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HomeMy WebLinkAboutBuilding Permit #720 - 337 SUMMER STREET 4/11/2012Permit NO: `�2,a Date Issued: TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION MAP Date Received IMPORTANT: Applicant must complete all items on this paf4e MAP NO: ? PARCEL: I ? ZONING DISTRICT; Historic District yesOno Machine Shop Village yes 100 year-old structure yes TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building Q Qtrce family ❑ Addition ❑ Two or more family ❑ Industrial ❑ Alteration No. of units: ❑ Commercial epair, replacement ❑ Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ' 5j� phc3 "VT `7�—Y _ r .®Fl im❑ Wetland=s 0 Waters edDstnR ®Water/Sewer'• ` - , - ' ' t - DESCRIPTION OF WORK TO BE PERFORMED: `WoF CJL) (V\OC)�03 (Identification Please Type or Print Clearly) Address: 33 !�!�- CONTRACTOR Name: ` -C E)5��-ii � 1 i .ate .&) Phone: 5-0 1� -• 3 9-1 - a Address: Ca- OAA „�CN� L�EC /h ►'3 - Supervisor's Construction License: cl -7 Q1 Exp. Date: 2 Id,__ Home Improvement License: j 7 U ( 6 Exp. Date: I ARCHITECT/ENGINEER Address: Phone: Reg. 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: $ cd �6P 6o, FEE: $ Check No.: ID S14 (� Receipt No.: 0S-1—+) NOTE: Persons contracting with unregistered contractors do not have mess to a guaranty fund mPr►.:5 S;rttac--Sinnatii"ra.nflrririnr;' - - 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 DATE APPROVED PLANNING & DEVELOPMENT ❑ ❑ COMMENTS CONSERVATION Reviewed on Signature 91 COMMENTS HEALTH Reviewed on Signature COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Connection/Signature & Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street FIRE DEPARTMENT - Temp Dumpster on site yes no Located at 124 Main Street Fire Department signature/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.$1oo-$1000 fine NOTES and DATA — (For department use ❑ Notified for pickup - Date Doc:.Building Permit Revised 2011 June/mi 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 a 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: Doc.Building Permit Revised 2008mi Location��� u"" No. Check # � Y5, �CG 25171 Date TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $� Foundation Permit Fee $_�_ Other Permit Fee $ TOTAL Building Inspector • W PO O w ci aai cn � a O w O w v a u q O a p w G w O w W p rx [C cn C w O. b p w G w" CQ z cn v Q o cn zCL C2 O c W � O QC3 m L j_J O. Ea CF ".' o 0 0. Ec 0 0 lw u cm fti 1D:� EMU :mm a O �H cl) CDE to m y l N C Co w CC -DO acoa m =moo c E a�z :�mor m C0.1 HZ O O O� cm *.. C CLO C F� 20. y _ m m w=.. 3 N m o� m Z `Ly C �+ ca CM W AE v -o v .y O o CO2 c m� ma_ `3 cm ZZ CL 0 U C O v v 4..1 a 2 6 O C E L 0 o cs Z aL Q. O y � C CD CM � C O•— CA Q CD co) CL.) .ff m CD 0 CD CL H ♦_-+ Z 3� O CD CD CD 0 cc o a . �Q CO) •C R cqo C3 J 'p C Z CD CL C.3 y c C C cc CL 0 LLI 0 19 W 19 W U) Renewalr ���� MA Home Improvement Contractor ��i License #170810 (Expires 12/23/2013) b0ndersen. �� Renewal by Andersen Corporation Federal Tax ID #41-1918413 an WINDOW REPLACEMENT Andersen Company 104 Otis St., Northborough, MA 01532 (508) 919-0900 • Fax: (774) 987-3013 _ CUSTOM WINDOW AND DOOR REMODELING AGREEMENT Name Date of SohN Zdclit4c\40fJ Awv.Q Buyer(s) Street Address, City, State, and Zip Co E -Mail Address Buyer(s) hereby jointly and severally agrees to purchase the products and/or services of Renewal by Andersen Corporation ("Contractor"), in accordance with the terms and cQndifions described on the front and the reverse of this agreement and on the attached specification sheet(s) (collectively, this "Agreement'III.Buyer(s) hereby agrees to sign a�ayt�Ipletion certificate after Contractor has completed all work under this Agreement. l V ) I5 ) t C (1 p 1� i VTotal JoAmount: 13 �c Deposit Received (33%):_q__(Q it Estimated St rti ng Date: Method of Payment: OCheck []Cash❑Financed Signature Balance at Start of Job (33%): L� Z I.� Balance on Substantial / Completion of Job (33%): Estimat d Co leriaa Date: � �( Ti ) Credit Cards are accepted for deposit only — maximum 1/3 of the project cost. Please see Credit Card Payment Form. By signing this agreement, you acknowledge that the Balance at Start of Job and the Balance on Substantial Completion of Job cannot be made by credit card and must be made by personal check, bank check, or cash. Buyer(s) agrees and understands that this Agreement constitutes the entire understanding between the parties, and that there are no verbal understandings changing or modifying any of the terms of this Agreement. No alteration to or deviation from this Agreement will be valid without the signed, written consent of both Buyer(s) and Contractor. Buyer(s) hereby acknowledges that Buyer(s) 1) has read this Agreement, understands the terms of this Agreement, and has received a completed, signed. and dated copy of this Agreement, including the two attached Notices of Cancellation, on the date first written above and 2) was orally informed of Buyer's right to cancel this Agreement. DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES. Print Name of Product Manager Buyer(s) Buyer(s)' Signatu L/i Signature p -LL J41. L.A K Print Name Print Name YOU, THE BUYER(S), MAY CANCEL THIS TRANSACTION AT ANY TIME PRIOR TO MIDNIGHT OF THE THIRD BUSINESS DAY AFTER THE DATE OF THIS TRANSACTION. SEE THE ATTACHED NOTICE OF CANCELLATION FORMS FOR AN EXPLANATION OF THIS RIGHT. ec ——————————————— �<- — — — — —— �— �<---------------� NOTICE F CELLATION NOTICE OF CANCELLATION Date of Transaction Z . You may cancel Date of Transaction . You may cancel this transaction, without any enalty or obligation, within this transaction, without any penalty or obligation, within three business days from the above date. If you cancel, any three business days from the above date. If you cancel, any property traded in, any payments made by you under the I property traded in, any payments made by you under the Contract of Sale, and any negotiable instrument executed I Contract of Sale, and any negotiable instrument executed by you will be returned within 10 days following receipt i by you will be returned within 10 days following receipt by the Contractor ("Seller") of your cancellation notice, by the Contractor ("Seller") of your cancellation notice, and any security interest arising out of the transaction will I and any security interest arising out of the transaction will be canceled. If you cancel, you must make available to the I be canceled. If you cancel, you must make available to the Seller at your residence, in substantially as good condition Seller at your residence, in substantially as good condition as when received, any goods delivered to you under as when received, any goods delivered to you under this this Contract or Sale; or you . may, if you wish, comply I Contract or Sale; or you may, if You wish, comply with the with the instructions of the Seller regarding the return ' instructions of the Seller regarding the return shipment of shipment of the goods at the Seller's expense and risk. i the goods at the Seller's expense and risk. If you do make Iffou do make the goods available to the Seller and the i the goods available to the Seller and the Seller does not Seller does not pick them up within 20 days of the date I pick them up within 20 days of the date of your Notice of your Notice of Cancellation, you may retain or disposeI of Cancellation, you may retain or dispose of the goods of the goods without any further obligation. If you fail to without any further obligation. If you fail to make the make the goods available to the Seller, or if you a ree I rs available to the Seller, or if you agree to return the to return the goods to the Seller and fail to do so, then s to the Seller and fail to do so, then you remain liable you remain liable for performance of all obligations under erformance of all obligations under the Contract. the Contract. To cancel this transaction, mail or deliver a I To cancel this transaction, mail or deliver a signed and signed and dated copy of this cancellation notice or any I dated copy of this cancellation notice or any other written other written notice, or send a telegram to Contractor. notice, or send a telegram to Contractor: Renewal by Andersen Corporation, 104 Otis I Renewal by Andersen Corporation, 104 Otis Street, Street,- Northborou h 01532, BY NOT LATER THAN Northborough, MA 01532, BY NOT LATER THAN MIDNIGHT MIDNIGHT OF 1'1/ . (Date) OF • (Date) I HEREBY CANCEL THIS TRANSACTION. I HEREBY CANCEL THIS TRANSACTION. Buyer's Signature Print Name Date Buyer's Signature Print Name Date RbA Copy - White Buyer Copy - Yellow Buyer Copy - Pink ©1BLLP2009.R8A-Ph.MANH Renewal R. .ewal by Andersen Corporation MA Home Improvement Contractor 104 Otis St.,bYAnde1'Senta Northborough, MA 01532 License #170810 (Expires 12/23/2013) WINDOW REPLACEMENT anMderaenCompany (508) 919-0900 -Fax: (774) 987-3013 Federal Tax ID #41-1918413 WINDOW SPECIFICATION SHEET Buyer(s) Name Date The Buyer(s) listed ab6ve hereby jointly and severally agree to purchase the goods and/or services listed below, in accordance with the prices and terms described on the Specification Sheet and the front and the reverse of the accompanying CUSTOM WINDOW AND DOOR REMODELING AGREEMENT, of which this Specification Sheet is a part. r WINDOW DETAIIS 1. CRntractor will Install a total o __9_ windows in Owner's home, using the following individual quantities: Double Hung (DB) [Equal sash ❑ Cottage sash (I/3 top, 2/3 bottom) ❑ Oriel sash (2/3 top. 1/3 bottom) Casement (CW) ❑ Hinge right ❑ Hinge left (as viewed from exterior): ❑ Standard handle ❑ Metro handle Double Casement (CDW) ❑ Standard handle ❑ Metro handle Casement / Picture / Casement (CPW) ❑ 1:1:1 or ❑ 1:2:1 ❑ Standard handle ❑ Metro handle 2 Lite Gliding Window (GW) Glider / Picture / Glider (GPM ❑ 1:1:1 or ❑ 1:2:1 Awning Window (AW) Picture Window (PW) Bay or Bow Window Patio Doors (see separate Door Specification Sheet) 2. E2/Yes ❑ No Qty of Windows to be Custom Fit Replacement: 3. ❑ Yes dNo Qty of Sills to be replaced by Contractor: 4. ❑ Yes 9No Qty of Windows to be New Construction Full frame (includes new interior & exterior casings) and actual Exterior casings: ❑ Pine ❑ Maintenance -free material ❑ Factory applied 908 Fibrex brickmold 5. Glazing to be: [?I'HP Low- E-4 TM ❑ Other If other, please specify: 6. Exterior color to be: ❑ White ❑ Sand [ Canvas ❑ Terratone ❑ Cocoa Bean 7. Interior color to be: ❑ White ❑ Sand [Canvas ❑ Terratone. ❑ Pine ❑ Maple ❑ Oak Note: Interior color can only b white, wood or same color as exterior. Wood interiors need to finished by Owner. 8. Hardware: ❑ White F] Stone [Canvas ❑ Brass ❑ Estate Hardware: Style: 9. ❑ Yes YNo Install Lifts with Double Hung Windows 10. Screens: windows to have: [Half or ❑ Full screens Screens to bc4nberglass ❑ Aluminum ❑ TruScene 11. Windows have grilles: [ Qty: Qty: MUS Draw grille patterns above GRILLE DETAILS ❑ No If yes: ❑ Grille Between Glass (GBr) [Removable Interior Wood (iNTw) ❑ Full Divided Light (FDL) Qty Qty: Qty: Otv: Otv: `Use additional sheet if needed Owner approved (initials): ( kffi V- ) ADDITIONAL WORK DETAILS 12. ❑ Yeso Contractor will remove metal frames of windows. Qty of Units: 13. F-1Yes❑�No Contractor will install new paint -ready or stain -ready casings. Int eri r casing qty of openings: Exterior casings qty of openings: ❑ Pine ❑ Maintenance -free material 14. F-1Yes[No Contractor will install new paint -ready or stain -ready inside or outside stops qty of openings: Interior stops qty of openings: Exterior stops qty of openings: ❑ Pine ❑ Maintenance -free material 15. Owner is a are that Contractor does not do any painting. ( �%� V ) Owner Initials 16. F-1Yes[o Contractor will wrap exterior casings with aluminum coil stock of color. Note: Wrapping may be required with storm window removal; removal of storm windows will leave screw holes in casing. 17. [Yes ❑ No Contractor will insulate, caulk and seal windows with 3 -point system to prevent water and air infiltration. 18.Y/Yes ❑ No Clean up all job related debris including old windows will be removed. Vacuum nightly. 19. V/ Yes ❑ No A limited warranty shall be issued to Owner upon completion of the job and payment in full. 20. [� Yes ❑ No Building Permit—Contractor will secure any and all necessary permits. The fee for the permit(s) is not included in the Contract Price and a separate check is required at the time of sale for this fee. 21. Yes ❑ No All discounts have been applied to this agreement price. 22. Additional job details: a 1576 0) C,i j A- f f 23. E�'Yes ❑ No Owner agrees to be present on the final day of installation for final inspection and to deliver final payment No final payment shall be demanded until the contract is completed to the satisfaction of all parties. It is agreed and understood by and between the parties that this Specification Sheet, along with the CUSTOM WINDOW AND DOOR REMODELING AGREEMENT, constitutes the entire understanding between the parties, and there are no verbal understandings changing or modifying any of the terms. This Specification Sheet may not be changed or its terms modified or varied in any way unless such changes are in writing and signed by both the Buyer(s) and Contractor. Buyer(s) hereby acknowledge that Buyer(s) has read this Specification Sheet. Renew Andersen Co rn tia Buyers) By: SMana ger Signature S, of 1 Print Name of Product Manager Print Nam Buyer(s) Signature Print Name 1- Address: 1. � I am. a employer with '�y 4. E]I am a general contractor and I employees (full and/or part-time). City/State/Zip: 2. ❑ I am a sole proprietor or partner- listed on the attached sheet MA Phone #: 5-6 5-1 ' (1200 Are you an employer? Check the appropriate box: 1. � I am. a employer with '�y 4. E]I am a general contractor and I employees (full and/or part-time). have hired the sub -contractors 2. ❑ I am a sole proprietor or partner- listed on the attached sheet ship and have no employees These sub -contractors have working for me in any capacity. workers' comp, insurance. [No workers' comp. inct,rance 5. ❑ We area corporation and its required.] officers have exercised their . 3,7 I am a homeowner doing all work right of exemption per MGL myself [No workers' comp. c, 152, §1(4), and we have no insurance required,] t employees. [No workers' -comp. insurance required.] Type of project (requiredj: 6. ❑ New construction 7. remodeling 8, ❑ Demolition 9. ❑ Building addition 10.❑ Electrical repairs or.additions 11.❑ Phtmbing repairs or additions 12.❑ Roof repairs 13.❑ Other *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 sheetshbwing the mune of the subcontractors and their workers' comp, policy information. I am an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name:_ Expiration Date: Policy # or Self -ins. Lic. k Job Site Address: 9 City/.State/Zip: N ow er VK 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 $1,500.0.0 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of tip 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 cerin fy 'the pa' `and penalties of perjury that the information provided above is true and correct Date: I �� 5i afore; / .. Dl-- 44 Official use only. Do not write in this area, to be completed by city or town officiaL City .or Town:. Peimitucense .# Issuing Authority (circle one): L Board of Health 2. Building Department 3. City/Town Clerk. 4. Electrical Inspector 5. Plumbing Inspector ,. -6. Other Contact Person; Phone # 'U"�i �•ir�"^. �..-___.._,;k e^:,,m �aryc�-..—r--�v�--h:"`:rp'!`r!e'*'"�r'w;,t[Y."f.-:+-:-3',a.-...;w�.,�v-...r.•r-•Jr=.—?fir,,=-� _ -• ten. �rc.....� :..�}L .+.�}+'. .:.5,...•w•.•--.� � F••:t'Y...�„��.w�.� "iT: 1t. b.��� T -,... . ,_ _ �•�."rn.i.e:t--�.. .n'a�c'-:= ^•''c.K.'r'."J .stir CfERTIFICATE -OF..LIABILITY INSURANCE o r�um WQ" THIS CERTIFICATE. IS ISSUED AS A MATTER OF'INFORMATION ONLY AND CONFERS NO RIGHT'S 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'ADDTITONAL INSURED, the poficy(iiss) 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 celidfioate Noldar in lieu of such endorsement(sj. PRODUCER 1-612-333-3323 Hays Oompaai.es - - CONTACT Jonalle Hargrove or Katie.Peimos PHONE FAX Na 612-333--3323 AIC,Noi 612-373-7270 JAM,E-MAIL ADDRESS: . BD South 6th Street ` PRODUCER cus ro Shite 7D0 Minneapolis, MN 55402 % COMMERCIAL GENERAL LIABILITY=TCPREM INSURER(S) AFFORDING COVERAGE NAIC R INSURED INSURER A: OLD REPtSLIC INS CD 24147 INSURER B: NATIOISAL UNION FIRS INS CO OF P.ITTS 19445 Renewal By Andersen Corporation INSURER C: 1D4 Otis Street INSURER D: Narthharough, MA 01532 . INSURER E: INSURER F': COVERAGES CERTIFICATE NUMBER: 25114267 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED. ABOVE FOR THE POUCY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAYPERTAIN, 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. I� SP I .TYPE OF INSURANCE ADDL SUER POLICY EFF POLICY EXP INSR POLICY NUMBER MM/DD MMIDD LIMITS' A GENERALLIABILnY MWZY 59313 1D/D1/1 10/01/12 EACH OCCURRENCE $ 1,D00,0D0 % COMMERCIAL GENERAL LIABILITY=TCPREM _ DAMAGE SES Ea occurtence $ 50 D , D D.0 MED EXP Any one person $ 10 , D D D CLAIMS -MADE OCCUR PERSONAL✓;: ADV INJURY $ 1,DD0,0D0 GENERAL AGGREGATE •. ,L , D 0 0, D D 0 GEN'LAGGREGATE LIMIT APPLIES PER PRODUCTS - COMP/OP AGG % . POLICY PRC-JECT LOC A AUTOMOBILE LIABILITY MWZB 21377 10/01/1 10/01/12 COMBINED SINGLE LIMIT $ 3,DDD,DDD (Ea accident) %- ANY AUTO BODILY INJURY (Par person) $ ALL OWNED AUTOS BODILY INJURY (PerB=Ident) •$ SCHEDULED AUTOS PROPERTY DAMAGE $ Z HIRED AUTOS (Perecdclant) $ 1 NON -OWNED AUTOS B X UMBRELLA.. LIAS X OCCUR 2503D519 10/01/1 10/01/12 EACH OCCURRENCE $ 25,000,000 AGGREGATE $ 25,01)0,00D EXCESSLKB. CLAIMS -MADE DEDUCTIBLE $ 8 % RETENTION . S 25 , 6 D D A WORKERS COMPENSATION MWC 117140 00 10/01/1 10/01/12 % WCSTATU DTH AND EMPLOYERS' LIABILITY YIN ANY PROPRIET DR/PARTNERIEXECU M E EL EACH ACCIDENT $ 1,000,000 OFFICER/MEMSER EXCLUDED? - IN IN (Mandatary in NH) I A EL DISEASE -EAEMPLOYEE $ 1,000,000 E.L. DISEASE -POLICY LIMIT$ 1,D -00,0D0 If yea, descdbeunder DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Addifional Remarks Schedule, it more space is required) Evidence of .Insurance. L.CK l It -K_: k It t1LJLUCK l+AroI.GL.LA I lUry "SHOULD ANY OFTHE ABOVE'Di•SCRISED.POLICIES BE CANCELLED BEFORE EPidence of Imoura me THE EXPIRATION DATE THEREOF, NOTICE WILL BE .DELIVERED IN - ACCORDANCE WfrH THE POLICY PROVISIONS • AUTHOR® REPRESENTATIVE - knsimoa ®.i9fiBanlip.ACORD CDRPDRATIDN..All riahts•reserved. AL-UKU ZZ •JZUU./Uq) ! ne AL.UKIJ name ana logo are regfszerea MWKS or-At.uw 25114267 - R�n- e%vava 1 IF L= Li mmrsix ,j ' . U-Fa�at• ([-1.5��•'P Iat-H� Cham Co��ietat • . ' F1� ��,i�.....i ,,,,�,,,ri. !t'C,�c,r.d„�;d„Q,i,,ar� � � . • ��t1��sTr..ie.�� rl�c Lc�TT.3 >.� • H- L C25 I]fl 51a DFi ,rx Lee• �tltrtMe ..... w r _ � , _ �Lt bel�.rs! , ' •