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43-048 (6)
r BP-2022-0024 89 AUTUMN DR COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 43-048-001 CITY OF NORTHAMPTON Permit: Alts Renovations Repair . PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) , .BUILDING PERMIT Permit# BP-2022-0024 PERMISSIONIS HEREBY GRANTED TO: Project# 2022 WINDOWS • . Contractor: License: SAMBRICO LLC DBA VISTA HOME Est. Cost: 25217 IMPROVEMENT 111478 Const.Class: Exp.Date:01/21/2023 ' Use Group: _ Owner: ROGOWSKY, NINA &EMILY ROGOWSKY Lot Size (sq.ft.) . SAMBRICO LLC DBA VISTA HOME Zoning: v WSP Applicant: IMPROVEMENT • Applicant Address - Phone: Insurance: 2097'RIVERDALE ST 413-382-0249 UB-2E072183-21 W SPRINGFIELD, MA 01089 ISSUED ON:01/11/2022 ( ; TO-PERFORM THE FOLLOWING WORK: REPLACE 11 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:A House # Foundation: c Gas: Final: Final: Rough Frame: Rough: Fire Department Driveway Final: Fireplace/Chimney: Final: Oil: Insulation: • Smoke: Final: THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. • Signature: 1 , k., 44 . T,i.k - , , Fees Paid: $40.00 • f 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 - Office of the Building Commissioner 1 ..-I � 1J,.`u llf V The Commonwealth of Massachusetts Board of Building Regulations and Standards FOR 4 Ji Gird Massachusetts State Building Code, 780 CMR MUNICIPALITY USE ouilding,g mit Application To Construct,Repair,Renovate Or Demolish a Revised Mar 2011 r�"v One-or Two-Family Dwelling I = IFS This Section For Official Use Only Budding Permit Nu4el De-2.0'22-•00.2-ti Date Applied: t It 0(u u Y 1 Z-:--------- /1.2 ' HI.7612 Z. Building Official(Print Name) Signature Date SECTION 1:SITE INFORMATION roperty Address: 1.2 Assessors Map&Parcel Numbers p\v4 -A)ta•r) ` . Mb(QM t '3 0 N 8 1.la Is this an accepted street?yes no Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: (A)5 P .236 au- . Zoning District Proposed Use Lot Area(sq ft) ' Frontage(ft) 1.5 Building Setbacks(ft) Front Yard 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: Public 0 Private 0 Zone: _ Outside Flood Zone? Municipal 0 On site disposal system 0 Check if yes® SECTION 2: PROPERTY OWNERSHIP' 2.1 Owgqer'of Record: \\c\G.1 \c„.c.A`.,,i\ Op...JS\C, WQACP. W O\ O10Z. Name(Print) 3 City,State,ZIP C6 J'Nr^ `7.0 , Gl\k—r101 - ci al No.and Street Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply) New Construction 0 Existing Building 0 Owner-Occupied 0 Repairs(s) 0 Alteration(s) 0 Addition 0 Demolition 0 Accessory Bldg. ❑ Number of Units Other Specify: b\alg., \ Brie Descnption of Proposed Work2: VO rl.a l A)a �u t- \-�. CA)T?),,� U--►\c'Ob-E -r \(' -CLL'' �\. Coo\lct L.A.1r40 s ._ IJ0 c,,,,--t.)c-r-t.) ov.a,. U-FAcToe . 27 SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1.Building $ cs.)5 C.-�,vU 1. Building Permit Fee:$40 e.—a Indicate how fee is determined: Standard City/Town Application Fee 2.Electrical $ 0 Total Project Costa(Item 6)x multiplier x 3.Plumbing ' $ 2. Other Fees: $ 4.Mechanical (HVAC) $ List: 5.Mechanical (Fire $ Total All Fees: $ le Suppression) Check No.875D Check Amount t/O c: Cash Amount: 6.Total Project Cost: $as,(a vi ¶ IRPaid in Full 0 Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) �/ 1 I&1 1a3 t \� \Wl`C, License Number O Expiration Date Name of CSL Holder List CSL Type(see below)_ ` Nc 6 Gc No.and Street Type Description n n U Unrestricted(Buildings up to 35,000 Cu.ft.) (�( �C11�, �`'U'7 �(�3V R Restricted 1&2 Family Dwelling City own,State, M Masonry RC Roofing Covering WS Window and Siding SF Solid Fuel Burning Appliances ` 'Xtkb \(\\"1 G‘h*OWJ kW),(D 1\AQk''r I Insulation Telephone Email address • Co N�.. D Demolition 5.2 Registered Home Improvement Contractor(HIC) \CQ os� (a lad S0.i\A‘96ob HIC Registration Number Expiration Date HI Company me or HIC Registrant Name "•i i`►€Sda). . A• NCv@ 1/411 s—�-aU�a�^-C1 9 cOQcvIN.3 No.and Street Email address ,GUI City/Town,State,ZIP Telephone SECTION 6: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 Issuanc the building permit. Signed Affidavit Attached? Yes No ❑ SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I,as Owner of the subject property,hereby authorize SUW Jn (D \—C.-- to act on my behalf,in all matters relative��to workauthorized by this building permit application. CC 1' CVC,X Print Owner's Name(Electronic Signature) 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 application is true and accurate to the best of my knowledge and understanding. cPrin Owner's or Authorized Agent's Name(Electronic Signature) Date NOTES: i 1. 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 not 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 www.mass.gov/oca Information on the Construction Supervisor License can be found at www.mass.gov/dps 2. When substantial work is planned,provide the information below: Total floor area(sq.ft.) (including garage,finished basement/attics,decks 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 �? �; l Massachusetts #""t'41'4.?,'e� 't ;a /Al' * Q i,y Jl ' b,�" DEPARTMENT OF BUILDING INSPECTIONS Pt . 4 Itii wt,1 212 Main Street • Municipal Building `Il wig./ " Northampton, MA 01060 stay ,j�,/ 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: 2 n (?\\v Q/ s)"• c �...0 0 40�Z � , r� c7Z our ?lo QQ The debris will be transported by: Name of Hauler: V 1 S ka, �C gvv? \ cik 9c\wpAQA (seA) Signature of Applicant: Date: 'Kt'2)-)-- The:CoOlin0.hioe alth of MasSaehuSetts • CZIPIS p 0. • ' . . 6/ Department of industrial Accidents -.I'Congres-sgtreet,:5ulte'100 , Boston,MA 02114-261 7' www.mass,golVdia ... i'oricers",4:ompeasation.Insitrance Aflidavii:Bu ilderSit:Ontractorsfbectricianstfluttibers. Tf)HE 141.111iWITICItlETFAIMIT.I.Ltic AtITIIORliV,, .„.. • Au rdieniti information • • •• . Please••Print Le. iiiiv Name ithisirifOrganiiiitiolitindividaaW t\Lc .(,0 „ — Address . , . . , . _ . , • . Ciiy/SateiZip.:-Ck)• ...%?cik.6 W\-- '0 NDVI. , Phone#: \5-soa-LA--wvo :Arelou an,employer?Chivit the appropriiitelsnv. 1-•.y1)eii1 priijeet.(reqUirei"):' t.C.1 ittl'ii!titploa.1.1.rilli_ " crOPliiie'ea.(f.41 ara4paii-t ).* 7.0 New construction .. ., . . 20 1 ntn'a sole.proprikor 6r piiiiiii;rshift'atidhiW4lio'etstiitOy,. .woikini; for tit::in -8..0 Reinodeling ._11.1ty i.-it.teity.[No waiters'cotitp.insuritnee r*Ittinit1.1 9. 0 Demolition 30 l' iitbiltiztxsvittiidDiiig-all wL;tk'Inyi•err.Noivolii,:ii‘wiry.IMAtramie-mxprireli 1 . — ...-. , -.• . . , -10,0 Building addition 4.0 I am a liom*tya+-..1 awl t:till lie'hiring,f-eprantetor\J.t6-coraliietlill twit;im my propettY.1 win' . . . .1.-oure itait alfc-oloraelors-citl),::r Live',,,t-titkei;;*eoi-nperLi-atiOn irturarice or me 5oie I I ID Electrical repairs oraddi dons pk4oti-with no.eatiployees_ i ID Plyttibinirepairs or additions .s. Iai ti-0.-tterat tinatretor and I Izace hiled the stitkontractom listed on the ttaeheti sheet. I j.0130or repairs TbeLw sub-euntthetors Ism'e ettiployeeSr?nd li.lvewinkers'eouip.tasumace.4 1** 9— keZLNAl•e 6.0 Wc an.a Corporation end its officers ittw,e,c7.ereiseil their totrigli kAcmpthm per ARIL 1 4 6iltet,\ \ e. 1$2,§4,4).,anti we have rio onfilo),tes.[Nei Workers'comp.insurance required.] \.A)k qaAls "Atly'applitmitt that eltIAS;:bok,#1 mast also till out the iwziition belowshoteirre their wthkeri'Compensation policy information. 1-1(mi:owners whit•suhtrit this atlidaliitindigatitip;they ant doing all work and then hhenittside contraetnes num subritit a net affidavit indicating itch. :Contraetio that ihich this hox nitistati_14)ed an adliitionat slieets,hiaWing the name of the stilsoutmetat'S Mid staterwheiher Moir those cittitiesitave 'employees.,littla sob-edrarietor.i..'litve mnployees.they trakt.PtiAide their svotkere eomp.policy raurili: V . ,I ons an"eiriployerthat is providing workgre eninpensatiOn insurance for my employees. Below is the policy and Job site inforination.: . .. . . . . .Insutunce-ecimpanyNante:: . V . _ -_, . Policy .#or Self-ins.Lie. : , . likpimtion Date:.' . . . Job Site Address i_ gCt N)s- oN't.., 0C . , ovistat,izio: Q .(3f U\(0k ,,KaA- 0\WQ- Aitaelf a cops of: the lOrke.re compensation policy declaration page(sh6wittg-the policy number and expiration date). . . , ,. . . Failure to secure coverage as.reqUired under ::• 1•GLie. 152,*25A is a crlatinal--yiolation punishable hy a.-line up to$1.,506:00:, and or'Otteslear intiniiionitint.di it:1:11iis eM11_,Iiiiitaititis in the lonn of a s179P,VoRK ORDER and a line of nit,to$250..00 a day iig6iiiit_E*t.ViOlatot..A:coPy of this statement itiay.he forwarded to tht Office.of investigations of the DIA fo'r tusuranee coverage verifieatiOn. I do hereby certifY wider the pains and.nenalti4s of perjury.that the inforniatianproi,ided above is true.and Carrect. . . Sienature: D•.. „\A i )CX,/L"/ Mite: \Di)--- , Ptione4i- '' ) .\5 —1-)t, _,A-,;("1 ck 0 ,. Officitil use-on ly. Do not.writeinthis area,lobe completed by city or town official • . . . , City or I'owiit'- - . • - PerinitfLiecitSe ti- . . , , , issuing-AtithOrity.(circle one): V ,. VV, ., ,. , , , . . . ,. , 1. !Olird•nf Health';...isuilditig Department .3.'.‘.cdtyt1aykn Clerk '.4.tiectriCal.litspectUr-5.Plumbing InspectOr 6litheri•:' f`' . '" ' •‘ ' . . .. . . , . . , . . • Conufet Person:- . ',. ' ''. , - - ' . . Phone#:' . • „ . • 2097 Riverdale Street = MA Lic#162058 `�aAl West Springfield, MA 01089 + CT Lic#0621848 7 Vista in, - PLATINUM Phone: 888.597.2323 HOME IMPROVEMENT vistahomeimprovement.comr�, ;tracer Fax: 413.382.0241 Jl1 Nor'Easter Window Contract Customer Information Nina Rogowsky (914)907-9927 Date: 11/13/2021 Emily Rogowsky (617)637-3758 Rep: David Lauzon 89 Autumn Drive ninarogowsky@gmail.com Florence MA 01062 All home improvement contractors and subcontractors must be registered and any inquiries about a contractor or subcontractor relating to a registration should be directed to: Office of Consumer Affairs and Business Regulation Ten Park Plaza,Suite 5170 Boston, MA 02116Phone: 617.973.8700 The following windows will be installed by Vista Home Improvement Total number of windows in the home 11 Total number of windows being installed , 11 Total number of patio doors being installed 0 Nor'Easter Double Hung - Double Pane Location Kitchen P Quantity 2 Size 32 x 52 Color White Exterior Color White •1, Color of Wrap aspen white Nail Flange Screen Half Screen Nor'Easter Two Lite Slider- Double Pane Location Kitchen Quantity 1 Size 38 x 32 Color White Exterior Color White Color of Wrap aspen white Nail Flange Nor'Easter Two Lite Slider- Double Pane Location Bathroom 1 Quantity 1 Size 31 x 22 Color White Exterior Color White Color of Wrap aspen white Glass Upgrade Tempered Glass Nail Flange Nor'Easter Double Hung- Double Pane Location Playroom Quantity 2 Size 32 x 38 Color White Exterior Color White ' Color of Wrap E aspen white Nail Flange Screen Half.Screen /. / / f / l ._ r/ ,,, / i;' / /. f I s`' ,c. '` This space intentionally,left blank /` f /' `£ . / /`' ''I Nor'Easter Double Hung- Double Pane Location Master Bedroom Quantity 2 Size 36 x 37 Color White Exterior Color White i Color of Wrap aspen white Nail Flange Screen Half Screen Nor'Easter Double Hung- Double Pane G Bedroom;1 �, Quantity 2 Size 36 x 37 Color White Exterior Color, White .• Color of Wrap aspen white Nail Flange Screen Half Screen Nor'Easter Bay/Bow- Double Pane Location Living Room � 7 Quantity 1 Size 52 x 92 Color White Exterior Color White ! Color of Wrap aspen white Nail Flange Details Bay Window Fees 1 Time Disposal Fee Included Lead Fee , . 11 Window Addons Alter Opening Larger 1 Mullion Removal 1 Additional Information- ' , ,' - We will be making double hung openings in the kitchen.bigger in height n 'i M 1 - r I, This space intentionally left♦blank ,-, i r i t f ‘ Homeowner's Association NO WORK SCHEDULE Contractor will not begin the work or order the materials before the third day following the signing of this Agreement, unless specified herein.Contractor will begin the work on or about 03/13/2021 Barring delay caused by circumstances beyond Contractors control,the work will be completed by 04/13/2021 WARRANTY The Contractor warrants that the work furnished hereunder shall be free from defects in materials and workmanship for the period stated below following completion and shall comply with the requirements of this Agreement. In the event any defect in workmanship or materials, or damage caused by the Contractor, its subcontractors, employees or agents, is discovered after completion of any job, Including cleanup,the Contractor shall, at its own expense,forthwith remedy, repair, correct, replace, or cause to be remedied, repaired or replaced,such damage or such defect in materials and workmanship.The foregoing warranties shall survive any inspection performed in connection with the agreed-upon work. Warranty Period Lifetime Measure Section Measure Set With-- Kevin Date Measure Is set for 11/22/2021 2 hour window Measure is set for 12-1 Total Contract Amount (All Discounts Applied) $25,217.00 Payment Deposit $250.00 Amount Financed' $24,967 00 Form of Payment Upon Signing Check Check# 173 Check Date 11/13/2021 Acceptance of Proposal I have read both sides of this document and accept the prices,specifications and conditions stated. I understand that upon signing,this proposal becomes a binding contract.You are authorized to do the work as specified. Payment will be made as outlined above. You may cancel this agreement if it has been signed by a party thereto at a place other than an address of the Seller,which may be his main office or branch thereof, provided you notify the Seller in writing at his main office or branch by ordinary mail posted, by telegram sent or by delivery, not later than midnight of the third business day following the signing of this agreement. Please refer to the Notice of Cancellation below contents of which are referred to above and incorporated herein by reference. DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES. '... .._. f /r. 1 _..,.,r,..�. J. ., .�„ ..f/_.... �. ff/ _.._1 ;,. _..f. ,J` -ff,. f / f/, �. This space intentionally Oft blarik f l` rr !C• /✓` /! / / Contractor, under provisions of Chapter 142A of the Massachusetts General Laws, is required to apply for and obtain all construction related permits.Contractor shall not be deemed responsible for delays in the work described in this agreement caused by regulator, permit granting or inspectional agencies,authorities or individuals. NOTICE: If Owner obtains his/her own construction related-permits for the work described under this Agreement, Owner is hereby advised that in the event of a dispute,judgment and non payment of Contractor,Owner will not be entitled to make claim to or collection from the guaranty fund established in M.G.L.c. 142A. Modification: This Agreement, except as to concealed conditions or delays occasioned thereby or by restarts, cannot be changed except by a written statement signed by both Contractor and Owner. However, cancellation by Owner is allowed in accordance with the Notice of Cancellation.Owner hereby grants Contractor a limited Power of Attorney to complete incomplete documents on Owners behalf. Completeness of Contract for Execution: Owner is hereby advised not to sign this Agreement unless and until all blank sections have been filled in or marked as void, deleted or not applicable, and until all exhibits and related or referenced documents that are incorporated herein are attached hereto. Attorney's Fees/Costs Owner agrees to pay all costs of collection, including reasonable attorney's fees, cost and expenses. Furthermore, interest shall be charged at the highest lawful rate of interest on any and all overdue payments. Copy of Agreement to be given to Owner: This Agreement is governed by the laws of the Commonwealth of Massachusetts. It must be executed in duplicate, and an original,signed copy hereof given to the Owner at the time of execution. No work under the Agreement shall begin prior to the signing of the Agreement and transmittal to the Owner of a copy therefor. /741/4— [%."-91/7 Nina Rogowsky Emily Rogowsky 11/13/2021 11/13/2021 Date Date ,49,40/00005e, David Lauzon Authorized Representative 11/13/2021 Date 1 r _ "s 1 F f / b / /,. <• <r !f r,;: rf </r' fr. / ` ref b it /< r` �•"� / �, �/ ° /r "•/ F a ' i, ,t ,r.'{. r r" Fr F' ..> .r/ ;;. i.. t 'fhis space intenti®n lly left blerik ,: '' i ;` R / r F r r F f / f f" / /" .' r f� i/. �•/' L !.f /tr 1. r- i jf� / /. i'r ": �.' i.. //' /; , . r F J•! fi '/ r.f- ff r.. f/: .: , / r � < 1 // fA I f` C / f ! r'! • / l • ACC 'IR?$ CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) �� 10/20/2021 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 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 David R Jarry Neill&Neill Insurance Agency Inc PHONE 413-7324137 FAX 413-7316629 662 Riverdale Street (Alc.No.Est): (NC,No): West Springfield,MA 01089 ADDRESS: dJ@neiilandneill.com • INSURER(S)AFFORDING COVERAGE NAIC# INSURERA: Western World Insurance Co. 13196 INSURED Vladimir Duducal INSURER a: Chubb chu V&D Home Improvement 776 North West Street INSURER C: Feeding Hills,MA 01030 INSURER D: 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 ADDL SUER POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MMIDDIYYYY) (MMIDDIYYYY) LIMITS A V COMMERCIAL GENERAL UABILITY NPP8747203 10/10/2021 10/10/2022 EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE OCCUR DAMAGE TO RENTED 100,000 PREMISES(Ea occurrence) $ MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: • GENERAL AGGREGATE $ 2,000,000 POLICY YE:JECT I I LOC PRODUCTS-COMP/OP AGO $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY(Per accident) $ HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY _ AUTOS ONLY (Per accident) $ UMBRELLA LIAB _ OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ B AND EMPLOYERS' 6S62UB-1K95803 04/11/2021 04/11/2022 AND EMPLOYERS'LIABILITY Y/N V I PER ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? n N I A • (Mandatory In NH) l • E.L.DISEASE-EA EMPLOYEE $ 1,000,000 I(Yes,describe under • DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS 1 LOCATIONS/VEHICLES (ACORD 101,AdditIonai Remarks Schedule,may be attached If more space Is required) ailysonc@vistahomeimprovement.com I CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRAT•N DATE THEREOF, NOTICE WILL BE DELIVERED IN VISTA HOME IMPROVEMENT ACCORDANC' TH THE POLICY PROVISIONS. 1346ELM STREET WEST SPRINGFIELD,MA 01089 " AUTHORIZED TATA I ©1988-2015 ACORD CORPORAT : All rights reserved. ACORD 25(2016/03) . The ACORD name and logo are registered marks of ACORD 1 .4 I!'n�2.1� DATE(MM/DDIYYYY) CERTIFICATE OF LIABILITY INSURANCE n3/16/9n71 Y 'IFICATE 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 poiicy(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 lieu of such endorsement(s). PRODUCER CONTACT NAME: SOUTHWICK INS AGENCY INC PHONE FAX P 0 BOX 100 (A/C,No,Ext): (A/C,No): E-MAIL SOUTHWICK,MA 01077 ADDRESS: 28TKC INSURER(S)AFFORDING COVERAGE NAIC# INSURED INSURER A: TRAVELERS PROPERTY CASUALTY COMPANY OF AMERICA SAMBRICO LLC DBA VISTA HOME IMPROVEMENT INSURER B: INSURER C: INSURER D: 2097 RIVERDALE STREET INSURER E: WEST SPRINGFIELD,MA 01089 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 ftDDL3UBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER (MMIDDIYYYY) (MMIDDIYYYY) LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS MADE ❑OCCUR. RENTEDDAMAGE TO PREMISES(Ea occurrence) nce) MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: AGGREGATEPROJECT ELOC GENERAL $ E POLICY PRODUCTS-COMP/OP AGG $ AUTOMOBILE LIABILITY COMBINED SINGLE $ ANY AUTO LIMIT(Ea accident) BODILY INJURY $ OWNED SCHEDULE AUTOS (Per person) AUTOS ONLY BODILY INJURY HIRED — NON-OWNED AUTOS ONLY (Per accident) AUTOS ONLY PROPERTY DAMAGE $ (Per accident) UMBRELLA LIAB OCCUR EACH OCCURRENCE $ r EXCESS LAB CLAIMS-MADE AGGREGATE $ DED I IRETENTION $ $ WORKER'S COMPENSATION AND PER OTHER EMPLOYER'S LIABILITY STATUTE ANY PROPERITOR/PARTNER/EXECUTIVE YIN UB-2E072183-21 03/12/2021 03/12/2022 E.L.EACH ACCIDENT $ 500,000 OFFICER/MEMBER EXCLUDED? (Mandatory In NH) El N/A E.L.DISEASE-EA EMPLOYEE $ 500,000 If yes,describe under E.L.DISEASE-POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONSILOCATIONSNEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space Is required) THIS REPLACES ANY PRIOR CERTIFICATE ISSUED TO THE CERTIFICATE HOLDER AFFECTING WORKERS COMP COVERAGE. CERTIFICATE HOLDER CANCELLATION TOWN OF WEST SPRINGFIELDS SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED 26 CENTRAL ST BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE , - WEST SPRINGFIELDS,MA 01089 ACORD 25(2016/03)(Rev.09-18) The ACORD name and logo are registered marks of ACORD 1988-2015 ACORD ORPORATION. r ghts reserved. Office of Consumer Affairs and Business Regulation 1000 Washington Street-Suite 710 Boston, Massachusetts 02118 Home Improvement Contractor Registration Type:. LLC SAMBRICO LLC Registration: 162058 D/B/A VISTA HOME IMPROVEMENT Expirations'.; 01/02/2023 2097 RIVERDALE ST WEST SPRINGFIELD,MA 01089 Update Address and Return Card. Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only TYPE:LLC before the expiration date. If found return to: Registration Expiration Office of Consumer Affairs and Business Regulation 162058 01/02/2023 1000 Washington Street -Suite 710 SAMBRICO LLC Boston,MA 02118 D/B/A VISTA HOME IMPROVEMENT BRIAN RUDD 2097 RIVERDALE ST gl4,'usi'4•4Hk'- WEST SPRINGFIELD,MA 01089 Undersecretary Not valid without signature to41v0,, r, - w-r on -''- ve.4..,ci rot Massachusetts... , . . ,i3O - to n o. f Professional Licensu.re Boni of Budding Regulations andStandards . . ......, , .... . • Co ns , , -visor . ...will,. .. .. _ , ,_ i:41.44b , . ,fiiiik ,,,,,,t,„g . ,..... . , ; _ , _,„,,,,.:,... ti.471,,,-' t5i3pires: 01 /211202 -, it, ... 1 : Swat - 4011Pkok . covo . ... . .. . gillie%ulf ' .0° • - . ,.P . / ,1,4iirtilik‘'‘' S:47 11610.111%). . . . , . , . e . ii:).016,11- cb444.0.,r.,,ort*rrttssto. ' 0 net, .., , . . „ , ._ , .. . .. . . , , .