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HomeMy WebLinkAboutBuilding Permit #81-14 - 100 SECOND STREET 7/24/2013 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: o Date Received Date Issued: Zy(q+ IMPORTANT:Applicant must complete all items on this page LOCATION 10 / Print PROPERTY OWNER ,JI0)e- L-f ►N.!! - Print 100 Year Old Structure yes no MAP NO:� PARCELW�I ZONING DISTRICT: Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑Addition XTwo or more family ❑ Industrial KAlteration No. of units: 2 ❑ Commercial R' Aepair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic 0 Well ❑ Floodplain ❑Wetlands ❑ Watershed District ❑Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: puri- r-% �m o-��uS_� tiNsr 5� -Z..�j4 "_d Identification Please Type or Print Clearly) OWNER: Name: Phone: Address: CONTRACTOR Name::J�ww\-T-;Jty-4vci c Phone: Address: Cl-1 {��rr'rv..yks IzoCJ 1,10 o eb,( Supervisor's Construction License: C5- 05,q Exp. Date: 2 -I - 2QjJ Home Improvement License: Irl 'z-��`Z Exp. Date: .5— ARCHITECT/ENGINEER /l) 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: $ I r-) 9L33 • "- FEE: $ Check No.: Receipt No.: NOTE: Persons contract' g with unregistered contractors do not have access tot a guar n fund Signature of Agpgy(?wASignature of contractor Plans Submitted [IPlans Waived ❑ Certified Plot Plan ❑ Sta ped Plans ❑ Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE_OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/1V4assage/Body Art ❑ Swimming Pools ❑ Well ❑ Tobacco.Sales ❑ Food Packaging/Sales ❑ Private(septic tank,etc. ❑ Permanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT ❑ ❑ COMMENTS CONSERVATION Reviewed on L( 75 Signature2A LA"I COMMENTS HEALTH Reviewed on Signature COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water& Sewer Connection/Signature Date Driveway Permit r+ DPW Tovv.. Engineer: Signature: = Located 384 Osgood Street FIRE-DEPARTMENT = Temp Dumpster on site yes. no Located at 124 Mair, Street Fire Department signature/date - r COMMENTS I Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: ELECTRICAL: Movement of Meter location, mast or service drop requires approval of Electrical Inspector Yes No DANGER ZONE LITERATURE: Yes No MGL Chapter 166 Section 21A=F and G min.$10041000 fine NOTES and DATA— (For department use ® Notified for pickup - Date F s [ Doc.Building Permit Revised 2010 Building Department The foltowing is-a list of the required forms to be filled out for the appropriate.permit to be obtained. Roofing, Siding, Interior Rehabilitation Permits ❑ Building Permit Application ❑ Workers Comp Affidavit ❑ Photo Copy Of H.I.C. And/Or C.S.L. Licenses ❑ Copy of Contract ❑ Floor Plan Or Proposed Interior Work ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks ❑ Building Permit Application ❑ Certified Surveyed Plot Plan ❑ Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses ❑ Copy Of Contract ❑ Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Mass check Energy Compliance Report (If Applicable) ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit New Construction (Single and Two Family) ❑ Building Permit Application ❑ Certified Proposed Plot Plan ❑ Photo of H.I.C. And C.S.L. Licenses ❑ Workers Comp Affidavit ❑ Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Copy of Contract ❑ Mass check Energy Compliance Report ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit In all cases.if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals that the apw-al period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be submAted with the building application Doc: Doc.Bui!ding Permit Revised 2012 Location��� rj/7 'Ir// ,STT ,-r 7— No. No. Date . - TOWN OF NORTH ANDOVER • Fn z ' Certificate of Occupancy $ ,,._ Building/Frame Permit Fee $ � Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check# D� Building Inspector N�R7 � N Town' of 0 - � No. .. I � Y - ,� 2q h ver, Mass �qScoc"Ic NawKN R^TEo OkP��.�9 U BOARD OF HEALTH Food/Kitchen PERMIT LD Septic System THIS CERTIFIES THAT Ri4NACA *�N ............................................ BUILDING INSPECTOR has permission to erect ....... buildings on 1.01. . ... .. ....... Foundation ................... ... ........ ........ ... Rough to be occupied as ..... is ,.'.&.....�.,......C.....P. �....����.5...................................... 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 MONTH ELECTRICAL INSPECTOR UNLESS CONSTR ST S Rough Service ........ ...................................................................... Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Building 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. SEE REVERSE SIDE Proposal X GBC 93 Burroughs Road Invoice_ CONSTRUCTION North Reading,MA 01864 978-551-8020 Submitted To: Richard Lambert Phone: 978-683-2555 Date: 07-22-2013 Address: 1012"d Street Project: Porch Renovation Location:Ri ht Side North Andover,MA 01845 `,L 0, We hereby submit specifications and estimates for: -Remove and dispose of first and second level existing side porches including framing, decking, walls,lattice, steps, and first level ceiling. -Provide temporary support for second level roof and save all trim, ceiling and framing. -Install 3 new concrete sonatube footings 4' —0" below grade. -Frame new first level porch deck and steps with pressure treated lumber and new second level porch deck with K.D. lumber covered with%exterior grade plywood. -Install rubber roof at second level deck, sealed and flashed at house and all support posts. -Both decks to be attached to existing house framing using"ledger locks", and properly flashed. -Attach existing second level roof framing to new support posts with mechanical fasteners. �' -All levels to be positively connected from concrete footings to second level roof. -Frame on top of second level deck with pressure treated lumber for decking attachment. -Install new ceiling at first level to match existing and light using existing wiring. i -Supply and install new Azek decking late Gray) at both levels and at new steps. -All decking to run in existing directiQ and to be-spaced for proper drainage. -Supply and install new Azek railings (White) 36" high at both levels and at outside of steps. -All decking and railings to be assembled and fastened with stainless steel screws. -Infill and patch siding at house using existing material from old porch wills. -All new trim (post and beam wraps, slat type lattice and trim) to be pre-primed pine. -Install new slat type lattice around bottom of first level to match existing. -All debris to be properly disposed of using onsite dumpster. -Cost to upgrade all new trim from pre-primed pine to azek. (TBD) Exclusions: Building permit fees, painting or staining,ledge/lame rock removal, the cost of light fixture if not recessed light and anything not mentioned above. We Propose hereby to furnish materials and labor—complete in accordance with the above specifications, for the sum of. Seventeen ThousApg Nine Hundred and 00/100 ( $ 17,900.00 ) Payment Terms: 40% down, 35% after all decking and trim and 25% upon completion. All work to be done in a workmanlike manner according to standard practices. Any alteration or deviation from the above specifications involving extra costs will become an extra charge over and above the estimate. All agreements are contingent upon strikes,accidents or delays eyond our con -ol. Owner to carry all necessary insurances. Authorized Signature: ' < E Note: This proposal maybe withdrawn y us if noV ccepted within days. Acceptance of Proposal -- e above prices,specifications and conditions are satisfactory and hereby accepted. You are authorized to do the work as specified. Payment will be made as o fined. x..31 Date of Acceptance: Signature: Office of Consumer Affairs and Business Regulation 10 Park Plaza- Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 172037 Type: LLC Expiration: 5/14/2014 Tr# 225211 GBC CONSTRUCTION, LLC. JAMES INTRAVAIA 93 BURROUGHS ROAD N. READING, MA 01864 Update Address and return card.Mark reason for change. E] Address ❑ Renewal n Employment E] Lost Card SCA 1 is 20M-05/11 mer Affairs Business Regulation License or registration valid for individul use only _Office of Consumer Affairs&Business Regulation g OME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Office of Consumer Affairs and Business Regulation ZgistratP 172037 Type: piration_ 5/14/2014 LLC 10 Park Plaza-Suite 5170 y Boston,MA 02116 GBC CONSTRUCTION,LLC. JAMES INTRAVAIA 93 BURROUGHS ROAD N.READING,MA 01864 Undersecretary Not valid wi hout signature d ' Massachusetts-Department of Public Safety Board of Building Regulations and Standards Construction Supcn icor License: GS-059800 , JAMES S INTfliAVAIA 93 BURROUgHS RD N READING�kIA 01864 r Commissioner Expiration 02/19/2014 The Commonwealth of Massachusetts Department ofIndustrinlAccidents Office of Investigations 600 Washington Street Boston,MA 02111 www.mass gov1dia Workers' Compensation Insurance Affidavit:Builders/ContractorstElectricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/fndividual): �'a C-- r1� �Yl coif 1 L C Address:_ X13 (2),,,(ro.,�k N �\_) cQ City/State,/Zip:_ �J0� Ole-dam,444 0 16b Phone Are you an employer?Check the appropriate box: Type of project(required): 1.[ I am a employer with t 4. ❑ I am a general contractor and I 6. ❑New construction f employees(full and/or part-time).* have Hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet.1 7. ❑Remodeling ship and'have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. workers' comp.insurance. 9. ❑Building addition [No workers'comp.insurance 5. ❑ We area corporation and its required.] officers have exercised their 10.0 Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 11.❑Plumbing repairs or additions myself. [No workers'comp. c. 152,§1(4),and we have no 12.❑Roofrepairs insurance required.]t employees.[No workers' comp.insurance required.] 13.E]other *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. Homeowners who submit this affidavit indicating they a're doing all work and then hire outside contractors must submit anew affidavit indicating such. TContractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. I am an employer that is providing workers'compensation insurance for my employees Below is the policy and job site information. Insurance Company Name:. ' � AQP .,.; V AYYye,,-z< V Policy#or Self-ins.Lie.#: Ex irationDate: 5��. (Lust Job Site Address: i \ 2►. sts�+ City/State/Zip: NUc4h A My9 OI fib-{ Attach a,copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as requiredunder 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 day against the violator. Be advised that a copy of this statement maybe forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do herehy cert! under t e ains andpenaltles ofperjury that the information provided above is true and correct. Si ature: Date: 7 Phone#: 9 rJ a O 11, fficial use only. Do not write in this area,to he completed by city or town offacial. ity or Town: PermiVUeense 0 suing Authority(circle one): .Board of Health 2.Building Department 3.CitylTown Clerk 4.EIectrical Inspector 5.PIumbing Inspector 6.Other - - Contact Person:_ Phone#: Information ation and Instruction's Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract ofhire,- express or implied,oral or written?, An employeris defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employes." MGL chapter 152,§25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced-acceptable evidence of compliance with the insurance coverage required" Additionally,MGL chapter 152,§25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapterhave been presented to the contracting authority." Applicants Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractors)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers'compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit maybe submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate he, City or Town Officials -Please-be sure that-the affidavit-is-complete-and printed legibly: The Deparim erifhas provided a space at the boitoin of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number whichwill be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current Policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town maybe provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Comm onweaXt�ofMfassacl?vsetts Dep.artrnent.offadustdal Accidents Office.ofInvestigafio.ns. 600 Wasbi gton.Street Boston}SIA 02111 TQL#617-7274900 at 406 oz 1-877-MASSAFB Revised 5-26-05 Fay,#617-727-7749 AGM CERTIFICATE OF LIABILITY INSURANCE D /DD/YYYI) �.� 3//1/21/2 011 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 WANED,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 Heu of such endorsement(s). PRODUCER CONTACT NAME: Linnane Insurance Agency Inc. PHONN.M; (978)664-2000 FA1AC NO:(978)664-0180 280 Main St. #101 ADRESS: PRODUCER ER 10 N. Reading MA 01864 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURERA:State Auto GBC Construction, LLC iNsuRERB:Travelers INSURER C INSURERD: 93 Burroughs Rd. INSURER E: North Reading MA 01864 INSURER F: COVERAGES CERTIFICATE NUMBER:CL113100591 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 SUBR POLICY EFF POLICY EXP LIMITS LTR POLICY NUMBER MMIDD MMID GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 GE TO RIERT� X COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence $ 500,000 A CLAIMS-MADE Fx_]OCCUR P2721511 /15/13 /15/14 MED EXP(Any one person) $ 10,000 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEMLAGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOPAGG $ 2,000,000 POLICY PRO LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMB $ (Ea acc ideM) ANY AUTO BODILY INJURY(Per person) $ ALL OWNED AUTOS BODILY INJURY(Per accident) $ SCHEDULED AUTOS PROPERTY DAMAGE HIRED AUTOS (per accident) $ NON-OWNED AUTOS $ $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS UAB CLAIMS-MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION wCYTATU- I JE OTR AND EMPLOYERS'LIABILITY YIN ANY PROPRIETOR/PARTNERIEXECUTIVE 61C(JB—SB26216-9-12 /14/12 /14/13 E.L EACH ACCIDENT $ 500,000 OFFICERIMEMBER EXCLUDED? N f A B (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 500,000 if yes,describe under DESCRIPTION OF OPERATIONS below EL DISEASE-POLICY LIMIT $ 500 000 I i i T I DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,it more space Is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE '�- Linnane/JIISTIN ACORD 26(2009/09) ©1988-2009 ACORD CORPORATION. All rights reserved. INSA75 rwnnorw% The ACORD name and logo are reaistered marks of ACORD r From: "Justin A. Araniz" <justin@linnaneinsurance.com>(? Subject: GBC Construction LLC, TBD Date: May 21, 2013 1:12:55 PM EDT To: <jimi43@verizon.net> 1 Attachment, 12 KB ,a��n® CERTIFICATE OF LIABILITY INSURANCE 5/21/013 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 WANED,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 House NAME: Linnane Insurance Agency Inc. PHONE (978)f64-2000 FAX o.(976)664-0180 280 Main St. #101 E-MAIL ADDRESS: INSURERS AFFORDING COVERAGE NAIC N N. Reading MA 01864 INSURERA:Tranelers Indemnity of America 25666 INSURED INSURER 8 GBC Construction LLC INSURER C: 93 Burroughs Rd. INSURER D: INSURER E• North Reading MA 01864 INSURER F: COVERAGES CERTIFICATE NUMBER.CL1352100885 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 ADL UBR POLICY EFF POLICY EXP LI LTR POCY NUMBER MM/DD/YY MM/DD/YYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL UABIUTY DAMAGE TO RENTED PREMISES a occurrence $ CLAIMS-MADE ❑OCCUR MED FRCP(Any one person) $ PERSONAL&ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 17 POLICY PRO LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNEDSCHEDULED BODILY INJURY(Per accident) $ AUTOS Al1TOS NON-0WNED PROPERTY DAMAGE HIRED AUTOS AUTOS Peraw'd $ UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ A WORKERS COMPENSATION WC STAN- OTH- AND EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE YIN D /16/2013 /16/2014 OFFICER/MEMBER EXCLUDED? ® N/A E.L.EACH ACCIDENT $ 500 000 (Mandatory in NH) E.L.DISEASE-EA EMPLOYE $ 500,00 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POUCY OMIT 1$ 500,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,If more space Is required)