25C-177 (2) 86 PARSONS ST BP-2019-1136
GIs 4: COMMONWEALTH OF MASSACHUSETTS
Map:Bio ck:25C- 177 CITY OF NORTHAMPTON
Lot -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: REPAIR BUILDING PERMIT
Permit# BP-2019-1136
Project JS-2019-001846
Est.Cost:$10582.00
Fee: $68.00 PERMISSIONIS HEREBY GRANTED TO:
Const. Class: Contractor., License:
Use Group: ADVANCED MITIGATION & RESTORATION GROUP LLC
056861
Lot Size(sg. R.): 4356.00 Owner: KINGSTON PATRICIA M
Zoning:URC(100)/ Applicant: ADVANCED MITIGATION & RESTORATION GROUP LLC
AT. 86 PARSONS ST
Applicant Address: Phone: Insurance:
40 MAINE AVE (413) 527-3473 WC
EASTHAMPTONMA01027 ISSUED OM4/16/2019 0.00:00
TO PERFORM THE FOLLOWING WORKTREE DAMAGE - STRIP REAR SLOPE OF
HOUSE, REPAIR FRAMING, INSTALL ROOF, GUTTERS, AND 1 WINDOW IN REAR OF HOUSE
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 4 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 Occuoancv Signature:
FeeTvue: Date Paid: Amount:
Building 4/16/2019 0:00:00 $68.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Louis Hasbrouck—Building Commissioner
File#BP-2019-1136
APPLICANDCONTACT PERSON ADVANCED MITIGATION&RESTORATION GROUP LLC
ADDRESS/PHONE 40 MAINE AVE EASTHAMPTON (413)527-3473
PROPERTY LOCATION 86 PARSONS ST
MAP 25C PARCEL 177 001 ZONE URCO 001/
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
SED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Buildinp Permit Filled out
Fee Paid
TyneofConstructiom TREE DAMAGE-STRIP PE OF HOUSE REPAIR FRAMING, INSTALL
ROOF GUTTERS,AND 1 WINDOW IN REAR OF HOUSE
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/Statement or License 056861
3 sets of Plans/Plot Plan
THE FO OWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFgFCAATION PRESENTED:
_Approved_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/Oft 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
�De Delay
_q-
Signature of Building Official 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.
City of Norther ptonRECE
Building Depar men
212 Main Sit get
Room 10( APO
2
P'
2
, , V
T
P
Northampton, MA 010
1 0 0
phone 413-587-1240 Fa 41
D�IT 0-vl�iq Fri
APPLICATION TO CONSTRUCT,ALTER,REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION
1.1 Property Address:
SECTION 2 PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.7 Owner of Re ortl:
SIX Caf-2ho's� 's+
N is(Print) H15V; way)
��& \ C TN.
Si azure
2.2 Authorized Agent,
Name(Pnnt) Current Mailing Address
Signature Tele,grion.
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 Estimated Total Cost of
Construction from(6)
3. Plumbing Building Permit Fee
R/
4. Mechanical(HVAC)
5. Fire Protection
6. Total=(1 +2+3+4 5) 10 , Check Number
This Section For Official Use 0 1
Date
Building Permit Number: Issued
Signature: 1z
11I
Building Commissionedinspackir of Buildings Date
06Li fl I = I niq @
EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR)
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 flllcd in by
i— rBuilding Department
Lot Size
Frontage
Setbacks Front f_'"'l
Side L: R:= L:i._.�I R: —
Rear
Building Height
Bldg. Square Footage
Open Space Footage 1 % r�
(Lot area minus bldg&paved
making)
4 o Parking Spaces �J
�owme&Location
A. Has a Special Permit/Variance/Findi g ever been issued for/on the site?
NO O DONT KNOW YES Q
IF YES, date issued:[=—=
IF YES: Was the permit recorded att Re istry of Deeds?
NO O DONT KNOW YES O
IF YES: enter Book [—= Page= and/or Document#I_. _J
B. Does the site contain a brook, body of water or wetlands? 1,10� 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 n0
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,gradin a avation,or filling)over 1 acre or is it part of a common plan
that will disturb over 1 acre? YES O NO 011
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
SECTION S-DESCRIPTION OF PROPOSED WORK feheek all applicable)
New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing
Or Doors ❑
Accessory Bldg, E] w Si ns )O]Demolition NeDecks 'tling Other
0
Brief Des uaP.%re�WorkMir
Q C 1 f r - � �I
S �Ii tOf��
Alteration of existing bedroom_Yes No Adding new bedroom Yes �Clo, In rP0., s�
Attached Narrative Renovating unfinished basement _Yes No
Plans Attached Roll -Sheet
a. Use of building :One Family:j— Two Fani Other
b. Number of rooms in each family unit: Number of Bathrooms
c. Is there a garage attached? Nr)
d. Proposed Square footage of
new construction. Dimensions
e. Number of stories? q ''J
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 fl.of wetlands?_Yes--4— No. Is construction within 100 yr. floodplain Yei
t
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, as Owner of the subject
property
hereby authorize
to act on my behalf, in all matters relative to work authorized by this building permit application.
Signature oftO1w�neer Date
W I� 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.
Sign un er t ains and per)alties o perjury.
e� (J/LJyr�
ri Name
re i
Signature of OiwhscAgent
Defe
SECTION 8.CONSTRUCTION SERVICES
81 Licensed Construction Supervisor: NoVt Applicable El
/1A(Name of License Holder: I !e_W G" W In— C (,— rJ5 I
V g l 0
Licnse Numbl,
IM Wuc � + on M ealRlaoan
Expiration Date
Signature Telephone
Not Applicable ❑
AkIn c � r r1 �roU� iWai -)
ompanv Name Regi trali Number
u nAVIS_ X1,5 I
Address �(3 Expiration Date
Telephone /
SECTION 10•WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.o.152,§25C(6))
Workers Compensation Insurance af0davit 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 _
Massachusetts �� a
DEPARTNENT OF BUILDING INSPECTIONS m
212 Hain Street a aunicipal evildiny
Nortlu ton, M 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 also addition to anypre-existing owneroccupied 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 he registered.
Type of Work:��t f,� a rpo[ l m f root fwP Est. Cost
PI ,, W&
'yam
Addressof Work: DIY R� &as
Date of Permit Application: I a 119
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 RESPONSIBILITIES 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:
Date 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
\ The Commonwealth ofMassachuselts
Department of Industrial Accidents
I Congress Stree; Suite 100
Boston,MA 0211 4-2 01 7
www.mass.goutdia
rkers'Compensation Insurance Affidavit:Butlders/Contra¢tors/Electricians/Plumbers.
TO BE FILED WITH THE PERMITTING AUTHORITY.
Applicant Information Please Print L/e� Rd
Name Busintes,s/Organs tiioowlndiividual): t� 100, r I I U P
Address: "IQ IS/Y.(.1 � N� 1 (��
City/State/Zip:'�,�m �MA_0142,#:
Are you an employer!Check�lthe appropriate box: Type of project(required)I :
2. m y
laa employer with eraployees(fall and/or parlimtruct
e)," 7. ❑New consion
I am a sole proprietor or partnership and have no employees working for me in & Remodeling
any capacity.[No workers comp.insurance required.]
3.MIam a homeowner doing all work myself[No omorscomp.insurance required.]t 9. ❑Demolition
4.pl am a homeowner and will be hirint tractors to conduct all work onto n Iwill lO�Building addition
g con y property.
ansu
re that ell connectors either have worker..•comocvsation inaamnce or ere sole 11.E]Electrical repairs or additions
proprietors with no employees. l Plumbing repairs or additions
S❑1 am a general contractor and I have amid the sub-¢omens m I...ed on th eanached Shen. I Roof repairs
Thesesub-contractors have employees and have workers over.ine... ` ill
6f]We are a evrmorati eand its officers have exemoval their righter exemption per MGL¢ 14.❑Other
152,§I(4),and we haver employees[No workers'comp.Insurance requimd.]
"Any applicant that checks box#1 must also fill out the section below showing their workers commencement policy information.
'Homeonmem who submit this affidavit indicating they are doing all work and then hire outside contractors most submit a new affidavit indicating such.
:Contractors that check this box must attached an additional sheet showing the name of the sub cappotors and state whether or not those entities have
employees. If the sub-covtracm s 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 andjob site
information.
Insurance Company Name:�r`u1` C.1 �U1rq (�
Policy#or Self-ins.LLiicI.,#: n� 1'IU L67433J"1-1 Ib Expiration Date: �1 I�,,3,, I
Job Site Address: 0 Ul &[2 b 11 C ku City/State/Zip: ! 0r�"1 Y�1 mom R/0—
Attach
/ '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$250.00 a
day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance
coverage verification.
I do hereby certify under the pains and penalties ofperjury that the information provided above is true and correct
Situargum Date'
Phone#:
Official use only. Do not write in this area,to be completed by city or town official
City or Town: Permit/License#
Issuing Authority(circle one):
1.Board of Health 2.Building Department 3.ChpTown Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person: Phone#:
c%le cC���orrn�ur/prr�f� a�'�`�'lrc:l:lnc,lTc:teh`.1
Office of Consumer Affairs and Business Regulation
10 Park Plaza• Suite 5170
Boston, Massit0usetts 0211$
Home ImprovemeW.COntractor Registration
TYPE LLC
ADVANCED MITIGATION 5 RESTORATION dJ1alR:LLC Regia<ra9an. 192217
40 MAINE AVE. E�fretlon; 06102=19
EASTHAMPTON,MA 01027 }'
TT
UpB A88rw aMMurn ad Mvkr8884rt/w MNYpe.
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------AA.ddnns pp}Pw_AI .O_EMgpmM OLwtCcd
> x NOMEIMPRMVEUELL CONTRACTOR VaUd for d lhWfa ud My
TYPE:LLC OMft of C gIMM AtW VA Hu l u t4:
a89iM� E MM19 I0 w of Momumr AMlkB W EUMwee R4gWANon
_iB2217 0&'022019 YOPrit POae-Suite 81M
ANCED MITIGA11ON.8 RESTORATION GROUP,LLC 80610n,MA 01118
MATTHEW GAWLE
40MAINEAVE.
EASTHAMPTON.MA 01027 Untlertaeccremry Not valid Without signaturo
ACOR CERTIFICATE OF LIABILITY INSURANCE °ATF'"M°°"Yw'
0511512018
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,ANO THE CERTIFICATE HOLDER.
IMPORTANT. NOR,certificate holder is an ADDITIONAL INSURED,the poliry(ies)must have ADDITIONAL INSURED provisions or be endo ped.
If SUBROGATION IS WAIVED,subject to the farms and conditions of the policy,certain policies may require an endorsement A statement on
this certificate does not confer right,to me certificate holder in lieu of such ermomement(s).
GOND
PPODucFR Have T Mel,ClaMCISR
Ross Insurance Agency.l In. ONE son (413)53&8300 ac xa: (413)538-8300
150 Lover WeslOeld Road iooxess,. rodarkl�ros
INSURER(91AFFORNNGCUVERAOE XAICX
Holyoke MA 0100) IxMIRERA: Tokio Marine Specialty insurance Company
INSURED INSURERS:
Advaced Mftigalion and Restoration Group.LLC INsuRERC:
40 Maine Ave Iryy.o;
INSURER E:
Eind-ampton MA 01027 1 INSURER F'
COVERAGES CERTIFICATE NUMBER: CLI851SM732 REVISION NUMBER:
THIS IS TO CERTIFY THATTHE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMEDABOVE 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.
F
YPIE OF IAM RARCE MDL Po PM LT E%P MMM
IN VIVO POLICY NUMBER ncom MMT
RLW.OENERAL UAULRY ETCH OCCURRENCE g 1.000,000
MSMADE ®WCLR PREMISES Ee wtmrenm $ IDD LOU
MEDEW(AP—prat 4 5,000
PPK1818516 051122018 051120019 PERBOxALSADVBIJURY S 1,000.1100
GATE UMITAPPLIES PER: GENERPLAGGREGRE S 2.000000
PRO 2,000,000
JEcT LOC ROOucTs-coMPICPAGG s
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BCHEOOLED BODILY INJURY(Pal ImAva) E
ONLY AUTOS
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NORGWl1E° PROPERTYDAMAGE $
AIROB ONLY AUTOS ONLY P_enl
UM.R LLALIAB OCOUR EACH OCOURRENCE s 1 000,000
A ...a LIM I ICLAIMS UvE PLB02B036 05112/2018 051122019 AGGREGATE L
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MRNEr18COMPENSATON PER °TH.
AND EMPLOVERe'IIABILJtt 1.Ix STATNF
MY PROPRIETMWTrERlE%ECU9VE E.L.EACH AOCOERT $
OFFICERWEMBER E%CWDE@ LJ NIA
(Mmatlary In un EL.DISEASE-EA EMPLOYEE $
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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.
AUngRNFD REPRESENTATIVE
01988-2015 ACORD CORPORATION. All rights reserved.
ACORD 25(2016103) The ACORD name and logo are registered marks DJACORD
ADVANCI OP ID:DA
ta�R� CERTIFICATE OF LIABILITY INSURANCE PA.
R%Uzg+a
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: N the cORifirate 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 andoreeme s.
PRODUCER co ACT William Lucard{
Haberman Insurance Group Inc RARE. --- rAx
—_
West Spdn Avenue A6 xo 413-781-7000 —�p„c xo:413-733 545
Wealm LUcale41,MA 01009
William Lucartli
MSURER(S)AFFORDING c,OVERAB NAIL•
- --
INSURER A.Travelers Insurance Company 40282
_. — _ -
Ixae[D Adva ration Group LL IxsuRERe
Restoration Group LLC
60 Maine Avenue wMIRERc
Easthampton,MA 01027 INMJRER D: _
INSURER E.
INSURER F:
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
THIS W TO CERTIFY THAT THE POUCIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POUCY 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 CLUMSPOU .
INM TYPE OF INSURANCE POU"NUMBER ICY EFF PwL1- EYP
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AUTOS AUTOS
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UMBRELLA LMB OCCUR EACH OCCURRENCE $
sucess LIAR CIAIMSMADE AGGREGATE E
DED RFTEPRONs
WORN ERSCOMPENSITION R
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A NY PROPRIETORNAR ARIENECIRrvE rIN 6HUBOG03334918 . 0811312018 05/13/2019 El,EACH ACCIDENT s 1.000,00
OAFAFICA„PJMEMBER EXCLUDED? Y❑N/A -
arylnNla EL.DISEASE-EAEMPLOYE f 1A00,0D
IT Eawl4e unEv
DESCRIPTION OF OPERATIONS ENvx EL DIS
DESCRIPTION
LIMIT $ 1,000OD
DESCRIPTION OF OPERATNNS I UNOURON81 VEMCLES("ORD tM,ANdleonal RmMM1t SoneveN,nIW G MNCNed N mwe yuere ReP eA)
The Workers Compensation policy does not provide coverage for proprietorl
partner/executive officer/member are excluded.
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.
AURIONMED REPRESENTATNE
a , CAA- C
®1988-2014 ACORD CORPORATII All rights reserved.
ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD
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