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32C-327 (5) 26 WRIGHT AVE BP-2016-1563 GIS #: COMMONWEALTH OF MASSACHUSETTS Map:Block:32C-327 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-2016-1563 Project JS-2016-002668 Est.Cost:$5950.00 Fee: $40.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: SEXTON ROOFING CO 99689 Lot Size(sq. ft.): 8494.20 Owner: DAN JEFFREY A&TALA R ELIA Zoning:URC(100)/ Applicant: SEXTON ROOFING CO AT: 26 WRIGHT AVE Applicant Address: Phone: Insurance: P O BOX 6327 (413) 534-1234 WC H O LYO KEMA01041 ISSUED ON:6/29/2016 0:00:00 TO PERFORM THE FOLLOWING WORK:REMOVE & RESHINGLE EXISTING ROOF 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/4 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 6/29/2016 0:00:00 $40.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner - Department use only r- - • City of Northampton Status of Permit: • Building Department Curb Cut/Driveway Permit 212 Main Street Sewer/Septic Availability .I IRoom 100 Water/Well Availability Northampton, MA 01060 Two Sets of Structural Plans phone 413-587-1240 Fax 413-587-1272 Plot/Site Plans 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 / % ( 4/ r5/7 Map Lot Unit A/6 Gk Zone Overlay District Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: 3-F CIF -0 A h ; dent /jG 1 s i 1/G6,6w#,,Pr, Name(Print) urrent Mai in Ad ///� 9' J s3 - 153j (/nature {- icl ua'1 Telephone Signature 2. uthorlzed Agent: 'p �c�l✓�y I9‘) CSX 3 a—7 Pn/ o ra Name(Pont) Current Mailing Address: �V6U " -3 ce- ?y 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 vi 6. Total= (1 + 2+ 3+4+ 5) 3 g�. �- Check Number /y gO �a This Section For Official Use Only Date Building Permit Number: Issued'. Signature: Building Commissioner/Inspector of Buildings Date Section 4. ZONING AU Information Must Be Completed.Permit Can Be Denied Due To Incomplete Information Required by Zoning The column to be filled in by Building Department Setbacks Front Side Rear 111 Latin= Open Space Footage 1.-- (Lot area minus bldg&paved �i� vnrkin_ d of Parking Spaces A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO 0 DONT KNOW Q' YES O IF YES,date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO O DONT KNOW Or YES O IF YES: enter Book Page and/or Document B. Does the site contain a brook, body of water or wetlands? NO 0 DONT KNOW la YES 0 IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained O Obtained a , Date Issued: C. Do any signs exist on the property? YES Q NO a W YES,describe size,type and location: D. Are there any proposed changes to or additions of signs intended for the property? YES 0 NO ,PJ IF YES,describe size, type and location: E. Will the consuuction activity disturb(�c'l'e`a�ring,grading,e&ration,or filling)over 1 acre or is it part of a common plan that will disturb over 1 acre? YES V NO IF YES,then a Northampton Storm Water Management Permit from the DPW is required. SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable) New House n Addition ❑ Replacement Windows Alteration(s) n Roofing [22 -- Or Doors D Accessory Bldg. E Demolition ❑ New Signs [o] Decks [C] Siding[0] Other[C] Brief Description of Proposed work: /Seiner/' a-i,d $J' p4ir C i o't-, SA JAI/ .&%z7/,47.0, ntaj-t Alteration of existing bedroom Yes 4-No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes 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 9. 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 OWNERSS AGENT`ORRCONTRACTOR APPLIES FOR BUILDING PERMIT l r ,Yi L , as Owner of the subject property S ,}�� ,/ hereby authorize L'/c-*I(./ leeeiI" wr to act on m behalf, in all matters relative to work authorize y this building permit app tion. Onebi ,1 �-el asp, /6 Signature of Owner Da e I, £) 1 /cAY �uG�r ,ea Owner/Authorized Agent hereby decla a that the s atements and information on the f egoing application are true and accurate,to the best of my knowledge and belief. Signed under pains and penalties of perjury. J• Seidesv s Prir�ITJartfe ���' G-/ /, 6 Signature of Owner/Agent Date • SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Not Applicable ❑ Name of License Holder r�e�ye a ✓' �V (-/ /%per/,�/�/' r n G4 License Number L2- it _ d ' J o / ID- S-/ 7 Address - Expiration Date ��ii061 V-d y '7 S — Signature 4Plephone 9. Intend Improvement Contractor: Not Applicable ❑ inci-c vJ g_Oc`T-(✓L 4 //�'�-�9 Co vNa I Registration Number rr - 166t._ c33 0- 15--( 7a- 1 —( 7 Ad ass Expiration Date /43/C 1 JJLN Q/ il Telephone,S3VV/d 3 V 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 0 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 108.3.5.1. 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 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: a/ 47'cAf •S% The debris will be transported by: reap/c Iij6(s-&-G The debris will be received by: ait,/e it pi SoryO-� Building permit number: Name of Permit Applicant t °oe / 'r/ 6&J 'I (.ail,' Date Signature of Permit Applicant firopoot — _ SEXTON ROOFING AND SIDING INC. (413) 5341234 t P.O. Box 6327 FAX (413) 539-9906 iareo;� Holyoke, MA 01041 sextonroofingdyhofmail.com Aram se—ri�isi IL�cn CT HIC #0605383 MA HIC #j1'�18`2399 wwww..sextonro1ofing coon, ce 985 SUBMITTED TO Cr.��C Coot, '(`�`�(J lnpHOWE�� JLnJOa NAME1�J 732 !DATE---_ _i—i\II smEr �4 W V ��y1 y,'�w �/� STATE ZIPCOOE Vert-I,@y« 1040 1e'_Yl �( eco LOCATION � Cr Re-Roof fumlatefe and Install.Off the rofr Main House :] Garage J Shed EMAIL _--_. _1 Proposal ear 9 der qv-6,4„_...t Complete,_/ Roof Preparation �T Fbme exterior to be protected by tarps and plywood T/u�,landscaping,trees to be protected En existing roofing material to be removed to existing decking, Including flashing, etc. tebe cleaned everyday with roll magnet debris removed at project completig / ' l GriCe noramtl existing decking replaced at$2.50 per sq.ft 2 5'" fl nC o as new decking/type: metal drip edge installed at eaves and rakes at—F4 J F-5 S-flfl edge dar Jf ng will be installed where necessary(see Special Requirements) new pipe boot flashing - O Bathroom Exhaust Vent c iermy with new lead 444 shall acquire al appropriate permits etc.for all roofing work Complete Roofing Sy-Mm _. '�9ek Battier metaled a tall eaves to protect from Ice dams(endmost*odes in Ste north) J 3' 1-1(f----- a Leak Barrier ineteyed S MOSS Mound penetrations and chimneys to protect critical areas gig-Anstalt Roof Deck Undedayment onlemalnder of roof O #15 Felt S-e R fiegc Felt Shingles /' /TKO O GAF ❑ CertainT�eed ❑ Tamko / O 30 year a 50 year 4 itetime Color 9.#a J(4C c` t�nstan Attic ventilation system stee``p over Ridge Vent O Roof Louvers Warranty Options &-WB guaranteed our workmanship for 25 full years it {�ereiry to fur materiel and Iaf�t ep n accordance with the above s lifI s,for the sum of: ;i tWl✓ hdf Cay f✓ je9ari�L.,twtlK1f r,tb�Nar�s($ �7 SC!TOIMkVteASFOLLoeM )- �I AV el 1 i MMaerWtaelmeed to be es pealed. M b becormel.dm aemlmWee manna: Authorizedfr J,z ' be Mead Only man mein edea from atom en wt[Icaere ITCMN /TALK(,emofrom atom meaeeuRe over erg Signature //ss �/ O dk.rMe My afierailon on ". y�educau ki adMlsaaee/eaWaaecanhol. Nob:This moose) , — T .Car a per mna.eW lo.M wdhdraxn rowed p iishro dere COnacerdptA i'l ' *x.aw-a% .t..,.l aPadan epdeand conditions soak. ..� ' _ _ -� ap ., d ere atrdtoomo to do the ..C..•tit n rapdR,eprmow.� �J . �. &a eros - --- .leaee ; .. , berrleinee in the Male.° Mae or ebraae areas due to the 000kllitv of milky!donne nr Mira The Commonwealth of Massachusetts —J,, Department of IndustrialAccidents Office of Investigations iltall_ ' 1 Congress Street, Suite 100 �i Boston,MA 02114-2017 J hiww.ithass.gov/dia Workers' Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers Apnlicant Information i Please Print Legibly Name (Bnsness;Orgarlvabor✓Indi;idual.: Sexton Roofing Co. - Address. P . O . Box 6327 City/State/Zip:Holyoke, Ma.01041 Phone ', 41-3-534-1234 Are you an employer? Check the appropriate box: Type of project(required): 1Iamaemployer with 4. I©II TTLageneral contactor andI employees (full . dor parttime)= hare.,`-sr' ed the soli o tractp:s 6. L NeW coat-lux-bon 2.LJ Iam a soleproprietor or parer. listed on the attached sheet. 7. H Remodeling ship and have no employees These subcontractors have g_ n Demolition welkin; for-rasan c- it employees and have workers' Y W 7 9. [Biding addition • POD workers' me ins°space comp:uurence re;u eil ❑ t are cc_pc ti and its 10 r, Blectr z_rep:;irs r'r Eons -1, I am ahome et Iov> all ierk officers r ;acre ped ,tee 1l.H P utbrg xep=_hs cradditions c *e-s' cos re of of exemption per MGL - [No p 12.7 Roof repass insurance emoted_] I c n t 2 31(4) and we,lake DU employees. 7No workers' 13.Ll Other L comp.immures required] _ 1 rising appaczttat checks box#1 mustelso fill our the section below slowing tere workers'compensationpolicy int rmaon. d Hometsmers wino stornit rots nffilnis ineicatnng they rs doing all worn en±gen be late outside contactors must submit a nog a..darit tinning snag Contactors Mat:neck this box mut attached an additonai sheetshawng the name of to sub-contactors and statevhether or not those=hues have employees. If she sub-contractors knee employ:es,i,ey mast rennin iter wmik:_e'comp.policy nember. I am an employer that is providing workers'compensation insurance for my employees, Below is the policy and job site eaformatien. mu mance Company IT:no::__, Policy id or Self-is. Liu 8' Expiration Date. Aid � V�t Job Site Address: ��� (� City/state/zip: < Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to seeme coverage as required udder Section 25A ofNMGL c.152 can lead to the imposition of criminal penalties of a fine up m$1530.00 and/or one-year fprisouraent,as well as civil penalties in the four of a STOP WORK ORDER pada fine pup to$250.00 a day against the violator Be advised that a copy ofthiQ dement may be forwarded to the Ofce of Investigations ofthe DLA for insurance coverage verification. Ido hereby certify under and penalties of perjury that the information provided above is true mad correct Suture,_. - Date:G/lf/ to Phone#: 413534 1234 Official use only. Do not write in this area, to be completed by city or town official - City or Town: PermitJLicense p _ Issuing Authority(circle one): 1.Board of Health 2.Building Depottwent 3. City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6. Other_ IContact Person: _ Phone m: .. • retie— ____— • D par(ne I Indilo i r d enfs 1. Of I ofnes dos Ii• a 600 Washi7Iglort Siteet BasYmt, MA 02111 - - 1 ;vx'w.mass.gav/a'ia - Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print LeEibly Nand(BusiaeulOrganistiorJtodividua:): 7/ ) (5.. CPA 54./:I url-1 0.'..) drl A_ddresS /11- ( 4Q / C;- r at / t �7 --77 Ci /State/Lu: errs=t?Y Li �,'df_,� V.::u1 3 -Phone A': 0l .� - / L/3 — et- Are tie you an employer? Check the appropriate box: : Type of project(required); [I a re a em:oyer with t. ❑ i am a gene.-al contractor and I r oioyees(nil]aadior oar dme)-' - have hired`e sun-contactors6. ❑New cons:mcann 2. I am a sole nropdztor cr putrzr- listed on the attached shit 7. ❑Remodeling ship and have nor employees These.ub-cooQact ors have S. ❑Denolidon word-SAPtenon z �;' . employees andh . leis' - Y F y I 9. ❑Building add'-ion Na -worker' c rp.insurance comp msarnce - ec—:ea] 5. ❑ We. zea sorporattor and its 1QLf Ede Pica]repairs or ad lunons officers have exercised thud I:.❑PPambing repairs or additions 3-❑ I am a hormovvzr doing ad work P rightafexempdon per MGL myself. [tio workers' camp. 12. 5Rooirepi_s insurance required.]t c. 152, §7(4), and we have no employees.[No wurcer' 13.2 Other 5dal d corp. insurance requed.l 'Any:ppbcznrtatchecl-s box#1 most also fill out the section below showing their workers'aomprnsati on policy iniotnetion. Homeowners who submL this affidavit indicating they are doing all work and Nen hire outside conostors must submits now aTdavit indicating such. l'Jsotaetatr that check this box must attached an additional sho-t showing the oam•of[he svb<onaactnrs and sate what or no Lhosc:n tiffs have employes. II the rub-mot-actors have employees,they must provide their workers'prop.policy number. I am an enplayer[hat is providing workers' compensation inscrance for my employees. Below is rhe policy and job site dlforrnaffcu. . ^ / Lociu ce Cn-ipany Name: /?X74 1/`IIL:-I ski Pocky Tor Self-las,Lic #. VWC_ )0/1 G(c /Qco C/b A Exoiradoa Date: 72rI/2. //7 Joh Site Address: 54 h'#t City/S��lZip: l/(ysY � - Attach a copy of the workers' compensation polity declaration page(showing the policy,unbar and expiration date). Failure to secure coverage as required under Section 25A efMGi a. 152 ran lead to the imposition of Cdninal penalties of fee up to $1,500.00 and/or one-year imprisonment,as well as civil penalties a the fo.-mof a STOP WORK ORDER and afore carp to $250.00 a day against the violator. Be advised that a copy-of this satementnay be forwarded to the Ounce of Mvesfeadans of the DLA. for insurance covenace verfcadom Zia hereby certify under the Tains and penalties of pe'Jury_har!ire information provided abape is true and correct Pact-= -e` Phone ht: �.. .1� q -R . Q c 9g Official use only. Do not write in Cl is area,to be completed by clad or town official City or Town: - - PermitiLicenseY Issuing Authority (circle one): 1.Board of Fenian 2.Bnilding Department 3.City/Town Clerk 4.Electrical Inspector S.Plumbing Inspector o,Other - - - Contact Person: Phone 1 ® DATE IMWIroIYYYYI ' acoRo CERTIFICATE OF LIABILITY INSURANCE 0 (MIODD16 �� 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 endorsemengst, PRODUCER CONTACT Leandro Guimaraes UNIVERSAL INSURANCE AGENCY Pa"c"x Eatf (508)752-9333 INC Nol: E-MAIL leandro@universalinsagenoy.corn 374 BELMONT ST. INSURER(s1 AFFORDING COVERAGE HAIL/ WORCESTER MA 01604 INsuRER A: AIM MUTUAL INS CO I 33758 INSURED INSURERS ALG CONSTRUCTION INC INsuRERc: INSURER S II 116 CHAPEL STREET INSURFRE CHERRY VALLEY MA 01611 INSURER F I COVERAGES CERTIFICATE NUMBER: 38399 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. ,NSR. :ADUL SUER POLICY EFF POLICY EXP LIMITS LIR TYPE OF INSURANCE - ,NSD WMD': POLICY NUMBER IMINDORYYYI 1MMDDMYYI ,COMMERCIAL GENERAL LIABILITY I I EACH OCCURRENCE 5 DAMACLAIMS-MADE I PREM ET(a occurrence) ISO OCCJR PREMLSETO ormrtenrel E JN/A MED DIP(Any one person) $ PERSONAL 8ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE s POLICY C r_cT PR T 1 LOC I PRODUCTS-COMPIOP AGO IS AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT -S (Ea amoenll ANY AUTO BODILY INJURY per person) $ ALL OWNED 1 SCHEDULEDN/A BODILY INJURY,Per accident) s AUTOS H NON OWNED I PROPERTY DAMAGE S HIRED AUTOS �AL'TOS (Per accident) _ i I UMBRELLA LIAB 1 OCCUR EACH OCCURRENCE $ EXCESS MB 1 CLAIMS-MADE N/A AGGREGATE I$ DED I I RETENTIONS 1 b i WORKERS COMPENSATION IER i 0TH- AND EMPLOYERS'LIABILITY X STATUTE ER — vPROPRIETOR/PARTNERJENECUTIVE "NI EL EACH ACCIDENT 5 1000.000 A Io aiCER/MEMBER LUDEov N/A i NA I WA VWC10060199052016A 03/12/2016 03/12/2017 'Manmrorym NH) F.L DISEASE-EA EMPLOYEE 5 1,000,000 rues.eeanbbN bobs, JSCRIPTON OF OPERATIONS below 1 LEL LYEEAea-POLICYLArr 5 1,000.000 wn DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES IACORD 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 SEXTON ROOFING ACCORDANCE WITH THE POLICY PROVISIONS. 102 PINE ST AUTHORIZED REPRESENTATIVE HOLYOKE MA 01041 Daniel M.Croowi ,CPCU,Vice President–Residual Market–WCRIBMA ©1988-2D14 ACORD CORPORATION. MI rights reserved. ACORD 25(2014/01) , The ACORD name and logo are registered marks of ACORD ACORD D CERTIFICATE OF LIABILITY INSURANCE DATE 6/30/2015 THIS CERTIFICATE IS ISSUEDAFFIRMATIVELY MSI MATTER OF INFORMATION ONLY AND CONFERSLTE RIGHTS UPON THE BY THE HOLDER.BELOW.CERTIFICATEDOES NOT AINSURANCELYOR NEGATIVELY CONAMEND,EXTENDCORALTERETEEEN THEE AFFORDED THEAUT AUTHORIZED THIS CERTIFICATEOF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed.If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAMMLisa Merritt Ormsby Insurance Agency,Inc. PHONE(AIC,No,Ext):(413)737-0300 I FAX(A/O.No): PO Box 710 E-MAIL ADDRESS:Imerritt@armsbyins.com West Springfield MA 01089 INSURERS AFFORDING COVERAGE NAIC# INSURED NSURER A:Colony Insurance Company 39993 Sexton Roofing and Siding Inc NSURER B: P.O.Box 6327 NSURER C: Holyoke,MA 01040 NSURER D: NSURER E: NSURER 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. POLICY EFF POLICY EXP INST ADD'L SUBR DATE DATE LTR TYPE OF INSURANCE NSRD WVD POLICY NUMBER (MMIDOIW) (MMIBDIW) LIMITS A z COMMERCIAL GENELIABILITY 101GL002159900 5/25/2015 6/25)2016 EACH OCCURRENCE :$1,000,000 CLAIMS MADE E I OCCUR DAMAGE TO RENTED ^RAL $100,000 PREMISES(Ea Occurrence) MED EXP(Any one person) $5,000 PERSONAL B ACV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER'. GENERAL AGGREGATE $2,000,000 Y POLICY FlJECTT N LOC PRODUCTS-COMP/OP AGG $2,000,000 OTHER: COMBINED SIGNED LIMIT $ AUTOMOBILE LIABILITY (Ea accident) ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per AUTOS _ AUTOS accident) HIRED AUTOS NON-OWNED PROPERTY DAMAGE AUTOS (Per accident) UMBRELLA LIAB OCCUR EACH OCCURRENCE 6 EXCESS LIAB CLAIMS MADE AGGREGATE S DED (RETENTION$ $ WORKERS COMPENSATION AND SPER TATUTE ORH - EMPLOYERS'LIABILITY YIN ANYPROPRIETOR/PARTNERrEXECUTIVE OFFICER/MEMBER EXCLUDED? _ N/A EL EACH ACCIDENT (Mandatory In NH) EL DISEASE-EA IF yes,describe under EMPLOYEE DESCRIPTION OF OPERATIONS below EL DISEASE-POLICY LIMIT S DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(ACORD 101.Additional Remarks Schedule,if more space Is requIred) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE V ` ACORD 25(2014/01) ©1988.2014 AGGRO CORPORATION.All rights reserved. The ACORD name and logo are registered marks of ACORD naus d . '.urs osiuwa^ uone: _---v.-,, tOtQ VW 3JIOA10Hx LZL9%08 Od - N01�35 P11=diLg .�- ti Ei Edc cs _nc uc-_Fi,3LC 888660-1v sp ePL is cue_ suoilernca 6 aorl n Aia opand;o uamueaa- si2esn .o Puev) ® G ad 51 Sp 40E5'2�A) 0 Y'C V/,i EliJ.0 J_ r.IT I c _I i;-1=n: 9ee0z =1 LI/Si/Z u..r.- 0D N "L�0a 1 _ c.-`-l1 -acr_�_rN — - — y- � , ///,--":._71 .+= /--� n , .`f "ice: F .F9rF �i