36-108 (5) 247 BROOKSIDE CIR BP-2017-0992
GIS #: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 36- 108 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: INSULATION BUILDING PERMIT
Permit BP-2017-0992
Project# JS-2017-001709
Est.Cost: $4347.00
Fee: $65.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: AMERICAN INSTALLATIONS LLC 106178
Lot Size(sq. ft.): 20647.44 Owner: MICKIEWICZ MATTHEW E&NOREEN
Zoning: Applicant: AMERICAN INSTALLATIONS LLC
AT: 247 BROOKSIDE CIR
Applicant Address: Phone: Insurance:
130 COLLEGE ST (413) 552-0200 WC
SOUTH HADLEYMA01075 ISSUED ON:3/3/2017 0:00:00
TO PERFORM THE FOLLOWING WORK:ATTIC & BASEMENT INSULATION &AIR
SEALING THROUGHOUT
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 3/3/2017 0:00:00 $65.00
212 Main Street, Phone(413)587-1240, Fax:(413)587-1272
Louis Hasbrouck—Building Commissioner
File#BP-2017-0992
APPLICANT/CONTACT PERSON AMERICAN INSTALLATIONS LLC
ADDRESS/PHONE 130 COLLEGE ST SOUTH HADLEY (413)552-0200
PROPERTY LOCATION 247 BROOKSIDE CIR
MAP 36 PARCEL 108 001 ZONE
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Bee Paid ) „
Building Permit Filled out t Ivll'.
Fee Paid
'fvpeof Construction: ATTIC& BASEMENT IN LATION&AIR SEALING THROUGHOUT
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Buildin. Plans Included:
Owner/Statement or License 106178
3 sets of Plans/Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFORMATION PRESENTED:
Lpproved Additional permits required(see below)
PLANNING BOARD PERMIT REQUIRED UNDER:§
Intermediate Project: Site Plan AND/OR Special Permit With Site Plan
Major Project: Site Plan AND/OR _ Special Permit With Site Plan
ZONING BOARD PERMIT REQUIRED UNDER: §
Finding Special Permit Variance*
_ Received&Recorded at Registry of Deeds Proof Enclosed
Other Permits Required:
Curb Cut from DPW _ Water Availability Sewer Availability
Septic Approval Board of Health Well Water Potability Board of Health
Permit from Conservation Commission Permit from CB Architecture Committee
Permit from Elm Street Commission Permit DPW Storm Water Management
,cm&itioIeflay
Sig . ure o Building •fhc:1 -- Date
Note: Issuance of a Zoning permit does not relieve a applicant's burden to comply with all zoning
requirements and obtain all required permits from Board of Health,Conservation Commission, Department
of public works and other applicable permit granting authorities.
* Variances are granted only to those applicants who meet the strict standards of MGL 40A.Contact Office of
Planning&Development for more information.
17-0470
DeparMem use only
\City of Northampton status of PemmL
% 1 `BUitditlg Department Crab CutrDdvexay Permit
212 Main Street sewerI$epbcAvaitabllity
/ Room 100 Water/Wellailabtlily
- Northampton, MA 01060 Twq Sets of strucg)ml;Plans
phone 413-587-1240 Fax 413-587-1272 PloUuilePians
\\:1\
Otherr&peoty ,
" AP
APPLICATION TO CONSTRUCT, ...
PL ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1•SITE INFORMATION
1.1 Proper y Address: This section to be completed by office
247 Brookside Circle Map Lot Unit_,,,„,_
Florence,MA 01062 yore Overlay District
Elm St District - CB District
SECTION 2«PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
Matthew dr Noreen Mickiewicz 247 Brookside Circle Florence,MA 01062
Name(Print) Current Mailing Address:
(413)219-8583
See attached - Tepptmne
Signature
2.2 Authorized Anent:
American Installations 130 College St., Ste 100 South Hadley,MA 01075
Name(Pint) Current Siang Address
American Installations 413-552-0200
Signehee Telephone
SECTION 3•ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Midst Use Only
completed by permit applicant _
1. Building $4,347.18 (a)Building Permit Fee
2. Electrical (b)Estimated Total Cost of
Construction iron(6)
3. Plumbing Building Permit Fee
4. Mechanical(HVAC)
5.Fire Protection
6. Totala(1+2+3+4+5) $4,347.18 Check Number 3.
This Section For Official Use Only
Building Permit Number. Iism
issued:
Signature:
Budding Commissioner/Inspector of Bkddngs Date
Section 4. ZONING All Information Must Be Completed.Permit Can Be Denied Due To Incomplete Information
Existing Proposed Required by Zoning
This column robe filled in by
Building Depumrmt
Lot Size I I � 1 1
Frontage
Setbacks Front I I
Side L: I R:1—_ L:! R 1 -!
Rea I ! I
Building Height (—'I
Bldg.Square Footage 1 LJ
Open Space Footage
(Lot area minus bldg&paved I I I
miring/
#ofPaTIdng Spaces
Fill:
(volume&Location)
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO 0 DONT KNOW O YES O
IF YES,date issued:I
IF YES: Was the permit recorded at the Registry of Deeds?
NO 0 DONT KNOW O YES O
IF YES: enter Book I I Page and/or Document AL
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 O , 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 O
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 0 Addition ❑ Replacement Windows Alterations) 0 Rootb+g 0
Or Doors O _
Accessory Bldg. ❑ Demolition 0 New Signs [TM Decks ID Siding 101 Other
Brief Deseripiton of roposed
Wank Attic and basement insulation and air sealing throughout
Alteration of existing bedroom Yes No Adding new bedtumn Yes No
Attached Narrative Renovating unfinished basement Yes No
Plans Attached inti -Sheet
Ga.If New house and or addition to existlnq'housinq,.coimaleto thefollowinq:
a. Use of building:One Family Two Family Other ,y
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. EnergyConservation 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 APPUES FOR BUILDING PERMIT
L Matthew d Noreen Mickiewicz
as Owner of the subject
properly
hereby authorize American Installations
to act on my behalf,in all matters relative to work authorized by this building permit application.
tt t t. 2128/17
Signature of Owner Date
1, American Installations as Owner/fwthodzed
Agent hereby declare that the statements and information on the foregoing application are toe and accurate,to the host of my knowledge
and belief.
Signed under the pains and penalties of perjury.
American Installations
Print Name
American Installations 2/28/17
Signature of 0/mei/Agent Date
SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable 0
Name of License Holder: Wesley K. Couture 106178
License Number
130 College St., Ste 100 South Hadley,MA 01075 9/29/17
Addres /' Expiration Date
0' syr re 3-552-0200
Signature/ }� D /' Telephone
9:Registered Home Improvement Contractor. - Not Applicable 0
Wesley Couture 175982
Company Name Registration Number
American Installations 6/27/17
Address Expiration Date
130 College St., Ste 100 South Hadley, MA 01075 Telephone 413-552-0200
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 Mached Yes a No 0
11..-Home Owner Exemption
The current exemption for"homeowners"was extended to include Owner-occupied Dwellings of one(1) 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 1083.5.1.
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 fano
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
Massachusetts e= C `e
( . L
d u m
OEPARTNENS OF BUILDING INSPECTIONSi ,��
AC .:-i 212 Main Street • Municipal Building V Fs
Northampton, W. 01060 -- yJre
Property Address: 247 Brookside Circle Florence,MA 01062
Contractor
Name: American Installations
Address: 130 College Street Ste. 100
City, State: South Hadley, MA
Phone: 43-552-0200
Property Owner
Name: Matthew&Noreen Mickiewicz
Address: 247 Brookside Circle
City, State: Florence, MA 01062
I, American Installations (contractor) attest and affirm that the building I intend to
insulate does not have any open air(knob and tube)wiring in the spaces to be insulated and that I have
provided the property owner with a copy of this affidavit.
Contractor s" natpre �
c.aiOA/ K. (/'ir[elirtc
Date C
2/28/17
•
mamma
11
Licensed&Insured • www.Americanlnstallations.com
MACSIt106178 American Installations
MA Registration N 175982
-Efficient Home Services-
130 College Street Suite 100,South Hadley,MA 01075 • Office:(413)552-0200 Fax:(413)552-0202 • Email:wpport@Ametlonlnstallations.com
AIR SEALING PROPOSAL
Matthew'17 ickiewicz
247 Brookside Cir
Florence. MA 01062-3550
Site ID: S00002246218
Project ID: P00000251749
Customer ID: C00000256289
Contract 1D: 20170220 MEAL
Description Quantity Location
Perform Air Sealing al Estimated 62.5 CFM50 Per Hour 14 Living Space $1,180.46
Exterior Dear Weather Stripping 3 N/A $8277
Door Sweep 3 N/A $69.54. .
Sub Total: $1,332.79
Utility Incentive Share $1,332.79
Customer Contribution $0.00
WARRANTY:American Installations,LLC will provide the above stated homeowner with a 2 year workmanship warranty.
American Installations,LLC hereby proposes to furnish all material and labor to complete the above scope of work in accordance with the above specifications
and all local and state building regulations for the Total Contract Value as stated herein.
ACCEPTANCE OF PROPOSAL:The above prices,specifications and conditions TOTAL CONTRACT VALUE=$ U
are satisfactory and are hereby accepted. You are authorized to do work as 0
specified.Payment will be 1/3 down prior to start of work,and balance due Down Payment=$ l7
PAID
Upon Completion. Balance Due Upon Completion=$ 0
476111-
Signature .. Date 2-20-17
Property Owner(Print) (Sign) )21/S
/�V/��, Date
Representative:(Print) Joel Martell (Sign) 21/5 ll Date zh2V
THIS AGREEMENT IS COMPOSED OF MIS PAGE AND THE REVERSE LLC HEREINAFTER REFERRED TO•s COM PANT,AND.n MER(S�Ix // UOPRIATE LAWS.REGULATIONS 410 ORDINANCE:OF THE
•
THE FOLLOWING TERMS AND CONDITIONS ALSO APPLY
1, THIS AGREEMENT%SUBJECT TO THE APPROVAL OF A MANAGER OF THE COMPANY FOR THIS AGREEMENT TO BE EFFECTIVE UNDER ANY CONDITION.
2. SHOULD DEFAULT BE MADE IN THE PAYMENT OF THIS AGREEMENT CHARGES SHALL BE ADDED FROM THE DATE THEREOF AT A RATE OF ONE AND ONE-HALF(1-1/31 PERCENT PER MONTH.(1814 PER
ANNUM)WITH A MINIMUM CHARGE OF$2.130 PER MONTH,AND IF PLACED IN THE HANDS OF AN ATTORNEY OR COLLECTION AGENCY FOR COLLECTION,ALL ATTORNEYS'FEES,EXPENSES AND COSTS
OF COLLECTION SHALL BE PAID BY THE CLIENT.IN ADO TION,CLIENT UNDERSTANDS THAT IN FAILING TO PAY ACCORDING TO THE ABOVE TERMS,COMPANY MAY HAVE THE RIGHT TO A LEIN ON THE
PROPERTY.
3. THE COMPANY AGREES THAT WHEN DELAYS BECOME KNOWN TO THE COMPANY,THE COMPANY WILL ADVISE THE CLIENT AS SOON AS REASONABLE.
4. COMPANY AGREES THAT,NOTWITHSTANDING ANY AGREEMENT FOR MATERIALS AND/OR LABOR BETWEEN COMPANY AND THIRD PARTY,COMPANY IS RESPONSIBLE TO CLIENT FOR COMPLETION
OF ALL WORK A TIMELY AND WORKMANLIKE MANNER.
5. ALL WARRANTIES
FOR EQUIPMENT AND PRODUCTS SUPPUED BY THE COMPANY UNDER THIS AGREEMENT SHALL BE THOSE GIVEN BY THE MANUFACTURERS OF SUCH EQUIPMENT AND PRODUCTS.
UNDER SUCH MANUFACTURER'S WARRANTIES,THE CLIENT MAY BE REQUIRED TO REGISTER OR MAIL IN A WARRANTY CARD OR OTHER EVIDENCE OF OWNERSHIP AND USE OF SUCH EQUIPMENT
AND/OR PRODUCTS IN ORDER TO ACTIVATE SUCH WARRANTIES.
6 THE QUOTATION ON THE PAGE HEREOF DOES NOT INCLUDE EXPENSES OR CHARGES FOR BOND OR INSURANCE PREMIUMS OR COSTS BEYOND NORMAL INSURANCE COVERAGE,ANY SUCH
ADDITIONAL EXPENSES,PREMIUMS OR COST SHALL BE ADDED TO THE TOTAL AGREEMENT AMOUNT.
7 THE COMPANY'S LIABILITY FOR CLAIMS ARISING OUT DF THIS AGREEMENT SHALL NOT EXCEED THE TOTAL AGREEMENT PRICE EXCEPT TO THE EXTENT THOSE DAMAGES ARE PROVEN TO BE SOLEY
DUE TO THE COMPANY'S NEGLIGENCE.
B. DURING THE DURATION OF THE WORK,THE CLIENT'S HOMEOWNERS INSURANCE WILL BE RESPONSIBLE FDR ANY AND ALL DAMAGES AS LONG AS THE COMPANY HAS TAKEN THE APPROPRIATE
ACTION TO PROTECT AREAS OF WORK,
9. THE COMPANY IS NOT RESPONSIBLE FOR PREEXISTING DEFICIENCIES OR HAZARDOUS MATERIALS THAT MANIFEST THEMSELVES DURING THE CONSTRUCTION PROCESS.E.G.WOOD ROT,MOLD,
NAIL POPS,DUCTWORK AND CONNECTIONS,PLUMBING AND VENT PIPES,DECKING DEFLECTION,ETC IF
COMPANY
MATERIAL
AS TO RC T
ERED PRIOR
TO OR DURING CONSTRUCTION,AND COMPANY IS NOTIFIEDIN WRITING, U WILL TO ASSIST CLIENT WITHIN COMPANY'S MEANS AND CAPABILITIES CORRECTTHE PROBLEM)
ON A TIME AND MATERIAL
SISION RETHAT CONDITIONS
ARE UNAVOIDABLEBY THE COMPANY AND TAALLNDTBENONSIPPREDBVIOLATION HFTHE AGREEMENT AND THAT DUE
TO THESE CONDITIONS THE DURATION OF THE WORK AND SCHEDULED DATE OF COMPLEN MAY DIFFER FROM THATAGREED ONO IF EUN9ERTHIS
AGREEMENT.
30. REPLACEMENT OF DETERIORATED DECKING,FASCIA BOARDS,ROOFJACKS,VENTILATORS,FLASHING,RPTTEPS.IOST5,INSULATION OR OTHER MATERIALS NOT
INCLUDED UNLESS OTNEaW CLE
NOTED HEREIN.
11THE COMPANY W
I DR RESPONSIBLEFORT
E SCRATCHING ORDENTING OF INTERIOR
ANDCEILINGS,AGTRIM,
IRSERSDOWNSPOUTS,
OW YSIEXCE EXISTINGMIAAND WINDOWS,DOORS,
OIL DROPLETS IN DRIVEWAYS HAIRLINEFRACTURES IN CONCRETE OR BLACKTOP DRIVES AND WALKS,OR DAMAGE TO PLANTS OR SHRUBBERY IF EXCESSIVE DAMAGE IS CAUSED BY COMPANY,
COMPANY WILL REPAIR OR REPLACEDAHAPAREA ONLY EGENERAEXPENSE
12. PROVISIONSCHAPTEROF LLAREQUIEARYVERMD OBTALL CONSTRUCTION-RELATED PERMITS,THE
ISHALL NOT BE DEEMED
RESPONSIBLE FOR DELAYSTHE ROVDESCRIBED NISPGRCEANDAYMD REGULATORY PERMITHANGINOISPEEIOXPT BYANC ;ANTHATENTSNDIBVBLT
13. THIS AGREEMENT,INCLUDING THE PROVISIONS RELATING TO PRICE AND PAYMENT SCHEDULE,CANNOT BE CHANGED ORALTERED EXCEPT BY A WRITTEN STATEMENT SIGNED
BY BOTH THE COMPANY
AN
THE CLIENT.
Y 14. ANYREPRESENTATIONS,STATEMENTS,OR OTHER COMMUNICATION NOT WRITTEN ON THIS AGREEMENT ARE AGREED TO BE IMMATERIAL AND NOT RELIED ON BY EITHER PARTY,AND DO NOT
SURVIVE THE EXECUTION OF THIS
15. THIS AGREEMENT CANNOT BE CANCELLED WITHOUT THE MUTUAL WRITTEN CONSENT OF BOTH PARTIES EXCEPT AS OTHERWISE SET FORTH HEREIN,
16. THIS AGREEMENT,AND ANY WARRANTYISi PROVIDED HEREUNDER SHALL NOT BE ASSIGNED EXCEPT BY OR WITH THE WRITTEN PERMISSION OF THE COMPANY.
17.
IF THE EFAILS
PERFORM ITS OBLIGATIONS HEREUNDER OR TERMINATES THIS AGREEMENT WITHOUT THE PRIOR WRITTEN CONSENT OF THE COMPANY,THE CLIENT SHALL BE LIABLE FOR
DAMAGES FORTHE GREATER OF THE COMPANY'S ACTUAL DAMAGES OR b%OF THE AGREEMENT FOR RESTOCKING FEE.
18, ANY CHANGES TO MATERIALS BY THE CLIENT(BRAND,STYLE,COLOR,ETC.}AFTER SAID MATERIAL HAS BEEN DELIVERED OR IS IN ROUTE TO THE CLIENT COULD RESULT IN A 5%RE-STOCKING FEE
ASED ON THE COST
19. TTHIS AGREEMENT SHALL BE SAID
ONLY UPON ITS EXECUTION BY ALL PARTIES HERETO,PRIOR TO WHICH TIME IT SHALL BE DEEMED A PROPOSAL.THE COMPANY RESERVES THE RIGHT TO REVOKE
THIS PROPOSAL 90 DAYS FROM DATE IT IS EXECUTED BY THE COMPANY IF IT IS NOT EARLIER EXECUTED BY THE CLIENT AND THE REQUIRED DOWN PAYMENT RECEIVED PRIOR TO THE EXPIRATION OF
SUCH 90 DAY PERIOD:AFTER 90 DAYS,AND IN THE EVENT COMPANY DOES NOT REVOKE THE PROPOSAL COMPANY RESERVES THE RIGHT TO REVISE ITS PRICE IN ACCORDANCE WITH ITS COSTS IN
EFFECT AT SUCH TIME.
30. IF ANY PROVISION OF THIS AGREEMENT SHOULD BE HELD TO BE INVALID OR UNENFORCABLE,THE VALIDITY AND ENFORCEBILITY OF THE REMAINING PROVISIONS Of THIS AGREEMENT SHALL NOT
BE AFFECTED THEREBY.
21. EVENT THE CLIENT AND COMPANY HAVE A DISPUTE REGARDING ANY OF THE TERMS,CONDITIONS,PROVISIONS,OR PERFORMANCE OF THIS AGREEMENT,THE PARTIES AGREE
TO PLACE THE MATTER INTO ARBITRATION BEFORE AN INDEPENDENT ARBITRATOR ASSIGNED BY THE AMERICAN ARBITRATION ASSOCIATION TO RESOLVE THEIR DISPUTE.
22, ANY DISCOUNT,PROMOTION,REIMBURSEMENT,OR OTHER PROGRAM THAT IS PART OF A STATE SPONSERED UTILITY PROGRAM(I E.MASS SAVER)IS SUBJECT TO THE AVAILABILITY OF QUALIFYING
STATE SPONSERED PROGRAM AND WILL BE SUBJECT TO TERMINATION IF THE STATE SPONSERED UTILITY PROGRAM IS DISCOUNTINUED. FURTHERMORE,THE TERMS AND CONDITIONS OE STATE
SPONSERED UTILITY PROGRAMS MAY BE ALTERED OR UPDATED PERIODICALLY WITH OR WITHOUT NOTICE.
23. AMERICAN INSTALLERS,LLC IS VDT AN AGENT OF ANY UTILITY COMPANY OF OTHER VENDOR WORKING BY,THROUGH,OR UNDER THE MASS SAVE'ENERGY PROGRAM.
24. WESTERN MASSACHUSETTS ELECTRIC COMPANY LTH E UTILITY)IS ENTITLED TO 100%OF THE ENERGY BENEFITS ASSOCIATED WITH ALL ENERGY CONSERVATION MEASURES,EXCLUDING THE VALUE
OF ENERGY COST SAVINGS BY THE HENT,BUT INCLUDING ALL RIGHTS TO ALL ASSOCIATED ISO NE ENERGY,CAPACITY AND RESERVES PRODUCTS COMPANY AGREES TO PROVIDE THE UTILITY WITH
SUCH FURTHER DOCUMENTAL ON AS THE UTILITY MAY REQUEST TO CONFIRM THE UTILITY'S OWNERSHIP OF SUCH BENEFITS AND PRODUCTS.
25. ACKNOWLEDGES THAT COMPANY IS NOT AN AGENT,VENDOR OR SUB-VENDOR OF THE UTILITY WITH RESPECT TO THE INSTALLATION OF ANY ENERGY EFFICIENCY
UNDERSTANDSMEASURES.IN HEVENT OF THE FAILURE OF ANY ENERGY CONSERVATION DEVICE TO PERFORM AS EXPECTED,CLIENT AGREES THAT CLIENT'S SOLE RECOURSE IS TO THE COMPANY AND NOT TO
CONSERVATION SERVICES GROUP CSG}OR TO THE UTIUTY THE UTILITY AND ITS OPERATING COMPANIES SHALL NOT MAINTAIN,REMOVE OR PERFORM ANY WORK WHATSOEVER ON THE ENERGY
CONSERVATION GES THAT ITS PARTICIPATION IN THE MASS SAVE HOME ENERGY SERVICES PROGRAM IS VOLUNTARY AND THAT IT
HAS CONSENTED FOR COMPANY TO INSTAL1THE PROPOSED UNDERSTANDS ACKNOWLEDGES
ENERGY CONSERVATION MEASURES.
26. CLIENT AGREES THAT IT SHALL NOT HOLD CSG,THE UTILITY,THEIR AFFILIATES OR OPERATING COMPANIES LIABLE FOR COMPANY'S FAILURE TO PERFORM ITS OBLIGATIONS UNDER THIS AGREEMENT,
FOR FAILURE OF THE ENERGY CONSERVATION MEASURES TO FUNCTION,FOR ANY DAMAGE TO CLIENT'S PREMISES CAUSED BY COMPANY OR FOR ANY AND ALL DAMAGES TO PROPERTY OR INJURY
TO PERSONS CAUSED BY THE ENERGYCONSERVATION MEASURES.
27. CLIENT IS RESPONSIBLE FOR THE PAYMENT OF ANY AND ALL FEDERAL STATE,OR LOCAL TAXES THAT ARE APPLICABLE TO THIS AGREEMENT
LIMEEED TIME OFFER.THE PRICES AND INCENTIVE OFFERED IN THIS CONTRACT ARE SUBJECT TO CHANGE IN ACCORDANCE WITH THE WESTERN MASSACHUSETTS ELECTRIC COMPANY MASS SAVE HOME
ENERGY SERVICES PROGRAM OFFERS
MA CLIENTS:You may cancel this agreement If It has been signed by a party thereto at a place other than an address of the seller,which may be his main office or
branch thereof,provided you notify the seller in writing at his main office or branch by ordinary mail posted,by telegram sent or by delivery,not later than midnight
of the third business day following the signing of this agreement. See the attached notice of cancellation form for an explanation of this right.
DATE CLIENT'S SIGNATURE
DATE COMPANY REPRESENTATIVE'S SIGNATURE
Licensed aInsured Lcommtros
• www.Americanlnstallations.com
MACSL#'106178 American Installations
MA Registration#175982
-Efficient Home Services-
130 College Street Suite 100,South Hadley,MA 01075 • Office:(413)557-0200 Fax:(413)552-0202 • Email:supporteAmericanlnstallations.com
WEATHERIZATION PROPOSAL
Matthew Mickicwicz
247 Brookside Cr
Florence. MA 01062-3550
Site ID: S00002246218
Project ID: P00000251749
Customer ID: C00000256289
Contract ID; 20170220 WORK
Description Quantity Location
Insulate Rim Joist With r Thermal Barrer Polyiso 75 Q913,g Space $330.00
Insulation Removal - 70 N/A $80.50
Thermal
..___1...
Hatch: Barrier Polyiso 2 inch(Attic) 1 Living Space $41/1
Damming 50 N/A $109.50
Attic Floor Open Blow Cellulose 8" 1.431 Living Space $2.289.60
Propavent2 oro' _. _ 30 Attic $114.90
Replace Bath Fan Hasa 2 NIA $48.18
Sub Total: $3,014.39
Utility Incentive Share $2,000.00
Customer Contribution $1,014.39
WARRANTY:American Installations,LLC will provide the above stated homeowner with a 2 year workmanship warranty.
American Installations,LLC hereby proposes to furnish all material and labor to complete the above scope of work in accordance with the above specifications
and all local and state building regulations for the Total Contract Value as stated herein.
ACCEPTANCE OF PROPOSAL:The above prices,specifications and conditions TOTAL CONTRACT VALUE=$ 1,014 39
are satisfactory and are hereby accepted. You are authorized to do work as
specified.Payment will be 1/3 down prior to start of work,and balance due Down Payment=$ 338.00 Gi 2.20.17
upon Completion. q s ,x / Balance Due Upon Completion=$ 676 39
Signature ,Ip`I-'Ar!'�, 1,�i•.,,\\ ,{Ibr,.M,/,. Date lig l7
Property Owner(Print) (Sign) �� Date
Representative:{Printf Joel Marten (Sign) /(////J`> Dat 2-20-17
MIS AGREEMENT IS CDMPC6ED OF THIS PAGE AND THE APIERSE'ME OF MISPAGE AND SH•LL CO"D"ED
LLC HERnrurrzs REFERRED mss COMowr Auom MERISI NAM warm LAWS,Resuunous AND ORDINANCE me
THE FOLLOWING TERMS AND CONDITIONS ALSO APPLY
1 THIS AGREEMENT
SUBJECT TO THE APPROVAL OF A MANAGER OF THE COMPANY FOR THIS AGREEMENT TO BE EFFECTIVE UNDER ANY CONDITION.
2. SHOULD DEFAULT BEMADE IN THE PAYMENT OF THIS AGREEMENT CHARGES SHALL BE ADDED FROM THE DATE THEREOF AT A RATE OF ONE AND ONE-HALF(1-1/2)PERCENT PER MONTH.(18%PER
ANNUM(WITH A MINIMUM CHARGE OF$2.00 PER MONTH,AND IF PLACED IN THE HANDS OF AN ATTORNEY OR COLLECTION AGENCY FOR COLLECTION,ALL ATTORNEYS'FEES,EXPENSES AND COSTS
OF COLLECTION SHALL BE PAID BY THE CLIENT.IN ADDITION,CLIENT UNDERSTANDS THAT IN FAILING TO PAY ACCORDING TO THE ABOVE TERMS,COMP ANY MAY HAVE THE RIGHT TO A LEIN ON THE
PROPERTY.
COMPANY3. THE AGREES THAT WHEN DELAYS BECOME KNOWN TO THE COMPANY,THE COMPANY WILL ADVISE THE CLIENT AS SOON AS REASONABLE.
P. COMPANY THAT,NOTWITHSTANDING ANY AGREEMENT FOR MATERIALS AND/OR LABOR BETWEEN COMPANY AND THIRD PARTY,COMPANY IS RESPONSIBLE TO CLIENT FOR COMPLETION
OF ALL WORK DESCRIBED IN A TIMELY AND WORKMANLIKE MANNER.
S.
ALL TR EQUIPMENT AND PRODUCTS SUPPLIED BY THE COMPANY UNDER THIS AGREEMENT SHALL BE THOSE GIVEN BY THE MANUFACTURERS OF SUCH EQUIPMENT AND PRODUCTS.
UNDER SUCH MANUFACTURER'S WARRANTIES,THE CLIENT MAY BE REQUIRED TO REGISTER OR MAIL IN A WARRANTY CARD OR OTHER EVIDENCE DF OWNERSHIP AND USE OF SUCH EQUIPMENT
AND/OR PRODUCTS IN OROER TO ACTIVATE SUCH WARRANTIES.
6 THE QUOTATION ON THE PAGE HEREOF DOES NOT NCL UDE EXPENSES OR CHARGES FOR BOND DR INSURANCE PREMIUMS OR COSTS BEYOND NORMAL INSURANCE COVERAGE,ANY SUCH
ADDITIONAL EXPENSES,PREMIUMS OR COST SHALL BE ADDED TO THE TOTAL AGREEMENT AMOUNT.
7. THE LIABILITY FOR CLAIMS ARISING OUT OF THIS AGREEMENT SHALL NOT EXCEED THE TOTAL AGREEMENT PRICE EXCEPT TO THE EXTENT THOSE DAMAGES ARE PROVEN TO BE SOLEY
DUE TO THE COMPANY'S NEGUGENCE.
8. DURING THE DURATION OF THE WORK THE CLIENT'S HOMEOWNERS INSURANCE WILL BE RESPONSIBLE FOR ANY AND ALL DAMAGES AS LONG AS THE COMPANY HAS TAKEN THE APPROPRIATE
ACTION TO PROTECT AREAS OF WORK.
9. THE COMPANYIS NOT RESPONSIBLE FOR PREEXISTING DEFICIENCIES OR HAZARDOUS MATERIALS THAT MANIFEST THEMSELVES DURING THE CONSTRUCTION PROCESS.E.G.WOOD ROT,MOLD,
ASBESTOS,NAIL POPS,DUCTWORK AND CONNECTIONS,PLUMBINGPRE-EXISTING DEFICIENCY OR 4 AZARDOUS MATERIAL IS ENCOUNTERED PRIOR
VENTTO OR DURING CONSTRUCTION,AND COMPANY COMPANY
WILL
TRYASST DEFLECTION,ETC.IF
ST NOTIFIED I C WRITING, ARE
UNA OID TO ASSIST CLIENT WAND EINE CONOT
BE CONS MEANSEDANDICAPABILITIES TOCORRECTTHEADTHPRO-AT USE
SUCHON A TIME AND MATERIAL BASIS. CLIENT AGREES CONDITIONSDA EO COMPLETION BY THE COMFNM THATAGREDTPEmNPPPLfOPE,UNDER OFTHEAGREEMENT AND THAT DUE
TO THESE CONDITIONS THE DURATION OF THE WORK AND SCHEDULED FDATmFepmPRSnorvMAYDRAFTFRQmTHSASWATIONEED ON.O APPLICABLE,UNDER ARETHIS INCLUDED
DAGREEMENT.
L0. DETERIORATED DECKING,FASCIA BOARDS,ROOF FPC%S.VENTILATORS,FLASHING,RAFTERS,JOISTS,IN SU.P➢ON OR OTHER MATERIALS ARE NOT INCW DED UNLESS OTHERWISE
NOTED HEREIN.
11 THE SCRATCHING OR DENTING OF INTERIOR WALLS AND CEILINGS,FLOORS,TRIM,GUTTERS,DOWNSPOUTS,EXISTING
OIL
CONCRETE OR BLACKTOP DRIVES AND WALKS,OR DAMAGE TO PLANTS OR SHRUBBERY. IP EXCESSIVE DAMAGE IS CAUSED BY COMPANY,
COMPANY EHAIRLINE
WILL REPAIR OR REPLACEDAMAGED AREA ONLY AT COMPANY'S EXPENSE.
12, THE COMPANY UNDERPROVISIONS OF CHAPTER 142A OF THE GENERAL LAWS S REQUIRED TO APPLY FOR AND OBTAIN ALL CONSTRUCTION.RELATED PERMITS.THEBE DEEMED
RESPONSIBLE FOR DELAYS
WORK DESCRIBED IN THIS AGREEMENT CAUSED BY REGULATORY PERMIT GRANTING OR INSPECTIONAL AGENCIES,AUTHORITIES,ORRINDIVIDUALNOT
13 THIS AGREEMENT,INCLUDING THE PROVISIONS RELATING TO PRICE AND PAYMENT SCHEDULE,CANNOT BE CHANGED OR ALTERED EXCEPT BY A WRITTEN STATEMENT SIGNED BY BOTH THE COMPANY
AND THE CLIENT.
10COMMUNICATION NOT WRITTEN ON THIS AGREEMENT ARE AGREED TO BE IMMATERIAL AND NOT RELIED ON BY EITHER PARTY.AND DO NOT
SURVIVE THE EXECUTION OF THIS AGREEMENOTHER
15. THIS AGREEMENT CANNOT BE CANCELLED WITHOUT THE MUTUAL WRITTEN CONSENT OF BOTH PARTIES EXCEPT AS OTHERWISE SET FORTH HEREIN.
16. THIS AGREEMENT,AND ANY RANTY(SI PROVIDED HEREUNDER SHALL NOT BE ASSIGNED EXCEPT BY OR WRH THE WRITTEN PERMISSION OF THE COMPANY.
1I. HEREUNDER OR TERMINATES THIS AGREEMENT WITHOUT THE PRIOR WRITTEN CONSENT OF THE COMPANY,THE CLIENT SHALL BE LIABLE FOR
FAILSDAMAGES FOR THE GREATER OF THE COMPANY'S ACTJAL DAMAGES OR 25%OF THE AGREEMENT FOR RESTOCKING FEE.
18. NT(BRAND.STYLE.COLOR,ETC.I AFTER SAID MATERIAL HAS BEEN DELIVERED OR IS IN ROUTE TO THE CLIENT COULD RESULT IN A 5%RE-STOCKING FEE
BASED ON THE COST OFSAID MATERIALS.
19. THIS AGREEMENT SHALL BE EFFECTIVE ONLY UPON ITSEXECUTION BY ALL PARTIES HERETO,PRIOR TO WHICH TIME IT SHALL BE DEEMED A PROPOSAL THE COMPANY RESERVES THE RIGHT TO REVOKE
EXECUTEDTHIS PROPOSAL BY THE COMPANY IF IT IS NOT EARLIER EXECUTED BY THE CLIENT AND THE REQUIRED DOWN PAYMENT RECEIVED PRIOR TO THE EXPIRATION OF
SUCH 90 DAY PERIYOD;AFTER 90 DAYS,AND IN THE EVENT COMPANY DOES NOT REVOKE THE PROPOSAL,COMPANY RESERVES THE RIGHT TO REVISE ITS PRICE IN ACCORDANCE WITH RS COSTS IN
EFFECT AT SUCH TIME.
20. ANY PROVISIONEBi.
THIS
AGREEMENT SHOULD BE HELD
TO BE INVALID
NVALID OR UNENFORC ABLE,THE
VALIDITY AND ENFORCEBLLITY OF
THE REMAINING
EMAINING PROVISIONS OF
T.
AGREEMENT
GREEMENT SHALL NOT
BE AFFECTED THEREBY
21. ARBITRATION,INTER TO ARB CLIENT ACOMPANY HAVE A DISPUTALTHE TERMS. BNPROVISIONS,OR PERFORMANCE OF HIS AGREEMENT.THE PARTIES AGREE
TO PLACEUNMRTINTOAREIEBENTROAOTHERPRBITRATOR ASSIGNED ERICAN ARBITRATION 0.4SOCMAISLATORESOLVE
THEIR DISPUTE.
R. DISCOUNT,PMREIMBURSEMENT,OR OTHER PROGRAM THAT IS PART OF STATE
SPONSERED UTILITY PROGRAM SAVE.)ISSUBJECT IS SUBjECT TO THE AVAILABILITY OF QUALIFYING
WILLSTATE SPONSERED PROGRAM AND SUBJECT•O TERMINATION IE TE SPONSERENOTITPROGRAMIS 015COVLATINVED, FURTHERMORE,THE TERMS AND CONDITIONS OF STATE
MAYSPONSERED UTILITY PROGRAMS BA ALTERED JOATYPERIODICALLYWITX RWITHOUT NOTICE.
AGENT23 AMERICAN INSTALLERS,LLC IS NOT AN F ANY UTILITY COMPANY OF OTHER VENDOR WORKING BY,THROUGH,OR UNDER THE MASS SAVE.ENERGY PROGRAM
EAELECTRICENY(THE UTILITY)IS ENTITLED TO 100%OTTENERGY BENEASSOCIATED WITH ALL ENERGY
ND T CONSERVATION MEASURES,EXCLUDING THE VALUEOF ENERGY COST SAVINGS BY THE
LUDING ALL RITOBTOALL ASSOCIATEDISO-WNENERGY,CAUCH(TY AND
RESERVES PRODUCTS.COMPANY AGREES TO PROVIDE THE UTILITY WITH
UTILITYSUCH FURTHER MAY REQUEST NONFIRM THE UTILITY'S OWNERSHIPOF OBENEFITS AND PRODUCTS.
S NT UNDERSAND ACKNOWLEDGES THCOMPANYISVTANgGEVIC VENDOR OR SUB-VENOOR O THE UTILITY
ITH RESPECT TO THE INSTTHEY ENERGY ETO
MEASURES.IN THE EVENT OF THE FAILURE OF ANYENERGY CONSERVATION OTSIOP PERFORM AS EXPECTED,CLIENT
AGREES THAT CLIENT'S URSE IS TO THE COMPANY THD NOT TO
CONSERVATION
SERVICES
ROUP(CSG)OR TO THE UTILITY.THE UTILITY AND OPERATING COMPANIES SHALLNOT MISSSREMOVE NRPERFORM ANY WORK WVOER ON THE ENERGY
CONSERVATION MEASURES INSTALLED.CLIENT AND ACKNOWLEDGES THAT ITS.PARTICIPATION IN THE MASS SAVE HOME ENERGY SERVICES PROGRAM IS VOLUNTARY AND THAT IT
HAS CONSENTED FOR COMPANY TO INSTALL THE SED ENGY CONSERVAION MEASURES.
76. THATOTHEIR AFFILIATES OPERATING COMPANIES LRNLEFOR COMPANY'SPTR PERFORM ITS OBLIGATIONS UER THIS AOREM
FAILUREFOR OF THE ENERGY CONSERVATION MEASURES FUNCTION,FOR ANY DAMAGE TO CLIENT'S PREMISES CAUSED BY COMPANY OR FOR ANY AND ALL DAMAGES TO PROPERTY OR INJURY
TO PERSONS CAUSED BYE ENERGYCONSERVATION MEASURES.
27 CLIENT IS RESPONSIBLE FORTHE PAYMENT OF ANYAND
ALL FEDERAL,STATE,OR LOCAL TAXES THAT MEAPPLICABLE TO THIS AGREEMENT.
UNWED TIME OFFER.THE PRICES AND INCENTIVE OFFERED IN THIS CONTRACT ARE SUBJECT TO CHANGE IN ACCORDANCE WITH THE WESTERN MASSACHUSETTS ELECTRIC COMPANY MASS SAVE HOME
ENERGY SEROCES PROGRAM OFFERS.
MA CLIENTS:You may cancel this agreement if it has been signed by a party thereto at a place other than an address of the seller,which may be his main office or
branch thereof,provided you notify the seller in writing at his main office or branch by ordinary mail posted,by telegram sent or by delivery,not later than midnight
of the third business day following the signing of this agreement. See the attached notice of cancellation form for an explanation of this right.
DATE CLIENT'S SIGNATURE
DATE COMPANY REPRESENTATIVE'S SIGNATURE
The Commonwealth of Massachusetts
Aa n Department of Industrial Accidents
ham,,„A
of in to Investigations
{n= 600 Washington Street
e .0 a 8
1%,'"'— ef ef Boston, MA 02111
;'a_.�osc• www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors!Electricians/Plumbers
Applicant Information Please Print Legibly
Name iBushiusiogiwizadoNmdniduaI) American Installations,LLC
Address: 130 College Street,Suite 100
City/State/Zip: South Hadley,MA 01075 Phone it: 413-552-0200
Are you an employer?Check the appropriate box: Type of project{required):
{ P.1 I am a employer with 31 4_ )7 I am a general contractor and I -
1 b. CJ New construction
employees(full and/or part-time).' have hired the submntracturs
2.0 I am a sole proprietor or partner- listed on the attached sheet. 7- Remodeling
ship and have no employees 'these sub-contractors have ' 8. [::j Demolition
working for me in any capacity. workers'camp.insurance. 9. Ci Building addition
1No workers'comp.insurance 5. ❑ We are a corporation and its
required.] officers have exercised their • I 0."-I Electrical repairs or additions
3. j I am a homeowner doing all work right of exemption per MGI. I I I.L j Plumbing repairs or additions
myself. [No workers'comp. c. 152,q1(4),and we have no 12.D Roof repairs
insurance required. ' employees.[No workers' ^-
comp_insurance required.] IllaN, Other Insulation
'Any appli unt that checks bon In must also ill out section aaiow showing their worker`compuasarion policy information.
`Ilom who submit tlia affidavit mdawing they an doing all work and aim hire°inside c al:ictors must submit a new aIidavit indirnring such
ret:
renovatorsthat cheek his box must attached un pilanioWlsh2al s1ww--losrhe nameuthe mbK'onimmoruna!line worker comp.pulley information_
I am an employer that is providing workers'compensation insurance far rm employees. Below is the policy and Joh site
information.
Insurance Company Name: Guard Insurance Companies
Policy a or Self-ins. L,i}e,€ AMWC"j731485 _., _.. +___ Expiration Date: 09/04/2017
Li�� �"`�
Job Site Address. r.^ a?i�� I 1c (1 GI CityStafGZrp:_Q(2fe11.C.� t !v y' ol� L
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 MGM c. 152 can{gad to the imposition of criminal penalties ofa
tine up to$1,500.00 atnfh,r one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a tine
of up to 5250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of
Investigations of the DIA for insurance coverage verification.
I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct.
Signature: 4._ # 4./r ' 4d.....�-f— Date: de
..-.�jS71�671'
Phone#: , 413-552--0200
I Official use only. Do nor write in this area,to be completed by city or town official
City or Town: Permit/License#
Issuing Authority(circle one):
i I.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical inspector 5.Plumbing Inspector
6.Other
Contact Person: Phone#:
/.
'�R oATEtenvowvvrn
E, CERTIFICATE OF LIABILITY INSURANCE 9/1/2016
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER-THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to
the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the
certificate holder 1n lieu of such endorsements).
PNOIDICER NAAME: Linda Powers
Walter F Grinnell PHONE (413)586-0111 FAX. N ),(4131589-6491
8 North Ring Street !ASA.REss.lporars@webberandgrinnell.corn
INSUREIeS)AFFORDING COVERAGE I _-MAICU
Northampton MA 41060 Nsu RA Employers }tablet Casualty,,,,, .
#mJREu nJSVRERa$erkahvre Hathaway GUARD Ins. Co.
American Inafallatians, LLC INSUREac:
Attn: NBS G Suzanne Couture INSURER O:_
130 College Street, Suite 100 INSURER E:
South Hadley NA 010T5 ,.. UREA F: {
COVERAGES CERTIFICATE NUMBERefaster Exp 9-2017 REVISIONNUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWTHSTANDING 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.
.. _
wySRwTYPE Cf -. POtCTMM6ER... • POLICY CPS FOUCYEXP
6WODTYYiNKOIXYYY
}` uses
cOMMEKCuLGEN€RAL
uAettnY I EACH OCGU EnL'E' s 5,000,000
A I X_Cl/WAS-MADE I OCCUR F 1i�Elbque�—
fPq sEs l¢aecglnrq¢el 5 500,000
X . LigMOr Liability I 503535217 1 9/412010 9/4/2019 IMEDy n114O91 1F 10,000
,_ I PERSONAL 6 AW INJURY S 1,000,000
GNL AGOREGME LW APi uS PER 1GENERAL AGGREGATE S 2,000,000
FRS r"""".
K POLICY_ IFCTOC I 41460OC6-GUMR/094GG S 2.000r000
--JOTRER S
AUT
OMONLE LIABILITY C29INEEDSINGL OMIT S 1,000,000.
A ANY AUTO SOIMLY INJURY(PU,person) S
ALL0901D SCHECULEO
x AUTOS 5[353521'= 9IIlI20J.6 9/412017 COCOA AkIY1At,e +WiS I
X HIPEOAUTOS X gl•uT'os N£o I ...patio R osRbe S
delnt. __..
I Pip-Basic �S 8,000
X UMBAFtU CABOCCUR
' £AC OCCURRENCE J S 1,000,000
A EACISSUAB CLAIMGMADE'I 'AGGREGATE Is 1,000,000
CEO 1 X RETENTfONS 10,000 '5.73539211 914/2016 , 9/4/2017
WORKERS COMPENSATION ss PER
J_ ORH
AND EMPLOYERS'LIABILITY - —
ANY P.ROI'+NIETOWPARTNER]fXECUTNE YM EL EACH ACCIDENT S 500,000
OSFlCERIMEWER EXCLUDED° NIA
B IMafpqury,n MH1 -- OR:WC60041.7 9/4/2016 9/4/2017 F L DISEASE-2A EMPLOYEE S _ 500,000
IDy ea beun0el
ESCRIVTIVNOF OPERATIONS oelmu EL DISEASE-PODGY OAT r S 500,000
A Corwerc.iai Property 5A3535217 914/2016 9/a/2017 4949441441102C $20,000
1 mm.vwes1,gR $40,000
DESCRIPTION OP OPERATONS I LOCATORS I VEHICLES(AGGRO lot AddIY4uIIRemarks SNrvWle,may be xue6M 11 more space is mqulted)
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 REPRESEMTARVE
Kevin Joyce/IIP -_ "Y
M1988-2014 ACORD CORPORATION. All rights reserved.
ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD
1NSn8rmnnn
igi Massachusetts -Department of Public Safety Unrestricted-Buildings of any use group which
Board of Building Regulations and Standards contain less than 35,000 cubic feet(991m3)of
Construction supervisor MEM enclosed space.
License: CS-106178
e. T
.� ,
WESLEY COU ' r
TTIJIE l
166 NORMMAI1N a G
South Hadley MA;01
ray a5: Failure to possess a current edition of the Massachusetts
ei a - -State Building Code is cause for revocation of this license.
�2...-nU� 'r'us Expiration
Commissioner 0920/2077 For DPS Licensing informationmsrt www.massGov/nes
= = Office of Consumer Affairs and Busi- ss Regi-lation
"el' ,
W Park Plaza - Suite 5170
Boston, Massachusetts 02116
Home Improvement Contractor Registration
Registration: 175982
_. _.' Type: LLC
Expiration: 6a712017 Tilt 265208
AMERICAN INSTALLATIONS, LLC
WESLEY COUTURE
130 COLLEGE STREET SUITE 100
SOUTH HADLEY, MA 01075
Update Address and return card.Mark reason for change.
scar :; COM 0511 El Address 9 Renewal 9 Employment 9 Lost Card
r%Le'F r„a// rfbI(. Aura/G
Oita ofCnsum Affairs&Business Regulation License or registration valid for individul use only
a _ N1OME IM
�ExpimdonPROVEMENT CONTRACTOR before the expiration date. If found return to:
istranon: 175582 Type: Office of Consumer Affairs and Business Regulation
_6t27/2017. LLC 10 Park Plaza Suite 5170
_,. Boston,MA 02116
AMERICAN INSTALLATIONS,EIC
WESLEY COUTURE -_Ez
130 COLLEGE STREET SUITE toll c c:,..-�
SOUTH HADLEY MA 01075 Undersecretary N valid without signature