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23D-162 135 MAPLEWOOD TER BP-2019-0844 GIs#: COMMONWEALTH OF MASSACHUSETTS Map:Block:23D- 162 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: ROOF BUILDING PERMIT Permit# BP-2019-0844 Project# JS-2019-001396 Est.Cost: $8000.00 Fee: $40.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor. License: Use Group: SEXTON ROOFING CO 99689 Lot Size(sq. ft.): 33497.64 Owner: MOORE LOUIS S zonina: URB(100)/ Applicant. SEXTON ROOFING CO AT. 135 MAPLEWOOD TER Applicant Address: Phone: Insurance: P O BOX 6327 (413) 534-1234 WC HOLYOKEMA01041 ISSUED ON.1/29/2019 0:00.00 TO PERFORM THE FOLLOWING WORK.-REMOVE AND REPLACE SLATE ROOF WITH NEW ASPHALT SHINGLES 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: Qi 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 1/29/2019 0:00:00 $40.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner HLUE City of Northam ton I P - Building Depart ent Curb Permit f A ' 212 Main St r t JAN 2 8 2 Avaiialr 4 �. Room 100 Water all ability Northampton, M 01 of ral Plans phone 413-587-1240 Fa 413- TON,�A , Pia APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR FAMI Y DWELLING SECTION 1 -SITE INFORMATION 1.1 Property Address: This section to be completed by office — � � _%S.� � 3 S lo��1�Lua�� ,�c�, Map Lot Unit Zone Overlay District Elm St.District CS District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: L , s '06 0 L i 3�'�1,9-ry e 4aa,:2 / Name(Print) Current MailingAddress: .'� dd"d Tel6plione Signature 2.2 Authorized Agent: O I�� G 3 �y�yc���� un/1 a/0-1/ Name urrent Mailing Address: / ,-- o?Q 2 3 V Signature Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building (a)Building Permit Fee 2. Electrical (b)Estimated Total Cost of Construction from 6 3. Plumbing Building Permit Fee 4. Mechanical(HVAC) 5. Fire Protection 6. Total=(1 +2+3+4+5) G Check Number This Section For Official Use Only Building Permit Number: IIsssued: Signature: P 29- Za19 Building Commissioner/Inspector of Buildings Date EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR) SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable) New House ❑ Addition ❑ Replacement Windows Alteration(s) EJ Roofing E!r _ Or Doors 0 Accessory Bldg. ❑ Demolition ❑ New Signs [1--3] Decks [Q Siding[p] Other[Q Brief Desc tion of Proposed Work: Xf&G tAe Q L" /�,D 1,4C f S 1A7�2��JL L[,/19 eCJ AN &,-1, - S71/tlg 1 S 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 constructio imensions 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 wetl s? Yes No. Is construction within 100 yr. floodplain Yes No j. Depth of basement or cellar fl r below finished grade k. Will building conform to a 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 1, 1&r,e-> &b OX as Owner of the subject property hereby authorize a}C '�o 2-6(j to act on my behalf, in all matters relative to work authorized by this building permit application. (Id 46C L 4 #441 c� / 4 4�l [/ Signature of Owner bite as Owner/Authorized Agent-hereby declare th the statements and information oh the foregoing application are true and accurate,to the best of my knowledge and belief. Signed under the pains and penalties of perjury. Print Name / l Signature of Owner/Agent D to SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction ,Supervisor: f c Not Applicable ❑ Name of License Holder: Cy 2 e �l .1� k f 5'2 �7 //.2R�q License Number / l,/, !i! Address L Exp�ion Date Signature Tele-phone 9.Re istered Home Improvernent.Contractor: Not Applicable ❑ D ( ✓l - / / I 1 � `t Compariv Name fRegistration Number Q) ) C- 140 �n �c aL/ l 2-/�-- 2-- r Address L I/ Expiration Date Telephone lL- /2_ V 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....... In" No...... ❑ City of Northampton Massachusetts 'A DEPAR222= OF BU.TLDIPG INSPFXTIOWS 9J aj„ 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: Est. Cost: 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 building permit as the agent of the owner: t /1a / 't / 2 ate 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 ' ° LSE G DEPAR25ANT OF BUILDING INSPECTIONS �`• 212 Main Street •Municipal Building yJ . a Northampton, MA 01060 ssb ..° jam° 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: 13 �5- �a%41,1/10,ZJI-r (Please print houuge'number and street name) Is to be disposed of at: (Please print name and location of facility) Or will be disposed of in a dumpster onsite rented or leased from: 3,11 L'2e (Company Naame anted Address) Signature of Permit 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. SEXTON I SIDING (413) 534-1234 P.O. Box 5327 FAX (413) 539-9906 Holyoke, MA 01041 sextonroofing@hotmaii.com CT HIC#0605383 MA HIC#118239 www.sextonroofing.com Since 1985 SUBMITTED TO PHONE C — Q DATE STREET JOB NAME /tee CITY STATE ZIPCODE JOB LOCATION Proposal to furnish as Install the following EMAIL ❑ Re-Roof furnish Tear-Off Main House ❑ Garage ❑ Shed Complete Roof Preparation po"Rome exterior to be protected by tarps and plywood Eihrubs,landscaping,trees to be protected Entire existing roofing material to be removed to existing decking, Including flashing,etc. prSite to be cleaned everyday with roll magnet debris removed at project completion ❑ Deteriorated existing decking replaced at$2.50 per sq.ft i t all new decking/type: rown metal drip edge installed at eaves and rakes WIF-8 ❑ F-5 ❑ Rake Edge q�--Wew flashing will be installed where necessary(see Special Requirements) ❑ Install new pipe boot flashing ❑ Bathroom Exhaust Vent ❑ R�eflash chimney with new lead 4,9,0 676 �We shall acquire all appropriate permits etc.for all roofing work C,omm ete Roofing System �J Leak Barrier installed at all eaves to protect from ice dams(and meet codes in the north) ❑ 3' W06'-- CBarrier installed at valleys,around penetrations and chimneys to protect critical areas Wo'Install Roof Deck Underlayment on remainder of roof ❑ #15 Felt QI,-Synth6 c Felt Shin�gl s � It ❑ GAF ❑ CertainTeed ❑ Tamko / ❑ 30year ❑ 50year �etime Colorll Attic ventilation systemCI;over Ridge Vent ❑ Roof Louvers :7e ty Options guaranteed our workmanship for 25 full years _jA$ropogf by to furnish material and labor-complete in accordance with the above specifications,for the sum of: z.� d .ro dollars($ �• arrnnEHr eE tMDE As Fatovvs N All Material is guaranteed to be as spedlled. AO work to be completed in a wwkmanlike manner Authorized according to standard practices. Any alteration or deviation from above specifications involving extra costs will be executed ony upon written orders,and will boom*an extra charge over and Signature above the estimate.All agreements contingent upon strikes,accidents or delays beyond our control. Note:This proposal may be Not responsible for water damWi age during n.Owner to pay responsible legal lees for no nt and apWicable interest of 1 r r moth. Withdrawn by us if not accepted within days. �IutptdtlYt of mal-The above prices,specifications and conditions Signature are satisfactory and are hereby accepted.You are authorized to do the work as specified.Payment will be made as outlined above. Date of Acceptance Signature ATTENTION HOMEOWNERS:Please cover all personal belongings in the attic,garage or storage areas due to the possibility of rooting debris or dust coming in through the cracks of the wood. Sexton Roofing and Siding will not be responsible for debris or dust in the attic or storage areas. The Commonweam of Massachusetts Department oflndasi &Accidents I Congress Street,Sane 100 Foston,MA 02H4-2017 www.massgov/dia N-Vorkers'Compensation Insurance Affidavit:Bwldeis(Contradors/Eledricians/Phumbers. TO BE FILED WITH THE PERMIZTING AUTRORTTY. Applicant Information Please Print Legibly Name(Business/organi adonandividuai):Sexton Roofing&Siding Inc Address:P.O. Box 6327 City/State/zip:Holyoke,Ma,01040 Phone#-413-534-1234 Are you an emptayern Cberk the appropriate box. Type of project(required): Lo I am a employer with employees(full andt-part time).* 7. ❑New construction 2a 11 I im asole proprietor orpa taersbip and have no employees woAring for me m 8. ❑Remodeling`any rapacdy-[No wonders'comP-Ins—-q---&] 3. I am a bomeowner .0 work 9. ❑Demolition ❑ long myself[No workers'comp_iaivance regrrired]t .❑4.4.[:]l am a homeowner amdwrhl be hiring rnahadors to conduct all work on my property. I will 10 Budding addition ensmethatall camrtactm either have wadmss'e®penssabon msurance or are sole 11.❑Electrical repairs or additions proprietors with no employees_ 5Q I am a general conhaorsheet.I have hued the sulrconfimam listed on the attached shee12 Plumbing repairs Or additions These sub-co akadms have employees and have wodcas'comp_ins .: I3-❑Roofrepairs 6.❑We are a corporation and its offices have exmmsed their right of hon MGL c. 14.❑Oilier aemP 1� _ 152,§1(41 and we have no employem[No workers'comp_insurmce required.] "Any applicant that checks box#1 most also fill out the section below showing theirwodras'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and hien hire outside contractors mast submit a new affidavitindioating such Contractors that check**box most attached an additional sheet showier the name of the srb-wntrarmrs and state whether oxnotthose entities have employees. If the have employem they must provide their workers'comp_policy number. I a7m as engdoyer drat is providing workers'compensadon inmrmrce formy employem Below is the p,oliey mrdlob site informalbon. Insurance Company Name-Travelers Property Cas Co of Am Policy#or Self-ins.Lic.#-7PJUBG07898212 Expiration :6/4/19 Job Site Address: Wt4 n o a, J-e,,r, City/Statelzip:L L 1,L Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date)_ Fail=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. Ido hereby cffh)yr under tk ains mind penalties of perjury that the mformation provided above is true mrd correct Signature: Date: 1� 1 ct t`I Phone#: Official use only. Do not write in this area to be completed by cUy or town of ciaL City or Town: PermWLicense# Issuing Authority(circle one): 1.Board of Health Z BudIdingDepartment 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: The Commonwealth of Massachusetts Department of IndustrialAccidents d 1 Congress Street,Suite 100 Boston,MA 02114-2017 www mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Aaalicant Information Please Print Legibly Name (Business/Organization/Individual):NRC Construction Inc Address: 66 Water St Apt 2 City/State/Zip:Milford, Ma. 01757 Phone #:774-287-1485 Are you an employer?Check the appropriate boa: Type of project(required): 1. ✓Q I am a employer with 4 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.F�I am a homeowner doing all work myself.[No workers'comp.insurance required.]t 9. El Demolition 4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will 10 0 Building addition ensure that all contractors either have workers'compensation insurance or are sole I Ln Electrical repairs or additions proprietors with no employees. 12.E]Plumbing repairs or additions 5.❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13. p DRoof repairs These sub-contractors have employees and have workers'comp.insurance.: 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 41 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 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'conTensadon insurance far my employees. Below is the policy and job site information. Insurance Company Name:Atlantic Casualty Policy#or Self-ins.Lic.#:R2WC947397 Expiration Date:8/16/19 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 herebyocerfoy under the pains andpenalties of perjury that tl:e information provided above is true and correct Si ature: Date: 0/4 /1l Phone#:X74-287-1485 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#: a D' CERTIFICATE OF LIABILITY INSURANCE nATE6261ZD18 S CERTIFICATE 1S 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 WTHEPOLICIES BELOW S CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURERP, AUTHO :MMESENTATIVE ORPRODUCERR,AND THE CEFMFICATE.HOLDER- -PORTANT;If the certificate holder is an ADDITIONAL INSURED,the poWiies)must be endorsed.If SUBROGATION IS WAIVED,subject to the erms and conditions of the porrcy,certain polices may require an endorsement A statement on this certifsc2ft does not confer rights to the ertificale holder in lieu of such endorsement(s), PRODUCER CONTACT NA E-Kathi Hutchinsarl Ormsby Insucmce Agency,Inc PHONE(AIC No.ET1):(413)737413110 FAX(AIC,Nor PO Sox T18 E-NAILADDRESS:Idrutdrinsoogorn�sbyins cin West Springfield MA 01089 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURERA:Colony Insurance Company '39993 Sodom Roofing and SldhV Inc INSURER H. PO Box 6327 INSURER C. H01y01132�MA 61041-6327 INSURER R INSURER E: INSURER F. COVERAGES CERTIFICATE NUMBER; REVISION NUMBER:- THIS UMBERR:THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANOING PNY 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 13Y THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THETER,IrlS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHONIN MAY HAVE BEEN REDUCED BY PAID CLAIMS. POLICYErr POLICY Exp INS7 A13M SUBFZ DATE DATE LTR TYPE OF INSURANCE NSRD ENO POLICY NIA'IBER L1lSQS A 101GL002159903 625r2D18 5252019 EACH OCCURRENCE S1,0W,000 X CONG ERC1AL GENERAL LIABILITY DAMAGE-TORENTED CLAIMS WOE D OCCUR PREMISES Ocaureire} 5100.0()0 MED EXP(Anyone person) 55.1:00 PERSONALS,ADV INJURY S1,000,0W GEMLAGGREGATE LIMIT APPLIES PER GENERALAGGREGATE SZD0G,0W Y POLICY Em FN-1 LOC PRODUCTS-COMCPIOP AGG SZOD3,DGO OITiER COMBINED SIGNED LIMIT S AUTOMOBILE LLABILITY (Ea accident) ANYAUTO BODILY IN.NRY(Perpessm) S ALL OWNEDSCHEDULED BODILY INJURY(Per S AUTOS AUTOS c6dent)' HIRED AUTOS NON-OWNED PROPERTY DAMAGE 5 AUTOS (Prs acedent) S RE-LLA LIABL_AOCCUR EACH OCCURRENCE S CESS LIAR I NUS MADE AGGREGATE S ED NTION 5 s WORKERS COUPENSATION AJIM EMPLOYFRM LIA30J" YM SrAATUT=— ER ANYPROPRIETOR/PARrMaUDMC:LMVc EL EACH ACCIDENT S OFFICERRIEt+BER EXCLUDED? � WA (Mandatory in KH) ELDISFASE-EA S IF yes,describe under WPL13YEE DESCRIPTION OF OPERATIONS below I I EL DISEASE POLICY LIMIT 5 DESCFWTION OF OPE;'A-MNS I LOCATIONS I VEHICLES tAC'ORD 164,Addtiord Remarks Sctrdate,if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRY POLICIES BE CANCELLED ED BEFORE THE EXPHtA'nDN DATE TNEtEDF,NOTICE WILL BE DELIVERED IN ACCORDANCE WTIM THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ACORD 25(2013101) ©1988-2V14 ACORD CORPORA-110N-All rights reserved The ACORD name and logo are registered marks of ACORD DATE(MWDD/YYYY) Ac�® CERTIFICATE OF LIABILITY INSURANCE ��- 09/10/2018 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 have ADDITIONAL INSURED provisions or 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 CAOMNTAcT ISABELE CORDEiRO Brazway Insurance PHONE 97855-5991 FAx 978-455-9934 (AlC o AIC No): 345 Main St Unit 61 AZLEss:info@brazwayinsuranceagency.com Tewksbury MA 01876 INSURERS AFFORDING COVERAGE NAIC# INSURER A:AMGUARD INSURANCE CO INSUREDNRC CONSTRUCTION INC INSURER B:ATLANTIC CASUALTY NIF INSURER C: 66 WATER ST APT B INSURER D: MILFORD MA 01757 INSURERE: 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 I ADDL 5 BR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE IND POLICY NUMBER MMID MMIDD LIMITS COMMERCIAL GENERAL LIABILITYEl F1 - EACH OCCURRENCE $1,000.000 CLAIMS-MADE FZ OCCUR PREMISES Ea occurrence $100.000 L307000225-0 08/22/2018 08/22/2019 MED EXP(Any one person) $5,000 PERSONAL&ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 POLICY M JET F� LOC PRODUCTS-COMP/OP AGG $2,000,000 OTHER: $ AUTOMOBILE LIABILITYLi COMBINED SINGLE LIMIT $ Ea accident ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED - BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPER- DAMAGE $ AUTOS ONLY AUTOS ONLY Per a.dent $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION OTH AND EMPLOYERS'LIABILITY STATUTE ER ANYPROPR Y� N/A EL EACH ACCIDENT $1,000,000 A (Mandatory in NH) R2WC947397 08116/2018 08/16/2019 EL DISEASE-EAEMPLOYEE $ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below EL DISEASE-POLICY LIMIT $1,000,000 01-1 ao a DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached it more space is required) CARPENTRY,ROOFING,PAINTING. CERTIFICATE HOLDER CANCELLATION SEXTON ROOFING&SIDING INC SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE PO BOX 6327 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 102 PINE ST HOLYOKE,MA 01040 AUTHORIZED REPRESENTATIVE t ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD Produced using Forms Boss Web Software.www_FonnsBoss.com(c)Impressive Publishing 800.208-1977 Office of Consumer Affairs and Business Regulation - 10 Park Plaza- Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Type: Corporation Registration: 11 B239 SEXTON ROOFING & Siding Inc Expiration: 02/14/2019 P.O. Box 6327 Holyoke, MA 01041 Update Address and return card. Mark reason for change. r, A ,____ n r-I ert,nln'/r. r 1 I nc+r`p•A Commonwealth of Massachusetts Division of Professional licensure Board of Building Regulations and Standards Constructiorr:Supevisor Specialty CSSL-099689 QXpires: 10/05/2019 � 4 I EVERETT J SEXTON PO BOX 6327- HOLYOKE MA 01041 L Commissioner STATE OF CONNECTICUT DEPARTAIENT OF CONSLIAIER PROTECTION HOME IMPROVEMENT CONTRACTOR EVERETT J SEXTON SR 102 Pine St HOLYOKE,MA 01040-2411 SEXTON ROOFING&SIDING CO LIC./REG NO. EFFECTIVE EXPIRES HIC.0605383 12/01/2017 11/30/2018 SIGNED