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13-098 (2) BP-2023-0748 78 COLES MEADOW RD COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 13-098-001 CITY OF NORTHAMPTON Permit: Alts Renovations Repair PERSONS CONTRACTING WITH UNREGIhTERED CONTRACTORS DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) BUILDING P '.RMIT Permit# BP-2023-0748 PERMISSION IS HEREBY GRANTED TO: Project# INSULATION 2023 Contractor: License: Est. Cost: 4500 NEWBURY INSULATION LLC 106113 Const.Class: Exp.Date: 02/03/2025 HINKLE GERALD A& ANNE CATHERINE DAVID Use Group: Owner: HINKL Lot Size (sq.ft.) Zoning: RI/RR/WP Applicant: NEWS Y INSULATION LLC Applicant Address Phone: Insurance: 34 MEADOW ST APT 6 (401)309-2685 84427 WOONSOCKET, RI 02895 ISSUED ON: 06/08/2023 TO PERFORM THE FOLLOWING WORK: INSULATION/WEATH ERI ZATI ON 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: Final: Final: Final: Rough Frame: Gas: Fire Department Driveway Final: Fireplace/Chimney: Rough: Oil: Insulation: Smoke: Final: THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Signature: e, • v . >2 . TAT, Fees Paid: $65.00 212 Main Street,Phone(413)587-1240,Fax (413)587-1272 Office of the Building Commissi i ner , CEO V11.z The Commonwealth of Massac sett Board of Building Regulations and Stan rdst/UN - 7 OR Massachusetts State Building Cod , 780 MR,t 217 CIPALITY ,� USE Building Permit Application To Construct,Repa ,RenoYep ' h a Revi ed Mar 2011 �^41 tr,r 'iNS fi One-or Two-Family Dwelling ECTION A- co This,�ection For Official Use Only y Building Permit Number: /J/f-43 }, . ritio Date Applied: 44J/ iZ 6-8 Zoz3 Building Official(Print Name) Signature Date SECTION 1:SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map&Parcel Numbers -78 Coles Met 24 1.1 a Is this an accepted street?yes no Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: 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 Owner'of Record: LurnC t1K1e \ c)r•-kAnamNur \ (Y)A 0toCo0 NameJ,Print) City,State,ZIP 7� CAtes Meodow t-1.01--309-2(45 g n , t LQ ,•CoAn No.and Street Telephone mail Address SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply) New Construction 0 Existing Building 0 Owner-Occupied 0 Re4tirs(s) Cl Alteration(s) 0 Addition 0 Demolition 0 Accessory Bldg. 0 Number of Units Other /Id Specify: 1fSW_OLc v'l Brief Description of Proposed Work2: Qt\'c Sect_lic 1 J 1O1ouifl (e,k1•.uf3 e a:✓-ck:L. -600f SECTION 4: ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1.Building $ L1500 1. Building Permit Fee:$ Indicate how fee is determined: 2.Electrical $ ❑ Standard City/Town Application Fee ❑Total Project Cost' (Item 6)x multiplier x 3.Plumbing $ 2. Other Fees: $ 4.Mechanical (HVAC) $ List: 5.Mechanical (Fire $ Suppression) Total All Fees: Check NoCheck Amount:lam 6.Total Project Cost: $ 60 0 Paid in Full 0 Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) I U 6 13 �, 2 i3 125 w.vC\ t,u License Number Expiration Date Name of CSL older List CSL Type(see below) No.and Street C Type Description �O �� U Unrestricted(Buildings up to 35,000 Cu.ft.) i It Restricted 1&2 Family Dwelling City/Town,State,ZIP M Masonry RC Roofing Covering WS Window and Siding 401—may—24285 a\� �(1tWbwl� SF Solid Fuel Burning Appliances 9 K1s1IIC U,A•Lo C' Insulation Telephone Email address D Demolition 5.2 Registered Home Improvement Contractor(HIC) Q"3(A,*n D IZ 13 121/4-I N C W O 1Kl)� �SW,Gktuc\ LLC HIC Registration Number Expiration Date HIC Company Name of HI Registrant Name n e W b u� 3N c teaa.) ��-, Qkc\fl q41� 0� 1�� a',a,.(am No.and Street J ,1 Email address 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 Issuance of 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 C t ¶ 't\\ ct. Li to act on my behalf,in all matters elative to work authorized by s buildin ermit application. mi /- ecr ml 15 2- Print Owner's l SiSignature) 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. Print Owner's or Authorized Agent's Name(Electronic Signature) Date NOTES: 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 i r 1� . Massachusetts 4fr L �'<<1, 'S J�,, DEPARTMENT OF BUILDING INSPECTIONS ;4 /,l 212 Main Street • Municipal Building t,N. Cbe er --'°p*-' Northampton, MA 01060 '3 -.• .O -ter"_ 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: "�vcA_. '(1V k(U(weN-GA Iq Lo na\ S i- N o,c-W) SM \& Q_ 62___. 9. C, The debris will be transported by: Name of Hauler: W.,W\(ju vtA \Mu\('a Uf\ Signature of Applicant: Date: (p )5 12- The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations == = Lafayette City Center 2 Avenue de Lafayette, Boston, MA 02111-1750 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Newbury Please Print Legibly Name (Business/Organization/Individual): Ne w b ury �n s u I at i o n Address: 34 Meadow Road City/State/Zip:Woonsocket RI 02895 Phone #:401 309 2685 Are you an employer? Check the appropriate box: Type of project(required): 1.Ii I am a employer with 3 4. ❑ I am a general contractor and I employees (full and/or part-time).* have hired the sub-contractors 6. El New construction listed on the attached sheet. 7. Remodeling❑ 2.❑ I 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 ILO Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.0 Roof repairs insurance required.] t c. 152, §1(4),and we have no Insulation employees. [No workers' 13.❑ Other comp. insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. r 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:Beacon Mutual Policy#or Self-ins. Lic. #: 84427 Expiration Date:12/05/2024 Job Site Address:78 Coles Meadow Rd City/State/Zip:Northampton MA 01060 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. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct. Signature: Date: 06/05/2023 Phone#: 401-309-2685 14.1 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 1❑Board of Health 20 Building Department 3❑City/Town Clerk 4.0 Electrical Inspector 50Plumbing Inspector 6.0Other Contact Person: Phone#: RCS PLANVIRW DIAGRAM Customer Hr,rrurPh,rrm: ( .r-_._ } Address _ __ (._Q_-___(....V t-eS_.2 _lGrkdoItd1RA Work Phone, (_.-_ i- Town _ r+ al -l-on __.,..._ -... CCII Ph.,ns., r T- Any hm+tatK+ns for ncress by large truck? No X Yas If yes,dourrtm -. Any sccc f c duet:born or landmarks? No /`'_ Yes II yn:,drr;'.ntxr Site ID: l G g (00( J Energy Specialist: CAITC - $'-(S Peviewed by; t AL. D61011 - 1t-t 2, • 1 Z N%.s AE. 2tt 'T86 To LYV - •33 ,E 0-IS �SWEEQS l 2.1 -rims To 4-4 ATC!-( • ' I U TAMMIrJ&-- qy 0 I ly I 2s cs Z` -? 0 cS I • I-t, /is L. I FEL 121xS I EFP is C— CR --� AFL • I1 C�T� d- ® 10 5-t ' 1 AM 3 ASL Zo v11� 81 � 1 CS ® 2, �� c s i/ crtgoe R • o�: 12 For Office Use Only Z 12 t Bushes Ladder Neighbor Proximity Pocket Door', I:;'rr P,o ators Fences) Existing Conditions X=Access 0=Vents Note Inside Square P=Poof S=Soffit G=Gable RV=Ridge Vent CS=Continuous Soffit CUE=Continuous Drip Edge T=Triangle Install 0=New Access Note in Circle C=Ceiling W is Wall S=Sheathing Temp Unless Noted Otherwise Q=Vents Note in Triangle R=8"Roof S=Soffit G=Gable M=12"Mushroom For Access 220040-t/'S AREA SUPPORTING MATH TOTAL,, i� 2) �� + ( ) _u _ AFL ICE cE[ �S � ,� �.. 4 7 2) Z � 12 + . � . I2Ic..F 19 2 L ' 8 % . t342 1 33 S ._ I4) 1 I le (p (e Li 2. ci If_ !b tam - ha4"01 + vu w + Am J. br K b -I 7 g LS —. _.______._____._.._. e u a4th • 4 ex+ doors Recommended i2 , Ventilation Calculation 1 I JI't 2 /3 0 0 r_f . '1 7 I q.I S I Recommended 3 ventilation Calculat o- AIR SEALING WORK HOURS ; , Air Sealing Work Hour Calculation r'J`i I . 2 s " I (P 7 Work Hours 4 6 8 10 14 16 (+2) Attic Sq.Footage <500 501-800 i 801-1100 1 1101-1400 I 1401-1700 1 1701-2000 2001-2300 Every 3002 Exceptional AFL Hours " Primarily Floored Attics Chimney or BF =1 Hour Multiple Chimney/BF=2 Hours Prefab/Modular Hours No Chimney=4 Hours i Chimney=6 Hours Exceptional KW Hours X<20 feet=1 Hoar 20 ft< X<40 ft=2 Hours X >40 ft=4 Hours Rim Joist Only Hours RJ<150 ft=1 Hour RJ>150 ft=2 Hours BMT Ceiling Only Hours Ceiling Area<2,000 sq ft=1 Hour I Ceiling Area> 00 sq ft=2 Hours ""NOTE:You MUST be INSULATING RJ or Basement Ceiling to specify R WOO BMT Ceiling ONLY Air Sealing Hours- 1�j ;" >_6"Loos nsul onI Cross Batt Insulation T,} Multipliers -1 >_6"Mix Batt&Loose Insulation _ Truss Construction ■ For Office Use Only CLEAResuIt` CONTRACT CLEAResult 41 Brigham St., Customer Name:LYNNE HINKLE Marlborough,MA,01752 Email:Not provided Phone:413-341-3414 Premise Address:78 Coles Meadow Rd,Northampton,MA 01060 Mailing Address:78 COLES-MEADOW RD,Northampton,MA 01060 Project ID:4824534 Date:April 26,2023 Job Description Contractor will perform or cause to be performed the following work on these"Premises"in a professional manner and in accordance with the terms of this Contract,including the attached recommendations/work order describing the work in detail (the"Work")which are incorporated herein by reference. Measure Description Location Quantity Unit Total Cost Customer Cost Attic Floor-10"Open Blow Cellulose Living Space 1342 SF $2,791.36 $697.84 Kneewall Wall-2"Thermal Barrier Polyiso Living Space 33 SF $158.73 $39.68 Hatch-2"Thermal Barrier Polyiso Living Space 1 each $47.37 $11.84 Damming Living Space 52 each $127.40 $31.85 Air Sealing at Estimated 62.5 CFM50 Per Hour Living Space 12 hr $1,131.96 $0.00 Exterior Door Weather Stripping(with AS hrs) Living Space 4 each $127.24 $0.00 Door Sweep(with AS hrs) Living Space 4 each $104.44 $0.00 Total: $4,488.50 Program Incentive: -$3,707.29 Weatherization Barrier Incentive: -$240.00 Customer Total: $541.21 Payment Customer agrees to pay Contractor for the Work,the Customer Share of the Contract Price as follows:Payment#1:$180.40 as a Deposit payable to CLEAResult upon signing the Contract(not to exceed 1/3 of the total retail costs). Mail check&contract to CLEAResult,41 Brigham St., , Marlborough, MA,01752. Final Payment:$360.81 as the final payment for the Work shall be payable to the Home Performance Contractor(HPC)or Independent Installation Contractor(IIC)upon satisfactory completion of the Work. Customer understands that he/she will not be required to pay the Utility Incentive Share of the Contract price in the amount of $3,947.29.Changes to individual line items and/or previous incentives may increase or decrease the size of the Utility Incentive Share. Dispute Resolution The IIC and Customer hereby mutually agree in advance that in the event that the IIC has a dispute concerning this Contract,the IIC may submit such dispute to a private arbitration service which has been approved by the Office of Consumer Affairs and Business Regulation and Customer shall be required to submit to such arbitration as provided in M.G.L.c 142A. Page 1 of 4 Document Ref:UNKMR-7DDMWJLBD6-GGKEO Page 1 of 5 You may cancel this agreement if it has been signed by a party at a place other than an address of the seller,provided you notify the seller in writing by ordinary mail posted,by telegram sent or by delivery,not later than midnight of the third business day following the signytg dhjs�re�q� eOT SIGN THIS CONTRACT IF THERE ARE ANY LANK SPACES. j`�'/(�((�( -��( 05/17/2023 Customer Signature Date Indicate your selebted IIC here,if applicable Initial here if you want the Program to assign a �. Participating tekl 'i(A Contractor ,( Kevin Cote CLEAResult Signature Date Name of CLEAResult Representative Page 2 of 4 Document Ref:UHKMR-7DDMW,ILBDS-GGKEO Page 2 of 5 Permit Authorization mass save Form Site ID: 4683604 Customer: LYNNE HINKLE I� Lynne C Hinkle , owner of the property located at: (Owner's Name,printed) 78 Coles Meadow Rd Northampton, MA 01060 (Property Street Address) (City) hereby authorize the Mass Save Home Energy Services Program assigned Participating Contractor listed below to act on my behalf and obtain a building permit to perform insulation and/or weatherization work on my property. ufaue - kle Owner's Signature: Date: 05 / 17 / 2023 saasoaaa tasaasaasaasssasasaasaas*aaaasaasaseasassaa 000asa.a*00 O a as FOR OFFICE USE ONLY We have assigned the following Mass Save Home Energy Services Participating Contractor to the above referenced project: Participating Contractor Date Name: CLEAResult Phone: 800-480-7472 Email: Page 1 of 1 For Office Use Orly R1143 IE. Island , '-- DRIVER LICENSE d I :F-rEDERAL IDENTIFICA_BC/41( ,,‘, • ,', '',,.-,,Ot:'/A... .. rilr :-.. 2-:-_,,:._.__.. _;.,,,,„...,.-:::-----7-- ___. , ...._,1 — . , 3 F,06902t03/1988 4d Lic#2870750 ' ki • ''',/'.1:::':'7'-'g'::#,--,:o• 41-,Px$,02/0312025 441 I § 02/11/2020 :11 ITRINGALI GUI' J, /''' ,,-,;'-'. JR 34 MEADOVV RO "-,---'''''::'" WOONSOCKE1, RI 028535-1961 02/031'1988 9 CLASS 10 9a END M 12 RESTP NONE -15SEX NI 18 EVES 13LP •", ,I. ,"I it%H(11 5'-i0" 17+4q.;•7 190 lb wHAIR BK9e.. ,,... 5 ior)81112361 , Y 1 P 1 Y O St 0 .Z UP C Y madpl.m licenseane.com/#state=eyJPZCI61mR1YmRhNTdkLTItMWItNDViMC1hN"U4LWE5NWI5MTE1MDA3ZCIsIm1ldGEi0nsiaW50ZXJhY3R b25UeX611'oicmVkaXJIY3QifX0%3d&client_info=e J1aWQi0iJk0GVkZDBi0SlmYztwLT... G Mass.gov Massachusetts Division of Occupational Licensure-Office of Public Safety and Inspections Guy Tringali • All Existing Licenses Held Activity Submitted Construction Supervisor Renewal If you currently hold or have previously held a license with the Office of Public Safety and Inspections("OPSI"),please make sure your license is linked with your OPSI account.A properly linked record will show all licenses below. Linking your license by registration code:Your Registration Code is found on your renewal form in the right-hand corner under License Number and Expiration Date.Request your authorization code by e-mailing OPSI-info@mass.gov with"Request for Registration Code"in the subject line.Please provide your license number and a contact number at which you can be reached. TRINGALI,GUY ••• Type License Number Status Expiration Actions Construction Supervisor Specialty CSSL-106113 Active 2/3/2025 ••• Don't see your license?Click here to search for it. Apply for a New License To apply for a new license,please click the button below: If you have already started an application,you can return to the application at any time by clicking the application link at the right,under Activity'. To check the status of a submitted application,click the link next to any submitted application at the right under"Activity'. APPLY FOP A NEW LICENSE;EXAM THE COMMONWEALTH OF MASSACHUSETTS Office of Consumer Affairs and Business Regulation 1000 Washington Street - Suite 710 Boston, Massachusetts 02118 Home Improvement Contractor Registration . ( (; .\ y i Type: LLC .:._.. yp e z# Registration: 193878 NEWBURY INSULATION LLC ,4 _...- = ...._ . Expiration: 12/03/2024 34 MEADOW RD APT 6 „4 - __ WOONSOCKET, RI 02895 114 ...... ssiii Update Address and Return Card. THE COMMONWEALTH OF MASSACHUSETTS Office of Consumer Affairs&Business Regulation Registration valid for individual use only before the HOME IMPROVEMENT CONTRACTOR expiration date. If found return to: TYPE:LLC Office of Consumer Affairs and Business Regulation Registration Expiration 1000 Washington Street -Suite 710 193878 12/03/2024 Boston,MA 02118 NEWBURY INSULATION LLC r - - GUY J.TRINGALI 34 MEADOW RD APT 6 ,, - , w� r a,/ WOONSOCKET, RI 02895 t Undersecretary NotlEllid without signature AWo CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 2/27/2023 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: Sandra)Niederwimmer Hunter Insurance, Inc. PHONE FAX 389 Old River Road, P.O. Box 1 JA/C,No,Exq:401.769-9500 (A/c,No):401-769-9502 Manville RI 02838-0001 ADDRESS: info hunterinsurance.net INSURER(S)AFFORDING COVERAGE NAIC M INSURERA:Ohio Mutual Insurance Company 25950 INSURED NEWBU-1 INSURER B:Beacon Mutual Insurance Co 24017 Newbury Insulation, LLC Guy Tringali INSURER :Westchester surplus lines _ 34 Meadow Road INSURER D: Woonsocket RI 02895 INSURER E: INSURER F COVERAGES CERTIFICATE NUMBER:411612866 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 LIMITS LTR INSR WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) A GENERAL LIABILITY Y BP 0035443 9/14/2022 9/14/2023 EACH OCCURRENCE $1,000,000DAMAGE TO RENTED X COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence) $50,000 ' CLAIMS-MADE X OCCUR MED EXP(Any one person) $5,000 PERSONAL&ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $2,000,000 POLICY PRO LOC $ JECT A AUTOMOBILE LIABILITY Y CPP0027300 9/14/2022 9/14/2023 COMBINED SINGLE LIMIT (Ea accident) $1.000 000 X ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Peracddent) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS (Per accident) A X UMBRELLA LIAB X OCCUR Y CX 0004015 9/142022 9/14/2023 EACH OCCURRENCE $1,000,000 EXCESS LAB CLAIMS-MADE AGGREGATE $1,000,000 DED RETENTION$ $ B WORKERS COMPENSATION 844P7 12/52022 12J52023 X WC STATU- OTH- AND EMPLOYERS'LIABILITY YIN TORY LIMITS ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $500,000 OFFICER/MEMBER EXCLUDED? NIA (MandatoryinNH) E.L.DISEASE-EA EMPLOYEE $500,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $500,000 C Pollution Liability G28338703 003 12/17/2022 12/172023 Limit 500000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) CLEAResult is listed as additional insured under the general liability per written contract subject to terms and conditions of policy. 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. ClearResult 112 Turnpike Rd. AUTHORIZED REPRESENTATIVE Westborough MA 01581 ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD