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HomeMy WebLinkAboutBuilding Permit #524 - 21 HIGH STREET 2/26/2010BUILDING PERMIT of �,:0 6Ati TOWN OF NORTH ANDOVER oa by: •6 0 APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received 4,'0cq%rev �SSACNU`��� Date Issued: Z.. I PORTANT: Applicant must complete all items on this page v %T L 7' LOCATION). l E`"1 tF- H (atLpaw-zne, r($ O i CrJ L Print PROPERTY OWNER i�. - "` N O Dz � --�- Print MAP NO: PARCEL: i ZONING DISTRICT: Historic District -no Machine Shop Village Re no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building One family Addition Two or more family Industrial Alteration No. of units: Commercial Repair, replacement Assessory Bldg Others: Demolition Other Septic Well Floodplain Wetlands Watershed District Water/Sewer DESCRIPTION OF WORK TO BE PREFORMED: Identification Please Type or Print Clearly) _ OWNER: Name:ljgvio Phone: 61-7— Address: 9v rl'S' 1�3 O (_-T L V tqL_,-'� d S , SZ) N qrLA/[ 1 L, NJ, -4 0 Z! �-- 3. CONTRACTOR Name: K0 v 0 tom' Phone: !-, t'i S`9 L - L S_ to b I -� Supervisor's Construction License: S 44- Exp. Date: 1,16 1 LG I Home Improvement License: 1 0 9 t+ � 0' Date: 610 1 2- 01 17 ARCHITECT/ENGINEER 11 Hr, c.s,g `1 Sst &PJ Phone: lo C7 1 -,? 6 9 L . Address: I1+ _,;-, Zu rr'S 4-o�3 �.00gQ1_V(N Reg. No. � C)Lr-L, FEE SCHEDULE: BULDING PERMIT: $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F. ;Vk Total Project Cost: $�— �-��y 4 - FEE: $Z -- Check No.: Receipt No.: 2 Z j NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund 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 PLANNING & DEVELOPMENT COMMENTS DATE APPROVED CONSERVATION Reviewed on Signature COMMENTS HEALTW. COMMENTS Reviewed on Signature Zoning Board of Appeals: Variance, Petition No: Planning Board Decision: Comments Conservation Decision: Comments Zoning Decision/receipt submitted yes Water & Sewer Connection/Signature & Date Driveway Permit DPW Town Engineer: Signature: Locatea su4 usgooa Street FIRE DEPARTMENT - Temp Dumpster on site yes ✓ no Located at 124 Main Street Fire Department signature/date hed /,0 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 Building Department The following is a list of the required forms to be filled out for the appropriate permit to be obtained. Roofing, Siding, Interior Rehabilitation Permits ❑ Building Permit Application ❑ Workers Comp Affidavit ❑ Photo Copy Of H.I.C. And/Or C.S.L. Licenses ❑ Copy of Contract ❑ Floor Plan Or Proposed Interior Work ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks ❑ Building Permit Application ❑ Certified Surveyed Plot Plan ❑ Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses ❑ Copy Of Contract ❑ Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Mass check Energy Compliance Report (If Applicable) ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit New Construction (Single and Two Family) ❑ Building Permit Application ❑ Certified Proposed Plot Plan ❑ Photo of H.I.C. And C.S.L. Licenses ❑ Workers Comp Affidavit ❑ Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Copy of Contract ❑ Mass check Energy Compliance Report ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit In all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals that the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be submitted with the building application Doc: INSPECTIONAL SERVICES DEPARTMENT:BPFORM07 Revised 2.2008 Location/c_) i oled 1c,1(_ No. 5� Date d TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 22011 _ Building Inspector O 0. Location /�'z No. Date -0 -22 /r NORT1y TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ 4CMU5 Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 4-/ d 22:6 `�- Building Inspecfc Mo'rM {- f '�'hr. ✓'fit► CMJ+ CERTIFICATE OF USE & OCCUPANCY TOWN OF NORTH ANDOVER Building Permit Number 524 Date: April 27, 2010 THIS CERTIFIES THAT THE BUILDING LOCATED ON 21 High Street Suite 206 — Bradford Medical MAY BE OCCUPIED AS Tenant fit un INACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. Certificate Issued to: RCG North Andover Mills LLC 21 High Street, North Andover MA 01845 Building Inspector CA m m m m m CA m y C � - R y Cl) CD n Z y C.O n. r CL = y a� -v o CD CDCL O r� �d CD o CD C CDCD y CLO CO) W,^ I CD S- CO) O 1 Z CD O CD O CD O 'Q b 7 I 0 �• y 0 ✓ ry Dam = n O CD CD HmCL Cc, �. m �, y = d .dr, ® y T ®n?m = m (All _lorry p y :E ?m y = z5.low 0o'm. 3m o _ eco oa = r O W O y • c7 -a �. CD d CAM. CL ccd- ,�. _ o O CO) CA �� *# oC � V- 7N% CD CD .) Er • D O i CA Wool CD i k r 0 _ 10 ms CD m GCO .�► : f I X a 3 < 'yet ray : 1 CD :• :� o _ 0CD p O n o C C n m d nom. • w •� c7 � ::r, -_t-o _ 00 z :r r -L -l'. , !. C/) "I _ Al cn v^,' ^ o o p O n o C C n o O m -TI 0-4 ::r, -_t-o - m 00 z :r r -L -l'. , !. C/) "I Al d CAGQ rt CD c ti N C� �A �i ICL O C KHALSA DESIGN INCORPORATED Architects & Engineers 17 Ivaloo Street, Suite 400, Somerville, MA 02143 p.617-591-8682 1 f. 617-591-2086 ARCHITECTURAL FINAL AFFIDAVIT April 20, 2010 City of North Andover, Inspectional Services Department North Andover, Massachusetts RE: Bradford Medical Associates Tenant Fitout, East Mill, 21 High Street, North Andover, Massachusetts Khalsa Design Inc. has visited the above referenced project during the construction period, and has provided construction related services in conformance with the Massachusetts State Building Code, Controlled Construction Section, 780 CMR §116.0. 1 verify, that to the best of my knowledge, information and belief, that the building has been constructed in substantial conformance with the construction documents for the project. The detection of, or the failure to detect, deficiencies or defects in the construction during review by this office does not relieve the contractor or its subcontractors of their responsibility to correct all deficiencies or defects, whether detected or undetected, in all parts of the work, and to otherwise comply with all requirements of the Construction Documents. Sincerely Yours, Jai Singh Khalsa, NCARB ZO AR If fN � -moi D cn No. 6042 CAMBRIDGE 5�' r/1 OF MPSSP Mass Registration Seal # 6042 Then personally appeared above named Jai Singh Khalsa made oath that the statement made by him is true. Before Me 'Notary Aaochuseh Notary Public7F My Commission Expires October 27, 2011 Name Commission. Expires o o as�2 v u o LE � y v cn A c cov o w o a: c x U � LL, 0 H w � a a x o g2 g u, 0 w w a w o c2 a V) rw o x o cL: c w a w v w z . cn v o v 0 o V) • c m C C v C* ` -4 ft C N O C Ag O ivV a m C L O •� C) m N � E a u O : ymr C ts E.E Z r' Q �ij • r_ o m `NGO<L� SCO 0 O*lf j Qf CD C N R m N y m 3 C m N O Ammo.* E o •dam&r mo :=CJ CD y O -CD0- 0� �•Q� p C O NQ :CRLct V d! O CD o '� Z : � C p n Q ` O C CD : of 3 HO a" O ... N o $ W C 4::5 Z O = C +. •N % O C U01 C:.uj E V C1 O "r O •N 'fl • V O p-0 C 0 CL H a m' o.o z �y�� H r S CL CO E v zoo a N 0 N C 0 cm CD cp C CIO O CD C �C N CD t r.+ O Z O 0 z 0 w w a O O O• L O Z a O CO) C � CD c Q■� CO3CD 0 O ■O 'g m co CLI .00 to � CO O 0 o- CM< co c ev Cc C co C7 y � C C C cc a C* LLI 0 CO) LLI Y/ W W w W U) .1 0 es t co co IC) tz Standard. Form of Agreement between Owner and RCG Builders LLC where the basis of payment is the Cost of the Work Plus a Fee without a Guaranteed Maximum Price The Owner and Contractor agree to the terms stated by this contract. This contract supersedes any prior agreements, representations, or negotiations, oral or written. No liquidated damages shall apply to this agreement. This contract consists of the following documents: 1. Obligations of the Parties 2. Contract Sum I Project Schedule 4. Signatures Exhibits Exhibit A: Estimated Cost of Work Exhibit B: Project Schedule Exhibit C: Drawings Page 1 of 6 1. Obligations of the Parties Obligations of the Contractor: The Contractor accepts the relationship of trust and confidence established by this Agreement and covenants with the Owner to cooperate with the Architect and exercise the Contractor's skill and judgment in furthering the interests of the Owner; to furnish efficient business administration and supervision; to furnish at all times an adequate supply of workers and materials; and to perform the Work in an expeditious and economical manner consistent with the Owner's interests and in compliance with all applicable governmental codes and regulations. The Contractor shall keep full and detailed accounts and exercise such controls as may be necessary for proper financial management under this Contract. The Contractor shall keep full and detailed records of all books, records, permits, licenses, correspondence, receipts, instructions, data, and drawings associated with the Project including all Subcontractor contracts, invoices, vouchers, insurances, lien waivers, and other correspondence. The Owner and Owner's Accountants shall have access to review, audit, and copy all Contractor documentation. The Contractor shall retain these documents for a period of three years after final payment. The Contractor shall maintain insurance at the following levels with the Owner listed as a co- insured: Type of Insurance Limit of Liability Commercial General Liability:$1,OOQ,000,00 Upon request, and at the cost of the Owner, the Contractor shall obtain a performance bond up to the total Cost of Work. Such costs shall be added to the Construction Volume. The Contractor understands that the Project will be financed by a construction lender and, then, by a permanent lender. The Owner may assign any of its rights under this Contract to the construction lender and the Contractor hereby consents to any such transfer provided no such assignment shall relieve the Owner of any of its obligations under this Contract, unless agreed to in writing by the Contractor. The Contractor shall execute any certificates, lien waivers, releases, receipts, and other documents as may be reasonably required by the construction lender or permanent lender including a subordination of its mechanic's lien rights to the construction lender's and permanent lender's mortgage or deed of trust. The construction lender for the Project will be: Obligations of the Owner: The Owner agrees to furnish or approve, in a timely manner, information required by the Contractor and to make payments to the Contractor in accordance with the requirements of this Agreement. Dispute Resolution: Claims, disputes or other matters in question between the parties to this Agreement shall be resolved by mediation or by arbitration. Prior to arbitration, the parties shall endeavor to reach settlement by mediation. Page 2 of 6 BUILDERS 2. Contract Sum Cost of Work: The Contractor shall provide a detailed estimated Cost of Work to the Owner (see Exhibit A). The sum of these costs, including the fee is as shown below: $46,161.00 Change Orders: The Contractor does not guarantee the Contract Sum in any form. In the event of changes to the Contract Sum, the Contractor will present written changes to the owner for costs that exceed the Contract Sum in the form of a Change Order. The Contractor will review all Subcontractor Change Orders before submittal to the Owner and Architect and make a recommendation for payment or non-payment. The Contractor's Fee will be calculated including any approved Change Orders. The Owner, Architect and Contractor will negotiate disputed Change Orders in good faith. Contractor's Fee: 15% of total construction volume up to $1 million, and 10% of construction volume over $1 million. This includes pre -construction and project management services, and field personnel and associated management overhead. The fee is based on actual costs incurred, with final true up, and is booked monthly in arrears. Specifically, 1. The cost of pre -construction and construction management services provided by RCG personnel is booked monthly in arrears based on the hours reported by each employee. 2. Hours are billed at the standard hourly billing rate established from time -to -time for each employee. The hourly billing rates effective 1/1/2007 are shown below. 3. The cost of pre -construction and construction management services provided by independent contractors is booked when invoiced and carried within the fee. 4. RCG Builders personnel functioning as tradesmen outside their management duties will be charged according to their hourly billing rate. 5. If a project is terminated or suspended by the Owner prior to completion, RCG Builders LLC is compensated for the actual cost of services provided prior to receipt of notice of termination or suspension from the Owner. 6. Total Construction Volume includes all construction trades, general requirements, insurance, bonds and miscellaneous costs deemed necessary to perform the construction of the project, but excludes permits and fees. Permits and Fees shall be paid directly by the Owner. 7. Construction management labor, standard tools and equipment, and labor -related overhead are covered "within the fee". Specialty tools or equipment, trade labor supplied by Builders personnel and approved transportation and meals costs shall be charged directly to the Owner without a fee. Employee Rate David Steinber h $125/hr Mike Bernier $125/hr Kieran Whelan $125/hr Jason Downing $50/hr Page 3 of 6 RS Subcontractors: UE The Contractor plans to hire Subcontractors to perform the majority of construction associated with this project. The Contractor shall provide the Owner and Architect information on all of the bids received by Subcontractors and the names of the Subcontractors selected. Owner shall have the right to reject a proposed Subcontractor; however, in the event that this leads to a higher Cost of Work, the Owner shall pay for the difference. The Contractor reserves the right to reject any Subcontractor, even if it is the lowest bid, and to dismiss Subcontractors from the job that have been previously approved by the Owner. Payments: The Owner shall make progress payments on the Contract Sum according to the Requisition process described below. The Contractor shall, at the conclusion of each calendar month on the project, present to the Owner an application for payment (Requisition) for costs incurred during that month. The Requisition shall include all invoices, vouchers, partial releases of liens, expense reports, and any other evidence to support the validity of the Requisition amount. The Contractor may requisition for completed, but unpaid work based on an expectation of payment upon receipt of funds. The Owner, the Architect, or their representatives shall be afforded five (5) business days to review such application and question the Contractor about its contents. In the event there are no disputes, the Owner shall pay the Contractor within 10 business days of receipt of the Requisition. Payment by the Owner does not represent that the Owner or Architect have made a detailed examination of the documentation, inspection of the work, or verification of the accounting. At the completion of the project, the Owner shall make a final payment to the Contractor based on a final Cost of Work with a truing up of fees. If further corrections to work are required that are not covered under warranties with Subcontractors, or that are not the outcome of negligence or poor workmanship by the Contractor, the Owner shall pay the Contractor for any work associated with performing the corrections based on the hourly rate agreed to in this contract. Retainage: The Owner shall not hold back any fees to the Contractor to ensure completion of the work. The Contractor will be expected to hold back fees from Subcontractors to ensure their performance based on the terms below: 10% of billed costs, unless otherwise approved by the Owner. Termination of Contract: The Owner shall reserve the right to terminate or suspend the Contract at its sole discretion. Within 15 days of termination or suspension, the Contractor shall present an accounting of all its costs incurred for reimbursement by the Owner. If the Owner elects to proceed with the project without the Contractor, the Owner shall have the right to assume the Subcontracts and agreements related to the Project. Working Capital: RCG Builders shall not bear the costs of Working Capital for the project. If the Owner would like the Contractor to gain beneficial pricing on its behalf by paying subcontractors ahead of the Requisition schedule, the Owner shall either (1) put on deposit with the Contractor a sufficient amount of Working Capital for the Contractor to pay these Subcontractors, or (2) make immediate payment upon request from the Contractor outside of the normal Requisition process. Provision of Working Capital shall entitle the provider to all discounts and savings associated with that capital. Page.4 of 6 .�? Date of Commencement: The Contract Time shall be measured from the date of commencement. The date of commencement of the Work shall be the date of this Agreement, unless a different date is stated below or provision is made for the date to be fixed in a notice to proceed issued by the Owner. February 24, 2010; or such time that Notification to Proceed'is given by Owner Contract Time: The Contractor shall provide to the Owner a Project Schedule (see Exhibit B). This Schedule is based on assumptions reached prior to the signing of this contract, which assumptions the Contractor shall attempt to clarify in the Schedule. However, the Schedule always assumes the Owner and the Architect respond promptly to requests for information and do not request any significant changes to the construction program. In the event that the Owner or Architect find any discrepancies with the Schedule or its Assumptions, they will promptly notify the Contractor, who shall make adjustments to the Schedule as necessary. According to the attached Schedule, the Contractor shall achieve Substantial Completion of the entire Work as follows: Date of Substantial Completion to be no later than_:A rill 30, 2010 The Contractor does not guarantee the date of completion. However, the Contractor shall not be entitled to additional fees based on delays in the project unless those delays can be shown to incur extra costs for the Contractor and were caused by the actions or requests of the Owner or Architect. The Contractor shall present an updated Project Schedule to the Owner and Architect on a weekly basis for their review. Page 5 of 6 4. Signatures The Owner's representative is: Dav!#A teinbergh, I?rinc pal RC�G, LLC 17 Ivaleo Street, Suite 100'.. Somerville, MA 02143 § 14.4 The Contractor's representative is: Kieran Whelan RCG.Builders LLC ;q0 17 lvalon Street, Su#e 100'. S©mervillej_-"'02143 UIL DER This agreement is entered into as of the day and year first written above and is executed in at least thre original copies, one for the Owner, one for the Contractor, and one for the Architect. Owner Contractor SigiVature Signature _N AV ltd 6 q Pr i6 K"vi IJ M13 Ltqrl Printed Name and Title Printed Name and Title `oo,jq ; f*_e : `2 Page 6 of 6 " Bradford Medical Associates Schedule of Values Estimated Cost Demolition $1,500.00 Dumpsters $1,050.00 Building materials $1,500.00 Frame & Insulate $1,000.00 Glass Entry Doors & Sidelight $1,000.00 Drywall and tape $3,000.00 Prime and Paint $3,000.00 Carpet (2880 SF) $5,760.00 VCT (200 SF) $1,000.00 Vinyl base $300.00 Kitchen Cabinetry $1,600.00 Plumbing $800.00 Electrical $8,000.00 HVAC $10,000.00 Final clean $150.00 Sub -total $39,660.00 RCG Builders fee $5,949.00 Total $45,609.00 Plus Building Permit $552.00 Total Construction $46,161.00 Permit Affidavit Project Number: BRADFORD MEDICAL ASSOCIATES Project Title: EAST MILL Project Location: East Mill North Andover Name of Building: 120 Water Street, North Andover Nature of Project: Commercial Tenant Fitout In accordance with section 116.0 of the Massachusetts State Building Code, I Jai Singh Khalsa Registration No. 6042 being a Registered Professional Engineer/Architect hereby certify that I will prepare or directly supervise the preparation of all design plans, computations and specifications concerning: Entire Project HVAC Fire Protection Electrical _Plumbing Other(Specify) ARCHITECTURE For the above named project and that, to the best of my knowledge, such plans computations and specifications meet the applicable provisions of the Massachusetts State Building Code, all acceptable engineering practices and applicable laws and ordinances for the proposed use and occupancy. I further certify that I shall perform the necessary professional services and be present on the construction site on a regular and periodic basis to determine that the work is proceeding in accordance with the documents approved for the building permit and shall be responsible for the following as specified in section 116:2.2: 1. Review of shop drawings, samples and other submittals of the contractor as required by the construction contract documents as submitted for building permit, and approval for conformance to the design concept. 2. Review and approval of the quality control procedures for all code required controlled materials. 3. Special architectural or engineering professional inspection of critical construction components requiring controlled materials or construction specified in the accepted engineering practice standard listed in Appendix B. Pursuant to section 116.2,3 1 shall submit periodically, a progress report together with pertinent comments to the _North Andover Building Inspector. Upon completion of the work, I shall submit a final report as to the satisfactory completion and readiness of the ro'ect for occupancy. AROy�T H Ky�ct�cj, l t4o. 604? � K AMBIDGE Jy R 2/23/10 e and Stamp MDate On this da of ¢ y 20 2�FA� H F Me the undersigned nota public, personally 7-3 Y �� � � � notary p � p Y appeared 3M Lw&Sk (name of document signer), proved to me through satisfactory evidence of identification, which were HL , to be the person whose name is signed on the preceding or attached document, and acknowledged to me that he/she signed it voluntarily for its' stated purpose. Sara E. Addie Public Commonwealth of Massachusetts MY Commission Expires October 27, 2011 My commission expires JAE 'UMMankup-aft jrAf,,.h,,,, 3 IA e.A - �.a"� 6U0 �Qshirzgfnn Street MA 62111' Worketn C8MP=R6DR:insurance .AMdavit: Mnt InhMulfim. eebidansombers C. -6— Addmss. 1-1 gityswwzi,' Sa Ka.-nw I I Lt- [ - ----- oz(�-:I L(-- -(7-- . AM OMPhlYer'? Check the RPPMPIriRft'bDr- a MInPiffycr wtih 4. n I Mn IL Serwal conftactur and I cuiplayl='(fun and/q5i-rj--tjrw).* 2- F1 I 1101'Asole--proprimmr arpartner. hMVt hired the s&cuwao.- rid Sb* and have no etuplay,= M the aMmIzed gisheerThesm wmking for me m any 'capacity. wolican;# pomp. *MMVM= su -co,stMatuts have work=s, comp. insurance. 5. D W= are A cumpaisfion and hi MqWmd-I 1 int a holm doing an work. Dmc=have 6tzraisad their3.0 rightof . =cinpift per MOL .Mysw yo wurin$ CO"Ti, Z -!JS 1(4V-jsnd-*t hem rai inswInce -mqmh&l MT10yeeL [No walkMN, wrrm. insurarice T37C of Prf#ed (reqair*.* -)40W c�"mt s. 0 D=rwhflon- addwM 0.0-E6CftiW Mpaits a radditic '1-0ft=bTngTC' ''eradcMo . PM Roof repairs aw Im r "6%6j 1 indiMing ;w=.kd. M".4 — 4c=bwww do zb=k &6 6— GW'n AV'"9 an w — k 'MW Ibm hie mWd, PT=y ===tin Mw*—j RINW"-Anz the "MM ofd= ud,--Gm� "d, 0 wbaki KAM'dfidavft gush' walk=* fMfi=zdM Instamce Company Name: oc j,06W k IV rLt,� Porky 9 or se -4= um Add&rc=w Sob site Z a of the CitymbftrETP.' 0 COPY workere per - ------- key dec:iamsou pop Failum to '=� wvm'aP as r=*td undw S=fion 25,k of MCIL r (showin.- &e Pufiq number Md 11�a d..4 _ i52 can 1=8dtD fine up it) ZL500.00 and/or one-year irnIpffiwmemit as well es OjvIj )=]f= in the inTositicM Gfc6nhw P=df= of a - Of Up W $2,50.00 It day apinit-the viaiwar. B ' fire farm Of 11 M? WDPLK One MdH fn C advised dart a copy of filis Mtm=tt . lm-wd9ftiOnr- of the DLA forer=geverrney be f0r� to the Office of I da karrby cerci w mad .p=aw= ofperjjvy aw the j"Aarwm2w provided Phonr, wyiL- in 6* wre, gV Oty or Tow= Imuing AuMority (circle one): L Board or H=ft 2- . SUH&M I)Opnrb,,a 3-'CdY'TGm-w . C3crk 4. Electrical lwpet:tur 5 6. Other Inspector Contact Parma: Phone jr�"IlA : dkroj Lit --N . A ACORD,, CERTIFICATE OF LIABILITY INSURANCE osizol09D GRODUCER INSURANCE MARKETING AGENCIES 306 MAIN STREET THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. WORCESTER, MA 01608 508 753-7233 INSURERS AFFORDING COVERAGE NAIC # NSURED INSURERA: Associated Employers Insurance 21865 RCG Builders LLC c/o RCG-LLC 17 Ivaloo Street, Suite 100 Somerville, MA 02143 INSURER B: INSURER C: INSURER D: INSURER E COVERAGES 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. POLICY EFFEM POLICY TION R TYPE OF INSURANCE POLICY NUMBER E MIM p LIMITS GENERAL LIABILITY EACH OCCURRENCE $ DAMAGE TO RENTED $ COMMERCIAL GENERAL LIABILITY CLAIMS MADE M OCCUR MED EXP (Any one person) $ PERSONAL 8 ADV INJURY $ GENERAL AGGREGATE $ GEML AGGREGATE LIMIT APPLIES PER PRODUCTS - COMP/OP AGG $ POLICY JPRO- LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMB $ ANY AUTO (Ea accident) BODILY INJURY $ ALL OWNED AUTOS SCHEDULED AUTOS (Per person) BODILY INJURY $ HIRED AUTOS NON -OWNED AUTOS (Per accident) PROPERTY DAMAGE $ (Per accident) GE LIABILITY AUTO ONLY -EA ACCIDENT $ OTHER THAN EA ACC $ ANY AUTO AUTO ONLY: AGG $ EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE i $ $ DEDUCTIBLE $ RETENTION i A WORKERS COMPENSATION AND WCC5005531012009 05/10/09 05110/10 WC STATu- O R X I E.L. EACH ACCIDENT $500,000 EMPLOYERS' LIABILITY ANY PROPRIETORIPARTNEWEXECUTIVE E.L. DISEASE -_EA EMPLOYEE $500,000 OFFICERIMEMBER EXCLUDED? If yes describe under SPECIAL PROVISIONS below E.L. DISEASE - POLICY LIMIT $500,000 OTHER DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS For Informational Purposes ACORD 25 (2001108)1 of 2 #S158999IM158998 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL --W_ DAYS WRWMN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT BUT FAI.URE TO DO SO SHALL BIPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE DNSU110K ITS AGENTS OR GCE 0 ACORD CORPORATION 1988