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24D-092 (15) BP-2024-0142 84 NORTH ST COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 24D-092-001 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-2024-0142 PERMISSION IS HEREBY GRANTED TO: Project# RENO 2024 Contractor: License: Est. Cost: 425000 DA SULLIVAN &SONS 053667 Const.Class: Exp.Date: 11/19/2025 Use Group: Owner: INC SULLIVAN D A&SONS Lot Size (sq.ft.) Zoning: URC Applicant: DA SULLIVAN &SONS Applicant Address Phone: Insurance: 82-84 NORTH ST 413-584-0310 MCC2002000093 NORTHAMPTON, MA 01060 ISSUED ON: 02/22/2024 TO PERFORM THE FOLLOWING WORK: CONVERT BUSINESS SPACE TO RESIDENTIAL UNIT 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: i ' Fees Paid: $2,975.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Office of the Building Commissioner / 9 -0�� Commonwealth'he of Massachus (902/ I * ,?lye .!, / r"1 �'? /� Office of Public Safety and Inspections Massachusetts State Building Code(780 CMR) Permit Application for any Building other than a One-or Two-Famil# g (This Section For Official Use Only) ! Building Permit NumberrZ Date Applied: Building Official: SECTION L•LOCATION Nb,R.t t' NB(111.1-rW%t' orl ©(p kiZ) No.and Street City o rn Zip Code Name of Building(if applicable) FV 09 2-- Assessors Map# Block#and/or Lot # Cr" SECTION 2 PROPOSED WORK Edition of MA State Code used 2/9t< 513C.If New Construction check here 0 or check all that apply in the two rows below Existing Building Repair 0 Alteration l( Addition❑ Demolition 0 (Please fill out and submit Appendix 2) Change of Use tg, Change of Occupancy 0 Other 0 Specify: Are building plans and/or construction documents being supplied as part of this permit application? Yes T!. No 0 Is an Independent Structural Engineering Peer Review required? Yes Pt No 0 Brief Description of Proposed Work Tiss po -p s A In _ CS it) LH 43VSLIvesS -to Q.re3t0esstiaL. ¶ wria u+uu. INuueet.D Wg-vv43.41Al2t Etc- c..C3 Hero INst&kt,1Al.41 goa � t Jf rce45. SECTION 3:COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATION,ADDITION,OR CHANGE IN USE OR OCCUPANCY Check here if an Existing Building Investigation and Evaluation is enclosed(See 780 CMR 34) 0 Existing Use Group(s): Proposed Use Group(s): Q tt,%VCt A't SECTION 4:BUILDING HEIGHT AND AREA Existing Proposed No.of Floors/Stories(include basement levels)&Area Per Floor(sq.ft.) 4 � J Pub 4. i9 SAD Total Area(sq.ft.)and Total Height(ft) SECTION 5:USE GROUP(Check as applicable) A: Assembly A-1 0 A-2 0 Nightclub 0 A-3 0 A-4 0 A-5 0 B: Business E: Educational 0 F: Factory F-1 0 F2 0 H: High Hazard H-1 0 H-2 0 H-3 0 H4 0 H-5 0 I: Institutional I-1❑ I-2❑ I-3❑ I-4❑ M: Mercantile 0 R: Residential R-1161.. R-2 0 R-3 0 R4 0 S: Storage S-1 0 S-2 0 U: Utility 0 Special Use 0 and please describe below: Special Use Description: SECTION fx CONSTRUCTION TYPE(Check as applicable) IA 0 IB ❑ HA IIB ❑ MA CI IIIB ❑ IV CI VA 0 VB ❑ SECTION 7:SITE INFORMATION(refer to 780 CMR 105.3 for details on each item) Water Supply Flood Zone Information: Sewage Disposal: Trench Permit Debris Removal: Public] . Check if outside Flood Zone 0 Indicate municipal 0 A trench will not be Licensed Disposal Site 0 0 or trench or specify: Private 0 or indentify Zone: or on site system 0 permit is enclosed 0 Railroad right-of-way. Hazards to Air Navigation: MA Historic Commission Review Process: Not Applicable 0 Is Structure within airport approach area? Is their review completed? or Consent to Build enclosed❑ Yes 0 or No 0 Yes 0 No 0 Vitt SECTION 8:CONTENT OF CERTIFICATE OF OCCUPANCY Edition of Code:3O, T-&. Use Group(s): Type of Construction: Does the building contain an Sprinkler System?: Special Stipulations Design Occupant Load per Floor and Assembly space: SECTION 9: PROPERTY OWNER AUTHORIZATION Name and Address of Property Owner Name(Print) No.and Street City/Town Zip Property Owner Contact Information: l V\041. L Sv t.1_,t..nr ,1 `Et3 -5 - 03(o = - �wkLk@_ 17►4Suw.\114r4•t l Title Telephone No.(business) Telephone No. (cell) e-mail address If applicable,the property owner hereby authorizes: Name Street Address City/Town State Zip to apply for and act on the property owner's behalf,in all matters relative to work authorized by this building permit application. SECTION 10:CONSTRUCTION CONTROL(Please fill out Appendix 1) If a building is less than 35,000 cu.ft of enclosed space and/or not under Construction Control then check here❑. Otherwise provide construction control forms(see section 107 in the code)as required. 10.1 Registered Professional Responsible for Construction Control(the professional coordinating document submittals) ViAtLl rra- T . uttskt 4t3-143 - g590 4131 $ Name(Registrant) Telephone No. e-mail address Registration Number In-,4 l\hri.$- ST n} Wier dl h(.Jr\ VA.�r wINIC ,L (a ;o 2,- Street Address City/Town State Zip Discipline Expiration ate 10.2 General Contractor VA- Su.kWirt 1 c,iNt 5 Company Name '/V Ck. Sv tLWAr-4 (--% " OS S Ural Name of Person Responsible for Construction License No. and Type if Applicable N c - Tc44 - 91-irtc Nvard ST. vA mtne o Street Address City/Town State Zip `&-SSl ci)3t b - - Telephone No.(business) Telephone No.(cell) e-mail address SECTION 11:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L c.152§25C(6)) A Workers'Compensation Insurance Affidavit from the MA Department of Industrial Accidents must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. Is a signed Affidavit submitted with this application? Yes 0 No 0 SECTION 12:CONSTRUCTION COSTS AND PERMIT FEE Item Estimated Costs:(Labor and Materials) Total Construction Cost(from Item 6)=$ BLS;COO.CO 1.Building $ ?_L3,S e1 •C/O Building Permit Fee=Total Construction Cost x_(Insert here 2.Electrical $ (oip,ego, pp appropriate municipal factor)=$ . 3.Plumbing $ Z(e,Sep•ex. 4.Mechanical (HVAC) $ ,s;a pp.0 O Note:Minimum fee;1 contact municipality) 5.Mechanical (Other) $ Enclose check payable to 6.Total Cost $ 111..4; QOO.OB (contact municipality)and write check number here ( I 9 7 SECTION 13:SIGNATURE OF BUILDING PERMIT APPLICANT 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�wledge and understanding. c 2c- try ,, ,? - - Please print'and sign name Title Telephone No. Date 30 N ilj-L checker. \Mg* dt1.t5 3 Below soi E 41.44011_,.[.e,M Street Address City/Town State Zip Email Address 3 N- / -' 4a-- - Municipal Inspector to fill out this section upon application approval: % ' Name I 1 Date • City of Northampton aYr+nM - fj .'i.t Massachusetts w '<e L� A f.: I *' 14 DEPARTMENT OF BUILDING INSPECTIONS y x .� � 212 Main Street • Municipal Building Jh OD ,�._., Northampton, MA 01060 'rs'I'H 1,.�‘^`` 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: The debris will be transported by: Name of Hauler: v S A Signature of Applicant:_` IiC Date: 2- /- 2�� . • t Appendix 1 Construction Documents are required for structures that must comply with 780 CMR 107. The checklist below is a compilation of the documents that may be required. The applicant shall fill out the checklist and provide the contact information of the registered professionals responsible for the documents. This appendix is to be submitted with the building permit application. Checklist for Construction Documents* Mark"x"where applicable No. Item Submitted Incomplete Not Required 1 Architectural _ _ 2 Foundation 3 Structural 4 Fire Suppression 5 Fire Alarm(may require repeaters) 6 HVAC 7 Electrical 8 Plumbing(include local connections) 9 Gas(Natural,Propane,Medical or other) 10 Surveyed Site Plan(Utilities,Wetland,etc.) 11 Specifications 12 Structural Peer Review 13 Structural Tests&Inspections Program 14 Fire Protection Narrative Report 15 Existing Building Survey/Investigation 16 Energy Conservation Report 17 Architectural Access Review(521 CMR) 18 Workers Compensation Insurance 19 Hazardous Material Mitigation Documentation 20 Other(Specify) 21 Other(Specify) 22 Other(Specify) *Areas of Design or Construction for which plans are not complete at the time of application submittal must be identified herein.Work so identified must not be commenced until this application has been amended and the proposed construction document amendment has been approved by the authority having jurisdiction. Registered Professional Contact Information !1-t2ig Qa,-gus -7`{3- 9S14, LQt4-814.10_Liesrw4 .14* he'll Name(Registrant) Telephone No. e-mail address Registration Number etCC.. Street Address City/Town State Zip Discipline Expiration ate - - Name(Registrant) Telephone No. e-mail address Registration Number Street Address City/Town State Zip Discipline Expiration Date Name(Registrant) Telephone No. e-mail address Registration Number Street Address City/Town State Zip Discipline Expiration Date Please follow this link for construction control forms to be used by Registered Design Professionals. Initial Construction Control Document u �41�► l To be submitted with the building permit application by a ; aki t Registered Design Professional Nktr for work per the ninth edition of the IMP Massachusetts State Building Code, 780 CMR, Section 107 Project Title: Sullivan Apartment Date:02/07/2024 Property Address: 84 North Street, Northampton, MA 01060 Project: Check(x)one or both as applicable: New construction X Existing Construction Project description: Conversion of 3rd floor office space to a single residential unit. I Michael Trzcinski MA Registration Number:47318 Expiration date:06/30/24,am a registered design professional, and I have prepared or directly supervised the preparation of all design plans, computations and specifications concerningl: Architectural Structural X Mechanical Fire Protection Electrical X Other:Plumbing for the above named project and that to the best of my knowledge,information,and belief such plans,computations and specifications meet the applicable provisions of the Massachusetts State Building Code, (780 CMR),and accepted engineering practices for the proposed project. I understand and agree that I (or my designee) shall perform the necessary professional services and be present on the construction site on a regular and periodic basis to: 1. Review, for conformance to this code and the design concept,shop drawings,samples and other submittals by the contractor in accordance with the requirements of the construction documents. 2. Perform the duties for registered design professionals in 780 CMR Chapter 17,as applicable. 3. Be present at intervals appropriate to the stage of construction to become generally familiar with the progress and quality of the work and to determine if the work is being performed in a manner consistent with the approved construction documents and this code. Nothing in this document relieves the contractor of its responsibility regarding the provisions of 780 CMR 107. When required by the building official, I shall submit field/progress reports (see item 3.) together with pertinent comments,in a form acceptable to the building official. Upon completion of the work,I shall submit to the building official a 'Final Construction Control Document'. Enter in the space to the right a"wet" or �,Ski Of MAssq electronic signature and seal: o y� MICHAEL P. TRZCINSKI ` ', MECHANICAL "' o.47318 �G r, 1�. Phone number:413-743-9500 x 304 Email:mtrzcinski@hesnor.com .j �+ Building Official Use Only Building Official Name: Permit No.: Date: Note 1. Indicate with an'x'project design plans,computations and specifications that you prepared or directly supervised. If'other'is chosen,provide a description. Version 01 01 2018 Initial Construction Control Document *1141401, 47, To be submitted with the building permit application by a Registered Design Professional • r for work per the ninth edition of the v�V m Massachusetts State Building Code, 780 CMR, Section 107 Project Title: Sullivan Apartment Date:02/07/2024 Property Address: 84 North Street, Northampton, MA 01060 Project: Check(x)one or both as applicable: New construction X Existing Construction Project description: Conversion of 3rd floor office space to a single residential unit. I Chris Babin MA Registration Number: 50798 Expiration date: 06/30/24,am a registered design professional, and I have prepared or directly supervised the preparation of all design plans,computations and specifications concerningl: Architectural Structural Mechanical Fire Protection X Electrical Other: for the above named project and that to the best of my knowledge,information,and belief such plans,computations and specifications meet the applicable provisions of the Massachusetts State Building Code,(780 CMR),and accepted engineering practices for the proposed project. I understand and agree that I (or my designee) shall perform the necessary professional services and be present on the construction site on a regular and periodic basis to: 1. Review, for conformance to this code and the design concept,shop drawings, samples and other submittals by the contractor in accordance with the requirements of the construction documents. 2. Perform the duties for registered design professionals in 780 CMR Chapter 17,as applicable. 3. Be present at intervals appropriate to the stage of construction to become generally familiar with the progress and quality of the work and to determine if the work is being performed in a manner consistent with the approved construction documents and this code. Nothing in this document relieves the contractor of its responsibility regarding the provisions of 780 CMR 107. When required by the building official, I shall submit field/progress reports (see item 3.) together with pertinent comments,in a form acceptable to the building official. Upon completion of the work,I shall submit to the building official a'Final Construction Control Document'. OF , Enter in the space to the right a"wet" or y���� >ygss electronic signature and seal: e RIS t\ • o A ,�, IN C7lj�i��� K10._ 5 Phone number:413-743-9500 x 307 Email:cbabin@hesnor.com Building Official Use Only Building Official Name: Permit No.: Date: Note 1.Indicate with an'x'project design plans,computations and specifications that you prepared or directly supervised. If'other'is chosen,provide a description. Version O1 01 2018 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations ( 600 Washington Street Boston, Mass. 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly ��Name(Business/Organization/Individual): �YI 9U'���'- G Address: SeA No au-^ SV 2� City/State/Zip: egt, p c V�/Apr D(b(aO Phone#: (k[Zj — Sys t 03( 0 Are you an employer?Check the appropriate box: Type of project(required): 1. 1 I am an employer with 4.f ` am a general contractor and I 6. I New construction employees(full and/or part time).* have hired the sub-contractors 7. Remodeling 2. I am a sole proprietor or partner- listed on the attached sheet. 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. _ Electrical repairs or additions 3. I am a homeowner doing all work officers have exercised their I L 1 Plumbing repairs or additions myself [No workers'comp. right of exemption perm MGL insurance required]t c. 152, § 1(4),and we have no 12. I Roof repairs 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. tHomeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $Contactors that check this box must attach 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: c J N S. Co. 011P' '�2A(.-eA+ Policy#or Self-ins.Lic.#: oz..000Q '32.02.2)A A- Expiration Date: ']—( - Job Site Address: % VVt.)'(1:%- S'( City/State/Zip:NU Llid s4 teNt 1/Ac4— m (O(.a O 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 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 $250.00 a day against violator. Be advised that a copy of this statement maybe forwarded to the Office of Investigations of the DIA for coverage verification. I do herby certify under tI e-peand penalties of perjury that the information provided above is true and correct. Si azure: Date: '2-- 9" L� Print Name: �`=r L- N Phone#: ' 3 '(4(Q) Official use only Do not write in this area to be completed by city or town official City or Town: Permit/license#: Issuing Authority(circle one): 1.Board of Heath 2. Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact person: Phone#: WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY INFORMATION PAGE Massachusetts Employers Insurance Company 54 Third Avenue, Burlington, Massachusetts 01803-0970 (800) 876-2765 NCCI NO 58713 POLICY NO. MCC-200-2000093-2023A. PRIOR NO. MCC-200-2000093-2022A ITEM 1. The Insured: D A Sullivan&Sons Inc DBA: Mailing address: 82-84 North Street FEIN:"-***0820 Northampton, MA 01060 Legal Entity Type: Corporation Other workplaces not shown above: 2. The policy period is from 07/01/2023 to 07/01/2024 12:01 a.m. standard time at the insured's mailing address. 3. A. Workers Compensation Insurance: Part One of the policy applies to the Workers Compensation Law of the states listed here: MA • B. Employers'Liability Insurance: Part Two of the policy applies to work in each state listed in item 3.A. The limits of liability under Part Two are: Bodily Injury by Accident $ 1,000,000 each accident Bodily Injury by Disease $ 1,000,000 policy limit Bodily Injury by Disease $ 1,000,000 each employee C. Other States Insurance: Coverage Replaced by Endorsement WC 20 03 06 B D. This Policy includes these Endorsements and Schedules: SEE SCHEDULE 4. The premium for this policy will be determined by our Manuals of Rules, Classifications, Rates and Rating Plans. All information required below is subject to verification and change by audit. Classifications Premium Basis Rates Code Estimated Per$100 Estimated No. Total Annual Of Annual Remuneration Remuneration Premium INTRA 000030134 INTER SEE CLASS CODE SCHEDULE Minimum Premium $575 Total Estimated Annual Premium $71,358 GOV GOV Deposit Premium $18,814 STATE CLASS MA 5403 State Assessments/Surcharges $93,194.00 x 4.1800% $3,896 This policy,including all endorsements, is hereby countersigned by y"`' "� �" — - 06/21/2023 Authorized ignature Date Service Office: Alera Group Inc 54 Third Avenue Attn: Webber&Grinnell Division Burlington MA 01803 8 North King St- Suite#1 Northampton, MA 01060 WC 00 00 01 A(7-11) Includes copyrighted material of the National Council on Compensation Insurance, used with Its permission. AC R® DATE(MM/DDIYYYY) �i CERTIFICATE OF LIABILITY INSURANCE 06/28/2023 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 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 Barbara Grynkiewicz NAME: Alera Group,Inc. PHONE (413)586-0111 FAX (413)586-6481 (A/C,No,Ext): (NC,No): Webber&Grinnell Division E-MAIL b nkiewicz webberand rinnell.com ADDRESS: gry @ g 8 North King Street INSURER(S)AFFORDING COVERAGE NAIC# Northampton MA 01060 INSURER A: Selective Ins Co of America 12572 INSURED INSURER B: Selective Ins Co of S Carolina 19259 D.A.Sullivan&Sons,Inc. INSURER C: MA Employers/A.I.M. 12886 INSURER D: Evanston/XS Brokers 82-84 North Street INSURER E: Northampton MA 01060-3255 INSURER F: COVERAGES CERTIFICATE NUMBER: Exp 7/1/24 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 TYPE OF INSURANCE LTR INSD WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO D CLAIMS-MADE X OCCUR PREMISES(EaENTE occurrence) $ 500,000 MED EXP(Any one person) $ 15,000 A S2444741 07/01/2023 07/01/2024 PERSONAL BADVINJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 3,0L10,0110 POLICY X JECOT LOC PRODUCTS-COMP/OPAGG $ 3,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 (Ea accident) ANY AUTO BODILY INJURY(Per person) $ B - OWNED / SCHEDULED A9108782 07/01/2023 07/01/2024 BODILY INJURY(Per accident) $ AUTOS ONLY /" AUTOS X /HIRED . NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY (Per accident) Underinsured motorist BI $ 250,000 X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 10,000,000 A - EXCESS LIAB CLAIMS-MADE S2444741 07/01/2023 07/01/2024 AGGREGATE $ 10,000,000 DED X RETENTION$ 0 $ WORKERS COMPENSATION XI STATUTE ERH AND EMPLOYERS'LIABILITY Y/N 1000 000 _ C I „ ANY PROPRIETOR/PARTNER/EXECUTIVE NIA MCC20020000932023A 07/01/2023 07/01/2024 E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under 10 ,00000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ , Limit: Occurrence $5,000,000 Contractors Pollution Liability D CPLMOL113382 10/01/2022 10/01/2024 Aggregate $5,000,000 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 CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN Evidence of Insurance Only ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD