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HomeMy WebLinkAboutBuilding Permit #422-2017 - 315 TURNPIKE STREET 10/19/2016 v BUILDING PERMIT of Na D RTagho 1� TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit No#: ��- >-0 f Date Received /6 " l�( - a0 t C,� �gss4 c►+us�t�5 Date Issued: 16 _ 1 - 1 / IMPORTANT: Applicant must complete all items on this page LOCATION � _ P PROPERTY OWNER eJ-)—%W_a f� rin2 -2 Print 100 Year Structure yes o MAP 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 ers: ❑ Demolition ❑ Other ❑ Septic ❑Well El Floodplain El Wetlands ❑ Watershed District ❑Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: and /0�711�/�O nue, � G/ r l- Identification- Please Type or Print Clearly OWNER: Name: 174e_r{^ys4%44k- Cy e9 e_ Phone:1779 5_2110S Address: S�/S �`1�I f�i Ar—. /U dd Uel'' ldk� J- Phone: Contractor Name. /S /�'�n Email: JLek?+S 14--I Address: D W , Supervisor's Construction License: Exp. Date. Home Improvement License: Exp. Date: q{ r.HIT-(;T/FNriniFi=Rff/C,7C._ DUId— Phone: 23���7�� Address:&rlln'k)l Z� LI .NjdReg. No. FEE SCHEDULE.BULDING PERMIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ Q FEE: $ 30 Check No.: i n l Receipt No.: 3l 0 IO S NOTE: Persons contracting with unregistered contractors do not have access to the aran 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 m U FORM PLANNING & DEVELOPMENT Reviewed On Signature_ COMMENT'S CONSERVATION Reviewed on Signature COMMENTS 11, HEALTH Reviewed on Signature COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water& Sewer Connection/Signature& Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street FIREDEPAOT—MF NiT, TempDumpstereonstte: ,yes __ ftUPI— r ! w �.. Loeated�af 12�'4tMainrSt�eet Fifdi epartment signature/date: COMMENT tS, i 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) I ❑ Notified for pickup Call Email Date Time Contact Name Doc.Building Permit Revised 2014 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 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 Photo Copy of H.I.C. And C.S.L. Licenses rF 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 I ECC Energy code Engineering Affidavits for Engineered products OTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg. Permit In all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals that the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be submitted with the building application Doc:Building Permit Revised 2014 Location TY e-rt10t tri c . No.Y a c-:�o f-7 Date / U' 1 Gj_ a.o 1 & • - TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ G '� Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check# I U( C Building Inspector r 1 NORT!{ A-. ve- No. 4Z2 tow 2611 C, ver, Mass, 0 L^K4 os a COCNICNRWKK �as RATED U BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System a op THIS CERTIFIES THAT ." 1S. ..... .... 014 � �a...�... ....4 MS �� BUILDING INSPECTOR ...... ............... . ........ .. Foundation has permission to erect .......................... buildings on !�t .....�.MeEr.. ... �'� ....... . .. Rough tobe occupied as .................................................... ........ .. ............................................. Chimney provided that the person accepting this permit shall in eve respect Ynform to the terms of the application p p p g p � p pp Final on file in this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR, UNLESS CONSTRUCTR.T. S ..... 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. v� t`�F a'FY )k !'� �zt�'h h14 �f .4�.4 ! 4�u�`khTf dw ,F ,r4 4 F1.c\4ta 'c`�f•tih ..�atr�S.�Mw)GR)h4,j�1� ` ti1�r.�'.KI � .>•J,`�4 , :.�.Y r' ,r r f` y t. a``� � rpt i s'• � t �.f t..7�a tris,_ ' .t-,��..=:1_`-i ._...i=S �, f:.:l _, ...a..f• ,iit.:...::.uii:_..,.�::�c.�zL.t�.::_ ..•.:.f.r....f, `r.- r.�,.. :.r_,..�.Lc._,ft��,'tL..�f�f.� s.�,i..r� zy^. -I 111 -------------- 77771=77, F777.7-MM777 M, 1171 ✓C �1Pa i'.�f� tR.4•� i i v oT 41.. t t-^ > -• t y t �_t S !.-1 t�. t�,t t t t 4'. rkfr � n �z �cy'r�lcj4�' .r��� �1"? .yL � �t Yj�f'�riq``s ; srR �I'i4' 1� o tiSrrl`tc� �1` '�'ti '�{��'.7 1 �f r,rr a . 17 r;r•, r r ¢(r !r �� - '• 00 ` s a •� • s cou //� ,Vw 1='/M r %, t of flame 'Utot"'aance REGISrERH4 AZTEC Tea-SMIPUCATION t2ate'trBaWd Cr r CONCERN NO. 400XASAVENUE manufadurnd TORROM,CA"03 0312007 •: CAL COMB r,410.01 (100)22&307 ' This h to cer*fit the matwials descnOedbelow,ftr f have b an flame rgbr*0tIia#kd(cr are lnhMdtly"nontlammable). / FOR 'w' kv y "a CHRISTIAN PARTY RENTALS o ,. ATTN MIKE GOULD' / y y;`4 '; I0 CLINTON DRIVE HOLLIS,SH 03049 Certi#Icatian,Is hereby made that:(check "a"'or"b•) The articles described below this certificate have been treated with a flame retardant chemical approved // and registered by five State Fire Marshal and that the applicationof said chemical was done in confer- ' Mance with the_laws.of the State,of California and the Rules and Regulations of the State Fire Marshal. d Name of chemical used Chem Reg No y " Meathod.of application ..w..... ,... .... ........................................ (b} The articles described below hereof"are mader from.a flame.-resistant fabric or material registered and approved be the State Eire Marshal for such use;Fabric has been tested and passers NPPA701.;96'. F* Trade name of flame-resistant fabric or material used. " blk .Reg:NO.......Htifm...,.. 1. WILL.NOT The:Flame Retardant Process Used ....,..,f............Se Removed by Washing "'or wsrot) f David Bradley. Chuck Miller-President ma of AppgcMw or Me / CUSTOMER ORDER NO. R164131 ITEMS MANUFACTURED: 1 30.'.x30'(2 PC)JUMBOTRAC TOP ONLY-ULTTRA WRME 2-30.'x2Q'JUMBOTRACMIDDLES TOP ONLY-ULTRA WIfITE Z-305x30'(2 PQ)JUMBOTRA+C;TOP ONLY-ULTRA WHITE, 4-30X20'JUR80r RAC MIDDLE'S`TOP ONLY-ULTRA WHITE I-405x40'(2 PC.)JUMBOTRAC TOP ONLY ULTRA WHITE 4.405r20'JUMBOTRAC MIDDLES TOP ONLY ULTRA WHITE qb I t /eee o� S� �j 'a / - , e 9 r f // ✓/ i0�� �2/ �r'/r ,r ,✓i � /a�, f o , ' ff'rate of "P't � � � ; REGISTERED AZTEC TEKS Oats treats{!or, Ada ICATION menufactured / CONCERaNO, 490ALASMAVENUE TORRANCE cA M03 0312007 � CrIL.COfl113 X419.4? '(000122"W ' This is to certify that Me materials desorlbedbdiow hereofhave.been Paine r+etaridanttmaW(or arei"hemotty narrftarrrmabte). ' FOR y� CHRISTIAN PARTYRENTALS s ATTN:MIKE GOULD I CLINTON DRIVE HOLLIS,SH 03049 tiµ. Certirication is ,hereby made that (check "'a'or"6'7 y� y , taj The articles described below this certificate hate been treated with a name retardant chemical approved Y apptiCa#ionof said chemical was done,In confer- yry and registered b the State fire Marshal and that#lie ' mance with the laws�of the State of California and the Elutes and Regulations of the a�`tate F1re.Marshal.. t l3arrre 4f cheirtical uSeci Ghern'Reg No ,» Meathod of application ....... ..,»„ ........ » ....» »..»..... » ..» (t>) The articles described below hereof are made from a flar ne-resistant fabric or material registered and approved be the State.l=fre Marshal for such use;Fabrk has been tested and Passes NFP'A701 96: Trade name of flame-resistant fabric or rhataxfal:asad.L-0 r Reg.Nn.,..... f ff.,.... u The Fame Retardant Pr6 esS Used WILL NO, ,......Be Rethoved by Washin y (Wa of*9t � ' lk Oavid Bradley Chuck Miller- President CUSTOMER ORDER NO. R164131 ITEMS MANUFACTURED; I-305x30'{2 PC)JUMBOTRAC TOP ONLY..tJLr°RA WHITE 2-305r30`JUM80.TRAC MIDDLE'S TOP ONLY ULTRA Wt ITE 2-305x30'f2 PC.j JUMIB0TRA C TOP ONLY UL7'l.A WHIT 4-30'x20'JUMB0TP.AC MIDDLESTOP 6AY-ULT P.A WHITE I-46 x40'(2 PC.)JUA4807"RAC TOP OAILY-ULTRA WHITE 4.405x20'JUMBOTRAC MIDDLES TOP ONLY-ULTRA WHITE I i I U I, L/ v I WIN, 44 �y eft lame Rem'aanreW REtiiSiERHD Oat$:treaiea or y AZTEC TV S APFUCAT18Al 490ALASKA AVENUE mauuta�huad CONCERN N& TOtRANCE,>CA t13C200 cAL-cow X0.01 (;iso s-tsar y This ft 10:cerft that Me ihatlfais descnbed ib oiw,hereal have been tlarile s'e�'ftrj ed(or are Inhemay non`tlami►mable). A � "AOR CHRISTIAN PARTY RENTALS A TT'IV:MIKE GOULD 98 CLINTON DRIVE MOLLIS,NH 03049 CeWriicadon Is hereby made that:{check "a-or"b"j r( (a) The.articles described below this certificate Have bsen_treated with aflame retardant,chemical approved andregistered by the State Fire Marshal and that fha applica k►hof said chemical v�ras;t#+�r1e its ogttl sr r manes with the taws of the State of Callfornla.and the.Riles and Regulations of the State Fire Marshal, Hattie of chemical used Chem Reg_No f H. y Meathod of application:.. . <. (b) The,articles igscribe t.below hereof art made from a flame resistant fabric pe Material registered and i approved be the State l=ire Marshal for such use3 Fabric has been testedand passes NFPAT01-96. Trade name of flame-resista t fabric or material ysed,.; n*#4r*b(rr -Roq.No. WlLL.NO7` 'I 'The Flame Retardant Process Used............ ..........Be Retinaved by Washing (wut ar tv#�noi) dry: , David Bradley Chudk Miller-President. z eme of Applicel-or PMERM N5rW09;9 �,a'`�F�°�-'e'.w /,'"`-"`"`-r+, /i////e// % "1•-,;l�yy"-gw"�yy�i�� �ti"/// Y �9/ g'1' //7 '. Y�:rK i/i / wr �i /�/. CUSTOMER ORDER NO. 8964131 ITEMS MANUFACTURED. 4-303 (2PC)JUMBO RACTOPON,LY ULM- WHITE 2-305(20"JUMBOTRAC MIDDLE$TOP ONLY ULTRA WHITE 2.:30'x30`j2 PC.).JUM86TRAC TOP ONLY_-.ULIRA.WHITE 4z 30c2l3y.lUMS0.1'RAG MJDDL£S T0P ONLYlJLT1 i+ HI ♦A 1-40540'(2 PC)JUMBOTRAC TOP ONLY--ULTRA WHITE 4.405(20'JUMBOTRAC MIDDLES TOP ONLY-ULTRA WHITE J • erre m ac 315 TURNPIKE STREET,NORTH ANDOVER,MA 01845 WWW.MERRIMACK.EDU P P St.Arm ?Fe-ifties Department Apartments Itswr Inner G lower I I im P Lai I ATOWer Lei ICounseling Center Ash vo�P Deegan Is Is mes Centre He�dsrrfi-all In. ation Center P ` I.. aruzoolleis —To Munizan Centre Center Off Iowa', MWerrimaic p P f iCorral tat F lowell On saw ,. -lowksbuly Pelham Campus PSakowic vera on O's ly.. I C Ce 7 luade Library -Haverhill f ` 1Half,,' florth 11 ver pflosidential it II Wage :. an M"onrl Hall P A' A4<QK P flaff",6 WA St.Ambrose Friary 14.Ala into Churc�o Christ Main Entrance the Teacher OGroduate and Frotessional Studies CAMPUS M�,R Q MERRIMACK ATHLETICS COMPLEX Q SAKOWICH CAMPUS CENTER •Bookstore:. � •Sparky's •DiCroce Family obby •The Warriors Den •:Gallant Arena } •Augie's Pub •Dunkin'Donutsl •Fitness Center QACADEMICJNNOVATIONCENTER •Merrimack Club •Markets lab j •OBrien Centerfior5tudenf5uccess " •Writers House � �AUSTIN HALL •Center forTeac Zing and Learning •Bursar's Office. ©SPORTS MEDICINE AND •Registrar HEALTH SCIENCES •Office of Financial Aid •Strength&Conlditioning Center Q MCOUADE LIBRARY •Athletic Training Center •Welcome Center (�VOLPE ATHLETIC CENTER •Zime •Lawler Rink a Commuter Students,Faculty/Staff •Blue Line Ctub i &Visitors •HammeLCourt P•Resident Students Only P Permit ParkingAnly � Welcome Center Visitors I The Commonwealth of Massachusetts Department of IndustrialAccidents I Congress Street,Suite 100 Boston,MA 02114-2017 y` 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):Christian Delivery&Chair Service, Inc./Christian Party Rental Address: 18 Clinton Drive City/State/Zip:Hollis, NH 03049 Phone#:603-883-5326 Are you an employer?Check the appropriate box: Type of project(required): 1.E]I am a employer with 25 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 8. ❑Remodeling any capacity.[No workers'comp.insurance required.] 9. El Demolition 3.❑I am a homeowner doing all work myself.[No workers'comp.insurance required.]t 10E]Building addition 4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers'compensation insurance or are sole I L❑Electrical repairs or additions proprietors with no employees. 12.E:]Plumbing repairs or additions 5.r7 I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.❑Roof repairs These sub-contractors have employees and have workers'comp.insurance.- 6.❑We are a corporation and its officers have exercised their right of exemption per MGL c. 14.❑✓ Other TENTS 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. t 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:NH Motor Transport Association Policy#or Self-ins.Lic.#:P000749NHMTA2016 Expiration Date:01-01-2017 �/ , � .S.T� oVrN Job Site Address: /3�S 1,; n City/State/Zip N• �_E-49- Q��jyf 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 certify under the pa i nd s o erjury tha information provided above is true nd correct. Signature: Date: /� Phone#:603-883-5326 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#: ACoOREP CERTIFICATE E OI LIABILITY INSURANCE DICTE{MM)DD(Y 8/30/2016. 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 114SURANCE 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(es)must be endorsed. If SUBROGATION 1S WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A Statement on this certificalte does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER C CT:Rhonda Noble NA141 THE ROMEY AGENCY INC. PHONE (603MM,No.cw )224-2552 FAXC'N {603)22A-8012 139 Loudon Road r.-MAIL .rnoble@rowleyageney.com $o 511 INSURERS AFFORDING COVERAGE NAIL# Concord NR 03302-0511 INSURER A:Citizens_'Insurance Cam an INSURED INSURERBa35?Qhilt3et:tS $a Ins Co.Christian Delivery �' Chair Service, Inc INSURERC:Hanover -Insurance Company dba :Christian Party Rental INSURER D; 18 Clinton Drive INSURERE., Hollis NE 03049 INSURER F: COVERAGES CERTIFICATE NUlvllaER:16/17 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 SY PAID CLAIMS. L 'TYPE OF INSURANCE SURR POLICY EFF POLICY EXP: POLICYNUMBER MrdIAD It9MlDD LIMITS GENERAL LIABILITY EACH OCCURRENCE _ S 1,000,00 X COMMERCIAL GENERALLIABILITY LIAMAUt T5 PREMISES{Ea occurrence S0,000 A CLAIMS-MADE I n l OCCUR BV084436309 /V016 /1/2017 MED EXP Aa we person $ 5,000 PERSONAL s ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GENLAGGREGATELIMITAPPLIESPER-. PRO€JUCTS-COMPKIP-AGG $: 2,000,000 POLICY 'X O PRX LOC $ AUTOMOBILE UA8111TY. COMBINED E aoa SINGLE LIMIT1,000,000 Yt� X ANY AUTO BODILY INJURY(Per person) $. �( ALL OWNED X SCHEDULED RDVO71690910 /1/2016 /1/2017 BODILYINJu'' AUTOS AUTOS (Peraccldent) $ X HIRED AUTOS X NOWOWNEDPROPER DAMAGE AUTOS Pei aCck1 $ X UMBRELLA LIAB X OCCUR ,EACH OCCURRENCE $. 4,000,000 ExCESSLIAB — C CLAIMS-MADE AGGREGATE $ 4,000,000 cED I I RETENTIONS RV084436509 /1/2016 /1/2017 WORKERS COMPENSATION WCSTATU- oTII- AND EIMPLOYERT LIABILITY Y LIM ANY PROPR1ETflR1PARTNER/EXECUTIVE YIN E.L.EACH ACCIDENT $ DFFICERIMEtuiBER EXCLUOED4 Q NiA - (Mandatory in NH) F.L.DISEASE-EA EMPLOYEE $ If yes,!describe under DESCRIPTION OF OPERATIONS below, E.L.DISEASE-POLICY LIMIT $ B Hired Car PhysicalV071690910 9!01/2016 9/41/2617 $'f�,()00Limiit,ACV at#Ise Damage Coverage 500CCMp Coil Dec!.Is (line of a hiss DESCRIPTION OF OPERATIONS t LOCATIONS I VEHICLES(Attach ACORD 109 Additional Rerrrarks,Schedute,it more spate is required). CERTIFICATE:HOLDER. CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEPORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVEREIY IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Rhonda Noble/RLN ACORD 25{2010/053 0'19882010 ACORD CORPORAT1,0N. All rights.reserved. iNfin25 nnin(IRIM Tha Af`nOn noma nnel We* nrn e4^ia4arae4 enortea Af a(,ttiRtll