accidents IOffiI ..4:", frir-' ce of Ini estigations r` 600 Washington Street i:F0 Boston, 102111 ;` 4�- - www.rass.gov/dia Workers' Compensation Insurance Affidavit: builders/Contractors/Llectricians/Plumbers Applicant Information L Please Print Legibly Name (BusinessfOrganizationJIndividual): C ,,c. / F/ % a / , , _ __ _` L`.( - r Address: A It E _ 1� S. I . : Gt l( 6 City/State/Zip: S A04,9 /1 0 l!(I Phone #: W I' tr?/ CS Are you an employer.Check/tthe appropriate box: : rea of Type project (required):4. am ageneral contractor and I ( q ) 1.�I am a employer with ❑ I 6. ❑New construction employees (full and/or part-time).* have hired the sub-contractors 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.t 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.n Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.111 Roof repairs insurance required.] t c. 152, §1(4), and we have no employees. [No workers' 13.❑ Other comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. tHo meowners 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: 444 IK S/ A.6.-, Policy#or Self-ins. Lic. #: Sze Ca, Y. Expiration Date: Job Site Address: 3 ,) 141.4 7/., "r City/State/Zip: /4/111.4.4,4,19 0 c 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 u�-- 'pains and pen •'es of perjury that the information provided alcove is true and correct. Signature: `c Date: &a f i t d a/60 Phone#: Li! S ?-14 Sr-S(c . 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): 1.Board of Health 2. Building Department 3. City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6. Other • Contact Person: Phone#: City of Northampton Massachusetts � %.. !;"7.;* DEPARTMENT OF BUILDING INSPECTIONS r 212 Main Street o Municipal Building il fib; Northampton, MA 01060 rsph;•,.���li�• INSPECTOR Louis Hasbrouck Chuck Miller Building Commissioner Assistant Commissioner HOME OWNER EXEMPTION ACKNOWLEDGEMENT The State of Massachusetts allows the homeowner the right under 780CMR 108.3.4 to act as his/her construction supervisor. The state defines "Homeowner" as, " Person(s) who owns a parcel on which he/she resides or intends to be, a one or two family dwelling, attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two- • year period shall not be considered a home owner." The building department for the City of Northampton wants any person(s)who seek to use the home owner exemption, to act as their own construction supervisor, to be aware that by doing so you become responsible for compliance with state building codes and regulations. The inspection process requires that the building department be called to inspect work at various stages, which include foundation/footings (before backfill), sonotube holes (before pour), a rough building inspection (before work is concealed), insulation inspection (if required) and a final building inspection. The building department requires these inspections before the work is concealed, failure to secure these inspections can result in failure to obtain a certificate of occupancy until the work can be inspected. If the homeowner hires other trades to perform work (electrical, plumbing & gas) the homeowner will be responsible to make sure that the trades hired secure their proper permits in conjunction to the building permit issued, and that they get their required inspections. Failure of the individual trades to secure the permits and inspections as required can DELAY the project until such time as the proper permits and inspections are made understand the above. (Home owner/resident's signature requesting exemption) I will call to schedule all required building inspections necessary for the building permit issued to me. Date Address of work location ' 1 City of Northampton 212 Main Street, Northampton, MA 01060 Solid Waste 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. Address of the work: c. The debris will be transported by: 41/441s ,le ' - cej i -. The debris will be received by: 4if 6,/4 S I-t /2e l 1 t . /v Building permit number: Name of Permit Applicant p / vu`k- (czlfc v� ( h G Date Signature of Permit Applicant ,c9431/cia aooptj gleAttozefini3, Mark Kelley MA RIC Lic. # 157863 88 Arcadia Blvd. CT HIC Lic. #0674414 Springfield,MA 01118 MA CSL Lic# 104631 Office:413-363-1276 Insured with Rejean Cell : 413-219-5569 3 Remillard Insurance Brain Begley 32 Emily Drive Northampton ,MA Exterior Construction hereby submits our proposal and specifications to strip and install a new roof rear upper section of bouse only; Our proposal includes the following: 1) Strip the entire roof,down to plywood. 2) Install 6ft of ice and water barrier around eaves of upper roof. 3) Install synthetic tar paper over entire roof. 4) Install 30 year architectural shingle color Q/C.,( •kk 5) Install new ridge vent 6) Will remove all existing gutters and install new gutters as well as down spouts ,rear upper sections of roof only. 7) Will clean all debris from property. 8) Dumpster will be on premises to remove from debris from house. 9)Roof will have a 5yr labor warranty and a 30yr manufactures warranty. 10) ill install new drip edge over eaves and rakes of entire roof color of drip edge 11)Will replace pipe in attic that has been broke 12)Permit will be pulled Additional Comments: If there is any rotten wood on any of the roofs that needs to be replaced it will be extra.We will let you know right away. TERMS OF PAYMENT AS FOLLOWS: 4,500.00 total A third will be needed at signing of contract,a third the day we start and a third when we finish. Homeowner has 3 days to cancel contract and be refunded his deposit. .Y 1. Job will be completed within 30 days of signed contract. ACCEPTANCE OF CONTRACT, THE ABOVE PRICES,SPECIFICATIONS AND CONDITIONS ARE SATISFACTORY AND ARE HEREBY ACCEPTED. EXTERIOR CONSTRUCTION IS HEREBY AUTHORIZED TO DO THE WORK AS SPECIFICED. PAYMENT WILL BE MADE AS STATED ABOVE. A FEE OF 1 1/�% (18% ANNUALLY)WILL BE CHARGED ON ACCOUNTS OVER 30 DAYS PAST DUE. IF LEGAL ACTION IS NECESSARY TO COLLECT ANY AND ALL AMOUNTS DUE, OR TO ENFORCE THIS CONTRACT ALL COSTS, INCLUDING REASONABLE ATTORNEY'S FEES WILL BE ADDED. ANY ARBITRATION WILL BE HELD IN MASSACHUSETTS AND MASSACHUSETTS STATE LAW IS TO BE APPLIED. SIGNATURE DATE: q/4 h_e AUTHORIZED SIGNATURE 11' DATE: LULA c r REJEAN REMILLARD INS Fax 14137860193 Jun 1 2016 10:49am P001/001 ® r DATE(MM/D.„,,Y) ACCIRLO CERTIFICATE OF LIABILITY INSURANCE . 6/1/16 THS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIRCATE HOLDER THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY aIAEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(SI, AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: II the certificate holder is an ADDITIONAL INSURED,the poiicyies) must be endorsed_ If SUBROGATION IS WAIVED,subject to the terns and conditions of the policy,certain policies may require ail endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). 1 - PROWCER CONTACT Mike Pelletier Rejean J. Remillard Ins Agency AP �x0_ (413) 789-3010 IDA,No; (413) 7B6-0193 1040 Springfield Street pDAllss mikep@rejeanxemil)-ard,com Feeding Hills, MA 01030 I __ INSURER(,S AFFORDING COVERAGE NAIC# INSURER A:Main Street American Assurance INSURm INSURER B:Pilgrim Insurance Co Patriot Roofing and Remodeling 1 irolinetc:AIM Mutual Ins Co ' 88 Arcadia Boulevard INSURER D: _ Springfield, MA 01118 INSURERS INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE USTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PE2100 INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH TNIS ' CERTIFICATE MAY BE ISSUED OR MAY PERTAIN. THE INSURANCE AFFORDED BY TIE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POUCIES.!MOTS SHOWN MAY HAVE BEEN REDUCED BY PAD CLAIMS. ACD 'SLeRl 1 POLICY EFF POLICY EXP LTR I TYPE OF INSURANCE 'INSR tW POLICY MA/80ii(MMICO/YYYY)'(Ns IlDLYYYYY) LIMTB A •GENERALLIADILITY Y Y MPT3283U 4/12/16 4/12/17EACH OCCURRENCE $ 1,000,000 -OANAGE1 X COMMERCIAL GENERAL LIABILITY 1 psE'scs'En .,ce,c9) 500,000 1 1 1 CLAIMS-MADE X OCCUR I MED EXP(lrryone 2nrson) 5 10,000 ',-A •; veR$3NALe.00V IN URY $ 1,000,000 GENERAL AGGREGATE $ 2 000 000 GEN'LAGGRE'•'ATE LMITAPPUE$PER • PROCJCTS-CONQ/DP AGG I$ 2,000,000 ICY i D 71 LOC I S B i AUTOMOBILELIADILITY IPGC00001006999 11/15/15 11/15/16 .ccicsio GLELa4rr S ANY AUTO SODSLY NARY tPer peson, $ 100,000 AI.LO$IeD x AUTOSJLEO BODILY INJURY(Per=Went) $ 300,000 —NON-CANNED PROPERTY DAMAGe $ 100 000 H:REDAUTOS AtiTC$ SPesaccieant) , I 1 (M RELLA UAB IOCCUR EACH OCCURRENCE _s ---4---4 .---_ 1 EXCESS LIAR CLAIMS-MADE' I I AGO REGATE S DE; RETENTION$ z ML�RKERS COMPENSATION 'WC STATU- ' OTH- C P EMPLOYERS'LlaeruYIN ry FORWARDED BY d_ I I YUMUS FR AND ANY PROPRIETORiPARTNER/EXECUTVE E.L.ErVH.aCOOENT $_ • :OFFICERS:EMBER EXCL UDEa7 Y ! N,•A (Mentl9gryinNH) I I EL.DISEASE-EA31P EE$ _ OEsClIPTIIONuOtnFJOP ERATONSaebe E.L DISEASE-POLIGY_MIT $ I 7 i 1 ISSGRIP11ON OF OPERATIONS I LOCATIONS/VENICLES IAtttdiACORD101,AnnerAner Roma nisSahedue,Ifmore space iareglireef) REF: Brian Begley 32 Emily Drive Northampton, NA CERTIFICATE HOLDER I CANCELLATION 1 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Town of Northampton ACCORDANCE WITH THE POLICY PROVISIONS. 212 Main Street , B'T Northampton, MA 01460 AUTHOR�2Eo REl!ESTATNE •/ • r /7iJ47 @1988-2D10 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD Phone: Fax: (413) 587-1272 E-Mai: 6/ 1 /2016 2 : 15 : 41 PM 8790 Z 02/02 ACC) CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDIWYY) a�,� 06/01/2016 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 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 04551 -001 C ACT Branch 4551-1 N E: Rejean J Remillard Insurance Agency Inc (aE"M�q." o.Ext): (413)789-3070 (�C.No.: (413)786-0193 1040 Springfield Street ADDREss: Feeding Hills,MA 01030 INSURERISI AFFORDING COVERAGE NAIC# wsURERA_A•I.M.Mutual Insurance Company . ,33758 (Patriot Roofing & Remodeling Inc INSURERS: INSURER C: _ 88 Arcadia Boulevard INSURER D: Springfield, INA 01118 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCEDLBY��PAID COLLIAIMS. IN1R 'TYPE OF INSURANCE la POLICY NUMBER POLICYE(MMIDDrerYY) {MWD EXP) LIMITS GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIAEIL TY CARTAGE TO RENTED $ PREMISES Ea occurrence) CLAIMS-MADE T OCCUR 1 MED EXP(Any one persor) $ ^ PERSONA_S ADV INJURY $ G=NERALAGGGREGA-E $ GEN`_AGGREGATE LIMIT APPLIES PER PRODUCTS•CMP/CP AGO $ �OLICY I pRe- UECT JOC v AUTOMOBILE LIABILITY I COMBINED SINGLE LIMIT $ (Ea acadent) ANY ALTO BODILY IN-JRY(Per pe^scn) $ ALL OWNED -SCHEDULED AUTOS AUTOS BODILY IN_UP.Y(Per 2Coce'tJ $ HIRED AJTOS NON-OWNED PROFER-Y DAMAGE AUTOS (DeratcidenI: $ $ UMBRELLA UAB OCCUR EACH OCCLRP.ENCE I EXCESSLIAB CLAIMS MADE AGGREGATE $ yyyyppRRKDEEEO CCqpM,�I RETEEpNTT Ch $ 77 g I AND Eh1P�L0�IYER8 LNJABTt4ENE X TOr%. LIIMIUS OEF A A\,PRO.1KE A6)R EXCLUDPE'/D�XECLTIriE Y J N EL EACH ACCIDENT $ 100 000.00 "7 F1 NIA AWC-400-7031064-2015A 9/112015 9/1/2016 �(rMandatory In NH) E L DISEASE-EA EMPLOYEE $ 100,000.00 D SsdlIC.KgOFERATIONS below E_ DISEASE-P000_MIT I$ 500,000.00 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Addltlonal Remarks Schedule,If more space Is required) CERTIFICATE HOLDER CANCELLATION TOWN OF NORTHAMPTON 212 MAIN STREET SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE NORTHAMPTON,MA 01060 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE - .1.1P 6.ea_ ©1988-2010 ACORD CORPORATION.All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD 8609 REJEAN REMILLARD INS Fax 14137860193 Jun 1 2016 02:17pm P001/001 y 6/ 1 /2016 2 : 12 : 39 PM 8790 @ 02/02 ,cam CERTIFICATE OF LIABILITY INSURANCE DATE(MMJDDJYY7'Y) B610112016 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ON Y AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMENEXTEND, OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTtFICATE OF INSURANCE COES NOT CONSI1T ATE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, th pollcy(ies)must be endorsed. If SUBROGATION IS WAIVED subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder In lieu of such endorsement(s). PRODUCER 04551-001 R `'t Branch 4551-1 Rejean J Remillard Insurance Agency Inc tkgorr,exti: (413)789-3070 (A f‘b: (413)786-0193 1040 Springfield Street AN8rEss: Feeding Hills,MA 01030 INsuRERLSI AFFORAING COVERAGE - AX...* _ INSURER a: A.I,M.Mutual Insurance Company 33758 INSUFtsD 1NSU.ER 8: Patriot Roofing & Remodeling Inc I .UBERC' 88 Arcadia Boulevard Springfield, MF. 0113.8 INsuRER D: — INSURER E' I AMAIt RF: + COVERAGES CERTIFICATE NUMBER; REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW VE SEEN ISSLE4 TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQJIREMENT, TERM OR CONDIT! CF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED DR MAY PERTAIN, THE INSURANCE AFFOR ED BY THE ?OLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS. EXCLUSIONS AND CONDITIONS o=SUCH POLICIES.LIMITS SHOWN MAY HAVE 6EEN REDUCED BY PAID CLAIMS. If+ I TYPE OF INSURANCE Ns�WFO POLICY NUMBER M,ppl'W(I (HMOCfrfer LIMITS �K.GENERAL UA9IUTY I .,. `EACH OCCURRENCE 'S { —IST'AAGETO REN COM,MERCIALG�aIERALU.oirl_TY' PR'cM.cES{_eott:rtSncal = CLAIMS.V:ADE I OCCUR f✓ED EXP(Ae)'ono ps'son;, S • — PEO RjNA.L E.ACV'INJURY $ _J GENERALAGGREGA.-E t GE\'i.AG'REGATE,JMIT AF'%_ES PER. 7R.00I.CTS-CC'P,Qn 46„6. f �OLI::( —E7°- I,Y�OC r -zmeiNECSINGLEUMIT $ RUTOY.OBILE LIPSLrr f ;Ea as dm[+ ANY A`J'O SCCILY INJURY(Per 9ersonl S ALL OWNEC E SCI-IOOULEC ECCILI INJI,�iY(Pgr g;pden[; S I HIi«_D AUTOS NQ1+xC:YN T ppg1-,•Da PCF I _^ `_AU DS IPsr}cc Ccrtl ; ---, • UMBI LLA UAB OCCUR EAC-i CCCURRE`10E $ _, - EXCESSUAB CLAIMSMuVE AGGREGATE g 1OEC 1 RETE'.T!ON 5 S ypR RfiCOMPEhSATlO X ITQ,nYIIMI rO ANDEMPIOYERs'uABa1lLU. S f ER ^.n FPpPRIETQ$papCTNER�' CUn'E Y,!1/l NIR AWC-400-7031064.2015A � 911,2015 . 911/2016 ELL EACH a.2CIDENT 5 100.000.00 A FFI ERrtp,EMSE,EX 11 U? U IM4ndatoryin NH) EL DISEASE.EA EMPLOYEE'1 ffLL44 pp _100,000.00 OtSC I ONr: rPERA. O'J$oelow E.L DISEASE.DOUCYLIMrr S 500,000.00 I IIr. 1 oESCR1PT10IV OF OPERATIONS I LOCATIONS I VEHICLES Weaken ACONO 101,Additional Rem arias Schaduie If more space is rsguir'ad) `J CERTIFICATE HOLDER CANCELLATION TOWN OF NORTHAMPTON 212 MAIN STREET SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE NORTHAMPTON,MA 01060 1 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH The POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ®1988-2010 ACORD CORPORATION.All rights reserved. ACORD 25(2010/05) The ACORD name and logo'are registered marks of ACORD gAflQ