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HomeMy WebLinkAboutBuilding Permit #871-15 - 30 DAVIS STREET 5/1/20151114V oa4 Permit NO: Date Issued: ` >E LOCATION J TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION JDate Received TANT: Applicant must 1 r. Print all items on this PROPERTY OWNER " �'CI (f I (f Sa-- . Print 100 Year Old Structure yesno MAP NO: PARCELM35 ZONING DISTRICT: Historic District yes no k Machine Shop Village yes k no TYPE OF IMPROVEMENT. PROPOSED USE Residential Non- Residential ❑ New Building XOne 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 PERFORMED: Identification Please Type or Print Clearly) OWNER: Name: Mf MrS. Phone:Q9S), 3B9.L4Sa3 Address: CONTRACTOR Name: r�. I Address: aos W\A S �- �\GNe4-Kk Supervisor's Construction License: Csr 09 91'�O Exp. Date: C9 .a '' co Home Improvement License: ARCHITECT/ENGINEER Date: lot -In - Phone: tt_Ln Phone: Address: Reg. N FEE SCHEDULE: BULDING PERMIT. $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F. ('Total Project Cost: $ l t d O FEE: $0 1 Check No.: Vlq Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access tot ntv fro Signature of,Agent/Owner Sigilafure of contractor ! Plans Submitted Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ Location No. �) I �15 Check # Date TOWN OF NORTH ANDOVER Certificate of Occupancy Building/Frame Permit Fee Foundation Permit Fee Other Permit Fee TOTAL 6 � Building Inspector $ Two— $ r•iIt Plans Submitted-❑ PlansWaived-E] Certified Plot Plan ❑ Stamped Plans ❑ TYP1 _OYSEWERAGEDISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ❑ .. Swimming Pools ❑ Well ❑ Tobacco.Sales ❑ Pood Packaging/Sales ❑ Private (septic tank, etc.. ❑ . .. Permanent Dumpster on Site ❑ THE. FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM PLANNING& DEVELOPMENT COMMENTS CONSERVATION COMMENTS HEALTH COMMENTS DATE REJECTED: DATE.APPROVED Reviewed on Signature Reviewed on Signature Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Plaf)ning Board Decision: V Comments Conservation Decision: :Comments Water & Semler Connection/Signature & Date Driveway Permit DPW Tovv;: Engineer: Signature: FIRE DEPARTME f `-,Temp Dumpster on site yes_ Located at 124 Mair, Street - �Fire'Departmdi t,signature/date`' COMMENTS Located 384 Osgood Street � no -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 El Notified for pickup - Date Doc.Building Permit Revised 2010 Building Department The fol?owing is =a -'list of the required forms to be filled out for the appropriate -permit to be obtained. Roofivg, 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 o Copy Of Contract ❑ Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Mass check Energy Compliance Report (If Applicable) ❑ 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 apo% -al period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be subm.+.ted with the building application Doc: Doc.Building Permit Revised 2012 sMo W 0 N 4mI 0 J Q LU 2 LL 0 0 m C N u t' \ O O LL N N u Q N (n O w of z Z � C + -O O O LL t � O d' cu > C L U _ C LL O Wa of Z z m J d L =OA O d' _ C LL u a of Z U W J W -C = O OC U i N N _ C LL U d CA Z Q s O _ @ C z Q W W LL i 7 m z ++ ,F, N . O N Y O E N n cc v O W p •Q. L N Z 0 z E * c O r 'fro S� d y m Z N CD 01 co r M tva N co��P V� �� Z .�mm 'w CL O O a app N Z C-) cc V > _ Cl) (1) y W pcn CD a >a� 4� V O O N Q ^ Z p Q O Q O W •N t t t _ c o 14- tN = NN .W c tm>>o c WJ G VJ-0 coy- =a aZ Z �CLp N _ `o v p Q mw— V : tm c� N o r a c Q m - mO Q WN cCl) Liua c� m t O "o - O O _ Ri O C . , •N o Z u E Q O -o p • w 0 W . N -0 o O _ ea c 0 M T. EIN # 51-05033313 amber MA Reg. HIC #121981 • MA Lic. #UCS 078130 • • fing Single -Ply Lic. # 1711 RAN= • S ,- 32 O. We are: ALicensed AInsured 4 -Factory Trained 4 -Factory 4Certified Installers April 26, 2015 Mr. & Mrz. Szelest 30 Davis Street North Andover, MA 01845 ACCREDITED BUSINESS '. New Steep Slope Roofing System Proposal Approx. 2,700 SF Main House and Shed TGLRC Inc. dba Lambert Roofing Company will provide certificate of insurances demonstrating that we are fully insured for workers compensation, general liability, automobile liability and a $5,000,000.00 umbrella policy. This documentation will be sent through the US mail or VIA E- MAIL/FAX to the above named party if not already provided. Upon completion of the roof and final payment, a shingle manufacturers warranty "5 -Star" and our executed two (2) year workmanship warranty will be sent to the named party. Conditions: Work to be Performed And Materials to be Utilized A Standard two (2) year workmanship warranty applies in addition to a "5 -Star" manufacturer's warranty. Under no circumstance will the watertight integrity of the building be in any way compromised. All work will be performed to the standards and expectations dictated by the 7'' edition building code and proper roofing practices founded in NRCA roof covering and waterproofing manual and manufacturers specifications. 1) A pre -roof walk around will be executed to observe and document any pre-existing conditions and or any special considerations. 2) Ensure landscaping and dwelling is and will remain properly protected. Please take special note that during demo of the existing roof system all valuables non - fastened are subject to falling during demo and debris will fall in the attic so preparing for this will avoid an inconvenient clean up. Lambert Roofing will not be responsible for the above-mentioned preparation. Page 1 3) Prepare for re -roofing by ensuring all safety measures are taken in accordance with OSHA and CMR Standards. 4) Remove existing layers of shingles down to the wood roof decking and properly dispose of debris from the jobsite. T.G.L.R.C., INC. will arrange for disposal. 5) Inspect wood roof decking, if we discover any rotted wood, removal and replacement will be performed at an additional cost of: • $3.95 per foot for rough pine removed and replaced. • $50.00 per sheet of CDX Plywood removed and replaced. Any Carpentry or extra work desired aside of what is being contracted for in this contract will be charged at $65.00 an hour, per man, plus materials upon approval and change order from owner. If we discover any pre existing conditions we will notify owner for approval. No work will be started without notification and owner approval. If wood roof decking and trim is sound, we will re -attach any loose wood to the rafters, sweep deck and prepare for installation. 6) Attach aluminum F8 drip edge to all leading edges. Color (Bsoym) CCV k ► 4--C 7) Apply a premium ice and water shield to the leading edges 6' up and around any penetrations including Chimney. Cover the balance of the roof deck with synthetic felt paper. We use, as our standard, a hurricane nailing system recommended in northeast regions. This means, we install six (6) nails per shingle to reduce the risk of shingles being damaged by high winds and the weather changes we encounter. 8) Install a new Certainteed Landmark S dard limited lifetime architectural style shingle roof system. Color: Weefk t' W& Certainteed Swift start and Shadow ridge over Shingle vent II ridge vents is also included in this scope of work. 9) Re -flash Chimney with new lead. 10) All debris generated by TGLRC Inc. dba Lambert Roofing Company will be cleaned up on a daily basis and properly disposed of from the jobsite. Roofing Warranties: UPON COMPLETION AND PAYMENT IN FULL A MANUFACTURERS 25 YEAR WORKMANSHIP WILL BE HONERED AND ISSUED BY "CERTAINTEED". A FIFTY YEAR NON PRO -RATED WARRANTY WILL BE ISSUED ON ALL MATERIALS, LABOR, TEAR OFF AND DISPOSAL BY MANUFACTURER. NOTE: No generic roofing materials are being utilized on this project. "All" Approved Certainteed materials are to be used on this project. Page 2 TGLRC Inc. dba Lambert Roofing Company agrees to: • Commence the described work on or about MAY 2015 • The described work will be completed in about (1-3) working days • Shall not be held liable for delays due to circumstances beyond our control • Shall not be held liable for any damages to landscape, attics and or fixtures due to circumstances beyond our control • Shall not be held liable and roofs are not covered under the workmanship warranty, for pre-existing conditions including but not limited to: o Mold and or wood rot o Defective, faulty, rotted or worn building counterparts such as, but not limited to: siding, gutters, masonry, plumbing and windows, all of which may jeopardize the watertight integrity of the structure if not in sound condition • Unless otherwise noted within this document, the contract shall not imply that any lien or other security interest has been placed on the residence Required Permits A building and dumpster permit may be required to remove and replace your roof. It is our obligation to secure these permits if required as the homeowner's agent. Note: Homeowners who secure their own permits or deal with unregistered contractors are excluded from the Guaranty Fund provisions of MGL c. 142A Additional Attached Documents, Agreements or Provisions • Insurance Documentation if not already provided • Arbitration Agreement • Contractor Registration Information • Notice of Cancellation Form This contract is the complete contract unless a signed Change Order has been executed between TGLRC Inc. dba Lambert Roofing Company and the Homeowner Page 3 Contract Price and Customer Obligations The total cost for all permits, warranty, labor and materials is: $10,'740 00 Ten Thousand S Payment Terms: a deposit of 1/3 is due with the signing of contract • Balance due upon completion. • A finance charge of 1.5 % per month (18% per year) will be added to all invoices on the 31 day. All legal and or collection fees will be paid by the binding holder of this contract • The law requires that any deposit or down payment required by TGLRC Inc. dba Lambert Roofing Company before the work begins may not exceed the greater of- * 1/3 of the total contract price or: o The actual cost of Special or Custom made materials which must be special ordered in advance to meet the completion schedule Acceptance of the Contract Proposal: DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES OR ANY UNRESOLVED ITEMS NOTE: Due to volatile pricing on building products, this contract is valid for 15 days of receipt. 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 the main office or branch thereof, provided you notify the seller in writing at the main office by ordinary mail posted, by telegram sent or by delivery, not later than midnight of the third business day following the signing of the agreement. Because of the three (3) day Notice of Cancellation, work may not commence for a minimum of seven (7) days after we receive this signed contract unless the contract is signed at our office. Signatures X Date: x, -,Zo" 1 Please sign, keep a copy and return one copy upon acceptance. Very Truly Y Rim Page 4 Workmanship You Can Dust" ert The Commonwealth of Massachusetts Department ofIndustrial Accidents Office of Investigations 600 Washington Street Boston, MA. 02111 UV www.massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): Address: acus wn+Q r s - City/State/Zip: }Aasia(ti I I Ma 015 JCS Phone #:-q 1 �3- 3-1 (4-9 Are you an employer? Check the appropriate box: Type of project (required): I. [�am a with employer 4. ❑ I am a general contractor and I ' � � have Hired the sub -contractors 6. ❑New construction employees (full and/or part-time). 2. ❑ I am a sole proprietor or partner- listed on the attached sheet. ❑Remodeling ship and'haveno employees These sub -contractors have 8. ❑ Demolition working for me in any capacity. workers' comp. insurance.g ❑Building addition [No workers' comp. insurance 5. El We are a corporation and its required.] officers have exercised their 1011Electrical repairs or additions 3. ❑ I am a homeowner doing all work right of exemption per MGL 11. ❑ Plumbing repairs or additions myself. [No workers' comp. c. 152, §1(4), and we have no 12.❑ Roofrepairs insurance required.] t employees. [No workers' comp. insurance required.] 13.❑ Other *Any applicant that checks box #I must also fill out the section below showing their workers' compensation policy information. T Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub -contractors and their workers' comp. policy information. lam an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name:. Policy # or Self -ins. Lic. #: (_ps (_0 ()'9j^ A C Expiration Date: Job Site Address: �`)U City/State/Zip: Q AY -0 O1/ Q_f - Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 and/or one=year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby cert6 un y pains and enalties ofperjury that the information provided pabove is true and correct. 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' compensation policy, please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition, an applicant that must submit multiple permit/license applications in any given year, need only submit one affidavit indicating current policy information (if necessary) and under "Job Site Address" the applicant should write "all locations in (city or town)" A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be fillgd 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 bum leaves etc.) said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address, telephone and fax number: The Commonwealth ofMassachusPtis Department of Industrial ,Accidents Office of Iavestigatitons E04 Washington Street Boston, MA. 02111 Tel, # 617-727-4900 at 406 or 1-877:MASSAFE Revised 5-26-05 Fay, # 61.7-727-7749 www.Mass,govaa. CS4"130 RICHARD J LAMMT 1.63 WINTER STiIMET Haverhill MA e1B30 If Office. of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 145221 Type: Private corporation Expiration: 12MO15 Tr# 246513 T.G.L.R.0 dba Lambert Roofing Company RICHARD LAMBERT 265 WINTER STREET HAVERHILL, MA 01830 Update Address and return card. Mark reason for change. 0 Address (:] Renewal C] Employment C] Lost Card a ACORV CERTIFICATE OF LIABILITY INSURANCE DATE (MWDONYYY) 04/01/2015 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 ALLAN INSURANCE AGENCY INC. 63 1/2 Jefferson Avenue 2nd Floor P.O. BOX 511 SALEM MA 01970-0511 NAME: CT Jerrold Kameras PHONE (976) 745-5905 FAX No): (478) 745-5483 EMAIL DRESS.Jerroldeallaninsurance.com INSURER(SI AFFORDING COVERAGE NAIC S INSURER AAssoicated Ind Ins Co INSURED TGLRC dba: Lambert Roofing Co. 265 Winter Street Haverhill MA 01830- INSURERS -Safety Insurance Co INSUR@rtC:National Union Fire Ins Co. INSURERDAce American Insurance Co. INSURERE:Ace American Insurance Co. INSURER F: rnv=DAn=Q nr-P'nPIr'ATF MIIMRr-R* 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 LTR TYPE OF INSURANCE DL SUER POLICY NUMBER POLICY EFF MMIDDIYYYY POLICY EXP MM LIMITS Haverhill MA 01830- GENERAL LIABILITY / / / / EACH OCCURRENCE € 1,000,000 RENTED PR MISDAIAAGE�'ao urrnnce) S 50,000 X COMMERCIAL GENERAL LIABILITY I I I I A CLAIMS -t ADE 7OCCUR XES1028029 11/12/2019 1/12/2015 MED EXP (Any one person) $ 1,000 PERSONAL BADV INJURY S 1,000,000 Xi Per Project Agg I / % I GENERAL AGGREGATE Is 2,000,000 / / / / I � � I GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS - COMP/OP AGG 5 2,000,000 S ri POLICY J( PRO- LOC JECT I I / / AUTOMOBILE LIABILITY / I J I Ea DINED SINGLE LIKI" 1,000,000 BODILY INJURY (Per pamcn) S ANY AUTO B BODILY INJURY {Pee xt elan=; S ALL OWNED 5-1 X SCHEDULED 6203819 AUTOS AUTOS PRPERAUTOSDAMAGE S NON-OWNED ON-O NED X (HIR[DAUTOS X 07/16/2014 7/16/2015 X UMBRELLA UAB X OCCUR E18430331 I I / I EACH OCCURRENCE $ 5, 000, 000 AGGREGATE S 5,000,000 C EXCESS LIAB CLAIMS -MADE 11/12/2014 1/12/2015 DED RETENTIONS S / / / / WORKERS COMPENSATION / % % / X VJC STATU- OTH- is AND EMPLOYERS' LIABILITY YIN I I ! I ANY PROPRIETORIPARTNERIFXECUTIVE E.L EACH ACCIDENT 1,000,000 D OFFICERIMEMBER EXCLUDED'! ® (Mandatory in NH) NIA S62UB-2E09875-2-19 ]KA 2/22/2014 12/22/2015 -� E.L. DISEASE - EA EMPLOY000 000 E 3_ 1 If yes, descMe under / / I I DESCRIPTION OF OPERATIONS 5o!ow E.L DISEASE, POLICY LIMIT 1 $ 1,000,000 W Worker's Compenstaion NH S62UB-BD81311-6-14 NE 2/22/2014 2/22/2015 same!:mcsas 1,000,000 pcicyabo.,e 11000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is required) CERTIFICATE HOLDER C:AAICFI I ATInIJ AVVKU AD ttUlUIUD) i ©1988-2010 ACORI�CORPORATION. All rights reserved. INS025 (201015101 The ACORD name and logo are registered marks of ACORD TGLRC Inc. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. dba Lambert Roofing 265 Winter Street AUTHORREPRESENTATIVE Haverhill MA 01830- �:.i .l I` . y� �y�, A�� AVVKU AD ttUlUIUD) i ©1988-2010 ACORI�CORPORATION. All rights reserved. INS025 (201015101 The ACORD name and logo are registered marks of ACORD