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23D-049 (3) 101 RIVERSIDE DR BP-2017-0343 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block:23D-049 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 N BP-2017-0343 Project# JS-2017-000562 Est.Cost: $8000.00 Fee: $40.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: SEXTON ROOFING CO 99689 Lot Size(sq.ft.): 14157.00 Owner: SHENEFIELD STEPHEN Zoning: URB(1001/ Applicant: SEXTON ROOFING CO AT: 101 RIVERSIDE DR Applicant Address: Phone: Insurance: P O BOX 6327 (413) 534-1234 WC H O LY O K E M A 01041 ISSUED ON:9/13/2 016 0:00:00 TO PERFORM THE FOLLOWING WORK REMOVE AND REPLACE EXISTING SHINGLE 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 Department Fireplace/Chimney: Rough: OI: 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: FeeTvpe: Date Paid: Amount: Building 9/13/20160:00:00 $40.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner / - Department use only City of Northampton Status of Permit: ' v , Building Department Curb Cut/Driveway Permit c`6/ 212 Main Street Sewer/Septic Availability ✓ 1 z Room 1O0 Water/Well Availability h� �39q° Northampton, MA 01060 Two Sets of Stmctural Plans. 6'a phone 413-587-1240 Fax 413-587-1272 Plat/Site Plans Other Specify PPLICATION TO CONSTRUCT,ALTER,REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION 1.1 Property This This section to be completed by office x,101 .--lwtk--ba t( f NSMap Lot Unit "' DQ+)`^nVOn, -Mk` Zone Overlay District Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: atQnhen SheneL11eld (m040(s non damx /69 t rk A-UQ a rl i rfrn —m4 naunio isName(Print) Cunent Mailing Atltlress' �� 0nntr00* n' 14`1Q0k TelephoneS/L�—�tO�O , Q Signature 2.2 Authorized Ayent: Yia inn, o .En 10/3-)q fbLo -e ,71A Cn( U Name(Print) Current Mailing Address: UI3 — S31-1a3L{ 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 p 6. Total=(1 +2+3+4+5) ,�.O Check Number /54/5" ii.11. This Section For Official Use Only Building Permit Number: IIYY��ii''/ Date — Signature: ¢ /Q Building Commissioner/Inspector of Buildings Date • SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable) New House n Addition ❑ Replacement Windows Alteratlon(s) ❑ Roofing Er 0r Doors 0 Accessory Bldg. ❑ Demolition ❑ New Signs [o) Decks [M Siding[MI Other[0] Brief Description of Proposed work: IP ./(1: (11Y rQ(1Q(Q Pui4 ria;(1;/�' (00P Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll -Sheet ea.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 CONTRACTORC�\y� IAIPPLIES FOR BUILDING PERMIT I, eph v \ 11 1Q n�`Y1 Y `is , as Owner of the subject property I hereby authorize 9k�t0n 1 WY'il to act on my behalf,in al relative te work th dzed by this builging permit application. Onrij cf- C achA 917/lip Signature of Owner ,r / q/� �i1�1/l Date I, / ��Y �'/ �gf,2 i.Wr/n as Owner/Authorized Age ereby dee are th t the statements and inform io on the foregoing application are true and accurate,to the best of my knowledge and belief. Signed under the pains and penalties of perjury. F/Pmdf Art Print Name y/7 Signature of Owner/Agent Date SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor:: /, y%Nott Applicable� ��7 �bl0 Name of License Holder: 4/49/egi Jt\�' (/n 2 License Number Adp(,IOx (gaY / ie 4 ()/ 1/ Emco/5 iragen 7 e ./T.5-Yil-Q3y Signature / Telephone 9, stared Home ImRrpyMl nt Contractor: Not Applicable 0 exon i6 -1/n i/KR-32 Co an Name Registration Number f U .duk (J917 164re 774 (' UXGI a/i ��Address Expiration Telephone -]1W-D7/J 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 ,jij 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,las definedL9by MGL c 111, S 150k Address of the work: IDI AI M2XIXUO)k 43d� )1r, hopt, l, 4_ The debris will be transported by: Q,orni 2+Q 1DHpoyc / The debris will be received by: Coryt pi c c )IS(r0 j Building permit number: "� ��" Name of Permit Applicant Q�Jt x ( rs100ci6 Date Signature of Permit Applicant j9ropofai SEXTON ROOFING AND SIDING INC www.sextonroofing.com 41/X0IP" MASTER tinting ffic Standard fatirs=m-- altessitook,w ____t ar'���`igt. P.O. Box 6327 p. 413.5341234 Holyoke, MA 01041 f. 413.539.9906 MA HIC# 118239 5extonrpofingahotmail.com SUBMTITED TO Stephen Shenefleld PHONE 617-510-1664 DATE 8-2-16 STREET /59 /3;',&gfr-r_ JOB NAME Mothers House ... CITY,STATE2IP Ar/!n, /a., 67,9 Ca2W 71 )08 LOCATION 101 RIvesbankRd.Northampton.Ma. SEXTON ROOFING HEREBY86SMITSSPECIF)CATIONS AND ESTIMATES FOR: 1) Strip and remove existing shingles and dispose of in proper landfill. 2) Inspect roofing deck and replace as needed. ($2.75 per sq.ft) 3) install new metal edging to rakes and eaves of mot(81 4) Install Ice and water shield 6'on eaves of main roof and on entire back porch,around chimney.and at intersecting roofs. 5) Install#15 synthetic roofing felt on remainder of roof. 6) Install new flanges over existing vent stacks. 7) Install starter shingles on eaves and rakes of roof. 8) Reflash chimney with new lead. 9) Install 1KO Architectural style roofing shingles as per manufacturers'specifications. 10)install new cap over ridge vent 11)Supply manufactures lifetime warranty and SRC 25 yr.workmanship warranty. x{a Tint udry try-44Y reArt- &ftr' ''°eY'S'gi'- -,° t' efit LA'15iv,/.4'40 6' be ase .l ALL CONTRACS INSURED WWW PROPERTY UAaILUEY AND WORKMAN$-COMPENSATION. We.$torose hereby to furnish material and labor-complete in accordance with the above specifications,for the amount of Eight Thousand Dollars($8.000.00)Payment to be made as follows:Due in MI upon completion Ali Material is guaranteed to boas specified All work to be completed ma Authorized workmanbke manner according to standard practices.Any alteration or Signature deviation from above specifh aeons involving extra costs will be executed only upon written orders.and will become an extra charge over and above the estimate. MI agreements contingent upon mikes.accidents or delays Note:This proposal may be withdrawn by us if not accepted beyond our control.Not responsible for water damage during construction. within(14)days. Owner to pay : .. ble. = fees for nom,.. cot andapplkable interest 1f aplena of"rope! The above prices,specifications and conditions are satisfactory and are hereby accepted. You Signature rt�' are authorized to the work as specified Payment will be made as outlined above. Signature Date of Acceptance. The Coinr;aonecih of kTassc_i:zseit D7 'Ntmen 'IndvsvralA idents Off e of Invest t ns 'emsT - 1CongrsSSieef, SuLe100 Boston I44021. 2017 vvorkers' Camper sationTvnlarance davit: Bnlders/Contradors,Z1ectricin vT1-nnbEIS ka^Lcznt Ttufrnatior' - PIemseprint T_e_Et1v 13=e 3rrucesstesua onctiC.d). Sexton Roofing & Siding Inc . Ad�±ess P .O . Box 6327 Ci?/Sty/L±n Holyoke, MA 01041 Phcne m. 413-534-1234 Are you as enployer? Check the appr op nate ho- Cape cc pie]ed(reo reap. 1 �] I am a esployer 4. ?m en rz_w a r _ 11 1 r. Uscioa=teea a L f sr eir 1 7 n D reL` situp 'Paribas.e a soyses These sabreont-actors hues 1 1 e. 1121 reser rienur ?.'arktlg for 1e n any capacity �1 J es a=a ha-65 T+O.ke=['=floe ] r. es �I � 'LE :i=ASG" L'Q 'work ' can=-±truce 5s.. ee — - ragrnedj 5. f ..orlon 'xrn 2adits '.❑betoirr -rso d o a _ — y of�cn -hart se�rdeedthoi n P 11 tong eCz'=:or aah^ ; e -.a I=m at>on�rraer dais aL w or_ n- �o Fo� s ng .ezenproanMEL i srnnnx.a' 152, §1(4), anwe have no ILc- 11 A.-I 0.3er e loyeesPioaorksrs' son?.=race re2ce3j .III, Lr leo .:Etna=Gass hal lease clic a 'or-Le sec5anb owirsigasw'sisne c upeas - plum nio=stio-_ c who submit-Es aEo43- maanthsvrse don '' co Tnia tLcnav -sa . matins t w anam.nmce _such c Pica gere that ceeck bonmusr athehed an adacEacal Eget sic-Eng foe Ganso—ft,he stfunsninams nal state whe5e- actUric crones have e snplw;eu =me s ao-wnt acton'Lmve emxlhy cs,tae}mrprcnist an w:.3r.ns' :. = policy rrbx. ▪inn an E1717.:03.'ET t ' s. 3'ng ro F _,r _nnue a_ jan y cr_57,570,5us 3.low t -7-b 57e. ksww'sce Cc-' .Ely Niches Polley# r]el_-ns.L15 a. ElriT3 oiDatC: 73o Sue -resat - e cru-cf ecru o:taew=rkers' agraTelsrh a Policy ire larann_ __ Pic pons n=. i d=rat n _ `a1rcto strong ccte - a reCned Sder SecSme? gill= c 15 car'sults h -rocs c cX_ --p - _s0 ren to d1,5C".00 aril co out-7u tnpriscarrent, rs woll as envoi malts nMe fart.Cf a_-C wCrJt 0.7111.1P.ani.E e gy p to$250.00 a g . a nct Le usiatoi Be ain.. That a top- ..-L statement o forroureei to rho OUace A --eesuganors cfrhe DLA fore crane coverage wentscarph I doh eby c_,y0+ ..endecr the Da5s21edpe^-a7±zes prferc, :.ler riperuch eel peoe e cjore-ke ze ruec--a-0^zU Sutra-cut Date' Phone#- 4135341234 - - 0>ksiI use onLy To nog write rn this area,to ba cern;Toted by cep or enxn cffid¢L City ler Toys. Pernitfficease f Issviny Authority(crude one): - 1 Boaid eXHealth 2-BuBdm Defa Lunt 3. Cfty/Tom Clerk 4.Electrical rrsrettor 5 Phrnhsg bapector 6. Other Contact Persen- _ Phone .: �i s N De_u,vrare;aoflrf str: Auld is Office of Investigms a; �+'1600 Washing on Street Bostmr, M_A 02111 \ w w,mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Centractors/Electricians/Plumbems Applicant Information Please Print Legibly Name(Business/3rgaristlomndividuali .4 / Ci„lc-fit/ur,� o Gf _L;JL Address: if4 C/1,ap/_/ 45 Ciry/State/Zip: C gic C'e i r l ALL V ret r Phony.ar: IC 1°`7 - USS _ C'/ Sy 9• I .Are you an emoioyer? Check the appropriate baa: T _ t're-oia : y:eof urajec / _� z 1 G C' I e 1 cont-actor L,d I 1.[amu ploye with r o E mea consmarr= e Coye s(hC andlor parr-Cure; = h e mcnha. ors 2.❑ rz.�esoleprooret- rpcn[n_ 1 r o theattachedsh _t. D Rem 1'._g ship and have no employeesl 8. ❑Deus:Coa employees tar'- ..kers' I aorl.'r- for me in my cepa:lint - o E PuildLrg aninlcity, i To workers' comp nsimce comp. itsuraace I. regau.edr 5. G Wee a cotpore n and is .❑Eiecircal repairs or andicone 3.ffl 1mm a homeowner doing all work officers have exercised ?heir 11 ❑brombirg reparcs or additions right of cuemndon per MOL myse}f. END workers' comp. - 12-71"Roofrerzds insurance reaed. t :. 152, §1(4) and we have no =Mayen.[No workers' 13.�Omer SSi n d compcssaace required.] 1 / Any apphaant thatehe:los box m1 must z:so nil out the section below showing their workers'compensation policy infocatien. lava-downerslava-downers who submit this affid nit indis:ng they are doff g ell work and than hire outside antra tors ars submit a new a5dnit indicting much. 1Conrarors that:beck Pfs box must attached an additional sheet showing the name of the rib-coneadnrs ad state wheelies;moot Goose anti do have employes. If the sub-ma rectors have employs,they mus:provide their work:es'comppolicy number I am an employer Ohm'is providing workers' compensation:rsarance for my employes. Below is[he policy mid job sire irforrnatio n. • [A LICo ,e_y'_iaae: 4/I4 C✓-t/'I'�f:-I /D'S . cr. ?occvmor Se ns.Lac.#: YUr _ /(1/1L> I g90-v1(an ExpiaaonD=_te. -47) l /L//7 Job Etc.Address: _ City/StateiZio: -. 2uch a copy of the workers' compensation policy deo:aranon page (showing the policy number and expiration date). - Failure to secure coverage as requiter under Section 25k ofi4CL c. 152 oar lead to the imposition of criminal penalties of a not up to 5 L500.00 and/or one-year imprisonment, as well as civil pe^_a lies n the foam of a SRO?WORK ORDER and aline Orap to 5230.00 a day agai=n[ the violator. Be adviser that a copy of_-ds sn:ement maybe forwarded to the Dace of levesdeanons of the DIA. for instrance coverage ve4ilicanoa Ido hereby cert order the pains and penalties of deduct:that Lie i'lin cm dim provided above isarea and ca.:rat Sl'+*,as=r _s Dao.. Rhone 4: 1,... 1 ±± q Ll 9C I, 't OTciel use only. Do nal write in This area, to be completed by city or town offietaL Lily or Town: Pe.-:nitil i cense 8 Issuing Authority (circle one): . 1.Board ofHealth 2.13 nil ding Department I Chy/Town Clerk 4.Electrical inspector 5.Plumbing Inspector 6. Other IContact Person: Phone`;: • ActRd CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDNENTY) AE(MWDNENTY) ire....---- 03/1B/2016 THIS CERTIFICATE I5 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(SI. AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(les) 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 NPME CT Leaner°GWmaraes UNIVERSAL INSURANCE AGENCY PHONE EM,. (508)752-9333 EiN,,.,or ADD SS: Ieandro©universalinsagency.cam 374 BELMONT ST. IasuRERtslAFeoRnwccovERA3E LANKY WORCESTER MA 01604 INSURER AIM MUTUAL INS CO __ 33759 ..... IN WRE0 INSURER 9: ALG ALG CONSTRUCTION INC INSURERc: INSURER 0 116 CHAPEL S I NEE? MEUR_ER!: CHERRY VALLEY . MA 01611 INSURER F: COVERAGES CERTIFICATE NUMBER: 35399 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 Bit ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED EY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS. EXCLUSIONS AND COND:T IONS OF SUCH POLICIES LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. • UB0 POLICY NUMBER POLICYEFTI,'POLICY EXP I LIMITS INm TYPE OF INSURANCE I ,• Iwo 1'IM r: moon aY ' COMNIEREIAL GENERAL LIABILITY EACH OCCURRENCE I t I 1iOMAbE1ONENT ens` DLAIMSMASE CI OCCUR PSEMIS-S LEE ocAnr 5 MED EYs.ff(Am one oelroml I F NIA I PERSONAL&ADVINJURY �TI$, GEEN&AGGREGATE NMI APPLIES PER GENERAL AGGREGATE IS I POLL I I Ate Li LOCrH RODUCTSS.CJM Io&AGs I s .OTHER. I I- i AUTOMOBILE LAME!, i... Ia -COImINeniE GLE LtMrt !---1 I ANY AUTO rrTB---ODIL JIJRY(Perp .so l 6 1 LOWt4EO &NODSSCHEDULED l N/A I BODILY INJURY tletlil ( nc5 ON-S I I HIRED AJTDS UTOawuc'n PROPERTY I M SRN ,G •.. _....� AUTOS ( n r — I F UMSRE LA IAB _-... OCCUR O RREME j_jF I EXCESS LIAe E :S I cuIM5.MADE N/A I AGGREGATE t_ DED RETENTIONS _ f i (WORKERS COMPENSATION PER PTH I AND EMPLOYERS OABILITY X'ETA JTE R (AwCRROPROTORW RTN %9CINSVE VIN � Ill EL EACH ACCIDENT F 1,000.000 A ra; e O. IwAI WA I NIA VWG100601a9052016A -3/1212016. 03/12,20171- )(Windom), i NHI i E.U.DISEASE EA EP _E)s 1000,000 txes.a nI _ .OpSUR rod OF underPERA-ION5 seism EL ass E-POLIOYL T ' F 1,000,000 . N/A 1 DESCRIPTION OF OPERATIONS/LOCANONs I VEHICLES (ACCORD Int Atlditenal RamaMa Sunptlulq maybe Planned if more space is required) Workers'Compensation benefits will be paid to Massachusetts employees only.Pursuant o Endorsement WC 20 03 06 B,no authorization Is given to pay dams for benefits to employees in stales other than Massachusetts if the ensured hires,or has hired those employees outside of Massachusetts. This certificate of insurance shows the pokey in force on the date that this certificate was issued(unless the expiration date on the above policy precedes the issue dale of the certificate of insurance). The status of this coverage can be monitored daily by aCCessing the Proof of Coverage-Coverage Verification Sear&tool at www.mass.gov/Iwd/workers-compensationdnvestigallons/. 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 AUTHDRZEn REPRESENTATIVE HOLYOKE MA 01041 A-1 �Co- t Daniel M.Cro v ay,CPCLI,Vice President-Residual Markel-WCRIBMA ©1988-2014 ACORD CORPORATION. All rights reserved. ^^^^„ ^^^f ^^ ThP AGGRO name and logo are registered marks of ACORD -----Th SEXTO-2 OP ID: ER TE(MMIDOOTTO (`ORO CERTIFICATE OF LIABILITY INSURANCE DA07/01/2016 0710112016 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 CONTACT Ormsby Insurance Agency,Inc. NAME Eric Dembinske 898 Westfield St PO Box 01090 F•HCA xc En 413-737.0300 (FuC Nop.413-737-0617 West Springfield,MA 01090 ADMDaiss. Eric Dembinske INSURERISJ AFFORDING COVERAGE RAW I/ INSURER A Atlantic Casualty Ins.Co. INSURED Sexton Rooting&Siding, Inc. ! INSURER B'.Quincy Mutual Fire Insurance '15067 PO Box 6327 Holyoke,MA 01041 , INSURER C• • INSURER INSURER E. i INSURER F'. I 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. INTSRR TYPE OF INSURANCE COOL SUER POLICY EFF POLICY EXP 'W INSO VD POLICY NUMBER (MMIDDNYYYI IMMIDDIYYYI') LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE b 1,000.000 CLAIMS-MADE X OCCUR 101 GL002159900 06/25/2016106/25/20171 I �AMAGc s?E Qccur 1 P REMISES Ea occunencel F 100,000 MED EXP(Any one person) is 5,000 I PERSONAL&ADV INJURY $ 1,000,000 INC AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $ 2,000,000 POLICY ,PRD.AGO $ 2,000,000 JEOT LOC PRODUCT6� OTHER I $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT I $ 1,000,000 (Ea codentll B ANY AUTO AFV206561 05115/2016 05115/2017 BODILY INJURY IPer person) 1 $ ALL OWNED X AUTOS To BODILY INJURY(Per aaadenn i $JO X • NDN-OWNED PROPERTY DAMAGE HIREDAUTOS X AUTOS (Per accident) ! $ I $ 11 UMBRELLA LIAR ' OCCUR EACH OCCURRENCE I $ EXCESS LIAR CLAIMS-MADE AGGREGATE I'. $ DED I i RETENTION$ $ WORKERS COMPENSATION , 1 ER - AND EMPLOYERS'LIABILITY STATUTE R 1 'ANY PROPRIETOR/PARTNER/EXECUTIVE YIN Er EACH ACCIDENT O R $ OFFICER/MEMBER EXCLUDED'! I�IN IA (Mandatory in NHl E L.D!SEASE-EA EMP_OYE9 $ ! desce describe under ribeRIPTION OE OPERATIONS delow EL.DISEASE-PODGY:ST I $ DESCRIPTION OF OPERATORS I LOCATIONS I VEHICLES (ACORD 101,AddIOonal Remarks Schedule,may be attached it more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL RE DELIVERED IN Everett SextonACCORDANCE WITH THE POLICY PROVISIONS, AUTHORIZED REPRESENTATIVE Eric Dembinske ©1988-2014 ACORD CORPORATION. All rights reserved. AGGRO 25(2014/01) The ACORD name and logo are registered marks of ACORD 7,2 Lam. ✓iJ. . 'Y/�r..0"f�`,i � �'� L %_.-�® _ 30 =_ 021 C_ 1 RUc�__Psrc � 39 =EXOh Y VF r G L:, ,r' l[ 2715/17 207396 EV=rt-1 SEXTCfi _ _ P,b. BOX c327 _-_ HHOLYOFE, �di;+ 01C41 -_- Mn of Building ./a ons a h o;y 'no+5�ndrrJe Lioense. 9S .-ru^1 n S� perKso _ _ = .iw o,p dlty EVERETT J S E),i ON PO BOX 6327 - HOLYOK_ Nq Oi0<i Com Tiss ions 10/05/2017