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Home My WebLink AboutBuilding Permit #428 - 1060 OSGOOD STREET 12/14/2007 (3) BUILDING PERMIT `iO oT" qti TOWN OF NORTH ANDOVER 3? 4`�t,' . 6•, oL APPLICATION FOR PLAN EXAMINATION ° t X04 .wr Permit NO: % Date Received Z;-1,7- -a— 3ysq, ap 1" SACHU`� Date Issued: IMPORTANT:Applicant must complete all items on this page LOCATION 5 Print PROPERTY OWNER a _ Q^tc2 ' .�- C, Print MAP NO: —PARCEL 9 ZONING DISTRICT: r J Historic District yes no Machine Shap 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 Repair, replacement Assessory Bldg Others: Demolition Other Septic Well Floodplain Wetlands Watershed District Water/Sewer DESCRIPTI N OF WORK TP BE PREF RM D: In r\�F1 h C�/��C .� �O�5 u C ' NO A y� �►, S `ma y � �/ c� 4_11ta. A l' ^ I enti cation please Type or Print Cl arly) OFM: Name: Phone: Address: CONTRACTOR Name: ' a r; C � Phone: , r Address: )t UJ A v d Supervisor's Construction License: ?5 Exp. Date: Home Improvement License: { Exp. Date: ARCHITECT/ENGINEER Lo 6rz, ESQ A�S . Phone: �_5- 00- 75- Address: w\ 5a Jo ✓e / v,4 A ot 9(1/ Reg. No. FEE SCHEDULE:BOLDING PERMIT.$,t12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $_ 1� UU FEE: $ � ( . 10 Check No.:_Tb Receipt No.: ��GL NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Signature-of Agent/Owner ~ _ �gnature of contractor ' 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 2007 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 ATE APPROVED PLANNING & DEVELOPMENT r� !f COMMENTS DATE REJECTED DATE APPROVED CONSERVATION COMMENTS DATE REJECTED DATE APPROVED .HEALTH 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 Located at 384 Osgood Street EIRE DEPARTMENT Temp Dumpster on site yes no Located at 124 Main Street Fire Department signature/date COMMENTS 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 ❑ 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 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 2.2007 Location No. Date 7 0: ORT#q TOWN OF NORTH ANDOVER N.ao :a,h•G 3? •. Ot Fap 9 Certificate of Occupancy $ Building/Frame Permit Fee $ d s+cMU Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # G� 20861] inginspector NORTH Tc ® of 0 No. "LA�E o� dover, Mass., COCMICMEWICK 1• oRATED BOARD OF HEALTH i PERMIT T D Food/Kitchen Septic System �- BUILDING INSPECTOR THIS CERTIFIES THAT.......... 0.0.J.. .... J��. ....L .F..S.......................... ........................ ................................. Foundation has permission to ere ........................................ buildings on ... . ................ Rough p� �. ( .. f- i1--1d-etQ . ik_l�ell-�Ui Chimney to be occupied as... h.... .... .........�r. ��.�f.. .�/.... � �........... Q.... f/ provided that the person acceptinshapect conform to theterms of the application on file in Final 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 CONSTRUCTI STARTS Rough 1 ........................................ Service BUILD ECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR 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. SEE REVERSE SIDE Smoke Det. Dec 06 07 02:23p David McCue 9789882136 p.2 07-/ -e6w Deval L.Patrick � ' 0�70�1�1f� Thomas G.Gatzunis,P.E. Grn-ema � '��>=0660 ' commissicner Timothy P.Murray Thomas P.Hopkins Lieutenant Governor �cy /6qpGqC� Director Kevin M.Burke 6' 66J www.mass.gov/clps Secretary AMENDED NOTICE OF ACTION DOCKET#: 07 162 RE: 1060 Osgood Street; 1060 Osgood Street 'North Andover 1. An application for variance was filed with the Board by David Samuels (Applicant)on October 12, 2007 7 Ridge Hill Way The applicant has requested variances from the following sections of the 2006 Rules and Regulations of the Board: Section: Description: 28.1 Applicant seeks relief from having to provide vertical access to persons with disabilities to the second floor tenant spaces located at 1060 Osgood Street, North Andover. 2. The decision was reviewed by the Board on Monday, November 19, 2007 3. After reviewing all materials submitted to the Board, the Board voted as follows: The Board determined that the variance request to Section 28.1 is not required at this time due to the fact that the spending by the proposed tenant does not exceed 30 % of the value of the tenant space (see 521 Section 3.7)and that no change in use is occurring under 521 CMR Section 3.4. The record shows that there has been a continued use of the second floor tenant space in question. NOTE: If the work being performed is reconstruction, renovation, addition, or alteration, compliance with this decision must be achieved by completion of the project and prior to final approval by the building department. Otherwise, if the work being performed is new construction, compliance with this decision must be achieved prior to the issuance of an occupany permit. Any person aggrieved by the above decision may request an adjudicatory hearing before the Board within 30 days of receipt of this decision by filing the attached request for an adjudicatory hearing. If after 30 days, a request for an adjudicatory hearing is not received, the above decision becomes a final decision and the appeal process is through Superior Court. Date: November 21, 2007 cc: Local Building Inspector ARCHITECTURAL ACCESS BOARD Local Disability Commission Chairperson Independent Living Center Dec 06 07 02:22p David McCue 9789882136 p.1 001, a Q ® yd/�� xys0 Deval L.Patrick � L' Thomas G.Gatzunis,P.E. Governor '0660 Commissioner Timothy P.Murray Thomas P.Hopkins Lieulenant Governor �6�>->2>0019 Director Kevin Burke Secretary www .mass.gov/dps TO: Local Building Inspector Variance Number:07 162 Local Disability Commission Independent Living Center FROM: ARCHITECTURAL ACCESS BOARD RE: 1060 Osgood Street 1060 Osgood Street North Andover Date: 11/2112007 Enclosed please find the following material regarding the above location: Application for Variance Decision of the Board Notice of Hearing Correspondence Letter of Meeting The purpose of this memo is to advise you of action taken or to be taken by this Board. If you have any information which may assist the Board in reaching a decision in this case, you may call this office or you may submit comments in writing. Dec 06 07 02:23p David McCue 9789882136 p.4 License: CONSTRUCTION SUPERVISOR '. Nmnber. CS 060354 Birthdate: 09/17/1967 Expires:09/17/2008 Tr.no: 2681.0 Restricted: 00 DAVID M MCCUE JR 37 EVERETT AVE WILMINGTON, MA 01887 Commissioner ' ��= cam` L��9 i''✓��•'.;'e/G`a" r l�;'i'��/�i �`� ..:�%�',.�� "f'i61'�i�,%•': -` Board of Building Regula ons and Standards One Ashburton Place - Room 1301 Boston. Massachusetts 02108 Home Improvement Contractor Registration Registration: 105399 Type: Individual Expiration: 7/1712008 DAVID M. MCCUE SR. David McCue 37 Everett Avenue Wilmington, MA 01887 Update Address and return card.Mark reason for change. Address [J' Renewal E] Employment Lost Card DPS-CAI 8 56M-04105-PC8688 J/e. 1�io»rn�ov�uma�7/n cl.i�hs�nr./a�elZa ` \ Board of Building Regalalioos and Standards License or registration valid for individul use only I� HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: � Board of Building Regulations and Standards a S x Registration: 105399 One Ashburton Place Rm 1301 ' '• Expiration: 7117!2008 Boston,Ma.02108 Type: Individual DAVID M.MCCUE SR. David McCue 37 Everett Avenue Wilmington,MA 01887 Deputy Administrator Not v id without signature ' v David M. McCue, Sr. 37 Everett Avenue Wilmington, Ma. 01887 978-658-7335 Fax: 978-988-2136 email:dmcsonaaot.com Construction Contract August 10, 2007 Juan Barreto 1060 Osgood St North Andover Ma. Hereinafter called the Owner. David M. McCue, Sr. 37 Everett Avenue Wilmington, Ma. 01887 Hereinafter called the Contractor. Massachusetts Home Improvement Contractor Registration Number 105399 Massachusetts Construction Supervisors Number 060354 Contractor agrees to do the following work for Homeowner: The contractor agrees toperform in a good and workman like manner, furnish the material and labor to demo and disposal of the existing non structural office partitions and fabrication of non structural partition as depicted in the submitted plans. for the total price of$7600.00 The contractor will begin the work upon receipt of the building permit barring delay caused by circumstances beyond the contractors control. The work will be completed in about 20 working days. The Owner hereby agrees and acknowledges that the scheduling dates are approximate and that such delays that are unavoidable by the contractor shall not be considered as violations of this agreement. The Contractor will be responsible to the Owner for any property damage or bodily injury caused by himself, his employees or his subcontractors in the performance of, or as a result of, the work under this agreement. The contractor agrees to carry insurance to cover such damage or injury, copies upon request. It shall be the Owners responsibility to remove artwork, pictures, mirrors, kmck knacks or any other item which may fall from walls in the work area due to vibration. The Owners is advised that work performed on the roof may cause dust or grit in the attic area, an attempt should be made to cover any stored property. The Contractor agrees that any agreement for materials and /or labor between the contractor and a third party shall be the contractor's responsibility. The contractor is responsible to the Owner for completion of all work described in a timely and professional manner. David M. McCue, Sr. will provide all Workman Compensation and Liability Insurance. All work will be performed by licensed or certified employees. All permits will be provided by David M. McCue, Sr. or subcontractors. All work will conform to the standards of the Massachusetts Building Codes, to the architectural plans submitted,and/or Manufacturers Engineering Specifications. David M. McCue, Sr. is contracted with LL & S Waste Products, Salem, NH for all trash disposal. Jobsite will be left broom clean daily. The property owner will be responsible for removing all wall hangings, pictures, art, and knick knacks, which could be damaged from vibrations in the work area. Care will be taken with shrubs and flowers, but due to construction, damage may occur, owner and contractor will discuss options prior to start-up. Landscaping will be left raked out, ready for finish, unless specified Any deviation of work to be performed or additional materials from the estimated/contracted description may affect the estimatelcontract price The building construction permit will be necessary in order to complete the scope of work included in this agreement, which shall be obtained by the Contractor. The Contractor under provisions of Chapter 142A of the General Laws is required to apply for and obtain all construction related permits. The Contractor shall not be deemed responsible for delays in the work described in this agreement caused by regulatory, permit granting or inspectional agencies, authorities or individuals. Notice: If the Owner obtains his own construction related permits for the work described under this agreement, the owner is hereby advised that in the event of a dispute, Judgment, and nonpayment of David M. McCue Sr. the owner will not be entitled to make a claim to or collect from the guaranty fund established by Chapter 142A, M.G.L. This agreement, including the provisions relating to price and payment schedule cannot be changed except by a written statement by both the contractor and owner. However cancellation is allowed by the owner at anytime prior to obtaining materials or start of work. The Contractor warrants that the work furnished shall be free of defects in materials and workmanship for a period of one year following completion and shall comply with the requirements of this agreement. In the event any defect in workmanship or materials, or damage caused by the Contractor, his subcontractors, employees or agents, is discovered within one year after completion of any job, including cleanup, the Contractor shall at his own expense, forthwith remedy, repair, correct, replace or cause to be remedied, repaired, or replaced, such damage or such defecting materials, or workmanship. The warranties shall survive any inspection performed in connection with the agreed-upon work. All warranties for equipment supplied by the contractor under this agreement shall be those given by the manufacturers of such equipment, which shall be and are hereby passed through directly to the owner. Under such manufacturer's warranties, the owner may be required to register or mail in a warranty card or other evidence of ownership and use of such equipment in order to activate such warranties. The owner's failure to mail in or register such documentation, which failure voids the manufacturer warranty shall not create any responsibility for the Contractor to warranty such equipment. This warranty gives the Owner specific legal rights. Under Massachusetts's law, sales of goods carry an implied warranty of merchantability and fitness for particular purpose. The Owner is hereby advised that they should not sign this agreement unless and until all blank sections have been filled in or marked as void, deleted or not applicable,and until all i r exhibits and related or referenced documents that are incorporated herein are attached hereto. The laws of Massachusetts govern this agreement. It must be executed in duplicate and an original signed copy hereof given to the Owner at the time of execution. No work under the agreement shall begin prior to the signing of the agreement and transmittal to the Owner of a copy thereof. TOTAL CONTRACT PRICE AND PAYMENT SCHEDULE Payments will be made according to the following SCHEDULE: $4000.00 upon signing contract. $3600.00 upon completion The Owner may cancel this agreement if it has been signed by the Contractor and Owner, provided that the Owner notifies the Contractor in writing at his main office by ordinary mailposted, by telegram sent or by delivery, not later than midnight of the third business day following the signing of this agreement. s� /r0/ hers Signatures Date Contractors signature Date David M. McCue License Number 060354 Registration Nu8mber105399 r NOTICE OF CANCELLATION YOU MAY CANCEL THIS TRANSACTION, WITHOUT PENALTY OR OBLIGATION, WITHIN THREE BUSINESS DAYS FROM THE ABOVE DATE. IF YOU CANCEL, ANY PROPERTY TRADED IN, ANY PAYMENTS MADE BY YOU UNDER THE CONTRACT OR SALE, AND ANY NEGOTIABLE INSTRUMENTS EXECUTED BY YOU WILL BE RETURNED WITHIN TEN BUSINESS DAYS FOLLOWING RECEIPT BY THE SELLER OF YOU CANCELLATION NOTICE AND ANY SECURITY INTEREST ARISING OUT OF THE TRANSACTION WILL BE CANCELLED. IF YOU CANCEL, YOU MUST MAKE AVAILABLE TO THE SELLER AT YOUR RESIDENCE, IN SUBSTANTIALLY AS GOOD CONDITION AS WHEN RECEIVED, ANY GOODS DELIVERED TO YOU UNDER THIS CONTRACT OR SALE; OR YOU MAY IF YOU WISH COMPLY WITH THE INSTRUICTIONS OF THE SELLER REGARDING THE RETURN SHIPMENT OF THE GOODS AT THE SELLER'S EXPENSE AND RISK. IF YOU DO MAKE THE GOODS AVAILABLE TO THE SELLER AND THE SELLER DOES NOT PICK THEM UP WITHIN TWENTY DAYS OF THE DATE OF CANCELLATION, YOU MAY RETAIN OR DISPOSE OF THE GOODS WITHOUT ANY FURTHER OBLIGATION. IF YOU FAIL TO MAKE THE GOODS AVAILABLE TO THE SELLER, OR IF YOU AGREE TO RETURN THE GOODS TO THE SELLER AND FAIL TO DO SO, THEN YOU REMAIN LIABLE FOR PERFORMANCE OF ALL OBLIGATIONS UNDER THE CONTRACT. TO CANCEL THIS TRANSACTION, MAIL OR DELIVER A SIGNED AND DATED COPY OF THIS CANCELLATION NOTICE OR ANY OTHER WRITTEN NOTICE, OR SEND A TELEGRAM TO DAVID M. MCCUE, SR., 37 EVERETT AVENUE, WILMINGTON, MA. 01887 NOT LATER THAN MIDNIGHT OF I HEREBY CANCEL THIS TRANSACTION. Date: ` AcG c/7 Buyer's Signature: r Dec 14 07 12:13p David McCue 9789882136 p.2 The Conzinonivealth of?tlassachusetts t � - Department of Industrial Accidents Office of Irrvest�gations 600 fl,ashin;ton Street Boston, 2114 02111 rt.+ww.rn ass.b ov/dt a Workers' Compensation Insurance Affidavit: BuilderslContractors/Electricians/Plumbers Applicant Information -�� Please .Print Legibly Name (Business,'Organizationllndtviduai): v.~ 4 rvL. a r- Address:�3? City/State/Zip: 9r?, L S` -- Are you an employer? Check the appropriate box: � Type of project(required): 1.�ma a ernp°oyer with — 4• ❑ I am a general contractor and 1 ` employees (full and'or part-time). * have'dred the sub-contractors 6. ❑Ne�v onst fiction 2.❑ T air.a sole proprietor or partner- listed on the attached sheet. ?. ® Remodeling ship and have no en ployees These suia-contractors have S. Demolition working for in any .capacity. employees and Lave workers' g Y p 9. ❑ Building addition [No worker' corp. insurance corp, insurance.t 5. Ware a corporation and its 10. Electrical repairs or additions required.] ❑ e 3.❑ 1 am a homewvner doing all ,,Nork officers have exercised their I LE Plurnbing repairs or additions myself. (No,,workers' comp. right of exemption per MGL 12.❑ hoof repairs insurance rewired.]+ c. 152, :1±1j,and we have no emp:ayees. [No Nvork.ers 1 .❑ Other comp. insurance required." � *k-N applicant that checks box ft must a!so fill ou:the s oon ae'.o« sLo:wing their workers compensa:±on policy intormanon. Homeowners who submit this afidavit irniicating they are damg all work ar•d then hire outside contractors must sub-nit a reg% attidavit ird.catine such. 'Cor i-actors that cheek Lias box riot attached an additional sheet showing:i-e nemc of the stib-coatrecteis znd state whether or r.ot those entities havc cn-pinyes. I'r:he sul-L�antraclors have employee:,they rr•ast provide t.^,cir kvorkers'comp policy number. I ant art emplo.ver that is providing workers'c o nip en satio it btsit ran ce for my employees. Below is the policy and job site in c-1-1110 tion. [r:surance Company .�a*tte: Policy;7 or self-ins Lio. Y: _ 20 —5�-�.•3 J Exoi_-atiot Date: Job site Ad re" in ir0 �— Git•%state,'Zip: Attach a colj% the workers' compensation police declaration page (showing the policy number and expiration elate). Failure to =.e .:re Coverage as required-cyder Section 25A of NIGL c. 152 zan 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-` OR:ti ORDER and a fine of up to 5250.00 a day against,he violator. Be advised that a copy of this statement may be fonvarded to the Office of Investigations of rhe DIA for insurance coverage verification. �r do hereby certift under thepains oral penalties ofperjury flint the information provided above is trite and correct. Siena_Ure��_�%sr-. 1. �2 _ Date:_ Phone Official use ono% Do not nu-ite in this area, to be completed iii'city or town official. City or Town.- _ _ PerinitLicense r Issuing Authority(circle one): 1.Board of Health ?.Building Department 3. City/Town Clerk d.Electrical Inspector 5,plumbing Inspector 6.Other Contact Person: Phone#: 14 07 12:13p David McCue 9789882136 p.3 ,y Butters IO:Uave mcl.ue,uo,vr - - Client#:5821 11MCCUECORPO ACORD. CERTIFICATE OF LIABILITY INSURANCE 1�11107'!YYYY) iODUCER THIS CERTIFICATEIS ISSUED ASA MATTER OF INFORMATION {UB International NE(WADM) ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR 299 Ballardvalie St ALTER THE COVERAGE AFFORDED BY TI-IE POLICIES BELOW. Wilmington,MA 01887 I 976 657-5100 INSURERS AFFORDING COVERAGE NA#C_ I INSURED INSURER A-. Shaul Companies McCue Corporation IN SURER B: Natalie Alarcon INSLRERC 35 Congress Street lNSJRER D Salem, NIA 01570 INSLIRERE: -- COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE SEEN ISSUEDTO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANCING ANY REQUIREMENT,TERM OR CONDIT10N OF ANY CONTRACT OROTN£R DOCUMENT WITH RESPECT TD WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDEC BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUwI:D BY PAID CLAIMS. 10 'YPECF'NSURANGE POLICY NUMBER FOUCYEFFeCriVE POALIGYEXP[RATION LIMITS LTR NSR k 'ti M!D YY DT MMl fYY A GENERAL LIABILITY Y63073868069T111-06 07101/06 07101/07 EACIOCCURRENCE 51000000 DAMAGE 70 RENTED $500000 COMMERCIAL GENiERALUA.BILITY A C r C_APAS MADE E OCCUR MED EXP(Ary we person) $10000 PERSOW L B ADV WJ'JRY 51000000 GENERAL AGGREGATE 52000000 GENT.AGGREGATE 01,14TAPPLIES PER- PRODUCTS-COMP!0?AGO $1000000 POL'.CY PRO- LCC EMP Ben 1000000 A AUTCMOSILEUABILITY IYA0810717K28781COF0 07101/06 07101107 CCNtBINEo SINGLE LIMIT $1000000 ANY AUTO (Ea acdclort)I ,�-- ALL OWNED ALTCS BOULY INJURY (�^erpersorj S SCHEDUI£D AUTOS HIRED AUTOS BCOILY INJURY S NON O'N. D ACOS Pe:ac[identj PROPERTY DAVAGE S (Pe.a[[idenl'. GARAGELIABILITY AUTOONLY EA ACCin NT S ANY AUTO OTHER THAN El,A.CL 5 AUTO ON'_Y. AGG S A FX.ESSiJMSR ELLAUASI•.iTY YSMCUP7171<288ARRIM 07101/06 107101107 EACH OCCURRENCE 52500000 �C.CLk ;IPIVSMADE A.GGREGAT'c 52500000 RErE�I uN E _ •S A WORKERS COMPENSATION AND YA0810717K2878COF6 67/01/06 07101/07 •�`'`-S?12f- OTR •r _ EMP-OYER$'LAS LITY I FI FACHAf(".IDFNT sw0006 4N"rKC.'�'Y•::KAY�KINr HF Ye'..V .t ;>--FaC Q•'+trMeER For J"'-� E L DISEASE-EA EMPLCYEE'$500000 '. BPECC - - .r — E.L.DISEASE-POLICY POLICY-, 5506000 I DTr1ER 1 DESCR:PTION Oc OPERATrONS!LOCATIONS VEHICLES"EXCLUSIONS ADDED By ENDORSE4ENT7 SPECIAL PROVISIONS Certificate holder additional insued under genera)liability policy per written contract CERTIFICATE HOLDER ---_-__ —__--_ CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION Evidence at Coverage DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL in_ DAYS WRITTEN NCTIC E TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILIT'OF ANY KIND UPON THE INSURER,ITS AGENTS OR iREPRESEN TATIV ES. - AUTHORIZED REPRESENTATIVE rW ACORD 2512001;087 1 of 2 #S1 SD?91M14923 MB003 a ACORD CORPORATION 1988