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HomeMy WebLinkAboutBuilding Permit # 8/10/2016 %A RTil s 4 Leo 0, BUILDING PERMIT �.ab „"."A",Y,,""Y", ,.,. . .. .•.•a o� TOWN OF NORTH ANDOVER ° � APPLICATION FOR PLAN EXAMINA h Perm roit NCI: �fi� Date Received � " 1 * °% I �S^SACfi41`.sE'��� Date Issued; IMPORTANT: A licant must com l.ete all items on this a e LOBATION �...'64N Print PROPERTY OWNED t t "ilk � Print MAP iqb: PARCEL:' V ZONING DISTRICT: Historic District yes n Machine Shap Village yes o TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential E1 New Building L.140ne family E1 Addition ❑ Two or more family E Industrial E Alteration I No. of units: E! Commercial - Re air, re lacement [I Assessory Bldg E Others: q C] Demolition E Other �1 '"4o, Id D Septic EI Well El Floodplain EWetlands El Watershed District F1 Water/Sewer g .w m � �•� ���"°R,df� C C", Identification Please Type or Print Clearly) OWNER: Name: , . ., Phone: Address: CONTRACTOR Na e: Phone: 1 ° � k "" v, Address: MA Supervisor's Construction License: Exp. Date: Horne Improvement License: Exp, Date: ARCH ITECT/ENGINEER . � i�M�/ �,. � Reg. No 1t � `.1 `1 �� -�". 1 ..� S— u,WW o Address: > � � ; .� �, � � Nr%�� ~ � „�m�I LJC C,:� FEE SCHEDULE:BULDING PERMIT:$12.00 PER$1000.00 of THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ ' J,0 t ,, ), FEE: $ Check No.: ,d Receipt No.:' 6' NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Signature of Agent/Owner—fis � , :� Si nature of contractor � g F ' REVOLU(SUN i WimegaTEMM-nm A.Contractor's Registration: All home improvement contractors and subcontractors engaged in home Improvement contracting,unless specifically exempt from registration by provisions of Chapter 142A of the Massachusetts General Laws,must be registered with the Commonwealth of Massachusetts. Inquiries about registration and status should be made to the Director of the following state agency: Office of Consumer Affairs and Business Regulation Home Improvement Contractor Registration Ten Park Plaza,Room 5170 Boston,MA 02116 (617)973.8700 B.Ctie aOrollation Rights: Client may cancel this Contract,without penalty or obligation,within three business days following the date on which Client signs this Contract. A Notice of Cancellation Is attached hereto for Client's convenience. C.Warranties:For a period of ten(10)years from Substantial Completion,Contractor warrants that the PV System has been designed and Installed In a good,workmanlike and substantial manner In accordance with all applicable building codes. In the event Contractor Is required to penetrate the roof of the Clients property in the course of Installation,and causes damage to the roof within a three (3)inch radius of a penetration,Contractor will repair such roof damage for a period of twenty(20)years from Substantial Completion or the remaining term of the roofs existing Installation warranty,whichever Is shorter,to prevent any water,rain or other Moisture leak,seepage or entry directly Caused by such penetration.These warranties are for normal use and conditions only.All warranty coverage to-equipment-and workmanship Installed by Contractor will be VOID If any alterations or repairs are performed by any person or persons not expressly authorized,In writing,by Contractor,THIS WARRANTY DOES NOT COVER:(a)Damage caused by external forces such as,but not limited to,vandalism,theft,terrorism,fire or act of God;(b) Damage caused by weather effects exceeding manufacturer tolerances,(c)Normal wear and tear or aging of a PV System;(d)Any Implied warranties: (a)Electric bills,water damages or any other consequential damages;or(0 Damage to the PV System or Its efficiency due to adjustment,moving,or tampering with the PV System or any of its components by individuals not approved by Contractor, D._0�a go-Qrd-ea. Any alteration or deviation from above specifications involving extra costs must be subject to a written change order signed by both parties,which shall be Incorporated Into this Contract,and Client shall be liable for any additional costs resulting from each change order. By Initialing the space below,Client hereby specifically agrees to execute a change order,and pay the additional costs,If It becomes necessary for Contractor to repair or replace un-approyed or non-code compliant electrical work In order to complete the PV System Installation and satisfy code requirements. Client's Initials: Client's Initials: ARBITRATION: CONTRACTOR AND CLIENT HEREBY MUTUALLY AGREE IN ADVANCE THAT IN THE EVENT CONTRACTOR HAS DISPUTE CONCERNING THIS CONTRACT,THE CONTRACTOR MAY SUBMIT SUCH DISPUTE TO A PRIVATE ARBITRATION SERVICE WHICH HAS BEEN APPROVED BY THE DIRECTOR OF THE EXECUTIVE OFFICE OF CONSUMER AFFAIRS AND BUSINESS REGULATIONS AND CLIENT SHALL BE REQUIRED TO SUBMIT TO SUCH ARBITRATION AS PROVIDED IN M.G.L.c,142A. Client: Date: 77(Z dk Client: Date. Contractor: Date: NOTICE: The signatures of the parties above apply only to the agreement of the parties to alternate dispute resolution Initiated by Contractor. Client may Initiate alternate dispute resolution even where this section Is not separately signed by the parties. E.Incentive Guarantee: By Client's initials below,Client acknowledges and agrees that Contractor has not and does not guarantee Client's qualification for,receipt of or amount of any tax credit,rebate,solar renewable energy credit(SREC)or other incentive amount in connection with the PV System,and any estimates of Incentives(wither In a PV System proposal or otherwise)are not guaranteed to be accurate or available. Client Is responsible for determining Client's and/or the PV System's eligibility for any Incentives and should consult with tax,legal and other advisors regarding availability and possible tax consNuences of claiming the same. Client's Initials: Client's Initials: 2 Northeast Solar 1 North Ave Suite A Burlington,MA 01803 781,240.6555 0"R e VOI U SLI ll.COM w,naREVOLU(SUN THIS HOME IMPROVEMENT SOLAR ENERGY CONTRACT (this "Contract") IS BETWEEN: Rex Melton ("Client") located at 705 bradford st Andover, MA 01845 ("Client"s Property") -AND- Northeast Solar Services, Inc.@ ("Contractor') of 1 North Ave Suite A Burlington, MA 01803, with Home Improvement Contractor Reg. No. 178137, which expires on March 17, 2016, and Federal Employer ID 46 0569853. Contractors sales person for this contract is David Bentley. The parties to this Agreement agree as follows: A. Installation of PV System The above Client(s) has engaged Contractor to perform the following residential contracting work (the "Work") in connection with the installation of the following photovoltaic solar energy system (the "PV System"): 38 Panasonic - Panasonic N325 watt modules (or equivalent) with 1 Solar Edge - Solar Edge SE 10000 inverters (or equivalent) and all mounting, disconnects, and all other PV System components necessary for a National Electric Code compliant PV System, totaling 12.35kW, located at Client's Property. B. Other Incluskm The Work shall further include: • Installation of the PV System in accordance with all State of Massachusetts interconnection standards. - All reasonable engineering and permitting casts, • The following building permits are required and will be secured by Contractor as ClienPs agent: Building and Electrical Permit. • Following the Installation, Client will receive a PV System orientation and a PV System Client's manual. Notice: It shall be the obligation of the Contractor to obtain all permits related to the Work. Clients who secure their own permits will be excluded from the guaranty fund provisions of Chapter 142A of the Massachusetts General Laws. IL COMPENSATION AND SCHEDULE A. Contract Price For Contractors performance of the Work under this Contract, Client will pay Contractor a total of: $ 47,106.21 (FORTY SEVEN THOUSAND ONE HUNDRED SIX AND 211100) DOLLARS USD (the "Contract Price"). B. Payment Schedule The Contract Price will be payable In accordance with the following payment schedule: Date Paid: $ 23.563.10 initial Payment - 50% (Due upon Contract signing, which is an amount less than the cost of the materials and equipment which must be specially ordered in advance of commencement of PV System Installation) $ 21 197.79 Progress Payment - 45% (Due upon Substantial Completion) S 2.366.32 Final Payment - 5% (Due upon Final Completion) C. Schedule The "Start Date" of this Contract Is the date Contractor receives the full amount of Client's initial payment of 60% of the Contract Price, Subject to adjustment for any Force Majeure reason stated In Section IV.,J., the Work Is estimated to begin within 12-16 weeks from the Start Date of this Contract. The parties agree that this date shall be automatically extended to the date of delivery of all materials and equipment which mut be specialty ordered. SobstanlW. Com Joh.. tion_ is estimated to occur within 16-20 weeks from the Start Date of this Contract, but the parties agree that this date shall be automatically shortened or extended to the date on which all racking and electrical work are complete and the PV System Is capable of generating power and ready and available for use subject to final government and utility approval. Mal C> MP/e11on is defined as the date on which all punch list Items are complete, all permits are closed, all other government and utility approvals are obtained and the Work is complete to the satisfaction of Contractor and Client. Client acknowledges and agrees that the Work involves permits, inspections and approvals from various government agencies and utilities, and therefore the liming of the Work may vary and is not within Contractor's control, Client further agrees that Contractor shall not be liable for any tosses, costs or damages related to any delays for reasons beyond Contractor's control, including all causes noted In the Force Majeure section of this Contract below. Northeast Solar l Nortim Ave Sulte A Burlington, MA 01803 7kil 240.6555 14fi ", V,I '.0H .d"8'70I1, K. Legal Compliance and Severability: Contractor and Client acknowledge that the form, substance, content and notices contained In this Contract are intended to comply with Chapter 142A of the Massachusetts General Laws, and regulations promulgated thereunder. In the event of any Instance of non- compliance, only such portion shall be invalid and the remainder of this Contract shall be in full force and effect, In addition, any such portion not In compliance shall be read and Interpreted so as to have Its Intended meaning to the Maximum extent allowed under such law and applicable regulations. L. Entire Contract: No Waiver Unless In Writing: This Contract constitutes the entire contract between the parties; there Is no representation, warranty, collateral contract or condition affecting this Contract except as expressed In It. No provisions of this Contract shall be changed or modified, nor shall this Contract be discharged or waived, In whole or part, except In writing signed by both parties. This Contract shall not be effective until fully executed by Client and an Authorized Representative of Contractor. M. Client's nresentafion of Authority: If this Contract is signed by less than all of the persons or entities who own the subject property, then Client who signs this Contract (or any of the provisions hereof) represents to Contractor that he, she or it has full legal authority to bind the other persons and/or entities. N. Governing Law: The laws of the Commonwealth of Massachusetts shall govern any proceeding or dispute related to this Contract. 0: Production Gap Guarantee: This production guarantee covers 90% of estimated production In year I and decreases at .5% each year for a total term of ten (10) years. This guarantee Is determined on an accrual basis and payments are made when the aggregate system production falls below total production estimated on the schedule above. Payments will be made at the end of each anniversary of the system's In service date of Interconnection. Production Gap Garranty Is void If site conditions and solar access change after the date of interconnection. Client's Initials: Client's Initials: P. 3rd party Financing: Should the client obtain financing from a 3rd party which is approved by the Contractor, the payment terms of the lender will apply. Client: V Date: Contractor: Name: Title: 1. Date. Northeast Solar 1 North Ave Suite A Burlington, MA 01803 781.240.6565 106113 VO 5 Olg C611 212015 �REVOLU,� • r r r A. Access.: To enable Contractor to perform its Work hereunder, Client shall grant during daylight hours adequate space on Client's property, as mutually designated by Contractor and Client, for the complete and proper installation, operation, maintenance and repair of the PV System as well as rights of Ingress and egress to, through and from such property and the space designated for the PV System. B. Scarcity of Materials! Rights of Termination: The PV System components to be obtained under this Contract are scarce commodities. In order to meet the performance requirements of the PV System described in this Contract, Contractor may substitute the specified brand of solar module or Inverter for a similar brand of module or Inverter that allows for more timely completion of the installation. Such substitution, if necessary, shalt be of UL approved devices, with aggregate performance criteria the same as equipment specified. The governing body for determining performance criteria shall be the CEC (California Energy Commission) that rates all UL approved modules. The key module statistic used for performance criteria will be the DC STC rating of the sum of the modules. The key inverter statistic used for performance criteria will be the AC output of the device, If, due to code requirements, equipment substitution, final engineering, space availability, etc., the size of a PV System decreases, Contractor shall re- calculate the Contract Price using its standard pricing method and the Contract Price shall be automatically reduced. Client shall be credited by the reduced amount. If clue to substitution the DC STC size of the PV System increases slightly, then Client shall not have to pay Contractor similarly. Contractor shall make every reasonable effort to ensure that PV System size does not decrease from the specifications. If the DC STC size of the PV System decreases more than 15% from the Contract's specification amount for any of the reasons stated in this paragraph, Client shall have the right to terminate this Contract within ten (10) days of Contractor's written notification to Client of such decrease, and Contractor shall then refund In full all funds paid to date under this Contract, but shall have no other liability to Client. Cc a ctor res s the right Ato terall rminaA�Coofra�clt n da�� appt"olaB wi43 ny li bilily t if any of the V Sy emt c actorr q e's thq righ do ll nt mlr tly ann r a e n t'availab'te-lrfthe even ich term anononiraa shall `\d al mo fes a by Ile tactor of nation. C. Limitation or Liabi&: In no event shall Contractor be liable In an amount exceeding the compensation paid by Client to Contractor under this Contract. Contractor shall not be liable for any Incidental, consequential or special damages or for economic loss or expense of for loss or profits or income of Client, or Client's consultants or agents or employees, or any of them, including but not limited to any electricity costs incurred should installation of the PV System be delayed beyond the commencement or completion schedule set forth above. D. Zoning: Client shall pay for all variances, special permits, or other costs related to zoning, including without limitation any fees or costs related to attorneys or engineers. E. Client's Property: Client agrees to remove or to protect any of Client's personal property, Inside or out, which may Interfere with or obstruct the Work, including but not limited to landscaping, and Contractor shall not be held responsible for damage to such properly. Client understands and acknowledges that proper operation of the PV System purchased hereunder Is dependent on Client's existing roof and equipment and Contractor shall have no obligation or liability for the condition thereof, or any other part of Client's improvements or equipment not purchased hereunder. Client expressly represents that the roof of the property upon which the PV System will be installed Is in good condition, with no known water inf ltralion problems or other structural defects. F. Jnsurance: Client must carry all fire, casualty, hurricane, earthquake, theft, and other Insurance related to Client's real and personal property. G. Canaelialian..2(,_S9fttLact: it Client cancels or breaches this Contract after the opportunity to execute three (3) day rescission has passed but before commencement of construction, Client shall pay Contractor the amount of expenses incurred to that date plus 20% of the Contract Price. If Client fails to pay said amounts within thirty (30) days of Contractor's demand for payment and Contractor files suit, Contractor shall be entitled to recover all of its damages including Its loss of net profits and attorneys' fees and costs if Contractor is the prevailing party. N. Costs of Collection: If Client fails to pay any amounts owed to Contractor when due, Client shall be liable for all costs of collection, including reasonable attorneys' fees, plus 18% Interest per annum on the unpaid balance. Contractor also shall have option of removing all or part of the PV System from Client's premises in addition to receiving payment equal to the value of the unpaid balance to cover all or a portion of Contractors consequential damages. 1.it els,: Contractor, any subcontractor(s) and any other persons or entities supplying labor and materials to Client under this Contract, have the right under applicable law to Impose a lien on Client's real property for the value of the labor or materials provided. Upon Client's payment of all amounts due under this Contract, Contractor will provide, upon Client's request, a release and waiver of any liens. J. Force Majeure: Contractor shall not be liable for any delay In material and/or equipment delivery or for failure to deliver or failure to perform the Work which results from any cause beyond the Contractor's control. Such causes Include but shall not be limited to: an act of God or of the public enemy; an act (or failure to act) of any government or utility; a fire, flood or epidemic; quarantine, restriction, strike, freight embargo, terrorism, theft or unusually severe weather; Contractor's Inability to obtain necessary materials, labor or transportation; custom permitting caused by Client's site conditions; homeowner association review or approval; building or other code requirements relating to Client's existing electrical system or building characteristics; and any other impediments to the Installation of the PV System arising from Client's acts or omissions andlof the condition of Client's property. Northeast Solar 1 North Ave Suite A Burlington, MA 01803 781.210.6555 1063re W 509 C&12.1015 Project Number: U1883-0196-161 August 4, 2016 RevoluSun I North Avenue Burlington, MA 01803 ATTENTION: Ian Clifford REFERENCE: Rex Melton Residence: 705 Bradford Street, North Andover, MA 01845 Solar Panel Installation Dear Mr, Clifford: Per your request, we have reviewed the layout and photos relating to the installation of solar panels at the above - referenced site. The following materials and components are proposed in the installation of the solar panels. Roof Structure: 2x 12 Rafters at 16" 0. C. Roof Material: Composite Shingles Based upon our review, it is our conclusion that the installation of solar panels on this existing roof will not adversely affect the structure of this house. The design of solar panel supporting members and connections is by the manufacturer and/or installer. The adopted building code in this jurisdiction is the 2009 International Building Code and ASCE 7-05. Appropriate design parameters which must be used in the design of the supporting members and connections are listed below: Ground snow load: 55 psf per Massachusetts amendments to the IRC (verify with local building department) Design wind speed for risk category Il structures: 105 mpli (3 -sec gust) Wind exposure: Category C Our conclusion regarding the adequacy of the existing roof is based on the fact that the additional weight related to the solar panels is less than 3 pounds per square foot. In the area of the solar panels, no 20 psf live loads will be present. Regarding snow loads, it is our conclusion that since the panels are slippery and dark, effective snow loads will likely be reduced in the areas of the panels, Solar panels will be flush -mounted, parallel to and no more than 6" above the roof surface. Regarding wind loads, we conclude that any additional forces will be negligible due to the low profile of the flush -mounted panel system. It is our conclusion that any additional seismic loadings related to the addition of these solar panels is negligible. During design and installation, particular attention must be paid to the maximum allowable spacing of attachments and the location of solar panels relative to roof edges, The use of solar panel support span tables provided by the manufacturer is allowed only where the building type, site conditions, and solar panel configuration match the description of the span tables. Attachments to existing roof joist or rafters must be staggered so as not to over load any existing structural member. Waterproofing around the roof penetration is the responsibility of others. All work performed must be in accordance with accepted industry -wide methods and applicable safety standards. Vector Structural Engineering assumes no responsibility for improper installation of the solar panels. Please note a representative of Vector Structural Engineering has not physically observed the roof framing, Our conclusions are based upon the site assessment and information provided by Revolusun and the understanding that all structural roof components and other supporting elements are in good condition, free of damage and deterioration, and are sized and spaced as outlined in the site assessment performed by Revolusun. Very truly yours, VECTOR STRUCTURAL ENGINEERING, LLC Roger T. Alworth, S.E, Principal RTA/dgd 1/2016 9138 S. State St., Suite 101 1 Sandy, UT 840701 T (801) 990-17751 F (801) 990-17761 www.vectorse.com 14 The CvitimoutvealNt ofMosseclurselts Delraylmout of lurlttstrlal Aceldeuls t7fflee of,lrtvesligrrflvtts Tj 1 Congress Street, Salle 1100 Boston, MA 021192017 w)PIP. m las ga l►/1l11i Workers, Cotillpeitsatiait lnsui'Rtice Affillavlt: I3llliil$i'8��'Onti'Rct©t'Bf+EiCCt1'lcians/l'lumbet's Applicogit Iii oi'll tion Plejia i-iiit Le ibl Na» 1e Northeast Solar Services Inc Address: I North AVO Suite A Ci /State/zi ,:tlurnngton l MA I u1UU3 phone #:781.270 - 6555 Are you nit employer? Check lite appropriate box: Typa of project (regnlred): 1. d I ant a employer with 12 h. ❑ 1 ant a general contractor and 1 ❑ New cottstruot{ou employees (flilI andlor part-time).e 2. ❑ I am a sole proprietor or partner- have hired lite sub -contractors listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub -contractors have g, [] Demolition working for me in any capacity, employees and have workers' comp. insurance. g [jBuilding addition (No workers' comp. Insttmitee, required.) 5. [] We are a corporation and its 10.[] Electrical repairs or additions 3. ❑ 1 am a homeowner doitig all work officers have exercised their I L❑ Plumbing repairs or additions myself, (No workers' comp. right of exemption porMOL 12.❑ Roof repairs insurance required,] t e. 152, § 1(4), and we have no employees, (No workers i 3,[] OtherSolar PV comp. insuranco required.] 'Any applicant that checks box I I nurstalm fill au1 tilt section below ahotving tlteEr workers' conipeitsattan polloy infotuiallott. t liomeowttert who submit this affidavit Indicating they are doing all work and ihsnhlra outside contractors mast submit a nate afttdavit Indicating such. iContractors that check this box must attsehed an additional sheet showing the name or the sub tontractora and sista whether or not those entities have etsiployces. If the subcontractors have eutployees, they must provide their workers' comp. policy whiter. I torr rin employer that Is provlifing workers' compensrrilon lnsm-ance for lily employees, 8elalEr is tha,pollcy andJoo elle ht orrnatlorr, Insurance Company Nat -no: Federated Mutual insurance Company Policy 1l or Selr--ins, l,ic. #; 9884086 Expiration bate: 12/31/2016 Job Site Address.Q !rL t r2,al rpt ` k, A"�W�'� CitylStatelZ{p:' AM -Of 6 l5 Attach a copy of lite workers' compensatlan policy declaratlon page (sltatring the policy rtaraber tend expiration rime). Failure to secure, coverage as required under Seollon 25A of MOL o. 152 can lead to the imposition of criminal penalties of a fine up to S 1,590.00 andlor one-year Imprisonment, as well as civil penalties In Me form of a STOP WORK ORDER and a fine of up to $250.00 a day against the violator. Be advised that n copy of this statement may be forwarded to the Office of lnvosiigations of the DIA for insurance coverage verification. I rio hereby cer llb dtrlI161, the pA111's dial pennlHes of Psdaty Aral Ilse lrlJ'orniallon provldiedl above is Irate and correct 781.270.4899 Dff elal rise only, Do not write hr tills area, to be coinpleletl by elty or town offleledt City or Town-, Pornill/Liconse f1 Issuing Authority (circle one): 1. Board of Healfh 2. [lallding Mpar'Imeut 3, Cilylrown Clerk 4. Meclricai Inspector S. Plumbing ltrspeelor 6,'OtllVk' .. Contatt Pcrsoul Phone Pt CERTIFICATE 4F LIABILITY INSURANCE DATE116rzo15m THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER, THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR HEOATiVELY AMEND, EXTEND OR ALTER THE COVERAOE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATES OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate hotder Is an ADDITIONAL INSURED, the pol(cy(tes) must he endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certlfleale holder PRODUCER FEDERATED MUTUAL INSURANCE COMPANY HOME OFFICE: P.O. BOX 326 OWATONNA, MN 65060 INSURER A: FEDERATED MUTUAL INSURANCE COMPANY 13935 INSUREO 297.678-9 INSURER B: NORTHEAST ELECTRICAL INC INSURER C: 1 NORTH AVE INSURER p: BURLINGTON, MA 01603 INSURERS: INSURER F. COVERAGES CERTIFICATE NUMBER: 0 REVISION NUMBER: 0 I - - THIS I$ TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED Pzuvr rum inc ruLn'l "'w 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 ...vera SAW sieve Deeva ns:niIran rav DeEn r: AIIMA l SRDL TYPE OF INSURANCE UBR POLICY NUMBER OLICY E PDDCY LIMIT$ A DBNERAL LIABILITY X COMMERCIAL DENEAALLiAB]L1TY CLAIM&MADE OCCUR N N 8884084 12/31/2016 12131!2016 EACH OCCURRENCE 51,000,00( AO RENTED $100,00( MED EXPtpnyenePersan} EXCLUDEC PERSONAL d ADV INJURY $1,000,00( 0ENERALA00AWATE $2,000,00( PRODUCTS r COMPIOP AGO $2,000,00( OEN'L AGORECIATE LIMIT APPLIES PER: X POLICY MSM LOG AUTOM0611.8 LIABILITY HAUTOBOAILY AUTOSULfiD JAy l3lRaDAUTOa NON -OWNED AUTOS N N 9664085 12/31/2016 12Y31r2a1e ME ED b1fi0LE LIMIT 51,ODO,00( INJURY (Psr Person)AALLO90 BODILY INJURY (PereaddenQ ROPE T AMA06 A X UMBRELLA LIAB EXOS$suAS X OCCUR cLAIMs•MAOE N N 9884087 12/31/2015 1213112016 EACHOCCURRENCE $2,000,00{ AOOREOATE $2,000,00( p8d RETENTION A WORRER$COMPENSATION AND EMPLOYBRS' LIABILITY ANYPROPAIBTORIPARTNERIEKECOTIVB OFACEIUMEMBEREXCLUDSO? (Mandatary in HH) Ifyes, describe falder DESCRIPTION Of OPERATIONS belaw NIA N 8864086 12/31/2015 12!3112016 aa��pp��U{I rH X ToRYLi lufs p�H. R E,LEAOHACCIDENT $1,O00,QOC ELDISEASE - EA EMPLOYEE S11000100C E,L DISEASE • POLICY LIMIT $1,000,000 DESCRIPTION OF OPERATIONS 1 LOCATIONS i VEHICLES (ANad, ACOAD 161, Addl#011 R+merks Sdxdule, H more SPAO Is required) THIS COPY IS NOT TO BE REPRODUCED FOR ISSUANCE Of CERTIFICATES. o vj" . X& 00 SHOULD ANY OP THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORI THE EXPIRATION DATE THEREOF, NOTICE WILL BE DEi7VERED It ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIIED REPRESENTATIVE -- „ ,. df 1986010 ACORD CORPORATION. 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