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HomeMy WebLinkAboutBuilding Permit #919-13 - 12 WALKER ROAD 6/26/2013 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit N0: Date Received � Date Issued: 3 IMPORTANT Applicant must complete all items on this page LOCATION ,R `t, °`_.1 M1 5+ �PIrlt � PR®PERT4YA®WNER L zn �� f "' 4 , ,.i ;. ^•a . ,�� t �, YearOld Structure YeS, p �- sk 2rS 2�Ht7%a�JrK� N ',MAP NO PAROEL� � =r , < , �w O INC DISTRICT . Histone Distr�ctx� : >,fyes K no a Ma'chme V Sh illage- 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 AWell . ,,. t ❑AFloodplam r ❑Wetlands, : ❑ Watershed:District { ❑`Water/Sewer: �: .a, ..,; f .x. . DESCRIPTION OF WORK TO BE PERFORMED: i �dentifii tion Please Ty�r�t Clearly) . OWNER: Name: -� rhw- i C.,� s,�, Phone: Address: CONTRACTOR Named `C> ` ' rksr Phone ti x M Atldr'ess4 Y? lr► f ✓• t E R ' 1 M1l M Supervisor's''Cons tructioneLicense R v J Home-;Irove m - f p meat License Exp Date. `� ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BOLDING PERMIT:$12.00 PER$9000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ 1 , y®� FEE: $- 264n- ---------- Check No.: 1 N Recei t No.: 5 NOTE: Persons contracting w th unregistered contractors do not have access to the guaranty fund Signature of Agent/Owner Signature of contractc.� TOWN OF NORTH ANDOVER o APPLICATION FOR PLAN EXAMINATION Permit N0: Date Received Date Issued: IMPORTANT:Applicant must complete all items on this page LOCATION Print PROPERTY OWNER Print 100 Year Old Structure yes no. MAP NO: PARCEL: ZONING DISTRICT: Historic District yes no Machine Shop 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 El Septic ❑Well ❑ Floodplain ❑Wetlands ❑ Watershed District ❑Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: Identification Please Type or Print Clearly) OWNER: Name: Phone: Address: CONTRACTOR Name: _ Phone: Address: Supervisor's Construction License: Exp. Date: Home Improvement License: Exp. Date: ARCHITECT/ENGINEER Phone: Address: Reg. No. r FEE SCHEDULE.BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ FEE: $ Check No.: Receipt No.: NOTE: Persons contracting j.-ith unregistered contractors do not have access to the guarantyfund Signature of�Agent/dw'ner Sig. ature of contra,. or Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ i *• C ? , Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OFSEWERAGE.DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ❑ Swimming Pools ❑ well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private(septic tank,etc. ❑ Permanent Dumpster on Site ❑ I 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 s Water & Sewer Connection/Signature& Date Driveway Permit DPW Tow;! Engineer: Signature: Located 384 Osgood Street FIRE DEPARTM'ENT - Temp Dumpster on site yes no Located at 124 Mair,`Street Fire Departinert signature/date } I COMMENTS ' I r Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: ELECTRICAL: Movement of Meter location, mast or service drop requires approval of Electrical Inspector Yes No DANGER ZONE LITERATURE: Yes No MGL Chapter 166 Section 21A-F and G min.$10041000 fine NOTES and DATA— (For department use ® Notified foricku - Date P p i I Doe.Building Permit Revised 2010 Building Department I ` The foli'owing 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 I i 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 j ❑ 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 appal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be subm:tted with the building application I Doc: Doc.Building Permit Revised 2012 I .Q Location ��"I �� '3 WO-0 LA f— Date + ' ' TOWN OF NORTH ANDOVER jZi �� � Certificate of Occupancy $ f , dI Building/Frame Permit Fee $ Foundation Permit Fee r x^ Other Permit Fee TOTAL $ i Check# l/50p 26566 i Building Inspectbr� NORTH Town of E : 1� Andover 0 ;.� - No. 1r, 0 a , ver, Mass, COCHICHIWICK U BOARD OF HEALTH Food/Kitchen PERMIT T LD Septic System .044AW...... �t coosdo'l. ......... BUILDING INSPECTOR THIS CERTIFIES THAT ...................j(1Q ..... .... ............. r Foundation has permission to erect .......................... buildings on ....e. ...... .. �..... Rough tobe occupied as ......... . .. .... ... �... ....................................................................... Chimney provided that the person acceptin this permit shall in every respect conform to the terms of the application Final on file in this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR a� UNLESS CONSTRUCT VUR' TS 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. SEE REVERSE SIDE 24 13 02:23p MGS Construction LLC 6034323282 p.1 PROPOSAL/01ONTRACT Meadowview Condominiums 5 waft-,er Road N. Andove.r, MA Roof Installation FROM: MGS Construction LLC 2 Lake Avenue PAGE NO. 1 OF 2 PAGES Derr},New Hampshire 03038 DATE: June 13.2013 Office: (603)216-2633 Cell: (617)293-7287 Fax: (603)432-3282 PROPOSAL SUBMITTED TO: Shawmut Management ADDRESS: Meadow View Condominiums 27 Charles Street 5 Walker Road North Andover,MA 01845 4,�,6;8. 1.0 11-, 12,and l3Building Contract (.. = ) ATTN:Matthew D`keman CITY/STATE: North Andover,MA JOB NAM---: Roof Replacement Project We hereby submit specifications and this proposal/contract for the.rolloll ing: BREAKDOWN: MGS Construction will remove 2 existing layers of roofing and flashing materials from roof field including the chimney lead MGS Construction will supple and install 6'of ice and water shield at roof eaves and valleys, 18"to either side of hip, 3'at all pipe boots/roof penetrations MGS Construction will overlap the ice and water shield P over fmcia/rakc boards to help protect against from ice dam damage MGS Construction«rill supply and install 301b felt paper to the remaining roof field MGS Construction will install all new drip edge and flashings MGS Construction will re-lead 1 chimney per building MGS Construction will supply and install manufactured leading edge to complete the roof perimeter as the manufacturers suggest MGS Construction will supply and install limited lifetime architectural shingles. Color to match new roof(completed by others)on building 1 MGS Construction will hurricane nail 6 nails per shingle to protect against blow offs Meadorview Condominiums 1 2013 Roofing project Jun 24 13 02;23p MGS Construction LLC 6034323282 p.2 In the event that unforeseen rot is found.A plywood replacement charge in the amount of$45.00 per sheet(labor and material)will be billed additionally to the contract amount. Any items not stated above are to be considered as an extra charge and will be invoiced separately from this billing.All other agreements to be made in writing between the customer and MGS Construction. SINGLE BUILDING PRICING: Each building will be re-roofed according to the above spec6cations Labor and material:$17,000.00 per building TERNBWOTICES:RESIDENTIAL MGS Construction is not responsible for any sbrmb,landscaping lal m or loose personal property damage while work is in progress.It is the home owner's responsibility to ensure that prior to the start of the project all arms of concern are prepared for start ofproject.Any shrubs,plantings,should be pulled away from the house to ensure t1-tat ne damage will be endured by work in progress.All planters,grills, patio furnishings,and other precious objects should also be moved prior to the start of any roofing or vinyl siding project All vehicles. should be parked at least 20 feet away from the home during all work in progress this is due to debris that could fall and or hit the vehicle. MGS Construction is not responsible for any damages to this pmpeaity as this should be considered as a formal notice.All interior wall hangings,including shelving,pictures,and other precious objects slionld also be removed due to heavy hammering until the project has been completed. MGS Construction takes extreme care in the setting up of the equip.inent,scaffolding.and tarps usedon each project in order to protect all property and landscapes.-Any exterior damages to property incurred by 141GS Construction will be remedied repairedfresolved by MGS Construction.However,we cannot be held liable for damages to phint and or flower beds,shrubbery,etc located within 15'of the perimeter of the work area. MGS Construction will not be held liable for craeked or damaged drywall or for any interior objects that may vibrate,sbake,or fall due to heavy hammering or normal construction work. MGS Construction estimates that this project will be started and corapieti within 14 business days weather permitting WARRANTY: MGS Construction will warranty then craftsmanship for 5 years from thedate of completion.This does not include acts of nature and or damages incurred by others. Manufacturer's warranty:The manufacturers all carry limited warranties on all products used(usually prorated after 5 years) PAYMENT TERMS: We hereby propose to furnish labor and materials to complete in ae ordaice♦vith the above specifications,for the sum of One Hundred Fifty Three Thousand Dollars($153,000.00 )per building with payments to be made as follows: A deposit in the amount of$76,500.00 is due upon completion of f<iur buildings The remaining balance in the amount of S76,500.00 is due within 7 days from the completion of final building NOTE:A ten percent(10%)of the fem iiing balanceivay beheld:Ibilel.ainage in fhe event of unusual circuinslances such as ininflr­ • properly damage incurred by MGS Construction or in the event ofliackordemd materials. Please note it is unlikely that a retainage would need to be held in most cases. All material is guaranteed to be as specified.All work to be completed in a workmantrke manner according to standard practices_ Any alteration or deviation from above specifications involving extra i:osts will be ew:cuted only u on written.orders,_ and will become an extra charge over and above the estimate.All ements contin int ion- s accident 1 c a g ogre g up , a nt or de ays beyond our control.This proposal subject to acceptance within 30 dal and'tis void at the r� ep y t thereafter .,phorr o undersigned. C t Authorized Signature 6u •`.-.V J �42 Meadowview Condominiums 2 2013 Roofing project Vjj1$ fiv�cila Booar d ot•' ''ct,�c,iMent Buildin�� "#'l:nl)!ic S�ftetr Construction SRL`ul,tti{)q.� . frrcl Stand,frdx License: pervisor License se: CS 57645 _ MARK E MO 18 NEWELL pR INI , N ATrLEBO ,± RO . MA 02760 � _ C'ouu»issiuni�� Expiratio _ n: 9/18/2013 �- Tr#: 10303 1 y i ✓V 2. ¢ r-069-00,11I -. Office of Consumer Affairs and usiness Regulation ij 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 171254 Type: LLC M GENDRON & SON CONSTRUCTION LLC MANUEL GENDRON P:O.-BOX 1024- DERRY, NH 03038 _ Update Address and return card.Mark reason for change. )PS-CAI ca50M•04rpq•G1Q1216 Address 0 Renewal [:1 Employment (� Lost Card � OfOce o// '��irvu ruealf c ✓f/��ac//creeCGs f�onsumer r't'iairs rii ncss-'Hegula�ou License or registration valid for individul use only rr HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: �'j��+'Registration: 171254 Type: Office of consumer Affairs and Business Regulation. � ti,\����fT� Expiration: :3/1/2014 LLC 10 Park Plaza-Suite 5170 ION LLC. Boston,MA 02116 M�t;NDRON i£$ON CONSTRUCT MANUEL GENDRON-:_ 6 ENGLISH RANGE DERRY, NH 03038 --� Undersecretary Not vyr id wi iout' ignature P" CERTIFICATE OF UTAB1ILITY INSURANCE D11 "''"'r' KATE 15 ISSUKIASA MATTER OF INFORIW'7M 010 AN(bNFERS NO RMHTS U ECEIU*ICA ERTFE DOES NOTAFFIRMATNELV OR NEGATNEIY AMEND.UTEND OR ALTER THE COVERAGE AFFORDED BYTILE POLICIES BELOW.ICATE OF INSURANCE DOES NOTCONSTMOTPA CONTRACT BETWEEN THE K&IJING IMSURER(S).AUTHORIZED tlfheoarti1`icalte floldec ec An ADDITIONAL INlMIRED,the pollcyl4s)must be endorsed, It WBROGATION 15 WAIVED,subject to d conditions of the policy,cartaln Dokks may require aM l eadomenlanIL A sbUmaet on this catilicale does not confer rights to M certflicate hdder in lieu of such srdarsm PRODUCER CONTACT IIIAAIE: PLANRIGHT INS&FINANCIA P NOTIE FAX z z4 MAIN ST STE 7A INC,NA So: IA/C.Noir SALEM,NH 03079-31.92 EasOL ADDrI£33: 7 NL4URE11"AiFORDMG COVM(3E NAIC0 I? URM IRSURERA: AAP.TFORDUMfiRWRrrMI ISUAMMC0LeANY M GERDRON&SON CONSTRUCTION LLC DBA AlGS a aURGR a: CONSTRUCTION RII8f1N6i jl�v MNER D. P O OR 1024 ISURER1.rDPRRY,NH 03038 ISURERF: CUMERAGES COi1FtCATEi UM111I R: F&MON NUNBt3I: RaR1<1�6111dR3�1 0 NOTWaMTAM MAWfREQWMaMT.MWORm1 noMWANTCrMT 1c10RwVNM1Crc1M1WWMIEEIELTT0w►srN7rtasce[isxJ►TEIMroE16>Y1600aw1` rERTA01.WANUM MMAFFORMBYflEPOMUCSSCMEDH13tM%SE WM'I'10AUI.D ETEI 11113. CLpS101IaAlOt:OMdiDM6OFW"ro1l im LbrimsHowmMAY IIAVE SM RILl11M M1t PAD CLAAR �R POLC V OR DATE POLICY A"DAW ITR TYPE OF WGURARGe L R IOLIC111UIsilJt (iR l OnLYYYYJ PrD�YT1 YI IMeTS GENERRLLL409 Tlf OCCURRENCE S COMMERCIAL GENERAL LIABILITY F6MISES OETo REM=EO s CLAIMS MADE 0OCCI.R. CE T(En oxurerr pJ EXP( v-e oe=* S RSCNAL9 ADV INJURY f GEIVL AGGREGATE LIMIT APPLIES PER AL AGGREGATE 5 POLICY [:]PROJECT LOC 00=S-COW)OP,AGIS S avrostroeaLELSI►aetTv r�sWCA.E s ANY AUTO IMIT(Ea amicWo ALL OwaeO AUTO$ Y INJURY S SCHEDULE AUTOS Per pemorn HIRED AUTOS OILY INJJRY S NONOVVNED AUTOS Per atrium PERTYDAMAGE S IPnr accident I UMBRELLA LIAR OCCUR ACH OCCURRENCE S EY ESSLIAB "CLAIMS-MACE GREGATE S DEOL1CT18Lf S RETENTION 4 s A NORKER'SCOMEkSAM MAND Iwo srAwroav I anfR 1!wL.Ovm13tj"%bTY T7M U@4292PSE6-13 00013 13 0606=2`114 X LIMITS ANYPROPERIrCPJPAF4TNERA:JGaJTIVE OFFCERftEM8ER F.XCLuDEO? Q E L.EACHACCIDENT S 10D.000 AM1411111mymme E.LWEASE-EAEMPLOYEE S 100,000 KY�hman,r�r EL.DISEASE-MICY LIMIT is 500,000 DE9CRrP'rlOv OF DEFRAY qN8 Cebu OMR"ON OF GPERA7MNS4ACATIOM9I ADICLE RFs7FdCnONsrl =U L ITEbI S 7M5RE1F1Aa3 ANY MOR C9RYIRCATE ISSUED TO THE CEIRTM•ATE HOLdF1i,kMC i W 0 WORKM COMP COVED AOR. CERTIFICATE HGLUE R (MCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLUMM BE CANCELLED Bl noc n�€��(PlFt4T10dM1 ."'m1. .M ".m Va--L BE L?mgm W ACCORDANCE WfTH THEFOLICY PROW 7AS1 mmmRamEximim �-- � ;11 ACO 25(20101`05) TRUC50 name snd logo are rewsleted mar 11 I; ACORD C reserved. i C'd z2MI bE09 7-1-1 uoliowlsuo7 gnlAI dp.n,7.n PL A7 unr ` CO oR ® CERTIFICATE OF LIABILITY INSURANCE DATE(�""DD"Y'") �� 3/19/2013 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFOR.%ATION OIILY 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 i 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 1he policy,certain policies may require atl end,rorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER cc;NTA NJIMCT Patricia BBlair. Financial Insurance Services Inc WOKE (603)932-6414 FAX (603)-032-3852 I JUC Nol. PO Box 950 A1IDDRESS:Pblais@fisins.cam INSURER(S)AFFORDING COVERAGE NAIC R Derry NH 03036 INSURER A:Peerless Insurance Co INSURED iN!.UR£R B: MISS Construction, LLC DBURERC: PO Box 1.024 IN!:URER O- iN!iURER E: Derry NH 03038 INSURER F: COVERAGES CERTIFICATENUMBER:13-14 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 OI ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFCRDEC) 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. INGR LTR TYPE OF INSURANCE F;DLICYNUMBE•Lt lAM1D�FR� MMlOD EXD u Hors GENERAL LIASMITY EACH OCCURRENCE S 11000,000 OAMAGETO X COMMERCIAL GENERALLIABILITY PEN;SES EaNTEnoccuence S 100,000 R A CLAIMS-MADE Q OCCUR =BP1035064 /3/2013 /3/2019 MED EXP/Any one person) S 5,DOD I PERSONAL&ADV INJURY S 1,000,000 GENERAL AGGREGATE S 2,000,000 GEN1AGGREGATE LIMIT APPLIES PER. PRODUCTS-COMPJOPAGG $ 2,000,000 X POLICY PRO- LOC S AUTOMOBILE LIABILITY COMBINED SINGLE UMn i t ANY AUTO BODILY INJURY tees person) S ALL AUTOS OWNED I AUTOS BODILY INJURY(Perac olanq 3 HIRED AUTOS NON-OWNED PROPERTY DAMAGE AUTOS Per accident S 3 UMBRELLA LIAR OCCUR EACH OCCURRENCE 5 EXCESS UAB CLAIMS-MADE AGGREGATE S DED RETENTIONS - S WORKERS COMPENSATION WC STATU- OTB- AND EMPLOYERS'LIABILITY Y J N LIMITSI �iCE"EIt BER EXCLUDE�ECUTtVE a NIA E.L.EACH ACCIDENT 5 J I !Mandatory In NH) E.L.DISEASE-EA EMPLOYEE S !ryes,describe Older DESCRIPTION OF OPERATIONS be1mv E.L.DISEASE-POLICY LIMIT S DESCRIPTION OF OPERATIONS 1 LOCATIONS I VEHICLES (Aeach ACORD 101,Addhional Reit-arks S:heduto,If more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE V1111TH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE I Rican Fragala/PAT ACORD 25(201(11115) ©1988-2010 ACORD CORPORATION. All rights reserved. 1111S025 mm�nsl n t 'Pian Q RnQ r)rra rsan�n�i!nn r.�ro eaniclne'ad martrc nr 6 f:flRrl t'd Z8ZEZM09 07 uoi}owlsuoo SJW dto:Z0 eL 97 unf