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" , :"� � ", , - , ., - ,�, . 1, , - ,, , , ::, , , , - �z�. ','�, , - � I � " , ," I " -, L ' ' , , - - , - ` - - , �, . ,.,, " ,,,,.,. ,,.,�,A-_r__c1,,,,'�,-' J's-" ��,,.�,4""�,,,,,:,,�L..,,�":� ,�L-,-,�,'I��",��,�,."-,:"��,,:�,�,,�.�,,,,,-�,�-,�,�,,�,.�.Li-�,-�.,-��,,�,--����".,-�,-�..,,-,..�,-r--,.,�,--,.-�,�,I , �,� �� � _`,�'� _�', - " - . `��'', !�,,", I ,,.,- .�- ,_ _L� _­_.�:__,,�, ,,_'__ �, _'. -,� - _: ; �_ :��,�......� � 1 ;AN� 1 " ,,, t - ' Town of Barnstable *Permit# .n 01�0 ]Expires 6 months from issue date pl;��( Regulatory Services Fee � °® Thomas F.Geiler,Director PREss, ps�,m .r Building Division MAY `Tom Perry,CBO, Building Commissioner 9K ,s�)Oo 2009 200 Main Street,Hyannis,MA 02601. OWIV OF BA www.town.bamstable.ma.us Office: 508-862-4038 h't�TAB.L' Fax: 508-790-6230 EXPRESS PARMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number �i /� Property Address 5 -(Tl�-�- Icy( lylty r- Jt-1 Residential Value of Work 06® Minimum fee of$25.00 for work under$6000.00 Owner's Name &Address K a4-,, �N Contractor's Name �JI �.a �Yt/J U1 c��L c4ti Telephone Number Home Improvement Contractor License#(if applicable) ( 253(,p Construction Supervisor's License#(if applicable) [AWorkman's.Compensation Insurance Chedlz!one: ❑ I am a sole proprietor ❑ I am the Homeowner 0,I have Worker's Compensation Insurance Insurance Company Name A �) Workman's Comp.Policy# _ LL 2 ' 0 3q I M S5 b 'd O Copy of Insurance Compliance Certificate must be on file. Permit Request(check box) c (l ...-JRe-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: Property Owner must sign Property Owner better of Permission, _A copy of the Home Improvement Contractors License is required. SIGNATURE: Q:Forms:expmtrg Revise061306 a The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington .street a Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): _FA a4_,� �,[Iy� L LG Address: O &x 1 g 8 City/State/Zip: C�)b-i- MA- OoQO_� Phone#: 5 6 9---Y ag ' C P qo-� Are you an employer?Check the appropriate box: Type of project(required): 1;,2�_I am a employer with 4. ❑ I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. El New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling 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.1 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 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 13.❑ Other employees. [No workers' comp. insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. f Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. :Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy andjob site information. Insurance Company Name: Ch Policy#or Self-ins. L✓ic. #: U E3 — b 3 q! (1) 575 6 — 0 d Expiration Date: Job Site Address: J Cam' `u City/State/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 certi the nd pe lties of perjury that the information provided above is true and correct. Sip-nature: Date: Phone#: u4 012 0/?- 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): I.Board of Health 2. Building Department 3. City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6. Other Contact Person: Phone#: nightFax N3-2 10/1/2008 1 :56: 31 PM PAGE 2/002 Fax Server IS SUE D A ':.: TE 10/O1/08 THIS CERTIFICATE IS ISSUED AS A MATTER OF DYFORwL&TION ONLY PRODUCER AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. WISE&QUINN INSURANCE AGENCY 449 PLEASANT ST COMPANIES AFFORDING COVERAGE BROCKTON MA 02301 COIJ3TCER Y A HARTFORD UNDERWRITERS INSURANCE CO INSURED COMPANY FRASER CONSTRUCTION LLC LETTER PO BOX 1845 cOMPAxv C LETrI�e COTUIT MA 02635 LETTER C D LETTER COMPANY E 1.E1'T ER THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LLSTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITTISTANDING ANY REQUIREMENT,TERM OR CONDTIION OF ANY CONTRACT OR OTHER DOCUMENT WTIH RESPECT•TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL TBE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS CO TYPE OF INSURANCE POLICY FV BER POLICY POLICY malls EFFECT lVE DATE EXPIRATION DATE I/DD/YY (MM/DD/YY GENERAL LIABII.PI'Y GENERAL AGGREGATE $ ❑COMMERCIAL GENERALUABILM PRODUCTS-COMP/DP AGG. $ ❑ CLAIMS MADE ❑ OCCUR. PERSONAL&ADV.INNRY $ ❑OWNER'S&CONTRACTORS PROT. EACH OCCURRENCE $ ❑ FIRE DAMAGE(Any One F7re) .$ MED.EXPENSE(Ally oneperson $ AlITOA40BII,E LIABII1TY conMBINED SINGLE LIMIT $ ❑ ANY AUTO ❑ ALL OINWED AUTOS BODILY INJURY $ (PuYerson) ❑ SCHEDULED AUTOS ❑ HIRED AUTOS BODILY INJURY $ (Per Accident) ❑ NON-OR'NED AUTOS ❑ GARAGE IJABILLI'Y PROPERTY DAMAGE $ ❑ EXCESS LIABILITY ❑ UMBRELLAFORM EACHOCCURRENCE $ ❑ OTHER THAN UMBRELLA FORM AGGREGATE $ STATUTORY LIMITS X A WORKER'S COMPENSATION EACH ACCIDENT $500,000 AND UB- 09/26/08 09/26/09 DISEASE-POLICY LIMIT $500,000 0341M556-08 E&IPLOIER'S LIABHXrY DISEASE-EACH EMPLOYEE $500,000 OTHER THE PROPRiEIY"ARTNERS/F� . OFFXTM ARE INCLUDED. DESCRIMON OF OPERATIONS/LOCATTOPIS/VEHLC7d+B/SPECTAI,TfPBLS THE DiSURED'S NLA WORKERS COALPRNSATTON POLICY AND ITSLINUTED OTHER STATES INSURANCE llmORSENIEN 1'AULHORIMS THE PA"IENT OF BEMMS FOR CLAILIIS MADE BY TILE INSORED'S IVLA IMaILOYEES IN STATES OTHER THAN ALA.NO AUrHORVATION IS GIVEN TO PAY CLAIIILS FOR BENEWS IN ANY STATE 07U RtTHAN II INSURED®RES,OR HAS E[IRM.E&H LOYEES OUTSIDE OF&LA.TERS POLICY DOESNOT PROVIDE COVERAGE FOR ANY STATE OTHER THAN ESIA. L17F TIME THLS REPLACES ANY PRIOR CERTIFICATE L%1JED TO TM CERTIFICATE HOLDER AFFECTING WORKERS COMP,M. COVI GE ........:::::.-.•..•.-::::.•.•:. . :. :::::::: ::}:-}: }:-}};:.;: :•�`i]�61 aAt1 #34 :::. _{::•:{;•:{{•:;:.:{{{•}:•:{{{:::: {{-.{:;{: :}:::[{:::::;:;{:;;:::::: TOWN OF BARNSTABI.E... SHOULD ANY OF THE ABOVE DESCRMED POLICIES BE CANCELED BEFORE THE PO BOX 40 NXPLRATION DATE TI]ERHOF,THE,1SSWNG COMPANY WILL ENDEAVOR TO 6IAIL HYANNIS NIA 02601 IO DAYS wRITIFN NOTICE To THE CERTIFICATE HOLDER NABIED TO THE LEFT, BUT FAILURE ToIIGIB,SUCH NOTTCESBALL]rWOSENOOBUGATIONOR L NI TT'OF ANY KIND UPON THE C031PANY,ITS AGENTS OR REPRFSIONTATIVES �UITIOHIIdip RfiP1iR9_TATIVE - )OWNFLA CARZT1-OKER r er�.-'�'crzracu Ooand,of•B*Idfog [onsand SC•andOds d 0petansc 'L�c�r+se 9 w � iii��:r 6�J7•g��C� AIJ 01V Tdi~ 96.98 . DEAM FPJASSER \ / 104 TW►INNNIEIII/ EAST FALf4611DUTH, 02-536 C�kimm�s^eianBr GTE ��� o�✓ aaaolzuee Board of Building Regulations and Standards License or registration valid for individul use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Registration; 112536 Board of Building Regulations and Standards EpFratiori _3%23/2011 Tr# 281021 One Ashburton Place Rm 1301 Type: DBA` Boston,Ma.02108 FRASER CONSTRUCTION_CO. ,f; DEAN FRASER 104 TWINN VIEW LANE E FALMOUTH,MA 02536 Administrator Not re i tie 6 Boar o uil in e ulan g g o s an tanlar One Ashburton Place - Room 1301 " Boston, Massachusetts 02108 Home Improvement Contractor Registration Registration: 112536 Type: DBA Expiration: 3/23/2011 Tr# 281021 FRASER CONSTRUCTION CO. DEAN FRASER P.O. BOX 1845 COTUIT, MA 02635 Update Address and return card.Mark reason for change. Address Renewal Employment Lost Card CA1 is 40M-OB/08-DBSLIFORMCA108212008 t� \y/yJ e l *CONSTRUCTION Fraser Construction, LLC IRODFING & SIDING Home Improvement License#112536 SPECIALISTS P.O. Box 1845, Cotuit NIA. 02635 508-428-2292 Email: fraser_construction@verizon.net www.fraserroofing.com FAX 1-508-428-0123 HICL#112536 CS#97668 WHITE CEDAR SIDEWALL PROPOSAL DATE: October 2, 2008 NAME: Karen Hill PHONE: 508-776-3162 MAIL ADDRESS: same JOB ADDRESS:. 51 Cove Rd. Centerville, MA 02632 FRASER CONSTRUCTION hereby proposes to perform the following services in neat and professional like manner and in accordance with the manufacturer's specifications and local building codes. *****WHITE CEDAR SIDEWALL**** Supply and Install 16" WHITE CEDAR CLEARS Supply and Install TVPAR 30 house wrap Supply and Install STAINLESS FASTENERS Clean and Remove Debris from work area daily Main Douse Aprox 1000 sq ft PRICE-$6,500 Initial Gable - small family room to right of house apron 200 sq ' •PRICE-$1,300 Initial Small Gable over front porch aprox 175 sq ft PRICE-$1,138 Initial GARAGE: Side Wall Nest Wall PRICE-$975 Initial Remove & patch bottom east side PRICE-$450 Initial 6 TRIM: ' PVC Corner Boards to match existing PRICE-$200 Initial Bilco Bulk Head C Style Installed • Regular Steel Construction PRICE-$625 Initial• Bead Board Fiberglass PRICE-$865 Initial- Building Permit $7 per $1000 Initial 2% Discount if paid by check immediately upon completion NO MONEY DOWN—NO Payment AT THE START OR PART WAY THRU Payments accepted are: CASH—CHECK—MASTER CARD—VISA—AMERICAN EXPRESS *Any payments not made within 30 days of completion will be charged 1 '/2%for every 30 day the payment is late. POSSIBLE EXTRA CARPENTRY: Any Rotted or Otherwise Deteriorated Trim Boards, Plywood Sheathing or Other Carpentry Needing Replacement will be done and charged for As an Extra at the Rate of$55.00 per Hour Plus Materials Plus 15% Overhead Mark-up on The Total Extras. Any alteration or deviation from above specifications will be executed only upon written orders and will become an extra charge over and above the estimate.All agreements contingent upon strikes, accidents or delays are beyond our control. Owner should carry fire,tornado, and other necessary . insurance upon the above work. FRASER CONSTRUCTION, LLC carries Workman's Compensation and Public Liability Insurance on the above work, certificate available upon request. This proposal may be withdrawn by us if not accepted within thirty days. DATE OF ACCEPTANCE: HOM,OWNER FRA C ON, LLC Town of Harnsta ble Permit# L16 653 Expires 6 months from Issue date �� Regulatory S � �' �� C�ffi .Fee 1639. Thomas F.Geiler,Director ti Building Division Tom Perry,CBO, Building Commissioner ( ?j0107 200 Main Street,Hyannis,MA 02601 Office: 508-862-4038 www.town.barnstable.ma.us Fax: 508-790-6230 EXPRESS PERMT APPLICATION - RESIDENTIAL ONLX Not Valid without Red X-Press Imprint Map/pazcel Number /i/9 Property Address L 4esidential Value of Work v 7Minimum fee of$25.00 for work under$6000.00 Owner's Name&Address �f Contractor's Name /( Telephone Number 50 8—q o Home Improvement Contractor License#(if applicable) oC J Construction Supervisor's License#(if applicable) ZWorkman's Compensation Insurance Check one: ❑❑ lama sole proprietor PEA MIT lam the Homeowner I have Worker's Compensation Insurance AUG 2 8 2007 Insurance Company Name TOWN OF BARNSTABLE Workman's Comp.Policy# C91 Lql p Copy of Insurance Compliance Certificate must be on file. Permit Request(check box) I Re-roof(stripping old shingles) All construction debris will be taken to S 6L14141( j ❑Re-roof(not stripping. Going over existing layers of roof) ❑ Re-side ❑ Replacement Windows. U-Value - (maximum.44) _ -- *Where required: Issuance of this permit does not exempt compliance with other town department regulations;i;e.Historic Co e *"Not i �, �s ,ation etc. I ry ro Owne ust si .11 1' /'`'7 weer Letter of Permission,., Homer > f ense is required. Y i SIGNA RE; rs , Q:Forms:expmtrg Rev'�se07 14 0 5 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 Legibly Name (Business/Organization/Individual): . Ez ayl�J,ln 1.� �l,(.A�,�1 Address: CD j g�{j. - - - City/State/Zip: MC-1 O a6ss Phone,#: So g-qA g- A Are you an employer?Check the appropriate box: Type of project(required): 1.VI am a employer with __� 4. ❑ I am a general contractor and I 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. $ 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 required.] officers have exercised their 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 11.0 Plumbing repairs or additions myself. [No workers' comp. c. 152, §1(4),and we have no 12.6KRoo'f 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 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 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:-'T" Policy#or Self-ins.Lic.#: I `T l7 Expiration Date: �j y Job Site Address: C�a1re 1 C dt City/State/Zip: rn Lam& 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 here=ersand etmltl s o per ry that the information provided above is true and correct. Si nature 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#: �1 C✓/'Ja--ca - - V �- 92LMM Fraser Construction CONSTRUCTION Roofing & Siding Specialists ROOFING SPECIALISTS' P.O. Box 1845, Cotuit MA. 02635 508-428-229Z Email: fraser construction(awerizon.net www.fraserroofmg.com Phone 1-508-428-2292 & FAX 1-508-428-0123 RE-ROOFING PROPOSAL DATE: August 11, 2007 tea: NAME: Karen Hill PHONE: 508-776-3162 MAIL ADDRESS: same . JOB ADDRESS: 51 Cove Rd. Centerville, MA 02632 FRASER CONSTRUCTION hereby proposes to perform the following services in a neat and professional like manner and in accordance with the manufacturer's specifications and local building code. -Remove and Haul away all of the old roofing material -Re-nail all plywood sheathing as needed. Supply and Install - CERTAINTEED LANDMARK /WOODSCAPE AR 30: 30 -Year Warranty, 5 year Sure Start Protection, CLASS A FIRE RATED, ALGA_ E Resistant, Extra Heavy Weight, Self Sealing, Multi- Layered, Architectural Style, Fiberglass Based Asphalt Shingle with New England's Exclusive COPPER/CERAMIC Stones with . a Full 10 Year Warranty against ALGAE Containment. Color: -U�'-t- �7 PRICE-$6,500 Initial Supply & Install - CertainTeed Winter - Guard: (ice 8s water shield) Waterproof Underlayment System (3ft. on eves and valleys, 18" on rakes, walls, and skylights) Supply & Install - Roofer's Select Underlayment Paper (as recommended by CertainTeed) Supply & Install - Hick's Ventilated Drip Edge or 8" Aluminum Drip Edge or smart vent as needed Supply& Install -Aluminum & Neoprene Soil Pipe Flashing Supply & Install-Air Vent Ridge Vent (as recommended by CertainTeed) Clean 8a Remove -Debris from work area daily: ,CERTAINTEED Warranties the shingles to be ALGAE resistant for the duration of the ! Sure Start Warranty depending on the shingle that was purchased. Any deviation or alteration from above specification will be executed upon written orders and will become an extra charge over and above the estimate. All agreements contingent upon strikes, accidents or delays are beyond our control. Owner should carry fire, tornado and other necessary insurance upon the above work. We, if not accepted within thirty days may withdraw this proposal. FRASER CONSTRUCTION: Carries Workman's Compensation and Public Liability Insurance on the above work, certificate available upon request. DATE OF ACCEPTANCE: Homeowner Fraser Co struction k d Board of Building Regulations and Standards One Ashburton Place - Room 1301 Boston, Massachusetts 02108 Home Improvement`Cortractor Registration - _ Registration: 112536 FRASER CONSTRUCTION CO. - Type: DID DEAN F Expiration: 3/23/2009 Tit 127920 P.O. BOX 1845R COTUIT, MA 02635 - - DPS-CA1 SS 50M-05/05-PC8490UpAddres dress d l card.Mark reason for change. — ❑ s [] Renewal Em to - --- - � .. _ ❑ p yment Lost Card Board of Building Regulations and Standards HOME IMPROVEMENT CONTRACTOR License or registration valid for in before the expiration date. If found etu dul use only Registration:,_112536 � Board of Buildinonsg turn to: Expfrdtiun: 3623/2}009 Tr# 127920 One Ashburton Place Rma1301 and Standards "lyre: D. .I - . Boston,Ma.02109 FRASER CONSTRUCTION GO.y M, DEAN FRASER / < 4556 RT 28 _ COTUIT,MA 02635 - -- - Administrator Not valid without signature. 4 o D .::: ��:� :. :. .....::. . . .:::::: '. .. .. ..: .:. .. .. .: •. ;:::;.:::::::::.:::•.::::::;:.::::.::::::::::.::. ;:::::::::::::::::::.:: DATE::.;:.::.;:.;;;:;:<_:.;:;<:::.:; Do PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY WISE & Q AN E HOLDER. THIS CERTIFICATE DOES NOT AMEND, IXTEND OFt 449 PLEASANT ST 'ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. BROCKTON MA 02301 COMPANIES AFFORDING COVERAGE COMPANY 24WCB A HARTFORD UNDERWRITERS INSURANCE COMPANY INSURED COMPANY FRASER CONSTRUCTION CO B PO BOX 1845 COTUIT MA 02635 COMPANY C COMPANY D 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 O 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. T TYPE OF INSURANCE POLICY EFFECTIVE POLICY EXPIRATION LTR POLICY NUMBER DATE(MM\DD\YV) DATE(MM\DD\YV) iAA LIMITSGENERAL LIABWTY TE $COMMERCIAL GENERAL UABWTYOP AGG. $CLAIMS MADE�OCCUR. NJURYOWNER'S&CONTRACTOR'S PROT. $E $RE DAMAGE(Any one tire) $ AUTOMOBILE LIABILITYMED.EXPENSE(Any one person) $ ANY AUTO COMBINED SINGLE $ LIMIT ALL OWNED AUTOS SCHEDULED AUTOS BODILY INJURY(Per Person) $ HIRED AUTOS NON-OWNED AUTOS BODILY INJURY (Per Accident) $ PROPERTY DAMAGE $ GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN AUTO ONLY: EACH ACCIDENT $ EXCESS LIABILITY AGGREGATE $ UMBRELLA FORM EACH OCCURRENCE $, OTHER THAN UMBRELLA FORM AGGREGATE $ A WORKER'S COMPENSATION AND EMPLOYER'S LIABILITY (UB-794XG 19-1-06) 09-26-06 09-26-07 STATUTORY UM ITS _° Wj THE PROPRIETOR/ EACH ACCIDENT $ PARTNERS/EXECUTIVE X INCL OFFICERS ARE: EXCL DISEASE—POLICY LIMIT $ , OTHER DISEASE—EACH EMPLOYEE $ 500 000 DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/RESTRICTIONS/SPECIAL ITEMS THIS REPLACES ANY PRIOR CERTIFICATE ISSUED TO THE CERTIFICATE HOLDER AFFECTING .. ::::::::.;.;:.>:.;;:. .:::...:.......................... WORKERS COMP CO V E RA :. ::......:: ::::.:......::::.::::::.. ::::::.:::.:..:::.::::.:::::::::................:. GE. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL FRASER CONSTRUCTION 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE PO BOX 1845 LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR COTU I T MA 02635 LIABILITY OF ANY KIND UPON THE COMPANY,ITS AGENTS OR REPRESENTATIVES. 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