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HomeMy WebLinkAbout0057 LONGFELLOW DRIVE �� , an ��Q� Y �-r�� ��� o � _, t :. . __ .- .. . � , � . . . . o , . :, , . �. .. �. ,,. :, . , ,: .. - .. �� .. .. ,: � �y �. �. � - r. _ .o� - .. � +.�. �.-: } -,� � - �.�r ;.. ,1: '�.� ne � - _ �. - ,_. '' 1'. � , . � � k .. .�:.ia ..:. C -_ ,. Z c Ar. � ... � .x r � .. � _ , r � �. .. �.. . . v .. u � _ x v. � .. .: _ .' . .- .. _ - i ', i e n n e • _ -4.. .. �L _ � � a r• .r _ N • - - � ✓ - - � �. _ -- :r ,, . 3 �'t, -: -. _�'.�' _ _ � � y .. e p • - - ',: .. - ..,,-� ;. .._ .. _. .. <. �. _ • - � ,. t .. .. _ q .. . _ �,.. - •.'. •: � eta - ;� � .: f r � t � _ .. ti.' ��Y� rb;. .. a. , , ��- t r .a .. �„ .. f� _ �'� a '� tr t�..� �C i. .. _ u - ..a' La _ � Y ¢ �� �, - * , Y .� .a., n �. e h �'. �i .. .. -..-' •. .. � u � .�5 i .. r .. 9 . -. � .. , ch ; � _ _ � •� � _ . _ �. _ c n ... n �.. ,� ., .. x . �.. .. . , _ � , .-. � - , .-----� `' 'r >. �z a. -- ,. .: F , .. _ �.: .; - - .,. .,:, :. � y .. �� -. � � .. ,� _. '.. _;. - _ _ � .. . �. .. :� ." ,� .� ... p. � e �, ... , ..;. �r.�. '� � - . .. - .. ,. F ' r. � _ _ �. � C , ..�. _ n' ... w .. .> �. r . �. ' ..> .. ,� w � -e _ �. Y ' tI � <, t ., .. � � ' .. � � � � -' 7 _ .. .:. .. z �,. �. .. .- .. r .. - r � ,. w ... ., .. - - _ , - .. - _ , - . � .. e .. �_ .'. :._ .. .: is ., j c�' TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map �fJ Parcel Application #_ _ Health Division. Date Issued VbJ,1 Conservation Division aut, Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board NOV 14 an.,, Historic - OKH _ Preservation/ Hyannis Project Street Addressfo Village N ff $- i Owner.`` Ile Address Telephone O'J- / Permit Request w it ( 1 Zrf � l0 h lavd � D Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood.Plain Groundwater Overlay Project Valuation 0, Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing _new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size_Pool: ❑existing ❑ new size _ Barn: ❑existing ❑ new size_ Attached garage: ❑ existing ❑ new size_Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes No If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name 5%iu Telephone Number 0" Address �ea r - License # 1.6 ® e Home Improvement Contractor# Email 9i(R ij V_c . -ced, 1(4nia" 6l� orker's Compensation # 'L<�06� f 5d ALL CONSTRUCTION DEBRIS RESULTING WFOM HIS PROJECT WILL BETAKEN TO SIGNATURE t DATE . `C. FOR OFFICIAL USE ONLY APPLICATION # DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: . ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. ��. The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street,Suite 100 Boston, MA 02114-2017 U1 www.mass,gov/dla Workers' Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHOWTY. Applicant Information Please Print_ Legibly Name (Business/Organization/individual): Cape Cod Insulation Address: 18 Reardon Circle City/State/Zip: South Yarmouth,MA 02664 Phone#: 508-775-1214 Are you an employer?Check the appropriate box: Type of project(required): I.©1 am a employer with 4 S employees(full and/or part-time). 7. ❑New construction 2 Iam a sole .� s proprietor or partnership and have no employees working forme in S. Remodeling an capacity. ❑ B y p ty.[No workers comp,insurance required.) 3.[]I am a homeowner doing all work myself.[No workers'comp,insurance required.)t 9• ❑Demolition 4.Q I am a homeowner and will be hiring contractors to conduct all work on my property. I will 10 ❑Building addition ensure that all contractors either have workers'compensation insurance or are sole 11.[]Electrical repairs or additions proprietors with no employees. 12.❑Plumbing repairs or.additions S.Q I am a general contractor and I have hired the sub-contractors listed on the attached shoot.Thes 13.[]Roof repairs e sub-contractors have employees and have workers'comp,insurnnce.t 6.C,]We are a corporation and its officers have exercised their right of exemption per MGL c. 14. ✓�Other Weatherization 152,§1(4),and we have no employees.[No workers'comp,insurance required.) °Any applicant that cheeks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeownera who submit thi3,af5davit indicating they are doing all work and then hire outside convectors must submit a new affidavit indicating such. ;Contractors that check this box must attached an additional sheet showing the name of the sub•eontractots 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: Atlantic Charter Policy#or Self-ins.Lic,#: WCE00431902 Expiration Date 06/30/2018 Job Site Address: � City/State/Zip'qy Attach a copy of thew rkers' coted pensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as requ 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 verification. 1 do hereby certify under thepains andpenalties ofperjury that the information provtded�ab�v�e Is true and correct i e' Henry Cassidy .i.�..w.,. ..�.,�,�..�.M !f�v� (f Date: i Phone#: 508-775-1214 Of etal use only. Do not write in this area,to be completed by city or town officlal. 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#: I • r Commonwealth of Massachusetts Division of Professional�icensure Board of Building Regulations F Cons r ; f and Standards prvisor CS-100988 `> � J` ires: 11/11/2019 HENRY E CAS, SIDY'y t "; 8 SHED ROW: J WEST YARM0I'1TH M�►xq 673� �� 1 , � � Commissioner �/> • 1 ,ems.� •------—-- - Office of Consumer Affairs and Business Regulation 1.0 Park Plaza Suite 5170 - -up Boston, Ma 02116 Home improveme.g,ftUSettS tractor Registration z - ,y "" Type: Corporation Cape Cod Insulation, Inc '' = r Registration' 153567 18 r , :., Reardon Circle' _ ;�))•�•yll "=:'" Expiration; 12/1q/2018 So, Yarmouth MA 02664 =f_ : = ' ' ,F 3CA 1 +i 20M•05i11 Update Address and return card. Mark reason for change, v/aa s0o�ntn�aa�acueaCff o�� /�tulJuc�ct4eCtd �`ALI�r,.�St;�_(�- .'�_(—t � Office of Consumer Affalrs&Business Regulation .HOME IMPROVEMENT CONTRACTOR Corporatlon Registration valid for Individual use only i T`ype.; :� :N• before the expiration date, If foun. + stratlon Exp1 Office of Consumer Affairs end urn to: 07 i� 5170 12/14/2018 10 Park Plaza• si ss Regulatlon �2 a Cape Cod Insulatl'f41 Boston,MA 11 HenryCassld `fi�tt j1 ` 18 Reardon CIrci So,Yarmouth, Undersecretary t al hout sl atu 1. -�� CAPECOD-27 KDOYLE CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD1YYYY) 06/30/2017 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. g' IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONALJNSURED 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 endorsements PRODUCER CNR�J CT Rogers&Gray Insurance Agency,Inc. PHONE ac,No:(877)816-2156 434 Rte 134 A/c,No,Ext: South Dennis,MA 02660 E- AIL;Ss•mail rogers ra .com INSURERS AFFORDING COVERAGE NAIC# INSURER A:Peerless Insurance Company 24198 INSURED INSURER B:SafetyInsurance Company 39454 Cape Cod Insulation,Inc. INSURER C:Endurance American Specialty Insurance Company 41718 18 Reardon Circle South Yarmouth,MA 02664 INSURER D:Atlantic Charter Insurance Com an 44326 _ 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. ILTR NSR I TYPE OF INSURANCE ADDL SUBR- POLICY EFF POLICY EXP im-WA POLICY NUMBERIMMIDDnOM) LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE a OCCUR CBP8263063 04/01/2017 04/01/2018 DAMAGE TSESO RENTED .100,000 MED EXP(Any onePerson) 6,000 PERSONAL BADVINJURY 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE 2,000,000 X POLICY❑JECT LOC PRODUCTS-COMP/OP AGG 21000,000 OTHER: B AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000,000 ANY AUTO 6232707 COM 02 04/01/2017 04/01/2018 BODILY INJURY Per person OWNED' ONLY X AUTOSSwWULN�EEEDpp X AUTOS ONLY X AUOTOS ON1LY BODILY INJURY Per accident PROPERTY AMAGE are 'dent `' , UMBRELLA LIAR X OCCUR EACH OCCURRENCE 2,000,000 X EXCESS LIAB CLAIMS-MADE EXCl0006635002 04/01/2017 04101/2018 AGGREGATE 2,000,000 DED RETENTION$ ._ D WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY X ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N R/O WCE00431902 - 06130/2017 06/30/2018 ]S16TUTE OFFICER/MEMBER EXCLUDED? � N/A E.L.EACH ACCIDENT 1,000,000 (Mandatory In NH) 1,000,000 If yes,describe under E.L.DISEASE-EA EMPLOYEE DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT 1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space la required) Workers Compensation includes Officers or Proprietors. Additional Insured status is provided under the General Liability and Auto Liability when required by written contract or agreement with the Certificate Holder. 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. _ - AUTHORIZED REPRESENTATIVE ACORD 25(2016/031 0 4QPA_,)Mr Arnon rnoonoATlnsr All.:«M� .. A HE oft Ta Town of Barnstable Regulatory Services AARNSTAALE, Richard V. Scali,Director MASS. 63., R, Building Division M Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section I, Julia Follett as,Owner of the subject property hereby authorize C C ' to act on my behalf, in all matters relative to work authorized by this building permit application for: 57 Longfellow Drive Centerville, MA 02632 (Address of Job) ** Pool fences,and alarms are the responsibility of the applicant. Pools are not to be filled orutilized before fence is installed-and all final i ature of Owner Signature of Applicant Print Name Print Name Date Q:FORM&OWNERPERMISSIONPOOLS 17 IME Town of Barnstable *Permit# ` -d3a Regulatory Services EQe * BALMSPABIX Richard V.Scali,Director - Building Division JUL 7 Paul Roma,Building Commissioner u 1 l 200 Main Street,Hyannis,MA 02601 (�� l E Q' 8A H N ST A B L E www.town.barnstable.ma.us Office: 50 - 6 - 0' EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY �-n Not Valid without Red X-Press Imprint Map/parcel Number ISC Pro erty Address 5-7 LNG- 9,�0 k)�0 Luz Residential Value of Work$Jr 9 co Minimum fee of$35.00 for work under 6000 00- Owner's Name&Address Jo`-t A �ouzi1 AQ�oj ce) Contractor's Name ZooFyocz- Telephone Number sos 509 4641D Home Improvement Contractor License#(if applicable)i2`6q 5? Email: rEU,G( &e4A.)Cr- .1CWLO Cw Construction Supervisor's License#(if applicable) to 9 q 67 ❑Workman's Compensation Insurance Check one: ❑ I am a sole proprietor - ❑ I am the Homeowner ! [ I have Worker's ompensati n Insurance Insurance CompanyName clip- AAAU Workman's Comp.Policy# Copy of Insurance Compliance Certificate must accompany each permit. Permit RMRe-roof st(check box) (hurricane nailed)(stripping old shingles) All construction debris will betaken to AlLly J ,pN$ ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) ❑ Re-side ❑ Replacement Windows/doors/sliders.U-Value. (maximum.32)#of windows #of doors: *Where 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&Construction Supervisors License is quired. SIGNATURE: C:\Users\decollik\AppData\Local\Microsoft\Windows\INetCache\Content.Outlook\L7U69LF2\EXPRESS(2).doc 01/25/17 oFt� • sAsxs�rnBM • 9� Town of Barnstable �FDMAra Regulatory Services Richard V.Scali,Director Building Division Paul Roma Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us. Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder NUM05 �FZ C-T , as Owner of the subject property hereby authorize �r--L WIAl r to act on my behalf, in all matters relative to work authorized by this building permit application for: (Address of Job) 1644A J ti �7 fature of Owner Date Print Name If Property Owner is applying for permit,please complete the Homeowners License Exemption Form on the reverse side. C:\Users\decollik\AppData\Local\Microsoft\Windows\INetCache\Content.Outlook\L7U69LF2\EXPRESS(2).doc 01/25/17 I * lFll Acd fie a ' ir tvFvt�a.rnes�gea��a . 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Z&&nay e�fatzza>�rsprosi�adabot�is aid r 5o q � Z�� �� i�tae�bF�artmen • jr r Massachusetts Department bf Public.Safety Board of Building Regulatio"s and Standards License:tSSL4)99'167 Construction SupervnmrSpeciattyi_ OLNERA KELLY_= 8 Mk it: s YAK z. c—ham Expiration: crrta'ra-tssoner tt2stfa17 - t r_.a Office of Consumer Affairs and Business Regulation `= 10 Park Plaza- Suite 5170 Boston, Massachusetts 02116 Home Improveme-hIDGontractor Registration Type: Individual Registration: 128957 OLNER KELLY - = -. � � � E>piration: 06/1342019 8 RHINE RD r YARMOUTHPORT,MA 02675 r L Update Address and return card. Mark reason for change. SCA1 L 20M-W11. - -- — — -- .LA 3tte_s_s t_i;R�aeW�1,i1_Pm�lQyment,0_Lost Card ,� �le-�o�ra�cra�rrvecclll o�C�lGcax2cac�cc6efla office of Consumer Affairs&Business Regulation - HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only TYPE.individual before thQ'expiration date. If found return to: Region EVIration Office of Consumer Affairs and Business Regulation 128g57 06/13/2019 10 Park Plaza-Suite 5170 �y B ot"n,AIIA 02116 per. O11VER P&KELLY 6 RHVt4F-RD- YARMOUTHPORT,MA 02675 Undwswmt Not valid without signature ACo CERTIFICATE OF LIABILITY INSURANCE 05-154017 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: DOWLING✓£O'NEIL INS PHONE Fax 9731YANNOUGH RD Arc No Ex : "C. No): HYANNIS,MA 02601 EAnnama -MAIL INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:ACE AMERICAN INSURANCE CO INSURED INSURER B: KELLY ROOFING INC INSURER C 8 RHINE RD YARMOUTHPORT,MA 02675 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE 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. IN R SR TYPE OF INSURANCE ANSRL yy�D POLICY NUMBER (MWDD YYY)EFF POLICY E)(P LIMITS GENERAL LIABILITY EACH OCCURRENCE g COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ CLAIMS-MADE i f OCCUR PREMISES Ea occurrence L_l MED EXP(Any one person) S PERSONAL&ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ POLICYFI PEa El LOC $ AUTOMOBILE LIABILi Y COMBINED SINGLE LIMIT $ Ea a.,tl nt ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY(Per aceident) $ HIRED AUTOS AUTOS ON-OWNED 4OaE�BTV, AMAGE $ $ UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS-MADE AGGREGATE $ DED I I RETENTIONS $ WORKERS COMPENSATION WC 5TATU- OTH. AND EMPLOYERS'LIABILITY Y/N X TORY LIMITS ER ANY PROPRIETOR/PARTNER/EXECUTIVF� NIA A E.L.EACH ACCIDENT $SOO,OOO OFFICERIMEMBER EXCLUDED? N UB 05-10-2017 05-10-2018 (Mandatory in under It yes,describe un 8HO85809 E.L.DISEASE-EA EMPLOYEE $500,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $500,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,If more space is required) TOWN OF YARMOUTH BUILDING DEPT SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE 534 WINSLOW GREY RD CANCELLED BEFORE THE EXPIRATION DATE THEREOF, SOUTH YARMOUTH,MA 02664 NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE I JOHN J.LUPICA,President ©1988-2010 ACORD CORPORATION.All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD