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HomeMy WebLinkAboutBuilding Permit # 1/26/2017 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Date Received Permit NO; Date Issued: IMPORTANT: Applicant must complete all items on this page rantF F PROPERTY OWNER �� _ Pram Year 01d Structure MAP N® PARCEL BONING [AT-R-1 T r [s oT[E DlStnct yes n0 Mach[re Shop no U[I age , yes TYPE OF IMPROVEMENT PROPOSED USE Residential Nan- Residential ❑ New Building ❑ One family ❑Addition ❑Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition [mer ❑Sept[c Well Floodplain ❑111letlands ❑ Watershed D[str[ct E CRIPTION OF WORK TO BE PERFORMED: Identification Please Type or Print Clearly) 7 OWNER: Name: Phone: r- 3ci Address: j `~l, o� CONTRACTOR Name __ '� __ _. m Phone: _ Address:- .:°� ...._. - - Siaperv[sor's Construction License -- CC ; Exp Date ZC Horne lm tovement License -- Exp Date:. P 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 Cost: $ Lq IL47 ,� FEE: $� d —. Check No.: Receipt No.: z4_1C� NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund .. ,....,.,........ . Si at ©f contractor .�- S[gnafure of AgentlOwnar 9. Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ NORTH e Town of �2 : _ �, Andover . 0 0-, ";.' �► No. h ver, Mass, cocMicnew�cx ��• 4A-re o 4a BOARD OF HEALTH Food/Kitchen PERMIT T LD Septic System THIS CERTIFIES THAT ...:..... .... .. ... ...........k....... . ,..........................................,.,..,............. BUILDING INSPECTOR �. 1 Foundation has permission to erect .......................... buildings on .......... ...,.,.......................... ......,.........,............... ® Rough tobe occupied as ........ . .. .. °....�.. .... ............. ...............................,..................,....... 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 Rough VIOLATION of the Zoning or Building Regulations Voids this Permit. Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR LESS CONSTRUCTION.,, T Rough _ Service ... . .... ................................... "' Final BUILDING INSPECTOR GAS INSPECTOR OccupancyOccupaney Permit Rec luired t® Occupy RuRough 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. c�............ /�............ Fedoral 10#05.0405629 Rl Contractor Registration Ito 8188 IMSE Ellgineel'ing MA Contractor Registration I'lo 120979 CT Contractor flog Istration H0520120 RISE 69 SlwsN 111111 1(goad,Cafflon,NJA 02021 CONTRACT rNGINEERINIG 339-5112-6335 1.-,%N 339-5112-6345 Page PR0618W 5 EN I FBED M TO BE rUrFN RKSE mr,CON MALT I (TVIA-IJES FOG114r rtjjB(;ASo n If CUSTOMER Fort V1011 AS UESCEOVED,DUOIN 1110NE VA TE C UEN T a CU3101aER (973)823-139.1 1/1 T2017 44136,13 SERWCC STREET BILLING rTR5ET 328 Main Street 328 Main Street Munn CITY.STATE,zw srrj'�jcc cory'STATIE'vp N(oh Andover, MA 01845 North Andover,NIA 01114i JOB ittenfil'tcei that thcle atc fvcc�ivj li"Oil',Jimmlt III)our home,in dc's 111v I cccisM lights are cet I i ficd ns w-rated(limikitioll Colnicj jt;jtedy we aoii create;I.;'clearance sllalvcafollfld file fixture by using 61mg1 s.s blanket insulation as :t damming material,wt iwmlation st ili N�ilVf:dlCd;Ivfw'the ity and clvwd cae ilivN%Olich conlailt rcccscd 1r1(1w;will reel be nisillaled. SFAUNO:llwyidc lallor,and rust i.ik I0'V 11 his vwO"1%ifl "Urt:dial lomf lionic will N.-k'I'l%tilll a iwallblol je�d of forlmxi in Wt fJl,.us%�Y-f�'rc�ial am)dla�!IW"llc WAS 6 P a 'lit k;vllmwc and indool air quality,Nlowri;fl'to lic ti'�Ijj IF)weal wur howc t�aa indlit14 CaBILs limlit's mid ollm plodllcl�" Vrilnail% k Ir scafisw indvdc air lcak"wc ho'colicni",Mmchvd ;md other onlua ted mva'k IIV nnlov4 are heel wcralt' ddrciscd') 'I itis will fequile�11)wnljw�hemi,hulvdildion in Cubic prof�f milmw(dell}of air intilll.qivfl v.ill Pacer,bill the a actual number ofel'ou ire nlit puarajittx& At the Completion of flirk,and Ill noadditional VOYA to Ilw liomeotma,a him)hlotwr door alft,1144 combustion o: c will lit;condmied by the sull-coillfavl4q to ensur Ilic ajcjy ortlic intfoor air(piality 1))�(In2rk!feet for darmlliw" DANINING:11mvide la1wr mul tit in�;iall�t 12'laser of R-39 Oul'acul F11101.03S!,Inills to(8 I'FIC v LA f-I'lovido labor olid numciials h)in'jall a 10"It en 1WR-33 Clas I Ccll"IOW 2(ftled I0 1123 1";"!erre t'0:1"I'"llell"n't. spact." sl()111;s 1,i,I'lovidc labor and Inatclials I,,fabricate and in.slall a ritlid firms instil otivir,covef fin file 01ole 1111m NI III, ACCE'SS:Vfo�itto labor mid matel ial'�14,in"'lall(I1 cowl}IIlo%ed,itwiLltin,k:o%,Cr Jog tllc jt �jvccy�64ding%1;6r. A small flat surlace orpl}\wfql will lie cmiled aroluld file opuning wishill file.!Itis. Tjli�will allow file covel",iniql'al weadwr- trippin to 1c,trict air 5237,63 llrtwide Lihor and materials In ilwall 16 insulated e'thall"t hose to eximill,halbromn fin(s), 5000) TNTILATIONL I'lovidt:h1hor and limmials to install NvillikI iiin,clitilei in(361l rafter haps to maintaili,;fir llo%%' to 130 stjimw flect ol'connnoll VVnIl. 'I'llcil CONINION\41151.1.S;11(oVide kill0f ond materials I*,inslall R-13 tulfioced Illu:f1th's i Ce:attrralt tt)9 05-0405629 RISE �i;1�t �T�1t"b"t'�ti R1 Contractor Registration Ho 8186 MA Contractor Registration lora 120979 CT Contractor Registration NoS20120 RISE60 Sb awcrntit Road.C"saloon,11A 02021 CONTRACT ENGINEERING "� � A 339-502-0335 FAX 33"1-wtt2-Crw��tS Page 2 'riM3 CONTRACT aA EATERVID nrTtr UETMER TIME 4 NIA-H ES Eo-rraatAERaaO MR17HE CutriebSJEAFOR WORK AS aaUm Roam tic 110,01 Caa3roraEn G+imur;, e+4ar'. WENT n V1,089 alwrlt Eugene Be iveau (973) 28-X1393 (11/1712017 4,136,13 23902 SERVICE STREET _. nURG STREET 3211 Main`strict 328 i'viaita Slim SERVICE Cirf rTxw'r'E.,Z[a" ntR.UIPC CnY,3TATE,ZW ... North Andover,NIA 01845 North Andover.MA 018,15 JOB DESCRIPTION install rigid board at.R-10 If prcater with the required lire rating That mews the scetiolls R»316.5A and 316,6 rCgnirMICnl„a or btaildinp„code. Scal Ill swsarorals wish FSK talrc. � w� �m. Id ii)or w rC'atar a"lith tlzw required� C:Cstt1" ON,M,'1 .1. �+1 l'rarwtde Iaal oy Ind nantwat3l,to install Ii"'id lwaad ail �"" a uired lana 1t" 6 silatare I'M oI'ca mmon v.ali,tarC4 ry;0`+�t.attk ... OVLRI1r1.•rt. Novi&Labatt and ora nc.wls na an,,+taall 7 It-2i denNd6 tr.aclxd t B ;,;I t R Ilulo,�e ill uhaiaan to 16)+;ql arc IL st of exterior uverli ang.1,c• atcd below,a law ntcd Poor wea,In drilling hook,ita lhz eawlia�lle Irrana Is, oww I toles drdlad,rill to lrltac s d. l"lltL.5 will be sv alcd,YIll t a Nterior_r.ld,:spackle;Ind leR in:1 relativdy aaa'4i otlt conk)ition.I'ana:4l1"d 41Td16i�L":atk411 toodl-up priminsri`paintintig,aill 1,ctile cushanaer' rrsgaarrtsilailit . i 5293,63 C'RA,WLSPAC t.Nov ide labor all in.atcrials to install (30)square feet of Fit,,ill board:at It-10 or preaater with shoo squired sire raaim, to the crawvlspace perimeter%wall lip to lite kill:and apaiaa.ct the band joist. I'"1 5 v pY 1 y a a ._ ........ _..,........�..._...,..._.._........... ...._.. &=mss�p GE'P&�dY�-C��S�'a�a2"� ; � � � ra1 CTYauarart r r"egi.1TGavion MA a3 815 RISE r �Tr Reall�strardnn rta 120979 CT cantraaa for RaagWraaionIR I S3 E r z l 1q 1p 60 SII acTnaMgt Roa�ai.C"anuksa.�d�111021 � ' fCx1P+EE & �r(a 339-;02-63315D`,C FAX339-2;92-61R�: Page I'M ;K%"5a aCNWaarr:'>s.aaTCFEU 0110t �wa:no-ar aF,� j !NIA-11 Swas T r aPVFSIWaCCV15RF0racaarr4wars Y'1`rvx 1 .aa ErPNFTLa°w CUPmfCTYY � I'3a;la�°�.11ma (97.8)m-439--, ��1'1��?tll� .Icl�a�ia4l:�a 22L;r02 "7 EdM"ltCE STPA CT 32 tNl ain`Street ���Main Street ezT.cauf ;LITd.STSTT;',T%E IERWCf.CiTV,STRTE Z M"'n '„^a;or111 Andover.MA 0 1 8=1 N North Andover.NIA M 3OB DESCRIPTION -- atla+l, E.TFr',YTaCYY"IR[ will:fiTrrh£ai9 NC1tl1 IP a&FYl .LIYd ekMIV ivl c aM"acs Io 111k coal6 t�Tt. e'naT ruYil axnl}°t RarlBccl r1av �M".1(61RTMwa%TF1 C'aiPT Tilpro. Garr ati�*.p6�@ Yttc+uYc .C'Ya9Yrrru#wast Gas arl'Cwrs F5' �racrWeatlpm`aa.n%t1 C#Y exceed+T ")Pcr a:T4caua3ae yc wr ea�atl:Tra tsau mUT�a ar9"�ra41"""»Marr rkae''p «�Mliaiww aTaLaT�taTca aura w Ibc film N'v40�aild Grua sa animas d°M.+$t1 ad f.SbYYM�L .ra,laT,lalicYl by a1a ,aaav9itaaT_ di Yo t7f the,<aaPaa%and I£a;I111114 4'a m WITUa.'U"B[loor araa a1M1 U1 ✓.a."a'lii Ise m'0.Y idUc GYKa!A 1`hYP f 11001,CpC'M,'P➢AY_�.aBL avr"cpPa'':P'4 aa1 01#1a;;YY lub wR".' 41%our�'V1W:1�oh 1a'S„faar,.OwaM1[M81 4 is&,,Y. t aml ana.`.p'111n Y rt911As,fkM d$tlC7lY 5wrh k Complete WC%I Yli c41,w,¢inula0.'t.a WO a3 ti'n5a%q➢'TP1 of Behar,COHIbustmM,��a.aa�apaar MPM a4�i#Pu iN 91GYM„a,. ,ton"ted fs a6att EPs,Gaga'.."I his has a al Ox#ap'V)b""it k.M1 no ca, a¢aa loo I ad.al .alismaaille v`�a:allaerb'd91io9a 11YC 1'u a'Y&IG1 4..a16 I'aa r:CCUIa."cl tit{1aN.'iii^tiii1U£FOai M1araa@PoY41a.#k,SYR 110adll1hfioU al Cum,11 ai:11aC IaMaYYTc`a{b'�,PWq;M�ti T6.'31'#a BBM9"417a111t'to do":YrYI£tlb�aS .e gICTITla4 ,�.mzarura'.`1in ffiIM.9GTaaaasa�aca;�slt` 1t aTaa¢sDTtaaaamaWflRaB `" p# +htl.lp6r Total: $4,727.04 Program 1ricellfiv : $3,025.00 customer Total: >1,702.04 WE AGREE 11 TY'ic,T'C/"GCM 6UfYhiMsbT'iETt`614:C5-CCYPRtrTLETC 1H,MACCORIDF IWE VAFtj ABOVE Sis C6FL6:pAY4T`NBt"3.FOR THE 5UP7 4r= '"One T110"SaIld SeV/(.Il 11tilidr+ec Two 041100 ollrar S S1,702.04 "TG`11h 11Ual TYPA U'UhFShdYT'EE:3.Vi1S'kI1TG(II IIEG4mV6)U,9CilECl1111}.43,hllU'F.fMil MMltt1;14)IC 14E:Ci1'3TG7A"fIUPk. Uf'4D}TV`aRhL tl&Ff'ECTY@"➢hPlU APNd'PfyV 10.kYY PVI"..p:TP➢GI"tE[APIa➢M.3 a:46,':T#?vAd:9afa,149;fi'-%Tt'b YlEtl'1Th'.°Cu!iT tYUG tFi itlat_hFtT&FiCe7nY CDY MF VFtlL4.aaF.Cla1%fEe4f.tp I,CPPAn4A'P f1fd Ffi➢'V Ua➢I*daI VIAL eA➢CL 6.61Eat 5aM UAYA.:bEE BaLVI 4rtt5Yi TCTpa I1hPU1'dT6n}I'T IPdP ✓'60 Cd0P.rrC"Pr'r'rli5 C'flptirt,ACT IF 7P6ECCE AtC E ANY BLANK SPACESP Ac ' :./" CUmT6t�P9a.Ct TS.fidw6.��.. FLUTIYC9CI'. 910f➢ATUiialae Er a"r.a^rtrrCM FltYTP2:TYPES CouTRAC7T t45 PTE W4'gTTaa77P1:4"w"V4 PaY axs0 NOT'EN&:C'U 1'FU 4°:'Y6PI9f1 TTATE CX.'ACCEPTANCE J'A".CC&'T6T CE UT C'C'a7TPP6R.`T•TFaT:6 URYAC"TMICL ,SCNI:UAUF ALI'".6Ud)Y-{M YI%TWC')a&:L bad'lE "JATOFACTU6TY TO US AP➢U ARE'IPTtMf IbV BtCC:EpiY:U.Y6}0.1 hUF hUTI MCJGMfX.F,I,F TU 11d JUT,W011K 10 VAYS. t 4 ST'"ECMFMO,PAYMVEW VOLL 11E P.#AU6 h`;Q'U71.IE➢PIU AYafSV'> RISEtt Shawinut Road, Unit 2 {Canton,Mew 02021 339-502-6335 ENGINEERING' www.RISEengineering.com i OWNER AUTHORIZATION FORM i ._... (owner's blame) owner of the property located at. y4 � ro ddress) . JJ r e_ (Property Address) . ,. .._,. ._...m.� Iereby authorize (Subcontractor) an authorized subcontractor for RISE Engineering, to act on my behalf to obtain a building pen-nit and to perform work on my property. This forrra is only valid with a signed contract. `File Kermit will be secured by the insulation contractor, at no additional cast. it is the homeowner's responsibility to close out this permit by contacting their municipality at the completion of this work. mm._._� owner's Signature 5ate WWI da f try CSSL-106019 TOXYT)LED11C 95 QU EENS STREET 93 East Greenwj�h pj 02,9 921 4., ME 17APROV"'n'ENT CONTRAC70R V tM - Type, p irati ow lylamols corpafation AFFORDABLE BUILDING&VVEA-1 HER)ZATEotq INC TME) LEDM 95 QUEEN ST#3 E.GREE"Mc�j,RI 02816 Restricted To:csst--IC Insulation Contractor v'a"ure to POSSess a current edition of the MassachjzeM Stale Building ade is cause for revocation Of anis 4cense- Ucenu or re.-istration valid for individul use eMy before the expiration date- It found return to: OWne of Consumer Aff2irs and Business Regulation 10 Park Pim-Suite 5170 Boston,MA 02 136 Not valid without sign"Ilure Tile COMMOnItleafth ofmassachuse& D4parwjenj qfladsislrial Accidents Ofjk-a of Investigations 6#0 Washington SWwel Amoon,31A 02111 cc Affidavit: Workers, Compensation Insiaran Pse leaPAO I 2nt Informskilon Name Address- A jj -Cl2;joq� Phone-#: "01 Was- E&nm ,&re-you an employer?Chttk&eapproprhic bol- Type of pra*t(ftquked): I.R4amaemployerwith IQ 4- El I am agencral witractor and 1 & E]New vMstruction 0-employees(M=&F pmt-ffine).� have hkeed the sdb-c€ -art rs 7. El Remodeling liswil on the attadied sheet I 2-E]I am a sole pr%dezor or partier- Ilmse sub-contractors have S. ElDefflolitio, ship and have kto eMPIGYMS W4)W-qg wmcitkanycapacily, %V-01kcre COMP,insurance. 9. []Building a&Man o-worker5'immp.inwVMce 5- El We are a corporation and its 10.[]El cal rquirs or additions offlars have exercised their ll.[-j PWmb*repairsOTaddifions re right exemption of per IVIGL 311 lam abGmeowner doing 9H 1"Tk Mysel o wors'comp. c.152,§1(4),and Ove have-no 12.El Roofmpaks f[Nkm empipyces.[No workess' inqu-'Mee J�qulreq insurance reqdimd'] iMy ROU=q Jbi dwcksTe,0XR]MIM 01DAU Old the tinea MOW uussainn P s =40in.- WO&'-Ukd'hZfk h'r&00t,;i0c TnMISUbDif atICIV affidav it indjCHIiH&SuCh- +GNtwrrthachtck this bm-muAqIM W mad&qjmg sit-M*aam and wformadan- heNft&"djOh S;te jnsltraerce company Name: -X -maon Date-' poliq 4 or df—idle. E s.Lic-9- T' Ibb Site Addre&q- i0y deegz7a&U page(showing the poli`number and eupiradon date). Attagh a copy of the werkere MmPePsafl"P01 Failure to secure ewjejage as required uncles'Section,25A ofMCYL c-152 can lead to the inTosition of climin3l PmAfi- Of a o up to 1,500-00 andibr oueycar AfflPfIs mmlern,as Ivell as ivil penalties in do fozmaf a ff0P WORK ORDER and a fineRa $ A ftt a cam of-Ehis 5fg,,-jnaa may&e forwarded to the;ice of ofupto$250.00-a day agaimtthf�violatol. BeadvL Investigatioris of thr,DIA for insurance Coverage vcyifi"ti0n_ on ed aDove Ri tm and comect Ihatth-oMfOrwaff I ifg hergby sere under the palin andpenaftleg qfFi'rftwY Sin Date- City or Town. Issaing Authority(cirelo Me)' I.Dara©f ins ter mrd of-Hcalth I BuDdIngDepartownI t City/Town Ck* 4.KkeWlval actor S.pf" i Pte r is 6.Other o Phone ateat persou, LC- DATE(MMrDDfyYeY} ACCPRID0 CERTIFICATEF LIABILITY 1< IU NCE 4/$/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($), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT- If the certiricate holder is an ADDITIONAL INSURED,the paiicy(ies) must be endorsed. If SUBROGATION IS WAPJEO, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the F certificate holder in lieu of such endorsement(s). p PRODUCER uae hCT Mi.ckz Veerman PHONr 407)723-6510F'I 4ai)7�e-1a2o i Loiselle Insurance Agency ( Arc Ha:R 279 Dexter Street E-MAIL S-micki@1oise1leinsurance.com P, 0. Box 1148 INSURER(S)AFFORDING COVERAGE NAIC U Pawtucket RT 02862-1148 INSWWRAEM Insurance Cm ajn INSURED INsURER s:Beacon. Mutual Insurance Co 0035 Affordable Building & Weatherization, Inc. FNsuRmc-,CNA/WESTEMN SURETY 0012 77 Pitnam. Street wwRERD-Argonaut Ins. Co. Unit 100B INSURER E: Providence RI 02906 1 INSURER F: COVERAGE$ CERTIFICATE NUMBER:Master 2016 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.TERRA 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 POLICES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS- POLICYEFF POLICY EXP iLTR TYPE OF INSURANCE POLICY NUMBER mmoDlYYYY UM LIMITS GENERAL LIABILITY EACw OCCURRENCE g 1,000,000 DA4IAGE TD HLNI tLY 50 000 X COMMERCIAL GENERAL UAHILITY PREAAJSES Ea ccarrence r A cLAu��6fAI3E ®carc+�R X 64157 /10/2016 /x0/2017 NtSDI�SPtAuyuacep ) s 5,000 P£RSONALAADV INJURY s 1,000,000 GENFRALAGGREGATE $ 2,000,000 nF`L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMWOP AGG 5 2,000,000 GE X PC3tIGY FRU LOC: S AUTOMOS"LIABRMY .tirs islNca tiner 1,000,000 y ANY ALITO pODILY€IWURY(}'erperson) S ALL OWNED X SC"EDULED BA364457 4/10/2016 /1012016 DODILYjwuRY(Peracddenl} $ o AUTOS AUTOS NON-OWNED PROPERTY DAMAGES HIRED AUTOS '" AUTOS Pcrasclde�It iAedlcad 5 X UMBRELLALIAB X tCLAJ�MSI-VAIDE EACH OCCURRENCE 2,QOf3,000 A EXCESS LIAR AccrxEc+rE s 2,0 00,000 DED RETENTION 10,00CU364457 /10/2016 /10/2016 B WORKERSCOMPCNSATRON WCSTATll- OTw- 3• AND EMPLOYERS'LIABOTYYJIN ANY PROPR;ETORlPAR1WRlEXECUTWE NrA £_L EACH ACCIDENT $ ��fl Ofl0 OFFICERMIEMBER EXCLUDED? 0300 /17/2035 117/2016 151ar�dat[uy in NH) G.L-DISEASE-EA EMPLOYE $ 500,000 Ir yes,de5cube under E.L DISEASE-POLICY two s 500 000 oEscRip Etonof OPERA ONS Wow C Employee Dishonesty 235&563 11n/2a16 /10/2017 g5o.aao D mass worker's Comp 033855 9117/2015 4/15/2016 ssaa,arna�saa,ovu&sa�i,ann DESCRIPTION OF OPERATIONS I LOCATIONS)VEHICLES(ARtach ACORO 101,Adc!Wi al Remarks Schedule,if mwe spate is required) National. Grid is teamed as an additional insured on the general and business auto policies as required by signed written contract. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, N0710E WILL BE DELIVERED IN C� ACCORDANCE WITH THE POLICY PROVISIONS. National Grid 40 Washington Street AUTI(CMIZED REPXf_9FNTATWE Westborough, MA 02581 Kicki Veerman/MICKI ACORO 25(2090105) ©1988-2090 ACORD CORPORATION. All rights reserved. IP1S0251�n+nnwln� Th.Ar.non of annon