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HomeMy WebLinkAboutBuilding Permit #391 - 43 SURREY DRIVE 11/18/2009 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit N0: Date Received Date Issued: / IMPORTANT: Applicant must complete all items on this page LOCATION H3 25,-kPRQ� DQ . Print PROPERTY OWNER fJr-U F- W AX f L t E Print MAP NO: PARCEL; ,9? ZONING DISTRICT: Historic District yes no Machine Shop Village yes no II TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building C&famil Addition Two or more family Industrial n 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: CI tJ ���-noD 1 C NF vJ C 146%v4F s 5 C ou"r TiTroP) Identification Please Type'or Print Clearly) OWNER: Name: 5-rLQj Phone: C(1$• 741f-c154o Address: 113 5 2QLy -PR. , &,I. woovm A 81�,y� CONTRACTOR Name: 94CIAC¢t--1 YnrN&k -.tc- Phone: 88d o 7g5 Address: Supervisor's Construction License: Q Oo15 Exp. Date: Home Improvement License: bIq Exp. Date: 6/91/10 ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE.BOLDING PERMIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. r Total Project Cost: $ �S, 6O U FEE: $_ j Cr E Check No.: rc/-1 Receipt No.: �� �/© NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Signature of Agent/Own / Signature of contract 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 COMMENTS HEALTH Reviewed on Signature COMMENTS Zoning Board of Appeals:Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments r 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 I 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 i THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM I DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT COMMENTS i i CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes i Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Connection/Signature& Date Driveway Permit i 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 TOWN OF NORTH ANDOVER I� APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received Date Issued: / IMPORTANT:Applicant must complete all items on this page LOCATION H3 5uRRL�) DQ . Print PROPERTY OWNER 15rr�-t3 L is AX f L t t_ Print MAP NO: 24 PARCEL: 9 ZONING DISTRICT: Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building anvil Addition Two or more family Industrial n 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: C1��cJ }Z �noD 1. t if v, C 146tt.1£n Cov�tr rz,roP� Identification Please Type or Print Clearly) OWNER: Name: 57-�-vf 04y—EL%. Phone: Q1$• 744-ci 9i Address: "b 5 MU9 Wk cid. Ac4 00NI M 61 CONTRACTOR Name: 91 i LAC¢ 1yNPc,,c -,,u4c. Phone: Ttn 67�� Address: y I R4 �Ut�4n, ;. , �nra2>. s� dR - � �n Supervisor's Construction License: /0 a Opt 5 Exp. Date: Home Improvement License: l�{ao/y Exp. Date: 619ba ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BOLDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. E Total Project Cost: $ � �S, 6V U FEE: $ P Check No.: r�1-41 Receipt No.: �� � 90 NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Signature of Agent/Own / Signature of contract Location No. Date „oR,h TOWN OF NORTH ANDOVER 41 � P s • ; ; , Certificate of Occupancy $ .1 Building/Frame Permit Fee $ s�CHU Foundation Permit Fee $ Other Permit Fee $ TOTAL $ 17 Check # � i r 2260 Building Inspector XAORTH Town 0 _ Andover . No. �I _ A o dover, Mass., COCKICKEWICK ADRATE D `s BOARD OF HEALTH Food/Kitchen .PERMIT T D Septic System BUILDING INSPECTOR THIS CERTIFIES THAT .`. !-� /...... '...........................................::................................... Foundation has permission to erect........................................ buildings on -- .... .... ....! ��1..... / Rough '�G�fly R.p�?� i)��F/ Chimney to be occupied as........................................................................................................................................................................ provided that the person accepting this permit shall in every respect conform to the terms of the application on file in Final 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 CONSTRUCTION ST TS Rough Service BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR 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. SEE REVERSE SIDE Smoke Det. Massachusetts- Department of puhlic Safct; Board of Build-m= illlij Construction Supervisor , icenSetndards ' License: CS 102099 Restricted to: 00 ROBERT BOERGESSON 6 JENNA DRIVE FAIRHAVEN, MA 02719 Expiration: 4/26/2012 (=nno=issiuniv ' Tr#: 102099 11/18/2009 08:48 9083870172 KITCHEN MAGIC INC PAGE 01 1 IIIIi!!Illi liill�l l llllll l if 1111 m2008 by Klitfion Mnatc, Inc, AGREEMENT MA LICJREO. NO.: RI LlC•/REG, NO.; Kitchen 1 ,mt in 291IC illlagic, ��C, 93468 otruM inquiries ro; � LICJREG. No.; ti�rsia pagfstratort Division, o0aa103a A DIVISION OF GRESN�LL CORP. Program coordlrtatm NY UCJREG. NOS,; One A Union Pincr, naseau' H175949QQpd PC2AEIN#232158775 MA CALL TOLL FREE Room rlvo: PC 216 FROM ANYWHERE: Boston, MA 02108 fautnam' �A•A (e»)727-3200 ext. xs239 Rotklond:1 17oo3•ooao 39 Loring Orly®,Framingham,t�fA Ot702 1-BQQ��37�0799 wefa cI heallen WC-02380-WAq ALL MAIL TO: R0.Box i37,Bloomsbury,NJ 08804 www.KltchenMa ic.eom CUSTOMER INFORMATION PRODUCT SPECIFICATIONS Color a a'al BUYER NAME eF Door AA Faml Street qj so�� 0A`f�OI� � • _ Door Design ' . City,State,ZIPS ___�r� �•_) ��'- . style., Phone(home)( 1e)7 ',` " tar.lMs, — Valance . �rroklcnn�{ ) count rt Material EdgeSty#e ,r/ a06 f (Mc IM i /Mr,/M, {{ •` �q �r /� wwklc 1Vmrp/ccJ1!ll Job Site LF Backsplash Material Height Approx,Start 44? Approx.Completion,CJ�c? Color LFY� 'Covaedop malerials ellrrrlpen iamimte requlrrasperare addend", Your kitchen will include custom laminate units. Seroises facing Application �'A WOod Substrate ow Cabinets U Direct Lamination Features Options _Ll� Reset the FOIiOwlnll Existing Appliances New Doors cfi New wall Cabinetry' New Drawer Fronts New Base Cabinetry" f Now Handles,,._ New TallCabinetry' Cabinet`over Frldge/Microwave / n+efinou�ngbunnlnpprrmusarorvqulred.ItHtireo911pntlenOfthe New Hinges 'PlV-mwtrhflntshedMaple itderice a eonimmOrtosocurssuchpermllsAthuhameowneraepenl' New Valance New Drawer Boxes 8 Tracks New Scribe Moulding New Shelves New Vinyl Base; BLK WHT BRN ALM t New Interior Ra11•pu —New Drop Leaf Sink Kit NIC • H07ti;owners In MA who secure lheh own permits et dual With Free-standing Lary Susan ehreQ(stored contractota aro eyeh ase hpm me aearsnlet Fond (if accommodations allow) New Glass Doors provfsim OrIM21.042A. RnNlty�!s dpas net faafa!!»row rghl!lancae. Now Laminate Exierlor t Remove Tile Backs lash KOO.rHpplrknatarmensadeixtP�brrorpMmher. Wall Cabinet Surface Window ) p kncnen Maple Is no, responc101t for the (NSI of edd<ionat, Sill replatemnnl Ot tclOcallon o1 elechltal mtl pplombinq tinea or parte, ase Cabinet Surface Remove Existing Cabinetry the prssence Andcandhfon otvielce cnnnet be dctttmtmd untlivmrk Tall Cabinet Surface Haul Away Debris no a liances has started- Hkchan Meplc Will net rash Vs Oppllances unless ( AP J app»lance-spndncga&ehut•ottvalvesexlrst. See addendum for additional work, explanations, remodeling, etc. Kit:fmnMngle,the Seller,warrants out products.undgrreaeonablehomou:mand aNWforaslongasyou,thnBirygr,ownyourrtMho.LnboronOil preduttaloworruntedforona(1)year front WARRANTY: ante of rod completion• This h the°nitro egreamam No Verbal Sgronmnntq wnl be honored. ThIA wnrrrnnty is non-transfanabin Find aclhaled upon ro mlpi Of paymsit In full. Khthon MFiglc reserves the egM M oubstltum and/or upgrade ourproduttA. We agree to furnlsh k'lbor ind matodals complete In q=rdaheo yMh above tmocifioat(ona for. PAYMEWT To eF Mune aS reu.ow;; t!Arf' Clolldr9 ($ / J no tax f� CJS anon F ,i Oesll�ve aryw7Jt I !J Cablttet &opl�i•eudace d�C� Da ter: V Countarop W rk Com ellen `—� ACCEPTANGEOFAGREEMENT5.The above prices,specifications?ndconditions are satisfactory,duyeraor9estowarkilqfnq commenced and farther aiirees to pay all Omits of ralleutjon,Including aftmey's fees and any other damages that maybe Incurred by the,Seller In the event Of Buyers breach of contract.Any alteration or deviation from the above speoiticaGons Involving extra costs will be exaeuted only upon written orders and will become an cxira charge abnve And beyond Inc estimate.We reserve the right to cancel this contract within scvon(7)days from bluoprinung.If we canget,we will notify you in writing,and any dowripaymenrys)you have made will be promptly returned.All contracts are eorttlngent upon strikes,accidents or delays beyond our ronnol, The owner of the site must carry fire,tornado,and other neresmrylnsuranct.Our workers are fully covered byWorkman'sCompensation lnsurance,unless otharwlsenoted wnhlnthis doeumant•the contract shalltU Imply^thetany lien or other security Interest h bean plooMon the rasidonca. Notice to Buyer:(1)Do not sign this agreement(f any of the spaces intended far Authorized Signetlirl: � - ---� the agreed terms to the extent of then available information are left blank. (2)You are entitled to a copy of this agreement at the time you sign it. (3)You Print Name r LLlf�- may at anytime pay off the full unpaid balance due underthis aggreement,and P.0,Box 737, Bloomsbury.NJ 08804 in so doing you may be entitled to receive a partial rebate of tFle finance and Insurance charges, (a) The Seller has no right to unlawfully enter your -� premises or Commit any breach of the peace to repossess goods purchased Date of Trans, ono_ " 200 under this agreement. (5)You may cancel this agreement If it has not been Signature signed atthe main office or a branch office of the Seller,provided you notify the Seller at his or her main office or branch afiice shown in the agreement by Signature 'rt - ordinary mail posted,by telegram sent or by delivery,not later than»Midnight of the third business day following the signing ofthisagreement. R1 Buyaw ln8fal here to aekttftwle 0e receipt of NnlfAs of Possibly Seeattachednotice Ofealreellationforanexplanation ofthis right. merrhanicsLten(RIGL5•d5-lg)� 00 DOORS 1 ID ERS1 PANELS ri N1 H # W H # W L mos 1t ,�`i` M i 5 L U {JIl A CN4 r `.7 }"',"ti y`tYSy l C LO M F:Q Al R a C1g yt f B R�1naJE ��7�Artp ALa. CsiPjtinlE3S E SpFAj- RJR{Xt.1Al.L PSS VsCt-.L A a 3LCL X11 D e3a,%Gt" asf M-0 a'aal,4_ RVA.R/ottv,w CL 00 +� 1 ae 2572 E -- n�� w/ obQ Cops s�aP�/ �vacxa� Cp ' L Ci ("64R C'Qe�.ws n7 Mrl�Otr- OCD 0 H l .L7/ '3es y�wtt '�tv' \s.�tRS 8LT1wStl•J wA1��— Ar=rJ 00 m CD Q l S Q'7 des N _ L rs+s�� Ntw case a-' STILES V-32 # REG # W L a'5 CL 7,wn c�—) m _ 7- I>D 1--1 QO 'r;��ty C7 �a4L FF7 3vtiiti i IS u R PQt�n4 QC �do42Cr ITEM COLOR LPPscR STYLE ti_o+.r GRV EDGE 6L'i n uP b%T%'% . VrrdvJL r,oE K�L'c-C8✓+cw ,waR s C 'j Q 7 z b QE.dr^J�ti St1fLF �rC 4y DA/KR f -�3 b 1�L.A��,J CaeinEr s 3 UtL495- 3fn1 Lr�u �� 8f'SLna P}L htS Z 6d rfr ♦ tA 9`04 LF [AGES a kn asvtww 4 2 i�J 75 LF k SF11(P SPECdAL PlYW006 ur-" SIlLowen'Mabein Yhortc 7hn�Bia �39�gR�J aHo l ) CONTRACT S WxLxTH 43SL" n WaRx"f E a IrI+'o�rpM�v atn erpA�6i401IM 4ES,,,) cerN�xea S '�`hC• ZIP 1" PIcruAE�s Q JO■16 �AcL (PO4t�� Biu ,4 X"">01Y 111R1� mll�jolly X x oon m CD N 11118/2009 08:48 9083870172 KITCHEN MAGIC INC PAGE 07 I •Z4 ✓fLR�riG IItJXI3Xg1�!?�f,/tf�.•�t./Yih1fY.(.'/Lldw3G43 t,,&-q Board of Building Regulations and Standard& License or registration valid for individul use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: � RenistretioAl 182869 Board of Building Regulations and Standards ��;<: zifatlon: 41312011 Tr# 282631 One Ashburton Place Rnn 1301 _r._.: Typet'"I rtdivittual Boston,mst.02108 ANTONIO PRAIA ANTONIO PRATA' 9 WEST ST tE LUNENBURG.MA 01462 Administrator Not valid without�ignatmro 11/18/2009 08:48 9083870172 KITCHEN MAGIC INC PAGE 06 A w aCERTIFICATE OF LIABILITY INSURANCE DRT€(MriIDDYM1Y) FRO[.TJCER 8417/09 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Babineau insurance Agenr_y, Inc ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE $46 Electric Ave HOLDER- THIS CERTIFICATE DOES NOT AMEND, EXTEND OR Fitchburg, MA 01420 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW, INSURED INSURERS AFFORDING COVERAGE NAIC It --- ---- _ ANTbNIo PRz1TA INSURER A Travelers Indett�l, o 9 REST 5T- TERRACE IrJ$UREI+B. Travelers WC NSURER r T�VtQEI3BiTitG, MA 03462 - —� II\C:JRER D Ie`SuftER E COVERAGES THE POLICIESOF INSURANCE LISTED BELOVVHAVE BEEN 1$$UEDTOTHE NSUREO NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REQUREMENr,TERM OR CONDITION OF ANY CM RACT OR OTHER DOCUMENT WITH RESPECT TO WHIG I THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDCD IBYTHE POLICIES DESCRIBED HEREN IS SUBJECT TOAD,THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES,AGGREGATE LIMITS SHOWN MAYHAVE BEN REDUCED BYPAIDCLAII0S. MN AWL TYPEMNSLIRAIMM POLICY NUMBER ��� P TION - Mr GENERAL LIA@ILIh LIMITS EACH OCCURRENCE s 1,000,000 A X Ci:WERCIALGENERALLIABUTY 68084235983 3/20/09 3/20/10 P L Feurmen S 300,00c) rL.AIh4 IN JF Ora IJP: hF-DOyP(Ary oneperson) -" P.cMNAL&AOVINJURY fi 1 00tl 000 - rENEIAL AGGREGATE $ 2,000,000 GENLA&GREGATFLIMTA-PLIESPER PRODUCTS-CANP/OPAGG $ 2,000,000 F%I-;Y P LL, AUTDMO&4e UAS UTY ANY AUTO CON8INEDSINGLrLIhfl,T r IEA atndir(} IVA OWNEDAUTOS "HECdJLEDAUfOSBRDLYINJURY $ (�9 per9on) MRED A!ITOS '11-14-OWNED AUTDg WD LY INJURY 1.Ar aGt�JeAl) PROPERTY DA,40L $ (Per aceMent) GARAGE UTA@n lry AUTO ONLY-FA ACCIDENT S ANY AUTO - J OTHER THAN SACC $ AUTOONLY: AW $ EXCESS I UMMELLALIANUiY EACH OCCURRENOE_ $ OCCLIR r1 AIMS MADE AGGREGATE R LIEDIXTISLE a PEM 0 MDRKERSCOhdPENRAMoN VJCSfA7U- CnH- A.No EMPLOYERS'LIABILITY B hNh'FROFRIFTORPt�TNERYrN ��&��B:UTIVE 6ECC>'B 013SM413 8/3/09 8/3/10 FI,EACHACODENi I a 100,000 OFFlCERm�Fr�R E;tCLIl Mandatory In NH) I IIv95.dswnbe ander E.L.DISEASE-EAEwLOYEd 100,000 goECIALPROVj„ONSndav F,L,fA5EA5E.P0uCYUAdff € 500,000 OTFE R wE;rRIPTION OF OPERATI ONS I LOCATIor,iS r VEH C LES 1 EX C LUSIONB ADDED RY EMJOPSErd,EW 1 SPECIAL PROM,TO NS CER T(FICATE HOLDER CANCELLATION 8HDLLD ANY OFThf ASOW DESCRIBEOPOLIMES BE CANCELLED BEFORE TW@ EXPIRA nON BATE THEREOF,THE ISSUM IWLRER VVILL ENDEAVOR TO MAIL 10 DAYS WRITTEN Kitchen Magic NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BLIT FAILLAETO Do W$HALL 1011. US Highway 22 IMPOar NO OMIC;ATION OR LIALDIL17Y OF ANY KIND LPDN THE INSURER ITS AGENTS OR Phillipsburg, NJ 08865 REPREMNTATIVES, AU11-MMZW REFRESENTATTVr LariSeth Gasn,er ACOR D 25(2009101) 0 1988,2009 ACORD CORPORATION. All rights reserved. The AC oR D nem a and logo are registered marks of ACORD 11/18/2009 08:48 9083870172 KITCHEN MAGIC INC PAGE 05 AC00. CERTIFICATE OF LIA13ILITY INSURANCE OPIDTZ DAtR,I�M�L„ryY, 917MA01 04 03 p8 rnowccn THIS CERTIFICATE 1S ISSUfrb AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CIE RTIFIGATE Brown sl ar6wx) of No, Xpr, HOLDER.THIS CERTiFICAT5 DOES NOT AMEND,EXTEND OR 222 CamRron Drive, °u;I.t,e .140 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW, Ph5.139.p5bi2.g Nd' 08865 1 Phone: 900-689`1092 Pam: 808-E29-571 P INSURERS AFFORDING COVES AGL Ngle� IN5VRR0 .�........_ ._.-�..•-"•� _...�._..__—. mau111!n N_._S,,m inA1 Inn cc --�-- 11000 mnnann 1. Twin City Fi,Yg 7nm G`p 347 Kitchen Magic Corp ._....�_. . .. �.,,.... and Greanoll Corp mr•,m[nc: Hartford Casua.'lL arta Cc 084 PO Sox 73'7 P aloom.lmry N7 08804 mnanrnn COVERAGE$ wawaR r. TH[AOUGCr or rmuRANCR UTTPO A9LOW NAV;09 IRAIJAa To THR NIIIAAO NNArp Alit C rnn THC POLILY OT.A100 INOJCATAD NOTMm/11lAN0Ye ANY AI OUMEM ANT.TEAM On LONOITION 0r AIN CONTRACT OR 01w0P DOCiIV,P,HT,17k A[hl'Ce.T n,YNi l'TI NL CCRT irmu r.MAY nR IN All 9 0k VAY Pa RTAIk,!HE-*I-A AN OC Arlon OCO OY TNG r0 LI06S OAS C A1210 11 OAK IN 10 5UnJACT TO All TNA MPV 1,[Nl.LUnmup AND GONOITDNA or a0C11 rCUUM 0.AOOR%QATa UUMh RkWJN UAT HAYa M_[n A I t UCE0 OY rATD GtAARP, 5R 100.1. PRVN kpIR=r/I' MAW CYPIRATION LtA an0 TWA C9 miVRANeA rOL1oY Nurm RR CAflI AUDO PAtR(MIAMM71 LIMITA nONeIIAL LMOILITV EACH aaG1RR[Nm A 1,000,004 A A C UMRGN4ePN/RA4LIA4g1TT 44UUNTE9574 04/01/09 04/01/10 PRRM PA(AsmaAi.j s 300,000 _ rtnwrMnac 000un MAorxrtAnr9RA1N�n.l s 10,000 �RRAerJA�,AnnY 1N�nRr A 1,000,000 a!n[RnL ndddhonTc s 2,000,000 OANR MORROATR LNIT APPURA RAR. PRaD�J6ta-Rcwrvor nao 1 2 400,000 X PQR14Y A'f ,err Loc AU?OMO@.kt 4146,61tT A .RNOmLo OMOIS LIMIT s 1,000,000 7C Am auro 94UtdtTtE9579 04/01/09 d4/pVia (EA RAawul ALL TATICO AUT00 AWAY W" ACI19OULRO M1TOn 1M Py„RT H1R[O AUTap nens,Y wnIRY NdN MNN18 MTOA (PM Ancm.,R A LIZ —M.q 4nAAaRwnnnm Alrn anLr-LAACRIOART ! ANYAUTO • __ ATNPR Tnau CA ACO 5 .. AVTOOYLV nac s 1 CAOAAsaJMnRALLALMRRITY .ArmDacunlrace s 51000,000 _ 1 C X aErnE fLOR/P MAOC 44XHUTZ8761 04/01/09 04/01/10 AOOPROATL 5 5,000,000 ---- s --^ t Dr.Ducmntr, a X n[lCPYmn s X0,000 s - --.J WORNARA OOMPANSATION AND 1VG pTATIi. OTn aMPLO"IRWLFAOdRY x' TORY UVITD An B nrvrylarMRTONFARt+JlRfxee,TpA 44vII5009 04/01/09 04/01/10 C.LCAOMArr,10CNT 5 1„000,000 Oa9JCAROAAMAAR rXCLVDLD! -- AI-,aRRPJ09Yaaa, O.L.OKlOrt-LnCMr%OYM s 1400,000 _ Ar[eIM rNMNAiekA nw._ C.L OIMAOC-TRILJOY MIT s 1„000,000 OTmI`R 0030mrTi0N 9A�PARATION11 L0GTNlNO fViNIe LII1lR1lL•LU110Nl ADDAD AY SNOORRAMANTf SPRCIAL PROYIININ! -i 5br Iueurance verifioation purposes CERWICATE HOLDER CANCELLATION ItITMAG MIOULO ANY or TIIAAOOVC m-cmam rOLI0105 PP 0ANOCLLr,O OCrORr,TML A)"ATOrJ OATR TNSRaOr,TNR ISSIPRO INSURER YRAL ANDAAVOR TO NAIL 10 SAYS YJ,Tr,�ei M"et OTHE GRRTmt[AtR NPLarR NAMrA TO TNR LRI"T.iWtAAnA�nA tYJ PP An hn,.Al, —� Kitchen Magic Carp lff`DCfl 001.I04l091 OR LIAOILITY Or ANYKmO uron TJC meuncn.IT,AuTNTO on V PO Hex 737 RRRAOANTATIYAS. j A1bolnel'lI.LCY NJ dAQl,14 AUa ORRARAIR!ATVP ACORA 26(2001/0) 0 ACORD CORPORATION 198a