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HomeMy WebLinkAboutBuilding Permit # 3/23/2016 ........... BUILDING PERMIT 00'R Tfl"6 TOWN OF NORTH ANDOVER 0 APPLICATION FOR PLAN EXAMINATION Permit No#: Date Received A 2 Date Issued: IM'PORTANT: Applicant must complete all items on this page LOCATION Print PROPERTY OWNER J Print 100 Year Structure es MAP PARCEL:27't�"b ZONING DISTRICT: Historic District S no Machine Shop Village yes (g.Ino TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential El New Building 1-i One family Ei Addition [I Two or more family F1 Industrial 11 Alteration No, of units: 9'Commercial IO(Repair, replacement 11 Assessory Bldg ri Others: 0 Demolition 11 Other DESCRIPTIO,,OF WORK TO BIE PERFORME Lill J, Identification- Please Type or Print Clearly OWNER: Name: Phone: Address: - Contractor Name: Phone: T 7 Email: 22, A Address: Supervisor's Construction License: C) —Exp. Date:. Home Improvement License: Exp. Date: ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT. $12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ 2 FEE: $ Check No.: Receipt No.: NOTE: Persons contracting wrtli'An'-icgistered contractors(16 not have access to the y od gua�afft O� ell, /Owner – ron NORTH i own of Andover O t y h ver, Mass, hffkn T O LANE r COC NIC NF M,ICK � S u BOARD OF HEALTH Food/Kitchen M I Septic System PER T T L mDmob" THIS CERTIFIES THAT ......... .. l BUILDING INSPECTOR :3 has permission to erect ................ buildings on Foundation ® ® ...��� .�.�� Rough $o be occupied as ... ..�. ... .. ..... .l.... �. ..... . ....... ....... . ....... �..........�........................ Chimney provided that the person acc pting this permit all 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. re* PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTION ST TS Rough ,�� .............. Service ..................... ...... ... .. ......... Final BUILDING INSPECTOR GAS INSPECTOR ccupancy Permit Required to Occupy Building Rough 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 Approvedthe Building Inspector. Burner Street No. Smoke Det. Tworney & Legare Cof1frOctin9p lfm 87 Sehnont Street North Andover„Ala 01845 a office.- 978-685-7447 Fax: 078-685-7446 tw(,)rneyaradlecl>:�re'a verizon.riet Date 3/17!2016 Name of Owner Rolfs Pub 39 Main Street North Andover,MA 01845 Provide and Install New Harvey Classic windows to the Front and Right side of building as discussed with owner. Color:BRONZE Windows to have Low E and argon gas to meet energy star requirements. Windows to have 5/8"window grids between the glass. BRONZE Front of building : 4-new replacement style double hung windows installed,caulked, insulated, new bronze exterior metal coverage. 1-117' mulled window unit 29"double hung.58"picture window 29"double hung,window to have tempered glass as required near stair location. 1-117' mulled window unit 29"double hung.58"picture window 29"double hung. Right side of building: 7-new replacement style double hung windows installed, caulked, insulated, new bronze exterior metal coverage. Siding Specs: Strip Existing vinyl siding off Front and right side of building and dispose of. Install new 3/8"foam insulation board over wall areas on front and right side of building. Provide and install Certainteed Mainstreet 4/4 vinyl siding over insulation board. Color To Be :SAVANNAH WICKER New soffit to be vinyl 12"SABLE BROWN All aluminum trim to be color: BRONZE Contractor to obtain permit for work Contractor to dispose of debris. Above is the specs for window and siding work. Job Total is$21,380.00 First payment on signing=$9,000.00 We hereby propose to furnish material and labor-complete in accordance with above specifications,for the sum of: Total: Payment to be made as follows: ✓"' � Authorized Signature: NOTE: This proposal may be'withdrawn by us if not accepted within days Acceptance of Proposal- The above prices, specifications and conditions are satisfactory and are hereby accepted. You are authorize I to do the work as specified. Signature: Payment will be made as out ined a ove. Date of Acceptance: Signature: Page 1 7" O7tdfy & Lagare Contracting, Inc. 87 Belmont Stivet North Andover„Ma 01845 Office: 978-685-74,47 Fax: 978-685-744 tworamieyandlegare@vee izoii.raet Date 3/17/2016 Name of Owner Rolfs Pub 39 Main Street North Andover, MA 01845 Second payment completion of one side=$9000.00 Substantial completion of job=$3380.00 We hereby propose to furnish material and labor-complete in accordance with above specifications,for the sum of: Total Payment to be made as follows: Authorized Signature: NOTE: This proposal may be wi drawn by us if not accepted within days Acceptance of Proposal- The above prices, specifications and conditions are satisfactory and are hereby accepted. You are authorized to do the work as specified. Payment will be made as outlined above. Signature: Date of Acceptance: Signature: Page 2 TWOMEY&LEGARE CONTRACTING INC. HOME IMPROVEMENT CONTRACT TERMS AND CONDITIONS(MGL 142A) 1.WORK:Provided the Homeowner performs under this agreement,the Contractor shall perform the work on the Property as specified Proposal,attached incorporated herein.The work does not include extraordinary conditions of which the Contractor could not reasonably be aware.If such conditions are encountered,this shall be an additional cost to the Homeowner.Materials selected by Homeowner may have to be ordered or custom made,which items are specified in the Proposal.The Contractor is not obligated to agree to any modifications,extras or change orders unless such items are agreed to in writing by the Contractor.All extras and changes shall be at an additional cost to the Homeowner.Contractor shall perform the work in a good and workmanlike manner using materials consistent with this contract.Lawn or Driveway may be damaged by dumpster or equipment. Due to material shortages Contractor may substitute materials of equivalent grade.Contractor to leave site Broom Clean,any additional cleaning by owner. 2. PERMITS:If a building permit is required for the work,the Contractor shall obtain same as Homeowner's agent.Contractor is not responsible for any other permits that may be required for the Work,and Homeowner is responsible to determine whether any zoning,planning or wetland related permits or approvals are necessary.Homeowners who secure their own permits or deal with unregistered contractors will not have access to the Guaranty Fund. 3. COMMENCEMENT AND COMPLETION:Homeowner acknowledges the commencement date of the work is fluid,and is subject to numerous factors such as scheduling other contractors,delivery of materials and weather.Contractor and Homeowner shall determine the commencement date of the Work when a more definite determination can be made and shall execute a written acknowledgment of same.The Work shall be substantially completed within_ days of commencement,except for longer periods as may apply to particular projects as Contractor shall notify Homeowner in the Proposal,and subject to delays for circumstances beyond Contractor's control.Notwithstanding,the commencement date and substantial completion date may be extended,and the Contractor will not be liable for delays caused by,labor or material shortages,delays in delivery of items selected by the Homeowner,governmental action, and unforeseen events beyond the Contractor's control,including but not limited to weather,strikes,war,the acts of third persons or the acts of the Homeowner.The Homeowner recognizes that the commencement date may be delayed due to scheduling or the completion of Contractor's other jobs. 4. PAYMENTS: Contractor agrees to perform the Work and to furnish the materials and labor specified in the Proposal for the amount as stated in the Proposal.Thirty percent(30%)of the total is to be paid as a deposit with the signing of this contract.Upon cancellation prior to commencement of the Work,any remaining deposit will be returned less the costs for materials ordered for which Contractor was unable to cancel. Final payment shall be due upon completion of the Work and Homeowner agrees it may not hold any retainage.Late fees may be applied for late payments.Homeowner shall pay _ Contractor's_reasQnable.costs.of collection,including attorney's fees and.costs.Time is of the essence hereof- 5. ereof5. WARRANTY:For a period of 2 years after substantial completion of the Work the roof will be free of leaks caused by defects in workmanship, but not those caused by ice backing-up or extraordinary weather events,including blizzards,tornadoes,hurricanes or storms of greater than a twenty-five year duration or intensity.Contractor gives no warranties with reference to any materials or equipment installed in the Premises,passes any such warranties directly to Homeowner,and Homeowner agrees to look only to the manufacturer with reference thereto.This limited warranty extends to the Homeowner only and is not transferable to succeeding Homeowners.This Limited Warranty specifically excludes(i)all consequential and incidental damages;(ii) damage due to ordinary wear and tear,abusive use,misuse,or lack of proper maintenance;(iii)defects which are the result of characteristics common to materials used;(iv)defects in items installed or supplied by anyone other than Contractor;(v)work done by anyone other than by Contractor;and(vi)loss or injury due to the elements.There are no other expressed or implied warranties or representations made or given. 6. ENTIRE AGREEMENT:This contract and all documents referenced herein constitute the complete and final agreement between the parties.In the event that any of the provisions of this contract shall be held to be invalid,the remainder of the provisions of this contract shall remain in full force and effect.Two identical copies of this contract have been completed and signed.Homeowner acknowledges receipt of a completed contract signed by the Contractor. 7. HOME IMPROVEMENT REGISTRATION:In accordance with M.G.L.c. 142 A,§9,Contractor is registered with the Bureau of Building Regulations and Standards Registration No: 136779.Homeowner may verify by contacting the Director at(617)727-3200,ext.25205.A Homeowner's rights under the Home Improvement Law(M.G.L.c. 142A)and other consumer protection laws may not be waived in any way.Homeowner acknowledges receipt of a copy of 780 CMR R6 and Massachusetts General Laws chapter 142A,and which are available online at www.mass.gov.Questions may be directed to the Consumer Information Hotline,(617)727-7780. 8. ARBITRATION:Contractor and the Homeowner hereby mutually agree in advance that in the event the Contractor has a dispute concerning this contract, the Contractor may submit such dispute to a private arbitration service which has been approved by the Secretary of the Executive Office of Consumer Affairs and Business Regulations and the consumer shall be required to submit to such arbitration as provided in M.G.L.c. 142A.No lien or security interest is imposed on the Property as a consequence of this contract,but Contractor has the right to record this contract or a notice of this contract,or seek a lien if the Homeowner breaches this Contract. 9. HOMEOWNER COVENANTS:The Homeowner agrees,represents and warrants that(a)the Homeowner grants permission to the Contractor to enter the Property to perform the work as covered by this contract;(b)the Homeowner has funds available to make full payment under this contract to the Contractor upon completion;(c)the Homeowner understands that construction as contemplated by this agreement creates a dangerous condition,and agrees not to enter portions of the Property under construction until the Contractor advises the Homeowner that the construction is completed;(d)Contractor may need use landscaped areas of the yard during the Work and Homeowner is responsible to provide protection for landscaping and(e)that code requirements may result in roofing nails penetrating through roof decking and will be visible on the underside of some surfaces.The Homeowner indemnifies,exonerates and holds harmless the Contractor from any loss,damage,claim,liability or expense(including reasonable attorney's fees,deposition costs and court costs)resulting from a breach of this provision.Contractor is not responsible for damage to landscaping that will grow back during the next growing season. 10.CANCELLATION:Homeowner may cancel this agreement provided Homeowner notifies the Contractor in wr' ing at t e address listed in the Proposal not later than midnight of the third usiness day ollowi the signing of this agreement. HOMEOWNER: Iry DATE: Job Description: l DEPOSIT: r, ....n,.J �w��:,:ou„� ,:_ �u, „n,��.,H_a....... r J"J Zf All "3ru/lJ ✓� VT r9 !y lTrf// H� 'r �I. 6� ,fiJ�,'a` � 1/" ;� r ,ro„<n„ :�dumwxwrvu rrmma�rxaaunun n;wvumrwwraw r � r 1 9� l i I err Jk+ami✓Y. lrVsrrrrilir i IC r 1✓lti0liilrn�or lNlriri/�r k!Y;r (dhn^�fn; y n�rrGrrJ� r��, !�; /fir, �r r r�. p ri pJ ' ✓rr r /ia p / J Ji i P l J r .a rrr` H ir ,,, ,,,,,�, ,.,,. ,,. ,,, ri,,,,g r rr,✓iA,✓/r 6r rr//i wrrra rn„/r,i,i,1,,,r, „i,�,�. ,�r yr, �� Fa !t r/ "> irrr v oti ����� (! V IfrdrUr/�✓ / i v Kh I 4 >Nri� wra /^�r /r Ji �1111s /�f/ er7A�Jf�n1HVG / r I r al?n� ri rHr i r �o r r r ,v ,/rr r�rr/ y>/rr warrny/xr %Hm�j��4 IG,rru/�1No;�i6� �N Hnr /TF9vri / ,y/r y �n11rNr✓rl/f,Vy,Hr,NrPrh;l�l�' �Gr� 1 �,Af p4', �H�/;,,,,, ,r o,,/e✓1 /H arD///S ,gYdf�fHJit�'rr,�%�lj,%JAY''1✓, ,G7 I Jn ✓Jr mfg i 1 r The C'oml?zonwerzlzh of A-lassachusetts g .Depart7azcnt ufrzzdustrial-4ccidefzts ` Office a f rizvesii ations ..600 Washingion Street Boston, AE4 07111 MTKT)V.Ma g ovldici Workers' Compensation.insurance Affida-A" - Bu l..ders/Contractors/4'leciriciAns/P'lumbers Please Print-Legibly 7`�,raMo($usinesslCtir ization/Indittidaal): i City/State/zip 14 Pbone AWe", u an employer?Check the appropriate boa: 1. am a employer with- ,� 4. 17 I am a L__nc;-al contractor and I Type of project(required): employees(full andlorparr-t:im ).* have hired the sut-contractors 6. 7 New Construction 2.❑ I am a sole proprietor or partner- listed on fhe attached sheet _ 7. ❑RemoLIing ship and have no employees Tnes'_sub—contractors have 8. F�Demolition worldng forme in any caTmcity. orl ers' comp.insurance. [No workers'camp.inc�,r,nce 5. Te are a corporation and its 9. J�Builain addition required.] 0*1�icen have exercised their 10.17 Electrical repairs or additions ').17 I am a homeowner doing all work right of en e',Mption per MGL 1 LF❑Plumbing repair or additions myself:No workers' comp. C. 152,§1(4),and we bave,no 12,[]Roof repairs insurance required,] t employees_ [hlo workers' camp.insuxancg required-] 13, OtherJ"),( .� Tloineovrn�;vmo surrmitfnis aE"adati _ inai..arin� v ars do Y r i c, •^,^�c t -1 na alt�rtf:ti ai d area hire ouasi&contacts rww t submit a new affidavit indicating such, =Cont acbr teat caa<;tni;as must attached an additional sheet snownna tae name of the sub-contractor and their workm'comF•. ^poiic 7 infarmzdon. I'am an employer that is providing ivorkers'compensation insurance for my emplavees Belo-41 is the pa =and job site information. Insurance Co Policy_ or Sel-ins.Lic. /',' t . Expiration i7ate: d�_... � '3ab Site Address: � � /� �/^� y i CitylStateLZip. � �� �� A,ttach a copy of the wor6ers' compensation policy declaration page(shoeing 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 E=up to S1,500.00 and/or one-year imprisonment,as well as cizdl penalties in the form of a STOP WORK ORDER and a fine of up to.5250.00 a day,against the violator. Be advised that a copy of this statement may be forwarded to the OfzEice or Investigations of the DIA for insurance covera.tre verinoation, Ido herak,cerci nder the pains and penalties ofperturt'that the information provided above is true and correct. D. .. L . Phony ._, ' [0fJf~7z.ciaI use oniv. Do not writc in this area, to he completed by c� ar town officioity or ToNvn: 1ernut/License rsuin,Authority(circle one): 1. Board of Health 7.Bt ldin8 Department 3.City=/Totwn Clerl, ".Electrical Inspector �_Plumbing Inspector 5. Ofher Conrcr Verson: Phone Client#:13298 TVVOMEY6 ACRD- CERTIFICATE F LIABILITY INSURANCE 6DATE 12912 5°"YY"' PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Doherty Insurance Agency,Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE P.O.Box 1985 HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. 21 Elm Street Andover,MA 01810 INSURERS AFFORDING COVERAGE NAIC a INSURED INSURER A. Arbella Protection Ins Company Twomey&Legare Contracting,Inc. INSURER B: 87 Belmont Street INSURER C: North Andover,MA 01845 INSURER D: INSURER E COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSRrOO'N Lyn Nan TYPEOFINSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS A GENERALLIASILITY 9520040230 06122MS 06/22116 EACH OCCURRENCE $1000000 DAMAGE TO RENTED nCOMM-LAiMS ERCWLGENERALLIABILITY x100000 MADE F-x�OCCUR MED EXP(Arty ono Parson) s5.000 PERSONAL&ADV INJURY $1,0()0,000 GENERAL AGGREGATE $2,000,000 GEML AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGG $2.000.()00 X POLICYF-j PRO LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ANY AUTO (Ea aldant) $ ac ALL OWNED AUTOS BODILY INJURY SCHEDULED AUTOS (Por parson) $ HIRED AUTOS BODILY INJURY NON-OWNED AUTOS (Par ecd ) $ PROPERTY DAMAGE S (Per accident) GARAGE UABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC S AUTO ONLY: AGG S EXCESSIUMBRELLA LIABILITY MCHOOCURRENCE $ OCCUR F]CLAIMS MADE AGGREGATE $ $ DEDUCTIBLE $ RETENTION $ $ WCSTATU 0TH• WORKERS COMPENSATION AND IS' FR EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVEE.L.EACH ACCIDENT $ OFFICER/MEMSER EXCLUDED? E.L.DISEASE-EA EMPLOYEE S B os,dosalbe Under SPECIAL PROM.IONS bolow E.L.DISEASE-POLICY LIMIT IS OTHER DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS Covering operations usual to Twomey&Legere Contracting,Inc... CERTIFICATE HOLDER CANCELLATION 10 Days for Non-Payment SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION Town of North Andover DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL —10_ DAYS WRITTEN 1600 Osgood Street NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT.BUT FAILURE TO DO SO SHALL North Andover,MA 01845 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPR A E i ACORD 25(2001108)1 of 2 #S32196/M32132 DML ORD CORPORATION 1988 ACC>RV CERTIFICATE OF LIABILITY INSURANCE DATE(MM1DDlYYYY, 03/23/2016 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 pollcy(les)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 Ileu of such endorsement(s). PRODUCER NAME C Diane LeBlanc DOHERTY INSURANCE AGENCY INC IAIC.No.PHONE Egli: (978)475-0260 1(A/C,No): ADDRESS: dleblanc@dohertyinsurance.com P.0 BOX 1985 INSURER(S)AFFORDING COVERAGE l NAIC 0 ANDOVER MA 01810 INSURER A: TRAVELERS INDEMNITY CO OF AMERICA(THE) 25666 INSURED INSURER 6: i TWOMEY& LEGARE CONTRACTING INC INsuRERc: _ INSURER 0: _^ 87 BELMONT STREET INSURER E: NORTH ANDOVER MA 01845 INSURER F: COVERAGES CERTIFICATE NUMBER: 39155 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS. EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE DD BR POLICY NUMBER MMIDDI EFF MMIDO) EXP LIMITS T COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S CLAIMS-MADE EIOCCUR I PREMISES Ea aecerrenco _ MED EXP(Any one person) S _ NIA PERSONAL&ADV INJURY S _ GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE S POLICY til EC C LOC PRODUCTS-COMP/CP AGG 5 _ OTHER is AUTOMOBILE LIABILITY COMBINED SINGLE LIMITS Ee accident ANY AUTO BODILY INJURY(Par person) S ALL OWNED SCHEDULED NIA BODILY INJURY(Per arradent) S AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS Par accident 5 UMBRELLALIAB OCCUR EACH OCCURRENCE 5 _ EXCESS LIAB CLAIMS-MADE N/A AGGREGATE17 DED 1 1 RETENTIONS �/ S — y WORKERS COMPENSATION X STATUTE ERH AND EMPLOYERS'LIABILITY — — ANYPROPRIETORiPARTNERtEXECUTIVE YIN E.L.EACH ACCIDENT S SOO,000 A OFFICERIMEMDEREXCLUDEDI NIA N/A NMA 6HUB029OM99415 09/18/2015 09/18/2016 `—— (Mandatory In NH) E L.DISEASE-EAEMPLOYEEl s 500,000 If yos,describo under DESCRIPTION OF OPERATIONS below I E.L.DISEASE-POLICY LIMIT I S 500,000 N/A DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached it more apace is required) Workers'Compensation benefits will be paid to Massachusetts employees only.Pursuant to Endorsement WC 20 03 06 B,no authorization is given to pay claims for benefits to employees in states other than Massachusetts if the insured hires,or has hired those employees outside of Massachusetts. This certificate of insurance shows the policy in force on the date that this certificate was issued(unless the expiration date on the above policy precedes the issue date of this certificate of insurance). The status of this coverage can be monitored daily by accessing the Proof of Coverage-Coverage Verification Search tool at www.mass.gov/lwd/workers-compensationfinvestigations/. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Town of North Andover ACCORDANCE WITH THE POLICY PROVISIONS. 1600 Osgood Street AUTHORIZED REPRESENTATIVE )' . L� North Andover MA 01845 (Daniel M.Cro�y,CPCU,Vice President–Residual Market–WCRIBMA ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD �"%✓r Cr 1(fly�leV Q'ryt Alrr�r/(/l'1 C�(°—"(lef.l.�[i�Al fl..r�lC', J"- "' Office of Consumer Affairs& Business Regulation I: ROME IMPROVEMENT CONTRACTOR Registration: 136775 Type: ,`Expiration: 8/2612016 Partnership TWOMEY+LEGARE CONTRACTING INC. SHAWN TWOMEY 87 BELMONT ST. N.ANDOVER, MA 01845 Undersecretary CS-067560 SHAUN M TWOMEY 61 PATROIT ST N ANDOVER MA 01845 10/25/2015 CS-055108 y DOUGLAS J LEGARE 79 GARY AVE HAVERHILL MA 01830 � M 09/02/2016