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HomeMy WebLinkAboutBuilding Permit # 9/7/2016 I BUILDING PERMIT TOWN OF FORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit No# Date Received �gss•ac+�us��t Date Issued: ��� - I PORTANT: Applicant must complete all items on this page LOCATION n nt PROPERTY OWNE Pint 100 Year Structure yes n0 MAP . PARCEL: ZONING DISTRICT: Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building e family ❑Addition ❑ Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial epair, replacement ❑Assessory Bldg ❑ Others: ❑,..,,�.,Dem ,��..t.'.`i.o;`,'"n El7 OFltoh;.ro.e;:,d�rmv PMl,�".y;i"u✓n'-��5x,"1.",�-�J.p.,„�.�W.�:�e�t..:a��.,^.':n",�d.r,sr,.. rku ” ®R r, Wel �s aw ym.� ,``a✓�., DESCRI TN OF WORK TO BE PERFORMED: Iden ifieatio - Please Type or Print Clearly OWNER: Name: Phone: ?- $• Address: � fio - - Contractor Name A, one: Email: Address: - I Supervisor's Construction License: [ Exp. Date:.. ( 4, E Home Improvement License: `7 7 Exp. Date: ARCH ITECTIENGINEER Phone: Address: Reg. No. FEE SCHEDULE.,BULDING PERMIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COSTBASED ON$725.00 PER S.F. Total Project Cost: $ ,C c FEE: $� Check No.: Receipt No,: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund NpRTIy ,9 Town o _ , 6 ndover 0 No. 4 -IFW7 = T x 4 o L„K9 h ver, Mass, coc"Ic"t wM. 1 7,q RATIE0 S L{ BOARD OF HEALTH Food/Kitchen PERMIT T LD Septic System THIS CERTIFIES THAT .... BUILDING INSPECTOR . .. .. ..i . .. 0.4 has permission to erect .......................... buildings on .1 ... dM�� �{ [v�.. Foundation .. ... .. .... ..........,. � 04 .V.A..' .. Rough tobe occupied as .......... .. .. ......... ... ......... .,. .. .�................................ Chimney provided that the person acceptin this permit shall in eve respect co'hform to the terms of the application p pp 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 MONTHS ELECTRICAL INSPECTOR. UNLESS CONST TI® Rough Service ......... . ...... .. ......... Final BUIL© INSP CTOR GAS INSPECTOR ®cc wancy Permit Required to ®ccac BuRough 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. Contract - Detailed Pella Window and Door Showroom of Haverhill ! Sales Rep Name: McLoughlin, Daniel ® 45 Fondi Rd Sales Rep Phone: 978-373-2500 Haverhill, MA 01832 Sales Rep Fax: Phone: (978) 373-2500 Fax: (978) 373-7274 Sales Rep E-Mail: mcloughlindv@pellaboston.com Customer ajonProject/Del very Address. Order Information Scott Hansen Hansen,Scott,1775758 Quote Name: Storm Door and Patio Door 104 Colonial Ave 104 Colonial Ave Order Number: 741 DV0119 NORTH ANDOVER,MA 01845-6349 Lot# Quote Number: 8185236 Primary Phone:(440)2202901 North Andover,MA 01845-6349 Order Type: Installed Sales Mobile Phone: County: Payment Terms: Deposit/C.O.D. Fax Number: Tax Code: MA TAX 6.25 E-Mail: shansen03@gmail.com Quoted Date: 812212016 Great Plains#: 11052574 Customer Number: 1008076389 Customer Account: 1003977351 Line# Location. Attributes 10 None Assigned Delivery/Setup-Delivery/Setup Item Price Qty Ext"d Price $235.00 1 $235.00 For more information regarding the finishing, maintenance, service and warranty of all Pella®products, visit the Pella®website at www.pella_com Printed on 8/2312016 Contract-Detailed Page 1 of 6 Customer: Scott Hansen Project Name: Hansen,Scott,1775758 Order Number: 741DVO119 Quote Number: 8185236 Line# Location Attributes 15 Porch Pella 350 Series, Double Sliding Door Vent Right l Fixed,71.5 X 79.5,White Item Price Qty Exfd Price $4,446,91 t $4,446.91 1:7280 Vent Right!Fixed Double Sliding Door PK# Frame Size: 71 112 X 79 112 ' 816 General Information: Yes,Standard,+1-50,+1-50,Vinyl,Nail Fin,Foam Insulated,6",1 318",4 518",No Sill Riser Exterior Color!Finish: White Interior Color!Finish: White '' Glass: Insulated Dual Tempered Low-E Low E Insulating Glass With Window Fashions Air Filled Non High Altitude Hardware Options: Keylock Included,White,White,Steel Viewed From Exterior Screen: Sliding Screen,White,Premium,Conventional Fiberglass Unit Accessories: Blinds-Between-The-Glass,White Performance Information: CPD Not Rated,Performance Class R,PG 50,Calculated Positive DP Rating 50,Calculated Negative DP Rating 50 Wrapping Information: No Interior Trim,Pella Recommended Clearance,Perimeter Length=302",Glazing Pressure=175. Frame Size:71.5"X 79.5' PVC Upgrade n 48-PVC Upgrade greater than 48 inches Qty 1 PD-2 Wide-Install 2-Wide Sliding Patio Door Qty 1 Finish Patio Trim-Finish PaintlStain Patio Door Interior Trim Only Qty 1 I.Line# Lacatloh Attributes 20 $750.00 Off Item Price Qty Ext'd Price ($750.00) 1 ($750.00) For more information regarding the finishing, maintenance, service and warranty of all Pella®products,visit the Pella®website at www.pelia.com Printed on 8/23/2016 Contract-Detailed Page 2 of 6 Customer: Scott Hansen Project Name: Hansen,Scott,1775758 Order Number: 741 DV0119 Quote Number: 8185236 Line# Location: Attributes 25 5%Same Day Item Price Qty Exfd Price ($196.60) 1 ($396.60) Line# ;Location:' Attributes 30 2% Pay in FUII item Price Qty Ext'd Price ($74.71) 1 ($74.71) Thank You For Purchasing Pella® Products PELLA WARRANTY: Pella products are covered by Pella's limited warranties in effect at the time of sale.All applicable product warranties are incorporated into and become a part of this contract. Please see the warranties for complete details,taking special note of the two important notice sections regarding installation of Pella products and proper management of moisture within the wail system.Neither Pella Corporation nor Pella Windows&Doors will be bound by any other warranty unless specifically set out in this contract. However,Pella Corporation will not be liable for branch warranties which create obligations in addition to or obligations which are inconsistent with Pella written warranties. Clear opening(egress)information does not take into consideration the addition of a Rolscreen[or any other accessory]to the product.You should consult your local building code to ensure your Pella products meet local egress requirements. Per the manufacturer's limited warranty,unfinished mahogany exterior windows and doors must be finished upon receipt prior to installing and refinished annually,thereafter. Variations in wood grain,color,texture or natural characteristics are not covered under the limited warranty. INSYNCTIVE PRODUCTS:In addition,Pella Insynctive Products are covered by the Pella Insynctive Products Software License Agreement and Pella Insynctive Products Privacy Policy in effect at the time of sale,which can be found at Insynctive.pella.com. By installing or using Your Insynctive Products you are acknowledging the Insynctive Software Agreement and Privacy Policy are part of the terms of sale. For more information regarding the finishing, maintenance, service and warranty of all Pella®products, visit the Pella®website at www.pella.com Printed on 8/23/2016 Contract-Detailed Page 3 of 6 .......................... ..... .. Customer: Scoff Hansen Project Name: Hansen,Scott,1775758 Order Number: 741DVOI19 Quote Number: 8185236 Product Performance Information: U-Factor,Solar Heat Gain Coefficient(SHGC),and Visible Light Transmittance(VLT)are certified by the National Fenestration Rating Council(NFRC).Manufacturer stipulates that these ratings conform to applicable NFRC procedures for detennining whole product performance.NFRC ratings are determined for a faxed set of environmental conditions and a specific product size.NFRC does not recommend any products and does not warrant the suitability of any product for any specific use. Design Pressure(DP),Performance Class,and Performance Grade(PG)are certified by a third party organization,in many cases the Window and Door Manufacturers Association (WDMA).The certification requires the performance of at least one product of the product line to be tested in accordance with the applicable performance standards and verified by an independent party.The certification indicates that the product(s)of the product line passed the applicable tests.The certification does not apply to mulled and/or product combinations unless noted.Actual product results will vary and change over the products life. For more performance information along with information on Florida Product Approval System(FPAS)Number and Texas Dept.of Insurance(TDI)number go to www.pella.com /performance_ Project Checklist Review (installed Orders Only) Before the Installation the Homeowner agrees to dr the following: Obtain Condo Association Approval Obtain Historic Approval Remove existing shutters and awnings Remove air conditioners Remove existing shades, drapes, window treatments, wall hangings, and personal belongings Move furniture at least 3 feet away from work area Tie or cut back trees, bushes and shrubs in the work area Arrange to have alarm system and doorbells disconnected Arrange to have any plumbing and electrical repairs or changes made by appropriate licensed contractor Provide a door handle and lockset for entry door if Pella handle and lockset is not purchased. Before the Installation Pella agrees to do the following:_ Obtain Building Permit(When required) Prefinish products when purchased in contract Durinq the Installation the Homeowner agrees to do the following: Keep pets safely away from work area Keep children safely away from work area Allow Pella Installer room to work safely within your home During the Installation Pella agrees to do the following: Deliver and unload products purchased per contract Place and remove drop cloths in work area then vacuum, and remove all debris at end of day Remove existing product, including storm windows, and dispose of it unless otherwise specified Install all products using method specified in contract per Pella Installation Instructions For more information regarding the finishing, maintenance,service and warranty of all Pella®products, visit the Pella®website at www.pelia.com Printed on 8/2312416 Contract-Detailed Page 4 of 6 ........................... . Customer: Scott Hansen Project Name: Hansen,Scott,1775758 Order Number. 741 DV0119 Quote Number: 8185236 Replace interior and/or exterior trim only if purchased If Purchased, install exterior primed pine wood trim or Composite. Composite will be unfinished. If Purchased, install interior trim matching wood window finish or White trim for Impervia and Encompass Install non-Pella entry door lockset provided by you. Pella is not responsible for it's quality or performance After the Installation the Homeowner agrees to do the following: Be available for completion and sign off to verify all products purchased are in working order Reinstall existing shutters and awnings Re-install existing shades, drapes, window treatments,wall hangings, and reposition furniture Arrange to have alarm system and doorbells reinstalled Reinstall air conditioners Remove stickers from product and save for energy rebate and tax purposes Wash all interior&exterior glass surfaces Fill nail holes and joints on interior trim if windows are to be stained (after staining) Clean up exterior casing issues due to storm window removal if full wrap or new exterior trim is not purchased ;Project Checklist has been reviewed JmmeIn'iti-:1 Product Only Addendum has been reviewed Customer initial Credit Card Account 4: Last 4 Digits Expiration Date: 1 Charge final payment to same account (Upon substantial completion) Customer initial For more information regarding the finishing, maintenance, service and warranty of all Pella®products,visit the Pella®website at www.pelia.com Printed on 8123/2016 Contract-Detailed Page 5 of 6 Customer: Scott Hansen Project Name: Hansen,Scott,1775758 Order Number: 741DV0119 Quote Number: 8185236 ❑Project Checklist has been reviewed Scott Hansen Dan McLoughlin Order Totals Customer Name (Please print) Pella Sales Rep Name (Please print) Taxable Subtotal $3,191.91 '7 � Sales Tax @ 6.25% $199.49 4 4ergna Ve Pella Sales Rep Signature V Non-taxable Subtotal $468.69 8123/16 8123116 Total $3,860.09 Date Date Deposit Received $3,860.09 Amount Due $0.00 Credit Card Approval Signature For more information regarding the finishing, maintenance, service and warranty of all Pella®products,visit the Pella@ website at www.pelia.com Printed on 8123/2016 Contract-Detailed Page 6 of 6 PELLA WINDOWS AND DOORS CONTRACT 7 PAYMENTS 1. TERMS AND CONDITIONS Pella shall be entitled to stop the Work upon written notice to Owner for any material default or failure by Owner,including but not limited to,the Owner's These Terms and Conditions are an integral part of the contract set forth on the failure to pay Pella the amount due within seven days after the date payment is Product Order(the"ContracP')between New England Window and Door LLC due. dba Pella Windows&Doors,Inc.("Pella")and the person(s)identified on the Product Order("Owner")to supply the products(the"Products"),and perform S. CORRECTION OF WORK the work(the"Work")described or referred to in such Contract. For Product Only purchases,a signed"Product Only Addendum"is a required part of the Pella shall correct installation Work not in conformance with the requirements contract. ofthe Contract,if notified in writing by the Owner within two years after the Completion Date or,if earlier,the date on which the Work is substantially 2. OWNER completed and payment of the Purchase Price made subject to a holdback as provided above.Correction of Work as herein provided shalt be Owner's sole Pella is not responsible for any existing security systems.Owner shall remove remedy for defective workmanship,and is provided in lieu of any and all other all shades;verticals,blinds,curtains,drapes or window mounted air remedies.Pel la's obligation to correct Work is conditioned on Pella's prior conditioners,prior to the installation of the Products.Pella's installers are not receipt of all payments then due. responsible for the removal or installation of these types of items. Pella is not responsible for pre-existing window coverings fitting on newly installed Pella y L1NHTED PRODUCT WARRANTY windows. Pella shall warrant all Pella products,but only in accordance with the Pella The Owner shall provide complete access to the work site between the hours Windows&Doors Limited Warranty.THIS LIMITED WARRANTY SHALL of 7:00 a.m,and 6:00 p.m.(Monday through Friday)for Pella's installers to BE THE SOLE WARRANTY WITH RESPECT TO THE PRODUCTS AND deliver the Products and perform the Work. PELLA SPECIFICALLY DISCLAIMS ALL OTHER WARRANTIES, EXPRESS OR IMPLIED,WRITTEN OR ORAL(INCLUDING WITHOUT 3. PELLA LIMITATION ANY WARRANTY OF MERCHANTABILITY OR FITNESS Pella will be responsible for and have control over construction means, FOR A PAR'T'ICULAR PURPOSE). methods,techniques,sequences and procedures and for coordinating all portions of the Work.Pella will be responsible for the Work of its Pella 10. NO CONSEQUENTIAL DAMAGES Contracto€s who will install the Products. UNDER NO CIRCUMSTANCES SHALL PELLA BE LIABLE FOR Unless provided otherwise in the Work description,Pella will provide and pay CONSEQUENTIAL,INCIDENTAL,INDIRECT,OR SPECIAL DAMAGES, for all labor,materials,equipment,tools and machinery,transportation,and WHETHER FORESEEN OR UNFORESEEN. other facilities and services necessary for the proper execution and completion of the Work, 11. HOME INIPROVEMENT CONTRACTORS The materials and equipment furnished under the Contract will be good quality All home improvement contractors and subcontractors shall be registered with and new unless otherwise required or permitted,the Work will be free train the director of the Home Improvement Contractor Registration Program defects not inherent in the quality required or permitted,and the Work administered by the Board of Building Regulations and Standards. Pella and conform with the requirements of this Contract.Pella shall not be responsible any of its subcontractors identified in this agreement have been registered. for damages or defects caused by abuse,modifications not executed by Pella, Any inquires about Pella or any of its subcontractors relating to registration improper or insufficient maintenance,improper operation or normal wear and should be directed to:Director,Home Improvement Contractor Registration, tear. Pella will keep the premises and surrounding area free from 10 Park Plaza,Room 5170,Boston,MA,D2116,617-973-8787,588-283-3757 accumulation of waste materials or rubbish caused by performance of the or visit the HIC website at http:/hvww.mass.goviocabar/ Work. 12. PERMITS(MA customers only) 4. CHANGES Pella is obligated to and will obtain the following permits for this project: _Building Homeowners who secure their own permits will be The Owner may order in writing changes in the Work consisting of additions, excluded from the guaranty fund provisions of Massachusetts General Laws, deletions,or modifications("Change Order"). Any Change Order shall chapter 142A. include an adjustment to the Price and the Substantial Completion Date,as determined by Pella. Pella reserves the right to approve or disapprove any In addition to the rights and warranties enumerated in this agreement,you may Change Order and any such Change Order mast be signed by both Owner and have additional rights under Massachusetts General Laws,chapter 142A and Pella to be effective. 780 Code of Massachusetts Regulations R6. 5. SUBSTANTIAL COMPLETION13. NOTICE OF CANCELLATION Owner understands and agrees that the Substantial Completion Date is an You may cancel this agreement if it has been signed by a party estimate only and that the actual date on which the Work is completed may be thereto at a place other than an address of the seller,which extended to allow for Change Orders requested by Owner ar if the time to may be his main office or branch thereof,provided you notify complete the Work is affected by conduct of the Owner,weather,labor disputes,availability of subcontractors,acts of God,fire or other causes the seller in writing at his main office or branch by ordinary reasonably beyond Pella's control.If for any reason the Work is not fully mail posted,by telegram sent or by delivery,not later than completed by the Substantial Completion Date(including any extensions midnight of the third business day following the signing of this contemplated above),but is substantially completed by such date,i.e.,the agreement. Product has been installed,but minor parts or components are missing or need to be replaced or repaired,a hold back proportionate to the cost of remaining See the attached Notice of Cancellation for an explanation of parts or work to be completed is acceptable.However,the holdback will not exceed the amount of the completion costs or 10%of the remaining unpaid this right. balance of the Price,whichever is less. 6. FINANCING Do not sign his contract if the-e are any blank spaces. If payment of the Price is financed with a financial institution through Pella,all financing paperwork must be completed upon signing of this Contract and the requisite approvals and authorizations for the full amount of the requested financing shall have been received from the financial institution. Costo iiire $123' Date DISPUTES THE CONTRACTOR AND THE HOMEOWNER HEREBY MUTUALLY AGREE IN ADVANCE THAT IN THE EVENT PELLA HAS A DISPUTE CONCERNING THIS CONTRACT, PELLA 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 Pella Windows & Doors Contractor Ho owne or NOTICE: THE SIGNATURE OF THE PARTIES ABOVE APPLY ONLY TO THE AGREEMENT OF THE PARTIES TO ALTERNATIVE DISPUTE SETTLEMENT INITIATED BY THE CONTRACTOR, THE OWNER MAY INITIATE ALTERNATIVE DISPUTE RESOLUTION EVEN WHERE THIS SECTION IS NOT SEPARATELY SIGNED BY THE PARTIES. NOTICE OF CANCELLATION Date of transaction: 8/23/16 You may cancel this transaction, without any penalty or obligation, within three business days from the above date. If you cancel, any property traded in, any payments made by you under the agreement, and any negotiable instrument executed by you will be returned within ten business days following receipt by the seller of your cancellation notice, and any security interest arising out of the transaction will be cancelled. If you cancel, you must make available to the seller at your residence, in substantially as good condition as when received, any goods delivered to you under this agreement; or you may if you wish, comply with the instructions of the seller regarding the return shipment of the goods at the seller's expense and risk. If you do make the goods available to the seller and the seller does not pick them up within twenty days of the date of your notice of cancellation, you may retain or dispose of the goods without any further obligation. If you fail to make the goods available to the seller, or if you agree to return the goods to the seller and fail to do so, then you remain liable for performance of all obligations under the contract. To cancel this transaction, mail or deliver a signed and dated copy of this cancellation notice or any other written notice, or send a telegram to Pella Windows and Doors, at 45 Fondi Rd., Haverhill, NIA 01832 not later than midnight of 8/26/16 (three business days from the date of transaction above). I hereby cancel this transaction. (Date) (Buyer's signature) The Co ut mo tz w e afth ofMassachage tts Department of IndustrialAccidents 1 Congress Street,Suite 100 Y Boston,MA 02114-2017 www.massgov/dia Workers'Compensation Insurance Af idavit:Buielders/Contractors/Elecbxiciaas/Plumbers. TO RE MED WITH THE PERlIH=Cy AUTHORITY. Applicant Information Please Print Legribly Nalne(BusinrWOrganiaation/Individaal): Aub Doon- Address: City/State/Zip: 14AY rt, i ff i Phone#: ®� Are you an employer?Check the appropriate box: Type,of project(required): mm a employer with employees(full.andlorpart-time).* 7. ❑New construction 2.❑I am a sole proprietor or partnership and have no employees working forme in $, WRernodeling any capacity.[Noworkers'comp.insa rance required] 1E]I am a homeowner doing all work myself[No workers'comp.insunince required]t 9. ❑Demolition IO []Building addition 4.❑I am a homeowner and will be hiring contactors to conduct all work on my property. I will ensure that all conhactors either have workers'compensation insurance or are sola- 11.Q Electrical repairs or additions proprietors with no employees. ,12:[-]Plumbing repairs or additions 5.F1 I am a general contractor and I have hired the sub-contractors listed on the attached sheet These mih contractors have employees and have workers'camp.insmmce.t 7 3. Roof repairs b.Q We are a corporation and its officers have exercised their right of exemption perMGL c. 14.Q Other 152,§1(4),and wo have no employees.[No workers'comp.insurance required.] *Any applicant that checks box#I must also fill out the section below showing their workers'compensation policy infeamation. t Homeowners who submit this affidavit indicating they are doing all work and th=lure outside contractors wast sufmrit a new affidavit indicating suck tCeutractors that check this box must attached an additional sheet showing tic name of the sub-contractors and state whether or not those entities have employees. If the sub-ranhactors have employees,they must provide their workers'comp.policy number. lam an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information_ Insurance Company Name: - —WI s MSC _._. Policy#or Self ins.Lic.#: C�l� (� Expiration Date: 77,/-177 Job Site Address: CitylStateJZip: 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. .I do hereby certit fy under thapains and penaWes of perjury that the information provided above is true and correct Simafore: A Date: Phone#: Offirlal use only. Do not write in this area to be completed by city or town offuiaL City or Town: Permit/License# Issuing Authority(circle one):. 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector S.plumbing Inspector G Other i Contact Person: Phare#: DATE A CERTIFICATE OF LIABILITY INSURANCE ox07nD1eMM1DomYYJ 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 BOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(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 lieu of such endorsements). PRODUCER CONTACT Dorolhy A.Cadeh,CIC,RPLU Fred C.Church,Inc. NAME: 41 Wellman Stree[ PHONE 978 3227231 FAX (878)454-1885 Lowell,MA 01851A1C N.I: (800)225-1865 AEUORESS: dcodell@hedcchurch.cam INSURER(S)AFFORDING COVERAGE MAIC N INSURER A: CBizens Insurance Cor7pany ofAmerioa 31554 INSURED New Hampshire Employers Insurance Company 13083 New England Window 8 Door LLC INSURER 8: — 45 Fondi Road INSURER C: Haverhill,MA 01832-1302 INSURER D: INSURER E; INSURER F: COVERAGES CERTIFICATE NUMBER:58475 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 NTH 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. 1XP LTR � TYPE OF INSURANCE INSR WVDSUBIPOLICY NUMBER MMMOYNYYY MMNRIYEfF POLIO EYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,OOD,000 X DAMAGE ENT111 COMMERCIAL GENERAL LIABILITY PREM SES Ee occu.. $ 100,000 CLAIMS-MADE 1XI OCCUR MED EXP(Any one person) $ 10,ODO A X CG0001 ,ZBN8181407 7!112018 7112017 1,009,000 -_ PERSONAL&ADV INJURY $ GENERAL AGGREGATE $ 2.000,000 GENT AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGG $ 2.000,000 POLICY X PR0. X LOC -- $ — — AUTOMOBILE LIABILITY COMBIN O SINGLE LIMIT a accident ANYAUTO BODILY INJURY(Per person) $ ALL OWNED SCHEOVLED BODILY INJURY(Peraccident) $ AUTOS AUTOS. NDN-OWNED PROPERTYDAMAGE $ HIREOAUTOS AUTOS (Per acLidenl UMBRELLA LIAR OCCUR EACHOCCURRENCE $ EXCESS LIAB CLAIMS-MAGE AGGREGATE $ OED RETENTION$ $ WORKERS COMPENSATION X IAC STATU- OTH- ANDEMPLOY£RS'LIABILITY YIN i.48YLIMIT, 509,000 B ANY PROPRIETORIPARTNEREXECUTIVE❑ NIA 8907024 7112016 711/2017 E.L.EACH ACCIDENT $ OFFICERIMEMBER EXCLUDED? 500,000 (Mandatory in NH) E.L.DISEASE-EA EMPLOYE $ 4 yes,describe under500,000 DESCRIPTION OF OPERATIONS below E.L.D)SEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 161,Additional Remarks Schedule,H mora apace is required) CERTIFICATE HOLDER CANCELLATION Town of North Andover 1600 Osgood street,Selle 2043 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Ndh Andover,MA 01845 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Client p Mstp58475 19515 4 Cert Holder# ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD May � L 4 CS-089853 WILLIAM[R NI CFiOLS 57 I'LA�RTTtEE RI}`. R HAiVERI�I t MA; 01830 . ` � *- 11712¢1,2016 'f cc of Consumer Affairs&Business]Regulation' License or registration valid for individal use only E IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Office of Consumer Affairs and Business Regulation .......... , egistration 183279 Type: . 10 Park Playa-Suite 5170 Expiration: 9/24/2017 Su lemeni C;ird PA Boston,MA 02116 NEW ENGLAND WINDOW&DOOR,LLC. PELL.A WINDOWS&DOORS : Wiliam Nichols 45 FONDI € OAD HA`lERHLL,MA 01832 - Undersecretary Not valid.without signature