Loading...
HomeMy WebLinkAboutBuilding Permit # 3/10/2016 gyClRTN BUILDING PERMIT 2 D '1�16 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION 0JAI Permit No#. Date Received ATe. CH 5 Date Issued: It 0 "IMPORTANT: Applicant must complete all items on this page e- LOCATION LCXC� � Print PROPERTY OWNER '2c�b Print �IbO Year Structure MAPPARCEL: ZONING DISTRICT: —Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED OSE Residential Non- Residential n- New Building El One family El Addition El Two or more family El Industrial El Alteration No. of units: El Commercial ORepair, replacement El Assessory Bldg Li Others: El Demolition El Other A �,W p di i I/ 5d DESCRIPTION OF WORK TO BE PERFORMED, C CA-<k xce colf-, A&W 0(\e�6 �b a*0<-� &bgO)r� 2E!�OVe gC6 CA00-F Cr\& k 8``k S) 'yJ Qj- Identification- Please Type or Print:Clearly OWNER: Name: Phone: Address: Contractor Name: .-lf�exus Phone: 2 R 1 -7 6 0 203 JIL �, C'e-3 Email: nNex(A-- Cob Address: O. 0qA 2R213 \Ao' ��ro7j (X\ Supervisor's Construction License: Q5 0"')X791 'Exp. Date:_ !±[71 Home Improvement License: 12-9 Exp. Date: ­71 i ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT.,$12,00 PER$1000.00 OF THE TOTAL ESTIMATED iCOST $125.00 PER S.F. a,0- Total Project Cost: $ ox FEE: P 1) 613,0 0,0, Check No.: Receipt No.: NOT Persons contracting WitI registe ed coftlftictors(Io not have access lo the guaranty fund h ------------------------------------------­------- --------— ........... wner 10n;;ture, oftoT ----------- NORTH Tow' n of 2 _ Andover , No. T ]� Z ".. h ver, Mass, COC.UC..EW.CR y1 RATED U BOARD OF HEALTH Food/Kitchen . PERMIT T LD Septic System THIS CERTIFIES THAT ..ti ,l,'� BUILDING INSPECTOR ..... 4#V%.... ....... .. ................ .. .......................'. .. .. has permission to erect.......................... buildings on .eft0w ..... �,..t��.t...... Foundation ... .......... Rough to be occupied as . ..t . .. . .�........X. .� .....�r�... �. Chimney provided that the person accepting this permit shall in every respect conform to the terms of the application Final on file in this office, and to the provisions of the Codes and By-Laws relating to the Inspection,Alteration and Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final /�• PERMIT EXPIRES IN 6 S Rough ELECTRICAL INSPECTOR, LESSCONSTRUCTIONT Service .................... ............................................. Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy PuRough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. Smoke Det. Page I of 4 Nexus 11 Carpentry Construction Design d P.O. Box 2823 Wobum, MA 01888 781 760 2031 Fax 978 975 1263 nexusearpentrykaol. Contract This is a contract between Robert and Kimberly Denney of35 Sandra Lane,North Andover MA 01845 (Hereafter referred to as the "owners") and Nexus 11 Services (hereafter referred to as "Nexus") dated February 8th 2016. GENERAL SCOPE OF WORK DESCRIPTION WE HEREBY SUBMIT SPECIFICATIONS AND CONTRACT FOR: work as stated to repair water damages as below Scope of work: General details 4, Meet with local building official and apply for permits 4, All work will be in accordance with local building code regulations and will be inspected by local officials prior to continuing with the next phase—Nexus will be responsible for arranging and being available for all inspections * Nexus will contact"Dig Safe"prior to commencing any excavation work for their clearance * All work will be coordinated directly between "owners" and Nexus 0 Nexus confirms that it is fully licensed, insured and ensures any sub-contractors utilized on this site will have the appropriate insurance coverage 4, Nexus will be responsible for the safe storage of all its property and any materials to be used on the site o Owner is responsible for removal and return of all items of the house in the areas that will be affected and their safe storage prior to our work commencing o Owner will then be responsible for returning all items to these areas of the home after completion of the scope of work SPECIALIZING IN QUALITY FINISH CARPENTRY,REMODELING,SPECIALIST ROOF SYSTEMS,SITE AND PROJECT MANAGEMENT Page 2 of 4 ® Remove and trash into Nexus supplied dumpster all trash associated with this project NOTE: appliances are not allowed to be put in dumpsters without additional costs "owners"are responsible for removal from site Scope of Work Kitchen water damage repairs; ® Provide dumpster to remove debris associated with this scope of work ® Furnish and install plastic protection to provide dust control ® Remove and trash existing "discovered" hardwood flooring ® Remove and trash existing wall cabinets ® Detach existing refrigerator and stove ® Furnish and install updated plumbing lines for sink, faucet, dishwasher and water feed to refrigerator Furnish and install updated electrical connections ® Furnish and install insulation to exposed exterior wall and to ceiling of basement laundry room ® Furnish and install patched sheetrock with smooth plaster finish to walls only - ® Install kitchen base and wall cabinets, construct island and associated trim details (supplied by owners and not included in this cost proposal) ® Furnish and install hardwood flooring to patch to remaining hardwood flooring ® Sand existing hardwood flooring existing and new hardwood flooring in kitchen and eat in area only ® Furnish and install 3 coats of polyurethane to existing and new hardwood flooring in kitchen and eat in area only ® Furnish and install paint grade baseboard trim ® Install sink and faucet(supplied by owner and not included in this proposal) ® Furnish and paint the 4 walls of the kitchen and eat in area ® Furnish and paint the ceiling of the kitchen and eat in area ® NOTE: no trim painting included 9 Furnish and install new suspended ceiling the in laundry room ® Install appliances and fixtures supplied by owners ® Proposed cost including materials and labor as noted above is Work not included in this contract Building department fees —Engineering or architect costs Permit costs —Unseen conditions Cabinets or counters —Painting or staining work not specifically noted in the above scope of work Appliances, sinks, faucets or fixtures Servpro, asbestos or any demolition costs previously invoiced —Utility upgrades, changes to existing layouts, lighting changes Any other work not specifically noted above SPECIALIZING IN QUALITY FINISH CARPENTRY,REMODELING,SPECIALIST ROOF SYSTEMS,SITE AND PROJECT MANAGEMENT Page 4 of 4 People Authorized to Sign Change Orders: The following peo . are authorized to sign Change Orders: "Nexus": ar Gotobed or ed White I � "Cli nf'- o,, rt o-Kimberley �ney Concealed Conditions: This Agreement is based solely on the observations"Nexus"was able to make with the area in its current condition at the time this Agreement was bid. If additional Concealed Conditions are discovered once work has commenced which were not visible at the time this proposal was bid,"Nexus"will stop work and point out these unforeseen Concealed Conditions to"Owners"so that"Owners'and"Nexus"can execute a Change Order for any Additional Work. Schedule of work It is agreed by both parties that this work will be coordinated with the"Owners"and"Nexus"to be undertaken in various stages to avoid complete disruption of the home environment."Nexus"will give"Owners"no less than 2 days notice prior to arriving on site for commencement of any of the agreed stages of work to allow"Owners" to prepare."Owners'commits to have sites identified for construction work available for start at the beginning of the scheduled day so as to avoid any unnecessary delays. Contract Cost and Payment Schedule: Total cost of work description and materials included in the proposal(except materialsAvork stated) -$11,454.16 (Eleven thousand four hundred and fifty four dollars and sixteen cents) PAYMENT SCHEDULE 1st Payment due upon signing this contract TOTAL$3,820.16 2nd Payment due upon Installation of Idtchen cabinets TOTAL$3, 820.00 Final payment due upon completion of scope of work TOTAL$3,814.00 Amount due upon signing this contract-$3,820.16 I have read and understand,and I agree to,all the terms and conditions contained in the proposal above.` Date .. ' '. "......... "Nexus"Authorization................... . P ................... Date.... .. .. 1.. f ........Client"Authorization. ........... . .... ........ .......�.... ....... Date..............................."Client"Authorization...................................................... SPECIALIZING IN QUALITY FINISH CARPENTRY,REMODELING,SPECIALIST ROOF SYSTEMS,SITE AND PROJECT MANAGEMENT I X71 '„ I P € � -' M--§` 330 0 C, -,. r €S s. £� r _ c, CA f im CN v Z � AI E 7ZS ��g E i e I ; it ii�l - t _ uhfIA € I { i1 I y I ] ; y� ll cl cn ---K— ----------- 36 �11' —z i, _ y a 4 s � s Page I of 4 ADM Nexus 11 Carpentry and Construction Design N, P.O. Box 2823 Woburn,MA 1888 78176020031 Fax 978 9751263 nexusearpentry(&,a0l.00M Contract, #2 This is a contract between Robert and Kimberly Denney of 35 Sandra Lane, North Andover MA 01845 (Hereafter referred to as the "owners") and Nexus 11 Services (hereafter referred to as "Nexus") dated March 8th 2016. GENERAL SCOPE OF WORK DESCRIPTION WE HEREBY_SU�BMIT SPECIFICATIONS AND CONTRACT FOR: work as stated for kitchen kitc:h�en renovation Scope of work: General details * Meet with local building official and apply for permits * All work will be in accordance with local building code regulations and will be inspected by local officials prior to continuing with the next phase—Nexus will be responsible for arranging and being available for all inspections * Nexus will contact"Dig Safe"prior to commencing any excavation work for their clearance * All work will be coordinated directly between "owners"and Nexus * Nexus confirms that it is fully licensed, insured and ensures any sub-contractors utilized on this site will have the appropriate insurance coverage * Nexus will be responsible for the safe storage of all its property and any materials to be used on the site * Owner is responsible for removal and return of all items of the house in the areas that will be affected and their safe storage prior to our work commencing * Owner will then be responsible for returning all items to these areas of the home after completion of the scope of work o Remove and trash into Nexus supplied dumpster all trash associated with this project NOTE: appliances are not allowed to be put in dumpsters without additional costs"owners"are responsible for removal from site SPECIALIZING IN QUALITY FINISH CARPENTRY, REMODELING, SPECIALIST ROOF SYSTEMS, SITE AND PROJECT MANAGEMENT Page 2 of 4 Scope of Work Kitchen rebuild; ® Provide dumpster to remove debris associated with this scope of work o Remove and SAVE existing rear entry door NOTE: door to be given to Ray ® Frame this opening in preparation for new sheetrock and siding ® Remove and trash the existing rear facing window Remove and re-work existing baseboard heat pipes to allow for installation of a 6' 0" Andersen 200 Permashield sliding patio door ® Remove and trash framing in this area to create rough opening dimension for the new 6' 0" x 6' 8" Andersen 200 Permashield sliding patio door ® Furnish and install new 60" x 6' 8" Andersen 200 Permashield sliding patio door- prefinished white on the interior and exterior and with "satin nickel"hardware ® Furnish and install insulation into this rear wall ® Remove and trash existing kitchen ceiling and the ceiling of the "eat-in" area Remove and trash existing hardwood flooring in the kitchen area only-NOTE: Leave flooring in "eat in" area o Furnish and install electrics to code inclusive of island outlets, 2 -pendants (supplied by owner)over new island, 1 ceiling fixture over potential table by bay window,tip to 6 recessed cans in the kitchen area and 1 exterior wall sconce outside new sliding patio door ® Furnish and install 2 kick space heaters fed from the existing floor zone (NOTE: 1 heater under kitchen sink and 1 under new window seat area) ® Furnish and install sheetrock with smooth plaster finish to exposed framing of walls and ceiling ® Install additional cabinets to kitchen layout NOTE: cabinets provided by "owners" ® hnstall "Bay window" cabinetry and window seat provided by "owners" (NOTE: all materials are expected to arrive pre-finished and ready to be installed) o Furnish and install new hardwood flooring to blend into existing flooring ® Sand entire hardwood flooring in kitchen and "eat in" area o Furnish and install 3 coats of polyurethane to this floor only(NOTE: no other floor areas to be included at this time) ® Furnish and install paint grade trim to new door, window and baseboard and to match to the existing style in the home, as closely as possible 4 Painting as included in contract#1- walls, ceiling and trim in kitchen/eat in area Work not included in this contract Building department fees Engineering or architect costs Permit costs Unseen conditions Kitchen window change nor its installation ($920.00 previously quoted being materials cost+ $200.00 labor cost) Cabinets or counters —Painting or staining work not specifically noted in the above scope of work Appliances, sinks,faucets or fixtures --Utility upgrades, changes to existing layouts, lighting changes Any other work not specifically noted above SPECIALIZING IN QUALITY FINISH CARPENTRY, REMODELING, SPECIALIST ROOF SYSTEMS, SITE AND PROJECT MANAGEMENT Page 3 of 4 PERMITS "Nexus"will accept responsibility to obtain the necessary building permits."Nexus"will act as a GC and work in accordance with fair and reasonable practices,and cooperate fully and under the guidance of the"Owners"and authorized parties.Nexus will pass the cost of the permit directly on to the"Owners"once advised by the Building department. Standard Exclusions: Unless specifically included in the"General Scope of Work"section above,this agreement does not include labor or materials for the following work(any Exclusions in this paragraph which have been lined out and initialed by the parties do not apply to this Agreement): Removal and disposal of any materials containing asbestos or any other hazardous material as defined by the EPA. Custom milling of any wood for use in project. Moving"Owners"property around the site. Labor or materials required repairing or replacing any"Owners"-supplied materials. Repair of concealed underground utilities not located on prints or physically staked out by"Owners",which are damaged during construction. Surveying that may be required to establish accurate property boundaries for setback purposes(fences and old stakes may not be located on actual property lines). Final construction cleaning("Nexus"will leave site in "broom swept"condition). Landscaping and irrigation work of any kind. Temporary sanitation,power,or fencing. Removal of soils under house in order to obtain 13 inches(or code-required height)of clear space between bottom of joists and soil. Removal of filled ground or rock or any other materials not removable by ordinary hand tools(unless heavy equipment is specified in scope of work section above),correction of existing out-of-plumb or out-of-level conditions in existing structure. Correction of concealed substandard framing.Removal and replacement of existing rot or insect infestation. Construction of a continuously level foundation around structure(if lot is sloped more than 6 inches from front to back or side to side,"Nexus"step the foundation in accordance with the slope of the lot). Exact matching of existing finishes. Repair of damage to roadways,sidewalks,or driveways that could occur when construction equipment and vehicles are being used in the normal course of construction. The"Owner"is to enter into contracts for all of the above-mentioned services and provide direct payment to"Nexus" for all of the services we are to provide."Nexus"will be responsible for removing all components and all construction materials relevant to the"scope of work"in this contract.The"Owners"have received a copy of the lead hazard information pamphlet informing them of the potential risk of the lead hazard exposure from renovation activity to be performed in the dwelling unit.This was received before the work began and the"owners"are responsible for informing their tenants of all potential hazards. Dumpsters,trailers and signs "Nexus"will provide as included in the cost of this project,a dumpster for the sole purpose of the removal of trash associated with this project.This dumpster should not be used by any persons for any other waste items or for any purpose outside of the specific use under the scope of work,unless authorization is received from"Nexus".Nexus may have on site for part,or the whole of the project,a trailer containing materials and tools belonging to"Nexus".This trailer will be parked in a position agreed to in coordination with the"Owners"and will be covered under the insurances of"Nexus"at all times."Nexus"will have on site,a sign,with our contact details,in the event that anyone has a need to contact us directly. Photographs "Nexus"reserves the right to,from time to time,take photographs of the contracted work for use in its general marketing or for production on its web site.At no time will"Nexus"share any personal contact details of the"owner" for any photographs that it may use without seeking authorization frorn the"owner". Warranties All the components supplied by"Nexus"as part of the original order are covered under the warranty exercised by "Nexus"and supported by the vendors.All labor and materials purchased from other suppliers to achieve completion of contract are warranted(1)one year from completion of the construction. Expiration of this Agreement: This Agreement will expire 30 days after the date at the top of page one of this agreement if not accepted in writing by "Owners"and returned to"Nexus"along with the necessary deposits within that time fi-ame. Changes in the Work: During the course of the project,"Owners"may order changes in the work(both additions and deletions). "Nexus" will determine the cost of these changes and the cost of this additional work will be added to"Nexus"profit and overhead. SPECIALIZING IN QUALITY FINISH CARPENTRY, REMODELING, SPECIALIST ROOF SYSTEMS, SITE AND PROJECT MANAGEMENT Page 4 of 4 People Authorized to Sign Change Orders: The following people are authorized to sign Change Orders: "Nexus": Mark Gotobed or Ged White t r ; "Client":Robert br Kimberley Denney Concealed Conditions: This Agreement is based solely on the observations"Nexus"was able to make with the area in its current condition at the time this Agreement was bid. If additional Concealed Conditions are discovered once work has commenced which were not visible at the time this proposal was bid,"Nexus"will stop work and point out these unforeseen Concealed Conditions to"Owners"so that"Owners"and"Nexus"can execute a Change Order for any Additional Work. Schedule of work It is agreed by both parties that this work will be coordinated with the"Owners"and"Nexus"to be undertaken in various stages to avoid complete disruption of the home environment."Nexus"will give"Owners"no less than 2 days notice prior to arriving on site for commencement of any of the agreed stages of work to allow"Owners" to prepare."Owners"commits to have sites identified for construction work available for start at the beginning of the scheduled day so as to avoid any unnecessary delays. Contract Cost and Payment Schedule: Total cost of work description and materials included in the proposal (except materials/work stated) - $14,575.00 (Fourteen thousand five hundred and seventy five dollars and zero cents) PAYMENT SCHEDULE lst Payment due upon receipt of permit 2nd Payment due upon Installation of sheetrock TOTAL $4, 859.00 TOTAL$4,858.00 Final payment due upon completion of scope of work TOTAL $4, 858.00 Amount due upon signing this contract-$0.00—contract#1 deposit covers this request I have read and understand, and I agree to, all the terms and conditions contained in the propos ��a{{l qq orrve. Date....EJ .1..�C�.............. "Nexus" Authorization............. . .. . I� r Date......�J. I .......... "Client"Authorization s,. . Date............ .... ............. "Client'Authorization..: i.!....\......<<. SPECIALIZING IN QUALITY FINISH CARPENTRY, REMODELING, SPECIALIST ROOF SYSTEMS, SITE AND PROJECT MANAGEMENT The Commonwealth of.Massachusetts _ Depcz�t�teni of Ifedustri0fl.A.ccidents z M r 1 Congress Street,Suite 100 Bostop,MM 02114-2017 ••' •, .y4¢ immmass gov/dia Waxkers'Compensation Insurance Affidavit:EuiXdexs/Contractors/Electriczans/Rluxnbexs. TO BE FILED WITH THE RRMfflT T'NG AUTHORLTY. Please Print I,e 'bl A licantTnformation . 1� Name (Business/Organizationftdividal): ' u .A.ddxess: City/State/Zip: A0t�� ® 1 'hone#: _?G0 Are you an employer?Checict1J appropriate box: Type of project(required): 1.1,[]I aur a employer with �,. y emp toees(fall and/or part-time)." 7. []New construction 2.L_I I am a sole proprietor or partnership and have no employees Working forme in 8. N'Remodelhig any capacity.[No workers'comp.insurance required] 9. El Demolition 3..❑I am a homeowner doing all work myself[No workers'comp.insurance required.]t 10 Q Building addition 4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers'compensation insurance or are sole 11.❑Electrical repairs or additions proprietors with no employees. 12_ 1 Plumbing repairs or additions -_ 5. I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.E]Roof repairs hese sub-contractors have employees and have workers'comp.insurance.t 14.❑Other 6.❑We are a corporation and ifs of igers have exercised their right of exemption per MGL G. 152,§1(4),and we haven'employees.[No workers'comp.insurance required.] y *Any applicant that checks box4l must also fill out the section below showing their workers'compensation policy information. Homeowners who submit this affidavit indicating they are doing all work andthen hue outside contractors must submit anew affidavit indicating such. tcontractors 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-conlraciors have employees,%CY must provide their workerscomp.policy number. X ani an employer that is pid-P1019Voi'rcei's'compensation insurance for my employees'Below is the policy and joh site infol'mation. Insurance Company Name: Policy#or Self-ins,Lie.#: Expiration Date- City/State/Zip: rob Site Address: Attach a copy of the workers' compensation policy declaration page(showing the policy number 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 verification. ado lice eby eei tify uncle I gins andpenalties ofpedull�trent the information pi ovicled alcove's true and correct. Date: � Y� Signature: Phone#: Official use only. Do notwi'ite in this area,to be completed by city or town official.. City or Town: Pexznit/License# Issuing Authority(circle one): 1.Board of Ifealth 2.Building Department 3.City/'Town Clerk 4.Electrical Inspector 5.plumbing Inspector 6.Other Contact Person: Phone#: Aa ®R®® [:f3/8/2016 E(MWDD/YYYY) CERTIFICATEOF LIABILITY INSURANCE 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 CONTACTLanr@ri Goldman NAME: Cross Insurance-Peabody PAH/CN o Ext. (978)532-5445 NC No):(978)532-2217 139 Lynnfield Street E-MAILs:lgoldman@crossagency.com INSURERS AFFORDING COVERAGE NAIC# Peabody MA 01960 INSURERA:Western World Ins. Co. INSURED INSURERB:Safety indemnity 33618 Nexus II Services LLC INSURER C: P.O. BOX 2823 INSURER D: INSURER E Woburn MA 01888 INSURER F: COVERAGES CERTIFICATE NUMBER-CL15102253381 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 SUBR POLICY EFF POLICY EXP TYPE OF INSURANCE LTR I SD WVD POLICY NUMBER MWDD/Y MWDD/YYY LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A CLAIMS-MADE FlOCCUR DAMAGES(-TO RENTED PREMISES Ea occurrence) $ NPP8290737 8/12/2015 8/12/2016 MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY❑JECTPRO F] LOC PRODUCTS-COMP/OPAGG $ 1,000,000 OTHER: Damage to Rented $ 50,000 AUTOMOBILE LIABILITY COEa aMBINEDccident SINGLE LIMIT $ ANY AUTO BODILY INJURY(Per person) $ 500,000 B ALL OWNEDSCHEDULED AUTOS X AUTOS 3116632 11/10/2015 11/10/2016 BODILY INJURY(Per accdent) $ 500,000 X HIRED AUTOS X NON-OWNED Peroa.dentDAMAGE $ 100,000 PER AUTOS Medical payments $ 5,000 UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? ❑ N/A (Mandatory in NH) E .DISEASE-EA EMPLOYE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT 1$ 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 Kim and Rob Denney THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 35 Sandra Lane ACCORDANCE WITH THE POLICY PROVISIONS. North Andover, MA 01845 AUTHORIZED REPRESENTATIVE f Lauren Goldman/MD1 p`�j aA24 6. �4fd&t4lA "^ ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD IN-9025(?mean v, r,,,, ,,,::: r/� ,�, ///r ";,r,,, c, ,o ,,:, �s rwi 1 /ii ,/;%///� ,,,r„ill r/ ril�.✓ r ,l/i„/ i....,,, /�/�// �f/", � rc r / /iii r,, / /f ,r ,,, r ,r ✓ / , r r /.r/ .lir, / r r r r / rr /, %r / _, rr r r rrr ,r rrr �/, ,rri rrr / r / /�, :,,, ✓/ / / / / rrr /�/, ,� r, / /, r rr r it r r / ,r / ,...;, / !r All r i" 'r i „”, v ,,, ri // � .:.rrr/ ,, „r/„/% ✓ ,, ,,, / ,,.. r ,�/, / /,, / �✓,r, ,,, r c"r�r r, rr r r i / r/ o�,✓o ✓" r // ..Ur, r v”,r a” "a- r r r i" rc'/i ,,,, r ..i %.../, / / ✓G r r J/ r.,, /i//v/ / rr. r,. /� r /. / ... «// / <- , / ,r // c�i...r,/// /ii„ �/,/ r.✓/ � � /r.,. /" it a r ,c rrr .ra „ /. r /ii ✓,,,,,,,,, „r, r / / / -/rr„ , r< r„ / a ,, ✓ /! v/,air r / //,oir, ,�/; , r r„r ;a/;, /,rr ;lar/ ,"i,. ,�/ // rl rrr, y r ,r, ,,,,, �, / �,,;'✓ ii�r //�i�f/ ' /�, i Office of or►sum r Affairs it and Business Regulation 10 Park Pla7iiSuite 5170r Boston, Massachusetts 02116 ',HC')meNl '''�r4`)1AC''6°r1e�1t' ,,1�rltri�l«t4��"Registration 1 Typw Individual xp4rat4od; 7111204" TO 269000 / r �r�Mntw.w And return caard,Mar reason for cha"' e, j 4., � <1cMre rr W Add , Rent nl �„.` 'nrplra°rr�¢ntIM t a �ynrd iridin use oral,. wrwa orrel„iatr�rtlaacea raParl I��ar lrrala a/i// �plMrer step,a lmejoM°c the cralair,atiaarr elle, lt`l"ouwral return tca. Typo lltra or( aanaanaer,rdamiandnadnea l&elnlrllaan /r//�� 10 Pal k M''vm °Suite 5170 r; / �rir ItldGrr� p Not rr0a'd wrllnarar&sigRAUrO // oil lr �Bogr mit I�Hmmldinj; � rt l lm m °mam a°lam License; 512" 1 GERALD WFUTE 2 GL �A� A VFR oin . �ratu�D� t 04M712 h �M oo� t ll et rr 16 " Iduluse only utrI,Jcensr registration valid for rRegulation to to:ofdoosu 'erAsirs uo before the expiration d IewVCME lCONTRACTOR TOR I Office of const airs avid Business Regulation ulation 10 Park Suite 5170 allow l && Ida t 13u , A02116 Gerald While, Gerald Whit 23 Glad r .. .. --Danvers,MA 0192 dersecretAry Not r salad wlithout signature, J