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HomeMy WebLinkAbout0076 TOWNHOUSE TERRACE cx, c Application number..... ...... ...........-/ .I. ...!.I. Date Issued.......fI .�........................................ sas.Hsrnsts. 1639. 10`� Building Inspectors Initials... ,... APR 1 � ���9 ....��................ Map/Parcel. D. ..�J......... . ................. T OWN OF BA STABLE EXPEDITED PERMIT APPLICATION: ROOF/SIDING/WINDO WS/DOORS/TENTS/STOVES/WEATHERIZATION PROPERTY INFORMATION Address of Project:' 7G Tu✓,Aa, e- NUMBER STREET VILLAGE Owner's Name: e?,t� OaC Ilel-fP Phone Number 5 yk- 7 7/ Email Address: Cell Phone Number Project cost S Z O L f-- Check one Residential v Commercial OWNER'S AUTHORIZATION As owner of the above property I hereby authorize to make application for a building permit in accordance with 780 CMR Owner Signature: 5 e,- A f(Q J-�a 04-41--&4 Date: TYPE OF WORK CD Siding U Windows (no header change)#_L_❑ Insulation/Weatherization 17 Doors (no header change)# Commercial Doors require an inspector's review J Roof(not applying more than 1 layer of shingles) n r Construction Debris will be going to Irl d S�e-/9'1GiJa CONTRACTOWS INFORMATION Contractor's name Home Improvement Contractois Registration(if applicable)# 17 3 Lq S (attach copy) Construction Supervisor's License# M S 7 07 (attach copy) Email of Contractor $LJee+ ; 1. C M Phone number L101- Z 2 R -9 goo ALL PROPERTIES THAT HAVE STRUCTIIRE516VFR 75 YEARS OLD OR IF THE SUBJECT PROPERTY 15 BN A HISTORIC DISTRICT, YOU MUST OBTAIN HISTORIC APPROVAL BEFORE A PERMIT CAN BE ISSUED. y APPLICATIONNUMBER............................................................ "F®I° Tents 0n1Yx Date Tent(s)will be erected Removed on number of tents total Does the tent have sides?Yes No (If yes please attach floor plan with exits marked) Dimensions of each Tent X X X Additional tent dimensions can be attached on a separate piece of paper. Check one: this event is a: for profit non-profit event. Check one: Food served Yes ' No Flame Spread Sheet of each tent must be attached.Provide a site plan with the location(s) of each tent I,f food is being served at your event please obtain a Health Department approval between the hours of 8:00am-9:30 am or 3:30 pm-4:30pm. Commercial events may require Fire Department approval. *WOOD/COAL/PELLET STOVES Manufacturer# Model/I.D. Fuel Type Testing Lab Offsets from combustibles:front _ back left side right side HOMEOWNER'S LICENSE LXEWTION Homeowner's Name: Telephone Number Cell or Work number I understand nay responsibilities under the rules and regulations for Licensed Construction I Supervisor in accordance with 780 CMR the Massachusetts State Building Code. I understand the construction inspection procedures, specific inspections and documentation required by 780 CMR and the Town of Barnstable. Signature Date PLICANT"S SIGNATURE Date Signature All permit applications are subject to a building official's approval prior to issuance. Kim Catallozzi �.From: Paul Baron <baronpm.ltc@gmail.com> Sent: Wednesday,April 10, 2019 3:11 PM To: Kim Catallozzi Subject: Re:Ouellette of Pine Brook Hi Kim, ; You have approval to replace.one [1]window at 76'Townhouse Terrace. Regards Paul A.Baron President Baron Property Management,ltE PO Box 1682 East Dennis,MA 02641 Email:baronpm.ilcoemail.com OfFtM M-38S-9499 Fax:-S08-385-7565 Cell:$08-3601557.. On Wed,Apr 10, 2019 at 9:51 AM Kim Catallozzi<kcatallozzi@renewaisne.com>wrote: i Good Morning Mr. Baron, Our company is seeking approval of a (1)window replacement project for Ruth Ouellette of 76 Townhouse Terrace. If you could please respond to this email that the project is approved it would be greatly appreciated. Thank you and have a great day. i Kim Catallozzi Permit Administrator Renewal by Andersen of Southern New England j 10 Reservoir Rd. Smithfield,R6 02917 w: 401-450-0708` RenewalByAndersen.corr Renewal by:Andersen sells,installs;and services energy- efficient replacement windows and patio doors resulting in beautiful homes and delighted homeowners: Our Company Mantra: . 1 ; f Irm- Renewa IT byAndersen. ' t WINDOW REPLACEMENT xn Ai�ittrn CifntFa[Fy {+S 1 F ,�..r... r.rna.�.n.rr.w�.w.arr.+.++wr�.,�.�rw-w..waawy-+v�rw -w•wvwy«.rwr+w.w wry+w+ '�www.�A�w.+..+,w...Tm -w.ewawMvr�rirwr.n.cnwr.ne+w.viw.w f Total Control Panel Login To:kcatalloizi@renewalsnexom Removethis sender from my allow list From:baronpm.11c@gmail.com You received this message because the sender is on your allow list. 1 1 I 4 i i F f} 4 qq. i 2 Renewal Agreement Document and Payment Terms Andersen. dba:Renewal B Andersen of Southern New England y g Ruth Ouellette Legal Name:Southern New England Windows,LLC 76 Townhouse Terrace RI #36079,MA#173245,CT.#0634555, Lead Firm#1237 Hyannis,MA 02601 WIRD)w RE LACEMERT 10 Reservoir Rd I Smithfield,RI 02917 - - H:(508)771-8681 Phone:866-563-22351 Fax:401-633-6602 I sales@renewalsne.com Buyer(s)Name: Ruth Ouellette ( Contract Date: 03/22/19_ Buyer(s)Street Address: 76 Townhouse Terrace Hyannis, MA 02601 Primary Telephone Number: (508)771-8681 Secondary Telephone Number. Primary Email: rutho1@loealnet.Com Secondary Email: Buyer(s)hereby jointly.and severally agrees to purchase the products and/or services of Southern New England Windows,LLC d/b/a Renewal By Andersen of Southern New England("Contractor"),in accordance with the terms and conditions described in this Agreement Document and Payment Terms;any documents listed in the Table of Contents,and any other document attached to this Agreement Document,the terms of which are all agreed to by the parties and incorporated herein b reference(collectively,this"Agreement'). h Buyer(s)hereby agrees to sign a completion certificate after Contractor a y s completed all work under this Agreement. Total Job Amount: $2,021 By signing this Agreement,you acknowledge that.the Balance Due,and the Amount Financed must be made by personal check;bank check,credit card,or cash. Deposit Received: $673 Balance Due: $1,348 Estimated Start: Estimated Completion: Amount Financed: 6-8 weeks 6-8 weeks $0 Method of Payment: Cash/.Check We schedule installations based on the date;of the signed contract and secondarily on. the date in which we complete the technical measurements.The installation date that we are providing at this time is only an estimate.We will,communicate an official date and time at a later date. Rain and extreme.weather are the most common causes for delay- Notes: 1/3 paid now, 1/3 paid at start;.1/3 paid at compl.Taxes paid in Barnastbl Buyer(s)agrees and understands that this Agreement constitutes the entire understandings between the parties and that there-are no verbal understandings changing or modifying any of the terms of this Agreement.No alterations to or deviations from this Agreement will be valid without the signed,written consent of both the Buyer(s)and Contractor.Buyer(s)hereby acknowledges that Buyer(s) 1)has read this Agreement, understands the terms of this Agreement;and has received a completed,signed,and dated copy of this Agreement,including the two attached Notices of Cancellation,on the date first written above and 2)was orally informed of Buyer's right to cancel this Agreement. NOTICE TO BUYER: Do not sign this contract if blank.You are entitled to a copy of the contract at the time you sign. YOU,THE BUYER,MAY CANCEL THIS TRANSACTION AT ANY TIME NOT LATER THAN MIDNIGHT OF 03/26/2019 OR THE THIRD BUSINESS DAY AFTER THE DATE OF THIS TRANSACTION, WHICHEVER DATE IS LATER.SEE THE ATTACHED NOTICE OF CANCELLATION FORM FOR AN. EXPLANATION OF THIS RIGHT. Legal Name:Southem New England Windows,LLC. dba:Renewal BX,44rseiSouthern New England Buyer(s). &kkk G Signature of Sales Person Signature Signature WrA Kevin Desmarais Ruth Ouellette PrintName of Sales Person. Print Name Print Name UPDATED:..03/22/19 Page.2 /.11 Office clfi Consumer ,affairs and Business Regulation 1000 Washington Street - Suite 710 Boston, Massachusetts 02118 Home Improvement Contractor Registration Type: Supplement Card 5 SOUTHERN NEW ENGLAND WINDOWS. LLC Registration:Expiration: 17324 173242U2U 10 RESERVOIR ROAD SMITHFIELD, RI 02917 Update Address and Return Card. sin .- r�r��"o=,,;•.- Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only TYPE:Supolement Card before the expiration date. If found return to: Registration Expiration Office of Consumer Affairs and Business Reo_uiation 173245 09/18/2020 1000 Washington Street-Suite 710 SOUTHERN NEW ENGLAND WINDOWS.LLC Boston,MA 02118 BRIAN DENNISON 10 RESERVOIR ROAD SMITHFIELD. RI 02917 Undersecretary M t without Signature riyiLA5!—?�J Diva sion of P1 ofessl- nal Lic-asure— oar ¢ 3 � y iRequiations and anda - p a res . 09/08/2020 RIAN D DENNISON E . .. 8 BLACKWELL DRIVE CHARLTON MA .-0,1507 ..- I The Coinnionwealth of Massachusetts 9? Department of Industrial Accidents I Congress Street,Suite 100 Al Boston MA 02114-3 Ol7 www mass gov/dia orkers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMIT LING AUTHORITY. Applicant Information 1)—)IA Print Legibly Name(Business/orsaniiation/Individua(): 1)— J A Jt Address: lU Set UDI �c� City/State/Zip:Sm l-f�A e_J t/?( DZQ 1 Phone#: �f Dl- ZZ Fr- Arrygn employer'Check the appropriate box: Type of project(required): a employer with ?!!Qtemployccs(full and/or part-time).' 7. New construction 2.D I am a sole proprietor or partnership and have no employees working for me in 8: Cj Remodeling any capacity.(No workers'comp.insurance required.] 3.[][am a homeowner doing all work myself.(,fo workers'comp.insurance required.]' 9. ❑Demolition 4.M I am a homeowner and will be hiring contractors to conduct all work on m 10 D Btilding addition y property. I will ensure that all contractors either have workers'compensation insurance or are sole I I. Electrical repairs or additions proprietors with no employees. (�i.®I am a general contractor and I have hired the sub-contractors listed on the attached sheet 12. P[umbing repairs or additions These sub-contractors have employees and have workers'comp.insurance.' 13.❑EZ of repairs f 6.M We are a corporation and its officers have exercised their right of exemption per NIGL c. 14.(v Other 411,/ dote l 152,S l(4),and we have no employees.(No workers'comp.insurance required.] 'Any applicant that checks box#I must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. ZContractors 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 thepolicy andjob site information. /� Insurance Company Name: P &15LSaAy—t 1.1 a • Or 'e 19 i Policy#or Self-ins.Lie.#: yVC a .3 1 : g -]Z.Ci 2 y Expiration Date: Job Site Address: Z& e i�Zerra --e. City/State/Zip: Attach a copy of the workers' compensation policy declaration.page(showing the policy numb r and expiration date). Failure to secure coverage as required under MGL c_ 152,§25A is a criminal violation punishable by 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.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verifleation. I do hereby cesti under the poi d penalties of perjury that the information provided above is true and correct Si--nature: '-, Date: 3 Phone 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 Health 2.Building Department 3.City/Town Cleric 4. Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: I Ac �� CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) 12/28/2018 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 CoBiz Insurance, Inc.-CO NAME` 1401 Lawrence St., Ste. 1200 PHCON o Ext: 303-988-0446 ac No:303-988-0804 11 Denver CO 80202 ADDRESS: COMaiI cobizinsurance.com INSURERS AFFORDING COVERAGE NAIC# INSURER A:Acadia Insurance Company 31325 INSURED ESLERCO-01 INSURER B: FiremenS Insurance Company of WA,D.C. 21784 Southem New England Windows, LLC. dba Renewal by Andersen of Southern New England INSURER C: Homeland Insurance Company of New York 34452 10 Reservior Rd INSURERD: Smithfield RI 02917 INSURER E INSURER F COVERAGES CERTIFICATE NUMBER:787175890 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 LTR POLICY NUMBER MMIDD/YYYY MMIDD/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY CPA3158728 V1/2019 1/1/2020 EACH OCCURRENCE $1,000,000 CLAIMS-MADE I OCCUR DAMAGE PREMISES Ea occurrence $300,000 MED EXP(Any one person) $10,000 PERSONAL&ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 PRO- X POLICY❑JECT LOC PRODUCTS-COMP/OP AGG $2,000,000 OTHER: $ A AUTOMOBILE LIABILITY CPA3158728 1/1/2019 1/V2020 COMBINED SINGLE LIMIT $ Ea accident 1 D00000 X ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS X X NON-OWNED PROPERTY DAMAGE HIRED AUTOS AUTOS Per.c..7 cc dem $ $ A X UMBRELLA LIAB X 10CCUR OPA3158728 1/l/2019 1/1/2020 EACH OCCURRENCE $15,000,000 EXCESS LIAR CLAIMS-MADE AGGREGATE $15,000,000 DED X RETENTION$ $ B WORKERS COMPENSATION INCA315872924 1/1/2019 1/1/2020 X STATUTE ERH AND EMPLOYERS'LIABILITY Y/N ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $1,000.000 OFFICER/MEMBER EXCLUDED? N/A (Mandatory in NH) If yes,describe under E.L.DISEASE-EA EMPLOYEE $1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,000 C Pollution Liability 7930073340000 1/1/2019 1/1/2020 Each Occurrence $2,000,000 Claims-Made Policy Aggregate $2,000.000 Retroactive Date 06/20/2013 Deductible $25.000 DESCRIPTION OF OPERATIONS/LOCATIONS I 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 ACCORDANCE WITH THE POLICY PROVISIONS. FOR INFORMATIONAL PURPOSES ONLY AUTHORIZED REPRESENTATIVE ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD i { oFst r Town. of Barnstable Expires 6nionthsfrorn issue..date Regulatory Services Fee * BARNSrABLE, v� 659_ Thomas F..Geiler,Director Building Division Tom Perry, CBO, Building Commissioner 200 Main'Street, Hyannis, MA 02601 www.town.barnstable.ma.us Office: 508-862-403 8 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION RESIDENTIAL ONL'St'' �J t Not Valid without Red X-Press Imprint Map/parcel Number €'ro rty Address_ TOW/1) kvse- ��� f Residential Value of Wort. ���' ' Minimum fee of$25.00 for work under$6000,00 Owner's Name&Address �/ A){� 76 �'/w/!/ Contractor's Name 1J7 es `-AUPI Telephone NumberOr €tome Improvement Contractor License#(if applicable) . , Construction Supervisor's License#(if applicable) V0 ❑Workman's Compensation Insurance Check one: X-PRESS PERMIT VElarn a sole proprietor the Homeowner ®Cr 2009 e Worker's Compensation Insurance /�,,,,,' TOWN OFBARNSTABLE Insurance Company Name_ (`fir/ al Workman's Comp. Policy# Ls Copy of Insurance Compliance Certificate must be on file. Permit Request (check box) ❑ Re-roof(stripping old shingles) All construction debris will be taken to ❑ Re-roof(not stripping: Going-over existing Iayers of roof) ;>Sj' - Replacement Windows/doors/sliders:U-Value ,, ,`1 (maximum .44) rY&re required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic.Conservation;etc. '**Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License is required, 4IG,NATURE: �- 1USk'F0l.MS\btuilding permit fbrms\EXPRESS.doa Revised 100608 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations -600=Washington-Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Lelliblv Name(Business/Organization/Individual): 0 0O V S ®Ci. A)L . Address: 83 l ✓rM Flprs f Or . City/St to/Zip:000N OC,`4 1 (VI��`� Phone #: �C� G 7f GL' Are 4u an employer?Check the appropriate box: Type of project(required): 1. I am a employer with y 4. ❑ I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors. 6: ❑ construction 2.❑ 1 am a sole proprietor or partner- listed on the attached sheet. 7. Remodeling ship and have no employees These sub-contractors have g, [],Demolition workingfor me in an capacity. employees and have workers' Y p h'• 9. ❑Building addition [No workers' comp. insurance comp. insurance.$ re uired.] 5..❑ We are a corporation and its 10.❑Electrical repairs or additions q . 3.❑ I am a homeowner doing all work ' officers have exercised their 11.❑Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑Roof repairs insurance required.]t c. 152, §1(4),and we have no 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. t 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.-ff fhe sub-contractors have emp oy e they-must provide-their workers—cump-potter number- - I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. '!1, Insurance Company Name: efica✓V Policy#or Self-ins.Lic.#: Expiration Date:. 10 V Job Site Address:�� ®wn City/S y( I-C tate/Zip: 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$250.00 a day against the'violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct. Si nature: G7 Date: Phone#: Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6. Other Contact Person: Phone#: use or regbtm&n x ii .f m ` 9 An.3ttrner Affairs& sines RPgulatittn Wore the txpi6ft da f if fo=&rdm to, i ME `IMPROVEMENT CCI� R4CTO . Mew t�I : One Aftuirtaa Place Rm.1291 W. 4 19535 W%INTO..02108 Y �xplr�t� �`�l �i21��1 :. Tr# -285438 TYPO; `_.. ttm ion • MOON ASSOC 19� •.rm � s DAMES MOOA1 L rY M -l}�i VIIOONSOCKET; R IV$ z s Undersecretary �. oa�rd ist tat tiia t.Rv<-„ul�aOsn��atai���t�i�tsia � �t ': d ,Vi IA Su � jila-,anry only . 'Orb* Aa lati JAMS DINI tiay S MOON PAINE ROAD FWtu W, cumammol RI om swet p_ isam for r anclaaa of tulslkewm 44 From:Shaunna Robinson,Hunter Insurance At:Hunter Insurance,Inc.. FaXID: To:Denise Glode Date:9/23/09 09:45 AM Page:2 of AC CERTIFICATE OF LIABILITY INSURANCE OP ID S DATE(MM/DD/YYYY). MOONA-1 09/23/09 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Hunter Insurance, Inc. HOLDER.THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 389 Old River Road, P.O. Box 1 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Manville RI 02838-0001 Phone: 401-769-9500 Fax:401-769-9502 INSURERS AFFORDING COVERAGE NAIC# INSURED Moon Associates IriC. INSURER A: DBA Gutter Helmet National Grange insurance Co 14788 DBA Renewal by Andersen of RI INSURER S: Beacon Mutual insurance Co. DBA Gutter Helmet Roofing INSURER c: DBA Moon Works 1137 Park East Drive INSURERD: Woonsocket RI 02895 INSURER E: COVERAGES 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.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. - LTR NSR TYPE OF INSURANCE POLICY NUMBER.- DATE(MM/DD/YY) DATE(MM/DD/YY) LIMITS GENERAL LIABILITY - EACH OCCURRENCE $ 1000000 A X COMMERCIAL GENERAL LIABILITY " MPS26619 09/16/09 09/16/10 PREMISES(Eaoccurence) $500000 CLAIMS MADE X❑ OCCUR - MED EXP(Any one person) $ 1 O 0 0 0 PERSONAL&ADV INJURY $ 1000000 GENERAL AGGREGATE $2 0 0 0 0 0 0 GEN'L AGGREGATE LIMIT APPLIES PER: - - PRODUCTS-COMP/OP ASS $2 0 0 0 0 0 0 POLICY PRO- LOC - -. JECT AUTOMOBILE LIABILITY - COMBINEDSINGLELIMIT $ 1000000 A X ANY AUTO B1526619. ,. - _09/16/09_ 09/16/10 (Ea accident) ALL OWNED AUTOS - - - BODILY INJURY $ SCHEDULED AUTOS - - .. - _ (Per person) - - HIREDAUTOS - - - BODILY INJURY $ . NON-OWNED AUTOS . - (Per accident) PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY - AUTO ONLY-EA ACCIDENT $ ANY AUTO EA ACC $ - OTHER THAN - _ AUTO ONLY: AGG. $ . EXCESSIUMBRELLA LIABILITY EACH OCCURRENCE - $ 10 0 0 0 0 0- A X OCCUR 0 CLAIMS MADE CUS26619 09/16/09 09/16/10 AGGREGATE $ �DEDUCTIBLE - - - - - XIRETENTION $10000 - - $ WORKERS COMPENSATION AND - X TORY LIMITS ER- EMPLOYERS'LIABILITY B ANY PROPRIETOR/PARTNER/EXECUTIVE 28586 - 10/01/09 10/01/10 EL.EACH.ACCIDENT " $ SOOOOO OFFICERWEMBER EXCLUDED? If yes,describe under - - E.L.DISEASE-EAEMPLOYEE $500000 SPECIAL PROVISIONS below - E.L.DISEASE-POLICY LIMIT $ 50 0 0 0 0- OTHER- DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT!SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION , BUILDIN .SHOULD ANY OF.T14E ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN Building Cont Reg. Board NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL Dept.Capitol Rill of Administration One Capi - IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR ' Hi Providence RI 02908 REPRESENTATIVES. AU 15PD REPRESENTATIVE ACORD 25(2001108) ©ACORD CORPORATION 1988 '76 CIF Renewal agc4,�Lr OntomcrNamc: 4 h doe- Ym,Ru,,, �/: ,/�1/� Addcesi U2.J/1.Ot/S // L &newel 6y A mn,d'R!Nc(;ape Cod ,"!�t Lt Sales Agreement Cc�.r4m<r ror. ,137 Park east Dr1.c �� City,smrc,ZiP: Otdu Number: _ W-nwhet.Rl om5 wrM4OW aa►uecraar .i n�dewmCo*Nb Phone•Mom-Wotk Pagr of pea:° lice mAR 195 1.12259.MA-135.t:£-562725 �( '� �, � UNITS adnkNNtaua. . y oiamr4r: yp,L16 - • VIE / 1 GOA6 s cG -� -/• t togf.m y a.p.� r. i N u..q.n f9ulnlny :MU Rswleamuaen ) �' ov4 G.agnw,ln+ao - -- f�e�e� frmIDulo.a4wr 8�1/ Aft �' "tom 117dT7`.7ty�ac� ,wr�,d,.,w � irr,>'duu/aTTG G� ..h.tedwM4dad .Wdea....gb.drommptwedb (J�_ zee wm..uw.a4+ a wrorei4a4 4eo►mr..4e wt Jct.awaEapama f vcrma for Tic and Co+,� t daro dtne mlac to ml o ttx tidrd budneea dq aRcrTOW e o aae at da of a don foe an A—pal .----.'font Mi.cdtu.naa C4.Uuw Lv.. fdeilL �^ rasa.ra,y i .coD^*+Rv4a4• tn^J.awW q.he.aea4raM^�.eMme4.yler wort►treYt eoa (�(,,, •aas.roa4r.sa.4a✓ A- dYw4W roua.aM 4 ONa Nw. 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