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16B-026 105 FERN ST BP-2017-0890 GIS 4: COMMONWEALTH OF MASSACHUSETTS Map:Block: I6B-026 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: KITCHEN&BATH RENO BUILDING PERMIT Permit# BP-2017-0890 Project# JS-2017-001507 Est.Cost:$47300.00 Fee:$305.00 PERMISSION IS HEREBY GRANTED TO: Const.Cass: Contractor: License: Use Group: THOMAS DADMUN 107919 Lot Size(sq. ft.): 10018.80 Owner: WOLFSON STEVEN J&BETTY L Zoning: URB(I00)' Applicant: THOMAS DADMUN AT: 105 FERN ST Applicant Address: Phone: Insurance: 60 SCHOOL ST (413) 387-7381 HATFIELDMA01038 ISSUED ON:1/25/20170:00:00 rf TO PERFORM THE FOLLOWING WORK:KITCHEN & BAT REMODEL 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 1/25/2017 0:00:00 $305.00 212 Main Street, Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner Department use only. City of Northampton Scows of Permit.. r Building Department Curb:CuuDriveway Permit Ia 24 20u ' 212 Main Street Sewer/Septic Availability I 1 ROOM 100 WaterM+el Availability Northampton, MA 01060 Tw0$etsof Stuctural Plans . . fl' -, , phg413-587-1240 Fax413-587-1272 Plot/Site Plans Other Spedfy 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 105 StMap Lot Unit F LarrtsxL , O r\ Dlo(o2- Zone Overlay District Elm St District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: TnAll \JDLF5CP Ins ft.(4) Sr, I F4It.it,x r; , IMA o lo(p2 Name(Print) 1 Current Mailing Address �� 13 " (12.1 ° 7ativ.-- Telephone Signaturituj /' 2.2 Authorized Agent: 6 'Clyt Diivr4oa (QD 'Udeal. ST, Iw61ILLD, NMA 01058 Name(Print) Address /: Yn (1 � — Current Mailingd13 38? - 73`dt Signature Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building 4. JNIboo ,,,:, (a)Building Permit Fee 2. Electrical b 1?to,VV0a (b)Estimated Total Cost of Construction from(6) 3. Plumbing 6 3 ti c'> Building Permit Fee13 S 4. Mechanical(HVAC) 4 o op D 5. Fire Protection 6. Total=(1 +2+3+4+5) ! ° `JI"aOQ , °° Check Number O This Section For Official Use Only Building Permit Numbe ' Date Dated: Signature: //%'�i;�'` ,// /-.., Y-/7 Building Commissioner/Inspector Buildings Date 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 Frontage Setbacks Front Side L: R: L: R: Rear Building Height Bldg. Square Footage Open Space Footage (Lot area minus bldg&paved parking) #of Parking Spaces Fill: (mInmc&Location) A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO O DONT KNOW YES O IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO O DONT KNOW O YES 0 IF YES: enter Book Page and/or Document# B. Does the site contain a brook, body of water or wetlands? NO O DONT KNOW O YES O IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained O Obtained ® , Date Issued: C. Do any signs exist on the property? YES O NO O IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property? YES O NO IF YES, describe size, type and location: 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 O NO O 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) Roofing n Or Doors 0 Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [I Siding[CO Other ICI] Brief Description of Proposed 1l pp`` Work: \L 3/4-(4 � S PitTUtLoe«n r iakoPI.L Alteration of existing bedroom Yes X No Adding new bedroom Yes X No Attached Narrative Renovating unfinished basement Yes X No Plans Attached Roll -Sheet Ba.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, f✓t ii vo iJai F3 ,as Owner of the subject property (� hereby authorize TlkhA Yk µd1-i to act on my behalf, m matt rs rel tiv to work authorized by this building permit pplication. 7a ��t '--I-- / .Z4-1/.20/7 Signature of Owner -I� ., 1, Date I, tN"WIFS VI1 )(&UT.7 ,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. -114iflrillk6 DIIk)4AVr.) Print Name / / J:-Y✓Lmnt L -- )1 � 2011 Signature of Owner/Agent Date .2A SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable IIName of License Holder: 1411}5 DA A U1-) C r IC 9 cul � [ License Number IPA (�'"i^ T, 10)M- t./IA) MA oto55 9124 / 01.) Add ( Expiration Date 41 -s61-4)3b1 Signature Telephone 9.Registered Home Improvement Contractor: Not Applicable 0 Int ix) (BLAn e I I L 01 tocv2 Company Name Registration Nuber Go d1 L SP; Oki-HU-0PARot�3g b �1018 Address Expiration Date Telephone 4 I3-367 - 7301 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: (05 tits Sr. i Fartw,.>Ce: The debris will be transported by: kr N/rn ut. 14-cl&L w(c The debris will be received by: Building permit number: Name of Permit Applicant w11}S DA-0 2.41, 20(9 Lv-it— ((kJ__ Date Signature of Permit Applicant VMassachusetts -Department of Public Safety Board of Building Regulations and Standards Cdpnst upen license: S10791 ur license:CS107919 THOMAS DADMVN MI SCHOOL STREET Hstfdd MA 91035 -. ..S,440r„ Expiration commissioner 09/242017 c. ,1 , els O-YYUy72t7YLI,IfP.Q JCC.0 Office of Consumer Affairs and]mess Regulation 10 Park Plaza - Suite 5170 Boston, Massactusetts 02116 Home Improvement tractor Registration Registration: 179682 Type: LLC - _ Expiration. 8/28/2018 Tra 419291 THE TUCKER GROUP LLC. THOMAS DADMUN 1 60 SCHOOL ST -- HATFIELD, MA 01038 Update Address and return card Mark reason for change ^ Address -"' Renewal J Employment G. Lost Card SCA a 4M-06,1i f CO ( m»uu. , eali c1LnRpg oa License or ton valid for indlYbWItl*OV Mee of Conner—n& aB18fur Bgohaooregistration y a . W HOME IMPROVEMENT CONTRACTOR before the expiration date If found return to: Registration' 119892 Type: Office of Comma Affairs and Business Regulation Exultation: BRBl2018 LLC l0 Park Plan-Shim 5170 Boston,MA 02116 THE TUCKER GROUP RA THOMAS DADMUN`. '. 80SCHOOL ST HATFIELD,MA 01038V .... ._—... Mersecretary Not valid without signature s►co o CERTIFICATE OF LIABILITY INSURANCE DATEiNIND°m-"' keeer----- 12/19/2016 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 CONNAME Susan Fleury, CIC, CISR King & Cushman Inc. aro_"uat (913)589-5610n F A No):(413)514-9022 P.O. Box 447 om:SFleury@ltingCUshman.com 176 King Street INSURER(S)AFFORDING COVERAGE NAIL Northampton MA 01061 _ INSURERA:Main Street America Assurance co. 29939 INSURED INSURER B: DAI3bIDN DESIGN 6 CONSTRUCTION INSURER C: 60 SCHOOL ST INSURER o: INSURER E: HATFIELD MA 01038-9797 INSURER F: COVERAGES CERTIFICATE NUMBER:CL16121401819 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADL SUMI RIMY EFF POLICY EXPI LTRINS() WYD I POUCY NUMBER IMM/ODM'YVI IMWDWYYVYI LIMITS X COCLAIMS-WOE GENERAL LIABILITY EACH OCCURRENCE : 1,000,000 A CtAIMDE `R J CCCUR DAMAGE TO RENTED J PREMISES o,arence) I 500,000 ail 13T46940 11/13/2016 11/13/2011 MED EXP(My Onepe#Q 10,000 PERSONAL aAUV INJURY 1,000,000 GEML AGGREGATE LIMIT APPLIES PER I GENERAL AGGREGATE 2,000,000 X POLICY. PRo- -,LOC 2,000,000 JECT PRODUCTS AGG OTHER: IderwRemvay AUTOMOBILE LIABILITY COMBINED SINGLE Wn $ I (Ea��CI ANY AUTO I BODILY INJURY(PWFKmI 3 ALL OWNED ri SCHEDULED AUTOS 1 AUTOS BODILY INJURY(Per 3 HIRED AUTOS NUN WMI WF➢ PROPERTY OAGE GE AUTOS (Per*cal) S $ UMBRELLA LMB _ OCCUR EACH OCCURRENCE E EXCESS UAB CLAIMS-MADE AGGREGATE S DEO RETENTION$ B WORMERS COMPENSATOR PER Ohl- AND EMPLOYERS'LINNUIY VIN STATUTE ER ANY RIETC(LPARTNER,EXECUTIVE - EL EACH ACCIDENT $ OFFCERMEMBER EXCLUDED? NIA I (Mandatory in NH) EL DI$EASE-FA EMPLOYE 9$ If yrs dNVlbe under DESCRIFTON OF OPERATORS Wow EL DISEASE-POLICY LIMIT 5 • • DESCRIPTION OF OPERATIONS I LOCATORS VEHICLES IACORD ICI,AMJMOnal Rama do SChedle,may be atadid',more warp 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 I PROVISIONS ��������{y AUTHORIZED REPRESENTATIVE N • t I IMAM \y � ..,Thi. .L.Rermn rnRPORATIIO . N.All DA>hts re . ACORD 25(2019/01) The ACORD name and logo are registered marks of ACORD • - - INS025v)1401) The Commonwealth of Massachusetts Department of Industrial Accidents ="'riit= t Office of Investigations z-I:E1= 1 Congress Street, Suite 100 Boston, MA 02114-2017 %+ 41 IM+ www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly j� Name (Business/Organization/individual): th)lANs) DESIGx7 4- Seirth6hca Address: (op Sabot- Sr. City/State/Zip: 411 Itkpl i\ 01o3b Phone #: 413-5b1-13b Are you an employer? Check the appropriate box: Type of project(required): I.❑ I am a employer with 4. y7 I am a general contractor and I employees (full and/or part-time).* have hired the sub-contractors 6. ❑ New construction listed on the attached sheet. 7. ! I Remodeling 2.❑ I am a sole proprietor or partner- ship and have no employees These sub-contractors have g. ❑ Demolition workingforme in anycapacity. employees and have workers' a y' 9. [' Building addition [No workers' comp.insurance comp. insurance.• required.] 5. ErWe are a corporation and its 10.11IElectrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑ Plumbing repairs or additions myself [No workers' comp. right of exemption per MGL 12 ❑ Roof repairs insurance required.] c. 152, §1(4).and we have no employees. [No workers' 13.11I Other comp. insurance required.] `Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. Homeowners 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: Policy#or Self-ins. Lic. #: Expiration Date: Job Site Address: 107 hnita3 31, City/State/Zip: rI"*UCt Mer DItia 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 S250.00 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 cern under theains and penalties of perjury that the information provided above is true and correct. Signature: Q Date: 341,85fi`I. AAt zoo Phone#: 4\ 1 3I5/ -'I 5t/[ 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#: DADMUN Design + Construction Project Address: Subcontractor List 105 Fern St. Jan. 24,2017 Florence, MA 01062 Subcontractor: Has Employees: Yes No SMG Plumbing and Heating X DL Powers Electric X Paul Ayotte X SDL Home Improvement X Right Way Drywall X New England Granite X Cortina Tile X ATE AA j EP CERTIFICATE OF LIABILITY INSURANCE D9/16/20 6 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 INSURERS), 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 WANED,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 Elizabeth Carballo NAME: Finck 6 Perras Insuranw Agency Inc. PHONE 6 No &D, (413)527-5520 ,iAtrc NOR 141)321-5910 6 Campus Lane E-MPDDDRE55:bcarballo@finckandperras.com INSURER(S)AFFORDING COVERAGE WJCe Easthampton MA 01027 INSURER AArbella Insurance Group 17000 INSURED INSURER e: S M G Plumbing 6 Heating INSURER C: 133 Wyben Road INSURER D: INSURER E: Westfield HA 01085 INBORERF.: ... . -. COVERAGES CERTIFICATE NUMBER:CL1691602490 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR. ADDL'.WOBR POLICY EFF POLICY EXP 1 LTR TYPE OF INSURANCE IX POUCY NUMBER IMM/DONYYYI (MMpDMYYY)! LIMITS X COMMERCIAL GENERAL LIABILITY i EACH OCCURRENCE S 1,000,000 DAMAGE A 1 CLAIMS-MADE LRAE I OCCUR PREMISES(Ere /once) S 50,000 9520043004 9/4/2016 9/4/2011 MED SSP(Any me Perm) $ 5,D00 PERSONAL 8 ADV INJURY $ 1,000,000 GE_N'L AGGREGATIE OMIT APPLIES PER GENERAL AGGREGATE $ 2,000,000 MC- X 4 Paley L._I.JECT E LOC PRODUCTS-COLIPNP AGO $ 2,000,000 I OTHER • $ • AUTOMOBILE CONED SINGLE LIMIT $ ANY AUTO BODILY INJURY(Pet parasol $ ALL OWNED SCHEDULED ' BODILY IWURY(Pera deet) $ ' 'AUTOS AUTOS _ NON-CMS ED PYOPERNOMt4GE $ 1 HIRED AUTOS ___ AUTOS _TR aMder2 .__ UMBRELLA LIAO OCCUR , EACH OCCURRENCE $ EXCESS JAB I lCIAIMSMADE AGGREGATE $ _ DEO I I RETENTION $ WORKERS COMPENSATION I IRR I OTR AND EMPLOYERS'LABILITY NI STATLTE i ER _ MY PROPRIETOR PARINEP/EXECUTIVE EL_ EACH ACCIDENT $_ ▪FFICE /MEMBER EXCLLOM? NIA -- ISM/Watery yesMcBee Mn EL DISEASE-EA EMPLOYEE $ It yet cBee=mar D ESCR'FRCN OF OPERATIONS ONO* - : EL.DISEASE-POJCY LIMIT S DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks^Schedule,may IN attached Il mon space Is requtra4) Proof of Coverage CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Tom Dadmun / D+C THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 60 School St. ACCORDANCE WITH THE POLICY PROVISIONS. Hatfield, MA 01038 AUTHORIZED REPRESENTATIVE E Carballo/SETH ®� 2--c ��G a ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014)01) The ACORD name and logo are registered marks of ACORD INS025(201401) A IS CERTIFICATE OF LIABILITY INSURANCE DATEM'OD 'lb THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY MD CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER THS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER TEE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: N the certificate holler Ilan ADDITION. -URED,the poticy(ie$)must •e endorsed, H SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies nvy require an endorsement A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsanengs). PRODUCER CONTACT DME. Bresnahan Insurance Agency, In PHONE -' PAx 100 Whiting Farms Road uxui pin. .(4131 538-_0536 it Nm: 5413) 534-4291 Holyoke, MA 01040 _ .. INSUIEISI AFFORDwi COVERAGE NAICa INSURER A:Foremost Insurance CO. Iraw+ED INSURER R:Maofre/Commerce Insurance Co. D L Powers Electric Inc INSURse C._ P.O. Box 16/ O6URER o. --- --. __ Easthampton, MA 01027 INSURER Er �. _ _....... INSURER F: I .,.•I COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS 10 CERTIFY THAT THE POLICES OF INSURANCE LISTED BELOW HAVE BEEN ISSUE0TO THE INSURED NAMED ABOVE FOR THE POLICY FENCE INDCATEit. NOTWITHSTANDING ANY REOU REEMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHCH THS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY TFE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES,LIMITS SHOWN MAY HAVE BEEN REDJCED BY PAID CLAIMS. INSR A •LSUER PWgflFF PWC(EAY LTR TYPE OF INSURANCE IINSR CND POLICY NUMBER IMMCONY]I LMmDryvwI LINTS A GSIERALUAOtUTY i ;SOP 08132922 Bi6/IE 8/6/17 EACH OCCURRENCE $ y 000.000 X COVERALL/80.1T? (NMERCUAL _L/80.ITY �J ,, DAMAGE TO RENTED _PRENEE51T:mussucrel $ 300.000 CIA neo Em AMorePe'su) 8_ 10,000 PERSONAL&ACV INJURY $ 1,000,000 � -_ _ .. --,,, I GENERAL AGGREGATE rS 2,000,000 GENtAC4OR GATE L MT aPP..ESPER PRODUCTS 00M18OP AGO $ 2.000.000 POLCY I LOC s AUTOMOBILE UABIUTY I 11/18/15( 11/16/16)coIsiNEDgiNCLELMr( BRZV197 EOMINEJl S ANY Auro BODILY IN IRY(PerGerson) S ALL OWKo X SCHEDULED BODILY IJURY Ue,geI Der $ ' AUTOS AUTOS NO PROPERTY DAMAGE 4 HIRED AUTOS _AUTOS I )F rscodet � $ UkeREUA UAB DOUR EACH occuPR=NCE $ EXCESS LAB CLAIMSXA� I - '.. AGGIEG9TE $Y .___... OED RETENTIONS _......... $ A YORKER COMPENsnnON WC08132229 6/6/16 8/6/11,X i TamrBi ggi& °,,Tri- ANC EMPLOVERSLIATRTY ro ANYP CPRIERPARTNEOK:I:VTIUE (N I E .EACH ACC RI $ 100,000 OWN£RMEMBER clic;DEO? NTA — IM rtbbnl I 'P ..DISEASE.EA EMPLOYEE $ 100 000 II rw, I DESCRIPTIO of OPERATION}Uebw ' E DISEASE POLICY LINn'.s 500,000 • r£SCRIPRON OP OPERATIONS I LOCATIONS U VESCISS (Attach ACORD VC R¢Irth.SCNMuk,if TON specs is rt4Jmn Electrical Contractors CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICES BE CANCELLED BEFORE TIE Ex FIRATiON DATE THEREDf, NOTICE WILL BE DELIVERED ei Dadmun Design & Construction ACCORDANCE WITH ME POLICY PROVISIONS, 60 School St. Hatfield, MA 01038 AVamwupsENTATr.E 0198:-2010ACORD CORPORATION. All rights reserved. ACC/R[126(2910/051 The ACORD name and logo are registered marks of ACORD Phone: Fax: E-Mail: tomd@dadmundc.cos A✓ CERTIFICATE OF LIABILITY INSURANCE DATE I ZiY'16 THS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION OILY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER THIS CERTIFICATE DOES NOT AFFIRMANVELY OR NEGATIVELY AMEND, EXTEND OR ALTER TEE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTANV E OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: N 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 onthiscertificate does not confer rights to the certificate holder in lieu of such erdorsenent(s). PRODUCER CONTACT NAME: Dale Frank InBllrarce Agency P-MNE 413 665-8324 FAX N. 1413) 665-1280 2 Amherst Road ADDRESS: wendy@dale£rankinsurance.corn P.O. Box 455 Sunderland, MA 01375 INSUREN(B)AFFORnCOVERAGE NAICp Ixsunut A:Connecticut Underwriters INSURED INSURER B: _ Paul Ayotte INSURER C: _ 92 Laurel Park INSURER D: PO Box 1063 INSURER F: Northampton, MA 01061-0331 INSURER 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 PERIOD INDICATED. NOTWTHSTANDING ANY REQUIREMENT, TERM OR CONDI TON OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS 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 POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR :AWL SUBRI POUCY EFF POUCY EXP I - LTR TYPE OF INSURANCE MR VNp POLICY NURSER fM MIWIYYYYI.(MdmeYYYYJ I LIMTS A GENERALUABILT' INN432953 2/8/16! 2/8/11 EACH OCCURRENCE a 500,000 R COMMERCIAL GENERAL LIABILITY EN PDAReMMAGassTOlEeRETETEn D ai I $• 100,000 : CLAIMS-WADE _OCCUR MED EXP(Ar one;person) $ 5,000. PERSONAL&AM/INJURY • $ 50(1,000 GENERAL AGGREGATE ' S 1,000,000- GOAL AGGREGATE umTAPPLIES PEE PRODUCTS-COMP/OP AGO S 500,_000 POLICY ECT LOC S AUTOMOBILE LABIUTY i COMBINED SINGLE LIMIT s ANY AUTO BODILY INJUURY(Per Gerson) S ALLOWNED SCHEDULED ! BODILY INJURY(Per Alden* S Auros AUTOS • HIRED AUTOS _ NON-OWNEDT • !.rsccid ntDAMAGE S S UMEIRELLA LIAB _OCCUR EACH OCCURRENCE $ EXCESSUAB CLAIM&MACE I AGGREGATE DED RETENTIONS S YORKERS COMPENSATION TORY!NC IT MTI*- I :0TR AJY IN IID EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE 7 E1 EACH ACCIDENT S I OFFICERMEMBER EXCLLLED? NI A - — (Mandatory In NH) E L.DISEASE.EA EMPLOYEE S • rye describe under DESCRIPTION OF OPERATIONS beow EL DISEASE-POLICY LIMY'. a • •I GESCRIPTON OF OPERATIONS I LOCATIONS I VEHICLES (ANN ACORD 101,Additional Remarks Schedule,Xmorespre u req,i S) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE TIE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Tom Dadmun ACCORDANCE WITH THE POLICY PROVISIONS. 60 School Street Hatfield, MA 01038 AUTOR!EDREFESENTATNF Wendy Leahy ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD Phone: Fax: E-Mail: A�d CERTIFICATE OF LIABILITY INSURANCE aemanI/1526i5e THIS CERTIFICATE IS ISSUED AS A MATTER OF MMQEIATI011 ONLY AMD CORPSES MO MOM UPON Na CEIFIENCATE HOLDIN TME CERTIFICATE GOES NOT AFFEEAMINI.Y OR MMMLTlVVtLY AIIEE, EILOID OR ALTER NE OOVEYEE AMMO= EY IRE Pdx1ES BELOW. TES CERTIFICATE OF MMN*AMCE DOES NOT CMERTUfE A CONTRACT EETMEEI 111E EEMIO EMMMaBME. AOTRORIZED REPRESENTATIVE OR PROOUCER,ARO THE CERTIFICATE MOLDER. Manta.% I the dRXMW bean R W AOGITIONAL MIMMED.the poll(*mum be Named. E MIEROEATTER M1 WAMEN eutee!m the twos wO sondem*of the OaSCy,Main pONCES RO)noire w OWN.tmia AOVEN-an Oa Waal dela not toe/dim S. manes Mat In Kw Bouch NOmmwXMq.). PROW= Cypao this Reeders, CTS* Webber c Grinnell 4113)514- �.9ay0113 yt{431)RI-us1 S North rang Street s9eRdersengwablrsa356grimatl.as Nottbasptan Nx 03000 _. ., __.. MORE.rkAlentiw __.___.. . __....19259 Winkle 9. SDI, Rose Iepioveaent COAtractafe Inc. I teeka9_,LL-.. 21 Chestnut Street yEno:__....... Eatfield HA 01030 IMIRMF; COVERAGES CERTIFICATE MMEERRNester 2010 REVISION ..- THIS is TcometTHAT THE POLICIES OF INSRAMCE LISTED BELOW 14AVE SEEN ISSUED TO T146 INBRED WMED ,'!1 Mcomet POR THE POLICY PERIOD 04DMCATED. NO?YNTHSTANORG ANY RECUNIEMENT.TEAM OR CONDRnON OF ANY CONTRACT the OTHER DOCUMENT PATH RESPECT TO WICK THIS CERTIFICATE MAY SE ISSUED OR MAY PERTAIN./NE INSURANCE AFFORDED BY THE POLICES DESCmM:D HERON IS SUI ECT TO ALL THE TERMS, EXCLUSION$AND CONaTXTNS OF SUCH MUMS.wank SNOHM ANY HAVE REOl wee wlD SY PAM CLASS.YFFOX TX _ V wMNaa 0001036ineala RDen X OONllmlYALaRMmA4.UNXlry McH 15 1,000,000 -T- x CWM6MNJE x OCCUR 100,oao .___. .:$5100-065 21112016 : 2/1/2011 INEDEXP�yi _fe8_j 3 10,000 A6NOHKaACNRMv 1 1,000,000 GEM'.r1GGREGATE UMET APPLES PER 004144K 00XwATE 5 2,000,000 I PCLCV C.00OCES-Care A00 iS 2,000,000• _ 0'KR AUT0N0e6 any ' t.. NILE ! 5 _ 1,000,000 A m Ay+6/0L, I`.YbnMaroon)v*MRY Maroon) • NN 0 * BGfEUaEu 4930081/ 21112016 31l/MYXI 19 ARYIP,/MYYN 1 8 ,ifiiEO AUTOS ,Y AMI ` OMIFO i . UnNse wedew ewe 6 100,000 X MON10.1A11AI X ocas 1 7EXkOIXunhoitC Is 1.000.000 A 'EXarAYAe - ! __._.. _�WYSJIAR rvA00X90ATE._.._.A. _5 090 f RETENTION/ 10.000 92203065 2/1/2015 i 2/1/2019pq 5 women GAewwAnM 1 I e na j R iQ f ANO EMYOYM'Mean _..-- ANYMteNsic PApnevexiconve ,X XIA 'U.EYM KCSEHT ++IS 300,000_ A P�Maw1EXoFncYw� Xmm0 EX41tK�> s XCYOI4466 2/23/2014 212262011 8i ORNa•IA WWW 903 BIOS A00 00I4mrMR seet Or OPERATIONS IMe. T 4 E4,PEAN•AMT 4ueT'1 600.000 066CIMRMOFOFWSCNtROOMkNV M601tl(ASM Wit.ANN0seem YENAw40 eEtieMEwsAmwYXynY14 The workers capon**tide pelsoy deaf not Anomie navwrags for 1Ma3 SabRidt, Rasdriak Dwpeey And Douglas hWidt. CLMxkaenit. Iversourca and Iatiaaal Grid, $$TA*, Yaatan Gas Co., Celeas s DMS CO., Wee as Co., and western la Rslaetrl0 ars named as xddittmal Insured per written a®tract With reagents to general Liability for work performed and per the teas and 000ditiebe of the Pena/- CERTIFICATE HOLLER CARCEIVLTION SHOULD ANY Of RE Mara DWRE@ POLRRSME rent l SO WORE DE SIPNATat DAZE D•SMOS. ROM at Ra aE9ARED M Accoca1El MMM POUCH IODISM. AMTMSIOWIS NM1A9Na 19/Pos .a- waw �C hEnderann, CZStF1CIN 0 lIS8014 ACCOD C300MA11011. AN sots aemwd. *CORD 2812011/01) The ACOROname and logo NV IllgillieredMNNS al COW 111162E/x/,m,: ACO CERTIFICATE OF LIABILITY INSURANCE MEEIIIIN1/ '16 THS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERDRCATE HOLDER THS CERDFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER NE COVERAGE AFFCRIED BY THE POLICIES BELOW. THS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURERS), AUTICI ZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER IMPORTANT: If the certificate holder S an ADDITIONAL INSURED, the policy@es) Aust be endorsed. N SUBROGATION IS WAIVED,subject to the Mrms and cendltiors of the policy,certain policies may:squint an atonement A atalem.m on this certificate does not confer rights to the certificate holder in lieu of such a dorsanentiet. PR Wlcat CONTACT NAE: Dale Frank Insurance Agency PHONE - - -- --- 413 665-8324 Ira. N. IavB) 665-12e0 P.O.2 herst4Road AD -Lss: Wendy@dalefrankineurance-con Box Sunderland, HA 01375 INSURE RSI AFFORDING COVERAGE MAIL II INeuaslA:Providence Mutual Fire Imuran INSUREDINSURERED INSURER B ._. _ Brian Johnson ISJRSq C: Right Way Drywall INSURER'S: 206 Coles Neadow Rd INEJRIRI E: Northampton, MA 01060 ___. . - -. .__. IALRERF: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICES OF INSURANCE LSTED BELOW HAVE BEEN It ED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NORMTHSTANDNG ANY REQUIREMENT,TERM OR CONDITION OF ANY CONRRACT OR OTTER MOMENT WITH RESPECT TO WHICH THIS CERTFIGTE MAY BE ISSUED OR MAY PERTAIN.THE INSURANCE AFFORDED BY TIE PCJCIES DESCRIBED HEREN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES LINTS SHOWN MAY HAVE BEEN REDUCED BY PAID CANIS. INSRI 4ECL,SIBf POLICY ETT KU CY QP LTR, TYPE OF INSURANCE INSR'VND PODGY MIIBER MM.TOMWY) IEIDOTTYY) VISITS Al GwstanuseLm • HOP 0093210 00 1/15/16 1/15/1T EACHOCCUMENCE L 14_900,000 _ • X caMERCLAL GEIEMLLIPaury DAMAGE PO RENTED PREMISES IES martens) YO 5 5O� 00 I ' J CLAMS-MADE OCCUR ED FNP Any are Pasco) 119 _ 5,000 I PERSONALS HDV INJURY 9 1,000,000 .. LGEERAL AGGREGATE -. ..-s 2,000,000 POLICY ro m PRODUCTS Acc s2_,000 0.00 C£NL AGGREGATE LAST APPLIES PER 1 $ AUTOMOBILE IJABIUTY _C M$INGLE LIMIT• 5 I COOLY INJURY[Per sewn) 9 ALLOW ALLOWIED SCHEDULED BODILY INJURY IPm soEerU $AUTO$ AUTOS NON—OWNED PROPERTY DAMAGE if HIRED AUTOS AUTOS Mee accident) f UMBRELLA UPS _OCCUR EACH OCCURRENCE I_5 I ROES WB CUWSNADEAGGREGATE S Dm RETENTIONS 1 5 —�:SMIRKERS COestrec ori IWC STATE- I DTH. MDsIPLOYERS LIABILITY YIN . L__.I TORY LRAM___ _FR _... _ •ANY PROFR1ERIRPARTNERE XLCUTH£ EL EACH CEM9 ' GEFLER EMBER EXCI ICED, IM NIA IMabab NN _EA YM4OY ESA. —----- ryOe a c,ea undo, EL:DISLASE _-_ oESCRIPTIon Cf OPERArwnstrrbv EL UISEA -valcv LNIT I MSCRIPnaI CFOPEMTKKIS I LOCATIONS 1 V9itl6 INd:n Atdm 101.A1311MUI1Nmha YlWy.r1 nue Scam b rtyuMl CERTIFICATE HOLDER CANCELLATION 1 SHOULD ANY OF THE ABOVE ce SCRIBED POUC ES E CANCELEEDBEFORE TIE EXPIRATION DATE TIEIaEOF, NOTICE WILL BE DELIVERED N Tom Dadmun ACCORDANCE WITH THE POLCY PROVISIONS. 60 School Street Hatfield, HA 01038 AURIONMO REPRESENTATIVE IWendy Leahy 01988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(201W05) The AC ORD name and logo are registered marks of ACORD Rene: Fax: E-Mail: ACOREI CERTIFICATE OF LIABILITY INSURANCE DATE(MMIBNYYVY) `----- 10/20/2016 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(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 Kasey Peters, Ext 103 Foley Insurance Group Inc. �mgNE (413)214-7474 FAX (a131 ua-Toa 37 Elm Street -ME nIL k eters@foie ante sou ucomC l ADDRESS: P yinaur g p. INSURER(S)AFFORDING COVERAGE NAICA West Springfield MA 01089-2703 INSURERA:Patrons Mutual Insurance Co of CT •20028 INSURED INSURERB:Travelers Indemnity CO Of CT _ 125682 ANDREY EORCBEVSEIY DEA New England Granite LLC INSURERC: 'I _ ATTN: Andrey Korchevskiy INSURER 0: 75 West School Street INSURERE. West Springfield MA 01089 INSURER F: COVERAGES CERTIFICATE NUMBER:CL16102009434 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. INSRI ADDL SUER I POLICY EFF POLICY EXP LIMITS TYRE OF INSURANCE !NW WYO POLICY NUMBER I(MWDDIYYYYI IMMIDMWYYI X COMMERCIAL GENERAL LIABILJTv ' EACH OCCURRENCE 5 1,000,000 L PREM A CLAIMS-MADE i X OCCUR I PREMISESGTISES(a ROENTED • 300,000 OR ELATcED I$ ' 50P2741752 5/23/2016 5/23/2017 MED EXP(Any one person) 5 5,000 PERSONAL SADV INJURY 5 1,000,000 GENL AGGREGATE LIMIT APPLIES PER. ' GENERAL AGGREGATE S 2,000,000 • X I POLICY PRO- LOC ' PRODUCTS-COMPIOP AGO S 2,000,000 JEOT _ .,I OTHER. I $ AUTOMOBILE LIABILITY I I COMBINED SINGLE LIMIT $ (Ea amoen0 ANY AUTO I BODILY INJURY(Per person) S �AL7OWNED SCHEDULED BODILY INJURY(Per avatlenll.3 NON-OWNED PROPERTY DAMAGE HIRED AUTOS AUTOS (Per accident) S • i5 UMBRELLA LIAB OCCUR , 1 EACH OCCURRENCE EXCESS LIAB CLAIMS-MADE: AGGREGATE_ 5 OEO I RETENTIONS I $ WORKERS COMPENSATION I I ' E ER !0TH' I AND EMPLOYERS'LIABILITY STATUTE I ANY PROPRIETOR/PARTNER/EXECUTIVE Y-IN E.L. ACH ACCIDENT 5 100,000 OFFICER/MEMBER EXCLUDED? Y NIA B _ — - '(Mandatory In NH) IMM219lID76716 10/22/2016110/22/2017' E.L.DISEASE-EA EMPLOYEE 5 100,000 if yet Rescnbe under DESCRIPTION OF OPERATIONS below i 1 E.L.DISEASE-POLICY LIMIT 500,000 • DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached it more space is required) Proprietor/Partner/Executive Officer/Member exclusion applies on Workers Compensation. CERTIFICATE HOLDER CANCELLATION tomd@ dadmundc.com SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THOMAS DADMUN THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 60 SCHOOL STREET ACCORDANCE WITH THE POLICY PROVISIONS. HATFIELD, MA 01038-9747 AUTHORIZED REPRESENTATIVE Brian Foley/LYNNE �_ —11-7.....- ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD INS025'2014011 Client#:41601 CORTII ACORD„ CERTIFICATE OF LIABILITY INSURANCE DATE(aMIDDIYYYY) 3/24/2016 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 I CONTACT NAME. Dinah Jacobsen People's United Ins.Agency MA WON ,e,)),413781-6871 -_- - I FAX 1391 Main Street, 3rd Floor IEMAa I ADDRESSmary.hoth@peoples.com . rri hoth eo @P P PO Box 4950 INSURER(S)AFFORDING COVERAGE _ NAIL/1 Springfield, MA 01101 INSURER A:Merchants Preferred Ins.Co. INSURED --_ _.. INSURER e: Cortina Tile of West Springfield INSURER C: 1645 Riverdale ST INSURER D: W.Springfield, MA 01089 —_ 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 REDUCED BY PAID CLAIMS. INSR AMYL SUBR POLICY EFF POLICY EXP I LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER (MRJOCIYYYY) ( MNDM'YYI 1 UMITS A AI COMMERCIAL GENERAL Lwelury BOp1071849 03/3012016 03/30I20171I EACH OCCURRENCE $1,000,000 CLAIMS-MADE X OCCUR RMI ORENTED S � ��IEa ossnnanml x500,000 Blanket Al Per Prior MED EXP(Any one person) s5,000 Written Contract Y 'PERSONAL a ADV INJURY $ GENt AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE s2,000,000 POLICY( ^'.JECT LOC ,PRODUCTS-COMP/OP AGO s2,000,000 OTHER, $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea ami $ ANY I BODILY INJURY(Per person) $ ALL OWNED - SSCHEDULED BODILY INJURY(Per accident) $ TSAUOS TOOWNEO PROPERTY DAMAGE '$ HIRED AUTOS AUTOS et accident) $ AI-X UMBRELLA LIAB`lX OCCUR CUP9146566 03/30/201603/30/2017 EACH OCCURRENCE $1,000,000 EXCESS LIAR CLAIMS-MADE AGGREGATE $1000000_ _r– BED X. RETENTION x10 000 's A IWORKERS co exviays COMPENSATION WCA1033448 03/30/2016 03/30/2017 X stens FR !ANY PROPRIETOR/PARTNER/EXECUTIVE F-- - E.L.EACH ACCIDENT s500,000 OFFICER/MEMBER EXCLUDED? I N NIA (MandatorylnNH) E L.DISEASE-EA EMPLOYEE s500,000 (DESCRIPTION under PERATIONS below _ _ _EL DISEASE-POLICY LIMIT s500,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached II more space is resumed) Blanket Additional Insured per Merchants form MU8277(1111);Blanket Additional Insured-Completed Operations per Merchants form MU8530(1111) Proof of Insurance CERTIFICATE HOLDER CANCELLATION DADMUN Design+Construction SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Attn: Tom Dadmun ACCORDANCE WITH THE POLICY PROVISIONS. 60 School Street Hatfield,MA 01038 AUTHORIZED REPRESENTATIVE P12046 L)M&CiOkina k A ( ©1988-2014 ACORD CORPORATION.All rights reserved. ACORD 25(2014/01) 1 oft The ACORD name and logo are registered marks of ACORD #S674601/M674571 DLJ