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Home My WebLink About0115 OLD STAGE ROAD 0 � � ' _ a G i o t. Town of Barnstable *Permit# Expires 6 months from issue date -PRESS PERMIT Regulatory Services Fee / S Thomas F.Geiler,Director APR 12 2010 ]Building.Division yl��s Tom Perry,CBO, Building Commissioner TOWN OF BA,RNSTA13LE 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXTRESS PERNIIT APPLICATION - RESIDENTIAL ONLY q Not Valid without Red X-Press Imprint Map/parcel Number I I Property Address t 0 (� [Residential Value of Work � �� 00 Minimum fee of$25.00 for work under$6000.00 Owner's Name&Address �� ►1 �(,1 �.� Contractor's Name Telephone Numberf� ' Home Improvement Contractor License#(if applicable) 114-4 3 i 0 Construction Supervisor's License#(if applicable) qC1 1,3IJ ❑Workman's Compensation Insurance Che one: [ I am a sole proprietor ❑ I am the Homeowner I have Worker's Compensation Insurance Insurance Company Name W orkman's Comp.Policy# e 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 layers of roof) ❑ Re-side ❑ Replacement Windows/doors/sliders. U-Value (maximum.44) "Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Prope wne) si Property Owner Letter of Permission. co of tha' o rovement Contractors License is required. SIGNATURE: Q:Forrns:expmtrg Revise061306 THE 71 : Town of Barnstable., Regulatory Services • y MAC16.79, Thomas F. Geller Director AIFD �A Building'Division Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 VM'u'.toWn.b arnstabk.ma.us Office: 508-862-4038 Fax: 502-790-6230 Property Owner MuSt , Complete and Sign This Section If Using A Builder as Owner of the subject property herebyauth r ze SG�(lQ,� I to act on rnY behalf in all matters relative to work authorized b building permit application for: n ( d ss of J ob) . ignature er O f Date AANaim -F hh Pria QTOPUNMOWNERPEnfIS S 10N The Commomveatth ofVlassachusetts Deparfm ' .Y ofindustriarAccidents v affcce of Investigations 600 Washington Street Boston,MA 02111 www•m ass. ov/dia g , Workers Compensation Insurance.Affidavit: Builders/Contractors/Electricians/PIumbers Applicaut Information Please Print Le 'bl Name (Business/Organization/Individual):. •Address: V. C, . X City/State✓Zip:_`+ 0Ckfi( K, MA 0&(011 Phone.#: Are you an employer? Check the appropriate box: -Type of project(required) L 0 I am a employer with 4. I am a general contractor and I mployees (full and/orpart.time).* have hired the stub-contractors 6• El New construction . 2. I am a'sole proprietor or partner- listed on the'attached sheaf 7, ❑Remodeling ship and have no employees These sub-contractors have g• Ej Demolition working for me in any capacity, employees and have workers' 9 Buuldin addition [No workers'comp.insurance,' comp.insurance:# g required_] 5, ❑ We are a corporation and its 10.[]Electrical repairs or additions 3.❑ I am a homeowner doingall work officers have exercised their • 11.❑Plumbing repairs or' additions myself [No workers' comp: right of exemption per MGL 12 �Zoofrepairs insurance required.]t c. 152, §1(4),and we have no employees. [No workers' •13F1 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. TContractrns that check this box must attached an additional sheet showing laic name of the sub-contractors and state whether ornotthwe entities have employees. If the subcontractors Dave cmployces,,they must providt their workers'comp.policy number• lam an employer•that isproviding workers'compensation insurance for my employees Below isihepoliey andjob site information Insurance Company Name: Policy#or Self-ins.Lic.M Expiration Date: Job Site Address: City/State/Zip Attach a copy of the workers' compensation policy declaration page shoSvin the olIc number an ( g P Y d expiration date),.. Failure•to secure coverage as required tinder Section 25A ofMCjL 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 penaltits 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 maybe forwarded to the Office of Investigations of the bIA urance covers Lre verification. Ido hereby u er then Ins- ndpenalties ofperjuty that the information provided above is. ue and correct Simature: l a Date: Phone # - — ofy'icial use only. Do not write in this aregYo he completed by city or town of,-jciaL City or Town: Per.mit/License# Issuing Authority(circle one); X.Board ofHealth 2:BufldingDeparfinent 3. City/Town Clerk' 4;E.lectricalInspector 5.Plumbinglnspector 6. Other Contact Person: Phone#: G/—fin .�' b �Pb ✓� P Bb�aft)'of 13'u� mR a^u a io s an an ar s License or registration valid for individul use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Registration: 124310 Board of Building Regulations and Standards Expiration: 6/1/2011 Tr# 284683 One Ashburton Place Rm 1301 Boston,.Ma.02108 Type: Individual. James Curley - James Curley 287 Fuller Rd. Centerville, MA 02632 Administrator —` Not valid without signature i �- Massachusetts- Department of Public Safety Board of Buildin.- Regulations and Standards Construction Supervisor.Specialty License License: CS SL 99138 Restricted-to: RF,1NS JAMES CURLEY 287 FULLER ROAD: CENTERVILLE, MA 026.32 - . i I. Expiration: 1/28/2012 Commissioner' Tr#: 99138 Board of Building Regulations and Standards License.or registration N�alid for individul use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Registratf6ri�__1-24310 Board of Building Regulations and Standards Expiration _6/1/2009 Tr# '130873 Place Rm 1301 One Ashburton TyP?: individual Boston,Ma.02108 James Curley _- -- James Curley = 287 Fuller Rd. Centerville,MA 02632 Administrator Not valid without is re • i oFTt+�rqs, Town of Barnstable * . Expires 6months from issue date • Regulatory Services Fee Thomas F.Geller,Director �' 1639. ♦0 PrEn►�w+� Building Division Tom Perry, Building Commissioner . U 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION RESIDENTIAL ONLY a , q Not Valid without Red%Press Imprint Map/parcel Number Property Address �. &� t ��'� C)t�,lC r Kick Residential Value of Work L 1 Owner's Name&Address 1t` of e .C2 - A Contractor's.Name Telephone Number m Home Improvement Contractor License#(if applicable) V Construction Supervisor's License#(if applicable) (kCP �rkman's Compensation Insurance —PRESS PERMIT Check one: []•I a a sole proprietor DEC 2008 . Q ,VmtheHonieovmer I have Worker's Compensation,Insurance, TOW N OF BARNSTABL Insurance Company Name Workman's Comp.Policy__#aQ�)Lj!3 4—50 1 a 6Q y - Permit Request(check box) Re-roof(stripping bUshingles) All construction debris will be taken to []Re-roof(not stripping. Going over existing layers of roof) _ . 0 -'id e Replacement Windows. U-Value V r 1 (maximum.44) *whtrtrequired: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Ccnservahoff ete: ***Note: Property 0 must sign Property Owner Letter of Permission. ovement Contractors License is required. t ;JG Signature T V" Q:Porms:expmirg Revise053003 The Commonwealth of Massachusetts Department of Industrial Accidents Ix Office of Investigations 600 Washington Street Boston,MA 02111 www.mass.gov%dia orkers' Com ensation Insurance Affidavit: Builders/Contractors/Electricians/Pluniberl �'�' P Please Print Le lb &-pplicant Information: name(Business/Organization/Individual): `� Id e V 4ddress: Ig� (d,tlil�� Ie �it /State/Zip: =d Phone.#: j)!&- Y V n employer?Check the appropriate box: . Type of project(required): a employer with 4• ❑,I am a general contractor and I 6 ❑New construction -- have hired the sub-contractors employees(full and/or part-'me.* Remodeling ❑ I am a sole proprietor or partner- ' listed on the:attached sheet. 7. ❑ These sub-contractors have g: ❑Demolition ship and have no employees employees and have workers' 9. ❑Building addition working.for me in any capacity. comp. insurance.x [No workers'comp.insurance 10.❑ Electrical repairs or additions required.] 5. ❑ We are a corporation and its officers have exercised their- l l.❑Plumbing repairs or additions ❑ I am a homeowner doing all work right of exemption per MGL 12.❑Roof repairs myself.[No workers'comp. c. 152,§1(4),and we have no insurance required.]t 13. Other .employees. [No workers' comp.insurance required.] ,u�15OA9.,,j ry applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information., orneowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavitindicating such. an additional:sheet.showing the name of the sub-contractors and state whether or not those entities have ntractors that check this box must attached rovide their workers'comp.policy number. doyees. If the sub-contractors have employees,they must p m an'employer that is providing workers'compensation insurance for my employees. Below is the policy and job site brmation. r trance Company Name: lU()ll iin (31 •Lo® Expiration Date: t icy.#or Self-ins.Lic.#: "1"tl Site Address: �'tS o e-- TA City/State/Zip: :ach a Eopy gf the workers' compensation prolicy declaration page(showing the policy number and expiration date). lure to secure coverage as required under Section 25A of MGL c. 152.can lead to the imposition of criminal penalties of a lip 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 Y ip to$250.00 a day against.the violator. Be advised that a copy of this statement maybe forwarded to the Office of esti ations of jDIAor an e c ra e verificationhereby certis penalties of perjury that the th&mation provided above is true and correct. 3 Date: 0 _ nature: . Ine : '115--cn Yfficial use only. Do not write in this area,to be completed by city or town official �ity or Town: Permit/License# issuing Authority(circle one): 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector L.Board of Health 2.Building Department i.Other Phone#: �ontact Person: • x: .as+*=>• amr a :s` s`NFn"4 .8"§'",�S.YM. ACORD CERTfFICATE OF LIABILITY INSURANCE oPln DS OArF(MMOonrrr) SPRIN-1 05 09 08 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Br den s Sullivan Ins Agency HOLDER,THIS CERTIFICATE DOES NOT AMEND,EXTEND OR 88 Falmouth Road ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Hyannis MA 02601 Phone: 508-775-6060 Fax: 508-790-1414 INSURERS AFFORDING COVERAGE NAIC# INSURED _. INSURER Associated Industries of SSA WSURFR B. Sprinkle Home Improvement Inc. NSURERC. 199 Barnstable Rd 9 E!S RER a Hyannis MA 02601 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 W TH 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 PAD CLAIMS, MPOLICY NUMBER - POLICY EFFECTIVE - PCUCYEXPIRATION - LIMITSLTR NIRD TTPf OF WSVRANCF DATE(MWOQ/YY) DATE(MNb90/YY GENERAL LIABILITY I EACH OCCURRENCE $ f,OMMERCW.GENERAL LIABILITY PREKSES(Ea oc[Urence) 3 I CLAIMS MADE. ..�.OCCUR - .. ! - WO EXP(Arty one person) $ - * I - PERSONAL 8 ADV N:UR( -. 0ENERALAGGREGATE GEN'L AGGREGATE UNIT APPLES PER: I. PRODUCTS-IOWA;P AGO Is POUCY 7 PRO- .. I JECT LOC I AUTOMOBILE LIABILITY COMBINED SINGLE UNIT S - ANYAUTO - (Ea accident) f} — ALLOWNEDAUTOS - - - --. BODILY INJURY 13 i SCHECULEO AUTOS (Perperson) HIREC AUTOS " BOOILY!WJRY II NON-OWNED AUTOS (Peraccidwl) _ 63 PROPERTY DAMAGE (Peraceldent) S GARAGE UABIUTY I • AUTO ONLY•EA ACCIDENT i .ANY AUTO - EAACC Is OTHER THAN. . AUTO ONLY: AGO 3 EXCEE&VAIBREUA LIABILITY - - EACH OCCURRENCE IS OCCUR CLAIMS MADE - .AGGREGATE - 3 1 GEDJCTEILE - IS REJENTON S — WORKERS CCMPYiNSATIONAND A T _ - TORY LIMITS ER _ EMPLOYERS'UABIUTY A AWC7004943012008 01/O1 08 01/01/09 I .L.EACNACCIOENTT S 500000 PINY PROPRIETOR/PARTHERrEXECUTNE - � _ OFFICMINEMBEREXCUJDE07 - E L.LYSEASE-EA EMPLAYEE _�.3 500600 N yet,clowdoe moor SF£CWL PROVISIONS below E.L.DISEASE-POLICY OMIT 15.500000 OTHER - - DESCRIPTION-OF O►SKATIONS/LOCATIONS/VEHICLES I EXCLUSIONS ADDED BY SNOOKSEMENT/SPECIAL PROVISION/ - CERTIFICATE HOLDER CANCELLATION SPRNKHO INOULDANY OF THE ABOVE OESCRISED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURERWILL EN09AVORTOMAIL ::0 DAYS WRITTEN Sprinkle Home Improvement, Ina NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL Fax #508-775-1350 YArgo Mack IMPOSE NO OBUOATION OR LIABILITY Of ANY HIND UPON THE INSURER ITS AGENTS OR 199 Barnstable Rd. Rf►RESSNTATIViS. Hyannis MA-02601 AUTHORIZED REPRESENTATIVE - - I-Kelley A.Sullivan ACORD 25(2001/08) O ACORD CORPORATION 1988 . .- r En7 lio-ir&o1'13'td1ding Regulations and Sta ul iarcls, y Construction Supervisor License License: CS . 6643 ya ;. Tr# �42.7 E'xpirafon: 10/8/2009 - Restriction. 00- BRAD K -PRINKL-E 1.90 LOr.-4ROPStANE W BARINSTABLE,'MA02068 Coniinn5ioiier� I 00 •35,000W,eaclosed'space 1A-Masonry only 1 G- 1 2 Fari ly•Homes € Failure to possess-a-currentcedition of We Massachusetts State Budding Code is cause for revocation Of.tliis license. e'n i 73 Board of>Building.Regulations and Standards . HOME I�APROV.EMENT CONTRACTOR l 'y Registration: 103757 Expiration: 7/9/2010 Tr# 27103,3 Type: Rrivate Corporation SPRINKLE HOME IMPROVEMENT, INC: -Brad`:Sprinkle: , 199,Barnstable,Rd. Qa Hyannis, MA-02601 1.A'dministrator• License or registration valid for individul use only before the expiration date. If found return to: Board of Building Regulations and Standards One Ashburton Place Rm 1301 Boston,Ma.02108 Not valid wilt sig tune 4 �' " 8 fr HOMEOWNER: DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES I authorize Sprinkle Home Improvement to act on my behalf in all matters relative to the work to be performed on this job (i.e. permits, applications etc.) if necessary. Peter or Shi ey Fisher 87Tmr K. Sprinkle Date Date Town of Barnstable a *Permit#,_;)0o?®a6 1i Expires 6 months from issue date Regulatory Services Fe ,/� S� i ,�$ Thomas F.Geiler,Director 3 Building Division X-PRESS PER Perry,CBO, Building Commissioner a7 Ilt�ii1�911�� Main Street,Hyannis,MA 02601 JAN 5 - 2007 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 TOWN EX&§S'rE APPLICATION RESIDENTIAL ONLY JJ11�� Not Valid without Red X-Press Imprint n Map/parcel Number �lJ"t 6 Property,Address niliLg-j' cltn+tf i e, Residential Value of Work ! Minimum fee of$25.00 for work under$6000.00 Owner's Name&Address , , !5 io i ► t (na 2C19� Contractor's Name C Telephone Number t2 Home Improvement Contractor License#(if applicable) Construction Supervisor's License#(if applicable) —0c [!�<orkman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ IAM the Homeowner I have Worker's'Compensation Insurance Insurance Company Name �/ 1Workman's Comp.Policy# W Z� q 66 L115 1 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 layers of roof) ❑ Re-side Replacement Windows. U-Value .0M (maximum.44) *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: operty Owner must si Property Owner Letter of Permission. H- rovement ontr tors License is required. SIGNATURE: Q:Forms:expmtrg Revise071405 r i' IV.HOME IMPROVEMENT CONTRACTOR REGISTRATION COMPLIANCE LANGUAGE A. All home improvement contractors and subcontractors shall be registered. Inquiries concerning a contractor or subcontractor relating to a registration should be directed to; Director,Home Improvement Contractor Registration One Ashburton Place,Room 1301 Boston,MA 02108 B. The owner may have three-day cancellation rights under MGL c.93, §48;MGL c. 140D,§10, or MGL c.255D,§14,as may be applicable. C. All warranties and the owner's rights under the provisions of 780 CMR R6 and MGL c. 142A D. In the event that the Owner does not pay the contractor per this contract,the property is subject to a mechanic's lien. E. No contract shall contain an acceleration clause under which any part or all of the balance not yet due may be declared due and payable because the holder deems himself to be insecure. However,where the contractor deems himself to be insecure he may require as a prerequisite to continuing said work that the balance of funds due under the contract,which are in the possession of the owner,shall be placed in a joint escrow account requiring the signatures of the home improvement contractor and owner for withdrawal. F. No work shall begin prior to the signing of the contract and transmittal to the owner a copy of such contract. I guarantee that all our workmanship and materials will be of high quality. Additionally,we are licensed,registered,and fully insured. Our signatures indicate that we have read,we understand,and we accept all provisions of this agreement. Do not sign this contract if there are any blank spaces. Owner ' Date Mr.Peter isheK Contractor George lfavis"President George Davis Builders,Inc. i Page 5 of 5 Lic.N 056130 Reg.4 107333 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations d 600 Washington Street y` Boston, AM 02111 ww I .mas .gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Le ibl Name (Business/Organization/Individual): L, No , is ( ( s in * Address:—Q.. tL1) VW d -A� City/State/Zip:, fj. a Phone#: Are Zam'aemployer n employer? Check the appropriate box: Type of project(required): 1. with� 4. El am a general contractor and I employees(full and/or part-time).* have hued the sub-contractors 6' El New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet t 7• [remodeling ship and have no employees These sub-contractors.have 8. ❑ Demolition working for me in any capacity. workers' comp. insurance. 9. ❑ Building addition [No workers' comp. insurance 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions required.] officers have exercised their 3.❑ 1 am a homeowner doing all work right of exemption per MGL 11.❑ Plumbing repairs or additions myself. [No workers' comp. c. 152, §1(4),and we have no 12.❑ Roof repairs insurance required.] t employees. [No workers' 13.0 Other comp. insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy infonnation: 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 their workers'comp.policy information. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. , Insurance Company Name: Policy#or Self-ins.Lic. #:—A) 2, Expiration Date: D Job Site Address: Ci /State/Zi : &n+- Ca ao�� Attach a copy of the workers' compehsation polic' 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$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify un he a d enalt s ry that the information provided above is true and correct. Signature: Dater Phone#: Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other a Contact Person: Phone#• .,� �lze 1°a�noraayaurecalC� a`��2�ua:rac�uveCxa Board of Building Regulations and Standards HOME IMPROVEMENT CONTRACTOR Registration: 107333 Expiration: 7/31/2008 Type: Private Corporation. GEORGE DAVIS BUILDERS, INC. George Davis 9 NEW VENTURE DR. UNIT 7 So. Dennis, MA 02660 Deputy Administrator J'fze '�amirrcanweaCtl BOARD OF BUILDING REGULATIONS License'. CONSTRUCTION SUPERVISOR Number CS 056130 '' #,; Expires;03'/_0112007 Tr.no: 8332.0 Restrfeted: .0 GEORGE F DAVIS` , c, 9 NEW VENTURE D.R#7 �, ,, S DENNIS, MA 02660 Commissioner n i JAN-05-2007 10 :09 AM GEORGE DAMS BUILDERS 5023945460 011111911 W*Vf?w WU At,1ictrin r nourartmA earl P.01 O OY raxuA,IWrL•10{if Klauranw 10,ewwulLl LnNr,v1wm11 1••«� 0.4TIE fAfl•UpOM1vwl MMP. CERTIFICATE OF LIABILITY INSURANCE M�$�'.� %( Q o6 THIS CERTIFICATE 10 talsveo A AA MATrrgt dF 1NFdR-kA N mortnsttr rag, Services, Inc, I ONLY AND C WjR!NO RIGHT$URaN YNE ttRY11CATE 65 walnut strut ate, 3Bo A.LTIATHECOVERAGE4PPORormbBYTTHEPICIL'dSELOW. W011991Oy Hk 02481 IlbOri®:791-431-2500 IPIX:781-431-6114 IINSUAMtdAM • WS tk%Wj k �NAICs INs.weaA. !l24► Ce �riilri d*Or s bavia auildars Inc. T�or�m �pevia IN�:LREA'c 9 N pt ventuto ii AoT1�b De»nss COVRRAGN>{ T`G F!'A;iCIF,$.�F'IJ9:RAF.CY:I Ifi"fF,.!) HWA?9EE1!I@R{,6Ti'r!J TI•,F.NfJ.,A!EL:PLahEEU A50YP FC:R THE POLICY P''NIiIC iN[7iLQ.Ti:_.N�!4Vi 4+'iT4tYt• w t .err.AE•,UR�1EAr rFPl.l pv rgrv,�n,i;k,JP ANY 0,01na•4CT OR 1.)1}LnF OGK'UML+IT1NrU+1*pRNCC'Y Y'4 WHI";H^Ji8 ti:cFTY°ICArE IAA':q„zaSl,�n vwvRTn-1uw^+E!raSJa.Wa.E.aRPexrrJE'DHvIHL1ritilgebpPEc' !nE0!iEng!rJla6MHCY•-)ALL17tETERn1S.L'CX,^S,ONS AND ^..Crf,m�nsnrna,n A:r;N Ort LIN't AH.OW4 NMt1'MOVE SS EN RK-Mi:C NY P4:A CLAAA0._+ L 0 TYIIt?F'k13URA4CI AQACYIagq _yC11Dp'}/1,[]rp A • OA. Al :1K I LtR18 ' GENERAL L14ki. Y - vOMMEOC[YL4tEf�Lu.LPJIL^'; I i �:.>�t;rlC.t't.V:R�!QP: �•—, 4 �-QA!Ozi .��^C1..,P. t PRP.W$EE(.OgCtWihY� S_ EKE IMy 011 P41Y-?11 � __._---,—•. FEAS:-NA,eh:vc,uRy' I oENEAk�u:GPAOAIt t3LA%.A•lk3itpl�ATF,L'4fl1 ApR EB Plrf I � 1 �fA`JCT9�_'>6"�!N'A��3�9.»...............-...... AtrrON06UMADAM ~ - �::a{r� I 1 i i i�A131M1EC SIN^LE UaU' 3 (Ba Ax.CArlli ALL GY�VEO AiJ:"Jt SC iE v tcJ A rCS 16(CIL K.UR af.!DILYIr,3„IRr �- I r:ou.:A'dNF.I,4r.'A I wF�+aa r G•h,14GP - i _.� - fo;�6cavAAm1 i { IgRR 'rOA00LWILMY - -� -- --- —.v. ANY AL i� iK,T,�nM - A-I I flMCii�lLtAIRiLLALNIILIIY __.. .. eAC M' 't+JRplSi:E OCY.UR L.1 I I;E(YJC.TIBL6 j I I --•----�f�—..___..__._. Yr FF!Cf;r�+•J'v'.�F!i\E77!E•GCr�TI�� A ._..�..._.__—._—_..—...�:. I>Rcal�Aoe51 03/es/06 03/Os/07 EL.EACHAC_CIPir <too,ego OFFa_�TEd9Lr�E(:LLGE7i I _ a as.aAccrdA:�nCor I I E L D „,SE-E i 6HVL"'+l 9 LOO,000 _ I SF£Ci;L�RO6'!^oICAIS xlax I —•--.•-_..-_., . L.C1t.4re;S -POL;� .ImllAl ( 7 7 ct c w`tB.—C.:wLr.wi,Cw.arwroslvlAueu:ilza`uroNswoomei'�6 d A , ;, - ...»_..a.....,....�.•,....__. :.... .._ __ .r L'7 CCRTIFlCAT!HOL52R -- CANCILLATiON m N981'A *MUD ANY a r►II PAmA oEoeft"roucur sI e►NCILLoio a uR�TH6lxnuurlrnr DA'!TN!lIM.11MIBEvao>tlsURlRwuLINrIAvs�RTO MAIL eArbwRITiEN ftw1k of Barnstable 2oilain0 ae�c, Na11C6TO TM WRrPCATO w=p I•wo r0 T4 LIFT,SUT FAILURE TO 60 t0 a'HAL_ uiiia 2 DO Main street WPOai No aaLKAATON OR VA441n'OF AW KIND ICON IME I4610MR,US A4&Ms uR Hyannis UK 02601 F�eaeurATn:a. A.CORG 25(TO 00 Hat arat warl4utt O ACORO CORFAORATIQN JM