Loading...
HomeMy WebLinkAboutBuilding Permit #350-14 - 60 ROSEMONT DRIVE 10/15/2013 1► f `kORTFf 1 BUILDING PERMIT 3�6�S�yao a611a�•OOL TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received Date Issued: '• r CHus IMPORTANT:Applicant must complete all items on this page .. LOCATION_& 11t�tSf 6AT,,&5J4-" A6Vr)IJ- I -Print PROPERTY OWNER AIA P#KtAZ13'A�yL/�t'1��� Print MAP NO: 1A PARCEQJ� b ZONING DISTRICT: Historic District yeno Machine Shop Village ye no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building KOne family ❑ Addition ❑ Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial Repair, replacement A-ObF ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic ❑ Well ❑ Floodplain ❑Wetlands ❑ Watershed District ❑Water/Sewer (7 ° ons yx t3 j Identification Please Type or Print Clearly) OWNER: Name: QH S �/ tl Phone 9'Is _kV_45cjg lkly6 Address: 1r7 U (/ ✓ l�ovt m ns" CONTRACTOR Name: Phone: 9 147-16100 061-7 c,6 00 �- tT Gc nh) Address: Supervisor's Construction License- Exp. Date* C'S-n&W Home Improvement License: f Exp. Date: / ARCHITECT/ENGINEER Phone: 1. Address: Reg. No. FEE SCHEDULE:BOLDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ o0 FEE: $+ I Check No.: A '? Receipt No.: NOTE: Persons ntr cti g with unregistered contractors do not have ac s to IhA guaranty fund %nature of Agent/Owner Signature_of contractor - /�- A TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit N0: Date Received Date Issued: IMPORTANT: Applicant must complete all items on this page LOCATION Print PROPERTY OWNER Print 100 Year Old Structure yes no MAP NO: 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 ❑ 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: Phone: Address: CONTRACTOR Name: Phone: Address: Supervisor's Construction License: Exp. Date: i Home Improvement License: Exp. Date: 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. Total Project Cost: $ FEE: $ Check No.: Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guarantyfund gnature of Agent/Owner S�goature_of contractor f Plans Submitted Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ Plans Submitted-❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ T TE_OF=:SEWERAGEDISPOSAL Public Sewer ❑ Tanning/MassageBodyArt ❑ .. 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 & DEVELOPMENTS ❑ ❑ 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 .a Conservation Decision: Comments Water& Sewer Connection/Signature& Date Driveway Permit DPW Toed: Engineer: Signature: Located 384 Osgood Street FIRE-DEPARTMI' NT --Temp Durripster on site yes no Located-at 124 Mair Street Fire Departme►it.signatu"r_e/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.$100-$1000 fine NOTES and DATA— (For department use ® Notified for pickup - Date Doe.Building Permit Revised 2010 Building Department The fol owing is--a list of the requi-red.forms to be filled out for the appropriate permit to be obtained. Roofh g, 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 o 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 o 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 cans if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals that the apw-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.tted with the building application Doc: Doc.Bui?ding Permit Revised 2012 Location�,Q RQ�I�'I dYJ No. Date 1k • = TOWN OF NORTH ANDOVER ,, • Certificate of Occupancy $ Building/Frame Permit Fee $/S — Foundation Permit Fee $ Other Permit Fee $ TOTAL $ t Check# Building Inspector � NORTI-� Town of ndover No. _ lith ver, Mass - O � d ► s � 3 COC «IC.t.'C.. y1. 0RATEo 0,���S U BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System THIS CERTIFIES THAT KO.O.tL..!. ...................................................... BUILDING INSPECTOR has permission to erect buildings on ......... Foundation .......................... ��...... .dry.+..,�.�-....Com' Rough to be occupied as ...��I. �o......I.... ........ . .:.� .................................................................. Chimney provided that the person accepting this permit shall In emery respect conform to the terms of the application 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 CONSTRUCTIO TART Rough Service ..................... .............. ................................... Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Reguired 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. SEE REVERSE SIDE tont>ract -�, << ' Tom Quinn .. ' , Employer ID (617) 939-1353 QUINYS ' CQNSTRUCTION 9�, c 27.1639714 (978) 265-2390 868 Mammoth Road • Dracut, MA 01826 torr`@quinwconstrucdmcom www.quinnsconstruction.com U���� &� e 1 of 3 Property Owner Information Name /� 6� 6�0G) �� �c - 6?i /711-1)21 f Street Address(NPost Office Box) Date ot <i�✓ ��� �u�2n,� � City/Town State Zip Code Job Name IV6 i2 Home Phone Cell Phone Email �- ? �� Job Location Mailing Address(If Different From Above) Salesperson(s): ! / ,/� Contractor Registration#: CS-039732 Ex.Date: REQUIRED PERMITS The following building permits are required. It is the obligation of the contractor to secure such permits as the homeowner's agent: List any and all necessary construction-relatedRermits. Note: Owners who secure their own permits or deal with unregistered contractors are excluded from the Guaranty Fund provisions of MGL c. 142A. Is an EXPRESS WARRANTY being provided by the contractor? NO YES **All terms of the warranty must he attached to the contract** NOTE: All home improvement contractors and subcontractors shall be registered and any inquires about a contractor or subcontractor relating to a registration should be directed to: Director,Home Improvement Contractor Registration One Ashburton Place,Room 1301 ?Boston;MA 02`10$ 617-727-8598 Unless otherwise noted within this document,the contract shall not imply that any lien or other security interest has been placed on the residence. ARBITRATION The contractor and the homeowner hereby mutually agree in advance that in the event the contractor has a dispute concerning this contract,the contractor may submit such dispute to a private arbitration service which has been approved by the Secretary of the Executive Office of Consumer Affairs and Business Regulations and the consumer shall be required to submit to such arbitration as provided in M.G.L.c.142A. Homeowner: �< GG/Ge. /ct Contractor: Date:_._. ice' - l 3 Date: NOTICE:THE SIGNATURES OF THE PARTIES ABOVE APPLY ONLY TO THE AGREEMENT OF THE PARTIES TO ALTERNATIVE DISPUTE SETTLEMENT INITIATED BY THE CONTRACTOR.THE OWNER MAY INITIATE ALTERNATIVE DISPUTE RESOLUTION EVEN WHERE THIS SECTION IS NOT SEPARATELY SIGNED BY THE PARTIES. ACCELERATION OF PAYMENT Homeowner's Financial Insecurity-A Contractor may not demand payments in advance of the dates specified on the payment schedule in cases where the homeowner deems him/herself to be financially insecure.. Contractor's Financial Insecurity-In instances where a contractor deems him/herself to be financially insecure,the contractor may require that the balance of funds not yet due be placed in a joint escrow account as a prerequisite to continuing the contracted work.Withdrawal from said account would require the signatures of both parties. THE CONTRACT MUST ALSO CONTAIN: 1. A Complete Description of any other documents which are part of the agreement; 2. A List and Description of other matters upon which the contractor and homeowner lawfully agree; 3. Any Other Provisions otherwise required by applicable laws of the Commonwealth. Remember,the Contract must be the Complete Agreement Between the contractor and the homeowner. Contract Tom uinn(6 7)u939-1-1353 QUINN'S CONSTRUCTION E 27-163ployer 9714 (978) 265-2390 868 Mammoth Road • Dracut, MA 01826 tom@quinnscanstruction.coin wu v.quinnsconstruc6mcom - Page 2 of 3 Modifications There shall be no modification, amendment, or change order made relative to this Construction Contract, Contractor's Work, or the Plans and Specifications without the express mutual modification signed by Owner and Contractor. a. Required Change Orders: The Specifications represent Contractor's best effort to be complete in detailing the scope of work to be performed. However, this contract is based solely on observable conditions of the structure in its status at time of Contract preparation. If additional concealed,unknown conditions are discovered in the course of construction,Contractor shall point out these conditions to Owner so Owner and Contractor can execute a signed Change Order for any additional work. Such orders shall specify additional fees, materials, labor and services, and become part of this contract. Additional costs, if any, shall be paid for by Owner in advance of execution of work specified in said Change Order.Failure of Contractor to request such payments in advance shall not be deemed a waiver of payments due. Any delays in Contractor's Work caused by required change orders shall not be deemed the responsibility of Contractor,and shall automatically extend the time of completion.Additional time required shall be stipulated within the Change Order. b. Additional Work Authorizations: In the event that required work cannot be priced in advance of completion of such work, (i.e. discovery of rot needing repair),an Additional Work Authorization shall be executed. Such orders shall describe work to be completed, and shall specify method of calculating additional fees,materials, labor and services to be charged upon completion,and become part of this contract.Payment shall be-due upon presentation of Contractor invoice. Any delays in Contractor's Work caused by required change orders shall not be deemed the responsibility of Contractor, and shall automatically extend the time of completion. Additional time required shall be estimated and stated within the Additional Work Authorization. -, T,the Homeowner have read and understand the above mentioned modification section and agree to the terms. / 'Homeowner's Signature Contractor's Signature Date Date The following schedule will be adhered to unless circumstances beyond the contractor's control arise: Work Scheduled To Begin: /U/ /S / - Gi Expected Date Of Completion: // //-3 l --'Dc,/'2 (Date Contractor will.begin contracted work) N (Date when contracted work will be substantially completed) TOTAL CONTRACT PRICE AND PAYMENT SCHEDULE The Contractor agrees to perform the work,furnish the material and labor specified above for the SUM of $ �l (*Include all finance charges in this amount*) Pants will be made according to the following SCHEDULE: t'�C�r_��L C'Y � g upon signing contract(*Not to exceed 113 of the total contract price OR the cost of special order items, whichever is greater*). $ by / / or upon completion of jll�% S �i? r�i�r��c./r� a-���!/i/�i�1� Wit' 1-9ZI— $ by / / or upon completion of $ /L� pon completion of the contract(*Law forbids demanding full payment until contract is completed to both parties'satisfaction*) In order to meet the completion schedule,the following material/equipment must be special ordered before the contracted work begins (*Law requires that any deposit or down payment required by the contractor before work begins may not exceed the greater of(a)one-third of the total contract price or(b)the actual cost of any special equipment or custom made material which must be special ordered in advance to meet the completion schedule*): $ to be paid for DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES Identical copies of the contract should go to the homeowner and the contractor. Homeowner's Signature contractor's Signature iu1 s / L�l� ' 2 i Date Date 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 his main office or branch thereof,provided you notify the seller in writing at his main office or branch 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. See attached notice of cancellation for an explanation of this right. Contratt Tom (9si706-6000 QUINYS CONSTRUCTION Employer 27-1639714 C: (617) 939-1353 868 Mammoth Road - Dracut, MA 01826 tom@quinnscom&uctimcom www.quinnsconstr'uction.com Page 3 of 3 WORK TO BE PERFORMED AND MATERIALS TO BE USED j Contractor agrees to do the following work for owners Contractors agrees install a premium Owens corning duration lifetime shingle roof systems(scope of work) LI Contractor to obtain building and other permits as needed. Customer to pay forp ermits at cost. U/Schedule the delivery of all materials, dumpster, cleanup. Er Proper protection of property. Proper removal and disposal of 1 layer of roofing, additional layers removed for 500 a Square Foot per Layer. 21"Run Magnets at end of day. M/Renailing of roof decking as needed .Replacement of up to 100 square or lineal feet of roof decking above this replaced for$2.80 a foot. [Installation otF8 Mill,white or brown Drip edge on all roof edges. ❑ (Optional) Installation of custom Heavy Duty F8 color of choice single and double drip edge. installation of Owens Coming Weather Lock Flex High Temperature Ice and water barrier 3,6,9 Feet wide and as needed in critical areas of roof. Installation of Owens Corning Deck Defense for shingle underlayment. Installation of vent pipe boots, step, base and counter flashings as needed. Inl stallation of a Owens Comings Duration Lifetime Shingle Roof using 6 nails per Shingle Exceeding the Manu- facturers Specifications. ❑ (Optional) Installation of Owens Comings Duration Designer Shingles. ❑ (Optional) Installation of Owens Comings Ervergy Star Duration Shasta White Shingles. 91/Installation of Owens Comings Ventsure strip ridge vent with wind baffles and caps on ridges. ❑ Installation of 12-inch lead flashings on the chimneys#. ❑ Installation of continuous circular, rectangle, or Facia Vents for Eave Ventilation as needed. ❑ Block off Gable Vents as needed. L/Roof System to be covered by Owens Comings System Advantage Preferred Non-Prorated Lifetime 50Y ear material Warranty and 10 year workmanship protection. ❑ Installation of PVC Trim, Facia & Rake Boards $20.00 a Lineal foot. Other Specifications and Conditions h Ofice of Consumer Affairs andBusiness Regulation ' 10 Park Plaza- Suite 5170 4� y Boston, Massag-hausels 02116 Home Improvement,',Q Actor Regisfzatio i QUINN'S CONSTRUCTION THOMAS OUINit- 868 MAMMOTH RD. DRACUT, MA 01826 - _ f OPS-CAI v SOM-04104-GIGIZ16 JIc Vcurmewe.crAe e`c ffa�tacl nae/i. License or registration valid for individul use only Office of Consumer Affairs&Business Regulation before the expiration date. If found return to: OME IMPROVEMENT CONTRACTOR Office of Consumer Affairs and Business Regulation egistration: 121604 Type' 10 Park Plaza-Suite 5170 � piration- 5/24/2014 DBA� Boston,MA 02116 QUINMS CONSTRUCTION THOMAS QUINN 868 MAMMOTH RD- g - � ��-�1iy` = � 1eY DRACUT,MA-01826 Undersecretary Not valid without signature ��re �,c�xaucsucea�Nr•cLCvl�a3sur�tNeCLLicense or registration vaIId for ind.Mdul Use only �\ Orrice of Consumer Affairs&Business Resaulation before the expiration date. if found return to: - �istfE IMPROVEMENT CONTRACTOR Of tce of Consumer Alairs and Business tRzgulation registration: 121644 Type, = X.-piration- 512412014. DBA 14 Paric?Ian-Suite 51770 Boston;IKA 02116 QU1NN�'S CONS T RUCTION THOMAS QUINN s u� 868 MAMIN101 H RD_ DRACUT,MA-01826 uadcrsecrctarr shot valid without signature Massachusetts -Department of Public Safety U�t����,�-B���or fnt Lsz j OLP ti t�ich Board of Building Regulations and Standards nasGLbac fee:(991 ')of Construction Super%Wir rontatn less-dim. >>, OOOLicense: CS-039732 ,x enclosed space. THOMAS J QUINN r 868 MAMMOTH RD DRACUT MA 01826 f Failure to possess a current edition of the Maseachuseits- 5tate Building Code is cause for revocation of this license. o-� 1 for DPS licensinginforrmtion nisi- 4__,v jvlass_Gov/DPS Commissioner 03/25/2014 The Commonwealth of Massachusetts L Print Form Department of Industrial Accidents quiqp- W Office of Investigations 1 Congress Street, Suite 100 Boston, MA 02114-2017 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information ) Please Print Le0bly Name (Business/Organization/Individual): /(/ IS ) )U_CVGQ 17 Address: % mlyol-H Rav;-4 City/State/Zi • aL Phone #: 0)917U:' Are you an employer?Check//the appropriate box: Type of project(required): 1.0 I am a em to er with (D 4. ❑ I am a general contractor and I P 6. E]New construction employee (full nd/or part-time).* have hired the sub-contractors 2.❑ 1 am a sole rietor or partner- listed on the attached sheet. 7. E] Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. employees and have workers' 9. ❑ Building addition [No workers' comp. insurance comp. insurance.: required.] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑ Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12. Roof repairs insurance required.] c. 152, §1(4), and we have no employees. [No workers' 13. Other 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: Z2h:K_1' UR — Policy#or Self-ins.Lic.#: V/1&, Noy Expiration Date: S ems/ Job Site Address:60 0_0_ Om �l 1/6 City/State/Zip:lufW74 AMd►t—� PJ)4 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$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby cern under the pains and enalties ofperjury that the in ormation provided above is true and correct. i Signature: _ - -- - - - !Date - ...- Phone# Official use only. Do not write in this area,to be completed by city or town official, City or Town: Permit/License# Issuing Authority(circle one): 1. Board of Health 2.Building Department 3. City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6. Other Contact Person: Phone#: OR ILI:LG - - CA"IISIT11CRATE OF Ull MOTY Ph SL4RANC > g�l►� �� -�,, �?191?3 THIS CWHEICAtr is Issum AS A IWATM OF I14POP-1iATIODJ @NLY AND CONFERS NO RIGHTS UPOm TjlE GERTIPIC.ITS HOLDER.Illils PIER.T IPIOA7? DO@S Nor AF;F6rwP:?ATfvELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIes 2EL0W- jM'5 CER11FICATE 01= INSURANCE t DOES NOT C0HST A CONTRACT 192"Re TWE ISSUING iN3lit1ER(S),AUTHORIZED REPP:Eut iL�i A FIV1=OR PRODUCER,AND THE CERTIFICATE HOLDER. ITWPORTANT. If the tarty I1c4der is an ADDITIORAL INSURED,the poldcy(leal erlusa ha el3daased. 1'r SUBROEATION IS WAIVED,subject W She wmv s and candiflons of the plicy,Cgft'n AgIICIES may MgU'm en endolzement A stGtsm*rt on this celtiffC820 doss not cordttr rights to the GWIMCM9 hOIE19F 10 Ilau aF such elidaTement(e). PRODUCER ��QO�$�40 �NI Se.grclra&M-211IflstaP.AsseC.tsdc s75�?aeT�sti PHDNe 3Qa North al in�^� Ailgover,R?A 0`1649 D L AIC Ro G-Cimra Ramirep- ADDD RESS. CUU -LfiER Ii SURED E hamts Quin INSUpa'R S AFFORHItdCs CDI/SRRGE tipiG� IHSURERn:£Jl9Yt�i�'FaL11J abR Quinn's come9l arti9ll 1NsURER r0lalfford ilia Co. 68 flRalslr ®S 1 RoadmmuRm c:A$betla PmtL_nc ion Ins.CD. �g2gp Elmo t VA 01925 lrssvR�1>3: ►Ivsv�e iNSURtA F: CO RAGI=S CERTIFICATE WUkl ER: Rf=MION NUMBLR: TI-!IS 18 TO CeRTIFY THAT THE POLI'-IES OF INSURANCE LISTED BELOW HAVE BEEN iS-9UZD`FO THE INSLIRED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWIrKSTANDING AfO*REQUIREMENT.TERM OR CONDITMON OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO W141CH THIS GS RTIFICATE MAY BE ISSUED OR A'IAY PERTAIN.THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL T14E TERMS. G.;CLUSION$AND C014DITIONS OF SUCH POLICIES.LNOTS SHOWY MAY HAVE BEEN REDUCED BY pA10 CLAIMS. ILS ii'?cOF(p($IlKAr:CE aD s GOLtSYNUSiBgR 1, Gr Ltu111E FIEP�AI.L3ASi6li� FACI4 OCCURREraCP ld r�i comm RCtaLGENF,,2`ALLIARILcV M021000227 09/95/93 Q717BJ9© PaEbt_ ISES�eacrurrcnce S 9(9/J,130 GLa!MS-MADE 1�, OCCUR AtEDUP anvDemn) S 6,01 PERSGNALSADVIINJURY S 1,000,05 Gi:NHRAI AGGREGAT9 ; 2.000,0 QErrL AC;GRcGATgP�04aPP{,tE3 PER: PRODUCTS-CC&IMPAGG S 2,tfL1f,170+ POLICY LOC s AU TO.MR1LE L(Aaftir' COM8INED SINGLE Lntrr ANT AUTO (Beac6tranl) a c,0©t,i?ICG ALL OVAMD AVM BODILY INJURY(Per Damon) 5 C X SCWEDULEDAUTOsBQ�QOd723a'I OSiOT/4 051117/43 BOD11WINJURY(Perawd" 5 HIREDAUTOS FROPeRlYDIIMAGE (Parceck�eni) 9 Nox-ov,^iEDauTos Underinsurad S 40U/30 UnInsumd IH-- U�ISRL L�auae occuR I s 9gQ1 G CESS LAE I EACH OCCURRENCE S ([lUNiS•'AA{!c ( AGGREGATE RETENTION- S +A+ORKEFES COMPENSAM--N S ANO&.7PL0YcR3'LlA9ILl17 Y!LN h 887�1.td�g 9TH' ANY PRCPRIETOR!PARLU0,:0 ECIRNE�� r:lA Qj�j�R7QG 99/9519x" 04196144 ELEAeliACCI0g D t9f}l3PJ CFFtC@RtttE lBeP.EsCLUD:Bi P.itnu'sC�ry In NH) 4GO,itQ' �!Pes tla3erbevnaar E.L.01SEAS -F EA@1PL0Yf 1 3 DESGiRIRT1DNOF0A RATIONSbelaty EL OEM--POUCYLIMIY S F!Q>i,13f1(} DiSGRIPfIbNOPpPEEv'AiTON91LOCAilON9rY�FRCLS,q(AI�ehA6C13D1G4, utUonatRaraae�8ehcdute.if�opseeto,�vt,� We Propielor'iThomes Ouinn Is Encluded underWorkem crimp TO L40LUER CANCELLATION s�eU6l3arJY9F rtlE AHC3VE tIESCRi@ED AOLICII=S BE CANC'sl.LE6 BEFORE ,"R EAPIRAT(ON DATE THEREOF. NOTICE WILL BE V=-LMReD IFJ ACCORDANCE WITH Tlrm POLICY PROVISIONS. utrlFil�R1ZED REPR�SF.IYTQTAli: ®1988.201)9 MRD CORPORATION. All rights reserared. 10086�6{JOBB/8 } The AGORD wal'rte and logo are rerois8ered ma ft of A,CORD