31B-038 (4) City of Northampton Map 31 B Lot03 8 Zone HB(100)/
Massachusetts Date issued 5/29/2020 0:00:00
Inspector of Buildings Permit # BP-2020-1177
Permit Fee$60.00
SIGN PERMIT
Business
Address 134 KING ST - T-MOBILE
Applicant InstallerNATIONAL SIGN CORP
Applicant Installer Address 780 FOUR ROD RD
Work Description illuminated wall sign - metro
Estimated Cost $1500.00
Building Department
Approval by:
I
File#BP-2020-1177
APPLICANT/CONTACT PERSON NATIONAL SIGN CORP
ADDRESS/PHONE 780 FOUR ROD RD BERLIN
PROPERTY LOCATION 134 KING ST- T-MOBILE
MAP 31 B PARCEL 038 001 ZONE HBO 00V
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
EN SEDREQUIRED DIE
ZONING FORM FILLED OUT
Fee Paid
Buiidiny,Permit Filled out
Fee Paid
Typeof Construction: illuminated wall sign-metro
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/Statement or License
3 sets of Plans/Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFORMATION 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/ORSpecial 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
Demolition Delay
Lofioak, I-
Signat re 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.
1
of Xort4ampton
� � �14ttssttrlTusrtts �� `�
j` N
DEPARTMENT OF BUILDING INSPECTIONS i.
212 Main Street • Municipal Building ✓��.r ^`tea
_ Northampton, MA 01060
INSPECTOR Application for a Permit to Place or Maintain a Sign
Sidewalk Sign, Marquee or other Advertising Device
(Application to be filled out In Ink or typewritten) NumberBAto`..01!.`.I�7 7
Plans must be filed with the Building Inspector-- Erection..................( )
before a permit will be rap�nted. Alteration.................(
ItZ��'V } Repair.....................( )
v Repainting...............( )
Removal..................( )
Y 2c� 2 20FEE........PAGAOPLOT..LAM:fA
o am on, Mass. �I a1'l
Nop, UILDIN( II1SP 2o.�U
To the Building Commissioner: A�'PTON.rnAc o6IONS
Application for a permit to place or maintain a sign or other adve 'sing device, or marquee.
BUSINESS NAME .... .... "y.a... .....I-.. .O.I' !.(�......................I........................
1. Location, Street and No. ....!!AyJ 1►A.'a.......
2. Owner's name ...
V JRL..C+.!..
...l.,.trf.YL.I.UU Yl tUd...CO M4 �X1C
3. Owner's address
c ` , b � .....Q)5 fit
4. Maker's name ... .)Q�t ..Wc�T.°✓..... ,? . .✓1,5.......................................................
5. Maker's address .ww'"!''?? .. .... .!1.U�.C..!1..... . ... 1r!.V.�S'�.A..�L.....la.O.l11,0
6. Erector's name ...!va t 01!1AA..... Y)...(OY.. .
7. Erector's address ...4a...60V... Rod...�.�...... ....A:l..! ........l ........(A.v3�.
SIGN KIND OF SIGN
(Designate)
1. Sign will be (check one) illuminated .ZNon-illuminated .......
2. Will sign obstruct a fire escape, window or door? .W.0... Marquee ...............
3. Lower edge will be Ch. Ins above the public way. Projecting ..............
4. Upper edge will be ...ft........ins above the public way. Roof .....................
5. Height .�)A.Ih..ins Width 15..ft.ollins Temporary.. ..........
6. Face area 0:1,sq. ft: Wall ..�.............
7. Inner edge will be '�l�isrom the building or pole. Sidewalk....................
8. Outer edge will be10....ins from the building or pole. Other.........................
9. Face of building %pole is .......ins back from the street line.
10. Sign will project .. ....ins beyond the street line.
11. Sign will extend ..0...ft .......ins above the building or Dolp.
12. Of what material will sign be constructed? Frame .............. ...... Face... 1� .....
13. Estimated cost $....lt.5 PQ.........
The undersigned certifies that the above statements are true to the best of his knowledge and belief.
4....G !'-ka..c.h..C.d....................
(Signature of Owner or Agent)
Page 1 of 3
' THIS FORM IS PART OF THE SIGN PERMIT APPLICATION
File No.
ZONING PERMIT APPLICATION
PLEASE TYPE OR PRINT ALL INFORMATION
1. Name of Applicant: Q 1r r
Address: 8
�� a I CT Telephone:
2. Owner of Property: I "I
//����
b S 5 Pi L
Address: 1 S a Gtelep one i59'
3. Status of Applicant: Owner Contract Purchaser Lessee
V"Other(explain): -1 N d Gl St Vl a'
4. Job Location: 13 4 l YI 0► ( 14-je_44 1--'D I yln_S
Parcel ID: Zoning Map# Parcel# District(s)
(TO BE FILLED IN BY THE BUILDING DEPARTMENT)
5. Existing Use of Structure/Property CbVV► MA e V L a)
6. Description of Proposed Use/Work/Project/Occupation: (Use additional sheets if necessary)
(C IS+ 100 WO a A(` tA S '
a�/'— ! It
C-45. 3 to �) oh c I'd e e I vah an
7. Attached Plans: ✓Sketch Plan Site Plan Engineered/Surveyed Plans
8. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO DON'T KNOW—ZYES IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO DON'T KNOW YES
IF YES: Enter: Book Page and/or Document# /
9. Does the site contain a brook, body of water or wetlands? NO DON'T KNOW V YES
IF YES: Has a permit been,or need to be, obtained from the Conservation Commission?
Needs to be obtained Obtained , Date issued
10. Do any signs exist on the property? YES >/ NO
IF YES: Describe the size, type and location:
3 ►D'' X t 5 '' (�o. _l IZ1� l�vt -�'D �/Gt-lam ly►
o ''
Are there any proposed changes to,or additions of,signs intended for the property? YES NO
IF YES: Describe the size,type and location:
Page 2 of 3
r
11. ALL INFORMATION MUST BE COMPLETED; PERMIT CAN BE DENIED DUE TO LACK OF INFORMATION
12. This column to be filled in by
the Building Department.
Existing Proposed Required by
Zoning
Lot Size
Frontage
Front:
Setbacks:
Side: L: R: L• R•
Rear:
Building Height
Bldg Square
Footage
% Open Space:
(Lot area minus bldg and
Paved parking)
# of Parking Spaces
# of Loading Docks
Fill: (volume&location)
13. Certification: I hereby certify that the information contained herein is true and accurate to the best
of my knowledge.
DATE: APPLICANT'S SIGNA URE l�Q
r U ��✓Vt t ��MA(2� t tJW(
Applicant's Email Address (required)
NOTE: Issuance of a zoning permit does not relieve an applicant's burden to comply with all zoning
Requirements and obtain all required permits from the Board of Health, Conservation Commission,
Department of Public Works and other applicable permit granting authorities.
Page 3 of 3
% C L o .-t Ca w a
DocuSgn Envelope ID:6COB3826-0OBD4795-B64B-A54877D2465F - .. ..
EXISTING PHOTO - SIGN A
+ a 15'-11 7!8"CUT SIZE
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MAIN ID 01
PHOTO ENHANCEMENT - SIGN A Scale: 1/2"
G01.08 SCHEDULE '
Mintec Film#47899.1 Deep Purple
'` £ or Arlon Translucent Purple Film#5480-0250048155460$L
Translucent Miratec Film#30532.1 Magenta Printed On White Vinyl
SPECIFICATIONS:
■
"Arlon Translucent Magenta Film#5450-0557D48155450 MANUFACTURE AND INSTALL TWO(1)FACE
Plaskolite Po carbonate FOR ONE(1)EXISTING CABINET SIGN
TUFFAK SL=Faces WHITE PLASKOLITE POLYCARBONATE TUFFAK SL FACE.
SEE COLOR FOR SCHEDULE
Pamela Braga-Andrade Manager, Property Management
is o��sw��, 03.25.20 GATE: DESCRIPTION:
South Water Signs# by T Mobile4 1Pmt(a t1^Q+�I at.Jrade, y
rE(Lsouth Water Signs 7039917 '
SWS Design
q14 N.CHURCH RD.,ELMHURST,IL 6 134 King St 5�13�2020
Northampton,MA
96115 134 IGeg St Nareiidmpton.Mq:Ar
City of Northampton Map 31 B Lot038 Zone HB(100)/
Massachusetts Date issued 5/29/2020 0:00:00
Inspector of Buildings Permit # BP-2020-1178
Permit Fee$60.00
SIGN PERMIT
Business
Address 134 KING ST - T-MOBILE
Applicant InstallerNATIONAL SIGN CORP
Applicant Installer Address 780 FOUR ROD RD
Work Description illuminated wall sign - metro
Estimated Cost $1200.00
Building Department
Approval by:
File#BP-2020-1178
APPLICANT/CONTACT PERSON NATIONAL SIGN CORP
ADDRESS/PHONE 780 FOUR ROD RD BERLIN
PROPERTY LOCATION 134 KING ST- T-MOBILE
MAP 3113 PARCEL 038 001 ZONE HB(100)/
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out
Fee Paid
Tygeof Construction: illuminated wall sign-metro
New Construction _
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/Statement or License
3 sets of Plans/Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFORMATION PRESENTED:
y 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/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
Demolition Delay
5 a9 0
Sign ure 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.
�t�l�. IIf �II���MYti�1�IIIi
` A, � .+.11Rttssttrlfusrtts � ;T
DEPARTMENT OF BUILDING INSPECTIONS a
212 Main Street • Municipal Building
Northampton, MA 01060
INSPECTOR Application for a Permit to Place or Maintain a Sign
Sidewalk Sign, Marquee or other Advertising Device
(Application to be filled out In ink or typewritten) Number .....................
Plans must be filed with the Building Insriector Erection..................( )
before a permit will be granted. Alteration.................(
Repair.....................( )
DRepainting...............( )
44r Removal..................( )
Z090 FEE........PAGE........PLOT.......
' �FNTnRT oFrcn<
D,n N ha ptorv;Mass. .......51!4.............20.�U
To the Building Commissioner: NAn4nroN INS
-Crr Ns
oe o
Application for a permit to place or maintain a sign or ott rad ertising device, or marquee.
BUSINESS NAME .... <�...............................................
1. Location, Street and No. ....!Ali...K�V (a......t._.. K 3 t✓�� � -)
2. Owner's name ...N-SA3.....�Jmk+k ... -etc..Cj....C.f;.l.nd ve y1". . d...4;0!1'l4-TRIC
3. Owner's address ..� ....�.�a�lf <K:u ..NQ I�i°S�'b Dj,� (4 Q $I
1 .l . r........ .........�►-.. .. -f- ..............
4. Maker's name ... .......................................................
5. Maker's address .. `d.,...
!. !.W. .
6. Erector's name ... A' ,A
-t! W ... `Sl l�...6CCw.
7. Erector's address ..A.0...6L)V.. bCI... 1 ...... `p't'�..! ....L D 1, U���)
SIGN KIND OF SIGN
(Designate)
1. Sign will be (check one) illuminated .. Non-ill(m+'nated .......
2. Will sign obstruct a fire escape, window or door? VD... Marquee ...............
3. Lower edge will be . .... .v($ins above the public way. Projecting ..............
4. Upper edge will be ........Ins above the public way. Roof
5. Height 5...ft. R.ins Width .!.(...ft..l4..ins Temporary.. ........
6. Face areaLWksq. ft. Wall ... ..........
7. Inner edge will be . 6 h om the building or pole. Sidewalk....................
8. Outer edge will X.....i from the building or pole. Other.........................
9. Face of building or pole is .......ins back from the street line.
10. Sign will project .D...ins beyond the street line.
11. Sign will extend .v...ft .......ins above the building or pole. //��
12. Of what material will sign be constructed? Frame ........................ Face...4C V,L �.l<,...
13. Estimated cost $...tl.�60..........
The undersigned certifies that the above statements are true to the best of his knowledge and belief.
....................
(Signature of Owner or Agent)
Page 1 of 3
THIS FORM IS PART OF THE SIGN PERMIT APPLICATION
File No.
ZONING PERMIT APPLICATION
PLEASE TYPE OR PRINT ALL INFORMATION
1. Name of Applicant: ` Q1r ' V 5
c O(o 03'1
Address: DU b a E!/V� I �T Telephone: 64�&-QI yq ' 1'5 k-1
2. Owner of Property: 12e `telb (QA d fi r Ims - VA
Address: 1 to S d d kTeelep one'S9'
3. Status of Applicant: Owner Contract Purchaser Lessee, 1
V"Other(explain): r�!4-- N 0 QI St v' �✓
4. Job Location: 13 l lii C l 1 1 fill
Parcel ID: Zoning Map# Parcel# District(s)
(TO BE FILLED IN//B''Y��THE BUILDING DEPARTMENT)
5. Existing Use of Structure/Property: WYE) Mil e ve aj
6. Description of Proposed Use/Work/Project/Occupation: (Use additional sheets if necessary)
tc e nVA Im 4-W 0 e V 1s+ ( s .
3= I�'► x
1 '- ►a CSS. 3 t, e Ic ya-h a+n
7. Attached Plans: ✓Sketch Plan Site Plan Engineered/Surveyed Plans
8. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO DON'T KNOW—ZYES IF YES,date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO DON'T KNOW YES
IF YES: Enter: Book Page and/or Document#
9. Does the site contain a brook, body of water or wetlands? NO DON'T KNOW V'� YES
IF YES: Has a permit been,or need to be, obtained from the Conservation Commission?
Needs to be obtained Obtained , Date issued
10. Do any signs exist on the property? YES ✓/ NO
IF YES: Describe the size,type and location:
3 '- I D'' k 15 I *' ) k" �U o. -► 0� ()PA -IS�a'tf-c I c yn-h A,
x I ► I— I o" ��15. std e f ifyo-4i bin
Are there any proposed changes to,or additions of, signs intended for the property? YES NO
IF YES: Describe the size,type and location:
Page 2 of 3
11. ALL INFORMATION MUST BE COMPLETED:PERMIT CAN BE DENIED DUE TO LACK OF INFORMATION.
12. This column to be filled in by
the Building Department.
Existing Proposed Required by
Zoning
Lot Size
Frontage
Front:
Setbacks:
Side: L: R: L: R:
Rear:
Building Height
Bldg Square
Footage
% Open Space:
(Lot area minus bldg and
Paved parking)
#of Parking Spaces
#of Loading Docks
Fill: (volume&location)
13. Certification: I hereby certify that the information contained herein is true and accurate to the best
of my knowledge.
DATE: a APPLICANT'S SIGNA URE
ros PewIM1� an Jn4a, f. 16M
Applicant's Email Address (required)
NOTE: Issuance of a zoning permit does not relieve an applicant's burden to comply with all zoning
Requirements and obtain all required permits from the Board of Health, Conservation Commission,
Department of Public Works and other applicable permit granting authorities.
Page 3 of 3
ty" x al) wct
DocuSgn Envelope ID:6CO83826-DOBD4795.864B-A5487702465F
EXISTING PHOTO - SIGN B
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1V-11 7/8"CUT SIZE
metroPCS1111-10"V.0
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SIDE ID 02
PHOTO ENHANCEMENT - SIGN B Scale:1/2"
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■Miratec Film#47899.10 eep Purple
or Arlon Translucent Purple Film#5460-0250048155460SL
j Translucent Miratec Film#30572-1 Magenta Printed On White Vinyl SPECIFICATIONS:
y ■or Arlon Translucent Magenta Film#5450-0557048155450 MANUFACTURE AND INSTALL TWO(1)FACE
Plaskolite Polycarbonate FOR ONE(1)EXISTING CABINET SIGN
metro TUFFAK SL White Faces WHITE PLASKOLITE POLYCARBONATE TUFFAK SL FACE
SEE COLOR FOR SCHEDULE
s
r
s
Pamela Braga-Andrade Manager, Property Management
metro '
o3.2s.2o DATE: DESCRIPTION:
South Water Signs# by T Mobile P awd (t43,21, M
'
r(L-South Water Signs 7039917 ' DESIGN
ATE
SINS Design
534 N.CHURCH RD..ELMHURST,IL 60126 134 King Stw 5/132020
4
Northampton,MA
a6215 134 Kiril 51_NaMampton,WA!
DocuSign Envelope ID:6cOB3826-DOB D-4795-B84B-A54877D2465F
PROPERTY OWNER PLEASE PRINT
ON YOUR LETTERHEAD OR PLACE
BUSINESS CARD HERE AND COPY
DATE: 5/13/2020
TO WHOM IT MAY CONCERN
This letter authorizes SOUTH WATER SIGNS and their agents to manufacture, service and
install or remove signs and/or awnings at the following location
Location: Metro by T-Mobile
134 King St
Northampton, MA
SOUTH WATER SIGNS or subcontractor is authorized to secure permits and variances by the
local governing body
DocuSignetl by:
NAME: Fpay4t�A t°JV —Qin dva�t )
Pamela Braga-Andrade Manager, Property Management
TITLE:
Notary Public:
County of:
State of:
My Commission Expires:
NATIS-04CL
ACORO°
CERTIFI. _CATE OF LIABILITY INSURANCE °A'11812020
0
–_� __L___L_ 1!8120
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 pollcy(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 Ileo of such endorsement(s).
PRODUCER ; �qcT Corrine S.Sternberg
Smith Brothers Insurance,LLC. -
68 National Drive No,eat):(860)430-3234 i1woZ__
Glastonbury,CT 06o33 .caternber —1thbrothersusa.com _
INSURER S AFFORDING COVERAGE NAICN
INSURERA:The Continental Insurance C _M_Pan 35289
INSURED _ INsuRERa:Ail America ._.___.._ 20222- --
National Sign Corporation INSURER c:Travelers Property Casualty Co of Amer _ 25674
Berlin,
Four Rod Road IN -q!mD:National Fire ins Co of Lift 20478
Bertin,CT 06037 — -.-.
INSURER E:
INSURER F:
COVERAGES CERTIFICATE NUMBER; REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES,LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR �
TYPE OF INSURANCE LiSUBRT—�y-- "�— - POLICY EFF POLICY EXP LIMITS
JOILPOLICY NUMBER
A X 1 COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE 1,000,000
C(AIkFS MADE rX OCCUR 15095061353 1119/2020 1119/2021 DAMA TO RENTED ES Me occufTenol = 300,000
j WO kx�Any_onerso,pe . S-- 15,000
--- — I PERso a ADV INJURY 1,000,000
GEN L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE Z+WO+DW
POLICY �i X L00 PROOU TS-COMPbP 2,000,000
OTHER; S
B AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1x000,000
_IF.e.esr,IsR�_�_ _
X
ANY AUTO BAP 9788685 1119/2020 1/19/2021 BODILY INJURY(Per aercm
At1T090NLYT LED
H1REO NON.OWNEp RODIpLY INJURY(Pe a
X AUTOS ONLY X AUTOS OI F Per nl �E S
C X UMBRELLA LIAR X OCCUR ` EACH OCCURRENCE S1000,000
eXCESSIIAB CLAIMSMAOE IZUP•14P21695.19-NF 1/18/20201 111912021 AGGREGATE s 5x0001000
DED i X RETENTIONS 10,000 PaEE
D WORKERS COMPENSATION ST/1T
AND EMPLOYERS'LIABILITY X
ANY PROPRIETOWPARTNERfEXECUTNE YIN !NIA 5095051305 1M912020 1/19/2021
OFFlC /ryF�MBER EXCLUDED4 E.L.EACH _ 500,00
00
(1►►�s++ �R�H)) EL.DISEASE-EA_E[�,PIOYE i 600,
M yea,desa@e ender
DE00
IF, NOF OPERATIONS bebw E.L.04SEASE-POLICY LIMIT 5001000
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,May be saached M mon space Is required)
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
Information Purposes THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS,
AUTHORIZED REPRESENTATIVE
ACORD 25(2016103) ®1988-2015 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks ofACORD
DocuSign Envelope ID:6COB3826-DOBD-4795-B84B-A54877D2465F
PROPERTY OWNER PLEASE PRINT
ON YOUR LETTERHEAD OR PLACE
BUSINESS CARD HERE AND COPY
DATE: 5/13/2020
TO WHOM IT MAY CONCERN
This letter authorizes SOUTH WATER SIGNS and their agents to manufacture, service and
install or remove signs and/or awnings at the following location
Location: Metro by T-Mobile
134 King St
Northampton, MA
SOUTH WATER SIGNS or subcontractor is authorized to secure permits and variances by the
local governing body
DocuSigned by:
NAME: Pap4tt& j�Y AVU, Y'adt, I Wk-A�t , Pr6rt_k'� 11�Lau,aV
Pamela Braga-Andrade Manager, Property Management
TITLE:
Notary Public:
County of:
State of:
My Commission Expires:
NATIS-04CL JTHOM
CERTIFICATE OF LIABILITY INSURANCE DATnervi
- -- ---_ 1/8/20 1/812020
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW, THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED
REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.
IMPORTANT: if the certificate holder Is an ADDITIONAL INSURED,the policy(les)must 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 Neu of such endorsement(s).
PRODUCER cT Corrine S.Sternberg
Smith Brothers Insurance,LLC, ' PHO No,Ext; 860 430-3234 FAX Y
88 National Drive i_t.__, ) tNC,No); _
Glastonbury,CT 06033 csternber ' mithbrothersuss.com
INSURER(S)AFFORDING COVERAGE INAIC a
M$URERA:The Continents(Insurance Companv 36289
INSURED INSURERS.All America 20222
National Sign Corporation INSVRERC:Travelem Property Casualty Co of Amer __26674
780 Four Rod Road IN yMf!D:Natlonal Fire Ins Co of Htfd _,•.__._ 20478
Berlin,CT 06037 __-____
INSURER E;
INSURER F: _
COVERAGES CERTIFICATE NUMBER REVISION NUMBER: __
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
1 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.
ILTR NSR TYPE OF INSURANCE ImArl BR POLICY NUMBER POLFCY EFF POLICY EXP LIdITi
A X COMMERCIAL GENERAL LUIBILrrY EACH OCCURRENCE 1,000,000
CLAtMSMADE C occUR j5095051353 1/19/2020 1119/2021 W TORENTEO 300,000
I
MEEX
Q P(Any one perm 15,000-MRSLON4 6 ADV INJURY S 1,000,000
L AGGREGATE LIMIT APPLIES PER: GENERAL REGATE 2,000,000
POLICY U [•• i LOC PRODUCTS-C P -2,000,000
I OTHER:
8 AUTOMOBILE LIABILITYCOMBINED SINGLE LIMIT 1,000,000
X ANY AUTO BAP 9788685 1119/2020 111912021 BODILY INJURY Par son
OWNED_ X8py�L�EED
AUTOS ONLY AUL4p BODILY INJURY Per a m XAUONLY egWyl AMAOE
_
^` _
C X UMBRELLA LIAR X I OCCUR - -- - _ EACH OCCURRENCE 5,000,000
EXCESSLIAB 17 CLAIMS-MADE UP-14P21895.19-NF 111912020 1/1912021
AGGREGATE = 61000,000
DEO I X I RETENTIONS 10,000
D WORKERS COMPENSATION X �Py
A
AND EMPLOYERS'LIABILITY
ANY PROPRIETOWARTNERIEXECUTIVE N 095051305 1N912020 1/19/2021 E.L.EACH NT —__ – 600,000
PI `�MEMBER EXCLUDED? N r _
Mory fn NHj E.L.DISEASE-EA 600,000
Kyst describe�ndw FA(PLOYEF�. s _
DESCRIPT: N T S E.L.01SEA •POLICY LIMIT I S 600,000
is
• M i
DESCRIPTION OF OPERATIONS 1 LOCATIONS I VEHICLES (ACORD 101,AddItIonal Remarks Schedule,may be attached N mon space Is rsqulredi
CERTIFICATE HOLDER -_ CANCELLATION-
SHOULD
NC TIOSHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
Information Purposes THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE PCLICY PROVISIONS.
_ I
AUTHORIZED REPRESENTATIVE _ 1
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