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HomeMy WebLinkAboutBuilding Permit #217-12 - 520 FOSTER STREET 9/15/2011 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: I Date Received Date Issued: J IMPORTANT:Applicant must complete all items on this page LOCATION aU Print PROPERTY OWNER Print MAP NO: ARCEL: ZONING DISTRICT: Historic District yes Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residen ' I Non- Residential ❑ New Building ne family ❑Addition ❑Two or more family ❑ Industrial ❑Alter aon No. of units: ❑ Commercial air, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other `-'rs7—C c ?�lFloodplaui Wetl'and's `' ��UVatersfied�Distncfr 18W 0-Y DESCRIPTION OF WORK TO BE PERFORMED: 13 Identification Please Type or Print Clearly) OWNER: Name: nuc �d Phone: Address: �C`� {� CONTRACTOR Name: Rb l'Qtj I T-)F'AJ/JiC`� Phone: �G� �Q -0?,90 Address: V_(�,l� a (, Q&i;F- i Supervisor's Construction License: Exp.Exp. Date: A" Home Improvement License: '��� _/ Exp. Date: / ARCHITECT/ENGINEER Phone: d Address: Reg. No. FEE SCHEDULE:BULDING PERMIT:$92.00 PER$9000.00 OF THE TOTAL ESTIMATED COST BASE ON$925.00 PER S.F. Total Project Cost: $ f 7, 7 6-0 �� FEE: $ i —p< Check No.: Z Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Signatureof:Agent/Owner � . f_�� i Signature of contractor' Location No. al Date HpRTM TOWN OF NORTH ANDOVER f 1q, Certificate of Occupancy $ CM�s<�' Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check it / 15:0 G-4p 2 2 4 5 � p Building Inspector Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ❑ S""ing 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 FORD DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT ❑ ❑ COMMENTS I CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature COMMENTS Zoning Board of Appeals:Variance, Petition No: Zoning Decision/receipt submitted yes c 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 I Dimension Totalsquare feet of floor area based on Exterior dimensions. Number of Stories: Total land area, sq. ft.: of Meter location mast or service drop requires ELECTRICAL: Movement p q approval of Electrical Inspector Yes No DANGER ZONE LITERATURE: Yes No MGL Chapter 166 Section 21A—F and G min.$100-$1000 fine r NOTES and DATA— For department use i ® 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 VOTE: 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 .hat the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording . nust be submitted with the building application Doc: Doc.Building Permit Revised 2008mi NORTm 9 To" Of No. � o , dover, Mass., 1` Q - LAKE e� COCHICHEWICK V 7d ADRATED 7 S U BOARD OF HEALTH Food/Kitchen PERM . IT. T D Septic System BUILDING INSPECTOR ZO THIS CERTIFIES THAT.................................................. . .' ".. , ..�.................... ....� . Foundation has permission to erect......... buildings on .................... .... .....d4vol ............. r.................... Rough to be occupied as M Chimney ........... ... .................... ". ............................ provided that the person accepting this pe it 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 CONSTRUC O 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 SSE Smoke Det. AORTH TO" of : Andover .. or dower, Mass., O COCHICEWICK �t oRATED PP "�C �JJ U BOARD OF HEALTH Food/Kitchen PERM . I.T .T D Septic System BUILDING INSPECTOR THIS CERTIFIES THAT...........................to ........................ .......6+00 ............d..i........................ Foundation has permission to erect........................ .............. buildings on .................... ..... ......... ... ..............�r.................... Rough ftWaamm 4 to be occupied as.............13........., .......... .... ............. ..1. �. . ............................ Chimney y ' e provided that the person accepting this pe it 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 CONSTRUCO TS Rough . ...................... .................. ........... Service BUILDING INSPECTOR Final OccupancyPermit 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 SWE Smoke Det. 104 Otis St.,Northborough,MA 01532 ,J&L WINDOWS,INC.,D/B/A g MA Home Improvement Contractor (508)919-0900•Fax:(774)987-3013 Renewal License#149601 (Expires 1/24/2012) 0 by Andersen. Federal Tax ID#83-0404201 WINDOW REPLACEMENT mAnd—C=NN CUSTOM WINDOW AND DOOR REMODELING AGREEMENT Buyer(s)Name Date of Agreement na + o �3 I f Buyer(s)Street Address,City,State,and Zip Code Ie� S- . ,� Qfi-YJ. E-Mail Address Home Telephone Number Work Tele hone Number y / / CSG ( U 41 2q4 Buyer(s)hereby jointly and severally agrees to purchase the products and/or services of J&L Windows,Inc.d/b/a Renewal by Andersen ("Contractor"),in accordance with the terms and conditions described on the front and the reverse of this agreement and on the attached specification sheet(s) (collectively,this"Agreement").Buyer(s)hereby agrees to sign a completion certificate after Contractor has completed all work under this Agreement. ) Method of Payment:*heck ❑Credit Card ❑Cash Total Job Amount: Estimated Start' g Date: ❑Financed Deposit Received(33%): /d`oO Balance at Start of Job(33%):(a (/UO Estimated Completion Date: If payment is by Credit Card, please fill out Balance on Substantial �rS the Credit Card Receipt of Deposit Form Completion of Job(33%):� 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. J&L Windo ,Inc.d/b/a Renewal by Andersen Buyer(s) Buyer(s) By: Signatur of Prod t Manager Signature Signature Cftt✓ 4� Print Name of Product Manager �� 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. - - — — — — — — — — — — — — —x- — — — — — — -- �<- - - - - - - - - - - - - - -x NOTICE OF CANCELLATION X NOTICE OF CANCELLATION Date of Transaction . You may cancel i Date of Transaction . You may cancel this transaction,without any penalty or obligation,within this transaction,without any penalty or obligation,within three business days from the above date.If you cancel,any I 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 be canceled.If you cancel,you must make available to the Seller at your residence,in substantially as good condition I Seller at your residence,in substantially as good condition as when received, any goods delivered to you under I as when received,any goods delivered to you under this this Contract or Sale; or you may, if you wish, comply 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 If you do make the goods.avoilable 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 dispose 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 ifyou agree goods available to the Seller,or if you agree to return the to return the goods to the Seller and fail to do so, then I to the Seller and fail to do so,then you remain liable you remain liable for performance of all obligations under I for performance of all obligations under the Contract. the Contract.To cancel this transaction, mail or deliver a To cancel this transaction, mail or deliver a signed and sired and dated copy of this cancellation notice or any dated copy of this cancellation notice or any other written other written notice,or send a telegram to Contractor.J I notice,or send a telegram to Contractor.J&L Windows, &L Windows,Inc.d/b/a Renewal by Andersen, 104 Otis I Inc. d/b/a Renewal by Andersen, 104 Otis Street, Street, Northborough, MA 01532, BY NOT LATER THAN Northborough,MA 01532,BY NOT LATER THAN MIDNIGHT MIDNIGHT OF (Date) OF .(Date) I HEREBY CANCEL THIS TRANSACTION. I HEREBY CANCEL THIS TRANSACTION. Buyer's Signature Print Name Date I Buyer's Signature Print Name Date RbA Copy- White Buyer Copy-Yellow Buyer Copy-Pink 104 Otis Street,Northborough,MA 01532 f&L Wln4ows,Inc.ci/b/fl Renewal MA HIC License#149601(expires 1/24/12) Phone 508.919.0900•Fax 774.987.3013 '* Federal Tax ID# 83-0404201 byAndersen. WINDOW REPLACEMENT an Mde Company OF GREATER MASSACHUSLM AND NEW HAMPS M WINDOW SPECIFICATION SHEEP Buyer(s)Name Date of A ment rya n `-rV escl za The Buyer(s)listed above 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. WINDOW DETAILS 1. Contractor will Install a total of windows in Owner's home,using the following individual quantities: 17>—Double Hung(DB) ❑ Equal sash ❑ Cottage sash(1/3 top,2/3 bottom) ❑ Oriel sash(2/3 top.1/3 bottom) Casement(CM ❑ 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 p Metro handle 2 Lite Gliding Window(GW) Glider/Picture/Glider(GPW) ❑ 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. ❑ Yes,:-N11 Qty of Windows to be Custom Fit Replacement: S. ❑ Yes,?.➢ Qty of Sills to be replaced by Contractor: 4. Yes ❑ No Qty of Windows to be New Construction Hill frame(includes new interior&exterior casings)and actual Exterior casings: ❑ Pine ❑ Maintenance-free material ❑ Factory applied 908 Fibrex brickmold 5. Glazing to be: ❑ HP Low-E-4 TM ❑ Other If other,please specify: 6. Exterior color to be:9 White ❑ Sand ❑ Canvas ❑ Terratone ❑ Cocoa Bean 7. Interior color to be: ,White ❑ Sand ❑ Canvas ❑ Terratone ❑ Pine ❑ Maple ❑ Oak Note: Interior color can only be white,wood or same color as exterior. Wood interiors need to finished by Owner. 8. Hardware:�hite ❑ Stone ❑ Canvas ❑ Brass ❑ Estate Hardware: Style: 9. ❑ Yes'�TNo Install Lifts with Double Hung Windows 10. Screens: windows to have: ❑ Half or ❑ Full screens Screens to be: ❑ Fiberglass ❑ Aluminum ATruscene GRILLE DETAILS 11.Windows have grilles:�-Yes ❑ No If yes6&Grille Between Glass(csc)❑ Removable Interior Wood(t1nwJ E] }till Divided Light(fDW Qty: ' Qty: Qty: 10 Qty: Qty Qty Qt': Er -H-1 DH DH DH DH CW/PICWre Glider CPW orG Draw grille patterns above 'Use additional sheet if needed Owner approved(initials): ADDITIONAL WORK DETAILS 12.� Yes Contractor will remove metal frames of windows. Qty of Units: 1 Yes ❑ No Contractor will install new paint-ready or stain-ready casings. Interior casing qty of openings: Exterior casings of openings: E] Pine E) Maintenance-free material 14�-*ss ❑ No Contractor will install new paint-ready or stain-re nside or outside stops qty of openings: Interior stops qty of openings: Exterior stops q o o nings: ❑ Pine Maintenance-free material 15. Owner is aware that Contractor does not do any painting. Owner Initials 16.❑ Yes�fN&Contractor will wrap exterior casings with al ' u coil stock of color. Note: Wrapping may be required with storm window- mo ;removal.of storm windows will leave screw holes in casing. 17.,n Yes ❑ No Contractor will insulate,caulk and seal win ows with 3=point system to prevent water and air infiltration. 18.© Yes ❑No Clean up all job related debris including old windows will be removed.Vacuum nightly. 19. Yes ❑ No A limited warranty shall be issued to Owner upon completion of the job and payment in full. 20. Yes ❑ No Buil • 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.E4Xes ❑No All discounts have been applied to this agreement price. 22. Additional job details: lDcv T1 0 23. 17 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 reed this Specification Sheet. `Renewal by A rse t of Greater MA and Buyer(s) Buyer(s) Signa of Product Manager S' tore � s tore nt Name of Product ger Print Name Print Name The COMMonweaWt of Massachusetts Departm nt ofIndustrial accidents Of xf of InvesfigFfions SOD 1�aslsington Street Boston,MA 62111 .UT .. rw.mass.govtdia Workarr' Compbnsation Instrrsnce ad v't'B6.ders/Contra.ctert l Pleas psr Print Leg l _A:rpikant Informidan Name(Budnrss 6maimdonnndivid"DI:- e �1 FJ ' 11t�e1'S Y1' Ci /Ste►tZi /V ora d���� Phone Type of projt t (required): Are you en employer?Check the eppropriLte bancot�tractnr eaci I - ' 1.�-I am a rsnploycr with• � D .. 4. ❑'I am a gca fi. ❑New Gonstructinn • rmployeos(f1ill mod/or part-timz),* -aw hirrd the sob-contractors listed on the attarhod sheet x 2,11 Ism a sole prapdrtor orpartner- Thtaa•sob-contractors have g, Doli on _ ship=6 him no rmpl°yees i r0i I comp.insuranoe. g, [j Bunft addifion wo for me is any capacsty. - [No rr�rkktrs'comp.insuusace 5. ❑ We ere a eotporation anis its '•10,Q Elechacal repairs Or additioas . c$ieets have exiet'isad their. raQ► d-I ' {#por MGL 11.(]Rlumbiag repairs or addiEians 3:Q I am a homeowner doing an'work of ezertrip e1�(13e workres'comp: e.I52,�.1(4)�D,Tand we have no ' I2.[]Roaf itpeirs m . inran�CrY;gnlrOd.I t � �IDpl0y�6••!1`0 WOIiti'Lr5' �.❑��{ , OMMP. a rcquimd.] *AMY applioeat tht 6wh bei R mn�also M out the seetioa Selo[Sbowing'hdr wo,10,'emnpeotaeon policy nmim�a are doing mnw,,l end thm hire mb ide==Rat=s naut submit i new ofndevit indieatinK zuctiti . t gnmo.who=bmit thu e$daeit iadicafine[hey r 'inF 1be n®e of the M6-=tn-- and their wmkcls,comp.Policy iaii>o�fien iontmetors that rh-ANJ b=molt attaabed as additinzml enratintt insurance far my encpIoyet:c �elmr.ia the pofiLy and jab site I am art employer fltat is pruyidirtg workers'camp. . ' infarrnatian. .. ) • Insurance Company NNW. � ' Jf l(' u• �' I�1�I�t'Cr Yl _ • #; �3tJ� lel,��.��•r� Espiratina Datc' � ' Policy#or self ins;Lira. aty�stsr , �l� Job RIM Address: � deelaratinn s:;e(sh.ovriag the policy autnber and erprrefma datE). Attach a copy of the Vrarkere eaacpensetina policy p og6on of criminal praalfics of a Fannro to seam coverage as regmmd lmdr r Secthn.Zk of MGL c. 152 can)cad in . imp lino ti its$1�DD.DD and/or ono-yoer impr4sonmrnt,as Won as eiv�l pr'naym in ft farm of a 5IC3P ¢rOR�ORDER and a foo P bo forwarded to the Office of -of up to:250.00 a day against ft violator. Be advised that a copy of this st�mant may Inv'[stlga6ow of the DIA.for insurance GDV=L9M v=ffimftoa. Ido hereby c ¢ the pauta'and penaEt erPf 097 thAt the ijzfor=don provided above ' tyres' nd comet 5ienetara' f - Detc' . Phone# D ftid use only. Da rtnt trite in this area,tv be eantplefed by city ar tasnn a�tcial . • PermitlLicense# . City or Town: Iasuing kuthority(circle ane): ector 5.PJ mbin Insp g actor L Board of Health L$uildrag Depsrtni t I C?ity/Town Clerk 4.lJlectrical Faap , 6.Other Phane#; Contact Persar: Massachusetts - Department of Public SafctN Boar-dlof Building-Re�uulations and Standards Construction Supervisor License License: CS 95707 BRIAN DENNISON 86 CREST CIRCLE M WORCESTER, MA 01603 Expiration: 9/8/2012 ( numis�iuncr TrT: 2622 7-7 4. Office of Consumer Affaies&Business Regulation Y. HOME IMPROVEMENT CONTRACTOR Registratia '01' Ex Pi 12 r __ t Card RENEWAL BY� BRIAN DENNIS •104 OTIS STREE ?: ,/� . �. NORTHBOROUGH,`"M '32 Undersecretary ACC> CERTIFICATE OF LIABILITY INSURANCE D .THIS CERTIFICATE IS ISSUED ASA MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS 1 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: ff.the certificate holder Is an ADDITIONAL INSURED,the poliicy(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 CONTACT Joseph McKeone PHONE S: Fax JP McKeone insurance Agency, Inc. N • 734-662-6100 AIC No EMAIL P.O.Box 333 ADDRESS: Ann Arbor, MI 461 D6-0333 INSURER(S)AFFORDING COVERAGE NAIC INSUREDINsuRERA.! Hartford Insurance Company 104 Windows, Inc. Renewal by Andersen INSURER B:Nautilus 1 D4 Otis SL INSURER C.: Northborough, MA 01532 INSURER D INSURER E: COVERAGES . INSURER F CERTIFICATE NUMBER: REVISION NUMBER: THIS !S 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 R AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. IL.TRTYPE OF INSURANCE D S pOLIM NUMBER POLICY POLICY � Latn'S B GENERAL LIABILITY EACH OCCURRENCE S I-000,000 coMMEAMS-MACIAL NERALUABILITY NC95B461' 10/01/2010 10/01/2011 PREMSES Eeoccunence 1$-100'000 CLAIMS-MADE ©OCCUR MED EJ<P Any one person s 5.D00 PERSONAL&ADV INJURY s 1 000 000 GENERAL AGGREGATE S 2 OOO OOO GEN'L AGGREGATE LIMIT APPLIES PER POLICY PRO- PRODUCTS-COMP/OP AGO S 2,000,000 AUTOMOBILE LIABILITY S 4 25MCCXD6390 10/01/2010 10!01/2011 COMBINED SINGLE LIMIT 1 000 000 ANY AUTO a acclde - ALLOWNED SCHEDULED BODILY INJURY(Par persoro $ X AUTDS BODILY INJURY(Par accldanQ $ HIRED AUTOS NON-OWNED AUTOS PROPERTY DAMAGE S er ecclde I S UMBRELLA LIAB OCCUR EXCESS L1AB I CLAIMS-MADE EACH OCCURRENCE S AGGREGATE S DED RETENTION S A WORKERS COMPENSATION S AND EMPLOYERS'LIABILITYY/N 35 WECPP1444 02/17/2011 02/17/2012 WC STATU- OTH- ANY PROPREMRfPARTNEREXECUTIVE OFFICER/MEMBEA EXCLUDED? ❑ N/A EL EACH ACCIDENT s 500 000 (Mandatory in NH) if yes descrloe under E"L DISEASE-EA EMPLOYEE $ 500 000 DESCRIPTION OF OPERATIONS below 1 EL DISEASE-POLICY LIMIT S 500.000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space Is required) CERTIFICATE HOLDER CANCELLATION INSURED COPY SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ®1968-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD Pel • . Dint ¢a DmEdA.umv • l�•-•Fa�¢ai'�11.�4•-P , , �r-}ice#(gym Coa{pletat • • .. , X29.. Q-x ' x "' 2 �+.`.�� 'ter-•+�+� - - • rte= • t.����+•�r-+.�r•�+--•�••�.-'•-jam � • _ DES1F�•l PFiE�S1.1FiE EPSFj 1 . �� 5 ahA na SCIL 1 pH.rte