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Building Permit #428-14 - 776 DALE STREET 11/12/2013
TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received Date Issued: �1 MPORTANT:Applicant must complete all items on this page We LOCATION �.:7ta T .. Pont PROPERTY OWNER Primo- 100 Year Old Structure yes nno MAP NO: _ PARCEL�_ZONING DISTRICT 'Historic District yesachine Shop Village yes TYPE OF IMPROVEMENT. PROPOSED USE Residential Non- Residential ❑ New Building A-One family El Addition ❑Two or more family El Industrial ❑Alteration No. of units: ❑ Commercial repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other Septic 0 Well 0 Floodplain ❑Wetlands C7 Watershed District D ` (I Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: fir; S`1I%1G12 f?,od� , �1-- LE Identification Please Type or Print Clearly) OWNER: Name: Phone: Address: CONTRACTOR Name: . .('��2_' �(41 �- _ Phone: Address: 3 "50�n l wt 5sur+-f IMA 0/67f6 Supervisor's Construction License:_ l O - 3 Exp. Date: 3._ Home Improvement License: f70S7 Exp. Date: i /J/o 11� - ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. V r/ Total Project Cost: $ 1-5,r (000- FEE: $ �16 Check No.: Receipt No.: �� I NOTE: Persons contractind with unregistered contractors do not have access to anty fund Signature of Agent%Ovvner Slgatiare,of_confractol Plans Submitted Lj Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ Location "')')& D✓ No. Date ////2- 0 ate // /L• - TOWN OF NORTH ANDOVER d . . Certificate of Occupancy $ Building/Frame Permit Fee $ � - Foundation Permit Fee � Other Permit Fee $ TOTAL $ ^t� Check# 2.7 0 .0- J Building Inspector i Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ -: 'TYPEOF=:SEWERAGEDiSP:OSAL Public Sewer ❑ Tanning/Massage/BodyArt ❑. . Swimming Pools D Well ❑ Tobacco.Sales ❑ Food Packaging/Sales -El 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 Conservation Decision: :Comments Water & Sewer Connection/Signature& Date Driveway Permit DPW To`v : 1Engineer: Signature: C _ Located 384 Osgood Street FIRE DEPAR'TME'NT --Temp Dumpster on site- yes_ no Located'at 124,Mair,Street:::.- -'Fire-06' signature/date` = - -'_• COMMENTS Dimension Number of Stories: Totals square feet of floor area based on Exterior dimensions. imensions. _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 Doc.Building Permit Revised 2010 Building Department The fol-3wing is-a list of the required forms to be-filled out for the appropriate.permit to be obtained. Roofivg, 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) o 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 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 submAted with the building application Doc: Doc.Building Permit Revised 2012 NORTH own of 2917 . ' . . ndover O - 0 No. 42f--++ * _ 444-.7,-, ver, Mass , A /I CONIC Nl wicK ORATED /eP���S S V BOARD OF HEALTH PER T L D Food/Kitchen Septic System ,) 01 BUILDING INSPECTOR T THIS CERTIFIES THAT .E !! f ..................................................... has permission to erect .......................... buildings on 3�* Foundation *.0 Rough to be occupied as .....� . ... ..... .. .. .. te, ... .. ......... Chimney provided that the person accepti g this permit shall in everyt 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 CONSTRUCTION AR Rough Service ...................... ........................ ........... Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Building 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 OCT-29-2013 TUE 02:20 PM ROCCO ROSE INS FAX NO, 5085804924 P. 01 CERTIFICATE OF LIABILITY INSURANCE DATE`AAMeD> ���® 10/229/9/ 13 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDU=P. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the polic res)must be endorsed. if SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement A stafament on ttris certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER NAME; _ Kirra Xotsio�oulos ._. Rocco Rose Insurance PHONE 508 584-710Q FAx N-1 (508) 580-4920 360 Oak Street nfss: kirra@roccorose-com Brockton, MA 02301 INSUR1ERSIAFFORDINGCOVERAGIw_• _• AIC-t INSURERA:E91,9LQ X Insurance Company -- INSURED INS(URERe:•Liber _•Mutual Paramo Daniela Construction INSURER X:: _- 544 North Maize St. INsuRFRo: Brockton, MA 02301 INSURERS: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS 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`6Y THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS. EXCLUSIONS AND CONDITIONS OF SUCH POUCIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. g ."... ADDI.SI)BR POLICYpp(fP•• LTR TYPE of INSURANCE POU LY NUMBER M1(CDIV MMIDDPYYYY LI GENERAL LIABILITY 3D43233 10/7/13 10/7/14 EACH OCCURRENCE _ i LQC10,00Q_ A DAMAGE RENTED A. 50,000_ S{ COMdERCIALCENEPAL LIAR ILITY P EIAIc !UFA CVtp . . 1 CLAIMS-MADE LX I OCCUR NEO FttP(Art�ore Dascn} $ '000 PERSONAL$IDV INJURY $ 1,X00 10–0-9 —" GENERAL AGGREGATE $ 2,00 000 GEN'IAGGREGATELIMITAPPUESPER PRODUCTS-COMPIOPAGG S 2,000,000• RRO• 3 X POLICY. LOC AUTOMOBILELIABIUTY ,tleg) ELM $ Ea •^__ BODILY INJURY(Pet Perscn) 3 ANYAUTO •– ---• AALI UYO&IED SCHEDULED BODILY INJURY(Par smident) $ NON-OWNED AUTOS PWacCl�t)A4WGE g HIREDAUTOS _AUTOS 3 UMBRELLA LIAR OCCUR EACH OCCURRENCE S, EXCESS LIAR CLAIMS-MADE AGGREGATE S DED RETENTION WC STATU- X>1H- B YORKERS COMPENSATION WC5-'31S-370076012 10/30/13 10/30/14 IMI X AND BAPLOYERS'LABII-ITV ANY PROPRIEMRIPARfNEIVEXECUTIVE Y!N F,L;EACHACC106Nf A;_. 500100.0 OFF{CERINIEMBER EXCLUDED? N r A E.L.DISEASE.EA EMPLOYE 509•000 IMandavy in NH) 11 oz.desUibauntler E.L.DISEASF-POLICY LIMIT S 500,000 DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS/LOCATIONS t VEHICLES!Attach ACORD 101,Additienar Remarks 6clwdWe,if more spew is roqurod) Workers compensation insurance coverage applies only to workers compensation laws of the state of MA. Segundo Loja-Simberina is exempt by the workers' compensation policy. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES 199 CANCELLED BEFORE THE EXPIRATION DATE THEREDF, NOTICE WILL BE DELIVERED IN Navejans Construction ACCORDANCE WITH THE POLICY PROVISIONS. AUINORILEDREPRESENTATIV Katie Eclan 0 j9_8844flO ACORD CORPORATION. An rights reserved, ACORD 26(2010105) The ACORD name and logo are registered marks of ACORD Phone: Fax: (401) 624-8744 E-Mail: Massachusetts-Department of Public Safety Bgard of Building Regulations end Standards' �`� . ',Cot�.atra rti�y� Suhcr�iwr Sheciall� ., License: CSSL-105943 ( VINCENT COL-ANGELO 3 HODGSONSTREET Tewksbury MA 01876 ) Iommi_ssoon er Mt Expiration 03/09/2016 ��/��ac�uuleGta s elle °iwnwnwecc��f o, Office of Consumer Affairs&Business Regulation ME IMPROVEMENT CONTRACTOR Type. 9, egistration: 170575DBA 1 piration: 111.012015 CD ROOFING VINCENT COLANGELO gam'= 2� 3 HODGSON ST TEWKSBURY,MA 01876 Undersecretary 3 Hodgson St. Residential/Commercial Tewksbury, MA.01876 , Masonry Ph: (978) 656-8497 Vincent Colangelo Free Estimates Lic. #170575 ROOFING Fully Insured Proposal Submitted to Homeowner Work To Be Performed At Name Ve4y f'r'nrt ing,I)q M Street = � Street >?6 bile, S f City AJ. Aidoue.r State MA City State Date It/6//'T Telephone " -60W_0Dl y-.S— Telephone 62q U— 6i rm 0 Yq h oy Cc/" ComC!p", Description of Work to be Performed: TO Sfr; —OPF 2 ;S ;� /cA r q/Id P/ us 9,1d r - %a Cy s �r,' edq i,) ee+ © � :rC—P Lo q4ef S re l d o s f S c �' -�'�a2 1�t'C Fe 1+ P4 Pe e ow Ve'l f &fl, V4ejf 60AA D/e fe ly Ce.-P/ 2 f n ofDrip Q-Ari 7 o fe- 'ffefp: �- 0 E O f'/t O hne A ) Gi W/P t g a'qe- ` `t.' 125 . (SO 'f'o S.' ear f 4 e r Z"e j -f' w; 4, ax 8S 6 6e Use. rcA Rood's %,e(ude,e.. r,'G2 r/v to cLeS Mcr fe r,n fs l,�or 6,2'" s-/e r- bigr Date work will start Date work will be completed All material is guaranteed to be as specified.All work"to be completed in a workmanlike manner according to standard practices.Any alteration or deviation from the above specifications must be made in writing on an Add-on/Modification of Contract form and may become an extra charge over and above the amount stated herein.This agreement is contingent upon delays beyond our control.Owners to carry fire,tornado and other necessary insurance.Our workers are fully covered by Worker's Compensation Insurance.Homeowner agrees to pay for all work as set forth below. If the homeowner defaults,homeowner agrees to pay all costs of collection,including reasonable attorneys fees,in addition to other damages incurred by contractor.Full Payment is due upon completion of work. We propose hereby to furnish material and labor-complete in accordance with the above specifications,for the sum of: dollars($ Sjp .^). Said amount shall be paid as follows: Note: This proposal may be withdrawn by us if not accepted within days. YOU, THE BUYER, 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 FOR AN EXPLANATION OF THIS RIGHT. THIS SALE IS SUBJECT TO THE PROVISIONS OF THE HOME SOLICITATION SALES ACT AND THE HOME IMPROVEMENT ACT THIS INSTRUMENT IS NOT NEGOTIABL . �r -Do Work will not begin untilgur right to cancel has expired and you - a de of o2 W'1 dollars($ "7f $0 n,"",unless this agreement provid a se. Signature of Contractor or authorized representative: - gp *([/We)have read the terms stated herein,they have been explained to(me/us),and(I/We)find them to be satisfactory and hereby accept them. Signature of Homeowner(s): 1S f �O Anxr� 36151 �- a. 51 : 'I TAS Ves,O bf',P = 3 I Mokr -- The Commonwealth of Massachusetts Department of IndustrlqlAccldints Office of Investigations 600 Washington Street Boston,MA 02111 www.mass.gov/dna Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Le2lbly Name(Business/Organization/Individual): T I! e T Address: City/State/Zip: --r;e,y K 5�u r,4 Phone#: q�0-65-6 ^ $YQ7 Are you an employer?Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. 91 am a general contractor and I 6 ' employees(full and/or part-time).* have hired the sub-contractors ❑New construction 2.El am a sole proprietor or partner- listed on the attached sheet. El Remodeling ship and'haveno employees These sub-contractors have 8. ❑Demolition working for me in any capacity. workers' comp.insurance. g• ❑Building addition [No workers' comp.insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL I L❑Plumbing repairs or additions myself. [No workers' comp. c. 152,§1(4),and we have no 12.❑Roof repairs insurance required.]t employees.[No workers' 13.[i Other comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. i Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. lam an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. " / Insurance Company Name: �t��/1 / (�/8 Gtol Policy#or Self-ins.Lic.#: NSP60060010 JYYU-� Expiration Date: /'/ A 7//.y Job Site Address: 7fe D9(P St City/State/Zip: / 1,D0w/' Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as requiredunder 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. Ido hereby ce der t1 ains and penalties of perjury that the information provided above/is true and correct. Signature: Date: Phone#• q78 CP l�_6- b q�7 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#: Informati®n and Instructi®ns ' Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or.written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152,§25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced-acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152,§25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance ofpublic work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractor(s)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers'compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. AIso be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(ifnecessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Co onwealt�o:fMassachusetts Department of Industrial Accidents Office of In:Vestigat ions. 600 Washington Street Boston,MA.02111 Tei,#617-727_4900 ext 406 or 1-877-MASSAFE Revised 5-26-05 Fax#617-727=7749 www mass,gov1dia CDROOFI.01 MGIRARD CERTIFICATE OF LIABILITY INSURANCE DATE 518120 3 5/8/2013 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(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 NAME: John M.Glover Agency PHONE F P.O.Box 700 ac No EAll(203)838-5554 ac No:(203)857-7848 Norwalk,CT 06852 EaNA1L ADDRESS: INSURERS AFFORDING COVERAGE NAIL INSURER A:Mesa Underwriters Specialty Ins.Co. 36838 INSURED INSURER 8:Massachusetts Workers Comp Vincent Colangelo dba CD Roofing INSURER C: 3 Hodgson Street INSURER 0: Tewksbury,MA 01876 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS 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 CONTRACTOR 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 AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ILTR TYPE OF INSURANCE bbL SUR POLICY EFF POLICY EXP INS MW POLICY NUMBER MMIDDNYYY) @RAMR= LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A X COMMERCIAL GENERAL LIABILITY MP0006001014422 4/27/2013 4/27/2014 PRG TO RE EM GES(Ea Eoccurrence) $ 100,000 CLAIMS-MADE X❑OCCUR MED EXP(Anyone person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 X POLICY jE LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Fa aqq! $ ANY AUTO BODILY INJURY(Per penton) $ ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) $ HIRED AUTOS NON-OWNED PROPERTY DAMAGE AUTOS PER ACCID $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAR HCLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ WORKERS COMPENSATION X WC STATU- OTH- AND EMPLOYERS'LIABILI Y YIN TORY LIMITS ER B ANY PROPRIEfOR/PARTNER/EXECUTiVE C-20-20-003639-01 5/14/2013 5/14/2014 E.L.EACH ACCIDENT $ 100,000 OFFICERWEMBER EXCLUDED? ❑ N/A (Mandatory in un E.L.DISEASE-EA EMPLOYE $ 100,000 IF yes,describe under DESCRIPTION OF OPERATIONS below EL.DISEASE-POLICY LIMIT 1$ 500,000 DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks Schedule,If more space Is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town of Tewksbury THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 1009 Main Street ACCORDANCE WITH THE POLICY PROVISIONS. Tewksbury,MA 01876 AUTHORIZED REPRESENTATIVE if Qv"� O 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD