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HomeMy WebLinkAboutBuilding Permit # 10/26/2016 v,ararH BUILDINGPSR IT O "�� 'mti �- "��,.° a� TOWN OF NORTH ANDOVER � ' 74, � APPLICATION FOR PLAN EXAMINATION " Date Received PermitNO- � ter .., � •. ACMt1'S�C''��� Date Issued: .•. .,,1 `O t _..___-_-- IMPORTANT: Applicant must complete all items on this page LOCATION t kid t 'ti 4 11Print PROPERTY OWNER ; ' f .. w tm ,mw, Print MAP NO: ', PARCEL ZONING DISTRICT- ,, Historic District yes �n� Machine Shop'pillage yeci _ ........... _..vm_._..._ -- TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building -'bne family Addition Two or more family Industrial Alteration No. of units: Commercial Repair, replacement Assessory Bldg /'others: Demolition Other 0 Septic 0 Well Floodplain C,1 Wetlands 1 Watershed District 0 Water/Sewer c' Identification Please Type or Print Clearly) OWNER: Name: Phone: Address: CONTRACTOR Name: � �. Phone: � ' " - o Address: of l" '(' 14 ° » L1,6 0i r a5 Supervisor's Construction License: Earp. Date: Home Improverhent License: Earp. 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 Cos : $ r'": FEE: $� Check No.: Receipt NOTE. Persons contracting cth canregistered contractors do not have access v the guaranty faand gAgent/Owner- Signature of contractor " Signature of �� �"� �� �.�� ,0� IF N t%ORTH town Amisidover 0 to No. "h ver Mass, cacmc"aw CK BOARD OF HEALTH Food/Kitchen PERMIT _ T LD Septic System A^ Ir EYLt�.E.......... ly BUILDING INSPECTOR THIS CERTIFIES THAT ......K Foundation has permission to erect.......................... buildings on .... ..47, ... ..............*........ .. .. ...v4G A a Rough VA ........... ..... Chimney ..........1413. to be occupied as .......r"7* ............$Ai�.* provided that the person accepting this permit shall in every respect conform to the terms of the application Final on file in this office, and to the provisions of the Codes and By-Laws relating to the Inspection,Alteration and Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTION STf S Rough Service .................... .I.. ........ ... ................ Final BUILDING INSPECTOR GAS INSPECTOR Oceupancr Permit Re uired to Occuov Buildin Rough Display in a Conspicuous Place on the Premises - Do Not Remove Final No Lathing or Dry Wall To Be one FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. Smoke Det. REVISE ENERGY OWNEEMENNEWMNEENNEMEM A DIPIETRO COMPANY As an employee of Revise Energy (DiPietro, Home Energy) holding an Unrestricted Construction Supervisor License (CS-056846), I hereby grant permission for either Dan Carroll, Matt Hammer or George Desroches of Revise Energy to apply for and or pull a permit in my name and under my license for Weatherization work. Weatherization work may include, air sealing, blown cellulose insulation, installation of weather stripping, door sweeps, thermax, etc. I approve this permit to be file un �er my name by either gentlemen listed above in the town of: fTj( v"' Sincerely, Cy/ John Cullen License # CS-056846 Cell: 781-526-5581 C DREVISE INERGY A y This agreement is trade by and among Nancy Ryan Revise Energy "52 Hewitt Ave 5 South Summer St North Andover, MA Haverhill, MA,01835 437901 Phone:(800)885-SAVE Tuesday,July 26,2016 1.DESCRIPTION OF WORK TO BE VERFORMED Revise Energy will perform or cause to be performed the following work on the customer's address above,in a professional manner and in accordance with the terms of this Contract,induding the attached recommendations/work order describing the work in detail(the"work")which are incorporated herein by reference.Pricing reflected below may be subject to adjustments in program pricing and offerings and is guaranteed for 30 days from the date the Contract is printed. Part Quant mice unit $ Custom Item 10 $85.000 Air Sealing $ ) Tze Et 850.00 Custom Item 254 $3.504 Poly KWS $ 889.00 Custom Item 216 $1.650 3.5"FG KWS $ 356.40 Custom Item 24 $3.500 Poly Gable $ (Al 7O 84.04 .. Custom Item 64 $3.700 Poly Rim Joist $ �D 236.80 $ s , Mass Save Incentive: $ 2,024.65 rrw�r /t ■rr�wwrM C er Sig re Date I f ��// 7/26/2016 Ll Z Z- f E 1 — Ck r i R se Energy Lure Date Name of Revise Energy Representive 2.PAYMENT:auVowwR stress to pay Revise Energy for the work as follows: Payment#1, $ 50.00 Credit card or check deposit is due at the time the Work is scheduled.Required payment Information will be collected over the phone by a customer service rewesentatlue at the time of sche"ng. (Nobe:Mastercard,Visa,and Discover accepted). Additional Payments and Final Invoice,. $ 341.55 Additional payments for the Work shall be due upon completion of the Work. if the final trtvoioe is being paid by deck,credit card information will still be required at the time of scheduling.Notify the customer service rewesentatNe that ycw are paying by dwck and your card will not be charged unless we fall to receive payment within 5 days of invoice. The Terms of this Agreement are contained on both sides of this pate Ruse Energy•5 South Summer St^Haverhill,MA 01835°(800)885-SAVE a heilo@ReviseEnergy.com-www.ReviseEnergy.com l;liRlvSS Of i ;RHi Kl1{N'I J.PROPO-SKI)ST'AR'T'D, TE AND COMPLETION SCIWI)IJI,E- R V ISF I'iNPiItC;Y will contact customer to schedule the Work at Ft nmtlually agreeable time,subicct to the avadahitily of Sdtx ontrdCtofs or materials,or to delays attributable to the weather or other events beyond Rl VISI ENI.,RC Y's control 4.CON't'RAUCOR i&GISTRAT10N. Maesachuscl:N law requires home in€provement contractors and subcontractors to be registered with the Director of Home Improvement Contractor Registration You may { €nquae about contractor registration by writing to Offiet of Consamer Affairs and llutiness Regulation,Ten Park Plaza,Suite 5170,Boston,NIA 02116.617-9''3-8700 S.PERMITS, REVISE:ENERGY mil obtain any necessary permits as the Customer's agent-Customers who secure their own permits ordeal with an unreg€stered contractor will be l'xCIDded from(Ire Guaranty Fund provisions of the I-lore Improvement Contractor Law 1 6.P_F,RFOR\tANCE Of'I-HE WORK AND CHA1NGE$. 6 1 REV ISU FNl-;RC;Y will not commence time Work prior to signing this Agreement and transmittal.of a copy,of Agreement to the Customer 6.2 This Agreement may be supplemented,amended,or moditicd only by the mutual agreement of the parties.No supplcme€u,amendment,or modification of this Agreement shalt be binning unless it is in writing and signed by all parties. 63 At times,our vaeatlreriztttiott team discovers situations in the structure during the course of the Work that indicates a risk Cor a health or safety concern for residents.Such concerns can include but are not limited to vemtla(ion,potentially f ni ardOnS materials such as mold or ashestos-or structural concerns In the case of health or safety concerns being identified,REVISE ENERGY reserves the right,per section 9.2 of this contma,to communicate concerns to the Customer and halt work until such concerns have been addressed. 6.4 The rebates and incentives available from the Mass Save�t)Home Energy Services Program and amounts due from the Customer are based on the best estimate of the simation in the structure by[lie REVISE,ENERGY home energy advisor.However,at times our weatherization team discovers situations in the home during the course of the Work that impact the availability ofrebates and incentives from the Mass Save Program.In such situations,REVISE ENERGY will communicate such changes to the Customer,including any impact on amount the Customer would be expected to pay for time Wort_The Customer wit]have t€le option to remove From the Contract the work elements that treed adjustment,or set up a separate contntct for performing the adjusted work. 6.5 REVISE ENERGY represents and warrants to the Customer that(a)the materials and equipment Furnished under this Agreement will be of good quality and new,(b)that the Work will be free from defects,and(e)that the Work will conform with the description ofthe Work described in Paragraph t- 7.INSURANCF AND REGISTRATION. RE.ViSE ENERGY represents and warrants to the Customer that it has a valid(ionic Improvement Contractor Registration(No. 185083)and the necessary insurance required by applicable law and nonnally maintained by prudent contractors in REVISE ENERGY's field,including,but not limited to,Workers Compensation Insurance for all employees who will perform the Work- 8,QUALITY OF WORK._ REVISE ENERGY agrees that the Work will be performed in a good and workmanlike manner,and that REVISE ENERGY will repair and replace,at its own expense,and promptly upon Customers request,any defects in workmanship and materials provided by REVISE ENERGY which appear up to(t)year atter completion o€the Work or within any longer period as permitted or required under applicable law,provided REVISE ENERGY has received final payment as provided herein. 9 PRE-EXISTING CONDITIONS&PROPERTY PROTECTION. 9.1 REVISE ENERGY shall not be responsible for any damages as a consequence of the Work performed in the home due to pre-existing conditions.'I'lmese conditions include but arc not limited to poorly fastened or broken drywall,moisture damage,non-code construction,cracked or fragile siding or shingles,old pipes and fiuings,rotting wood,etc. 9.2 REVISE ENERGY reserves the right not to perform Work upon the discovery of asbestos,mold,or any other potential health risk to the Customer.In this event,the Customer is responsible for remedying the at-risk situation,including any necessary removal of hazardous materials and all bills for services to date shall be paid immediately. Work cannot resume until remediation is complete. 9.3 While REVISE ENERGY will make best efforts to protect any property of the Customer,it is the Customer's responsibility to remove or protect,including dust protection, any personal property including the home itself REVISE ENERGY will not be responsible for damages to or losses ofany of the above mentioned property not properly protected prior to the commencement of the Work. 19 GENERAL PROVISIONS, [0.1 REVISE ENERGY reserves the right,the extent permitted by applicable law,to have,file or maintain a mechanic's or material men's lien,or to file a notice of intention to lien,and to take any other steps to perfect and enforce such a lien,irCustomer fails to pay REVISIT ENERGY as provided herein. 10.2 This Agreement shall be constnred in accordance with the laws of the Commonwealth of Massachusetts. 10.3 This Agreement forms the complete integrated agreement between REVISE ENERGY and Customer.The parties represent and warrant that in executing this Agreement, they are not relying on any representations,warranties or terms other than as expressly contained herein.This Agreement supersedes all prior agreements between the Customer and Contractor and may not be altered absent a subsequent written agreement signed by both parties.You may cancel this Agreement if it has been signed at a place other than the REVISE ENERGY's normal place of business,provided you notify REVISE ENERGY in writing at its main office or branch office by ordinary mail posted,by j telegram sent or by delivery,not later than midnight of the third business day following the signing of this Agreement See the attached notice of cancellation font for an explanation of this right. 11.ENERGY BENEFITS The Sponsoring Utility Company(the Utility)is entitled to l00%of the energy benefits associated with all Energy Conservation Measures,excluding the.value of energy cost savings by the Customer,but including all rights to all associated ISO NE Energy,Capacity and Reserves Products.REVISE ENERGY agrees to provide the Utility with such further documentation as the Utility may request to confirm the Utility's ownership of such benefits and Products. I2,NOTICE CONCERNIN SP NSORSBIP. "12.1 Customer understands and acknowledges that REVISE ENERGY is not an agent,vendor or sub-vendor ofThe Sponsoring Utility Company(the Utility)with respectu) the installation of an energy efficiency measures.In the event of the failure of an energy conservation device to perform as expected,Customer's sole recourse is to Contractor and not to Clearesult or to the Utility.The Utility and its operating companies shall not maintain,remove or perform any work whatsoever on the energy conservation measures installed. 12,2 Customer understands and acknowledges that their participation in the Mass Save Home Energy Services Program is voluntary and that they have consented for Contractor to install the proposed energy conservation measures. 12,3 Customer agrees that it shall not hold Clearesult,the Utility,their affiliates or operating companies liable for Contractor's to perform its obligations under this agreement, for failure of the energy conservation measures to function,for any damage to Customer's Premises caused by Contractor or for any and all damages to property or injury to persons caused by the energy conservation measures. 11 LIMITED TIME OFFER, . — The prices and incentive offered in this Contract are subject to change in accordance with The Sponsoring Utility Company Mass Save Home Energy Services Program 05crs. 4.CONTRACE fANCELLAIW—N. Under Massachusetts taw,you may cancel this agreement if it has been signed by a party thereto at a place other than an address of the seller,wbi£h may be h6 main office or a branch thereof,provided you notify the seller in writing at his main office or branch by ordinary mail posted,by telegram seat or by detivery, t later than midnight of the third business day following the signing of this agreement. REVISE ENERGY DATA COLLECTION FORM Advisor Name&u �)��+ V Nv l Site ID 93--19v[ Date Customer Ni:�.__. �i ...._.._.—.._.. _ _.L..__ Address S��y�_c(�y_I_�yS�N.__F1�C .._ --- Town '`1,... Q. ta............. Phone 11 �1?� i _�-_1�3�{...-- Elec.Utility ��I L2_ Acclit q1^�T___j.�iJ.�...___--- Gas Utility C�'....--- AcCtlfg6?-3r62'_Q�'� Owner enter P—U t Siding Type ���+ — Year Built A 60 Occupants Fridge Make Checked under siding? o N Balloon Framing YN Bedrooms Fridge Model Roof Mat. AS(Ji ALl— Winter T-Stat° / Summer° Fridge Year Mechanicals Health and San DHW Type HVAC TAsbestos Y p K+T Y/N 1 U d 3 C) 6 ype AA.�- Kitchentchert Fan Fuel � Yr �� Fuel � 9�Yr � VB Required Y N Structural Y N in attic YO AFUE Size q0 °F 0 Distr /SSF Moisture Y UN CO Detector G N #Floors StyleCJ4 Deeper Savings Oi HVAC S Ceilings ,af,v« Ranch,cap•,htagsad,Grmhra, Service Y N Windows Opp? � � Tripfeaecke,co+temaaary,etc. pp.? Y N Area Type HVAC Sales Opp? Y N k Single Pane Single Family,Mo3[bFamily,Condo,Townhouse Finished BSMT? Y N Partial Electric Service Opp? Y N Values ANNOPr_ U�R&6 = D l:J tC (Yoo}a32 -4120 FOP- r 0YHL- •How long have you M mk i SLIT 1 Egvv� &P F— lived here? -What projects have {MASS SRUC INS TD 1'56' fU a r trfF NO. � ��� qd� you completed? t- w-� 0540YOT,�_-o W`r-,- IV_S kAo-O -How long do you plan WAN03V Z i0 q V-S &r"NHIAM ` ?'Ito live 6� o Comfort re? 601 fr�a2 � 1 -,2 *Most important �S {4 t.c7 A f-Pq-0!°S fi rooms? I -What temperature do a �w �� � 5 u O`\ yoset the heat when rr you're home? 5 f 3�-5 C)lFLC3 5 6 -Do you turn it down at a SW 1es night? -is that for savings or comfort? *Do you notice a temperature difference !` throughout the home? i Where? I' + C" MID �lYl�r� -Nn �-€,� � Have you done anything to address comfort? Windows �a •How do you like your .1 windows? *What solutions have r SSa r you considered? HVAC 3r •How old is your heating system? r (� *Any concerns about , it? t ( 1 •Who services it? ' *Noise a concern with your heating/cooling? {y�� I *Distribution? r Pianview Diagram Gusto _ Nc y Y�YFIf�I Advisor Name: - Address _� - Advisor Phone #: Town Any limitations to access by truck? Site ID NOTES Any work scoped outside of Best Practices? Approved by: > Al 1ZT (�0 't k-w TANS. (5�`) t0 RVS wu: 1 KsUt-A-r, V.-Y w -Z r, �� ((a t4') }} ©INSULRTE k1NS V�j 3,Y" F" 4 0 "r Uuy ( I(s¢1 ExT5V0 1-1 ('To TPEAr 7ngf S1l7W (,3,3 r� ( (A1.5ULOTC GflRLP 6rQ0S V4 gtrPot-q t4416) sPftC+w TD '-%CrE-1T fkVUE T-A-V-- `-J6-Ftr NQ A(.Ctss To CAA,-- C>AY tno 5N1AUL- 0 SPACE IN T12 i i. 3. I' The C'orttinonwealtla, of Massachusetts I rrint corm � t Department of Industrial Accidents ffice aaf Investigations I Congress Street, Suite ILIO �.- Boston, A 02114-2017 °> wwminass. -ov/dia Workers' Compensation Insurance Affidavit: Badders/(;'oiitraetors/Electricians/Plumbers A _ lfeant Information � Please Print I.,eibf Name (Business/organizatioMrid'ivi'dua!):� � w� rr� �t���it v f ------------ Phone -" -__.... .......,..._.�. _-__... City/State/Zip: Are you an employer? Check the appropriate box: 'Type of project(required): 1.q'I am a employer with i- 4. [] I' am a general contractor and.I employees(full and/or part-ti" e). k have hired the sub-contractorsh. ❑ New construction m 2. 1 am a sole proprietor of partner_ listed on the attached sheet. 7. [❑ Remodeling ship and have no employees "These sub-contractors have 8. ❑ Demolition working for me in any capacity. employees and have workers' 9. g Building addition. [Na workers' comp. insurance comp. insurance.t required.] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions 3.[] 1 am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.[:] Roof repairs insurance required.]-t c. 152, §1(4), and we have no employees. [No workers' ., comp, insurance required.] *Any applicant that checks box 91 must also fill out the section below showing their workers'compensation policy information. 1,Homeowners who submit this affidavit indicating they are doing all workand then hire outside contractors must submit a new affidavit indicating such, tContractors that check this box must attached an additional sheet showing the name of the sub-coraractors and state whether or not those entities have employem if the sub-contr°aetors have employees,they must provide their workers'comp.policy number. lain ran employer that is provialiiag ivoi-k'ers'eoiiipensation itistaratice for my employees. Below is the policy and job site information, I.nsurance Company Name: Y _._.. (._-.._._ 'r 'x ( . ` Expiration.Date C)1-i I Folic #or Self-ins. Lie,. #: s:�9 '1, (..> Job Site Address _.._.. I .-- r Cit /State/Li i . Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration slate). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of 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 dayagainst the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. Ido hereby cern )starter thead .and enalties o ° er"ur that the ita ortnation provided above is true and correct. St ° nature: t° Phone Df. ficial use only. Do not ivrite in this area, to be completed by ciO7 or town of�ciraC - - City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2, (wilding(Department. 3. City/Town Clerk 4, Electrical Inspector 5. Plumbing Inspector 6. father Contact Person: Phone#: Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5 170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 185083 Type-, Corporation Expiration: 4/25/2018 Tr# 288111 DIPIETRO HOME ENERGY JOSEPH DIPIETRO 5 SOUTH SUMMER ST. HAVERHILL, MA 01830 Update Address and return card.Mark reason for change. SCA 1 0 20M-0S,11 Address [:] Renewal Employment Lost Car irAffas&i3usiness Regul�lt'611 OfficeOf consume HOME IMPROVEMENT CONTRACTOR Type: Registration'. 18 1 6083 Explratjoaj Corporation DIPIETRO HOME E14 SOLUTIONS,INC. JOSEPH DIPIETRO 5 SOUTH SUMMER ST, HAV ERHILL,MA 01830 ljuderseeretftrY i i Unrestricted -Buildings of any use group which Massachusetts - DeparTmel7r cT rub ,c Sa`e:y contain less than 35,000 cubic feet(991M)Of �v�ru o; � .iair,c, ?eyu:a ;c s a � �•,cN u� enclosed space. i—icense CS-056846 1. JOHN TD CULLEN= 46 VALLEY 8T ° Wakefield IA DA 80 Failure to possess a current edition of the Massachusetts State Building Cade is cause for revocation of this license. 534103120' For DPS Licensing information visit: www,mass.Gov/oP5 C:)rnrn issioner DATE(MMfDDNYYY) ACoK�� CERTIFICATE OF LIABILITY INSURANCE 20/25/2016 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(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 endorsement(s). PRODUCER CONTACT Emily Costello Costello Insurance Agency, Inc. PHONE - (976)374-6352 FAX NoF t97a1szi saz7 2 S. Kimball St. EMAILecostello@costelloinsurance.com ADDRESS: ISO BOX 5248 INSURER(S)AFFORDING COVERAGEw NAIL# -- - — _ ..-- -...._ Bradford MA 01835 INSURERA:Colony Insurance Company -___ ......... ... ...... --- -- - . ..... INSURED INSURER8:Commerce Insurance Co. 34754 -- -- --- --- .._-- -....... ....... ........ Dipietro Home Energy Solutions, Inc. INSURERC:Star Insurance Company. DBA: Revise Energy INSURER D: --- - - .... .......... . 5 South Summer St INSURER E: Bradford MA 01835 INSURER F - COVERAGES CERTIFICATE NUMBER:CL1642500527 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. I%- ------------TYPE OF INSURANCE ---------- ------ ........ ADDL 5138Rj POLICY EFF POLICY EXP LIMITS LTR D POLICY NUMBER MMfD01YYYY MMlODNYYY X COMMERCIAL GENERAL LIABILITY EACH OGCURRENGL i$ 1,000,000 ... J ......j -DAMAGE FO RENTED--- --- -- -- --- A, OLAIMS-MAD£ X OCCUR PREMISE$(Ea occurrence) S 50,000 . ... BACEP305047 4/25/2016 4/25/2017 MED EXP(Any one person) $ 10,000 L&ADV INJURY $ 1,000,000 .,PE,.. R _SONA GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY JECT ( LOC I € PRODUCTS.-COMPIOP AGG $ 2,000,000 ....... ... .. ...... .......... ... OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 ._.......... L a_accldentl.............................. ANY AUTO BODILY INJURY(Per personi $ $ ALL OWNED --. SCHEDULED i _- --- -- -- HS6325 4/18/2016 4/18/2017 BODILY INIURY(Per accident) $ W.....-.. AUTOS — -- ---- -- -- NON-OWNED PROPERTY DAMAGE $ X HIRED AUTOS ; X AUTOS (Per accident) ---------- --------------..._....................._...... e $ X UMBRELLA EXCESSLABAB OCCUR EACH OCCURRENCE $ _1,000,_000 A CLAIMS-MADE AGGREGATE s -- X - ---.................. DED RETENTION 10 000 EXC305048 4/25/2016 4/25/2017 $ PER WORKERS COMPENSATION X STATUTE �RH AND EMPLOYERS'LIASILITY , - --- ------- -- ANY PROPRIETOWPARTNERIEXECUTIVE f N i E.L EACH ACCIDENT $ 1,000,000 OFFICERWEM8ER EXCLUDED? N J N 1 A _.__ ___ ____. ....__ .. _.... C (Mandatory lnNH) WC 0856525 00 4/20/2016 4/20/2017 E.L DISEASE EA EMPLOYE $ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 11000,000 !business personal property PACEP305047 4/25/2016 4/25/2017 25,000 A i DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,maybe attached if more space Is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town of North Andover THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 120 North Main Street ACCORDANCE WITH THE POLICY PROVISIONS. North Andover, MA 01845 AUTHORIZED REPRESENTATIVE Emily Costello/HOYECI ©1986-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD INS025 orrl4011