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HomeMy WebLinkAboutBuilding Permit #678 - 119 MARTIN AVENUE 3/2/2015 ® MAPFRE The Commerce Insurance Company1' Citation Insurance Companyw Commerce " 'ore Road,Webster,Massachusetts 01570 508.949.1500 www.commerceinsurance.com f INSURANCE- March SORANCEms'March 13, 2014 BUILDING COMMISSIONER or Board of Health or INSPECTOR OF BUILDINGS Board of Selectmen TOWN/CITY HALL Town/City Hall NORTH ANDOVER MA 01845 RE: Our Insured: JAMES LOGUE Property Address: 119 MARTIN AVE Policy#: BCDJBS Date of Loss: 03/11/2014 File#: HWVN61-CMVXK2 Claim has been made involving loss, damage, or destruction of the above captioned property which may exceed $1,000, or cause Massachusetts General Laws, Chapter 143, Section 6 to be applicable. If any notice under Massachusetts General Laws, Chapter 139, Section 3B is appropriate, please direct it to my attention. Please reference the above captioned insured, location, policy number, date of loss, and file number on any correspondence. DIANE LECLAIR Telephone: (508)949-1500 Ext: 15004 Sr Claim Representative,Property Toll Free: 1-800-221-1605, Ext: 15004 On this date, I cause copies of this notice to be sent to the persons indicated above, at the address above,by first class mail. March 13, 2014 WATER DAMAGE TO CLOSET IN BASEMENT FROM PIPE FREEZE. CIC 254 (Rev.4/95) MAIL C78 NORTH BUILDING PERMIT o�`<�`ED 616 6.16 q�o TOWN OF NORTH ANDOVER F ow p APPLICATION FOR PLAN EXAMINATION T n O Permit NoM ) Date Received �ssAATED CHus���5 Date Issued: `� I TANT: Applicant must complete all items on this page LOCATION �I_ Print PROPERTY OWNER. --- _ _ _ ENTrr _ Print loo Year Structure yes o MAP PARCEL: ZONING; DISTRICT:�r Historic District yes no Machine Sho Village_ es no �.._ - - � -p- wg._-- yes _= TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family El Addition ❑Two or more family El Industrial [I Alteration No. of units: [I Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other Septic ❑Well 11Floodplain ❑Wetlands 0 WatershedDistrict ❑Water/Sewer _ DESCRIPTION OF WORK TO BE PERFORMED: l mak' Identification- Please Type or Print Clearly OWNER: Name: Phone: Address: //�' o Contractor'Name A Address: Supervisors Cons ruction License � 15/ _ _ _:Exp. Date - n Home Improvement License-, ., �_� _ .--Exp. Date: _ ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $K11_14:5 _FEE: $ 33 Check No.: p C U1 .1-1 Receipt No.: NOTE: Persons contracting with u is a contractors do not have access to the n i d Signature of Agent/Owner _ _ _. signature of contractor 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 o Building Permit Application o Workers Comp Affidavit o Photo Copy Of H.I.C. And/Or C.S.L. Licenses o Copy of Contract ❑ Floor Plan Or Proposed Interior Work o Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks o Building Permit Application ❑ Certified Surveyed ry ed Plot Plan rt Y o Workers Comp Affidavit o Photo Copy of H.I.C. And C.S.L. Licenses o Copy Of Contract o Floor/Cross Section/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) o 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 Li Certified Proposed Plot Plan o Photo of H.I.C. And C.S.L. Licenses o Workers Comp Affidavit o Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) o Copy of Contract o Mass check Energy Compliance Report Li 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:Building Permit Revised 2014 i 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 PLANNING & DEVELOPMENT Reviewed On Signature_ 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 on site• yes. . _ no Located,at 124 Main Street - - - Fire.'Departinent signature/date 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 Call Email Date Time Contact Name Doc.Building Permit Revised 2014 Location t 11 &022r No. Vr Date 1� • - TOWN OF NORTH ANDOVER Certificate of Occupancy $ , Building/Frame Permit Fee $ x C Foundation Permit Fee $ 't �rJfl' � Other Permit Fee $ TOTAL $ ' Check#�—D � L�- 28517 uilding Inspecor NORTIy _ _ . WL . _ _ ., ¢6 c . . ver 0 ... . r le No. _0;";Fo,do�w h ver, Mass, coc"Ic"aw�c« y1• VATIE S fJ BOARD OF HEALTH Food/Kitchen PERMIT T L D Septic System THIS CERTIFIES THAT ��e ....... .�.... .... BUILDING INSPECTOR ...... . .................. ................. .................. .......... A Foundation has permission to erect A%W ..................... buildings on ......(.1a,....... ... .................... 110. _ � Rough u h t0 be occupied as ..................... Chimney p' ...... ... ... . . ........t.... t. 0100 ... � y provided that the person accepting this permit all 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 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTIO A Rough Service ................... ... ............... .............................. Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Buildinz 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. next step Living, home energy solutions This agreement is made by and among Jim Logue Next Step Living, Inc.("NSL") 21 DrydockAvenue,2nd floor 119 Martin Ave Boston,MA 022-10 North Andover, MA 01845 phone: (866)867-8729 Site ID: 410238 23-Dec--14 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 accordan ce with the terms of this Contract,including the attached recommendations/work order describing the work in detail(the"Work")which are incorporated herein by reference: Description SealingAir Recommendations $450.DC Work Location: Attic Flat ,Perform Air Sealing at Estimated 62.5 CFM50 Per Hour 6 $75.00 Hr $450.00) Weatlierization Recomirenclations S1,588.1 s Work Location: Attic Flat 'Damming 98 $2.05 Lnft $200.90 Vent bath fan to soffit exhaust = 2 $f1$75 Each $2377:50 Propavent 2'or 4' 51 $2.00 Each $102.00 �4ttic S#alr Cover The"rural Barrer with;Carpentry - i - f$_237.65 Each T $237165 Attic Floor Open Blow Cellulose 6" 5522.._ $1 20 soft � � $662-40— 'Install 662.40'Install 2"Thermal Barrier Polyiso on Kneewall 15 $3.31 soft $49.65 Work Location: Foundation Insulate Rim Joist with 6.25"Fiberglass Batting 56 $1.75 Lnft $98.00 Initial Investment: f 41®0%AltsealtOg ln�cenfive up;#o Program Ntax r ',$45 ;0©' 75%Weathenza#lon'Inc�ntfve up�OYProgramM�x . $1 Total EstlmatedAnntaaF=ErSergy 5avings from the Above tmptovements CustomV' ture a Date 23 Dec 2014 Andrew Carpentier NSL Signature Date Name of NSL Representative A72872g 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"inquiry@nextsteplivinginc.com"www.nextstepliving.com s TERMS OF AGREEMENT 410238 3.PROPOSED START DATE AND COMPLETION SCHEDULE NSL will contact customer to schedule the Work at a mutually agreeable time,subject to the availability of subcontractors or materials,or to delays attributable to the weather or other events beyond NSL's control. 4.CONTRACTOR 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 to: Office of ConsumerAffairs and Business Regulation,Ten Park Plaza,Suite 5170,Boston,MA 02116.617.973-6700. 5.PERMITS NSL will obtain any necessary permits as the Customer's agent. Customers who secure their own permits or deal with an unregistered contractor will be excluded from the Guaranty Fund provisions of the Home Improvement Contractor Law. 6.PERFORMANCE OF THE WORK AND CHANGES 6.1 NSL will not commence 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 modification of this Agreement shall be 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,per 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 home during the course of the Work that impact 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 Customer will have the option to remove from the Contract the work elements that need adjustment,or setup a separate contract for performing 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 and warrants to the Customer that it has a valid Home Improvement Contractor Registration(No:162111)and the necessary insurance required by applicable law an d normally maintained by prudent contractors in NSL's field,including,but not limited to,Workers Compensation Insurance for all employees who will perform the Work. 8.QUALITY OF WORK NSL agrees that the Work will be performed in a good and workmanlike manner,and that NSL will repair and replace,at its own expense,and promptly upon Customer's request,any defects in workmanship and materials provided by NSL which appear up to(1)year after completion of the Work or within any longer period as permitted or required under applicable law,provided NSL has received final payment as provided herein. 9.PRE-EXISTING CONDITIONS&PROPERTY 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 the at-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 will make best efforts to protect any property of the Customer, it is the Customer's responsibility to remove or protect,including dust protection,any personal property including the home itself. NSL will not be responsible for damages to or losses of any of the above mentioned property not properly protected prior to the commencement of the Work. 10.GENERAL 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,orto file a notice of intention to lien,and to take any other steps to perfect and enforce such a lien,if Customer fails to pay NSL as provided herein. 10.2 This Agreement shall be construed in accordance with the laws of the Commonwealth of Massachusetts. 10.3 This Agreement forms the complete integrated agreement between NSL and Customer. The parties represent and warrant that in executing this Agreement,they are not retying on any representations,warranties or terms other than as expressly contained herein. This Agreement supersedes all prior agreements between the Customer and Contractor and may not be altered absent a subsequent written agreement signed by both parties. You may cancel this Agreement if it has been 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,by telegram sent or by delivery,not later than midnight of the third business day following the signing of this Agreement. Seethe attached notice of cancellation form for an explanation of this right. 11.ENERGY BENEFITS. The Sponsoring Utility Company(the Utility)is entitled to 100%of the energy benefits associated with all Energy Conservation Measures,excluding the value of energy cost savings by the Customer,but including all rights to all associated ISO-NE Energy,Capacity and Reserves Products.NSL agrees to provide the Utility with such further documentation as the Utility may request to confirm the Utility'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 event of the failure of an energy conservation device to perform as expected,Customer's sole recourse is to Contractor and not to RISE Engineering(RISE) or to the Utility.The Utility and its operating companies shall not maintain,remove or perform any work whatsoever on the energy conservation measures s installed.Customer understands and acknowledges that their participation in the Mass Save Home Energy Services Program is voluntary votary 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 affiliates or operating companies liable for Contractors to perform its obligations under this agreement,for failure of the energy conservation measures to function,for any damage to Customer's Premises caused by Contractor or for any and all damages to property or injury to persons caused by the energy conservation measures. 13.LIMITED TIME OFFER. The prices and Incentive offered in this Contract are subject to change in accordance with The Sponsoring Utility Company Mass Save Home Energy Services Program offers. 14.CONTRACT 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 mail posted,by telegram sent or by delivery,not later than midnight of the third business day following the signing of this agreement �QuisstOrner Advisor Name____ Address K A Advisor Phone #: g 7 8 --R Town Any limitations to access by track? Site I® v 2 /Un NOTES Any work scoped outside of Best Practices? Approved by: ',,-- 67 0 Gyrs 415 - A lJ b4j"M"U3- Rv , t) eA-I- l So d- Z C` ® �✓'� RL C.ovfrS --s 5 'T l�z, L6 tG iso CU � 2 �L 7 S 5 i dpi l�— I to t � JXeofrlcweo 2/If'' �/f/G�'onsumer Affai (�'d ]business Rei gul tri®n ® Park Pla e Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 162111 Type: Supplement Card Expiration: 1/14/2017 NE)(T STEP LIVING INC. ROGER OUELLETTE 21 ®RY®®CK AVE. 2TH FL BOSTON, MA 02210 Update Address and return card.Mark reason for change. Address F-] Renewal F] !Employment Lost Card DPS-CA' :, SOt.1-Q;04-G X1216 s, office of Consumer Affairs dpi Business regulation License or registration valid for individul nese only �?�?BIOME IiViPROVEMENT CONTRACTOR the expiration date. Iffound return to, -- Office of Consumer Affairs and Business Regulation Registration: 162111 Type: 10 Park Plaza-Suite'5190 is r _ Expiration: 1!1412017 Supplement Card Boston,MA 021 NEXT STEP LIVING INC. Irk ROGER OUELLETTE f/y' 21 DRYDOCK AVE.2TH FL BOSTON,,MA 02210 %/Ito@valid�witlnolnt sn nnatenre Undersecretary G. � Massachusetts Department of Public Safety Board of Building Regulations and Standards Construction 5upeniwr 5peciolh License ROM A 55 STAKMI OIE ROAD Q 1 � A Ex//pirppation�� •rfr!(1r1!+SI(lnf'r a�U��Y�®UV i RnMoiled To: CSS OC e Onsuh- 00 Ccntra(r(L®r Fzj0 ure to possess a current adition of the Wfl,assachusetts estate BuiOding Code is cause for revocOon of,this Hcanse. For DPS Licensing!AfCFM-zta®nVISA: The Commonwealth of Massachusetts Department of IndustrialAccidents W Office of Invesfigadons a n 1 Congress Street, Suite 100 r a v Boston,MA 021142017 °qM www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Busines(Business/organization/Individual): Text Step Living Address: 21 ®rydock Ave City/State/Zip: Boston, MA 02210 Phone#:(666)667-6729 er?Check theappropriate bozo Are you an employType of protect(required): 1.8 1 am a employer with 650 4. ® I am a general contractor and 1 6. 0 New construction employees(full and/or part-time).' have hired the sub-contractors 2.❑ 1 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.t required.] 5. ® ale are a corporation and its 10.0 Electrical repairs or additions 3.0 1 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. [Tela workers' 13.�other _ comp. insurance required.] `Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t 13omeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new atiida,'it indicating such. $Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not tho3e entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: A+.LM Mutual Insurance Company Policy#or Self-ins. L,ic.#: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 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$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage v fi tion. I do hereby certify render the pains andpen es .perfury that the information provided above is true and correct Signature: Phone# I official use use only. Do not write in this area,to be completed by city or town official. City or'frowns Permit/License,# issuing Authority(circle one): 1.Board of health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: NEXTSe1 GP ID:EL CERTIFICATE ®F LIABILITY INSURANCE DATE(MMIDDIYYYY) 10/0112014 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION 0"y y AND CONFERS NO RIGHT§UPON TH9 09RTIFGCATP HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ASTER THE COVERAGE AFFORDED BY THE POLICIES BELl THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIM RgP FSENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the;ert0ficate holder is an ADDITIONAL INSURED,the Pollcy(ies)must be endorsed. If SUBROGATION Iq�V�+IN_ ,QgI�6$tq 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 ill lieu of such endorsement(s). PRODUCER CNA ATE CT Erin Lyons McLaughlin Igpsuranco Agency PHONE y01=6.6=2776 FAX No:781=660`02 828 Lynn$el0s Parkwpy IL Etd Melrose,INA 02176 EMAIL ADDRESS: John E.McLaughlin Jr. INSURER(S)AFFORDING COVERAGE NAIL 0 INSURER A:Nautilus Insurance INsuRED QeleSct 15121111 Diving,Inc. INSURER 8:Commerce Insurance Company 3475 21 Drydock Avenue,2nd Floor INSURERC:A.I=M.Mutual Insurance Co. Boston,ISA 02210 INsuRERD: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 PII®I� 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. ILTR OR POL CY EFF POLICY EXP LIMITS OF INS TYPE URANCE POLICY NUMBER MMIDDNYYY (MMIDDATM A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 ® E�CP2010,098=12 ®913012014 09/3®12015 DAMAGE O E TED CLAIMS MADE OCCUR PREMISES Ea occurrence $ 1901000 MED EXP(Any one person) $ 0,p000 PERSONAL&ADV INJURY $ r tf GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ WrQ}rO,AQ POLICY❑jRC LOC PRODUCTS-COMPIOP AGG $ g OTHER: D SINGLE LIMIT AUpOMOBILE LIABILITY Ea accid COMBINEent $ 1,QOQ,®Q BIDEDS 14MMBGKKOM 09/30/2014 09/30/2015 BODILY INJURY(Per person) $ SCHEDULED BODILY INJURY(Per accident) $ AUTOS PROPERTY DAMAGE NON-OWNED Per accident) $ �° AUTOS $ B OCCUR EACH OCCURRENCE $DCLAIMS-MADE E�U783547012014 09/30/2014 00130/2015 AGGREGATE $ETENTION$ $ WORKERS COMPENSATION A I STAER PER H AND EMPLOYERS'LIABILrrrTO BE ISSUED BY CARRIER 09/30/2014 00/30/2015 E.L.EACH ACCIDENT $ 500,000 C ANY PROPRIETORIPARTNER/EXECUTIVE YN I A OFFICERIMEMBER EXCLUDED? El E.L.DISEASE-EA EMPLOYEE $ 500,000 (Mandatory In NH) If yes,describe under E.L.DISEASE-POLICY LIMIT $ 500,00 DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 109,Additional Remarks Schedule,may be attached If more space is require FOR INFO TION OM-Ly CERTIFICATE HOLDER CANCELLATION INFO-01 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN For information Only ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE 1111988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014111) Thi�� NR�OIq)� �°� �� r��@ ®B� f ACORN,