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HomeMy WebLinkAboutBuilding Permit # 9/1/2016 NORTH q ® 9 BUILDING PERMIT �� y4..:, � � ?a OL TOWN OF NORTH ANDOVER ° u '� APPLICATION FOR PLAN EXAMINATION Date Received Permit NO: 74 ORATto/SPP k.(�7 Date Issued: l SSACHUS i IMPORTANT: Applicant must complete all items on this page LOCATION Print PRC�PERT�`, UVER � ; Pr�O 11/1AP N 011 ARCEL BONING DISTRICT: H€storrc Distract:' yes' nca' Ma'chrneShopl/rllage yes no.:: TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building One family Addition Two or more family Industrial Alteration No. of units: Commercial I ' Repair, replacement Assessory Bldg - Others: r: Demolition i Other Septic d WellQ Floodplain 1IIletlans i Watershed Drstrict U WaferlSewer. ItWA6.4-&e Pfm Identification Please Type or Print Clearly) OWNER: Name: Phone: Address: CONTRACTOR Namepj Phone: a� � - - - Address, Supervisor's Construction License Exp Dated�c t5r -. � Dome Improvement Licernse: Exp Da e ARCH ITECTIENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PEF?S.F. Total Project Cost: $ -fi FEE: $ Check No.: Receipt No.: a NOTE: Person co tracting with rcnregistered contractors do not have access to the guaranty fund Signature o A ignatur of contractor, N®RTTF owe. of `� _ �., 6Andover ® "vim yry No. n h0 .w to h ver, Mass, *kvn6/ COC MICNRM.KK`�' 04ATED p. C7 U BOARD OF HEALTH Food/Kitchen PER T LD Septic System THIS CERTIFIES THAT ................... .G�Q ........ ��..'.�.. .. BUILDING INSPECTOR . .. ....................................... 5� ��� + Foundation has permission to erect .......................... u'rldings on ........................... ... ..............I.................... � Rough ,,,�jam. to be occupied as .. .........................G� ..... ....... .... ... ....... > ...... ....... ..... ...L-I... ..1 chimney provided that the person accepting this permit shall in every respect conform to the erms of M 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 MONTHS ELECTRICAL INSPECTOR. . LESS CONST CTION Rough Service Final BUIL©IN INi ECTOR GAS INSPECTOR ®chancy .Permit Required„to ®ceuwy Buiidin 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 Approved by the Building Inspector. Burner Street No. Smoke Det, i the Cornmonweal'th of 112aysq� husetts . 8pa-ftxeni aflndust ial-4ceidents 1 congre,�s mpeet,suite X 00 — d .Sastov,Ili.02114-2 017 " �o�kexs'Coxmpea�.sati:o�x��•aucedavat:$udders/Coyt�rac�axsl.�i+,ecf�cxciax�,s/.�X�nbe�'s. TO=W"W:>.y R TM PMvRTT'NCx AUTf lop-M- AppjicantInfnxmatinn - �IeaseRxiut lle�ibl Nemo (Susiess/dxgaaizatioWfndi-ddual.)' O C Qtylstatefzip: C� ��ecnc 6'l GtWphane#: -62a ire ycu an empleyer? Cieci��lie��apnpriafe box Typeof project(Y ecYrii ed) 1 I asv a employcz i employees( and/azpart 4ivae),* 7.• New DOA9i Holl 2.�Iantasaleptoprzdnraxpar tershipaud7�aYeuoemployewwozkfngformein. 8. Rolnodahlig any capacity.[No o'k—,comp-insurance req*edl 9. �l3em olitio� J[]lam abomenwnar doing4 woxkmysel£END wozkers'comp.-insmauce zecluired.l E 10 []Bujl ding addition 4.rl I am a hameomaxand Elbe biting contmeLOrs to conduct all work onmy propezty. '-W' 11.[]Electt`�ca1 repairs ox.additions ensure the,all contactors either have wozkers'compensafion insurance or are sole �, proprietors��zt'nno e npxoyees. 12 0 Plumbixag xepairs or additions �.��aru a.general contractor and�ltavelvred-ths sub-contractors Iisted onii7e aihacbed sheet. 13.•Q Roo£:repa-"irs 1.hese sub-eeniraotorshav�ez�nployees andhaveworkers'comp_insnrance.� 14.Ll Qtl'iEr ' b.�We are acorporat~ipit andiis oi�eers have egercised-theii zip of o�empt€nu pezxvlCrI.a. ^ and Yr,* enc e nployaes,WPworlcers'comp.insufmcesequiredl •. a `Auyapplicaattlaa cheeksb6x41must:also�Out the seetronbelovtslrovtingtheirW 'cors'compensationpolinyirrrormalion i Horaeo�ters v�1ia sulirfiiik aftidavifiindicahngfl�y are dniagall�vnrkmdthenhim outside eontractorsmusLs i�itanet5�a£ davrtindicaiing such g ontrantas batrJierlstlzisbo nursi a`Laef ed a r additional sheetshowingthp none,ofthe snb-con-tractors and state vftther ozPotr Ua n ent t"have employees.I-Ethnsub- ziJre.c�O Aar-& ployecs,iheymvstpcoridefbes workers'nnmp.polrcynuuiber oa 7 art erri loyextTzat ioviczi ig voxke ug comer er2satzar�zrxsxrrul2cefa�rrxy MPIp ,gees:'Below isthe ponq andjob szte �nfarrnatia�2. - Insurance Compaayaze: cc �' �� CityJ�ta�e/.�.p: � C`tG1�•2d�� ��f'� Job Site.Ad&ass m � Attach a copy of thovVorkers' cox�xpe atioxt poiZcy cleclarali on page(sb.o ug the PORCYnumbex'ane eXpirat'0DL d;ef'e). pail-Ure to S`ec]I2�cavetage as requrxeri•au6ar M xGL a. 152, §25A.is a cximzual iolation punisbablo lay a fe Ftp to$1,500.00 and/ox one-year cov6taga as y as Well as civil.panalties inthe form o:'a ST 2 WORK ORDIR a7a.d a fine o�'ztp to$250.00 a day against the-violator_&copy oftbis statement may be fbiwatdedto&D Ofctce ofhlvestigaixons of theD7A frit ante cayexage vexMcatiozz. ' ?A e�ei3�cex i mer tt2 e p¢zns a d penalties o el'" tlacc the i�orm�rtio�t rto�ideci c�Xia;�e is free r correct Date: , Si abue: I?hone official zrse ori%y. Do root-wive in this area,to he completed by cite or torvs�0 cl- L City or Tagaax: ernaitfLicexxse# fEsuing.Avthoxltg(circle one): ' �.�+lectrical� eetar 5.121>�xobzngSx�s ectox 1.-'Board offleal iZ 2.BvIdiugDepartme-gat 3.City/Town Clerk p P &.Other Coxztac.tI'exso a: Yhone : -dafttar- Authorization to Perform Services and Direction of Payment Michael Doran 08/03/2016 Customer Name: Date of Loss: Loss Address: 57 Mill Pond NORTH ANDOVER MA 01845 City: State: Zip: Insurance Company: SAFECO Claim Number(if available): 872014236037 The undersigned Customer, being the building owner, owner's representative, or resident, authorizes the Provider identified below to perform any and all necessary cleaning and/or restoration services on Customer's property located at the property address above, and with respect to items that need to be cleaned at a remote location to remove and clean such items as necessary. Customer authorizes SAI=ECO Insurance Company, herein referred to as "Insurance Company,"to pay Provider solely and directly for that portion of the work covered by Customer's insurance policy, If, for any reason, Customer receives a check from Insurance Company made payable to Customer, Customer agrees to pay Provider immediately upon receipt of the check. In order to expedite payment to Provider, Customer hereby appoints Provider as attorney-in-fact, authorizing Provider to endorse Customer's name on Insurance Company checks or drafts, and to deposit Insurance Company checks or drafts for Provider services. Customer agrees to pay Customer's deductible in the amount of$ $0'00 that applies to this claim. If any amounts owing to Provider for Provider services are not covered by insurance, Customer agrees to pay those amounts to Provider within fifteen (15) days of Customer's receipt of invoice. It is fully understood that Customer and its agents, successors, assigns, and heirs are personally responsible for any and all deductibles and any costs not covered by insurance. Interest and finance charges will be charged at the maximum allowable by law, or at 1.5% per month, whichever is less, on accounts over thirty(30) days past due. Time is of the essence. Customer agrees that Provider is working for the Customer and not Customer's insurance company or any agent/adjuster. Property Owned By: Michael Doran Remarks: I HAVE READ THIS AUTHORIZATION TO PERFORM SERVICES AND DIRECTION OF PAYMENT, INCLUDING THE TERMS AND CONDITIONS OF SERVICE ON THE NEXT PAGE HEREOF, AND AGREE TO SAME. Customer Reviewed Customer Information Form: G Y ON O (� Provider's Signature: Customer's Signature: A"lid "Uk ti _ Franchise Legal Name: KEJO CORP Printed Name: Michael Doran d/b/a SERVPRO®of: The Andovers Date: 08/03/2016 Date: 08/03/2016 E-mail Address: michaeldoranarts@gmail.com Contractor License#: ©SERVPRO®INTELLECTUAL.PROPERTY,Inc. ALL RIGHTS RESERVED FE-051707 1,0 28000 05116 Each SLR 11PJ?6f'Frmichise rs li�depe)rderuly Owned and Operated. Authorization to Perform Services and Direction of Payment Terms and Conditions of Service READ CAREFULLY Note: This Contract includes a limitation of liability and limitation of remedies. 1. SERVPRO®is one of the largest nationwide Cleaning and Restoration Franchise Systems in the United States,The SERVPRO®Franchise owner identified on the front of this Contract(the"Provider")is an independent contractor who agrees to perform the services identified on the front of this Contract(the"Services').Client agrees to purchase,receive,and pay for the Services pursuant to the terms and conditions of this Contract. Servpro Industries,Inc.,the Franchisor,is not a party to any agreement with Client,is not a guarantor of the Provider's Services,and is not subject to liability arising out of such Services. 2. Provider's performance of the Services is limited by,among other things,the pre-existing conditions and characteristics of the premises,material, fabrics,furniture,and/or other items.PROVIDER EXPRESSLY DISCLAIMS ANY RESPONSIBILITY OR LIABILITY FOR ANY PRE-EXISTING CONDITIONS.Client shall retain responsibility and shall be liable for all effects of and costs necessary to correct such conditions,including,byway of example and not limitation,the conditions identified below: (a) Provider may,in its sole discretion,pre-test materials for removability of spots or stains;dye or colorfastness;shrinkage;fading;adhesive breakdown;or other problems.It is not always possible to determine these conditions in advance. PROVIDER DOES NOT GUARANTEE SPOT OR STAIN REMOVAL AND COLOR FASTNESS OR PREVENTION OF SHRINKAGE,FADING,OR ADHESIVE BREAKDOWN. (b) Provider DOES NOT GUARANTEE that wall and coiling cleaning will restore the original color to painted surfaces. (c) Not all fabrics are conducive to cleaning.Provider shall use reasonable efforts to advise Client of any adverse effects which may be reasonably foreseen due to the nature of the fabric or material involved. PROVIDER DOES NOT GUARANTEE THAT SUCH MATERIALS CAN BE CLEANED OR THAT THERE WILL BE NO ADVERSE EFFECTS FROM ANY ATTEMPT TO CLEAN SUCH FABRICS. (d) A variety of materials are used in the manufacturing,upholstery and/or installation process.These materials include racking,lining,tacks,or other unknown substances that may cause discoloration or other adverse effects to the face material.Client acknowledges that it is impossible to determine when such adverse effects may occur and PROVIDER DOES NOT GUARANTEE AGAINST SUCH ADVERSE EFFECTS. (e) Client acknowledges and agrees that mold is commonly found throughout the environment and that it is impossible to eradicate mold. PROVIDER DOES NOT GUARANTEE THE REMOVAL OR ERADICATION OF MOLD. (f) Client acknowledges and agrees that limited photographs or video of the damage and cause may be made solely for work process and insurance claims purposes. 3. PROVIDER SPECIFICALLY DISCLAIMS ANY AND ALL OTHER WARRANTIES AND ALL IMPLIED WARRANTIES(EITHER IN FACT OR BY OPERATION OF LAW)INCLUDING, BUT NOT LIMITED TO,ANY IMPLIED WARRANTIES OF MERCHANTABILITY AND FITNESS FOR A PARTICULAR PURPOSE OR ANY IMPLIED WARRANTY ARISING OUT OF A COURSE OF DEALING,CUSTOM OR USAGE OF TRADE. THIS CONTRACT PROVIDES FOR THE PROVISION OF SERVICES AND DOES NOT PROVIDE FOR A SALE OF GOODS. 4. Limitation of Liability: IN NO EVENT SHALL PROVIDER,ITS OWNERS,ANY OFFICERS,DIRECTORS,EMPLOYEES,OR AGENTS, FRANCHISOR,OR AFFILIATES BE RESPONSIBLE FOR INDIRECT,SPECIAL,NOMINAL,INCIDENTAL, PUNITIVE OR CONSEQUENTIAL LOSSES OR DAMAGES, OR FOR ANY PENALTIES,REGARDLESS OF THE LEGAL OR EQUITABLE THEORY ASSERTED,INCLUDING CONTRACT,NEGLIGENCE,WARRANTY,STRICT LIABILITY,STATUTE OR OTHERWISE,EVEN IF IT HAD BEEN AWARE OF THE POSSIBILITY OF SUCH DAMAGES OR THEY ARE FORESEEABLE,OR FOR CLAIMS BY A THIRD PARTY.THE MAXIMUM AGGREGATE LIABILITY SHALL NOT EXCEED THREE TIMES THE AMOUNT PAID BY CUSTOMER FOR THE SERVICES OR ACTUAL PROVEN DAMAGES,WHICHEVER IS LESS.IT IS EXPRESSLY AGREED THAT CUSTOMER'S REMEDY EXPRESSED HEREIN IS CUSTOMER'S EXCLUSIVE REMEDY.THE LIMITATIONS SET FORTH HEREIN SHALL APPLY EVEN IF ANY OTHER REMEDIES FAIL OF THEIR ESSENTIAL PURPOSE.Some statesicountries do not allow the exclusion or limitation of incidental or consequential damages,so the above may not apply to you. 5. Should Provider bring legal action to collect monies due under the Contract or should the matter be turned over for collection,Provider shall be entitled,to the fullest extent permitted under law,to reasonable legal fees and costs of any such collection attempt,in addition to any other amounts owed by Client.This attorney fee provision shall not be effective or enforceable in jurisdictions where attorney fee provisions are made reciprocal or invalid by operation of law.Consent is hereby given for filing of mechanic's liens by Provider for the work described in this contract on the property on which the work is performed if Provider is not paid. 6. Any labor,materials or other work beyond that identified in this Contract shall require a written amendment to this Contract and will result in additional charges. 7. Any claim by Client for faulty performance,for nonperformance or breach under this Contract for damages shall be made in writing to Provider within sixty(60)days after completion of services.Failure to make such a written claim for any matter which could have been corrected by Provider shall be deemed a waiver by Client. NO ACTION,REGARDLESS OF FORM,RELATING TO THE SUBJECT MATTER OF THIS CONTRACT MAY BE BROUGHT MORE THAN ONE(1)YEAR AFTER THE CLAIMING PARTY KNEW OR SHOULD HAVE KNOWN OF THE CAUSE OF ACTION. 8. A failure of either party to exercise any right provided for herein shall not be deemed to be a waiver of any right hereunder. 9. CLIENT AND PROVIDER EACH WAIVE THEIR RESPECTIVE RIGHTS TO A TRIAL BY JURY WITH RESPECT TO ANY AND ALL CLAIMS OR CAUSES OF ACTION(INCLUDING COUNTERCLAIMS)RELATED TO OR ARISING OUT OF OR IN ANYWAY CONNECTED TO THIS CONTRACT AND AGREE THAT ANY CLAIM OR CAUSE OF ACTION WILL BE TRIED BY A COURT TRIAL WITHOUT A JURY. 10. If any provision of this Contract is found to be ineffective,unenforceable or illegal for any reason under present or future laws,such provision shall be fully severable,and this Contract shall be construed and enforced as if such provision never comprised a part of this Contract.The remaining provisions of this Contract shall remain in full force and effect and shall not be affected by the ineffective,unenforceable or illegal provision or by its severance from this Contract. 11. No modification,termination,or attempted waiver of this Contract shall be valid unless in writing and signed by the party against whom the same is sought to be enforced. SERVPRO®Franchisees are always looking for motivated employees. SERVPRO's individually owned and operated franchises offer a variety of positions including crew chief, production technician, marketing representative, administrative assistant,and many more. 28000 05/16 Each SERVPRG( Franchise is hidependend),Osoied acrd Operated, Servpro SERVPRO of Lawrence 2064 SERVPRO of Salcm/Plaistow 5389 SERVPRO of The Andovers 5390 978.688.2242 office@servprooflawrence.com PO Box 328 Lawrence,MA 01842 Tax ID#02-0353691 Client: Doran Demo Permit Property: 57 Mill Pond North Andover,MA 01845 Operator: PNOTAR6 Estimator: Paul Notartomaso,Jr. Business: (603)475-2447 Company: SERVPRO Of Lawrence-SERVPRO Of The E-mail: Paul@ServproOfLawrence. Andovers-SERVPRO Of Salem/Plaistow com Business: 8 Blakelin St Lawrence,MA 01841 Type of Estimate: Water Damage Date Entered: 8/25/2016 Date Assigned: Price List: MAEMBX AUG 16 Labor Efficiency: Restoration/Service/Remodel Estimate: 2016-08-25-1143 Servpro SERVPRO of Lawrence 2064 SERVPRO of Salem/Plaistow 5389 SERVPRO of The Andovers 5390 978.688.2242 office@servprooflawrence.com PO Box 328 Lawrence,MA 01842 Tax ID#02-0353691 2016-08-25-1143 Main Level I-S•I'•y z•r•F...r s°- Living Room Height: 8' T UgR-., J i612.00 SF Walls 264.70 SF Ceiling 876.70 SF Walls &Ceiling 264.70 SF Floor 29.41 SY Flooring 76.50 LF Floor Perimeter 76.50 LF Ceil, Perimeter DESCRIP'T'ION QUAN'TIT'Y UNIT PRICE TAX RCV DEPREC. ACV 1. Tear out wet drywall,cleanup,bag,per LF-up to 4' 10.00 LF 4.20 0.49 42.49 (0.00) 42.49 tall 2. Tear out wet carpet pad and bag for disposal 198.53 SF 0.45 0.87 90.21 (0.00) 90.21 3. Tear out wet drywall,cleanup,bag for disposal 198.53 SF 0.81 2.36 163.17 (0.00) 163.17 Totals: Living Room 3.72 295.87 0.00 295.87 Total: Main Level 3.72 295.87 0.00 295.87 Level 2 Sink Room Height: 8' z N 3 = 172.00 SF Walls 24.30 SF Ceiling r 2's nk Ru „ c},,, 196.30 SF Walls &Ceiling 24.30 SF Floor r 2,70 SY Flooring 21.50 LF Floor Perimeter 21,50 LF Ceil.Perimeter u s•3 Haihnmm DESCRIPTION QUANTITY UNIT PRICK TAX RCV DEPREC. ACV 4. Remove Vanity 4.00 LF 6.43 0.00 25.72 (0.00) 25.72 5. Tear out wet drywall,cleanup,bag,per LF-up to 2' 10.75 LF 2.88 0.26 31.22 (0.00) 31.22 tall Totals: Sink Room 0.26 56.94 0.00 56.94 2016-08-25-1143 8/25/2016 Page: 2 Servpro SERVPRO of Lawrence 2064 SERVPRO of Salem/Plaistow 5389 SERVPRO of The Andovers 5390 97 8.68 8.2242 office@servprooflawrence.com PO Box 328 Lawrence,MA 01842 Tax ID#02-0353691 tY nsct Bathroom Height: 8' T 202.67 SF Walls 38.94 SF Ceiling 241.60 SF Walls&Ceiling 38.94 5F Floor 4.33 SY Flooring 25.33 LF Floor Perimeter 25.33 LF Coil. Perimeter mss.k, DESCRIPTION QUANTITY UNIT PRICE TAX RCV DEPREC. ACV 6. Tear out wet drywall,cleanup,bag,per LF-up to 2' 12.67 LF 2.88 0.31 36.80 (0.00) 36.80 tall Totals: Bathroom 0,31 36.80 0.00 36.80 Total: Level 0.57 93.74 0.00 93.74 Line Item Totals: 2016-08-25-1143 4.29 389.61 0.00 389.61 Grand Total Areas: 1,645.33 SF Walls 570.92 SF Ceiling 2,216.25 SF Walls and Ceiling 570.92 SF Floor 63.44 SY Flooring 205.67 LF Floor Perimeter 0.00 SF Dong Wall 0.00 SF Short Wall 205.67 LF Ceil,Perimeter 570.92 Floor Area 633.61 Total Area 1,64533 Interior Wall Area 1,516.50 Exterior Wall Area 168.50 Exterior Perimeter of Walls 0.00 Surface Area 0.00 Number of Squares 0.00 Total Perimeter Length 0.00 Total Ridge Length 0.00 Total Hip Length 2016-08-25-1143 8/25/2016 Page: 3 Servpro SERVPRO of Lawrence 2064 SERVPRO of Salem/Plaistow 5389 SERVPRO of The Andovers 5390 978.688.2242 office@servpi,00flawretice.com PO Box 328 Lawrence,MA 01842 Tax ID#02-0353691 Summary for Dwelling Line Item Total 385.32 Material Sales Tax 4.29 Replacement Cost Value $389.61 Net Claim $389.61 Paul Notartoinaso,Jr, 2016-08-25-1143 8/25/2016 Page: 4 Servpro SERVPRO of Lawrence 2064 SERVPRO of Salem/Plaistow 5389 SERVPRO of The Andovers 5390 978.688.2242 office@sei-vprooflawi-etice.com PO Box 328 Lawrence,MA 01842 Tax ID##02-0353691 Recap of Taxes Material Sales Tax(6.25%) Clothing Sales Tax(6.25%) Storage Tax(6.25%) Line Items 4.29 0.00 0.00 Total 4.29 0.00 0.00 2016-08-25-1143 8/25/2016 Page: 5 Servpro SERVPRO of Lawrence 2064 SERVPRO of Salem/Plaistow 5389 SERVPRO of The Andovers 5390 978.688.2242 office Co)servprooflawrence.com PO Box 328 Lawrence,MA 01842 Tax ID#02-0353691 Recap by Room Estimate: 2016-08-25-1143 Area: Main Level Living Room 292.15 75.82% Area Subtotal: Main Level 292.15 75.82% Area: Level 2 Sink Room 56.68 14.71% Bathroom 36.49 9.47% Area Subtotal: Level 2 93.17 24.18% Subtotal of Areas 385.32 100.00% Total 385.32 100.00% 2016-08-25-1143 8/25/2016 Page: 6 Servpro SERVPRO of Lawrence 2064 SERVPRO of Salern/Plaistow 5389 SERVPRO of The Andovers 5390 978.688.2242 office@servpi-ooflawrence.com PO Box 328 Lawrence,MA 01842 Tax 1D#02-0353691 Recap by Category Items Total % GENERAL DEMOLITION 385.32 98.90% Subtotal 385.32 98.90% Material Sales Tax 4.29 1,10% Total 389.61 100100% 2016-08-25-1143 8/25/2016 Page: 7 Main Level 17' 10'1 �o v� 2' in Living Room f:314"—3 Oc 10' 8" - 10181' .. oa 00 -—3' 2" uu �-3' 1011 Main Level 2016-08-25-1143 8/25/2016 Page: 8 .................................. Level 2 —171411 Master Bedroom N 00 218" 51 9„ 8' 7T' �-- 2'- 2T Sink Roo Closet �' in m ib T 51t Bathroom t' $, 1'? Level 2016-08-25-1143 812512016 Page:9 C@ DATE(MMIDDIYYYYI �'►CC7�a CERTIFICATE OF LIABILITY INSURANCE 08/19/2016 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 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 CONTACT NAME: Dabney Collier PHONEFax C/o Collier insurance ..(,Ma—No.Extl: (901)529-2900 LAIC,No): (901)_529-2916 606 S.Mendenhall;Suite 204 ADDRESS: Memphis,TN 38117 INSURER(S),AFFORDING COVERAGE NAIC# INSURER A: American Zurich Insurance Company 44142 INSURED INSURER B Adams Keegan,Inc. -....._m INSURER C 6750 Poplar Ave Ste 400 Memphis,TN 38138 INSURER D; INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:15TNO09858085 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 ADDL SUER NUMBER POLICY EFF POLICY EXP LIMITS LTR WSD WVO POLICY NUMBER MMlDDlYYYY MMIODIYYYY COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE 5 DAMAGE RENTff'CLAIMS-MADE r OCCUR PREM SESOEa occur ence 5 MED EXP(Any one person) S PERSONAL A ADV INJURY $ G£N'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE S POLICY C-_1 JECT FLOG PRODUCTS-COMPIOP AGG $ OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE $ _(Ea accident ANY AUTO BODILY INJURY(Perpersan( $ ALL OWNED SCHEDULED .....__....._ .............. AUTOS _ AUTOS BODILY INJURY{Peraccidenl) $ NON-OWNED PROPERTYIJAMAGE $ HIRED AUTOS AUTOS 5 UMBRELLALIAB I OCCUR EACH OCCURRENCE S H_ EXCESS LtAB CLAIMS-MADE AGGREGATE 5 DED RETENT10N5 Is WORKERS COMPENSATION xPER AND EMPLOYERS'LIABILITY STATUTE ER Y r N ANY PROPRIFTORIPARTNERIEXECUTIVE E.L.EACH ACCIDENT $ 1,000,000 A OFFICERIMEMBER EXCLUDED? N I A WC 56-11-865-02 12/41/2415 12/01/2416 - -°- - (Mandatory In NH) E.L.DISEASE-EA EMPLOYE $ 1,000,000 If yes,describe under DESCRIPTtON OF OPERATIONS below E.L.DISEASE-POLICY LIMIT 5 1,000,004 Location Coverage Period: 12/01/2015 12/01/2016 Client# 2410-MA 1 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,maybe attached if more space Is required) Coverage is provided for KEJO Corporation dba:SERVPRO of Lawrence Bi only those co-employees Weekly of,but not subcontractors 8 BLAKELIN ST to: Lawrence.MA 01842 CERTIFICATE HOLDER CANCELLATION Doran SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE (Michael 7 MITI Pond North THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Andover,MA 01845 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE__ ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2614/01) The ACORD name and logo are registered marks of ACORD SEP-01-2016 THU 04:03 Pik SERVPRO OF LAWRENCE FAX N0. 9786877706 P. 02 WHITKE1 OP ID-.PI . DATA(p1R!lPD1YYYYI CERTIFICATE OF LIABILITY INSURANCE 0910112016 JNFORMATION ONI.Y AND CORS NO GHTS UPON THE CERT151CATE'HOLDE111- YNfS CERTIFICATE IS ISstj MATTER OF OIR NI<GATIVELY AMEND, EXTEND OR ALTER�IHECOVIERAGE AFFORDED BY THE Pau EIS CERTIFICATE DOES NOT. F RMAT BELOW, THIS CERTIFICATE OF,INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWI=I=N THE ISSUING INSURI R(S), AUTHORIZED Rf`pRE3irNTATIVts OR PRODUCER,AND THE CERTIFICATE Hp1.DL:R, as must tea endorsed, If SUBROGATION IS-WAIVED,subleat to IMPORTANT: If t1ja caniflcate holder Is an ADDITIONAL. INSURED, khe pollcy(l ) the terms and conditions of the policy,certain pollales may require an endorsement. A statemelat on this ce lflcata does not confer rights x0 the Certificate holder in Ilou of such endorsements. AOT James FR.Mc Donald PRDAUGER ;M a C d:6U8.708Z7012 Stanley McDonald Agency 80$788-6160 1101 Main street n MALI Onalaska,WI 646130 Nato# James R.{VTC L}anaia IN6URER 9 AFFORoING C4VERAG!~ iNSURERA,Rockhlll Insurance Crani an 28053 INSURER o.Thq Federal Inoun nco'CO- 20281 INOURsu KeJo Corporatlon 20699 dba Servpro of Lawrence INsuRr c:ACE Pro e -&casualty See Note For Named insured IN6URERAs po Box 328 INSURER E,. Lawrence, MA 01842 INI3upER F; 00VRRAGE8 CERTIFICAT NUMRF-R: RRVIMED NUMBER; THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED DELOW H1iVE SEEN ISSUED TQ THE INSURED NAMED ABOUF FR Tt{!<POI-ICY PERIOD IN T FICA7E MAY 6SSUED OR NMAY PERTAIN, THEINSURAN4E AFFORFED ERM OR COND17ION OF Y THE' POLICIES D SCRCT OR �BED HE DEIN is SNT I IJB3EC7 TO ALTH RESPEOT �HEI TIMRM5, EXCLUSIONS AND CONDITIONS QF SUCH POLICIES.LIMITS SHOWN MAY HAVE UE11N REDVC51}BY PAID CLAIMS. L1M1T8 a TYPE CFINSURANG!' App 00"GYRUMOPR M1O MM! P L EACH OCCURRENCE S 2,000,00 A X COMMERCIAL GENERAL LIARILiTY 50,00 CIA1tALEE AL oOCIlR ENVP016006-00 '0310112016 03/0112017 oaa 6 Mao 'EXP{An one arson $ 8:000 PERSONAL&ADV INJURY $ _ 2,000,000 [3ENERAI.AOGREGATE $ 3100010.00 G>N`L AGGREGATE LIWTAPPLIE8 PER; 3'000,000 LOC pFtODUCTa-COMPIDP AGO S � POLICY❑jPCT $ OT E ! C0M$NED SIN L ]MIT S AUTONMO$II.E I.]AEII.ITY RODILY INJURY{Por parson) 8 ANYAUTO WUPiLYINJURY(per¢catdeR:) S RLLCWNEP 90HEPULEO R AUTOS - U 1.8, NE 0 HIRED AUTOS AUTOS $ EACH OCCURRENCE 110001000 uMORELLA I.IAS _ OCCUR1,000,flD0 C EKCE66WA13 CLAIM-MADE 14100798617 1)111412016 01114/2017 AGGREGATE $ I000p $ EO X RETENT D P - WORKERS COMPENSATION AND FMPLOYERS'LIA13ILITY YIN E.L,EACH ACCIDENT $ ANY PROPRIETOR1PARTNERJRXECUTIVE /A E.L.DISE,A$R-EA.EMP1.oYF S OFFICERMIEMB£R>:sfC uDE,D? N (Mandatory,rn NH) 41 Bnu�4vs�riba u0nder E,G.D1&1wA&E-POLICY LIMIT $ A Pollution Liab D eNVRa10004.00 03/0112016 03101/20/7 P01111130011 260 B Employaeplshonesty 670-56.47 03101/2016 03101/2017 Crime 26,000 DE$ORIPTION OF Qp 0N30NS 1 LOCA`n0N$1VEHICLES IACORD qa7,Addrtlondl Remarks Snha4ulo,mvY be astachad Ir more upaGe la requlrad) CERTIFICATE H0113SR CANO T10N TOWNN02 8MOULD ANY OF THE ABOVE USSCRI130D POLICIOS 9E CANCELLED BEF01t1✓ THE EX?IRATION ELATE THEREOF, NOTICI; WILL- BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Town of North Andover loop Oagood Street AUTHORIZEDREi'RE6ENTA-mr; North Andover,MA 01845 'Aw� 1.888-2014 ACORD CORIpORATION, All rights reserved- ACORD 25(2014101) The ACORD name and Iogq aro reglstered marks of ACORD SEP-01-2016 THU 04:04 PM SERVPRO OF LAWRENCE FAX N0, 9786877706 P. 03 WH1'TKE1 Paas NOTEPAD INSUREVONAMe KeJo Corporation Op ID: PI We 0910112016 limed Inured: ejo Corporation dba Servpro of Lawrence dba Servpro 02 Lawrence-Thras dbs Sarvpro of Lawxsnoe-Two dba Saxvpro of Salem/Plaistow dba Seirvpso of The AndoverH SEP-01-2016 THU 04:04 PH SERVPRO OF LAWRENCE FAX NO. 9786877706 P, 04 AC �� DA CERTIFICATE CERTIFICATE aF LIABIL.ITY INSURANCE F09/01/2016 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 GOES NOT CONSTITUTE A CONTRACT BE:,TWEeN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the Certificate holder Is Ian ADDITIONAL INSURED, the pollcy(168)must —0 endoreed. It SUBROGATION IS WAIVED, subject to the terms And conditions of the pollCy,certaln pollcloR may require an endorsement. A statement on this certificate does not confer rights to th6 cortlfleate holder In Eleu of such endorsements , TACT PRODUCER -.- Dabney Collier PHONB?AIC No ExtI, 909 628-2800 Arc Nob (01).529-2916 cls Collier Insurance -MAIL 608 S.Mendenhall,Suite 200 A �S! ___ - -- MernphlS,TN$6117 [NSURER[BIAFFORDINGCQVERAGE —_ NAIC Y..,:.- INsu�tERA; American ZurichlUsuranae Company 40142 hIN9U RE1} INSuRI R F{ Adams Maean.Inc, INSURE1 9769 Poplar Ave ate 440 Memphis,TN 38138 INSURER P COVERAGES CERTIFICATE NUMBER:t5TN008858085 REVISION NUMBER; THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE I-ISTED BELOW HAVE BEEN ISSUE=D 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 SY PAID CLAIMS, tNTYPE OF INSURANCE POLICY NUM6ER 'Mmi hOtlLD�YlYWIf LIMITS CUMMFRoiAL GENERAL 1-1011-ITr EACH OCCURRENCE b CLAIMS-MADE n OCCUR A MISES rya oocurranca). MED EXP An ane t�arsan $ - •-•^ PERSONAL d ADV iNJLIRY $ GEN'[.AGGREGATE LIMIT APPLIES PER'S _GEN(;RAL AGGREGATsr POLICY❑287 ED LOC PRODUCT9-COMI?lOP.AGG $ .µ ,• _-_ OTHER: COM AUTOMOBILE UAEIUTY BODILY mjUAY(Por perBon) $ Yw ANY AUTO AUTOS NED SCHEDULED 130DILY INJURY(Par acddentl $ NON-OWNED PR PER'�1rtSAMAGE $ HIREDAUTO$ AUTOS araW9§N}„_ UMBRELLALIABOCCUR EACH OCCURRENCE EXCESS LIAR HCLAIMS-MAGE AGGREGATE DEG RETENTION $ WORKERS COMPENSATION X TA E AND EMPLOYERT LIABILITY Y 1 N ANY PROPMETOAN 1 A IPARTNSWEXECUTIVE ❑ WC 66-11-885-02 12/01/2015 12!0112016 E.L.EACH ACCID:NT $ 1,000,000 A OFFICE R/MWBER EXCLUDED? (Mandalory In NH) 01,DIfiE;ASt GA GIaIPLOYE 5 1,000,000 IrV6 4sacr(be Irstler EL,DISEASE•PO[.ICY LIMIT $ 1,00O,OOD D CRIPTION OF OPERATIONS balow Locatlon Coverage Period: 12/0112015 12/01/2015 Client# 2410-MA DESCRIPTION OF OPERATIONS I LOCATIONS f VEHICLES (A�ORD tot.Additional Ralllarks 9clladulc,may be gtlllohad If more spaca Is roqufrsdi Coverage Is provided for KEJO Corporation dba:SERVPRO of Lawrance Bi only Whose co-employoos Weekly of,but not anbcontr000rs 8 BLAKELIN ST to: Lawrarim,MA 01642 CERTIFICATE HOLDER CANCI=LLATION Town of North Andover SHOULD.ANY OF THE ABOVE DESCRIBED POLIC158 81!CANOELLFD BEFORE 1600 06good St. THE EXPIRATION DATE THEREOP, NOTICE WILL BE DELIVERED IN North Andover,MA 01545 ACCORAANC6 WITH THE POLICY PROVISIONS, AUTHORI2I:q-B!~PRQrieNiAT]l1E_.-.._-.__._...,...___. t' 19BB-2©14 ACORD CO .,. � RPORATION, A11 rights reserved. name. ACORD 25{20141011 The ACORI7 and logo are reflistered marks of ACORD Office of Consumer Affairs&Business Regulation License or registration valid for individul use only ,i'== �=-'-'•HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: S'44--Zq Registration: 158271 Type: Office of Consumer Affairs and Business Regulation �F Expiration: 12/34/2017 Private Corporation 10 Park Plaza-Suite 5170 Boston,MA 021 IG KEJO CORPORATION SERVPRO OF LAWRENCE,ET ALS, GREGG WHITE - 8 BLAKELIN STREET ' }� LAWRENCE, MA 01$41 Undersceretar}' ivot valid witlrout signafure `rtassacnusetts Department of PUbi€c Safery Board of Building Regula[€ons and Standards License: CS-067690 GREGG M WHITEa'�^ 4 CHATBURN RD WINDHAM NH 03087 02/20/2018