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HomeMy WebLinkAboutBuilding Permit #506-2016 - 1401 GREAT POND ROAD 10/21/2015 NORTH BUILDING PERMIT °� quo TOWN OF NeRV-1 ANDOVER APPLICATION FOR PLAN EXAMINATION Date Received �R'<oTIED Permit No#: � 9 °RATED Ss US Date Issued: a �� IMPORTANT: Applicant must complete all items on this page LOCATION 1401 Print PROPERTY OWNER Ct::L0t i-4Abc Print 100 Year Structure yes MAP _�0 PARCEL: �2�7 ZONING DISTRICT: Historic District yesnno Machine Shop Village yes TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential + ❑ New Building ❑ One family ❑Addition El Two or more family ❑ Industrial ❑Alteration No. of units: [I Commercial @Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Other ❑ Demolition 0 Septic ❑Well Floodplain El Wetlands ❑ Watershed Distract q Watet/Sewer, DESCRIPTION OF WORK TO BE PERFARMED: 0 x 12 ©47-\2- 0?1 V— wtomv � T— Identification- Please Type or Print Clearly OWNER: Name: Cd c�rjN�E CaNDc�il��►�++v rd�1 '` qtr Phone: Address: lqof � go� ��"�� ao l ccr5 (0,i L Contractor Name: �x ��- 'hone Email: GA,;G+G• 4 0V-a Le E Address: 2G3 6k-ept�xO 1-167 kL4-k-ynk?Mn Supervisor's Construction License: 0$$ l FEZ-(3 Exp. Date. Home Improvement License: 1Z5 CP 5 Exp. Date: --3I LA 2`'I ARCHITECT/ENGINEER Phone:��78�=SoZ Address: Som t iDt tfi - 1�flfc^��Keg. No. � r-1'� 3 _ FEE SCHEDULE:BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. FEE: $ Total Project Cost: $ �J � U Check No.: � Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access my fund Building Department FRoofing, s a list of the required forms to be filled out for the appropriate permit to be obtained. iding, Interior Rehabilitation Permits ng 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 OTE: 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 4- Photo Copy of H.I.C. And C.S.L. Licenses Copy Of Contract Floor/Cross Section/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 OTE: 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 2012 IECC Energy code Engineering Affidavits for Engineered products OTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg. Permit peals In all cases if a variance or special permit was must thenequired he Town Clerks et this recorded at the Registry of Deeds. one copy and proof of refice must stamp the decision from the Board of cording that the appeal period is over. The applicantg must be submitted with the building application Doe:Building Permit Revised 2014 Kurt Slimak Plans Submitted C project ger ; ❑ Stamped Plans ❑ TYPE OF SEWERAGE I 283 Second Avenue { Waltham,MA 02451 Public Sewers S ag Pools ❑ Well ' ' ' 617)212-4081 roveme�c5 Mobile. 408-6738 caging/Sales ❑ ,,ouraintenance and imp for proPe� Fax:( � Private(septic tank,etc. email:laut.sb'n'�. ww w.spsinconline.con -�-r� --FALLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM PLANNING & DEVELOPMENT Reviewed On Signature_ COMMENTS CONSERVATION Reviewed on Signature COMMENTS 0TL9EALTH Reviewed on Signature Ne jMMENTS Zoning Board of Appeals:Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments ,Conservation Decision: Comments I Water& Sewer Connection/Signature& Date Driveway Permit a DPW Town Engineer: Signature: Located 384 Osgood Street FIREDEPARTMEf�T Tempj©umpsfer onsite. ,yes. .a, .-_t djdt`,12 A - - } Loea e 4 MaintSt�eet� - 'Fi' mentsgnature/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 A161 '" No. 60(a a Date . - TOWN OF NORTH ANDOVEr•_ Certificate of Occupancy. $ Building/Frame Permit Fee $�D Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check a+ .� Building Inspector NORTH own of E . ,, Andover , O - 0 No. - C h ver, MassOc;6�xk21 a O LAKI cocHicnewrcw S u BOARD OF HEALTH Food/Kitchen PERMIT T LD Septic System THIS CERTIFIES THAT ..... 0...�i"�'�'Qe ���M ��11 �LS BUILDING INSPECTOR has permission to ere ......................... buildings on .. ......'...06�4..? ....................._..................... Foundation Rough to be occupied as . .�.. P�'..... ..... . ..... .......... "1 - �'�. .... Chimney M provided that the person accepting 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. AL2 PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTIONS ARTS Rough f 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. i 1 'Proposal .for Services (ITS) 1'roj ect: The Colonnade 1401 Great Pond Road North Andover, MA 01845 Prepared For: Rick Stern Sutton Management Company,Inc. PO Box 773 North Andover,MA 01845 (978) 689-9994 Prepared By: Chuck Huntley Schernecker Property Services,Inc. 283 Second Ave,Waltham,MA 02451 (781)487-2516 chucic.huntley@spsinconline.com w-ww.spsincontine.com SPS H'1C#; 123615 Expiration Date: October 22,2015 Date Submitted: October 1,2015 Proposal#F: 5441821 i t The Colonnade-Guttx,Root*siding,and Decks The Colonnade i Proposrlk.5441 R21 1 { The work heretofore described is scheduled to comluence on October 1,2015 with an expected duration of t approximately 42 days.Substantial completion is expected by November 12,2015. i i Acceptance of Proposal The undersigned,as authorized representative(s)of the property listed,have read the terms stated herein and accept i the teens as written. a X-I '1,Tfrt ._ DAN 310ATURE DAna Chuck HuntI Vice President RiA=Fgaii Oiwg {,L1.5'G1 ti P ► � `:.t\1E TrFur NV4ETIT1.� Sehetnecker Property Services 283 Second Avenue,Wailltam MA 024511900.424.2468 1 spsincoaline.com The Cblonnade-Gutter,Roof,Siding,and Decks The Colonnade I Proposal#:5441821 Scope of Work. General Description: SPS,Inc.will provide the necessary supervision,labor,and materials to perform the work specified in this PFS in a good and workmanlike manner and in compliance with applicable laws and codes.The pricing provided in this PFS encompasses,in general,the following: Roofing: Garage roof replacement to include removal of existing roof system to expose the roof deck for inspection.Repairs to the roof deck will be completed using the allowances provided in this proposal.If additional work is required a written change order will be required.The new roof system will included waterproof membrane, synthetic underlayment and metal edge flashing to prepare the surface for GAF architectural shingle. Included Areas: • Detached garage soffit • Steep roof areas of the detached garage Low slope area of the detached garage will received a fully adhered EPDM membrane • Dumpster costs and permits • Roof deck and framing replacement up to the allowance quantity • Replace deteriorated fascia with new PVC Excluded Areas: • Siding repair or replacement Total Price for work as specified in the Scope of Work: $53,345.00 Additional Items,Alternate Items and Unit Prices Pricing provided on Page 3 is for specific items not included in the contracted Scope of Work.Please note that these items are additional to the"Total Price". Schedule of Work The work heretofore described is scheduled to commence on October 1,2015 with an expected duration of approximately 42 days.Substantial completion is expected by November 12,2015. Acceptance of Proposal The undersigned,as authorized representative(s)of the property listed,have read the terms stated herein and accept the terms as written. 10/19/15 GNATURE DATE SIGN �E,,` A..;.d' DATE SI Chuck Huntl Vice President \;" ;_ 1�t t NAME TITLE NAME TITLE Schemecker Property Services 1283 Second Avenue.Waltham MA 024511800.424.2468 1 spsinconline.com The Colonnade-Gutter,Roof,Siding,and Decks The Colonnade I Proposal#:5441821 Total Price for work as specified in the Scope of Work Type of Price/Type Item Description Quantity Quantity of Quantity Extended Price 1. New roof on freestanding garage(see attached 1.00 Job $26,825.00 $26,825.00 addendum for specific contract quantities included for rotted sheathing and framing) 2. New vinyl on front of freestanding garage 1.00 Job $7,500.00 $7,500.00 3. New PVC soffit on front of freestanding garage 1.00 Job $2,000.00 $2,000.00 4. New gutters and downspouts on front of freestanding 1.00 Job $2,800.00 $2,800.00 garage 5. Repair roof leaks on upper rear rubber roof at 1.00 Job $6,600.00 $6,600.00 mansion 6. Replace upper rear IOx 12 deck at mansion 1.00 Job $4,500.00 $4,500.00 7. Power wash existing vinyl siding 1.00 Job $1,500.00 $1,500.00 8. Rake Board Replacement with New PVC Rake 1.00 Job $1,620.00 $1,620.00 Boards on the Freestanding Garages Only(135 LF) Total: $539345.00 Additional Items, Alternate Items and Unit Prices Type of Price/Type Item Description Quantity Quantity of Quantity Extended Price 1. Replace damaged sheathing 1.00 SF $3.50 $3.50 2. Replace damaged framing 1.00 BF $15.00 $15.00 Schemecker Property Services 1283 Second Avenue,Waltham MA 024511800.424.2468 1 spsinconline.com The Colonnade Pro msalll:5441821 { 'rhe Co:°unode-Goner,Rosi;Siding,and Deis l 1 i t i Property Notes & Present Job Conditions The following conditions were identified during the visual analysis of the property.These notes are not meant to be, nor to replace,an engineering report.Additional historical information and/or an invasive analysis would be likely to provide further information. Pricing NouI s EPA RRP /Lead paint The pricing provided assumes that the property was built after 1978 or that the work being performed will not require SPS,Inc.to follow the EPA guidelines for renovation,repair and painting(EPA RRP rule).if the work is subject to the guidelines of the CPA RRP rule or any DEP or local rule regarding lead paint,then the pricing will be re-evaluated and will likely increase. Permit SPS,Inc.acting as the Owner's agent;will apply for and obtain any necessary construetion-related permits. The cost of any such permits will be paid by SPS,Inc.and shall be included in the pricing provided,unless specifically excluded.The Owner or its agent shall assist SPS,Inc.,with any required signatures,documents,or other cooperation necessary to obtain such permits.Construction control by a licensed engineer or architect,if required by the permitting authority or if elected by Owner,is not included in the pricing provided and is to be contracted directly by the Owner. Unforeseen Conditions/Change Orders Renovation work involves removal of existing materials to expose hidden surfaces.By its nature,renovation work is liked++to result inuncovering conditions that were not foreseen.It is hikely thatunforeseen conditions will be uncovered when existing materials are removed.Unforeseen conditions usually necessitate changes in the scope of work and an increase in the tdtal price of services.Changes to the scope of work as a result of unforeseen conditions will be presented to the.Owner or managing agent in the form of a written Change Order.All Change Orders,regardless of the reason for the Change Order,must be documented and approved in writing by SPS,Inc. and Owner or Owner's agent.Change Orders may be approved by email. Additiorall Priciill; "ti`Utc::s The pricing provided assumes that the property will require SPS to follow the EPA guidelines for renovation,repair and painting(EPA RRP Rule). ° Architecture and engineering work and/or hiring of licensed architects or engineers is excluded unless specifically included.If the municipal authority requires'construction control'by a licensed architect or engineer the cost of such construction control will be estimated and presented as a chango order to the work.Such change order will require owner approval before continuing work. ° All carpentry are dependent on town of North Andover building inspector approval.Any additional work required by the building inspector will be priced separately as a change order. Schema(cr Pr"y Services 1293 Second Awnue,Waltham MA 02451 1800.424.24681 spsinconline.com The Colonnade-Gutter,Roof,Siding,and Decks The Colonnade I Ptnposallt:5441 R21 1 t Proposal Tcrms Proposal:This proposal is valid until October 22,2015.If this proposal has not been accepted by said date,then this proposal is deemed withdrawn by SPS. Acceptance of Proposal:The signature of the Owner or Owner's authorized agent shall constitute Owner's agreement to the terms and conditions contain herein. Owner's Managing Agent-If Owner has engaged tie services of a property management company(`'managing agent")to act on its behalf with regard to the subject matter of dais agreement,the managing agent and its representatives shall be considered authorized agents of the Owner.With relrnrd to the subject matter of this agreement,Owner shall be bound by and SPS,Inc.shall be entitled to rely upon statements and aeon of the managing ugent. Entire Agreement:This proposal and any doeume:tts specifitmily listed holder Contract Documents or incorporated by reference constitute the entire agreement between SPS,Inc.and Owner.Both patties wrarant that there have been no promises,obligations or undertakings,oral or written,other titan those herein set forth.No material modification of the terms of this Agreement shall be effective unless approved in writing by SPS,inc.and Owner or Owner's agent.Modifications may be approved by email. Work Progression:Start dutes,amount of time needed to complete the work,and completion dates will be estimated at the time of signing of the PFS,prior to dte;commcncemetn of the work.The schedule may be modified by mutual agreement for any reason.Changes in the Scope of Work are likely to impact the schedule.Inclement weather and other circumstances beyond SPS,Inc.'s control are also likely to cause changes in die work progression.belays caused by Owner,its managing agent or their representatives,may result in additional charges. Representations:SPS,Inc,is in the business of providing maintenance and capital improvement services to real properly.The PFS contained herein has been prepared on the basis of a visual inspection of die property.SPS makes no warranties or repr:scntations about the physical condition of the property at the time of this proposal. ,. Materials Storage and inspection:SPS,lac.requires that it be allowed to store the materials and equipment necessary for the performance of the specified work on the property in a_mutually agreeable.location.Such materials and equipment shaft be subject to inspection and approval by the property agent. Protection of Work Areas:The work areas are to be secured and protected during die performance of the work.Unless otherwise noted.SPS lac,will be responsible for damages to the Owner's property caused SPS Inc.during the performance of the work. Rubbish Clean Up and Removal:SPS,Inc.will dispose of rubbish,trash and debris resulting from the performance of the work in a manner approved by the Owner or authorizod agent.Such disposal will be in compliance with applicable laws and regulations.SPS,Inc.shall maintain the job site in reasonably neat and clean condition during the peformance of the work. Completion and Acceptance-The work will be deemed to he complete when the conditions as dcscribcd in the PPS have been performed by SPS,Inc.Upon completion,SPS,Inc.will pruvide notice to die Owner that the entire work or an agreed portion thereof is complete:.Upon such notification,the Owner or Owner's agent will promptly inspect the work and will notify SPS,Inc.of any incomplete or defective work.SPS, Inc.shall take such measures as are reasonably necessary to complete such work or remedy such deficioncios, Insurance:SPS,Inc.maintains Worker's Compensation Insurance,General Liability Insurance and Automobile Insurance.Upon request,SPS, Inc.will facilitate the delivery of a Certificate of Insurance from its insurance agent naming the property Owner as an"Additional Insured." Warranty:Unless otherwise noted,SPS,Inc,warrants the work performed under this PFS against defective workmanship for a period of two (2)years from the date ufcompletion and acceptance.This warranty is expressly conditioned upon the Owner's fill performance of its payment obligations hereunder,Any holdback or nonpayment by Owner will invalidate this warranty. Owner shall also have the right to terminate the agreement for convenience.Owner shall give SPS,Inc.ten(10)days advance written notice. Owner shall be responsible for paying SPS for all work performed to the date of termination plus SPS reasonable costs of demobilizing plus twenty percent(201A)of the value of the work remaining to be performed wider the agreement. Nominal versus nctunl dimensions:The actual dimension of a 2x4 is approximately 1.5",L 3.5"."2x4"is the nominal dimension.The actual dimensions of many materials differ from their advertiser]nominal dimensions.Nominal dimensions arc used in proposals and specifications. SPS does not assume responsibility or liability For the discrepancy between any nominal versus actual measurements. Indemnity.,To the fullest exusnt perniftiud by taw,the Ownershali indchnniry,defvnd,and hold hannicss SPS,Inc.s and its agents and employees of and from any claims by third parties or unit owners arising out of SPS,Ine.'s performance hereunder unless it is finally adjudicated that such Schomecker Property Serviceh;12R3 Swond Avemhe,Waltham MA 024511 900A241462 I spsincordine.com The Commonwealth of Massa.chusetts Department oflndustrialAccidents 1 Congress Street, Suite 100 Boston,MA 02114-2017 www mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legibly Name(Business/Organization/Individual): Address: Z�3 City/State/Zip:��o, �1,�, Ao til& 02Q )L Phone#: Ce1-1 2(Z 2-1 Are you an employer?Check tthje�appropriate box: Type of project(required): I am a employer with 1y employees(full and/or part-time).* 7, ❑New construction 2.❑I am a sole proprietor or partnership and have no employees working for me in $, remodeling any capacity.[No workers'comp.insurance required.] 3.F1 I am a homeowner doing all work myself.[No workers'comp.insurance required.]i 9. Demolition 4.❑I am a homeowner and will be hiring contractors to conduct all work on my properly. I will 10 E]Building addition ensure that all contractors either have workers'compensation insurance or are sole 11.❑Electrical repairs or additions proprietors with no employees. 12.❑Plumbing repairs or additions 5.❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.Fqfoof repairs These sub-contractors have employees and have workers'comp.insurance.# 6.Q We are a corporation and its officers have exercised their right of exemption per MGL c. 14.❑Other 152,§1(4),and we have no employees.[No workers'comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. i 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 state whether or not those 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: I ( In;,—c-re S J,A ,g LLC Policy#or Self-ins.Lic.#: 19 c 6a X�2y�o t I Expiration Date: k/l /fr Job Site Address: 1�jnl Cp P0444_ rj City/State/Zip: Klcv-44 l�,,a,,,4� ►'1i� G��G,r Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by 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.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby cer .0 un,ler the p ' s a enalties of perjury that the information provided above is true and correct. Si ature: Date: Phone#: Official use 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 dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house 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=contractors)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' compensatioti'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 Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street, Suite 100 Boston,MA 02114-2017 Tel.# 617-727-4900 ext. 7406 or 1-877-MASSAFE Fax#617-727-7749 Revised 02-23-15 www.mass.gov/dia A oRV CERTIFICATE OF LIABILITY INSURANCE DATE(MMI 12/1s/2o20Y144 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 CON NAMTACT Claire Boutilier Cleary Insurance Inc PHONE (617)723-0700 A' N .(617)723-7275 226 Causeway Street a oRL .cboutilier@clearyinsurance.com INSURERS AFFORDING COVERAGE NAIC# Boston MA 02114-2155 INSURERA:Continental Western Insurance 10804 INSURED INSURERB:Union Insurance Company 5844 Schernecker Property Services, Inc. INSURERCAcadia Insurance Company 1325 1 283 Second Avenue INSURER D: INSURER E: Waltham MA 02451 INSURER F: COVERAGES CERTIFICATE NUMBER:2014-15 Liability 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 ADDLSUBR POLICY EFF POLICY EXP LIMITS LTR TYPE OF INSURANCE _Wa POLICY NUMBER MMtDl'YY MMID tYYYY GENERAL LIABILITY EACH OCCURRENCE 5 1,000,000 X COMMERCIAL GENERAL LIABILITY PREMIE (EaE occurrenceoccurrencel S 300,000 A CLAIMS-MADE a OCCUR CPA 0183614-18 2/31/2014 2/31/2015 MED EXP(Any one person) E 5,000 PERSONAL 8 ADV INJURY S 1,000,000 GENERAL AGGREGATE S 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG S 2,000,000 POLICYFX PRO- LOC $ AUTOMOBILE LIABILITY (Ea accidpntl COMBINED SINGLE LIMIT _ 1,000,000 ANY AUTO BODILY INJURY(Per person). S B ALL OWNED X SCHEDULED HAA 0183615-16 2/31/2014 2/31/2015 BODILY INJURY(Peraccident) S AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ X HIRED AUTOS X AUTOS (Per accident) $ X UMBRELLA LIAB X OCCUR EACH OCCURRENCE S 5,000,000 C EXCESS LIAB CLAIM MADE AGGREGATE S 5,000,000 DED RETENTION$ UA 0183516-18 2/31/2014 12/31/2015 $ C WORKER$COMPENSATION X I WC ORYSTATU- OTH- AND EMPLOYERS'LIABILITY LIMITS I __I ER ANY PROPRIETOPIPARTNEREXECUTIVE Y 1 N E.L.EACH ACCIDENT $ 1,000,000 OFFICEP'MEMSEREXCLUDED? a NIA 5074780-12 2/31/2014 2/31/2015 (Mandatory in NH) �CA E.L.DISEASE-EA EMPLOYE $ 1,000,000 If yes.describe under DESCRIPTION OF OPERATIONS below (Excludes MA) E.L.DISEASE•POLICY LIMIT $ 1,000,00 DESCRIPTION OF OPERATIONS f LOCATIONS IVEHICLES (Attach ACORD 101,Additional Remarks Schedule,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 WITH THE POLICY PROVISIONS. Schernecker Property Services, Inc. 283 Second Avenue Waltham, MA 02451 AUTHORIZED REPRESENTATIVE Claire Boutilier/JCB I ACORD 25(2010105) ' O 1988-2010 ACORD CORPORATION. All rights reserved. IUCR7fi rx nnr ,im The ACORD name and ioclo are registered marks of ACORD Client#:1025557 SCHERPRO - ATE(MhVDOKYYY) ACORD.., CERTIFICATE OF LIABILITY INSURANCE D1v18/2014 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 NAME: Wagner USI Insurance Solutions LLC PHONE E,n:413-750-4222 ,vc Ne,610-537-4670 123 Interstate Drive E-MAIL DDRESS: kathy.wagner@usi.biz A9 West Springfield, MA 01089 INSURER(S)AFFORDING COVERAGE I NAIC N 855 874-0123 INSURER A:ABC Mass Workers Comp SIG 199999 INSURED INSURER B Schernecker Property Services,Inc. INSURER C: 283 Second Avenue INSURER D: Waltham,MA 02451 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 PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR 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 INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR INSR WVD POLICY NUMBER MM/DD/YVY MM/DD/YYV GENERAL LIABILITY EACH OCCURRENCE S_ COMMERCIAL GENERAL LIABILITY DAMAGE IS Ea RENTED S CLAIMS-MADE 0 OCCUR MED EXP(Any one person) S PERSONAL&ADV INJURY $ GENERAL AGGREGATE IS GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGG S POLICY pR�Oj LOC S AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident S ANY AUTO BODILY INJURY(Per person) 5 ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) S NON-OWNED PROPERTY DAMAGE S HIRED AUTOS AUTOS Per accident S UMBRELLA LIAB OCCUR EACH OCCURRENCE s EXCESS UAB CLAIMS-MADE AGGREGATE S DED RETENTIONS s A WORKERS COMPENSATION ABCMA12000115 1/01/2015 01/01/2016 X TORYII U-WC MI5 OTH- rR AND EMPLOYERS'LIABILITY Y/N � T ANY PROPRIETORIPARTNER/EXECUTIVEE.L,EACH ACCIDENT S1.000,000 OFFICER/MEMBER EXCLUDE09 a N/A - (Mandatory in NH) E,L.DISEASE-EA EMPLOYEE S1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT S1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,it more space Is required) Proof of MA Workers'Compensation Coverage Proof of Massachusetts Workers Compensation Coverage CERTIFICATE HOLDER CANCELLATION For insurance Purposes only SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN QQ ACCORDANCE WITH THE POLICY PROVISIONS, AUTHORIZED REPRESENTATIVE ©1988-2010 ACORD CORPORATION.All rights reserved. ACORD 25(2010105) 1 of 1 The ACORD name and logo are registered marks of ACORD I #S13921784/M13920367 PZPZP Massachusetts -Department of Public Safety 1 Board of Building Regulations and Standards Construction Supen icor License: CS-083665 `` KURT M SLI IW '�•. 42 SEARLE ST. Georgetown MA :01833 i " "' Expiration Commissioner 03/07/2016