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10D-010 (2) 129 WATER ST BP-2022-0065 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block: I OD-010 CITY OF NORTHAMPTON Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: window replaced BUILDING PERMIT Permit# BP-2022-0065 Project# JS-2022-000116 Est.Cost: $6400.00 Fee: $40.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: PELLA PRODUCTS, INC 096558 Lot Size(sci.ft.): 9583.20 Owner: PELLA PRODUCTS, INC Zoning: URB(100)/WP(7)/ Applicant: PELLA PRODUCTS, INC AT: 129 WATER ST Applicant Address: Phone: Insurance: 155 MAIN ST (413) 772-0153 WC GREENFIELDMA01301 ISSUED ON:7/19/20210:00:00 TO PERFORM THE FOLLOWING WORK:INSTALL 5 REPLACEMENT WINDOWS 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. LiolizA1/4_, Tit Certificate of Occupancy Signate: i FeeType: Date Paid: Amount: Building 7/19/2021 0:00:00 $40.00 212 Main Street, Phone(413)587-1240, Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner Department use only • City of Northampton us of Permit: Building Departmen do y ' t/Drtveway Permit 212 Main Street 7 SeVv4 eptSvailability t z 'ka - f Room 100 ''r ` <. WateNell ailability \` r • Northampton, MA 01060; ,„ 1 Tw. ets of Structural Plans phone 413-587-1240 Fax 413-5 =' i P .t/Site tans • l o70h0on s her pecify APPLICATION TO CONSTRUCT,ALTER, REPAIR, RENOVATE Olt-DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION 1.1 Property Address: This section to be completed by office Map i OD Lot I O Unit Zee,/s /0/51 Q /OS,; Zone Overlay District Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: )ey1 V/ /— /Zi /rJa -"/• d7 /_.PPds ' 7'fr --?'/a5 Name(Printj Current Mailing Address: S CI_ li -/ii Lf • Telephone Signature 2.2 Authorized Agent: P-c flit lat/'eAe&-t ' _Z 1 /'T l PI;i 5T ri-ee'7 ii AM- d'f,0 Name(Print) Current Mailing Address: —e/t/-1L. 116" 72 0/r 3 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) 4 /ion . 0 O Check Number 7 get /�L This Section For Official Use Only Building Permit Number:gJ" #"�"05 Date Issued: Signature: ://77 Building Commissioner/Inspector of Buildings Date 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 filled in by Building Department Lot Size r_._... _________ ..I __.__."._ __a .__.--I Frontage 'E.__ _ _ ____ _ L._____.. Setbacks Front 3 Side L:`.. R: L:I I R: 1 LI Rear ___e.__i 1 Building Height r-----1 r-- Bldg. Square Footage f--` Open Space Footage _ % (Lot area minus bldg&paved _ parking) #of Parking Spaces `- •--_ Fill: (volume&Location) A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO 0 DONT KNOW 0 YES a IF YES, date issued:[ IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DONT KNOW 0 YES 0 IF YES: enter Book j Page ' and/or Document# B. Does the site contain a brook, body of water or wetlands? NO O DONT KNOW O YES O IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained O Obtained O , Date Issued: C. Do any signs exist on the property? YES O NO L.J.. IF YES, describe size, type and location: i ._� D. Are there any proposed changes to or additions of signs intended for the property? YES 0 NO IF YES, describe size, type and location: 1 E. Will the construction activity disturb(clearing,grading,excavation, or filling)over 1 acre or is it part of a common plan that will disturb over 1 acre? YES Q NO ( IF YES, then a Northampton Storm Water Management Permit from the DPW is required. SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable) New House ❑ Addition ❑ Replacement Windows Alteration(s) n Roofing n Or Doors ��' Accessory Bldg. ❑ Demolition ❑ New Signs [El] Decks [EJ Siding [El] Other[0] Brief Description of Pro osed L / Work:/.pp/,4Ca? 5 a-i/7dOWi Gi.fir� ioA/1 inry i9/ii?Jd74f LF)ii--1 A/4 (4i49f'..eI 7G /7 ft!•¢a�fr a.A4cbr.3o 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 construction. Dimensions 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 wetlands? Yes No. Is construction within 100 yr. floodplain Yes No j. Depth of basement or cellar floor below finished grade k. Will building conform to the Building and Zoning regulations? Yes No. I. Septic Tank City Sewer Private well City water Supply SECTION 7a-OWNER AUTHORIZATION-TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, e//ems y/ AA- , as Owner of the subject property — hereby authorize 'a //t /9/104-1z _L i�`Ke 7 C_ to act on my behalf, in all matters relative to work authorized by this building permit application. S- t_ �c au '/0/2-i Signature of Owner Date I, / /1 firnalt ,f _2 ,G- , 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. Signed r e pains and penalties o rjury. Print Nam W � �j , to 0 r �"d f1` J/ j"! Signature of Owner/Agent Date SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder: / ^/1g V e-r &Va. 1 (/"�! `,^� License Number Address Expiration Date y/3 77.? ri /'7 S gnas e 9. Registered Home Improvement Contractor: Not Applicable 0 / //ct Al a% C L'. - ��c Company Name Registration Number /SC M411/1 CT f / nAJd 1It4 D/3a/ / 'ZZ7`/ Address Expiration Date Telephone Vk'72,? /A5-7 3/23/`22 — y3l7 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 0 City of Northampton --tM Mom\ o r oti SS,... .....s,- N. . ._;• Massachusetts ��: - << d i. �. DEPARTMENT OF BUILDING INSPECTIONS y; �F ; R; 212 Main Street •Municipal Building , �kP J .� Mu. Northampton, MA 01060 'r3'th• " 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: /27 li' -e'r' S i (Please print house number and street name) Is to be disposed of at: Pe/`AL, il'',,i-r--tc>f /S- `li-/•, K--iwe4/r.e/ (Please print name and location of facility) Or will be disposed of in a dumpster onsite rented or leased from: (Company Name and Address) 7/ zi Signatur 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. DocuSign Envelope ID:590C1BAA-2517-451F-B8FC-4215AEB53B04 Pella Products Inc. ?k 155 Main Street Greenfield, MA 01301 To Whom it may Concern: I,Cheryl A Fox , as property owner, give permission to our contractor, Pella Products Inc. to obtain a building permit for the installation of windows and/or doors in my home. Located at; 129 Water Street Leeds MA 01053 Please accept this letter in place of my signature on the permit application. Thank you, DocuSigned by: Glw. .l a AzSignature: s BA7CA4077457432... Date: 6/25/2021 DocuSign Envelope ID:590C1 BAA-2517-451 F-B8FC-4215AEB53B04 �j� Contract - Detailed ��/ '� Pella Window and Door Showroom of West Springfield 69 Ashley Avenue Sales Rep Name: DuBois, Kyle G Sales Rep Phone: 413-668-6157 West Springfield, MA 01089 Sales Rep Fax: 413-736-3390 Phone: (413)736-9239 Fax: (413) 736-3390 Sales Rep E-Mail: kdubois@pellasales.com Customer Information Project/Delivery Address Order Information Cheryl Fox Fox Cheryl 129 Water Street Leeds MA 01053 Quote Name: Fox Cheryl 1430705 Windows 129 Water St 129 Water St Order Number: 739W2GD091 Leeds, MA 01053-5300 Lot# Quote Number: 14152155 Primary Phone: (413)5864085 Leeds,MA 01053 Order Type: Installed Sales Mobile Phone: County: Payment Terms: C.O.D. Fax Number: Tax Code: MASS E-Mail: calfox@verizon.net Quoted Date: 5/31/2021 Great Plains#: 1006273380 Customer Number: 1010113483 Customer Account: 1006273380 Customer Notes: House built in 1947,presumed lead safe practices.Includes installation,building permit,sales tax,and disposal.Current promotion$6500.00 minimum.0%financing for 60 months OR 50%off of qualifying install.Order verification to be performed to verify sizes and method of install accuracy. PRICE IS GOOD UNTIL 6/25.Price increases to come after then. Replacement of 5 windows using white impervia. 10-year Pella Care Guarantee included.Installation includes Pella flashing tape,low expansion foam insulation,and interior/exterior caulking as necessary. Extended lead time vinyl and fiberglass windows/doors due to material shortages, install date would be set up by our install department once order verification has been completed and windows have been ordered. Promotional check/credit card-$6400 $3200 deposit recieved via CC.$3200 due upon completion. For more information regarding the finishing, maintenance, service and warranty of all Pella®products, visit the Pella®website at www.pella.com Printed on 6/22/2021 Contract-Detailed Page 1 of 9 DocuSign Envelope ID:590C1BAA-2517-451F-B8FC-4215AEB53B04 tausworner: eryr rux rroieut Name: Fox Cheryl 129 Water Street Leeds MA 01053 Order Number: 739W2GD091 Quote Number: 14152155 Line# Location: Attributes 20 Bedroom 1 Impervia, Double Hung,29.75 X 44.75,White Item Price Qty Ext'd Price $1,471.90 2 $2,943.80 1:Non-Standard SizeNon-Standard Size Double Hung,Equal PK# Frame Size: 29 3/4 X 44 3/4 2090 General Information: Standard,Duracast®,Block,Foam Insulated,3", 1 11/16" Q Exterior Color!Finish: White Interior Color!Finish: White Glass: Insulated Low-E NaturalSun Low-E Insulating Glass Argon Non High Altitude Hardware Options: Cam-Action Lock,White Viewed From Exterior Screen: Half Screen,Conventional Fiberglass Performance Information: U-Factor 0.30,SHGC 0.51,VLT 0.59,CPD PEL-N-126-00850-00001,Performance Class LC,PG 30,Calculated Positive DP Rating 30,Calculated Negative DP Rating 30,Year Rated 08111,Egress Does not meet typical United States egress,but may comply with local code requirements Grille: No Grille, Wrapping Information: No Exterior Trim,Pella Recommended Clearance,Perimeter Length=149". Frame Size:29.75"X 44.75" EAC-1 -Exterior Aluminum Capping(Coil Stock) Qty 1 PF-1 -Interior Pocket Installation Qty 1 LP-1 -Lead safe practices this opening Qty 1 Line# Location: Attributes 21 Bedroom 1 Impervia, Double Hung,23.5 X 37,White Item Price Qty Ext'd Price $1,311.39 1 $1,311.39 1:Non-Standard SizeNon-Standard Size Double Hung,Equal PK# Frame Size: 23 1/2 X 37 2090 General Information: Standard,Duracast®,Block,Foam Insulated,3", 1 11/16" U Exterior Color/Finish: White Interior Color!Finish: White Glass: Insulated Low-E NaturalSun Low-E Insulating Glass Argon Non High Altitude Hardware Options: Cam-Action Lock,White Viewed From Exterior Screen: Half Screen,Conventional Fiberglass Performance Information: U-Factor 0.30,SHGC 0.51,VLT 0.59,CPD PEL-N-126-00850-00001,Performance Class LC,PG 30,Calculated Positive DP Rating 30,Calculated Negative DP Rating 30,Year Rated 08111,Egress Does not meet typical United States egress,but may comply with local code requirements Grille: No Grille, Wrapping Information: No Exterior Trim,Pella Recommended Clearance,Perimeter Length=121". Frame Size:23.5"X 37" PF-1 -Interior Pocket Installation Qty 1 EAC-1 -Exterior Aluminum Capping(Coil Stock) Qty 1 LP-1 -Lead safe practices this opening Qty 1 For more information regarding the finishing,maintenance,service and warranty of all Pella®products,visit the Pella®website at www.pella.com Printed on 6/22/2021 Contract-Detailed Page 2 of 9 DocuSign Envelope tr: . yi uXBAA-2517 a51 F-BBFC 4215AEB53Booiect game: Fox Cheryl 129 Water Street Leeds MA 01053 Order Number: 739W2GD091 Quote Number: 14152155 Line# Location: Attributes 25 Bedroom 2 Impervia, Double Hung,29.75 X 44.75,White Item Price Qty Ext'd Price $1,471.90 1 $1,471.90 1:Non-Standard SizeNon-Standard Size Double Hung,Equal PK# Frame Size: 29 3/4 X 44 3/4 2090 General Information: Standard,Duracast®,Block,Foam Insulated,3",1 11/16" Q Exterior Color/Finish: White Interior Color/Finish: White Glass: Insulated Low-E NaturalSun Low-E Insulating Glass Argon Non High Altitude Hardware Options: Cam-Action Lock,White Viewed From Exterior Screen: Half Screen,Conventional Fiberglass Performance Information: U-Factor 0.30,SHGC 0.51,VLT 0.59,CPD PEL-N-126-00850-00001,Performance Class LC,PG 30,Calculated Positive DP Rating 30,Calculated Negative DP Rating 30,Year Rated 08111,Egress Does not meet typical United States egress,but may comply with local code requirements Grille: No Grille, Wrapping Information: No Exterior Trim,Pella Recommended Clearance,Perimeter Length=149". Frame Size:29.75"X 44.75" PF-1 -Interior Pocket Installation Qty 1 EAC-1 -Exterior Aluminum Capping(Coil Stock) Qty 1 LP-1 -Lead safe practices this opening Qty 1 Line# Location: Attributes 30 Bedroom 2 Impervia, Double Hung,23.5 X 37,White Item Price Qty Ext'd Price $1,311.39 1 $1,311.39 1:Non-Standard SizeNon-Standard Size Double Hung,Equal PK# Frame Size: 23 1/2 X 37 2090 General Information: Standard,Duracast®,Block,Foam Insulated,3",1 11/16" Exterior Color/Finish: White Interior Color/Finish: White Glass: Insulated Low-E NaturalSun Low-E Insulating Glass Argon Non High Altitude Hardware Options: Cam-Action Lock,White Viewed From Exterior Screen: Half Screen,Conventional Fiberglass Performance Information: U-Factor 0.30,SHGC 0.51,VLT 0.59,CPO PEL-N-126-00850-00001,Performance Class LC,PG 30,Calculated Positive DP Rating 30,Calculated Negative DP Rating 30,Year Rated 08111,Egress Does not meet typical United States egress,but may comply with local code requirements Grille: No Grille, Wrapping Information: No Exterior Trim,Pella Recommended Clearance,Perimeter Length=121". Frame Size:23.5"X 37" PF-1 -Interior Pocket Installation Qty 1 EAC-1 -Exterior Aluminum Capping(Coil Stock) Qty 1 LP-1 -Lead safe practices this opening Qty 1 For more information regarding the finishing, maintenance,service and warranty of all Pella®products,visit the Pella®website at www.pella.com Printed on 6/22/2021 Contract-Detailed Page 3 of 9 ' DocuSign Envelope ID:590C1 BAA-2517-451 F-B8FC-4215AEB53B04 uusturrier:t.•rieryi rux rruject game: Fox Cheryl 129 Water Street Leeds MA 01053 Order Number: 739W2GD091 Quote Number: 14152155 Cheryl A Fox Kyle DuBois Order Totals 82N6r (Please print) reakc§0§dFgpp Name (Please print) Taxable Subtotal $3,289.41 el. 6 a Az (,t, 7 f iS Sales Tax @ 6.25% $205.59 s'# ii4ft}'Silr'iMfjre `Pe� °S'dt; bftlitignature 6/25/2021 6/22/2021 Non-taxable Subtotal $2,905.00 Total $6,400.00 DaIIoousigned by: Date Deposit Received $3,200.00 e "a Az Amount Due $3,200.00 ` iltflft*M1Fovai Signature For more information regarding the finishing,maintenance,service and warranty of all Pella®products,visit the Pella®website at www.pella.com Printed on 6/22/2021 Contract-Detailed Page 9 of 9 Pella Products, Inc. 155 Main Street Greenfield, MA 01301 Office:413-773-1157 Ext.317 Cell:413-834-8799 To: Building inspector From:Trevor Bross—Installation Manager Date: February 21, 2021 Subject: Building Permit Applications& Designees Pella Products Incorporated is in the business of replacing windows and doors for our customers. Our process includes providing a building permit for each and every project. I am a licensed Construction Supervisor. Building Permits will be applied for using my CSL#CS-096558 and my HIC#142279. Please find a copy of my licenses below. Commonwealth of Massachusetts Construction Supervisor Division of Professional Licensure Unrestricted -Buildings of any use group which contain Board oif Building Regulations and Standards less than 35,000 cubic feet(991 cubic meters)of enclosed Consthitisii{tervis;:,, space. CS-096558 crpires 03/0112022 TREVOR BROSS 10 GEORGE STREET GREENFIELD o i�y r 1 ft�f1 t:t0>-N` ' Failure to possess a current edition of the Massachusetts State Building Code is Buse for revocation of this 8ce at Commissioner ,t sac d"""��' For infoimatlon about this license I '. l Call(617)727s200 or visit rrww n ass;lov li Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only TYPE:Corporation before the expiration date. If found return to: Registration Expiration Office of Consumer Affairs and Business Regulation 142279 03/23/2022 1000 Washington Street -Suite 710 PELLA PRODUCTS,INC: : Boston,MA 02118 ELWIN HERRINGSHAW - �i 155 MAIN STREET 'aC! GREENFIELD,MA 01301 Not valid without signs e Undersecretary Each Installation will be staffed by our installers who are all licensed in accordance with current building codes. Below listed are our installers and their license numbers. Please accept these individuals as my designees. Willard Brown CS106010 Vladimir Shevchuk CSSL099209 Scott Bowdish CSSL100232 Bill Leger CS89338 Christian Lambert CS065102 Robert Kairnes CS113305 Igor Kravchuk CS094911 The Commonwealth of Massachusetts Department of Industrial Accidents ►� Office of Investigations = 1= Lafayette City Center - j' 2 Avenue de Lafayette, Boston,MA 02111-1750 wwwmass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): PELLA PRODUCTS, INC Address: 155 MAIN STREET City/State/Zip:GREENFIELD, MA 01301 Phone#:413-772-0153 Are you an employer?Check the appropriate box: Type of project(required): 1. ■❑ I am a employer with 50 4. El I am a general contractor and I 6. New construction employees(full and/or part-time).* have hired the sub-contractors listed on the attached sheet. 7. ID Remodeling 2.❑ 1 am a sole proprietor or partner- ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. employees and have workers' 9. ❑ Building addition [No workers' comp. insurance comp. insurance.: required.] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑ Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑ Roof repairs insurance required.]t c. 152, §1(4),and we have no employees. [No workers' 13.0 Other comp. insurance required.] *Any applicant that checks box#l 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'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: EMC INSURANCE COMPANIES Policy#or Self-ins. Lic. #:6H 15382 Expiration Date:01-01-2022 Job Site Address: /Z j City/State/Zip:ltdQ MA die S3 Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of 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$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. l do hereby certify d the pains and pen It' perjury that the information provided ahove is true and correct. ) S i gnature: Date: ' Phone#: y); 272 a/$ 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(check one): I❑Board of Health 20 Building Department 31:City/Town Clerk 4.0 Electrical Inspector 50'Iumbing Inspector 6.0Other Contact Person: Phone#: PELLPRO-01 CHRISTINE AWRE, CERTIFICATE OF LIABILITY INSURANCE D(MMIDDD 0 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 ACT Christine Sullivan Phillips Insurance Agency,Inc. (acNNo, ),(413)594-5984 FAX 413 592-8499 97 Center Street (A/C,No):( ) Chicopee,MA 01013 qiD I ss christine@phillipsinsurance.com INSURER(S)AFFORDING COVERAGE NAIC/ INSURER A:EMC Insurance Companies 21415 INSURED INSURER B:Union Insurance Co of Providen Pella Products,Inc INSURER C: 155 Main St INSURER D: Greenfield,MA 01301 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 ADM SUER POLICY NUMBER POLICY EFF POLICY EXP LIMITS LTRINSD WVD (MMIDDIYYYYI IMMIDD/YYYY1 A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE X OCCUR 6A15382 1/1/2021 1/1/2022 REtMISESIEaEocwrtence) $ 500,000 MED EXP(Any one person) $ 10,000 PERSONAL&ADV INJURY $ 1,000,000 GEM_AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY X E LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: $ A AUTOMOBILE LIABILITY (Ea accident) OMBINED SINGLE LIMIT $ 1,000,000 X ANY AUTO 6215382 1/1/2021 1/1/2022 BODILY INJURY(Per person) $ OWNED SCHEDULED AUTOSE�ONLY _ AUTOS BODILY �p BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS ONLY (PPer accident) $ A X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 4,000,000 EXCESS LIAB CLAIMS-MADE 6J15382 1/1/2021 1/1/2022 AGGREGATE $ 4,000,000 DED X RETENTION$ 10,000 $ B WORKERS COMPENSATION X STATUTE OTH- ER AND EMPLOYERS'LIABILITY 6H15382 1/1/2021 1/1/2022 500,000 ANY PROPRIETOR/PARTNER/EXECUTNE YNN N/A E.L.EACH ACCIDENT $ aRc/MEM R EXCLUDED? (Mandatory in N ) E.L.DISEASE-EA EMPLOYEE$ SOO,000 E yes,describe under 500,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) Installation Floater$50,000 Included Operations usual to the sale and installation of doors&windows. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town of Leeds(Northampton)BuildingCommissioner's THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ( p ) ACCORDANCE WITH THE POLICY PROVISIONS. Office 212 Main St Northampton,MA 01060 AUTHORIZED REPRESENTATIVE ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD