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HomeMy WebLinkAboutBuilding Permit #153 - 1160 GREAT POND ROAD 7/31/2012 BUILDING PERMIT �NORTH ;tio TOWN OF NORTH ANDOVER 32 y.: •_ . °L APPLICATION FOR PLAN EXAMINATION JV Permit N0: Y'1 Date Received a,Q"�'tArs Pv �SSACHU`��� Date Issued: ' IMPORTANT:Applicant must complete all items on this page } `L®CATsI.O,Nt ►�e�. Opt O ( ,. w .� - Print i PROPERTsY�"OWNEFtt j j off_ C�C?lt_ i. MAP3N0 PARCEL ; ZONING D;ISf RIOT; �__ Mistonc,Distnct yes nos :F Machine>Sho Villa _P.),_ _g_a i, 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 -. Septtc� - (Nell` ;` Floodplain Wetlands " `�Watersiied District. . .. ater/Sewer,=- G DESCRIPTION OF WORK TO BE PREF O MED: f Identification Please Type or Print Clearly) OWNER: Name: Phone: Address: iC�ONTRACaTORName:=I/VLM hone Adtl'ress: / .S'� _ _Wo?vl Supervisor.'s,Consteuction},License:� -ee�e� l .�I Expl .Date ,,Tib .y,. HomeImprovementlLicense - _ �< 1 Exp sD"ate ARCHITECT/ENGINEER Co&e Phone: Address: Reg. No. FEE SCHEDULE:BOLDING PERMIT:$12.00 PER$9000.00 OF THE TOTAL ESTIMATED COST BASED ON$925.00 PER S.F. Total Project Cost: $ i FEE: $ f Check No.: t,/ _� `� Receipt No.: X573 NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Signattare-of Agent%Owner Signature of contractor 7,,de4w�zlzzz 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 o Workers Comp Affidavit o Photo Copy of H.I.C. And C.S.L. Licenses o 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) o 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 o Workers Comp Affidavit ❑ Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Copy of Contract o 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 DEPARTMENr:BPFORM07 Revised 2.2008 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 Water & Sewer Connection/Signature&Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street FIRE=DEPARTMENT Temp Dumpster onsite -yes t no :�-� �._ i Located at 124 MainStreet : ;� lil ``� �� a' �: -4 z •j? *�-0: '°° �Fire'Departmeintisig I COMMENTS. } 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 153 Date l- /./0. . .... NpRTM TOWN OF NORTH ANDOVER pF ��co 1tip FOS e° e•e LA PERMIT FOR MECHANICAL INSTALLATION ,no•r•'4h 'rs•9'SUcHUSES . This certifies that m •. . . . . . . . . . . . . . .f. . . has permission for mechanical installation . . . . .T©!U. . . f. . in the buildings of /.�.�d� J Sc ��a �eii� i at 1 �, . .l�l.�.�,t� dr ,Andover, Mass. Fee. Lic. No.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .�6. GAS INSPECTOR WHITE:Applicant CANARY:Building Dept. IPINK:Treasurer The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 s� www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): l Address: cL`� 2 Iry c l ' City/State/Zip: �� �C Phone k�k--�7�oZ. Are rfan employer?Check the appropriate box: Type of project(required): 1.Rf I am a employer with 3 4. ❑ I am a general contractor and 1 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. E]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 are a corporation and its required.] officers have exercised their 10.❑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.❑Roof repairs insurance required.]f employees. [No workers' ,, /�n _ r�ce 13.❑Other i•}c�(� comp.insurance required.] ce ye-'eat_ *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. f Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $Contractors 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: Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address: /Z�, � ®j 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 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 may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. l do hereby certify and r t rep ins and penalties of perjury that the information provided above is trite and correct. Si nature. Date: Phone#: Official itse only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License# 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#: Information and Instructions 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 of hire, express or implied,oral or written." An employer is 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 dwellinghouse of another who employs to do p ys p ersons maintenance,construction or repair work on such dwelling house p g se � or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." 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 chapter have 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-contractor(s)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 may be 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 line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom 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 which will 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 may be 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 Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 Tel. #617-727-4900 ext 406 or 1-$77-MASSAFE Revised 5-26-05 Fax# 617-727-7749 www.mass.gov/dia i Sheet Metal Commercial Guidelines/Life Safety/Critical Systems Inspection Checklist Yes No/ N/A, v Set of stamped engineering documents and detailed description of mechanical system to be installed has been provided All workers performing sheet metal work onsite has valid Massachusetts sheet metal ` license V /All sheet metal work being performed with proper journeyperson-to-apprentice ratios Fire dampers with access door properly installed and checked for operation I . Smoke and combination fire/smoke dampers with access doors properly installed- actuator checked for proper operation(May also be verified by fire department during t fire alarm testing) Duct smoke detectors with access doors properly located / (May also be verified by fire department during fire alarm testing) V Smoke/atrium exhausts stems installed and operation verified Y p /Stair (May also be verified by fire department during fire alarm testing) ir pressurization tion systems installed(where required) and operation verified (May also /Greaverified by fire department during fire alarm testing) se /kitchen hood exhaust system installed with all seams and connections welded airtight with properly located cleanouts. Proper cles`ances, fire rated enclosures and / pressure testing required. resl,:aint3 instali�:,c? *rtie. required.on equipment and do t:.. ,v -- uct penetrations in fir'e'ratc>4 suall>and floors sealed Metal roofing systems installed watertight using proper materials and fasteners Flexible duct runs installed 6'-0"maximum length Ductwork installed using proper hanger spacing, hanger stock threaded rod and angle ` iron uc ork D tw /plenum connections sealed substantially airtight V Ductwork insulated by means of external covering or internal lining Volume dampers installed for each supply air branch duct New/clean-properly sized filters installed(final inspection) Testing and Balancing report complete coinp lfinal si -of( � � I11"o Calnan _ & Associates WeBuild... C ON S T R U C Ti ON MA NAG E RS T 07.901.0200 F 617.801.0201 I www.jcainan.com SUBCONTRACT LETTER OF INTENT Subcontract No.: 12197.002 Vendor No.: 4815 Contract Date: 07/24/2012 Subcontractor: M J Mechanical Inc Project: Brooks School Street Address: 39 Lazarus Way Location: 1160 Great Pond Rd City,State,Zip: Salem, NH 03079 North Andover, MA,01845 JCA Project No.: 12197. Contact Name: Mitch M Owner: Brooks School Telephone No.: 603-898-5772 Architect: Cube 3 Studio Facsimile No.: 603-893-6403 ?,{[j. .3T .w....a...: jF `,�.r%< IFy� t•4i a ,_ .. .. '> ..M.. ,.�eY3a��. ._.m_.�. _�... _ �. ,$q Y ; r777771 1 15500. HVAC 17,800.00 Total Contract Amount: $17,800.00 Scop a of Work Includes but is not limited to): 1 All work in accordance with the project specifications, drawings,addenda,and the terms and conditions of the Prime Agreement and Subcontract Agreement. 2 Subcontractor to sign&return the Letter of Intent by FAX within 3 to 5 business days of receipt or prior to arriving on jobsite. 3 Refer to attached"Exhibit B" -Scope of Work Qualifications and Insurance Requirements: 1 Insurance Requirements are described in"Exhibit C—Project Insurance Requirements',included within this document. 2 Certificates of Insurance,endorsements,and waivers of subrogation,must be received by J.Calnan&Associates prior to Work commencing. 3 Certificates must name JCA Job#12197,Brooks School&J.Calnan&Associates,Inc.are included as additional insured.as additional insured. Subcontractor shall provide complete waivers of subrogation,and all of Subcontractor's insurance coverage as required by the Subcontract Agreement shall be primary. 4 All subcontractors&their employees MUST wear safety helmets on all J.Calnan&Associates projects and must follow the health and safety requirements as set forth in the Prime Agreement and Subcontract Agreement. .....v.i .,. x1viVUVlVllulL1V1.11J►uV. L1Vlil1JG UGCtlfill Page 1 of 1 The Official Website of the Office of Consumer Affairs and Business Regulation(OCABR) Division of Professional Licensure Mass.Gov Mass.Gov Home State Agencies A-Z Topics Home>Division of Professional Licensure> j ONLINE SERVICES _.............................---............................_......._........_............................................................._............... ...................................................................................... ._......- ; Check a License oil Professional License Locate a Licensed Professional By the Division of Professional Licensure Online Address Change Contact the Agency SEARCH CRITERIA More... i Profession:Sheet Metal Workers Last Name:beginning with messer ` REFERENCES& First Name:beginning with mitchell RELATED INFO City:salem i State:nh Disclaimer Regarding Zip Code:03079 Website License Searches NEW SEARCH Enforcement Process Gloss ry LIC. BOARD LIC. TYPE LIC' NAME CITY/STATE LIC' NUMBER STATUS Glossary of License Status Sheet Meta[ I t MITCHELL M. Codes Yorkers; Master/unrestricted 9717 MESSER SALEM,NH Current _ . .. __ More... Your search has resulted in 1 licenses Note:If the licensee cannot be found by name and the name typically has apostrophes,spaces, hyphens or periods try doing the search again without these characters.Examples: If the last name is"O'Donnell",try searching for"ODonneWor"0 Donnell" If the last name is"McDonald",try searching for Nc Donald" If the last name is"St.Hetens',try searching for"StHelens"or"St Helens' If the last name is"Jones-Doe',try searching for"JonesDoe'or"Jones Doe" The page above has been generated by the Division of Professional licensure web server on Friday,July 27,2012 at 7:16:00 AM. ©2007-2011 Commonwealth of Massachusetts Site Policies Contact Us http://license.reg.state.ma.us/public/pubLicRange.asp?profession=Sheet Metal Workers&... 7/27/2012 CUBE STUDIO architecture ❑ interiors ❑ planning BULLETIN Distribution to the Representative of the: Owner ■ The Brooks School Architect ■ CUBE 3 Studio CUBE 3 Studio LLC Document B Contractor ® J. Calnan&Associates,Inc. Field ❑ PROJECT: The Brooks School BULLETIN NO: B-001 (name,address) Counseling Center OWNER: The Brooks School DATE OF ISSUANCE 25 July 2012 TO: Eric Persichetti ARCHITECT CUBE 3 Studio LLC (Contractor) J.Calnan&Associates, Inc. 3 Batterymarch Park ARCHITECT'S PROJECT 12039.00 5th Floor Quincy, MA 02169 N0: CONTRACT FOR: The Brooks School CONTRACT DATE: Proposal Request: Please submit an itemized proposal for changes in the Contract Sum and Time for proposed PR modifications to the Contract Documents described herein.Refer to this Document in the X Proposal.Submit final costs for Work involved and change in Contract Time(if any)within 7 Working Days to the Architect. NOTE:THIS IS NOT A CHANGE ORDER NOR A DIRECTION TO PROCEED WITH THE WORK HEREIN. Supplemental The Work shall be carried out in accordance with the following supplemental Instructions: instructions issued in accordance with the Contract Documents WITHOUT CHANGE IN SI CONTRACT SUM OR CONTRACT TIME.Prior to proceeding in accordance with these instructions,indicate your acceptance of these instructions for minor change to the Work as consistent with the Contract Documents and return a copy to the Architect within 7 Working Days. Construction Change In order to expedite the Work and avoid or minimize delays in the Work which may affect Directive: Contract Sum or Contract Time,the Contract Documents are hereby amended as described CCD below.Proceed with this Work promptly.Submit final costs for Work involved and change in Contract Time(if any)within 7 Working Days to the Architect, FOR INCLUSION IN A SUBSEQUENT CHANGE ORDER,WHICH CHANGE ORDER SHALL THEN MODIFY THE CONTRACT DOCUMENTS AND CONTRACT SUM. NOTE:NOT VALID UNLESS SIGNED BY BOTH THE ARCHITECT AND THE OWNER BELOW. Summary: Bulletin#001 Description: Partition changes at the office to accommodate millwork and RCP changes to accommodate lower ceiling existing conditions. Attachments: A-101,A-551 ISSUED: AUTHORIZED: CONFIRMED: BY BY BY Chris Santoro 07.25.12 CUBE 3 Studio LLC Date J.Calnan&Associates,Inc. Date The Brooks School Date Contractor's Response: Amount:$ (Increase/Decrease) Time: (Increase/Decrease) Notwithstanding anything that may be interpreted to the contrary in the Contract Documents,no Construction Change Directive,nor any Supplemental Instruction or Proposal Request constitutes or will constitute or substitute for a properly executed Change Order,in the form of an AIA G 701 Change Order or otherwise,which Change Order only shall memorialize and confirm agreement of the parties to the Contract to the corresponding Change in Work,the amount of adjustment,if any,in the Contract Sum,and the extent of adjustment,if any,in the Contract Time. The Owner,Contractor and anyone receiving or relying upon this Bulletin agrees to indemnify and hold harmless CUBE 3 Studio,LLC,their principals,employees,partners,contractors and agents from any claims,including their own,that this or any other Bulletin constitutes a Change Order. Q B CUBE 3 Studio LLC 360 merrimack street, building 5, 3rd floor, lawrence, ma 01843 p:978.989.9900 f:978.989.9954 www.cube3studio.com Mitch Messer From: "Mitch M"<mimechanical@comcast.net> To: "Mj Mechanical Mitch Messer"<mjmechanical@comcast.net> Sent: Friday, July 27, 2012 7:41 AM Subject: Fw: Brooks School ------Original Message------ To: Potts,Matthew Subject: Re: Brooks School Sent: Jul 5, 2012 8:13 AM Matt, I can follow up with a proposal if required. Price to demo the existing HVAC unit and duct work. Will install one new 4-ton split unit with one steam coil. Will mount unit above new dropped ceiling and connect the existing fresh air duct with a new damper actuator. Will run insulated duct work and install new 2x2' diffusers. Will install one new 1-row steam coil rated @80,000 Btu's. Will install new steam valve with a proportional 0-10 Vdc actuator. The thermostat will be 7 clay programmable with a modulating heating output. Will run refrigerant piping to a pad mounted condenser. Unit will be high efficiency with refrigerant R-41OA. Note*-there are ceiling issues not shown on drawing. May have to install unit in one of the offices and lower the ceiling a few inches. May also want to install a strip of electric baseboard in the 2 outside wall offices. Cost- $17,400.00 Does not include power wiring. ADD*- cost to add a 2nd steam coil to add extra heat to the 2 outside walled offices. $2,550.00 ------Original Message------ From: Potts,Matthew To: Mj Mechanical Mitch Messer Subject: Brooks School Sent: Jul 2, 2012 10:51 AM Mitch—Please see the attached drawings. If you have my questions give ine a call. Thanks, MATTHEW POTTS Special Projects Estimator J. Calnan&Associates, Inc. TEL 617.801.0253 CELL 617.276.5069 FAX 617.774.0369 3 Batterymarch Park, 5th Floor Quincy,Massachusetts 02169 7/27/2012 --10411 a ACOORO CERTIFICATE OF LIABILITY INSURANCEDATE(MWDDIYYYY) F7/24/2012 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 endorsement(s). PRODUCER CONTACT Lynn Masello NAME: y FIAI/Cross Ins-Manchester PHONE , (603)669-3218 FIC No:(603)645-4331 1100 Elm Street E-MAIL lmasello@crossa enC COm ADDRESS: g y INSURER(S) AFFORDING COVERAGE NAIC# Manchester NH 03101 INSURER A:Travelers Ins. Co. INSURED INSURER B: M.J. Mechanical, Inc. INSURERC: 39 Lazarus Way INSURER D: INSURER E Salem NH 03079 INSURER F: COVERAGES CERTIFICATE NUMBER:11-12 GL & BA 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 INSURANCEADDLSUBR POLICY EFF POLICY EXP LTR POLICY NUMBER MMIDD MMIDD/YYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY PREMISES Ea 77— occurrence $ 300,000 A CLAIMS-MADE Fx-1 OCCUR 8559AO2A /18/2011 /18/2012 MED EXP(Any one person) $ 5,000 PERSONAL 8 ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN 'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGG $ 2,000,000 X POLICY PRO- rJECT LOC $ AUTOMOBILE LIABILITY Ea COMBINED SINGLE LIMIT 1,000,000 A ANY AUTO BODILY INJURY(Per person) $ ALL OWNED X SCHEDULED 8559A497 /18/2011 /18/2012 BODILY INJURY(Per accident) $ AUTOS AUTOS (P ) NON-OWNED PROPERTY DAMAGE X HIRED AUTOS X AUTOS Per accident $ Business Auto Extension $ UMBRELLA LIABOCCUR EACH OCCURRENCE $ EXCESS LIAB HCLAIMS-MADE AGGREGATE $ DED I I RETENTION $ WORKERS COMPENSATION I WC STATU• OTH- AND EMPLOYERS'LIABILITY Y/N ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT OFFICERIMEMBER EXCLUDED? ❑ N/A $ (Mandatory In NH) E.L.DISEASE-EA EMPLOYE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) JCA Job#12197, Brooks School. Brooks School & J. Calnan & Associates, Inc. are included as additional insured with respects to the CGL as per written contract to the extent permitted by the policy language. GL Additional insured form CGD037 applies. A waiver of subrogation in favor of the above included additional insureds applies per policy form CG2404. Above listed are also included as additional insured with a waiver of subrogation on the business auto policy per policy form CAT353. Refer to policy for exclusionary endorsements and special provisions. CERTIFICATE HOLDER CANCELLATION insurance@jcalnan.com SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN J. Calnan & Associates, Inc. ACCORDANCE WITH THE POLICY PROVISIONS. Attn: Mike Crowther 3 Batterymarch Park AUTHORIZED REPRESENTATIVE 5th Floor Quincy, MA 02169 Lynn Masello/JSC 42 ACORD 25(2010105) ©1988-2010 ACORD CORPORATION. All rights reserved. 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