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12C-060 (5) 16 CLOVERDALE ST BP-2017-0171 GIS a: COMMONWEALTH OF MASSACHUSETTS Map:Block: 12C-060 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-2017-0171 Project!! JS-2017-000279 Est.Cost:$5200.00 Fee: $40.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: SEXTON ROOFING CO 99689 Lot Size(sn. ft.): 10018.80 Owner: WYLDE ALAN S&SALLY D Zoning: R1(100)/URA(1001/WSP(100)/ Applicant: SEXTON ROOFING CO AT: 16 CLOVERDALE ST Applicant Address: Phone: Insurance: P O BOX 6327 (413) 534-1234 WC HOLYOKEMA01041 ISSUED ON:8/9/2016 0:00:00 TO PERFORM THE FOLLOWING WORK:STRIP & SHINGLE ROOF MAIN HOUSE ROOF INCLUDING FLAT 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# Foundation: Driveway Final: Final: Final: Rough Frame: Gas: Fire Denartment Fireplace/Chimney: Rough: O1: 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 8/9/2016 0:00:00 $40.00 212 Main Street, Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner Department use only Rt..10:n — 1.1 'ty of Northampton Status of Permit: ZG10 B 'Iding Department Curb Cut/Driveway Permit 0g .12 Main Street Sewer/Septic Availability Room 100 WaterNJell Availability or er„�,-1 nr7r:-ii•- -mpton, MA 01060 Two Sets of Structural Plans tic0 of rao:�"'*'�• one 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 /G C'G Map Lot Unit V / /Z >/ // Zone Overlay District riogr-{'fl _ Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owwner of Record: Na(e(Print) S P IA4 Lu 1 Current�Mailing Address: y s r IA(Prif c- Ca . r 4A411, l z. ; — � l�s, - �� Telephone Signature 2.2 Authorized Agent: Nam 'n) I Current Mailing Adress: jeCef Shy,/ a3V 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 tea 6. Total=(1 +2+3+4+5) 3.-; 2nQ Check Number /5/S 4 This Section For Official Use Only Date Building Permit Number: Issued: Signature: Building Commissioner/Inspector of Buildings Date SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable) New House n Addition ❑ Replacement Windows Alteration(s) n Roofing ❑/ Or Doors O Accessory Bldg. E Demolition ❑ New Signs [O] Decks [U ] Siding[p] Other[CO Brief Descri•tion of Proposed Work: Alteration of existing bedroom Yes 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 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 CONTRACTORRAPPLIES FOR BUILDING PERMIT I, _R I�I /u/It t , as Owner of the subject property Q a hereby authorize Se- 4 a- Lei I i �r11 to act on my behalf, in all matters relative to work autholhed by this building permit application. Gila A e. C. Signature of Owner Date j L • P 11 ` , 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. &,-rill5* r Print Name Signature of Owner/Agent Date 0/0/( SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: -(' C Not Applicable ❑ Name of License Holder: [� ��[/ J 1 �] 1—ti'J 9'4 6 _ License Numge/ r _ C =» kit l.K) m - / 7 Addr:.s Expiration Date t2ou- 3 y71_— Signature Telephone S.Realstered Home Improvement Contractor. Not Applicable 0 4r >. I v6,/f r Y j- 3 yyCompanypp�� Name Registration Number Address Expiration Date r7U L tic) Z,.."0/4:1Q &tj / Telephone 35 c/�1� y 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 0 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 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 l The Cornonconnioiecirk of;15-asatoonoo.o25,5 z. D ,0az7 0 1 0. " 2..nr P '—`a1 Con fres s 57 6 e".1, 4 00 ,--40 .mass g 0100142 rk.ats, toc,mpeasatiOr, i.'2i:.rance ' :fa-Lwit: b� tde-s?Centrntt sX..edi ci nsT1r_ bers Br-BCe_3i TT forts"z;.tion Please Print LegblT D .v-,ess, g,m oLinonnoo Sexton Roofing & Siding Inc , __ P. O . Box 6327 GiciStgegli6Holyoke , MA 01041 -_-. 413-534-1234- -c s._ v *_ - _ _ .,ym Li acne-u c H1 ' .1 . r ▪of dt” c5L..` y o 0 1. s skateP a ranee- : 4.cs_w. . erapicyen .s or I I 9 .�� 4 .raai`a =rune I' r =nuance - . v ▪ a:or} . arii_t; _0.'_-I= c „ r ,C %:i' a: .n .ona I .ana D - 2 —�r,W2 o m e r >o a au __ :t¢s ^„'"'.uas I __ ' T > > a✓ar j S�a ,o .,nE,. 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Di:u caecao:r L d ✓ cue- or toi -:aci III 11 Cati. or oTMz F r=lai:arise hIs ss c} Cor 1e on II 1 Ford o`Ee_ n 2 BkrarkrakDepennert 3 C taTkr-t Clerk 4.Deroono2LI nnspeetc: 1 PA ' LLtxg Lspecier I 16. Oner ....._ _ - - C :uct er,oa'. Phone e- i1 ' .... - _.. ___ - 2.. _� 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: f t. C/a-vdk /c Yy The debris will be transported by: O®, �,u.Z 5 S fn�s� The debris will be received by: 4 B°p t.% Building permit number: Name of Permit Applicant 410 //G Date Signature of Permit Applicant y_ .v .. .L tc Gj l-et f.GCS pp 1� 400 as i T: d 5: e f9 f .do / ITA 027 71 .V1571t Workers' Compensate n Ideardeco Affidavit: Bt nders/Coutr aorsITlect iciaess,iiumbers Annlicent ln`orena.tion Please Print Leeibly A ^tuse-sctp c cl.xaa0m3d u ): '� ' L Cr,✓1 c..! - ! .c:1 ;i 2 i AdLesS //i ( %ADL- I 1, to Zip Cs PIA-7e/2; ,.) 1 C 1. rb. ,ne.6': ,n/ 0 %;u�_) - es 9.c A ce ertapl v r? Check:112 appropriate both w l _ 14. N Ethers] con-sector and 1 E. of - , huts h:ree.Le :!bnaotos 6 eNw coy ___ mh. e c r 7- 7s)l` ".� -L21:2:2:^P12:2222omw.:. 71ibs. h. - C s. � C1 aelm¢ tap aunt harp - P _e thresh sub-En:mast=hat A 0 them n workires for Ink thy cava e sum myths and haws septhesth j0 i-" E v IClcn I Zo c c - r 7 �wm e s o >r .ten I l_ q,; L1 5. v e vol 2 n and-sI 10 —[Elsrecal reoids e a u'ronc EI v.a n bs712e ngoilwori '&Z13 hc ethethissdtheir l.E ji-m grepars or ua.,rss ✓ 'ti - r SST= re' rp. so e MGT, 12.[r rr'r .repai.; t,menserequh .]` c 152, 91(4), d _saxo _ em cyees.N:• Le_s 13.L Otte S 1 [4.! comp. ctsurmce r-gtred.] 1 ants ar " � box MI rust aiso:ki out to se boe Ie nka uak_ _ pes uFancy infor :wan. ..-.... . bmits tont- omens n N';7:.o.:.vit IId drgCary_-»hmg.2 work the L,. rrLr and must [e wt not otooc Imitating a .�. gout= 5ft e. ndNe can s have emp Lx ,the m al tthe °.Meir waken' of tho o . and swtewselh nl :en'atins hzVe qmplones. If Mitt sui<on nclnn have amp loyoes,they must yovlde Mei r..w.lvn'ctmp.pollryn umber. - ;am an emj;rkyar rhat is provi roarkea'rornperscrion insu;.once for my Eq;Dfoyees. ask IP i;:he volicy nett Joe site }yea.- a s'r.-, c r ,.n_y'vaW:o: /Fi %v i Clnl U?in.,( t17v S . (me . _ ...._ c,G'cy or 'e;.i-iae,U: re: V (k1 C. J(/1 (o C/Q90C _(.:j/c A ErnizadonData: L65 I/7 /7 Jei Seta Address:: °OitytStelZic:-..... SYach a copy of the workers' comp ensa can policy d_claradDa page fshocriag the policy number and expiraLon data,). =arm %sate coverage as requhth=for Section ESA „T ertitT, 152 can-cat to the theposairra of c nzinel peralttes of a 9m to 21,522.35 dor Oar-r2217 27222222502==t,u_m_d_s shams thin ansf a STOP WORK ORDS ands i_ of p to F25.0 30 a day aF;a *sst the violator. Ee adviser Lhat a cow;tfthis sa :meet may Cis toraerded to'the Ouc_of Imes3oarions of the CLS for izs;rs_ncs=sera es vc;fl5ca5or_ 2eh Pent aer4i,andet the pmns nd p_.._fes o, A 7.des:J:14T Setherthsrlon provid=e abcpe thue a i corrac_ _ we Qrs 7 :s_c,.ly, ors e l.is : ec, to be car piered ey red or:61f."7 off r/cL City or Town: Per nut License,: !I Iss_ing Authority (drele one): LBeard oiE_1b 2thistailthinhpe.2rtment }.City/Town Clerk 4. Esc"Aral `Inspector S.PlumbngInspector E.Otter - Contact Person: Phone#: - Prrel SEXTON ROOFING AND SIDING INC www.sextomoofng.com , IIMOwier-asTER Setting the Standard se a �L___ ` P.O. Box 6327 ataems�iZra�,im� p. 413.534.1234 Holyoke, MA 01041 f. 413.539.9906 MA HIC# 118239 sextonroofng(dhotmal7•com SUBDBTFBD TO Sally Wylde PHONE 3206965 DATE 52-16 STREET 16 Clovadde St. JOB NAME From MaInRoof CITY,STATE,ZIP Floae ce,Ma. JOB LOCATION SEXTON ROOFING HEREBY SUBMrTSPBCIFICATIONS AND EffIMATes FOR: 1) Strip and remove etisdmg shingles and dispose of in proper landfill. 2) Inspect roofing deck and replace as needed. (12.75 per sq.ft.) 3) Install new metal edging to rakes and eaves of roof(8") 4) Install ice and water shield as ewes(6'),and arena skylights. 5) Install#15 synthetic roofing fek on remainder aloof 6) Install starter.Singks on eaves and rakes of roof. 7) Install IRO Architectural style roofing shingles as pmmamfam.am'specifications. 8) Install 2 new roof lamas. 9) Supply manufactures lifetime warranty and SRC 25 yr. wohmans1ip warranty. �� ALL CONTRACTS INSURED WITH PROPERTY LIABILITY AND WORR6(ANSCOMPENSATION. Y1V 6 Pr0¢eseandaprr hereby to furnish material labor—complete in accordance with the above ifteations,for the amount of /Two Thousand Four Hundred Dollars(f2,400.00)Payment to be made as follows:Due in full upon completion All Material is guaranteed m be as speed. All wale lobe completed in a Aid workmanlike manner according tsmadatdcodices. Any al®uma Sim deviation from above specifications involving eats tan wnbe eaeaed only upon wnnen ceded,and will become au tan mare over and ohne ate estimate. All agreements cooing=upon S accidents or delays bested Note:This proposal may be withdrawn by us if not accepted our tonnnl. Not responsible for warm damage dining construction. Owner witthin(1,0 days. to pay responsible legal f a for and app1Aeablemrmat. Arta-to - Pmts The above Sifnanne `� prices,specifications andconditions are satisfactory aare SSignatureA '41 le ------1 ® BATE(MMloonn\m A o CERTIFICATE OF LIABILITY INSURANCE 03118.12016 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 endorsements). PRODUCER q°me CT Leandro Guimaraes UNIVERSAL INSURANCE AGENCY Ric No Eno- (508)762-9333 I lac Not: ADDRESS: leandro@universalinsagency.com 374 BELMONT ST. INSURERISI AFFORDING COVERAGE NAIL WORCESTER MA 01604 INSURERA.: AIM MUTUAL INS CO 33758 INSURED INSURER B: ALG CONSTRUCTION INC INSURER CI INSURER D 1 115 CHAPEL STREET INSURER E:_ CHERRY VALLEY MA 01611 - 1 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. NO'wI1Hs:ARDING 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, EXCLJSIONS AND CONDTIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. (NSR, [ADM SUBRI I POLICY EFFPOLICY EXP L D WM TYPE OF INSURANCE (NSVD' POLICY NUMBER ITAWDDYTI I IMMNONYYM I LIMITS I i COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE I $ F REM(E I O HENT] GLNNS M4Dc �, OCCUR PREMISES(Ea occurrence) I $ MED�(Any one person) I e III I N/A PERSONAL 8 ADV INJURY I $ ITL NGGREGATE LM,T PJWuES PER GENERAL AGGREGATE I S LPOJCY JET LOC kPRDDUCTE-COMPIOP AGG 1£ I O'HEa. s NUTOMOBILELIABILITYCOMBINED SINGLE LIMIT E (EaBODILYe evJoenr ANYAUTO JURY(Pari person) I I IS ALL OWNED gcHEDULD I AU-o6 OTOS N/A (BODILY INJJ RY(Per accident)1 S in—' NON-OWNED PROPERTY DAMAGE IS DREG AUTOS AUTOSgLR06 � (Perancient` S I ' UMBRELLA LIAR H OCCUR I EACH OCCURRENCE l5 I EXCESS LIAB CLAIMS-MADE N/A I AGGREGATE I s JAD RE-ERGOTE H WORKERS COMPENSATION I IX 5TRTUT- I 19Th I AND EMPLOYERS LIABILITY Y(Ni JP NYuROPRIETORARTtu RIEx O E E.U.IE c ACCIDENT I £ 1,000,000 A OEF.CEREMEMa Ruw aDE M AI'WA A VWC10960199052016A 103/12/20161 03/12/20171 (Mandatory in NH) ; I E.U.DISEASE-EA EMPLOYEE! S 1,000.000 UI yes.describe under I !DESCRIPTION 3C OPERATIONS below, C.L.DISEASE-POLICY LIMIT Iib 1,000.000 I N/A DESCRIPTION OF OPERATIONS I LOCATIONS(VEHICLES 1 CORD 101 Add,t,nnal Remarks Schedule may allached if mere space Is required) Workers'Compensation benefits will be paid to Massachusetts employees only. Pursuant to Endorsement WC 20 03 06 5, no authorization is given to pay claims for benefits to employees in stales other than Massachusetts if the insured hires,or has hired those employees outside of Massachusetts. Ths certificate of insurance shows the policy in force or,the date that this certificate was issued(unless the expiration dale on the above policy precedes the issue gate of this certificate of insu-anoe). The status of this coverage can be monitored daily by accessing the Proof of Coverage-Coverage Verification Search tool at wmm..mas.govilwd/workers-compensatioNmva'dgations.1. 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.CroWIey,CPCU,Vice President-Residual Market-WCRIBMA 171988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD ----Th SEXTO-2 OP ID: ER ACORO CERTIFICATE OF LIABILITY INSURANCE °A,E,MMDD 4.----- 07/0712016 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 policylies)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 Eric Dembinske Ormsby Insurance Agency, Inc. PHONE FAx 698 Westfield St PO Box 718 lac.No,Eel:413-737-0300 I WQ Net:4134374617 West Springfield,MA 01090 EE4RAIL Eric Dembinske ADDRESS.. INSURER(S)AFFORDING COVERAGE NAIC p INSURER A Atlantic Casualty Ins. Co. INSURED Sexton Roofing &Siding, Inc. INSURER B:Quincy Mutual Fire Insurance .15067 PO Box 6327 Holyoke,MA 01041 INSURER c • lINSURER D: SURER_ IN RER E: 1 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 ANC CONDITIONS OF SUCH POLICIES LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. TYPE OF INSURANCE OL u�BIR POLICY EFF POLICY EXP LIMITS ANSD IVWd POLICY NUMBER IMMIDDC VYY) !UNWOUND/11 LAR X I COMMERCIAL GENERAL LIABILITY i i EACH OCCURRENCE I$ 1,000,000 DAMAGE TO RENTED CLAIMS-MA?_ X 1 OCCUR 101GL002159900 06/25121116'O6I251201] PREMISES(Ea Occurrence[ I a 100,000 _ 'IMED EXP(Any One person) $ 5,000 PERSONAL d ADV INJURY $ 1,000,000 SNI AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE £ 2,000,000 POLICY I I PRO. LOC I PRODUCTS-COMPIOP AGO £ 2,000,000 1 CTHER I I $ AUTOMOBILE LIABILITY I I COMBINED SINGLE LIMIT $ 1,000,000 _ 1 Ea acclaenn B Imo' AAUTO iAFV206561 95/1512016 OSH El201] BODILY INJURYJU (Pe.Fe ) $ 1 1 ALLUOWNED X AUTOS _D BODILY INJURY(Per accident l £ XI X NON.OWNED PROPERTY DAMAGE $ HIRE.AU Os 1 Ad 0S (Pe,accident) UMBRELLA LIAB 1 OCCUR ' I EACH OCCURRENCE 1 $ EXCESSCESB LIAR I CLAIMS-MADE I I 1 AGGREGATE I $ • DE] I RETENTION£ I I WORKERS COMPENSATION 1 STPTUTE ERµ AND EMPLOYERS'LIABILITY 1. IANY PROOnRIETORIPARTNERIEXECUTVE . N 'NIA EL EACH ACCIDENT S I MHER EXCLUDED? I(Mandatory in NH) I • 1 E L DISEASE.EA EMPLOYEE $ yes describe de, 1 Dside,OR OPERATIONS been EL.DISrASE-POLICY UM:T £ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES {ACORD 101 AddiiUenal Remarks Schedule.may be attached 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 Everett Sexton ACCORDANCE WITH THE POLICY PROVISIONS, AUTHORIZED REPRESENTATIVE Eric Dembinske ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD