16C-032 418 SPRING ST BP-2019-0333
GIs#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 16C-032 CITY OF NORTHAMPTON
Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL 042A)
Category:ROOF BUILDING PERMIT
Permit# BP-2019-0333
Project# JS-2019-000540
Est. Cost: $10000.00
Fee: $40.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: SEXTON ROOFING CO 118239
Lot Size(sq.ft.): 121096.80 Owner: SAVINO SCOTT A&
Zoning:URA(100)/WSP(26)/ Applicant: SEXTON ROOFING CO
AT: 418 SPRING ST
Applicant Address: Phone: Insurance:
P O BOX 6327 (413) 534-1234
HOLYOKEMA01041 ISSUED ON:9/16/2018 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: 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 Siinature:
FeeType: Date Paid: Amount:
Building 9/16/2018 0:00:00 $40.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Louis Hasbrouck—Building Commissioner
Lw�z�
- �,� Department se only
f City of Northam tonR EC E I f Per it
Building Departr ient curb Ci t/Driv way Permit
212 Main Str tSewer/ eptic vailability
I !�, •�I ROOM 100 SEp 7 Ater ell A ailability
' Northampton, MA 10 Two Se s of E tructural Plans
=» phone 413-587-1240 Fax 413 &G a ING IN Plan
NORTHAMPTON,M
APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION 6f-- l 9 73 J—s
1.1 Property Address: ' QThis section to be/^commpleted by office
Map I� Lot O 5L Unit
Zone Overlay District
Elm St.District CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.11 �Owne/r'of Record: I /
Name(�)� Curren M ling Addre
a / (' 444 / D �o C_ - ?�6
.4 f 61 r �/ L Pte^ Telephone
Signa ure
2.2 Authorized Agent:
z L5a�
Name(Pri t) Current Mailing Address:
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 u
4. Mechanical(HVAC)
5. Fire Protection
6. Total=(1 +2+3+4+5) Check Number
This Section For Official Use Only
Date
Building Permit Number: Issued.-
Signature:
ssued:Signature:
Building Commissioner/Inspector of Buildings Date
G @
EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR)
., i .. . UIVO�N�:!� , uta
r; :u:o
SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable)
New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing `>�
Or Doors 0
Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [M Siding[0] Other[0]
Brief Description of Proposed J
Work: �Q C 1J2.� � � Fy,�"4%.L 9 h LI !6nl
Alteration of existing bedroom Yes No Adding new bedroom Yes No
Attached Narrative Renovating unfinished basement Yes No
Plans Attached Roll -Sheet
6a. If New house and or addition to existing housing, complete the following
a. Use of building : One Family Two Family Other
b. Number of rooms in each family unit: Number of Bathrooms
c. Is there a garage attached?
d. Proposed Square footage of new cons ruction. Dimensions
e. Number of stories?
f. Method of heating? Fire 6sor Woodstoves Number of each
g. Energy Conservation Compliance. Masscheck Energy Compliance form attached?
h. Type of construction
i. Is construction within 100 ft. of w nds? Yes No. Is construction within 100 yr. floodplain Yes No
j. Depth of basement or ar floor below finished grade
k. Will buildin form 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
as Owner of the subject
prope r
hereby authorize 91
to a my behalf, in all matters relativeYo work authorizefd by this building permif application.
Signature of Owner Date
as Owner/Authorized
Agent hereby declare that the sta ments and information on the fore oing application are true and accurate,to the best of my knowledge
and belief.
Signed der the pains and penalties of perjury.
Print Name
Signature of Owner/Agent a e
SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable ❑
Nam of License Holder: �� lz°' 32— LrCq
License Number
d A6 - S-- /9
AGAdress Expiration Date
r
Signature Telephone
9 istered Improvement Con tor: Not Applicable ❑
ComDanv Name Registration Number
A dress Expiration Date
06Telephone
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...... ❑
City of Northampton
z.
Massachusetts
�3:
}� DEPARTMENT OF BUILDING INSPECTIONS y
212 Main Street • Municipal Building
Northampton, MA 01060
AFFIDAVIT
Home Improvement Contractor Law
Supplement to Permit Application
The Office of Consumer Affairs and Business Regulation("OCABR")regulates the registration of contractors and
subcontractors performing improvements or renovations on detached one to four family homes. Prior to
performing work on such homes,a contractor must be registered as a Home Improvement Contractor("HIC").
M.G.L.Chapter 142A requires that the"reconstruction, alteration, renovation, repair, modernization, conversion,
improvement, removal, demolition, or construction of an addition to any pre-existing owner-occupied building containing
at least one but not more than four dwelling units....or to structures which are adjacent to such residence or building" be
done by registered contractors.
Note:If the homeowner has contracted with a corporation or LLC,that entity must be registered
Type of Work: t 19 q Est. Cost: 1/Q
Address of Work:
Date of Permit Application:
I hereby certify that:
Registration is not required for the following reason(s):
_Work excluded by law(explain):
_Job under$1,000.00
Owner obtaining own permit(explain):
Building not owner-occupied
Other(specify):
OWNERS OBTAINING THEIR OWN PERMIT OR ENTERING INTO CONTRACTS WITH UNREGISTERED
CONTRACTORS OR SUBCONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK ARE NOT
ELIGIBLE FOR AND DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND
UNDER M.G.L.Chapter 142A.SUCH OWNERS ALSO ASSUME THE RESPONSIBILITES FOR ALL WORK
PERFORMED UNDER THE BUILDING PERMIT.SEE NEXT PAGE FOR MORE INFORMATION.
Signed under the penalties of perjury:
I hereby apply for a buildi ermit as the agent of the
owner:
/
D to Contractor Name HIC Registration No.
OR:
Notwithstanding the above notice,I hereby apply for a building permit as the owner of the above property:
Date Owner Name and Signature
City of Northampton
,'• �' Massachusetts e?'
DEPARTMENT OF BUILDING INSPECTIONS D5 z
212 Main Street •Municipal Building
\ Northampton, MA 01060 rSFyyC�`�
Debris 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.
The debris from construction work being performed at:
(Pled print hou:�6u� d street name)
Is to be disposed of at:
17 61) d9 I'd a v VA
(Please pftl name and location of facility)
Or will be disposed of in a dumpster onsite rented or leased from:
(Company Name and Address)
Signature-ofPermit Applicant or Owner Date
If, for any reason, the debris will not be disposed of as indicated, the Applicant or Owner shall notify the
Building Department as to the location where the debris will be disposed.
--�ro�fl�ar
SEXTON ROOFING AND SIDING INC
www.sextonroofing.com
41
19O MASTER-- A=6
Setting the Standard
P.O. Box 6327
p. 413.534.1234 Holyoke, MA 01041
f. 413.539.9906
MA HIC# 118239
sextonroofin ahotmail.com
SUBMITTED TO Scott Savino PHONE 626-8706 1 DATE 9/11/18
STREET 418 Spring St. JOB NAME
CITY STATE ZIP Northampton,Ma. JOB LOCATION
SEXTON ROOFING HEREBY SUBMITSSPECIFICATIONS AND ESTIMATES FOR:
1) Strip and remove existing shingles and dispose of in proper landfill.
I i
2) Inspect roofing deck and replace as needed. ( $2.75 per sq.ft. )
3) Install new metal edging to rakes and eaves of roof. (81') i
4) Install ice and water shield on eaves (6'), vent stacks, in valleys, chimney, skylights, 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) Install IKO Architectural style roofing shingles as per manufacturers' specifications. (Charcoal)
9) Install new cap over ridge vent.
10) Supply manufactures Lifetime warranty and SRC 25 yr. workmanship warranty.
ALL CONTRACTS INSURED WITH PROPERTY LIABILITY AND WORKMANS-COMPENSATION.
We 30ropose hereby to furnish material and labor—complete in accordance with the above specifications, for the amount of
Ten Thousand Dollars($10,000.00)Payments to be made as follows: Due in full upon completion
All Material is guaranteed to be as specified. All work to be completed in a Authorized
workmanlike manner according to standard practices. Any alteration or
deviation from above specifications involving extra costs will be executed only Signature_
upon written orders,and will become an extra charge over and above the
estimate. All agreements contingent upon strikes,accidents or delays beyond Note: This proposal may be withdrawn by us if not accepted
our control. Not responsible for water damage during construction. Owner within(14)days.
to pay responsible legal fees for non-payment,and applicable interest.
Meeeptance Of 3prop0l;al The above prices,specifications
and conditions are satisfactory and are hereby accepted. You Signature \
are authorized to the work as specified. Payment will be
made as outlined above. Signature
Date of Acceptance.
T
The Commonwealth of Massachusetts
Department of IndustrialAccidents
I Congress Street, Suite 100
Boston,MA 02114-2017
www mass.gov/dia
N arkers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers.
TO BE FILED WITH THE PERbIITTING AUTHORITY.
Applicant Information Please Print Legibly
Name(Business/Organization/Individual):Sexton Roofing&Siding Inc
Address:P.O. Box 6327
City/State/Zip:Holyoke, Ma, 01040 Phone#:413-534-1234
Are you an employer?Check the appropriate box: Type of project(required):
1.❑I am a employer with employees(full and/or part-time).* 7. E]New construction
2.❑I am a sole proprietor or partnership and have no employees working for me in 8. E]Remodeling
any capacity.[No workers'comp.insurance required]
3.[:][am a homeowner doing all work myself[No workers'comp.insurance required]t 9. ❑BuildDemoing II
10 Q Building addition
4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will
ensure that all contractors either have workers'compensation insurance or are sole 11.0 Electrical repairs or additions
proprietors with no employees. 12.❑Plumbing repairs or additions
5.❑✓ I am a general contrador and I have hired the sub-contractors listed on the attached sheet 13.❑Roof repairs
These sub-contractors have employees and have workers'comp.insurance.t
6.❑We are a corporation and its officers have exercised their right of exemption per MGL c. 14.❑Other
152,§1(4),and we have no employees.[No workers'comp.insurance required]
*Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information_
t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such_
:Contractors that check this box mast 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 thepolicy and job site
information.
Insurance Company Name:Travelers Property Cas Co of Am
Policy#or Self-ins.Lic.# 7PJUBGo7898212 Expiration Date:6/4 /19
Job Site Address: City/State/Zip:
Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date).
Failure to secure coverage as required under MGL c. 152, §25A is a criminal violation punishable by 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$250.00 a
day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance
coverage verification.
I do hereby certify u the pains and penalties of perjury that the information provided above is true and correct.
Sienature: Date:
Phone#: 6�Z 3 -S-3 V- /Z 3
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#:
The Commonwealth of Massachusetts
Department of IndustrialAccidents
1 Congress Street,Suite 100
Boston,MA 02114-2017
www.massgov/dia
Workers'Compensation Insurance Affidavit:Builders/Contractors/Elech icians/Pinmbers_
TO BE FILED WITH THE PERMITTING AUTHORITY.
Applicant Information Please Print Letibly
Name(Business/Organization/Individual):LDG Homes.Improvement,Inc
Address:18 Spring St. 1 st floor
City/State/Zip:Milford, Ma.01757 Phone#:(774)214-6239
Are you as employer?Check the appropriate box Type of project(required):
1_❑✓ I am a employerwith 5 employees(firs and/or part-time)-* 7. ❑New construction
2_[11 am a sole proprietor or partnership and have no employees working for me in $. Remodeling
any arty.[No workers'comp.insurance required.]
3-E]I am a homeowner doing all work myself[No workers'comp.insurance required_]t 9.10❑Demolition
addition
on
4_FJ I am a homeowner and will be hiring contractors to conduct all work on my.property. I will Building
ensure that all contractors either have workers'compensation insmanee or are sole 11.0 Electrical repairs or additions
proprietors with no employees.
12.E]Plumbing repairs or additions
5.Q I am a general contractor and I have bird the sub-mittractos Iisted on the attached sheet
These sub-contractors have employees and have workers'comp.insurau t 13.R]Roof repairs
6.❑We are a corporation and its officers have exercised their right of exemption per MGI.c. 14.[:]Other
152,§1(4),andwe have no employees_[No workers'comp_insurance required.]
*Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information_
t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
:Contractors that check this box most attached an additional sheet showing the name of the sub-cordractDrs and state whether or not those entities have
employees. If the sub-couhactors 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-Travelers Indemnity Company of America
Policy#or Self-ins.Lic.#:UB-1 K196202-18 Expiration Date:0221/19
Job Site Address: City/State/Zip:
Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date).
Failure to secure coverage as required under MGL c.152,§25A is a criminal violation punishable by 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$250.00 a
day against the viol or.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance
coverage verificati
I do hereby c the pains and penalties of perjury that the information provided above is true and correct
attne: Date:
Phone#: 1 239
O ffuial use only. Do not write in this area,to be completed by city or town offXial
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#.
® CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY)
0712312018
TWS.CFATIFICATE 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 CONSTTITJTE 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 and endorsement A statement on this certificate does not confer rights to
the certificate holder in lieu of such endorsement(s).
PRODUCER CONTACT
NAME
A COSTA INSURANCE AGENCY PHONE FFAX,21RANKLIN COMMONS (AIC•No,Ext)= No):
E-MAIL
FRAMINGHAM,MA 01702 ADDRESS:
783BY INSURER(S)AFFORDING COVERAGE NAIL#
INSURED INSURER A: TRAVEL ERS INDEMNITY COMPANY OF AMERICA
LDG HOMES IMPROVEMENT INC INSURER B:
INSURER C:
INSURER D:
18 SPRING ST 1ST FL INSURER E:
MU—FORD,MA 01757 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 NDICATED_ NOTWITHSTANDING
ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED DR MAY PERTAIN.THE INSURANCE
AFFORDED BY THE POLICIES DESCRIBED HIEREM IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY
PAID CLAIMS
INSR ADD SUB POLICY EFF DATE POLICY EXP DATE
LTR TYPE OF INSURANCE L R POLICY NUMBER (MMIDDIYYYY) (MMOMYYYY) LIMITS
GENERAL LIABILITY EACH OCCURRENCE I$
COMMERCIAL GENERAL LIABILITY
CLAIMS MADE OCCUR PREMISES
TO RENTED $
REMISES(Ea occurrence)
EXP(Any one person) Is
PERSONAL&ADV INJURY Is
GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE is
POLICY [--]PROJECTF—]LOC PRODUCTS-COMP/OPAGG Is
AUTOMOBILE LIABILITY COMBINED SINGLE I$
ANY AUTO LIMIT(Ea accident)
ALL OWNED AUTOS BODILY INJURY $
SCHEDULE AUTOS (Per person)
HIRED AUTOS BODILY INJURY $
(Per acodent)
NON-OWNED AUTOS PROPERTY DAMAGE is
(Per accident)
UMBRELLA LIAR8 OCCUR EACH OCCURRENCE �s
EXCESS LIAB CLAIMS-MADE AGGREGATE Is
DEDUCTIBLE Is
RETENTION $
1$
A WORKER'S COMPENSATION ANDX WC STATUTORY OTHER
EMPLOYER'S LIABILITY YIN UB-iK196202-18 02212018 021212019 LIMITS
ANY PROPERITORIPARTNER/FY.ECUTIVE NIA E LEACH ACCIDENT 5 100,000
OFFICERIMEMBER DCCLUDED?
(Mandatory In" EL DISEASE-EA EMPLOYEE $ 100,000
If yes,descnbe under I
DESCRIPTION OF OPERATIONS below EL DISEASE-POLICY LIMFF I$ 500,000
DESCRIPTION OF OPERATIONSILOCATIONSNEHICLESIRESTRICTION5/SPECIAL ITEMS
THIS REPLACES ANY PRIOR CERTIFICATE ISSUED TO THE CERTIFICATE HOLDER AFFECTING WORKERS COMP COVERAGE-
CERTIFICATE HOLDER CANCELLATION
SEXTON ROOFING&SIDING INC SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCEI IED
102 PINE ST BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED
IN ACCORDANCE WITH THE POLICY PROVISIONS.
PO BOX 6327
AUTHORIZED REPRESENT
HOLYOKE,MA 01040 !~
ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD 1988-2010 ACORD CORPORATION. All rights reserved.
A�D' CERTIFICATE OF LIABILITY INSURANCE DATE 61262018
IS 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 POUCIES BELOW
IS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZE
EPRESENTATWE OR PRODUCER,AND THE CERTIFICATE HOLDER
MPORTANT:If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed.If SUBRDGATION IS WAIVED,subject to the
enrm and conditions of the policy, certain policies may require an endorsement A statement on this certificate does not confer rights to the
ertificate holder in lieu of such endorsement(s).
PRODUCER CONTACT NAME:Kathi Hutchinson
Ormsby Insurance Agency,Inc. PHONE(AIC,No,Ext):(413)737-0300 FAX(A1C,No):
PO Box 718 E-MAIL ADDRESS:khutchinson@ormsbyinscom
West Springfield,MA 01089 INSURERS AFFORDING COVERAGE NAILYi
INSURED INSURER A:Co)ony Insurance Company -34493
Sexton Roofing and Siding Inc INSURER B:
PO Bax 6327 INSURER C:
Holyokz,MA 01041-G327 INSURER D:
INSURER E
INSURER F:
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER-
THIS
UMBERTHIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED.NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
POLICY EFF POLICY EDLP
INST ADOL SUER DATE DATE
LTR TYPE OF INSURANCE NSRD WVo POLICY NVLTRER IDONYI MMIDD LIMITS
A IOIGLOC12159903 6/252018 6252D19 EACH OCCURRENCE S1,DO0,DDO
X COMMERCIAL GENERAL LIABILITY
CLAIMS MADE I OCCUR DAMAGE TO RENTED S100,0D0
PREMISES Ea Occurrence)
MED EXP(Any one person) S5,D00
PERSONAL&ADV INJURY S1,000,000
N'L AGGREGATE LINUT APPLIES PER GENERAL AGGREGATE SZOD0,000
Y ]jE T –]LOC PRODUCTS-COMP/OP AGG 12,DDO,DOO
POLICY FN
OTHER
COMBINED SIGNED LIMIT S
AUTOMOBILE LIABILITY (Ea accident)
ANY AUTO BODILY INJURY(Per person) 5
ALLOWNED SCHEDULED BODILY INJURY(Per 5
AUTOS AUTOS czident)
HIREDAUTOS NON-OWNED PROPERTY DAMAGE
AUTOS (Peracrident) 5
5
UMBRELLA UAB —OCCUR EACH OCCURRENCE S
CESS LIAR CLAJMS MADE AGGREGATE Is
ED ETEIMDN S 5
PER
WORKERS COMPENSATION AHD OTH-
STATUTE ER
EMPLOYERS'LIABILITY YIN
ANYPRDPRIETORJPARTNER/EJCECUTIVI EL EACH ACCIDENT S
OFFICEWM._MBER EXCLUDED? NIA
(Mandatory in NH) EL DISEASE-EA 5
IF yes,d scribe underEMPLOYEE
DESCRIPTION OF OPERATIONS below EL DISEASE-POLICY UM1T S
DESCRIPTION OF OPERATIONS I LOCATIONS I VEi1CI ES(ACORD 101,Ackfiki al Remarks Schedule,irmom space is required)
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE D7 PIRATION DATE
THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
ACORD ZS(2014/01) O 1988-2014 ACORD CORPORATION.All rights reserved-
The ACORD name and logo are registered marks of ACORD
n�JIr> (! 0J) J1rG'>ri��f>rrr'r`�
'. Office of Consumer Affairs and Business Regulation
4
10 Park Plaza- Suite 5170
Boston, Massachusetts 02116
Home Improvement Contractor Registration
Type: Corporation
Registration: 118239
SEXTON ROOFING &Siding Inc Expiration: 02/14/2019
P.O. Box 6327
Holyoke, MA 01041
Update Address and return card. Mark reason for change.
sG, •� ?�ie.n5 n
n cmr!rnrT'+e�♦
Commonwealth of Massachusetts
Division of Professional Licensure
Board of Building Regulations and Standards
Constructiort,511pervlsor Specialty
CSSL-099689 Expires: l0/OS/2D19
/ -
EVERETT J SEXTON
PO BOX 6327
HOLYOKE MA 01.041
Commissioner
CONNECTICUTSTATE OF
DEPARTMENTOFCONSUAYER PROTECTION
HOME IMPROVEMENT CONTRACTOR
EVERETT J SEXTON SR
102 Pine St
HOLYOKE,MA 01040-2411
SEXTON ROOFING&SIDING CO
LIC./REG NO. EFFECTIVE EXPIRES
HI C.0605383 12/01/2017 11/30/2018
SIGNED