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44-014 (32) 08/31/2006 08:27 2037762288 DEWBERRY PAGE 011 WBERRY- GOODKIND , INC . AUG 3 1 2006 FACSIMILE TRANSMITTAL SHEET TO; FROM: Dept of Bldg Inspection Guys Daddi COMPANY: DATE: City of Northampton,MA. 8/31/2006 FAX NIJM'R;FR TOTAL NO.OF PAGES INCLUDING COVER 413-587-1272 4 RE, YOUR REFERENCE NUMBER: BP App—254 Old Wilson Rd 4363-04 0 URGENT El FOR REVIEW 0 PLEASE COMMENT 0 PLEASE REPLY 0 PLEASE RECYCLE Please see attached contactor insurance and license information for the Building Permit Application submitted for the Verizon Wireless installation at: 254 Old Wilson Rd,Northampton,MA Please contact me at 203-776-2277 with any questions or comments Thank • Christopher 08/31/2006 08:27 2037762288 DEWBERRY PAGE 02 • iPj P OqCl tsrl:'atsagaaoras " 600` 4' LYSs!Strcca . • . ii a.'.Cm p.'7°atiot1tu:r Airlda it .. •,.TP TC,6=VitCRM:4,7TON'• ' ' •"Sea*PRzTl,o t.11, Q4iri . Cif} . 0itan Baer e'c p .-Oix aII\rotas e.111 ❑i sre sgl: rcpr:e eiiti. no eoc:�aes?uti ieax cna • aa�amic rimnm_-•--� ,a� •ci, —:mueonpJoy criiding:wori coin pe:snnom emya;p: Ss.wa iiig0 isj0 'z 14xsu; Green ? of:ta.iit .Cv unica-tio's' Inc.- •. • • l Sri: ._. .yfo1fiab'c c1v T T 03894 nit-ip}>oy.'t4; f:q.C131.'. :5.69:-8.6'a1 : r. iss^ w ATG ' . ' ' ?am,A: WC3?•87462:... . __ ❑1 sm o 'p rrp$t ,g=:i:at�aeaor ar'lidn i5.:rsd W. 'i`Stesttreators listed b w w1 a� -Cos iQiioHi:; • • WOt f$' castipeSse pe ist • OY r C 77 Cis. —,,,til-yayso:f` . • C�sa7y amc: .. 'Add:-s:: ' ... . . ^..-er s.Company' pain p:;' Attach oddli ows:Amu IC neekessry` .. •Fa iL•dl ss '•=ovc 4ea..=-aur_duaisi S»oar?iA a:')4I 3.:Tp cas'teac,n};_', osiacin aitzja iael;.. alli.,c!p dizre:eat.st,Sckd-Dc rid,'c:unc.ye w- sad*soLtiz r7S W:a.8sof7iii p a14:1L the tom of s S PPP WQR1 UZY,frEjt.and 23212f:'.. SZQQ.00 li try 8eistill n . onac„raod 13ac.a of tip,, .may be: o[wa:ded lil the 0 Ba se Of 1Me5� nticus ':na ),A.1.ist sav er.vithoy., /do.terety Ar,mums *ocrai,70 Af tj n.taco lira INOrrnat1100.11 h#a:rue CHQ rY a'.!tea kts: '`�C f ..4t::• .. n=iaclrtaa: 5.71CtOi D•ro1.1],n . ' • i'ah7c r. {603;' 5569-8601 • - . i. .Q15aa1 liar{S*2Y..1'.3n;Fin writs il}1:-.15 arao E m'atit6r g.Ra nr row.•. 1 ' '.iCth"?Rwc---,_ •'Pe_mPf;icanse.'in•„`• D!Jba.ma r . c sd-atmn�a.prnc= k 0 Chock if lrir,.iyyate:rN:�b:�e ti erequlrcr: .. .LI,tl7ur'. _ I. 08/31/2006 08:27 2037762288 DEWBERRY PAGE 03 Certificate of Liability Insurance Date of Issue01/04/2006 Producer This Certificate is issued as a matter of information J. Cl/ton Avery Agency;inc.. only and confers no rights upon the certificate holder. 21$ou �Street This certificate does not amend,extend or alter the PCBox15T1? coverage afforded by the policies below. Wollebcfe,MN 03894--1510 (603)569�25lS __ ..- Companies Affording Coverage Company C N A --- A Insured GREEN MTN COMM Company C N A5. T Green Mountain Communications Company c PO Box 356 Company Continental Casualty Wolfehoro Falls,NH 0389E-0356 0 Company Commerce&Industry E Company F Coverages 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 deetibed herein is subject to all the terms,exclusions and conditions of such policies,limits show may have been reduced by paid claims. Co I Type of Insurance Policy Number Policy Effective Policy Expiration Limits Ltr I _ Date Date General Liability General Aggregate $2,000,000 ' A L] Commercial General Liability C2082342699 12/31/2005 12/21/2008 Products-Camp/Op Aga $2,000,000 Claims Mad W Occurrence Personal&Adv Injury Si 000,000 ❑ Owners&Contractors Prot Each Occurrence 31,000,000 ❑ .Fre Damage(any one fire $300,000 Med Exp(Any one person) $10,000 Automobile Liability Camtined Sin9ie Limit $1,000,000 0 Any Auto C208234270it 12/31/2005 12/3112006 U All owned Autos Bodily Injury (Per Person) PI Scheduled Autos Q Hired Autos Bodily Injury W Non-Owned Autos {Per ACadent) Property Damage C Garage Liability Auto only Ea Accident • Any Auto Other Than Auto Only: ❑ Each _ __ .. _.. • Aggregate Excess Liability E U C2082342718 12/31/2005 12/31/2006 aci�Occurrence $S, , '(] Umbrella Form Aggregate _ $5,000000,000000 ❑ Other Than Umbrella Form i _ _ Workers Compensation and WC3a2091t3 12/31/2005 12/31/2006 WC statu- ErOther1.0, fart Limits L_. Employers'Liability EL Each Accident —r$ 0000000 Executive,officers ❑ Inc) EL Disease _AIL-Policy Limit 90,,680 ExCI EL ee Disease-Ea Em la Y $1.000.000 Other Description of Operations/Locations/Vehicles/Special Items _-..-J Coverage as per terms and conditions of policy._ ^� Cert'rficate Holder _ Cancellation Should arty of the above described policies be cancelled before the expiration thereof,the issuing company will endeavor to mail 30 Green Mountain Communications days written notice to the certificate holder named to the left,but P 0 Box 356 failure to mail such notice shall impose no obligation or liability of any kind upon the company,its agents or representatives. Authorized Representative Wolfeboro Falls,NH 03896 .Thomas A O'Dowd m CO W v N m m cn op 4,.,..x. - •-..... -- - : "may' - ' - - -- -• N ..ism �3y =4�ii r +t24E s3a r; ati _ - - •e - _ fir -' .=-.•-r••''-.''�, ��J� ]j1 #' W cn to ayr+. -3-- _'ice^� arise iv co co • kct. ... f - - - - - _ -- I>. id ` F "� _ � - 'fi .Y � [� � ., __ , . r _ 21__ 9 • • - . -. 'R:�T4J]1.•-: ed10• a`_; ;'• _ - rn • • -,..:, ...?..,:,.. .,.,_ ., , __ _,_--,-- ,_t: - . . ... ,„ . ..... .,.. .:ALLENS- TOWN:-.1NH':/-0- 3--276.:7.:-:-: . . = .._.. • x•- •....:,,._; ,-:�=:r•.>« ,..vim=.i.. -.144.aq:. .ee :-.1 _ ,._w_ �,._ - .. - '- _..._. -U A OD A