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17D-034 (8) 30-32 STRAW AVE BP-2022-0089 GIs#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 17D-034 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-2022-0089 Project# JS-2022-000157 Est.Cost: $7600.00 Fee:$40.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: SEXTON ROOFING CO 99689 Lot Size(sq.ft.): 5096.52 Owner: Servicenet Inc Zoning: URB(100)/ Applicant: SEXTON ROOFING CO AT: 30 - 32 STRAW AVE Applicant Address: Phone: Insurance: P O BOX 6327 (413) 534-1234 WC HOLYOKEMA01041 ISSUED ON:7/23/20210:00:00 TO PERFORM THE FOLLOWING WORK:STRIP & SHINGLE ROOF POST THIS CARD SO IT IS VISIBLE FROM THE STREET Inspector of Plumbing Inspector of Wiring D.P.W. Building Inspector Underground: Service: Meter: Footings: Rough: Rough: House# Foundation: Driveway Final: Final: Final: Rough Frame: Gas: Fire Department Fireplace/Chimney: Rough: Oil: Insulation: Final: Smoke: Final: THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. LaiciAL, P Certificate of Occupancy Signature. l.Tr FeeType: Date Paid: Amount: Building 7/23/2021 0:00:00 $40.00 212 Main Street,Phone(413)587-1240, Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner The Commonwealth of Massachusetts w ' Board of Building Regulations and Standards ---.FOR Massachusetts State Building Code,-780 CMR,7t edition MUNICIPALITY USE Building Permit Application To Construct,Repair,Renovate Or Demolish a Revised January One-or Two-Amity Dwelling 1,2008 • This Section For Official Use Only Building Permit Num . 3/ ? S! Date Applied: Signature: • 7_Z-3.-ZZ / Building Commissioner/Inspector of Buildings Date ( Z _ - SECTION 1:SITE INFORMATION 134 o c 1.1n r perty Address: I.2 Assessors Map&Parcel Numbers &- . .STAu 4 1?.0 . - ,_ day 0 w 1.:this an accepted street?yes no Map Number Parcel Number o 4 �'' • y 1.5t t tang Information: 1.4 Property Dimensions: v� o - - g m Z istrict Proposed Use ___-_ Lot Area(sq It) Frontage(It) 0 Cl o O 1.'_ $i ildittg Setbacks(ft) FrontYard - - Side Yards Rear-Yard Required - Provided Required Provided Required - Provided 1.6 Water Supply: (M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Zone: ' Outside Flood Zone? Public 0 Private ElY —' Check if yes❑ Municipal❑ On site disposal system CI • SECTION 2: PROPERTY OWNERSHIP' 2. Owner'of Record: - Name(Print) - Address for Service: - - eh 4.4z_t 4 it c ,.-L - .. 2 ct --V) 3 S-=- . - - Signature Telephone • SECTION 3:DESCRIPTION OF PROPOSED WORK'(check all that apply) New Construction 0 Existing Building 0-"Owner-Occupied 0 Repairs(s) CI Alteration(s) CI Addition 0 J Demolition 0 Accessory Bldg.0 Number of Units Other © -Specify:_ Brief Description of Proposed Work': - 1 >.l 44.-e 4'i a' Apese .t •�a""ov,. "A t.' / - ?4t` - • SECTION 4:ESTIMATED CONSTRUCTION COSTS • Item • Estimated Costs: ' Official Use Only (Labor and Materials) _ - I.Building $ 1. Building Permit Fee:$ Indicate how fee is determined: - _ ❑Standard City/Town Application Fee 2.Electrical $- i L3 Total Project Cost (Item 6)x multiplier - x 3.Plumbing • - $ ' • 2. Other Fees: $ 4.Mechanical (HVAC) $ List: - 5.Mechanical (Fire Total All Fees: Suppression � / r ' Check No31 Check Amount 6Cash Amount: 6. Total Project Cost: $ -7 1 CF��• t, ElPaid in Full CIOutstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSI) (J / S C i ly /E,y�- Frere 1 13e,t too Licensewer �;/ Dati ' Name 'Pee}of C/S�L�Holder/ �l �f C/� j O (BO ( 0- ! List CSL Type(see below) L No.and Street[ p � f� t� Type Description I),') QT) , f f!y� 00 /1 II Unrestricted(Buildings up to 35,OII0 cu.ft.) R Restricted 1&2 Family Dwelling City State,L11-. M Masonry RC Roofing Covering WS _Window and Siding SF Solid Furl Burning Appliances I Insulation - __._,. Telephone Email address D Demolition .�_ I 5.2 Registered HomeImprovement Contractor(HIC) p i 3 )Px n gc�dc� and`oir r e. i 1�'a3 �.. HIC Registration Number - :. £yiirsiion;Da1 HIC Corypatry Name or egistrant Name � ,..e � � � . No.and Street Pon rl 2Y ill (�ho(f,t ilf f /44/tie KC, m' d/Lj-7/ 1-f43-53/—/a Fit address City,State,L1Y Telephone SECTIONS: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 ' 'fEr' No 0 SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT l 1,as Owner of the subject property,hereby authorize top&tea Qpc /arr�' ne-- ` to act on my behalf,in all matters relative to work authorized by this building deanit applicaiion.SJ c)/ e J ry (IorI 7/Ca /// Print Owner's Name(Electronic Signatture) Date SECTION 7b:OWNER'OR AUTHORIZED AGENT DECLARATION By entering my name below,I hereby attest under the pains and penalties of perjury that all of the information contained in this plication is true and accurate to the best of my knowledge and understanding_ MUST BE SIGNED by Owner or Authorized Agent Date NOTES: I_ An Owner who obtains a building permit to do his/her own work,or an owner who hires an.unregistered contractor (not registered in the Home Improvement Contractor(HIC)Program),will IIt have access to the arbitration program or guaranty fund under M.G.L.c.142A.Other important information on the HIC Program can be found at L3ww.mass.gov/oca Information on the Construction Supervisor License can be found at tiernRv_rnass_govi s 2. When substantial work is planned,provide the information below: Total floor area(sq.ft.) (including garage,finished basement/attics,clerks or porch) Gross living area(sq.ft) Habitable room count Number of fireplaces_ Number of bedrooms Number of bathrooms Number of half/baths Type of heating system Number of decks/porches Type of cooling system Enclosed Open 3. "Total Project Square Footage"may be substituted for"Total Project Cost" _ City of Northampton .. , Massachusetts ?S' �.f * fc. .1- DEPARTMENT OF BUILDING INSPECTIONS �`: iO a 212 Main Street • Municipal Building yJ Cs Northampton, MA 01060 ems. c$ CONSTRUCTION DEBRIS AFFIDAVIT (FOR ALL DEMOLITION AND RENOVATION PROJECTS) In accordance of the provisions of MGL c 40, S54, a condition of Building Permit Number is that all debris resulting from this work shall be disposed of in a properly licensed waste disposal facility, as defined by MGL c 111, S 150A. • The debris will be disposed of in: Location of Facility: 76"1.) 0j41-L,,r \,t1 v ( ( I AA- The debris will be transported by: Name of Hauler: O c r 0-11e& LI fG1 ( # (Ufe c 4.-4- Signature of Applicant: Date: /? / ABropo at SEXTON ROOFING AND SIDING INC www.sextonroofing.com IIKO P.O. Box 6327 Setting the Standard t ` ;,,.w,� Holyoke, MA 01041 #:1�► NEIMI1111112.1111114.1,11116.111•■ p. 413.534.1234 f. 413.539.9906 MA HIC# 118239 sextonroofing@hotmail.com SUBMITTED TO Service Net PHONE 570-8238 DATE 6/28/21 STREET 21 Olander Dr kcoelhoca)servicenet.org CITY,STATE,ZIP Northampton,Ma. 30-32 straw Ave.Florence,Ma. SEXTON ROOFING HEREBY SUBMITS SPECIFICATIONS AND ESTIMATES FOR: 1) Strip and remove existing shingles and,dispose of in proper landfill. 2) Inspect roofing deck and replace as needed @$105.00 per sheet. 3) Install new metal edging to rakes and eaves of roof. (white/brown) 4) Install ice and water shield on eaves(6'), vent stacks, in valleys, chimney, and at intersecting roofs. 5) Install synthetic roofing underlayment on remainder of roof. 6)' Install new flanges over existing vent stacks. 7) Install starter shingles on eaves and rakes of roof. 8) Install IKO Architectural style roofing shingles as per manufacturers' specifications. 9) Install new cap over ridge vent. 10)Reflash chimney as needed @ $300.00 11) Supply manufactures Lifetime warranty and SRC 5 yr. workmanship warranty. ATTENTION HOMEOWNERS:PLEASE COVER ALL PERSONAL BELONGINGS IN THE ATTIC,GARAGE,OR STORAGE AREAS DUE TO POSSIBLE ROOFING DEBRIS OR DUST COMING THROUGH CRACKS OF WOOD DECKING. We Propose hereby to furnish material and labor-complete in accordance with the above specifications for the sum of Seven Thousand Six Hundred DOLLARS 07,600.00) PAYMENTS TO BE MADE AS FOLOWS: due in full upon completion All Material is guaranteed to be as specified. All work to be completed in a Authorized workmanlike manner according to standard practices. Any alteration or Signature deviation from above specifications involving extra costs will be executed only upon written orders,and will become an extra charge over and above the estimate.DAMAGES TO BUSHES AND OTHER VEGETATION'MARKS ON HOUSE MAY Note: This proposal may be withdrawn by us if not accepted BE UNAVOIDABLE AND WE ARE HELD HARMLESS. Not responsible for water within(14)days. damage during construction. Owner to pay responsible legal fees for non- payment,and applicable interest. Zitteptante at)ropo%al The above prices,specifications and conditions are satisfactory and are hereby accepted. You Signature are authorized to the work as specified. Payment will be no lcu ro - Sr V P of op made as outlined above. Signature Date of Acceptance. 1- 14-VI • D1epartment ofIndusfri.alAccideizts • I_ k.„.: •' ,—._„'4 Office of Investigations ,, • • Lafayette_City Center 7 - 2Avenue de Lafayette, Boston,MA 02/77-1750 www.mass.gov/ditz Workers' Compensation Insurance davit:Builders/Contractors/Electricians/Plumbers .• Applicant Information PIease Print Legibly' . Nsme( usinessiorgsri tiorilindivirtmty Sexton Roofing&Siding, Inc . . Address:P.O. Box 6327 , -, ' . .' • City/State/Zip:Holyoke, MA 01041. Phone#:4137534-1234 Are you an.employer?Check the appropriate box: Type of project(requited): 1.❑ I am a employer with 4. © I am a general confractorand I 6. 1-1New consulncQon employees(full and/or part-time).* have hired the sub-contractors 2-❑ I am a sole proprietor orpattier- ' listed on the attached sheet • 7. ❑Remodeling • . - ship and have no employees These sub-contractors have • S_ Ei Demolition • working for me in anyacii.y. - .employees and hate Aaikers' d c� 9. ❑Building addition - [No workers' comp.insurance 0Omp.msUr-nce t . required.] - 5. El We are a corporation and its ' 10.0 Electrical repairs or additions officers have exercised their .11.❑Plzmmbi-� repsirs or additions 3.El I am a homeowner doing all wuik myself [No workers' cutup. _ :right of exemption per MGL • 12.1:1 Roof repairs . - insurance required.]t ' , • c. 152,§1(4),and we have no . . employees. [No workers'- •13.[(Other _ comp.insurance required.] *Any applicantihat checks box#1 Mast also fill outthe section helow:shovriag-tlieir work=rs'comPensation policy information_ • • . t Homeowners who submittlais aMdaviiiudicatiaig they are doing all wink and thenhire outside contractors must subMit anew affithwitindicatingsuch. • tCoatractors that check-this baxmust shucked an additional sheet showing thenameof the sub-cant actors and state whether or not those entities have . employees. If the sub-contracuns have employees,they must provide their warkas'camp.policy number. • I uric an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site ' • information: • • • „Insurance Company Name:Travelers Property CAS CO OF AM ' • . Policy#or Self-ins.Lis i:7PJUB0007898220 Expiration Date:6/4/20, • - Job Site.Address: 0— 5 ) S .t sii z ' -C� City/State/Tip: I i,,L.,, • ' Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). ' Failure to secure coverage as required tinder Section 25A ofMGL c.152 can lead to the imposition of criminal penalties of a - .fin'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.forkffirance coverage verifcaiion_ , I do hereby certify under thi6 ', and perialties-ofperjury that the it formation provided above is true and correct ; :� • -l Si4natse: Date: r! e 2 / - Phone#: 413-534-1.234 • • . • 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): • ;• 10Board of Health 20BuildingDepartment 3.0CitylTown Clerk 4.DEIectrical Inspector Sf?lumbing • Inspector 6.0 Other • • Contact Person:' Phone#: ACORO® CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYI) 06/14/2021 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 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 CONTACT NAME: Eric Dembinske ORMSBY INSURANCE AGENCY �p"/c°.No.Ext): (413)737-0300 FAX No): E-MAIL ADDRESS: edembinske@ormsbyins.com P 0 BOX 718 INSURER(S)AFFORDING COVERAGE NAIC# WEST SPRINGFIELD MA 01090 INSURER A: TRAVELERS PROPERTY CAS CO OF AM 25674 INSURED INSURER B SEXTON ROOFING &SIDING INC INSURERC: INSURER D: PO BOX 6327 INSURER E: HOLYOKE MA 01041 INSURERF: COVERAGES CERTIFICATE NUMBER: 665015 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 ADDL SUBR POLICY EFF POLICY EXP W LIMITS LTRINSD VD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ DAMAGE TO RENTED CLAIMS-MADE OCCUR PREMISES(Ea occurrence) $ MED EXP(Any one person) $ N/A PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY PRO JECT LOC PRODUCTS-COMP/OP AGG $ OTHER: $ AUTOMOBILE LIABILITY - COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS N/A BODILY INJURY(Per accident) $ - _ NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS (Per accident) UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE N/A AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION - X PTATUTE ERH AND EMPLOYERS'LIABILITY ANYPROPRIETOR/PARTNER/EXECUTIVE YIN E.L.EACH ACCIDENT $ 1,000,000 A OFFICER/MEMBEREXCLUDED? N/A N/A N/A 7PJUB0G07898221 06/04/2021 06/04/2022 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 N/A DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Workers'Compensation benefits will be paid to Massachusetts employees only.Pursuant to Endorsement WC 20 03 06 B,no authorization is given to pay claims for benefits to employees in states other than Massachusetts if the insured hires,or has hired those employees outside of Massachusetts. This certificate of insurance shows the policy in force on the date that this certificate was issued(unless the expiration date on the above policy precedes the issue date of this certificate of insurance). The status of this coverage can be monitored daily by accessing the Proof of Coverage-Coverage Verification Search tool at www.mass.gov/Iwd/workers-compensation/investigations/. 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. AUTHORIZED REPRESENTATIVE - Daniel M.CroWy,CPCU,Vice President-Residual Market—WCRIBMA ©1988-2014 ACORD CORPORATION, All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD V acuRldosed , lEEPadsu . d'S JE§Pacissi lizliParif 1, r ume.I1 '£illownxed2a 24-imErZ MignIP luveif- Xno )Amilinv 2Erpassi . #asaaat ;pawl.ts SID PPOO "412d4 Falaithag3 a4 ea Vans slit,kr awatiarr oar ifprozsrii ,j rod 1 Sri t I ; ,i ` ...s �,s.,� ram, 'w 01 daaulJE Ecl r w.� 'WI-W101V2Pun P Sazamo W omaas aa=3 aIA7ASJ 7 RoI t salt[t 1 0 10 14bo V t c 1KPl�7 .25:1 sxo#tea 0 0 ,,,, r crov_,,,„bp,ifl v_w_l_u_skAA=taeHLuedamact ozezrnsui _izep-wtsic&vsaa aaml � IssuiZairszaropiecmcqsaaperaxo-qozaqu a_I-..-,., aaaptttQuxtagpptuagsli.ea 4ssxaawggaiddr,Ctrv: fL dm=,LaoopoisarEianwa[ pair lr}[$'ay 3211[OO I 7 iim J313 d1•41oe a�o3ng iaP q �sqFaa ovod10osasotd❑'9 vvgspoq"map'a°parsgs wps P [aasLFper_sa pona=cditsEva y Dv - s a s s =somaa= a __ op°Q aodosl UCIIXAMZIWSLItla u iI Wax-Lpocioad,Cosissportiimsgiaca osszoprwirolloppiaqigaiparazamaamtecssiDv 0OI +I gspy►oKI3 *1=1pBo op3:c auxgvimIn'£ a<a -. . JaPPdaaa s.gsF Eft — S13 - 3C-716'd -15. --O ms:appv WI 00 VI JAL,'UCii) (AA(Ai lienrsAgnivogagaboxamrlo ZZEMN ARP."'SIA1a61;lia MIoL Lia/Y.1';L 6Qn et 'J _tf f ACO/?0 DATE(r"roD'm r) CERTIFICATE OF LIABILITY INSURANCE 11/13/2020 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 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 mum Edson DeSouza MAYFLOWER INSURANCE GROUP INC No,tl; (774)773-9702 FAX (Arc.Nola �5: Edson@mayflowerinsurance.com 299 Court Street INSURERS)AFFORDING COVERAGE NAM E Plymouth MA 02360 INSURER A: HARTFORD UNDERWRITERS INS CO 30104 INSURED INSURER B: MNP CONSTRUCTION INC INSURER C: INSURER D: 45 EXCHANGE ST APT 3E INSURER E: MILFORD MA 01757 INSURERF: COVERAGES CERTIFICATE NUMBER: 595621 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 POUCIES_LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS_ INSR ADOL SUER POLICY EFF POLICY EXP LTR TYPE OF INSURANCE risD WVD POLICY NUMBER (MMIDDIYYYY) (MMIDD/YYYY)_ LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S DAMAGE TO RENTED CLAIMS-MADE OCCUR PREMISES(En occurrence) S MED EXP(Any one person) $ N/A PERSONAL&ADV INJURY $ GENL AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ PRO- POjE LICY LOC PRODUCTS-COMP/OP AGG $ OTHER AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) ANY-AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOS N/A BODILY INJURY(Per accident) $ AUTOS NON-OWNED PROPERTY DAMAGE HIRED AUTOS AUTOS (Per accident) $ UMBREILAUAB OCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS-MADE N/A AGGREGATE $ DEC RETENTIONS _ $ WORKERS COMPENSATION X ATUTE ER AND EMPLOYERS'LIABILITY ANYPROPRIETOPARTNER/EXECUTIVE YIN R/ EL EACH ACCIDENT $ 1,000,000 A OFFICERIMEMBEREXCLIDEm PEA N/A NLA 6S60UB1K70970620 11/16/2020 11/16/2021 (Mandatory in NH) EL DISEASE-EA EMPLOYEES 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below EL DISEASE-POLICY LIMIT $ 1,000,000 N/A DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,AM:Mional Remarks Schedule,may be a laehel if more space is required) Workers'Compensation benefits will be paid to Massachusetts employees only.Pursuant to Endorsement WC 20 03 06 B,no authorization is given to pay claims for benefits to employees in states other than Massachusetts if the insured hires,or has hired those employees outside of Massachusetts. This certificate of insurance shows the policy in force on the date that this certificate was issued(unless the expiration date on the above policy precedes the issue date of this certificate of insurance)_ The status of this coverage can be monitored daily by arrpcsing the Proof of Coverage-Coverage Verification Search tool at www.mass.govflwd/workers-compensation(rnestigations/. 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 POLICYPROVISIONS_ Sexton Roofing & Siding Inc 102 Pine St AUTHORIZED REPRESENTATIVE Holyoke MA 01041 " CL Daniel M.C y,CPCU,Vice President—Residual Market—WCRIBMA ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD DATE ( D)YYYY) A Q CERTIFICATE OF LIABILITY INSURANCE 11/24/20 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 CONTACT NAME Art Calvillo AX One Family Insurance (PAljcNi FtI. 978-403-5942 (A No): 978-403-5943 1 Main St Suite 15 Dan : art@lfarmlyinsurance.com Lunenburg,MA 01462 INSURER(S)AFFORDING COVERAGE NAIC I INSURER A: Evanston Insurance Company INSURED INSURER B: MNP CONSTRUCTION,INC. INSURER C 45 EXCHANGE ST APT 3E MILFORD,MA 01757 INSURER D INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER. THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE US f EL)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.OMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR UUR POLICY EPP POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER IMIAIDD/YYYY) (RW/DD!YYYY)._ LIMITS X COMMERCIAL GENERAL_UAEIIJTY EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED CLAIMS-MADE I X OCCUR PREMIat,(Ea occurrence) $ 100,000 MED EXP(Any one person) $ 5,000 A Y Y 3ET9385 11/20120 11/20/21 PERSONAL&ADV INJURY $ 1,000,000 GENT_AGGREGATE DMn APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY JE° LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY (Per $ AUTOS ONLY AUTOS ( ) HIRED NON-OWNED PROPERTY DAMAGE AUTOS ONLY _ AUTOS ONLY (Per accident) S UIIBRFI I A LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS-MADE AGGREGATE $ DED I RETENTION$ $ WORKERS COMPENSATION PER OTH- AND EmisLOYERS'LLABtuTY STATUTE ER YIN ANY PROPRIETOR/PARTNER/EXECUTIVE E N/A EL EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? (Mandatory in NH) EL OISFASE-EA EMPLOYEE $ If yes.de under DESCRIPTION OF OPERATIONS below EL DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS!LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) CERTIFICATE HOLDER - CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCFI I FD BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN SEXTON ROOFING&SIDING INC ACCORDANCE WITH THE POLICY PROVISIONS. 102 PINE ST P.O_BOX 6327 AUTHORIZED REPRESENTA irAHOLYOKE,MA 01040 + . ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD