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HomeMy WebLinkAboutBuilding Permit #1058-15 - 101 PRESCOTT STREET 6/16/2015 BUILDING PERMIT NORTH q •a O TOWN OF NORTH ANDOVER ` p APPLICATION FOR PLAN EXAMINATION * Yy* y h T Permit NO: to Date Received3,y"°gwT.o'p"�``�* SSACHU`�� Date Issued: I ORTANT: Applicant must complete all items on this page LOGATIOIV r O I. Pc L lV �, 1; K l( '9� i•_. 0 , ' , o P. PROPERTY 01NNER �:. --nn.t Y x MAPfNO. PARCEL T ZONING3DI8T,RICT Historic Districf yes nq .Machine Shop Village, yeses no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building One family Addition Two or more family Industrial Alteration No. of units: Commercial Repair, replacement Assessory Bldg Others: Demolition Other Septic: woll Floodplain1. : . VI%etlands Wa#erstied District' { _ Water/Sewe�� -- DESCRIPTION OF WORK TO BE PREFORMED: Identification Please Aype or Print Clearly) OWNER: Name: Phone: Address:16k 'CONTRACT QR, Narne r ,.Phone.__. _ ;Address: ► - - r _ Supervisor's Co nstruction�License; Home Improvement License: a ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE.,BOLDING PERMIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ FEE: $ U Check No.: , I Zo Z Receipt No.:Oqkq NOTE: Persons contracting with e e ed contractors do not have access to thea nd S niS ature:of A ent/Ovvner Sl naturerof Zcontractorr Building Department The following 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 i ❑ 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) o 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 appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be submitted with the building application Doc:INSPECTIONAL SERVICES DEPARTMENT:BPFORM07 Revised 2.2008 Al Plans Submitted Plans Waived Certified Plot Plan Stamped Plans TYPE OF SEWERAGE DISPOSAL Public Sewer Tanning/Massage/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 Signature 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 i Water & Sewer Connection/Signature&Date Driveway Permit DPW Town Engineer: Signature: Located 384 bs ood Street <FIREADEPA' TMENT .Temp,Dumpster,onrsite yes: �. nog ...h' -k...at-J 24 .Located{ ;MainStreet+ Fire D..epartmentsigriatu're/dated h�, O-0CMMENTSR . r V �.:. 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.$100-$1000 fine NOTES and DATA— (For department use) ❑ Notified for pickup - Date Doc.Building Permit Revised 2008 Location� A-,e i No. Date i . - TOWN OF NORTH ANDOVER Certificate of Occupancy, ! $ Building/Frame Permit Fee Foundation Permit Fee $ Other Permit Fee 11'rEv��� $ TOTAL $ Check#_0j'?,P2 26 4 Building Inspector NORT#i Town of s E :...I,. ndover, O �`. 0 &A- I No. [, _ CIOh ver, Mass, (OR coc"ICMIWICK y1' S V BOARD OF HEALTH Food/Kitchen PERMIT LD Septic System THIS CERTIFIES THAT N Ah ........ ik� BUILDING INSPECTOR .............................. . ............ . ... .......... ..... ....... ........... Foundation has permission to erect .......................... bu Ings on ...1.0.1......... .................. ... ............�.�.. ........... Rough 4to be occupied as .�� ..�L�...16+W...... ....... .....��...... Ilc. .. ... ............................. Chimney provided that the person accepting this permit shall in every respect conform to the t sof 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 CONST TIO ARTS 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. r� next step living® home energy solutions This agreement fie made by and among Next Step Living, Inca("NSL") Nancy Bartlett 21 Drydock Avenue;2nd floor 101 Prescott StBostonr.MA:0221Q North Andover, MA 01845 phone: (ass)867-8729 Site ID: 417122 30-Apr-15 1. DESCRIPTION OF WORK TO BE PERFORMED NSL 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;including the attached recommendationstwork order describing the work In detail(the"Work")which are Incorporated herein by reference: uantity Air Sealing Recomm6ndations Work Location: Attic Flat Perform Air Sealing at Estimated 62.5 CFM60 Per Hour 6 $85.00 Hr $510.00:,, 1/Vork Location: Attic Flat Damming 24 $2.05 - Lnft $48.20 . Replaca Bath Fan Hose 1 . $50 00 tach $50;1)0 Propavent 2'or 4' 46 $2.00,..... Each $92.00 Attic Floor*n­.,Blouv Cellulose 7`' 432 $130 ;,:sgft $561,130 1Nork:Locattpn Foundation Insulate Rim Joist With 2"Thermal Barrier Polyiso 1'04 $3:52 sgft $366.08 lnitial-lnvestrnenf:� $1 628.88 1Ob%Airseahng;lnce(t4iv u �ep to.:Program Max: $51800 Total Not Invesiment. 75%VNeafherizatron lncenti Estimated Annual Energy Swings from the Above Improvements: ; ,;.,$��t 06 , 2. PAYMENT. CUSTOMER agrees to pay NSL for the work as follows: Payment#1: $100.00 -Credit Card or E-check deposit is due et the time the:Work is scheduled..R,equired.payment Irnoimation vAl be collei ted over the phone by a customer service . representative at the time of scheduling..Deposit Is not'to exceed 113 of the total retail costs. (Note:Mastercard,Visa,and Discover accepted).,. Additional Payments and Final Invoice: $179.72 -A�(Qnai Payment$for the Work shall be due upon completion of the Work. If the final invoice is being paid by check,credit card information will still be required at the time of scheduling. Notify,the customer�ervice representative that you are paying by check and your card will not be charged unless we fail to receive payment within'5 days of invoice. .4 CIO L30AFprmer Signat to 2015 Alden Young NSL Signature Date Name of NSL Representative A1002511 The Terms of this Agreement are contained on both sides of this page Next Step Living•21 Drydock Avenue•2nd floor•Boston,MA 02210•(866)867-8729•lnquiry@nextsteplivinginc.com•www.nextsteplivins.com TERMS OF AGREEMENT 417122 3.PROPOSED START DATE AND COMPLETION SCHEDULE 'NSL will contact customer to schedule the Work at a mutually agreeable time,subject o et thin availability of subcontractors or materials,or to.delays attributable to the weather or other events beyond NSL's control. 4.CONTRA,OTOR REGISTRATION Massachusetts law requires home improvement contractors and subcontractors to be registered with the Director of Home Improvement Contractor Registration, You may inquire about contractor registration by writing 1o: Office of Consumer Affairs and Business Regulation,Ten Park Plaza,Suits 5170,Boston,MA 02116.617.9738700. 5.PERMITS NSL will obtain any necessary permits as the Customers agent Customers who secure their own permits ordeal with an unregistered contractor will be excluded from the Guaranty Fund provisions of the Home Improvement Contractor Law. 6.'PERFORMANCE OF THE WORK AND CHANGE 6.1 NSL will not lommence the 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 modified only by the mutual agreement of the parties.No supplement,amendment or modifrcatlon'of this Agreement shall lie binding unless it is In writing and signed by all parties. 6.3 At times,our weatherization team discovers situations in the structure during the course of the Work that indicates a risk for a health or safety concern for residents..'Such concerns can include but are not limited to ventilation,potentially hazardous materials such as mold or asbestos,or structural concerns. In the case of health or safety concerns being Identified, NSL reserves the'right,par section 9.2 of this contract,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®Home Energy Services Program and amounts due;from the Customer are based on the best estimate of the situation In the structure by the NSL home energy advisor. However,at times our weatherization team discovers situations in the h0me during the course of the Work that impar the availability of rebates and Incentives from the Mass Save Program.:•In such situations,NSL will communicate such changes to the Customer;Including Any Impact on amount the,Customer would be expected to pay for the Work:The Custornowill have the option to remove-from the.Contract the work elements that need adjustment,or setup a separate contract•forperforming.the adjusted work. 6.5 NSL 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(c)that the Work will conform with the description of the Work described In Paragraph 1. 7.INSURANCE AND REGISTRATION NSL represents andwarrants.to the Customer-that it has a-valid,Home Improvement Contractor Registration(No:,162111)and the necessarylnsuraitoe required by applicable law and normally maintained..by rodent contfac(ors.in NSL's field,inclptling,burnt ihited to,Workers Compensadon lnsuranrxr for all employees who vn11 perform ttie.Work I QUALITY OF WORM NSL agrees that the Work wits be performed in a good and workmanlike manner,and that NSL will repair and replace,at its own expense,and promptly uponCustomefs request,any defects In workmanship and materials provided by NSL which.appear up to(1)year after completion of the Work orwithin eny,bnger.period.as:permitted or required under applicable law,provided NSL has.received final payment as provided herein:.,, `9:PRE-EXISTING CONDITIONS&PR_OPERTY-PROTECTION 9.1 NSL shall not be responsible for any damages as a consequence of the Work performed In the home due to pre-existing conditions. These conditions include but are not limited to poorly fastened or broken drywall,moisture damage,non-code construction,cracked or fragile siding or shingles,old pipes and fittings,rotting wood,etc. 9.2 NSL 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 theat-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 NSL'wi i make best efforts to protect any propertyof the Customer, it Is the Customer's responsibility to remove or protect,including dust protection,any personal property Including the tome:itself. NSL will not be responsible for damages to or losses of any of the above mentioned property not property protected prior to the commencementof the Work. 10.QENE,RAL,PROVISIONS. 10.1 NSL 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 oiintention to lien,and to take any other steps to perfect and enforce such alien,If Customer fails.to pay NSL as provided herein, 10.2 This Agreement shall be construed In oomrdance withthe laws of the.Commonwealth of Massachusetts 10.3 This Agreement"the complete intagrated.agraementbetween N$Land:Customer.The pattres,reptesentend warrant that in executing this;Agreemeint;fhey are.not retying on any representations;warranties ortemis other than`as expressly contained hereln..Tlils Agreement supersedes ail prior agreements between the Customer and Contractor and may not be altered absent a subsequent winter ai�reement signed by both parties. "' .. • You may cancel this Agreement if it has peen signed at a place.other than the NSL's normal place of business;provided you notify NSL in writing at Its main office or branch office by ordinary mail posted,t yte"ram sent or by delivery,not later then mldn�jht of fire third business day following the signing of this Agreement.Seethe.attached,notloe of canceliatlon form for an explanation of tfIr. 11.rNIRGY BENEFITS. The Sponsoring Utility Company(the Udlltyj Is enutled fo 1Ob96 of the energy benefits associated with all Energy ConsWatloh-Measures excluding the value of energy cost savings by the Customer,but including all rights to all associated ISO-NE Energy,Capacity and Reserves Pmdu0,,.NSL agrees to provide the UtilitywHh such furtherdocumentation as the Utility may request to confirm the Utlilty's ownership of such benefits and Products. 12.NOTICE CONCERNING SPONSORSHIP. Customer understands and acknowledges that NSL is not an agent,vendor or sub-vendor of The Sponsoring Utility Company(the Utility)with respect to the.installation of an energy . efficiency measures.In the`eveht`of the faliu 'f an energy conservation device to performas expected,Custom:i sots recourse is to Contractor and hot to RISE Engineering(RISE) or to the Utility.The Utility and its operating obmpanles shall not maintain,remove or perform any work ikhatsoev4 on the energy obr►seivation measures Installed. 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. Customer agrees that it shall not hold RISE,the Utility,their affriiates or operating companies liable for Contractors to perform tis obligations under this agreement,for failure of the energy conservation measures to function,for any damage to Customer's Premises caused by ConftMror.•fur.any:and:ail;damages to property:or injury to.persons caused by the.::. energy conservallon measures... 13.LLIM ED T ME OFFER, :. .: The prices and incentive offered in this Contractani subjectto change in accordance with The Sponsoring Utility Company Mass Save'Home Energy Services Program offers. 14.CONT RAtrT CANCELLATION Under Massachusetts law,you may cancel this agreement If it has been signed by a party thereto at a place other than an address of the seller,which may be his main office or a branch thereof,provided you notify the seller In writing at his main office or branch by ordinary mag posted,by.telegram.sent or.by delivery,not laterlhan... midnight of the third business day following the signing of this agreement, Mass Save Planview Diagram Customer HMZY Advisor Name: Address 16 d k pz-5C0r Advisor Number: X13 &0 Town Imo( A-Nu,<-cam Any limitations to access by truck? Site ID _ I1I7 M-L. / (, NOTES > 3 lzC- ,- �G� Br 1�ZtSC 1 Q�oPI � I�Q-01-tT a- E2.6-(t� �l� 5 7'' oBC. � —z-r+-r X13 6 Z" (11,y o �/ i �serr�— 23� F16 ;j to' Q ni 3 � STQ66-T- V The Commonwealth of Massachusetts Department of Industrial Accidents W Office of Investigations a d I Congress Street, Suite 100 F Boston,MA 02114-2017 www.mass,gov/dia Workers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): Next Step Laving Address: 21 Drydock Ave City/State/Zi : Boston, MA 02210 Phone#:(866)867-8729 Are you an employer?Check the appropriate box: Type of project(required): 1.[]�, I am a employer with 850 4. ❑ I am a general contractor and I employees(full and/or part-rime). have hired the sub-contractors 6. [D New construction 2.® I am a sole proprietor or partner- listed on the attached sheet. 7. ®Remodeling ship and have no employees These sub-contractors have g, ❑Demolition working for me in any capacity. employees and have workers' 9. Building addition [No workers' comp,insurance comp. insurance. � ❑ required.] 5. ❑ We are a corporation and its 10.[]Electrical repairs or additions 3.El I am a homeowner doing all work officers have exercised their 11.❑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 Insulation employees. [No workers' 13.©Other _ comp. insurance required.] *Any applicant that checks box M must also fill out the section below showing their workers'compensation policy information. t I lomeowners whe submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidal•it indicating such. lContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or jot those Ofttities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. f am an employer that is providing workers'compensation iasurance,j`or my employees. Below is the policy and job site information. Insurance Company Name: A.I.M Mutual Insurance Company Policy#or Self-ins. Lic.M AWC-400-7030025-2014A Expiration Date: 9/30/15 Job Site Address: City/State/Zip: Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can Iead 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 may be forwarded to the Office of Investigations of the DIA for insurance coverage v f tion. I do hereby certify under the pains and in s perjury that the information provided above is true and correct Signature: Date: 10/ 81 /1 Phone#:(3[dQ)&_7-M9 Official use only. Do not write in this area,to be completed by city or town official. City or Town: PermitlLicense# Issuing Authority(circle one): 1.Board of(Health 2.Building(Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: JXeoofoos iceumer Aff4( n 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 162111 Type: Supplement Card Expiration: 1/1412017 NEXT STEP LIVING INC. ROGER OUELLETTE 21 DRYDOCK AVE. 2TH FL BOSTON, MA 02210 Update Address and return card.Mark reason for change. E] Address F-1 Renewal R Employment Lost Card DPS-CAI 5OM-04/04-GI01216 92. License or registration valid for individul use only Office of Consumer Affairs&Business Regulatior, ROME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Office of Consumer Affairs and Business Regulation Registration: 162111 Type: 10 Park Plaza-Suite 5170 Expiration: 111412017 Supplement Card Boston,MA 02I lli NEXT STEP L)VING INC. ROGER OUELLETTE 21 DRYDOCK AVE.2TH FL BOSTON!MA 02210 UndersecretaryC/ ,W/Yafid without signature k Massachusetts Department of Public Safety Board of Building Regulations and Standards Construction Supen-isor Special" License- CSSL=102811 ROGER A OVELLETT 55 ST ®1�RA o ` ar*dck RK 029 9 � Expr ration Cornmissronet . tfictedd To: CSSUC e Msulation Contractor Faiure to possess a current edition of the Massachusetts Stare Building code is cause for revocedoo ou thus license. For[SPS Ucenshp,Wo'Ormation esfdut: etww.Mas�.Gnv/DE'S NEXT S-1 OP ID:EL .a►�Rv CERTIFICATE OF LIABILITY INSURANCE DATE(MMO)DIYY 10/01/20144Y) THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION O%y AND CONFERS NO RIGHT$ UPON TIV GORTIFICATIE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BEI.Wf. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REp PSENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the Certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION 14 WAIVEQ,Quo the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to flip certificate holder in lieu of such endorsement(s). PRODUCER C5OMEACT Erin Lyons McLaughlin Innsurance Agency PHONE 781-665=2775 828 Lynnfeils ParkWsy Arc No Exit: FAI�c Ne:751-665.02 Melrose,MA 02176 E-MAIL John E.McLaughlin Jr. ADDRESS: INSURERS AFFORDING COVERAGE NAIL 0 114SURER A;Nautilus Insurance INSURED Next Step�Iving,Inc. INSURER a:Commerce Insurance Company 3475 21 Drydock Avenue,2nd Floor Boston,MA 02210 INSURER c:A•I.M.Mutual Insurance Co. INSURER D:AXIS Insurance Company 15610 INSURER E INSURER 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 RPR(!% INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH TI1I8 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. iLTR TYPE OF INSURANCE D POLICY NUMBER MPMIODY EFF MMOD EXP LIMITS A COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 CLAIMS-MADE ®OCCUR ECP2010198-12 09/30/2014 09130/2015 PREMISES Ea occurrence $ 140,00 MED EXP(Any one person) $ 0190 PERSONAL&ADV INJURY $ 1, oleo GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 9,Qp4,QP POLICY El JE LOC PRODUCTS-COMP/OP AGG $ OTHER $ AUTOMOBILE LIAftifi COMBINED SINGLE LIMIT Me accident $ 1,OOIi,OID ANY AUTO 14MMBGKKOM 09/30/2014 09/30/2015 BODILY INJURY(Per person) $ ALL AUTOS OWNED X AUTOSSCHEDBODILY BODILY INJURY(Per accident) $ X HIRED AUTOS NON-OWNED PROPERTY DAMAGE AUTOS Per accident $ $ UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 5,000108 D EXCESS LIAB CLAIMS-MADE E�083547012014 09/30/2014 09/30/2015 AGGREGATE $ DED I I RETENTION$ $ WORKERS COMPENSATIONPER OTH AND EMPLOYERS'LIABILITY X STATUTE ER C 0 Y PROPRIMBERIEAXC NERIE ECUTIVE YINN/A/A TO BE ISSUED BY CARRIER 09/30/2014 00/30/2015 E.L.EACH ACCIDENT $ 500,00 (Mandatory In NH) E.L.DISEASE-EA EMPLOYE $ 500,00 If describe under CRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 DES DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space Is required) FOR YIYk'OplaTION ONLY CERTIFICATE HOLDER CANCELLATION INFO-01 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE For Information Only THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLI..Y PROVISIONS. AUTHORIZED REPRESENTATIVE ©1988.2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014191) Thi ARARR Ri)Ip¢if pM I'gg IleIfg ofACORI