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HomeMy WebLinkAboutBuilding Permit # 12/28/2016 0* tA ORT�J "O'D ', 111,'rBUILDING PERMIT TOWN OF NORTH ANDOVER 0 APPLICATION FOR PLAN EXAMINATI Permit NO: Date Received "All. DateIssued-, ............ IMPORTANT: Applicant must coinL)Iete all items on this pae LOCATION_(,� Print PROPERTY OWNER : - I Print MAP NO: PARCEL:_01iONING DISTRICT: Historic District yes no Machine Shop Village 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 ..................1-1............ Repair, replacement Assessory Bldg Others: )(DemolitionOther ---------- L Septic LJ Well Ll Floodplain Wetlands Li Watershed District F Water/Sewer C V_% tj,.)A�� v-evvkca4tJ CA Identification Please Type or Print Clearly) OWNER: Name: - y Ac, Phone- ckT8 '61 Address: CONTRACTOR Name: —Phone: Cl 7 KlAddress: _7 OA- Supervisor's Construction License: Exp. Date: Home Improvement License: Exp. Date: L S_ LI I(�Iik ARCH ITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BUING-PENMF"P 41",PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Co FEE: $ Receipt No.: Check No., 11 L�� NOTE: Ptrvoiiscoiiti,*acttn-g"'W"itli,,"t'i'!,I rc_,�'hstered contractors do not have access to the aran U11 Signature of Agent/Owner Signature of contractor . ...........­.— 54 own of A No. LAM; h ver, Mass, coc"Ic N[w1cm X1'4 A0"tATED A4�` S 't U BOARD OF HEALTH Food/Kitchen PERMIT T LD Septic System THIS CERTIFIES THAT V1A�I o LOW W��i ;. � rea .�... BUILDING [INSPECTOR ....... ..... .. ...... .,......... ... .. .......... ......... .. ...... has permission to erect .......................... buildings on .... .1 ....Sri. ,�.� . . foundation....... .. . Rough to be occupied as .................... . Of,. C.� 11� � .6 ................ ...... . . .. .......... .. ... Chimney 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 TS Rough .,. .. .. .......................... Service ,...... .. ..... ... ... ..... Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to QccM Buildin 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. Servpro SERVPRO of Lawrence 2064 SERVPRO of Salem/Plaistow 5389 SERVPRO of The Andovers 5390 978.688.2242 office@servprooflawi-eiice.com PO Box 328 Lawrence,MA 01842 Tax ID#02-0353691 Client: Mcgrath,Kathy Home: (978)682-0025 Property: 247 Brigdes Lane N, Andover,MA 01845 Operator: BWHITE Estimator: White, Brian Business: (978)688-2242 x 13 Business: PO Box 328 E-mail: bwhite@servprooflawrence. Lawrence,MA 01842 con-► Type of Estimate: Water Damage Date Entered: 11/29/2016 Date Assigned: Price List: MAEMSX_NOV16 Labor Efficiency: Restoration/Service/Remodel Estimate: 2016-11-29-1414 i 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 01.842 Tax lD#02-0353691 2016-11-29-1414 Main Level Bath Closet Height: 8' ------ ........ 216" 64.69 SF Walls 6.32 SF Ceiling clo'el 71.01 SF Walls &Ceiling 6.32 SF Floor I a4T) 0.70 SY Fl001'i11g 7.67 LF Floor Perimeter 10.17 LF Ceil.Perimeter Door 21 611 X 61811 Opens into BATHROOM DESCRIPTION QUANTITY UNIT PRICE TAX RCV DEPREC. ACV 1. Tear out n'(41--salvageable the floor&bag for disposal, - 6.32:S F 2.89 0.10 18,30 (0,00) J8301' I Tear out non--sale underlayment&bag�for disposal 6.32 SF 1.24 0,04 7.88 (0.00) 7 88 3. Clean floor-Heavy 6.32 SF 0.50 0,00 3,16 (().0()) 3.16 4. Apply plant-based anti-microbial agent 6.32 SF 0.23 0.02 1.47 (0.0()) 1.47 5. Tear out baseboard 7,67 LF 0.38 0,00 2,91 (0mo) 191 ........... Totals: Bath Closet 0.16 33.72 0.00 33.72 �--GT Bathroom Height: 8' 6'1 I-Lallmhy 182.67 SF Walls 41.55 SF Ceiling Baffir in q " 224.22 SF Walls&Ceiling 41.55 SF Floor 6 2'2Hal 4.62 SY Flooring 23.50 LF Floor Perimeter 28.50 LF Ceil. Perimeter 6" S. Door 21 6" X 6' 8" Opens into HALLWAY Window Y 4' Opens into Exterior Door T 611 X 61811 Opens into BATH-CLOSET DESCRIPTION QUANTITY UNIT PRICE TAX RCV DEPREC. ACV 6. Tear pqtnon-salvageable tile floor 4.,bagjor dj# psil 2.89 0,6j2 120,28 (0.00) 120.28 7. Tear out non-sale underlayment&bag for disposal 41.55 SF 124 0,23 51.75 (0.0()) .51.7.5 8. Clean floor-Heavy 41.55 SF 0.50 0,03 20.81 (0.00) 20.81 9. Apply plant-based anti-microbial agent 41.55 SF 0.23 0.10 9.66 (0.00) 9.66 " 10. Tear out baseboard 23.50 LF 0,38 0.00 8.93 (0.00) 8.93 11, Remove Toilets 1.00 EA 21.57 0.00 21.57 (0,00) 21,57 2016-11-29-1414 12/29/22016 Page: 2 Servpro SF,RVPRO of Lawrence 2064 SERV'PRO of Saler/Plaistow 5389 SERVPRO of The Andovers 5390 978.688.2242 office@servprooflawr•ence,com PO Box 328 Lawrence„MA 01842 Tax 1D#02-0353691 CONTINUED -Bathroom. DESCRIPTION QUANTITY UNIT PRICE 'FAX RCV DEPREC;. ACV 12, Remove Vanit 2.50 LF 6.47 0.00 16.18. (Q.00) 16 18 ' 13, Remove Sink-single 1.00 EA 16.19 0.00 16.19 (0,00) 16.19 1.4. Air mover(per 24 hour period)-No monitoring 10.00 EA 24.95 0.00 249.50 (0,00) 249.50 2 for 5 days Totals: Bathroom 0.98 514.87 0.00 514.87 1 M--s Laundry Room Leight: 8' `'" 136.22 SF walls 23.75 SF Ceiling +-5'2 +r j 159.97 SF walls &Ceiling 23.75 SF Floor 2.64 SY Flooring 16.17 1_,F Floor•Perimeter 21.33 LIQ Ceil.Perimeter i ( Door 5' 2" X 6' 8" Opens into HALLWAY DESCRIPTION QUANTITY UNIT PRICE TAX RCV DEPREC. ACV 15 I r' tl l ru salvageable the floor&bag for 23.75 SF 2.88 0.36 68.76 (0.00) 68.76 drsposaal 16. Tear out non-salt'underlayment&bag for disposal 23.75 SF 1.24 0.13 29.58 (0.00) 29.58 17. Clean floor-Heavy 23.75 SF 0.50 0.02 11.90 (().00) 11.90 18. Apply plant-based anti-microbial agent 23.75 Slq 0.23 0.06 5.52 (0.00) 5,52 19, Tear out baseboard 16.17 LF 0.38 0:00 6.14 (0.00) , 6.14 ?CJS "l+mar out wet drywall,cleanup,bag,perLF-up to 2' 1.6.17 LF 2.90 0.39 47.28 (0.00) 47.28 �t)t 21, Washer-Extractor-Remove&reset 1.00 EA 98.56 0.00 98.56 (0.00) 98.56 22. Dryer-Remove&reset 1.00 EA 28.51 0.00 28.51 (0.00) 28.51 23. Air mover(per 24 hour period)-No monitoring 10.00 EA 24.95 0.00 249.50 (0.00) 249.50 2 for 5 days Totals: Laundry Room 0.96 545.75 0,00 545.75 2016-1.1-29-'1414 12/28/2016 Page: 3 Servpro SERVPRO of Lawrence 2064 SERVIIRO otSalem/Plaistow 5389 SERVPRO of The Anclovers 5390 978.688.2242 office@servpj-oofl,,iwrence.com PO Box 328 Lawrence,MA 01842 Tax ID#02-0353691 Hallway Height: 8' Or I laundry Room 4 106M SF Walls 35,00 SF Ceiling 141.89 SF Walls&Ceiling 35.00 SF Floor T 3.89 SY Flooring 11.17 LF Floor Perimeter 2'4^ 2`6" -• 4 2'6" 24,33 LF Ceil. Perimeter Door 21 611 X 61 811 Opens into BATHROOM Door 51 2" X 6` 811 Opens into IAUNDRY-ROOM Missing Wall- Goes to Floor Y X 61811 Opens into Exterior Door 21 611 X 61 8" Opens into Exterior DESCRIPTION QUANTITY UNIT PRICE TAX RCV DEPREC. ACV 35.00 SF 188 0.53 101.33 (():()0) 10133 �4, 'rear out tion-salvageable tile floor&bag for disposal 25, Tear out non-sale underlayment&bag for disposal 35.00 SF 1,24 0.20 43.60 (0,00) 4160 26. Clean floor-Heavy 35.00 SF 0.50 0.02 17.52 (().00) 17.52 27, Apply plant-based anti-microbial agent 35.00 SF 0,23 0.09 8.14 (o,m)) 9.14 M Tear out baseboard 14.17 LF 038 0.00 4.24 (omo) 4.24 29. Air mover(per 24 hour period)-No monitoring 10.00 EA 24.95 0.00 249.50 (0.00) 249.50 2 for 5 clays 30, Dehurnidifier(per 24 hour period)-Large-No 5,00 EA 71.22 0,00 356.10 (().00) 356.10 monitoring I for 5 days 31, Coiit,,iiiiiiietitB-,ii-i-iei-/Aii-lock/Decoii.Chamber 64.00 SF 0.64 0.28 41.24 (0.00) 41.24 Totals: Hallway 1.12 821.67 0.00 821.67 Storage Height; 8' 417.33 SF Walls 197.17 SF Ceiling 614.50 SF Walls&Ceiling 197,17 SF Floor 21.91 SY Flooring 51,33 LF Floor Perimeter 15,2" 56.33 LF Ceil.Perimeter 7 Closet3:H'j34 Door 21 611 X 61 811 Opens into Exterior Door T 6" X 61 8" Opens into LIVING-ROOM DESCRIPTION QUANTITY UNIT PRICE TAX RCV DEPREC. ACV 2016-11-29-1414 12/28/2016 Page:4 Servpro SERVPRO of Lawrence 2064 SERVPRO of Salem/Plaistow 5389 SERVPRO of The Andovers 5390 978.688.2242 otTice@servprooflawi-eilce.coyyi PO Box 328 Lawrence,MA 01842 Tax ID#02-0353691 CONTINUED-Storage DESCRIvrION QUANTITY UNIT PRICE TAX RCV DEPREC. ACV 32, Dehumidifier(per 24 hour period)-Large-No 5.00 EA 71.22 0.00 356.10 (0.00) 356.10 monitoring I for 5 days, 33, Content Manipulation charge-per hour 0.50 HR 38.50 0.00 19.25 (0.()0) 19.25 34. Clean floor 98.58 SF 0.34 0.00 33,52 (0.00) 33.52 35, Apply plant-based anti-microbial agent 99.58 SF 0,23 0,25 2192 (0,00) 22.92 Totals: Storage 0.25 431.79 0.00 431.79 Closet Height: 8' ----- ------ 1 3'1"' 96.67 SF Walls 12.33 SF Ceiling 109.00 SF Walls&Ceiling 12.33 SF Floor -2'6 1.37 SY Flooring 11.67 LF Floor Perimeter 14.17 LF Ceil,Perimeter Door 21 6" X 61 8" Opens into LIVING-ROOM DESCRIPTION QUANTITY UNIT PRICE TAX RCV DEPREC. ACV ---------- 36, Tear out wet non-salvageable carpet,cut&bag for 1233 SF 0.48 0105 5.97 (0.00) 5,9,7 lisp. 37. Tear out wet carpet pad and bag for disposal 1.2,33 SF 0.45 0.05 5.60 (().0()) 5,60 38, Apply plant-based anti-microbial agent 12,33 SF 0.23 0.03 2.87 (().00) 2.87 39, Clean floor-Heavy 12.33 SF 0.50 0.01 6.18 (().0()) 6.18 40, Air mover(per 24 hour period) -No monitoring 5.00 EA 24.95 OM 124.75 (0.00) 124.75 1 for 5 days Totals: Closet 0.14 145.37 0.00 145.37 2016-11-29-1414 12/28/2016 Page: 5 Servpro SERVPRO of Lawrence 2064 SERVPRO of Salcm/Plaistow 5389 SERVPRO of The Andovers 5390 978.688.2242 office @set-vproof'lawreiice.coni PO Box 328 Lawrence,MA 01842 Tax ID#02-0353691 -9'- Height: 8' Living Room ------ ------------ 3'10 W 603.33 SF Walls 291,70 SF Ceiling 895.03 SF Walls &Ceiling 291.70 SF Floor :Ig k' 32.41 SY Flooring 7142 LF Floor Perimeter 90.42 LF Ceil, Perimeter 17'6" L -17'10"- Door 11 9" X 61 8" Opens into CLOSET-2 Door 6f ]I" X 61811 Opens into 1120-CLOSET Door 2' V X 61 8" Opens into CLOSET-3 Missing Wall 31 9" X 81 Opens into OFFICE Door V 10" X 6' 8" Opens into CLOSET-UNDER Door 21 611 X 61 811 Opens into STORAGE Door 21 6" X 61 811 Opens into CLOSET DESCRIPTION QUANTITY UNIT PRICE TAX RCV DEPREC. ACV 41. Dehumidifier inidifier(per 24 hour period)-XLarge-No 5.00 EA 101.25 0.00 506.25 (().0()) 506.25 monitoring 42. As mover(per 24 hour period)-No monitoring 35.00 EA 24.95 0.00 873.25 (0.00) 873.25 7 for 5 days 43, Tear out wet non-salvageable carpel,cut&bag for 291.70 SF 0.48 1.28 141.30 (().()0) 141.30 disp. 44, Tear out wet carpet pad kind bag for disposal 291,70 SF 0.45 1.28 132.55 (0,()()) 132.55 45. Apply plan(-based anti-i-nicrobialagent 291.70 SF 0.23 0.73 67.82 (0.()0) 67.82 46. Clean floor-Heavy 291.70 SF 0,50 0J8 146.03 (0.()()) 146.03 47, Content Manipulation charge-per hour 3.00 1 IR 39.50 0,00 115,50 (0,00) 115.50 48, Tear out tackless strip and,bag,for ciisprasal 25.00 LF 0,78 0.14 19,04, ((),00) 19.64 49. Reinove wet suspended ceiling tile and bag for 80.00 SF 036 035 29.15 (0.00) 29.15 SA 'fear out and bag wet insulation-Category 3 water 80.00 SF 1.14 0.35 91,55 ((),()0) 91.55 Mice droppingsO Totals: Living Room 4.31 2,123.04 0.00 2,123.04 2016-11-29-1414 12/28/2016 Page: 6 Servpro SERVPRO of Lawrence 2064 SERVPRO of Salem/Plaistow 5389 SERVPRO of The Andovers 5390 978.688,2242 of't'ice@sei�vpt-ooflawi-ence,corn PO Box 328 Lawrence,MA 01842 Tax IDIf 02-0353691 - Closet Under Stas Height: 8' 13 173.11 SF Walls 27.50 SF Ceiling - i-Undcl, . 1 200.61 Sl7Walls&Ceiling 27.50 SF Floor 3 4" 106 SY Flooring 21,33 LF Floor Perimeter 23.17 L1, Ceil, Perimeter 4'- Door 1 1' 10" X 61811 Opens into LIVING.-ROOM DESCRIPTION QUANTITY UNIT PRICE TAX RCV DEPREC. ACV 51. Air mover(per 24 hour period)-No monitoring 5.00 EA 24.95 0.00 124.75 (0.0()) 124.75 1 for 5(lays 52,,,' cat-out wet non-salvageable carpet,cut&bag for 27.50 SF 0.48 0.12 1132 (W)0) 13.32 53, Tear on(wet carpet pad and bag for disposal 27,50 SF 0.45 0.12 12.50 (().00) 12,50 54. Apply plant-based anti-microbial agent 27.50 SF 0.23 0.07 6.40 ((),00) 6.40 55. Clem floor-.Heavy 27.50 SF 0.50 0.02 13.77 (0.0()) 13.77 56. Content Manipulation charge-per hour 0.25 HR 38.50 0.00 9,63 (0.00) 9.63 Totals: Closet Under Stairs 0.33 180.37 0.00 180.37 Closet 2 Height: 8' 65.67 SF Walls 5.81 SF Ceiling Y 5.81 SF Floor 71.48 SF Walls &Ceiling 0.65 SY Flooring 7.92 LF Floor Perimeter -2-7" 9.67 LF Ceil.Perimeter Door It 911 X 618" Opens into LIVING-ROOM DESCRIPTION QUANTITY UNIT PRICE TAX RCV DEPREC. ACV 57. Air mover(per 24 hour period)-No monitoring 5.00 EA 24.95 0.00 124.75 (uo) 124,75 I for 5 days 58. Apply plain-based anti-microbial agent 5.81 SF 0.23 0.01 1.35 (().00) 135 59. Clean floor-Heavy 5.81 SF 0.50 0.00 2.91 (0.00) 2.91 Totals: Closet 2 0.01 129.01 0.00 129,01 2016-11-29-1414 12/28/2016 Page: 7 Servpro SERVPRO of Lawrence 2064 SERVPRO of Salem/Plaistow 5389 SERVPRO of The Andovers 5390 978,688,2242 office@sei-vpi-oofl,,twi-ence.com PO Box 328 Lawrence,MA 01842 Tax ID#02-0353691 1120 Closet Height: 8' 11 6" 1 159.22 SF Walls 32.67 SF Ceiling n'20c1 191.89 SF Walls&Ceiling 32.67 SFFloor 3.63 SY Flooring 18.75 LF Floor Perimeter ,viq Ru.111 25.67 LF Cei I�Perimeter 111 Door 61 1111 X 61811 Opens into LIVING-ROOM DESCRIPTION QUANTITY UNIT PRICE TAX RCV DEPREC. ACV 60. Air mover(per 24 hour period) No monitoring 5.00 EA 24.95 0.00 124.75 (0.00) 124.75 1 for 5 days 61. Apply plant-based anti-microbial agent 32.67 SF 0.23 0.08 7.59 (0.()0) 7.59 62. Clean floor-Heavy 3167 SF 0.50 0.02 16.36 16.36 63. Tear out wet drywall,cleanup,bag,per LF-up to 2' 1835 LF 2.90 0.46 54,84 (0.00) 54,84 tall 64, Toarout,and,bag wet insulation 37,50 SF 0,64, 24,16 (0.00), 24.16 65. Tear out bawboird 18.75 LF 0.38 0,00 7.13 (Ho) 7.13 66. Containment Barrier/Airlock/Decon.Chamber 64.00 SF 0.64 0,28 41.24 goo) 41,24 Totals: H2O Closet 1.00 276.07 0.00 276.07 Closet 3 Height: 8' 87.33 SF Walls 10,50 SF Ceiling Owti 3 97.83 SF Walls & Ceiling 1 O.50 SF Floor 1,17 SY Flooring 10.50 LF Floor Perimeter 13.00 LF, Ceil.Perimeter Door T 6"X 61 811 Opens into LIVING-ROOM DESCRIPTION QUANTITY UNIT PRICE TAX RCV DEPREC. ACV --- --------- 67. Air mover(pet-24 hour period)-No monitoring 5.00 EA 24.95 0.00 124.75 (0,00) 124.75 I for 5 days 68. Tear out wet non-salvageable carpet,cut&bag for 10,50 SF 0.48 0.05 5,09 (0,00) 5,09 disp. 69. Tear out wet carpet pad and bag for disposal 10,50 SF 0,45 0.05 438 (0,00) 4.78 70, Apply plant-based anti-microbial agent 10.50 SF 0.23 0.03 2.45 (0.00) 2.45 71. Clean floor-Heavy 10.50 SF 0.50 0.01 5.26 (0,00) 5,26 Totals: Closet 3 0.14 142.33 0.00 142.33 2()16-11-29-1414 12/28/2016 Page: 8 Servpro SERVPRO of Lawrence 2064 SERVPRO of Salem/Plaistow 5389 SERVPRO of The Andovers 5390 978.6882242 office@sei-vpt-ool'tawi-eiice.coni PO Box 328 Lawrence,MA 01842 Tax lD#02-0353691 Closet 4 Height: 8' 3'8" 98.00 SF Walls 12.83 SF Ceiling Clowt 4110.83 SF Walls &Ceiling 12.83 SF Floor 1,43 SY Flooring 11,83 LF Floor Perimeter '4' set Und,r S 14.33 LF Ceil. Perimeter Door 21611 X 61811 Opens into OFFICE, DESCRIPTION QUAN'r1'rY UNIT PRICE TAX RCV DEPREC. ACV 72, '1'ear out wet non-salvageable cat-pet,cut&bag for 12.83 SF 0.48 0.06 6.22 (0,00) 6,.22 lisp. 73, Tear out wet carpet pad and bag for disposal 1183 SF 0,45 0.06 5,83 (uo) 5.83 74. Apply plant-based anti-i-nicrobialageut 12.83 SF 0.23 0.03 2.98 (0.00) 2.98 75, Clean floor-Heavy 12.83 SF 0.50 0.01 6.43 (0.()0) 6,43 Totals: Closet 4 0.16 21.46 0.00 21.46 Office Height: 8' JJ T 6"' - Closed 4 3'9" 319.33 SF Walls 127,13 SF Ceiling T)nde, Office. 446.46 SF Walls &Ceiling 127.13 SF Floor 14,13 SY Flooring 39.08 LF Floor Perimeter .. 44.08 LFCeil.Perimeter ....... Door 21 611 X 61811 Opens into Exterior Missing Wall 31 9" X 81 Opens into LIVING_,ROOM Door 21 611 X 61 8" Opens into CLOSET-4 DESCRIPTION QUANTITY UNIT PRICE TAX RCV DEPREC. ACV X Tear out wet iron-salvageable carpet,cut&bag for 127.13 SF 0,48 0.56 61.58 (0,00) 61.58 lisp. 77, 'Fear out wet carpet pad and bag for disposal 127.13 SF 0A5 0,56 57,77 goo) 57,77"' 78. Apply plant-based anti-microbial agent 127.13 SF 0.23 0.32 29.56 (().()0) 29.56 79. Clean floor-I leavy 127.13 SF 0.50 0.08 63.65 (0.()()) 63.65 80. Content Manipulation charge-per hour 1.00 HR 38.50 0.00 38.50 (0.00) 38.50 Totals: Office 1,52 251.06 0.00 251.06 Total: Main Level 11.08 5,616.51 0.00 5,616.51 2016-11-29-1414 12/28/2016 Pago: 9 Ser•vpro SERVPRO of Lawrence 2064 SERVPRO of Salem/Plaistow 5389 SERVPRO of The Andovers 5390 978.688.2242 office@ servprooflawrence.co m PO Box 328 Lawrence,MA 01842 Tax 1D#02-0353691 Job DESCRIPTION QUANTITY UNIT PRICE TAX RCV DEPREC. ACV 81. Add for personal protective equipment(hazardous 3.00 RA 8.67 1.37 27.38 (0,00) 27.38 cleanup) 82. Equipment setup,take down,and monitoring(hourly 6.001-18 46.14 0.00 276.84 (0.00) 276.84 charge) 83. Haul debris-per pickup truck load-including dump 3.00 EA 160.57 0.00 481.71 (0.00) 481.71 fees 84. Asbestos test fee_full service survey-base fee 1.00 EA 380.00 0.00 380.00 (0.00) 380.00 85. Asbestos test fee-full service survey-per sample 7.00 EA 50.00 0.00 350.00 (0.00) 350.00 86. Negative air fan/Air scrubber(24 hr period)-No 2.00 DA 72.99 0.00 145.98 (0.00) 145.98 monit. I for 2 days during demo 87. Add for HEPA filter(for negative air exhaust fan) 0.10 EA 190.28 1.09 20.12 (0.00) 20.12 Totals: Job 2.46 1,682.03 0.00 1,682.03 Line Item Totals: 2016-11-29-1414 13.54 7,298.54 0.00 7,298.54 Grand Total Areas: 2,51.0.47 SF Walls 824.26 SF Ceiling 3,334.73 SF Walls and Ceiling 824.26 SF Floor 91.58 SY Flooring 303.34 LF Floor Perimeter 0.00 SF Long Wall 0.00 SF Short Wall 375.17 LF Ceil.Perimeter 824.26 Floor Area 914.43 Total Area 2,510.47 Interior Wall Area 1,35050 Exterior Wall Area 159,17 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 2016-11-29-1414 12/28/2016 Page: 10 Servpro SERVPRO of Lawrence 2064 SERVPRO of Salem/Plaistow 5389 SERVPRO of The Andovers 5390 978.688.2242 officeC�servprooflawrence.coni PO Box 328 Lawrence,MA 01842 Tax ID#02-0353691 Summary for Dwelling Line Item Total 7,285.00 Material Sales Tax 13.54 Replacement Cost Value $7,298.54 Net Claim $7,298.54 White,Brian 2016-11-29-1414 12/28/2016 Page: 1 l 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 Recap of Taxes Material Sales Tax(6.25%) Clothing Sales Tax(6.25%) Storage Tax(6.25%) Line Items 13.54 0.00 0.00 Total 13.54 0.00 0.00 2016--11-29-14414 12/28/2016 Page: 12 Servpro SERVPRO of Lawrence 2064 SERVPRO of Salern/Plaktow 5389 SERVPRO of The Andovers 5390 978.688.2242 office @ servproof7 awrence.com PO Box 328 Lawrence,MA 01842 Tax Ill#02-0353691 Recap by Room Estimate: 201.6-11-29-1414 Area:Main Level Bath Closet 33.56 0.46% Bathroom 513.89 7.05% Laundry Room 544.79 7.48% Hallway 820.55 11.26% Storage 431.54 5.92% Closet 145.23 1.99% Living Room 2,118.73 29.08% Closet Under Stairs 180.04 2.47% Closet 2 129.00 1.77% H2O Closet 275.07 3.78% Closet 3 142.19 1.95% Closet 4 21.30 0.29% Office 249.54 3.43% Area Subtotal: Main Level 5,605.43 76.94% Job 1,679.57 23.06% Subtotal of Areas 7,285.00 100.011% Total 7,285.00 100.00% 2016-11-29-1414 12/28/2016 Page: 13 j Servpro SERVPRO of Lawrence 2064 SERVPRO of Salem/Plaistow 5389 SERVPRO of The Andovers 5390 978.688.2242 office@set,vprooflawl•eiice.com PO Box 328 Lawrence,MA 01842 Tax 1D#02-0353691 Recap by Category Items Tota[ % APPLIANCES 127.07 1.74% CLEANING 347.10 4.76% CONTENT MANIPULATION 182.88 2.51% GENERAL DEMOLITION 1,717.31 23.53% PERMITS AND PEES 730.00 10.00% HAZARDOUS MATERIAL REMEDIATION 19.03 0.26% WATER EXTRACTION&REMEDIATION 4,161.61 57.02% Subtotal 7,285.00 99.81% Material Sales Tax 13.54 0.19% Total 7,298.54 100.00% 2016-11-29-1414 12/28/2016 Page: 14 Main Level 29' 10" Clos Closed �t jy �—T7,r m 14, �f ; 3, 10, Storage m 6' 1„ T 6„ -� 3' �, Laundry Room N Bathroom b 6"-� N H2O Clos`8t i00 Hal ;C th Closet I T 6"7 3' 8" 3'4" —� N Closet t4'O Living Room M et Under r Closet an Office - LO Q c� 29' 2„ Main. Level 2016-11-29-1414 12/28/2016 Page: 15 n� Authorization to Perform Services and Direction of Payment Customer Name: Cathy Mcgrath 11/27/2016 Date of Loss: Loss Address: 247 Bridges LN City: North Andover State: MA Zip: 01845 Insurance Company: Self Pay Claim Number(if available): 16120$65 The undersigned Customer, being the building owner, owner's representative, or resident, authorizes the Provider identified below to perform any and all necessary cleaning and/or restoration services on Customer's property located at the property address above, and with respect to items that need to be cleaned at a remote location to remove and clean such items as necessary. Customer authorizes Self Pay Insurance Company, herein referred to as"Insurance Company,"to pay Provider solely and directly for that portion of the work covered by Customer's insurance policy. If, for any reason, Customer receives a check from Insurance Company made payable to Customer, Customer agrees to pay Provider immediately upon receipt of the check. In order to expedite payment to Provider, Customer hereby appoints Provider as attorney-in-fact, authorizing Provider to endorse Customer's name on Insurance Company checks or drafts, and to deposit Insurance Company checks or drafts for Provider services, Customer agrees to pay Customer's deductible in the amount of$ $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: Cathy Mcgrath 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: O Y O N Provider's Signature: Customer's Signature: ("� Franchise Legal Name: KEJO CORP Printed Name: Cathy Mcgrath d/b/a SERVPRO®of: The Andovers Date: 12/06/2016 Date: 12/06/2016 E-mail Address: Contractor License #: OSERVPROW INTELLECTUAL PROPERTY,Inc. ALL RIGHTS RESERVED FE-051707 1.0 28000 05116 f ach SFRVPR0`Franchise is Independently Moved and Operated. 3 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,materiat, 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 color fastness;shrinkage;fading;adhesive breakdown;or other problems.It is not always possible to determine those 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 ceiling 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 backing,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 forwork 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 states/countries 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 ANY WAY 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 SERYPRO'"Fi curchise is Grdependewlp Ouwed crud Operated. POLICY NUMBER,ENVP016006-00 COMMERCIAL GENERAL LIABILITY CG 20 37 07 04 THIS ENDORSEMENT CHANGES THE POLICY, PLEASE REAP IT CAREFULLY, ADDITIONAL INSURED -- OWNERS, LESSEES. OR CONTRACTORS - COMPLETED OPERATIONS This endorsement modifies insurance provided under the following; COMMERCIAL.GENERAL LIABILITY COVERAGE PANT SCHEDULE Name Of Additional Insured Person(s) or Organization(s); Location And Description Of Completed Operations .Any person or organizattnn for whom yon are performing In respect to any location where thoNamed Wured is operations when you and such person or organization ha.'4e performing:"yo=work." agreed in writing in a contmot or agreomentf effected prior to the date your operations for that person or organization commenced,that suchperson or organization be added as an additional insured as your policy. . y Information required to complete this Schedule,if not shown above,will be shown in the Declarations. Section 11.Who Is An Insured 15 amended to include as an additional insured the person(s) or organlzation(s).shown In the Schedule, but only with respect to liability for"bodily injury"or"property dam- age"caused,In whole or In part,by"your work"at the location designated and described in the sched- We of this endorsement-performed for that additional insured and included-in the"products-completed operations hazard". Page 7 of t GG 20'37 07 04 P ISO Properties, Inc.,. 2004 I _Ue Commonwealth of Hassachuseits Depr trnent o,f'InduSt,°iajAccrdents }5` uz 100 I Congress�S`iTeet Boston, MA 02� �2017 _ F w www mass go-vtdia W Vj e7rs' Compensation xn suranee A_MdadP 8 �A�77CFJ O s r�T �ci aansl um ers. . TO BE F.0 ED '.� _,p�,ease Priest xss '�I A. ' Lieant ltzfax'zuationt _ Name CBusinesslOigariixatioz�ldndividusl}: .AC1cTress: g � c0 iotatdzip: 'c riatebox: Type ofproject()requixec7): Axe yor<an exnployer�CJzeclrtlie apex p 7. LI NdWd6 triiction 1 ain.aemployer yA.���- eMpiopw(toll.aud/orpart t3ma)." � 8. [1 Remodel3lig 2.[]I am a sole proprietor orpartnersliip sngbave no employees Working forme iu R. �.Demolxtioxt any opacity,gTo-workers'comp.inswauce zeguired.] 30Ism alrovaeowner doing ail work myseif.gT°workers'camp,insurancerequired.]; 10 E]Euilding addition 4-ElI am abameowner and will be hiring contractozs to eondue€;all worlk()"My property. I w�13 ���Eleafxical�e *8 or acic�itiaPs emurc-that all coutmettits eitherbavo workers'oompensatlon Snsurance or are sola _2 �:F��bbg reps.rs or addztious proprietors with no enip� em, 5[]I am a gene=ral eontractpr and lhave hired.fbe sub-confzaefozs listed onthe attached sheet 13,.[]Rb6frCpairs 'These sub-contractors bate employees andhawwarkers'comp.ins3naoce 14.[]MCI: S.pWe KO a corpozatiori.and ifs,ofcers have exrcisedtbeirright o£�xempfion per MGL o. 152,§1(4},u4d wabavbno eFmplogees.[No�vorkers'comp.zns�uancezecp zecl] * appltcantthatchecks box#lsaust alsol3ll outthosectioabelowshowing�eir�orkers'compensatsoupolicyinfo3mation f Homeowners wha submrttivs a,�iidavrt indiAtmgthey are doing all wozk�e name of fhe sub contraefozs and state vnc�the or spot those eIA*1�ye 1i Contractozs that checkihis lio t rirust att ehadin additional sheetshowin$ employees. I the sub noniractors bane emplcyeos,they mustpro-ride thein workers'camp.palieyn�er. to ex'treat isproviding-War�'ers'conpensatian insurance for my MMP ioyees Belary is tie palzcy aradroa"site X am an emp d' information. � �' UMToo Company'Name:NMen—C FOlicy O I1&[�� CitylStatelZip: 13 'e lob Site Address: olio nux�tbar and expt'atzoxs date). AtEach a copy'of the Workers' compe. a on policy c�ecXa�ra#i° a c axinal�o ati upuishable by'a ab up to$�.,500.Q0 Failure to secure eaverageasraqueduuderMGL a.152, 25A and/or oue~yCar lxnpxlson:ment,as well as niv%1 Pmalt[ s In the foxinb fazyvarded to the OOof a MP eO OR733ER ofthe�lA rinsrxrar<c�a clay against the,violator.A copy oftbis statCzaent may 4 coverage-Ver fxcatiou. trzepains �er�alties afper my at ti=te znfor radian rovzde�mro�ve s a/ue ar?�correct .fid ere y - Date, ate: Phone 4: use only. Do rat write in this area,za be co�pleter pfcial by city or to-wiz offzcia Fermi t/�icensa City or Tort' xssuiug A.utho-�ty(cix cle ons): i p ector f.$o and of [eaXtb 9,-)3 uildangIepartnent 3.CitylTo wzi Cleriz ,ElectricaYXns ecto r 5.1'lumlOi€ng Xnsp 6.Other Phone#: f Contact ReY$01L: WHITKE1 OP ID. PI �CQRQ� DATE CERTIFICATE 4F LIABILITY INSURANCE {MMlDD1YYYY) 11/91/2016 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 endorsoment s . PRODUCER NAME CT dames R. Mc Donald Stanley McDonald Agency PHONE xt.608-788-616Q IFAX No: 1101 Main Street 608-788-7012 Onalaska,WI 54650 E-MAIL James R.Mc Donald AADR SS: INSURER(S)AFFORDING COVERAGE NAIC?R INSURERA:Rockhill Insurance Cam an 28053 INSURED KeJo Corporation INSURERB;The Federal Insurance.Ca. 20281 dba Servpro of Lawrence INSURt;RC:ACE Property&Casualty 20699 See Note For blamed Insured PO Box 328 INSURER 0: Lawrence,MA 01842 INSURER E: INSU RER F: COVERAGES CERTIFICATE NUMBER-. 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 ADD S B POLICY EFF POLICY EXP LIMITS LTR D D POLICY NUMBER MMIDDIYYYY MMIDDIYYYY A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE. $ 2,000,000 DAMAGE CLAIMS-MADE �OCCUR ENVP016006-00 03/01/2016 03/01/2017 PREMSES Fao RENTED� ce $ 50,000 MED EXP(Any one person $ 5,000 PERSONAL&ADV INJURY $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 3,000,000 POLICY 0 JECT 0 LOC PRODUCTS-COMPIOP AGG $ 3,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accldenl) $ AUTOS AUTOS NON-OWNED PROPE TY DAMAGE $ HIRED AUTOS AUTOS UMBRELLA LIAR OCCUR bE.L. OCCURRENCE $ 1,000,000 (`, EXCESS ILIA Id CtAIMSMADE M00798617 07/7412076 01/14/2017EGATE $ 1,000,000 DED X RETENTION$ 10000 $ WORKERS COMPENSATION TR UTE OTH- AND EMPLOYERS,LIABILITY ANY PROPRIETORIPARTNERIEXECUTIVE Y❑ N!A ACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? (Mandatory in NH) F.L.DISEASE-FA EMPLOYEE $ If yes describe under DESdRIPTION OF OPFRATIONS below E.L.DISEASE-POLICY LIMIT L$ B Property Section 670-66-47 0310112016 03/01/2017 B Crime 670-66-47 0310112016 03/01/2017 DESCRIPTION OF OPERATIONS I LOCATIONS f VEHICLES (ACORD 161,Addttlonal Remarks Schedule,may be attached If more space is raqufred) Certificate Holder Is Additional Insured Per Attached CG 2037(07104)And CG2010 (07104)A.T.I.M.A. Policy#ENVP016006-00 CERTIFICATE HOLDER CANCELLATION TOWNN03 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE E=XPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE;POLICY PROVISIONS. Town of North Andover Building Department AUTHORIZED REPRESENTATIVE 120 Main Street North Andover,MA 01845 ©1988-2014 ACORD CORPORATION, All rights reserved. ACORD 26(2014101) The ACORD name and logo are registered marks of ACORD Ace 12/22/20CERTIFICATE OF LIABILITY INSURANCE DATE(M2/20 6 - 16 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 ondorsement(s). PRODUCER CONTACT NAME: Dabney Collier PHONE 901 529-2900 �. ............_ FAX, 901 529-2916 c/o Collier Insurance E-M No.Ext): ( ) tAfcNo}; ( ) t;-MAIL. 606 S. Mendenhall;Suite 200 ADDRESS: Memphis,TN 38117 INSUREROJAFFORDING COVERAGE NAIC# INSURERA: American Zurich Insurance Comppgy., _. .., 40142_ INSURED INSURER B: Adams Keegan,Inc. 6750 Poplar Ave Ste 400 INSURER C Memphis,TN 38138 INSURER D INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:16TNO09858085 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 -_.Al)�Dl MMIDOJYYYY POLICY NUMBER .ppL3CYEFF�. ._MMIDDIYYYYPOLICY EXP LIMITS LTR IN VD COMMERCIAL GENERAL LIABILITY EAGH OCCURRENCE $ _-. CLAIMS-MADE DAMAGE TO RENTED OCCUR -_ PREM€$ES Ea occurrence $ MED EXP{Any one person) $ PERSONAL&ADV INJURY $ G_EN'L AGGREGATE LIMIT APPLIES PER: GENERA(.AGGREGATE $ POLICY „,.I PRO_ EJ LOC PRODUCTS-COMPlOPAGG $ OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS HIRED AUTOS NON-OWNED PROPERTY DAMAGE $ AUTOS Per accident UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENT€ON$ $ WORKERS COMPENSATION X STATUTE OERH AND EMPLOYERS'LIABILITY ANY PROPRlETORIPARTNEPJEXECUTIVE YIN . .EACH ACCIDENT $ 1,000,000 A OFFICERIMEMBER EXCLUDED' [7EL NIA WC 56-11-865-03 12/01/2016 12/01/2017 {Mandatory in NH) E.L.DISEASE-EA EMPLOYE $ 1,000,000 If yes,describeunder DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY Lt MST $ 1,000,000 Location Coverage Period: 12/01/2016 12/01/2017 Client# 2410-NIA 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 Town of North Andover SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Building Department THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 120 Main St. ACCORDANCE WITH THE POLICY PROVISIONS, North Andover,MA 01845 AUTHORIZED REPRESENTATIVE O 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD j r Y r innr, nIii('Irf//�r/-llrr.;.«ir�rf,�r/L' Office of Consumer Affairs do Business Regulnaion License or registration valid for individul use only yt it ',HOME IMPROVEMENT CONTRACTORbefor•e the expiration(late. If found return to: I ,Registration: 158271 Type: Office of Consumer Affairs and Business Regulation Expiration: 12/31/2017 Private Corporation 10 Park I'laza-Suite 5170 Boston,MA 02116 KEJO CORPORATION SERVPRO OF LAWRENCE, ET ALS. GREGG WHITE 8 BLAKELIN STREET LAWRENCE, MA 01841 Clnrlerseererary f' 6i valid withow sivntrturc `elassachusetts De'partwelnt of Put)hc Safety Board Of Budding Ftegulzwons and Standards cense CS-067690 GREGG M WHITE .° 4 CHATBURN RD r ° ' WINDHAM NH 03087 r E ��.xprr�ttic�n 02/20/2018