HomeMy WebLinkAboutBuilding Permit #683-15 - 77 SUGARCANE LANE 2/2/2015Permit No#:
Date Issued:
BUILDING PERMIT
TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Date Received
IMPORTANT:
must con
all items on this
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-PROPERTY OV1/NER (���� - -
P� - - Punt 100 Year Stru ,0 y s nb,,
MAP .r V PARCELZONING QIST13 :Historic District yesp Village yes
TYPE OF IMPROVEMENT
PROPOSED USE
Residential
Non- Residential
❑ New Building
❑ One family
El Addition
El Two or more family
El Industrial
❑ Alteration
No. of units:
❑ Commercial
❑ Repair, replacement
❑ Assessory Bldg
❑ Others:
❑ Demolition
❑ Other
0 Septic, ❑ 1Nell'
❑1Floodpla.in `Wetlands.
❑Watershed=Datnct,
;:Wates
/Sewer
OWNER: Name:
Address:
DESCRIPTION OF WUKK I U tSt rtKrUKivitu:
- Please Type or Print Clearly
Phone:
Address:: 1,1
Superuis.or's Con ruction! License:__ _sv__=_Exp::Date: _ _ --
- _.
Homelrnprovement'L�cense _-��_l� Exp;:,;Date:-
ARCHITECT/ENGINEER Phone:
Address: Reg. No.
FEE SCHEDULE: BULDING PERMIT: $� 112.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F.
Total Project Cost: $ �a�0 FEE: $ 5a �
Check No.: �00 ` 2 Receipt No.:
NOTE: Persons contracting withg' er&contractors do not have access to thea ty J
,
?.I,j7
- r -JIM r
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
PLANNING & DEVELOPMENT Reviewed On Signature
COMMENTS
CONSERVATION Reviewed on Signature
COMMENTS
HEALTH
COMMENTS
Reviewed on Signature
Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes
r
Planning Board Decision:
2
Conservation Decision:
Comme
Comments
Water & Sewer Connection/Signature & Date Driveway Permit
DPW Town Engineer: Signature:
Located at -,12
Fire Depai
5
Dimension
Number of Stories
Total land area, sq. ft.:
Total square feet of floor area, based on Exterior dimensions.
ELECTRICAL: Movement of Meter location, mast or service drop requires approval of
Electrical Inspector Yes No
DANGER ZONE LITERATURE: Yes
MGL Chapter 166 Section 21A —F and G min.$100-$1000 fine
NU I E5 and DATA — (For department use
❑ Notified for pickup Call Emai
Date Time Contact Name
Doc.Building Pen -nit Revised 2014
No
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/Cross Section/Elevation Plan Of Proposed Work With Sprinkler Plan And
Hydraulic Calculations (If Applicable)
❑ Mass check Energy Compliance Report (If Applicable)
❑ Engineering Affidavits for Engineered products
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
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: Building Permit Revised 2014
Location �QmNaja-,V—
No.
Date ]�2 15
Check #
28522
TOWN OF NORTH ANDOVER
Certificate of Occupancy $
Building/Frame Permit Fee $ ` i-:6
Foundation Permit Fee $
Other Permit Fee $
TOTAL $
Building Inspector
,40
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next step Living,
home energy solutions
This agreement is made by and among
Next Step Living, Inc. ("NSL")
Ed Shaw 21 Drydock Avenue, 2nd floor
77 Sugarcane Ln Boston, MA 02210
North Andover, MA 01845 phone: (866) 867-8729
Site ID: A780376
20 -Jan -15
1. DESCRIPTION OF WORK TO BE PERFORMED
NSL will perform or cause to be performed the following work on the customer's address above, in a professional manner and in accordance
with the terms of this Contract, including the attached recommendations/work order describing the work in detail (the "Work") which are
incorporated herein by reference:
vvorK Location: Attic Flat
Perform Air Sealing at Estimated 62.5 CFM50 Per Hour 12 $75.00 Hr $900.00
WeatherizationRecommendations
Work Location: Attic Flat
Whole house fan box: Thermal Barrier Polyiso 2" (Attic)
Attic Stair Corer Thermal Barrier with Carpentry
Damming
Vent ;bath fan to: roof;f(apper
Propavent 2' or 4'
1
$209:21
Each
$209.21
2 '
$237:65
Each
$475.30
212
$2.05
Lnft
$434.60
.41 ,
$11x3;75
Each .
$475.100.
123
$2.00
Each
$246.00
536:
$1.08sgft;
$1,650::88
`100% Alrsealing Incentive up .. Program 1. ax $60Q:00':
75 % Weathenzation Incentive up to Program Max $2,000:00
Estimated Annual:;E1lergy. Savings`from the Above Improvements $4
2. PAYMENT: CUSTOMER agrees to pay NSL for the work as follows:
Payment #1: $100.00
-Credit Card or E -check deposit is due at the time the Work is scheduled. Required payment information will be collected over the phone by a customer service
representative at the time of scheduling. Deposit is not to exceed 1/3 of the total retail costs. (Note: Mastercard, Visa, and Discover accepted)
Additional Payments and Final Invoice: $1,698.99
-Additional Payments for the Work shall be due upon completion of the Work
If the final invoice is being paid by check, credit card information will still be required at the time of scheduling. Notify the customer service
representative th ou are paying by check and your card will not be charged unless we fail to receive payment within 5 days of invoice.
L
Customer Signature D to
20 Jan 2015 William Calder
NSL Signature Date Name of NSL Representative A780376
The Terms of this Agreement are contained on both sides of this page
Next Step Living - 21 Drydock Avenue " 2nd floor - Boston, MA 02210 - (866) 867-8729 " inquiry@nextsteplivinginc.com - www.nextstepliving.com
TERMS OF AGREEMENT
3. PROPOSED START DATE AND COMPLETION SCHEDULE
NSL will contact customer to schedule the Work at a mutually agreeable time, subject to the availability of subcontractors or materials, or to delays
attributable to the weather or other events beyond NSL's control.
4. CONTRACTOR REGISTRATION
Massachusetts law requires home improvement contractors and subcontractors to be registered with the Director of Home Improvement Contractor
Registration. You may inquire about contractor registration by writing to Office of Consumer Affairs and Business Regulation, Ten Park Plaza, Suite
5170, Boston, MA 02116.617.973.8700.
5. PERMITS
NSL will obtain any necessary permits as the Customers agent. Customers who secure their own permits or deal with an unregistered contractor will be
excluded from the Guaranty Fund provisions of the Home Improvement Contractor Law.
6. PERFORMANCE OF THE WORK AND CHANGES.
6.1 NSL will not commence the Work prior to signing this Agreement and transmittal of a copy of Agreement to the Customer
6.2 This Agreement may be supplemented, amended, or modified only by the mutual agreement of the parties. No supplement, amendment, or
modification of this Agreement shall be binding unless it is in writing and signed by all parties.
6.3 At times, our weatherization team discovers situations in the structure during the course of the Work that indicates a risk for a health or safety concern
for residents. Such concerns can include but are not limited to ventilation, potentially hazardous materials such as mold or asbestos, or structural
concerns. In the case of health or safety concerns being identified, NSL reserves the right, per section 9.2 of this contract, to communicate concerns to
the Customer and halt work unfit such concerns have been addressed.
6.4 The rebates and incentives available from the Mass Save® Home Energy Services Program and amounts due from the Customer are based on the
best estimate of the situation in the structure by the NSL home energy advisor. However, at times our weatherization team discovers situations in the
home during the course of the Work that impact the availability of rebates and incentives from the Mass Save Program. In such situations, NSL will
communicate such changes to the Customer, including any impact on amount the Customer would be expected to pay for the Work. The Customer will
have the option to remove from the Contract the work elements that need adjustment, or set up a separate contract for performing the adjusted work.
6.5 NSL represents and warrants to the Customer that (a) the materials and equipment furnished under this Agreement will be of good quality and new,
(b) that the Work will be free from defects, and (c) that the Work will conform with the description of the Work described in Paragraph 1.
7. INSURANCE AND REGISTRATION
NSL represents and warrants to the Customer that it has a valid Home Improvement Contractor Registration (No: 162111) and the necessary insurance
required by applicable law and normally maintained by prudent contractors in NSL's field, including, but not limited to, Workers Compensation Insurance
for all employees who will perform the Work.
8. QUALITY OF WORK.
NSL agrees that the Work will be performed in a good and workmanlike manner, and that NSL will repair and replace, at its own expense, and promptly
upon Customers request, any defects in workmanship and materials provided by NSL which appear up to (1) year after completion of the Work or within
any longer period as permitted or required under applicable law, provided NSL has received final payment as provided herein.
9. PRE-EXISTING CONDITIONS & PROPERTY PROTECTION
9.1 NSL shall not be responsible for any damages as a consequence of the Work performed in the home due to pre-existing conditions. These conditions
include but are not limited to poorly fastened or broken drywall, moisture damage, non -code construction, cracked or fragile siding or shingles, old pipes
and fittings, rotting wood, etc.
9.2 NSL reserves the right not to perform Work upon the discovery of asbestos, mold, or any other potential health risk to the Customer. In this event, the
Customer is responsible for remedying the at -risk situation, including any necessary removal of hazardous materials and all bills for services to date shall
be paid immediately. Work cannot resume until remediation is complete.
9.3 While NSL will make best efforts to protect any property of the Customer, it is the Customer's responsibility to remove or protect, including dust
protection, any personal property including the home itself. NSL will not be responsible for damages to or losses of any of the above mentioned property
not properly protected prior to the commencement of the Work.
10. GENERAL PROVISIONS.
10.1 NSL reserves the right, the extent permitted by applicable law, to have, file or maintain a mechanic's or material men's lien, or to file a notice of
intention to lien, and to take any other steps to perfect and enforce such a lien, if Customer fails to pay NSL as provided herein.
10.2 This Agreement shall be construed in accordance with the laws of the Commonwealth of Massachusetts.
10.3 This Agreement forms the complete integrated agreement between NSL and Customer. The parties represent and warrant that in executing this
Agreement, they are not relying on any representations, warranties or terms other than as expressly contained herein. This Agreement supersedes all
prior agreements between the Customer and Contractor and may not be altered absent a subsequent written agreement signed by both parties.
You may cancel this Agreement if it has been signed at a place other than the NSL's normal place of business, provided you notify NSL in writing at its
main office or branch office by ordinary mail posted, by telegram sent or by delivery, not later than midnight of the third business day following the signing
of this Agreement. See the attached notice of cancellation form for an explanation of this right.
11. ENERGY BENEFITS.
The Sponsoring Utility Company (the Utility) is entitled to 100% of the energy benefits associated with all Energy Conservation Measures, excluding the
value of energy cost savings by the Customer, but including all rights to all associated ISO -NE Energy, Capacity and Reserves Products. NSL agrees to
provide the Utility with such further documentation as the Utility may request to confirm the Utility's ownership of such benefits and Products.
12. NOTICE CONCERNING SPONSORSHIP.
Customer understands and acknowledges that NSL is not an agent, vendor or sub -vendor of The Sponsoring Utility Company (the Utility) with respect to
the installation of an energy efficiency measures. In the event of the failure of an energy conservation device to perform as expected, Customers sole
recourse is to Contractor and not to Conservation Services Group (CSG) or to the Utility. The Utility and its operating companies shall not maintain,
remove or perform any work whatsoever on the energy conservation measures installed.
Customer understands and acknowledges that their participation in the Mass Save Home Energy Services Program is voluntary and that they have
consented for Contractor to install the proposed energy conservation measures.
Customer agrees that it shall not hold CSG, the Utility, their affiliates or operating companies liable for Contractor's to perform its obligations under this
agreement, for failure of the energy conservation measures to function, for any damage to Customer's Premises caused by Contractor or for any and all
damages to property or injury to persons caused by the energy conservation measures.
13. LIMITED TIME OFFER.
The prices and incentive offered in this Contract are subject to change in accordance with The Sponsoring Utility Company Mass Save Home Energy
Services Program offers.
14. CONTRACT CANCELLATION Under Massachusetts law, you may cancel this agreement if it has been signed by a party thereto ata
place other than an address of the seller, which may be his main office or a 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 this agreement.
. Mass Save Planview Diagram
Customer. SInr1 w Advisor Name:
Address � � o (r� cn� 4\ Advisor Number:
Town ��jl,/le� Any limitations to access by truck?
Site ID b V (fes
NOTES L
S
-�eOefiocweo ConsumerAff4(
]���°]� ��� o Suite 5 1 70
®
> '
Boston, Massachusetts 02116
Home imprr®ve ent'Cont actor Registration
Registration: 162111
Type: Supplement Card
Expiration: 1/14/2017
NE®CT STEP LIVING INC.
ROGER OUELLETTE
21 DRYD®CK AVE. 2TH FL
BOSTON, MA 0221
JPB-C,ki C, 50M-04104-G^0121E
Jr,
>, ®ffrece of Consumer Affairs & Business Regulation
�r 98®i!!iE lVlfiPROVEMENT CONTRACTOR
<y Registration: 162111 Type:
•`i
Expiration: 1!1412017 Supplement Card
f..
NEXT STEP UMNG:ING.
ROGER OUELLETTE
21 DRYDOCK AVE. 2TH FL
BOSTON, MA 02210 Undersecretary
Update Address and return card. Mark reason for change.
Address [] Renewal F-] IEmpRoyment F] (Lost Card
]License or registration valid for individui use only
before the expiration date. iff found return to,
Office of Consumer Affairs and Business Regulation
10 Park Plaza - Seita 519®
Boston, MA 0211,6
without signature
Massachusetts - Department of Public Safety
Board of Budding Regulations and Standards
Construction Supenisor SpecialltN
License' QSSL-` 02BII
R OGIlER A ®Vl LIZ'TT'T
Warmck RN 029
Expiration
r,ornmissioneI
Ree( lcted To: CSSUC e MsulaAioIR COntrF&cMOF
FaHure to possess a curUek edition of the Ga11MOChusetts
state Bu li ling Cade is gause for revocAlorn VOWS HOS'nsee
For DPS Lo"censing Wormation,&,dot: %IftIjz\,JAQss.GOv/DV S
The Commonwealth oaf °Massachusetts
Department o f °In dustrdal Accidents
Office oef °Invesfigadons
I Congress Street, Suite 100
Boston, MA 02414-2017
www.mass.gov1dia
Workers' Compensation Insurance Affidavit: Buflders/Contractors/Electricians/Eluunbers
AAppficant Information Please Print Lefbly
Nal'I<lle (Business/Organization/Individual):
Next Step Living
Address: 21 Drydock Ave
Boston, MA 02210
Phone #o (866)667-6729
Are you an employer? Check the appropriate box;
I. CH I am a employer with 850 4. ® I am a general contractor and I
employees (full and/or part-time).* have hired the sub -contractors
2.0 1 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. employees and have workers'
[No workers' comp. insurance comp. insurance.t
required.] 5. ®ale are a corporation and its
3. ® I am a homeowner doing all work officers have exercised their
myself. [No workers' comp.
insurance required.] t
right of exemption per 11/ICCL
c. 152, §1(4), and we have no
employees. [No workers'
coma. insurance required.l
Type of project (required):
6. ® New construction
7. ®Remodeling
8. ® Demolition
9. ® wilding addition
10.n Electrical repairs or additions
I I.® plumbing repairs or additions
12.0 hoof repairs
13JI-31 Other Insulation
*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 affida, -it indicating such.
tContractors that check this box must attached an additional sheet showing the name of the sub -contractors and state whether or not thow Entities have
employees. 1_f 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, ®b site
information.
Insurance Company Name: A.I.AA Mutual Insurance Company —
Policy # or Self -ins. Lic. #:AWC-400-7030025-2014A Expiration Date: 9/30/15
Job Site Address: City/State/Zip:
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 fiction.
I do hereby ce#W t sander the pains ape-ni FFes perjury that the information provided above is trace and correct
Signa e: Date:
Phone #-���� _7 -3-7d
Official use only. Do not write in this area, to be completed by city or town official.
City or Towne 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 #:
NEXTS=9 OP ID: EL
� Y
CERTIFICATE OF LIABILITY INSURANCE
DATE(MMIDDIYYYY)
i®/01/2®14
THIS CERTIFICATE IS ISSUED AS A MATTER OF 9NFORMAT90M ONy AND CONFERS NO RIGI1T% UPON TH9 WRTIFIGATP HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR A( TER THE COVERAGE AFFORDED BY THE POLICIES
BELDVV. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRArT BETWEEN THE ISSUING INSURER(S), 4PTHORIMP
RgP PSENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
QIPMANT: If the reetificate holder Is an ADDITIONAL INSURED, the policy(les) must be endorsed. If SUBROGATION I4- _ 5"Qg eo )��
the terms and conditions of the policy, certain poUcies may require an endorsement. A statement on this certificate does not confer eight§ to Jhq
certificate molder in lieu of such endorsernent(s).
PRODUCER
lMgLaughlifl l�ppsaa'anc® Agency
528 Lynn felgs Parkwpy
Melrose, MA 02175
John E. McLaughlin Jr.
CONTACT
NAME:EPlrl Lyons
PRONE 761=665.2775 �c No : 761=665=02
AIc No Ery
EMAIL
ADDRESS:
INSURER(S) AFFORDING COVERAGE MAIC 0
INSURER A: N9aUtiiUS IrnSUFanCe
INSURED. , , I ,v i �Iving, Inc.
21 Drydock Avenue, 2nd Floor
Boston, MA 02210
INSURERS: COMMerce Insurance Company 3475
INSURERC:A.I.M. Mutual Insurance Co.
INsuRERD:AXIS Insurance Company 15610
INSURER E:
INSURER F:
GES CERTIFICA-WE NUMBER: KE-VuSiON NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY P�RI8P
INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH j IE
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS,
TR
TYPE OF INSURANCE
POLICY NUMBER
POLICY EFF
MMO]DIYYYY)
POLICY EXP
(MMIDDNYYYI
LIMITS
A
COMMERCIAL 612 9 "(RAL LIABILITY
EACH OCCURRENCE $ 9,000,000
PREMSES Eaoc urrence $ 100,000
CLAIMS MADE ®OCCUR
��P2®�®955=t2
®�/3®/2024
Og/3®/2®95
MED EXP (Ary one person) $ 0,000
PERSONAL &ADV INJURY $ 4#9,4
GEN'L AGGREGATE LIMIT APPLIES PER:
GENERAL AGGREGATE $ MP0100
-PRODUCTS $ �, OUPO
RO
POLICY ❑ JECTP' LOC
$
Ea aCOMoc denOtSINGLE LIMIT $ 2 a�®i?,�P '
OTHER:p
AUTOMOBILE UABII ifY
BODILY INJURY (Per person) $
ANY AUTO
14MMOOItKOM
09/30/2024
09/30/209 u
BODILY INJURY (Per accident) $
ALL OWNEDSCHEDULED
AUTOS NO OWNED AUTOS
HIRED AUTOS AUTOS
PROPERTY DAMAGE $
Per accident
$
UMBRELLA UAB
OCCUR
EACH OCCURRENCE $ 5,000 00
AGGREGATE $ 0190.40
EXCESS LIAB
CLAIMS -MADE
EpU753547092024
09/30/2014
09/30/2095
DED RETENTION $
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITYYa
$
X STATUTE ERH
TO BE ISSUED BY CARRIER
09/30/2014
0 / 30/2015
E.L. EACH ACCIDENT $ 500,000
EL. DISEASE - EA EMPLOYEE $ 500,000
OFFICERIME BER EXCLUDE[ ?CECUTIVE
(Mandatory In NH)
If yes, describe under
DESCRIPTION OF OPERATIONS below
N / A
E.L. DISEASE - POLICY LIMIT $ 500,000
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space is required)
FOR :ENFORMTION ONLY
INFO -01 I
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
For Information Only I ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
TION. All riohts reserved.
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