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HomeMy WebLinkAboutBuilding Permit #116-14 - 80 SETTLERS RIDGE ROAD 8/5/2013 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit N0:11� r ' Date Received Date Issued: .&, IMPORTANT:Applicant must complete all items on this page LOCATION PROPERTY OWNER f. 1 ;6- J r/Z Print 100 Year Old Structure yes no MAP No: PARCEL:LO ZONING DISTRICT: Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building lc�-6ne family 0 Addition ❑Two or more family ❑ Industrial [s7-Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic ❑Well ❑ Floodplain ❑Wetlands ❑ Watershed District B-Nater/Sewer DESCRIPTION OF WORK TO BE PERFORMED: fZ_L tn cr J r- a 0/4 rZ c�a jvA Identification Please Type or Print Clearly) OWNER: Name: Phone: Address: CONTRACTOR Name:_K6�E V �0 r. 57 Phone: ' _�q • ,�acJ ] Address: Lu ;. T� P�V c Supervisor's Construction License: 5'z,2 �15 Exp. Date: 3 ^/ Home Improvement License: 1f) 3 Exp. Date: g '/ 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. 00 Total Project Cost: $ 3 3 17 o $ _ FEE: $ Check No.: Receipt No.: _ G,r!�g NOTE: Person cont acting with unregistered contractors do not have access to the guaranty fund `Signature of Agent/Owner Signature of contra_cto ___ _ Plans Submitted ❑ Plans Waived 0 Certified Plot Plan ❑ Stamped Plans ❑ Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Swimming Pools ❑ Tanning/Massage/Body Art ❑ Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ i 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 ---u 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 Tow Engineer: Signature: Located 384 Osgood Street F`IRE':DEPARTMFNT - Temp Dumpster on site yes no Located at 124 Maiq Street Fire Departinentsignature/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.$10041000 fine NOTES and DATA— (For department use ® Notified for pickup - Date I Doc.Building Permit Revised 2010 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 o Copy of Contract o Floor Plan Or Proposed Interior Work o Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks o 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) o 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) o Building Permit Application o Certified Proposed Plot Plan o Photo of H.I.C. And C.S.L. Licenses Li Workers Comp Affidavit o Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) o Copy of Contract ❑ Mass check Energy Compliance Report a 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 subm;tted with the building application Doc: Doc.Building Permit Revised 2012 R—DLocation 1�f ` No. - IL Date l • - TOWN OF NORTH ANDOVER tfi=ED ria' • Certificate of Occupancy $ Building/Frame Permit Fee $� Foundation Permit Fee Other Permit Fee TOTAL $ Check# . �, r . ._ Building Inspector Enter construction cost for fee cal - North Andover Fee Calculation Construction Cost 33,008.00 m $ - $ 396.10 Plumbing Fee $ 49.51 Gas Fee 100 comm. $ 100.00 Electrical Fee $ 49.51 Total fees collected $ 595.12 80 Settlers Ridge Road 116-14 on 8/5/2013 Remodel Master Bathroom i KEEN CONSTRUCTION CO. GP a 21 HEWITT AVENUE PROPOSAL NORTH ANDOVER. MA 01845 Tel: (978)691-5201 All home improvement contractors and subcontractors engaged in home improvement contracting, unless Oka Fax:(978)682-3231 specifically exempt from registration by Provisions of Chapter 142A of the general laws,must be registered with i Submitted .�`Ri,�, 3 ! . i _. the Commonwealth of Massachusetts. Inquiries about To. —_----,.--_ �t.-_r-�_- ------_, L-Io t--- registration and status should be made t t he Director, Home Improvement Contract Registration,One Ashburton L>- r � �` ��" '` E_ ��i__-._...._.._ Place,Room 1301,Boston,MA 02108 (617) 727-8598. ---.-.-------_......._..._. _ Owners who secure their own construction related fi d�% //4,;4 L /�J til/ �/`� permits or deal with unregistered contractors will - - — — be excluded from the Guaranty Fund Provision of MGL c.142A. PHONE DAT REGISTRATION NO. "N N.C) 3, 1/1 j MA. H.I.C. 108383 26-0462904 C/S=Customer Supplied S+I=Supply+Install l See Attached Appendix A 4 We hereby submit specifications and estimates for work to be performed and materials to be used: i -- --__ .......... --- i _._---_._..___._-- i Ii -- -- --------- ------------ -- --... ----------- -----................... - -- - -- - i - --- - --__-- - -- -. -- ----- ---------- ------------ ------------ > Construction related permits: ____._.,...._..._.__....__—..._... _............ .-.-.._............. ....._._..____...,.,......__........ ..... ............-...............................-...................................................... ..... ...... ................_........................................ ................. ...... --_............................. _.-._...... ..... _____..._.......... ......... _... WORK SCHEDU4E Contract r�rilljnc�t b gin.toe work or order the materials before the third day following the signing of this Agreement,unless specified her! Sryq. PMa�ctor will begin the work on or about�11 (date). Barring delay caused by circumstances beyond Contractor's control,the work will be completed by / I (date). The Owner hereby acknowledges and agrees that the scheduling dates are approximate and that such delays that are not avoidable by the Contractor shall not be considered as violations of this Agreement. WARRANTY The Contractor warrants that the work furnished hereunder shall be free from defects in materials and workmanship for a period of I '_following completion and shall comply with the requirements of this Agreement. In the event any defect in workmanship or materials,or damage caused by the Contractor,ffis subcontractors,employees or agents,is discovered within one year after completion of any job,including cleanup,the Contractor shall,at his own expense,forthwith remedy,repair,correct,replace,or cause to be remedied, repaired,or replaced,such damage or such defect in materials or workmanship.The foregoing warranties shall survive any inspection performed in connection with the agreed-upon work. We Propose hereby to furnish material and labor-complete in accordance with above s ecifications,for the sum of r t -I I _ C� ~� L''�'1 1 V .O `J s✓; C l Y�r`E� ``'t b t�!�,`t.(' J' 'i t LL.dollars($ �t-' Payment to be made A follows: )' ($ ) upon signing Contract; KENNETH B. KEEN/ROBERT A. KEEN Name of Contractor/Designated Registrant ($ ) upon c04npletiod of , 21 HEWITT AVE. $treat Address (.$ upon completion of N. AkD E_R; MA 01845 City/State shall be made forthwith upon (978)691-5201 (978)682-3231 completion of work under this contract. Phoge I Fax Notice: No agreement for home improvement contracting work shall require a r4l)r r i' fes.£✓) down payment(advance deposit)of more than one-third of the total contract price Name of 7,;k", or the total amount of all deposits or payments which the contractor must make,in } �- advance,to order and/or otherwise obtain delivery of special order materials and Authonzed signature equipment,whichever amount is greater. Note:This proposal may be withdrawn by us if not accepted within days. Acceptance Of Proposal-I have read both sides of this document and all attached documents and accept the prices,specifications and conditions stated. I understand that upon signing,this proposal becomes a binding contract. You are authorized to do the work as specified. Payment will be made as outlined above. You,the Buyer,may cancel this transaction at any time prior to midnight of the third business day after the date of this transaction.Cancellation must be done in writing. DO NPT T SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES. Signature Da ��".�l Signature Date IMPORTANT INFORMATION ON BACK 11111i NORTH own Of E ndover No. - AILo "�11 h , ver, Mass, �` 3 ,/- COCNICH2.11. S U BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System THIS CERTIFIES THAT ..................`. I' !1 �.�..�'",.... ..... ,,,,,,,,,,,,,,,,,,,,,,,,,, BUILDING INSPECTOR .... ............................... Foundation has permission to erect .......................... buildings on ..&Q...... . .... ...... ......... Rough to be occupied as .......... ..........,6&4.4►......A"Mw4r d. ......®.•••................... Chimney provided that the person accepting this permit shall in every 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 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 KEEN CONSTRUCTION CO. 21 HEWITT AVE. N. ANDOVER, MA 01845 978-691-5201 KeenConstructionCo.com Kent, Jerry & Kellie 80 Settlers Ridge Rd. N. Andover, MA 01845 978-975-1904 Contract # 5045: Appendix A Date: 7/30/2013 Remodel Master Bath: Remove existing shower, tub, and all plumbing fixtures including shower end wall Remove wallboard of entire bath approx. 42" from floor Remove existing flooring and underlayment ' Remove existing door Dispose of all materials Supply & install plumbing and fixtures as selected by customer from Peabody Supply including upgrading drain to 2" pipe ($2000 allowance for upgrade) Supply & install electrical as needed including fan/light combination similar to FanTech 5" recessed light fixture($2000 electrical allowance) Supply & install upgraded insulation as needed Supply & install cement board in shower and gypsum tile backer in remainder of bathroom where the will be installed Skimcoat plaster to smooth finish as needed Supply & install plywood underlayment on floor for the Supply & install new door from bedroom to reverse the swing Supply & install new window sashes, including two double hung and one half circle and all related trim as needed Paint walls, ceiling and trim (two coat finish, two neutral colors) Total Price: $20,369.00 (twenty thousand three hundred sixty nine and 00/100 dollars) Price does not include cost of permits, tile (material or installation), vanity or top (material or installation), shower door, any unusual, unsafe or inadequate existing conditions or any changes required by inspectors. Payment Schedule: $5000.00 due upon signing contract $4000.00 due when demo is complete (plus permit fees) $4000.00 due when rough plumbing and electrical is complete $4000.00 due when plaster is complete $3369.00 due when contracted work is complete C / -7 Customer Robert A. Keen Date Date Michael 234B Pleasant Street Methuen, MA 01844 JamesKITCHEN AND BATH DESIGN PHONE:978.689.4724 FAX: 978.945.8808 FMAIL michael@michaeljamesdesign.com nDesig , Inc.cWEBSITE:wwwmichaeljamesdesign.com PROPOSAL 2A Customer: Kellie and Jerry Kent Home: 1-978-975-1904 Date: May 17,2013 Pages: 1 of 1 Job site: 80 Settlers Ridge Rd. No.Andover.MA #1 Vanity cabinet with 6 drawers&3 French feet 60"x 2a"x 34 1/2" $ 1,964.00 #2 Toilet topper cabinet with crown molding 24"x 30"x 8" $ 440.00 #3 Two drawer storage cabinet with crown 41. 3/4"x 12"x 54" $ 11447.00 #4 Matching mirror with crown and bottom molding 30" x 36" $ 393.00 #5 Vanity countertop and backsplash $ 938.00 #6 Handles and knobs for the cabinetry $ 112.00 #7 Bathroom plan and shower design fee $ 900.00 #8 Tile selection,design and consultation fee $ 450.00 #9 Plumbing and lighting future selection and consultation fee $ 250.00 #10 Installation of the cabinetry $ 840.00 #11 Sales tax $ 330.88 #12 Sub Total $ 8,064.88 #13 Initial Consultation Fee $ (350.00) #14 Total $ 7,714.88 #15 The prices above include: #16 Dynasty brand Williamsburg Cocoa Coffee Maple vanity with three French feet #17 Dynasty brand Williamsburg Cocoa Coffee Maple toilet topper with crown #18 Dynasty brand Williamsburg Cocoa Coffee Maple two drawer storage cabinet with crown #19 All wood cabinet construction with solid wood dovetail drawers #20 Full extension soft close drawer guides and soft close door hinges #21 Vanity top selection from remnants(includes ogee edges and ogee edged backsplashes) #22 Forte brushed satin nickel knobs for the cabinetry doors #23 Forte brushed satin nickel handles for the vanity drawers #24 Tile consultations at National Tile and Tony's Tile #25 Plumbing and lighting consultations at Peabody Supply and FW Webb, Methuen #26 Delivery #27 Prices do not include: demolition or remodeling work,plumbing fixtures,lighting fixtures, shower doors,wall tiles, floor tiles,shower tiles,a counter surface for the area below the two drawer storage cabinet or any cabinets or accessories not listed #28 Terms of payment; 50%deposit due at order time;balance due prior to delivery of the cabinetry to the jobsite #29 Please sign and date below to confirm the information shown above and return a signed copy and a 50% deposit check to Michael James Design,Inc. to place your order. Orders may not be cancelled since all items are made to order. #30 Si nature X C / Date: a j Michael 234B Pleasant Street, Methuen, MA 01844 fames KITCHEN AND BATH DESIGN PHONE: 978.689.4724 FAX: 978.945.8808 EMAIL: michael@michaeljamesdesign.com Design, Inc. WEBSITE: www.michaeljamesdesign.com TILE PROPOSAL Customer: Kellie and Jerry Kent Home: 1-978-975-1904 Date: June 25,2013 Pages: 1.of 1 Job site: 80 Settlers Ridge Rd. No.Andover,MA #1 79 sq. ft.Val Navona Beige 12"x 12"floor tiles $ 335.00 #2 17 sq.ft.Val Navona Beige 2"x 2"mosaics for the shower floor $ 300.00 #3 205 sq.ft.Val Navona Beige 6"x 6"field tiles for the bathroom walls,shower walls $ 1,015.00 and shower ceiling #4 108 pieces of Val Navona Beige 3"x 6"bullnose edges $ 430.00 #5 62 pieces of Crema Marfil marble pencils for top&bottom of border tile $ 680.00 #6 22 Metal Age Listellos for inside the shower area $ 485.00 #7 9 sheets of 1"x 1"Cappuchino Mosaics for room border tiles and shower inserts $ 220.00 #8 Mastic,Thin Set,Power Grout and Caulking $ 450.00 #9 Allowance for 2 Marble Corner Shelves $ 120.00 #10 Allowance for shower thresholds $ 600.00 #11 Subtotal $ 4,635.00 #12 Sates tax $ 289.69 #13 Total $ 4,924.69 #14 The prices above include: #15 Val Navona Beige floor tiles,wall tiles,shower ceiling Files and bull nose edges #16 1/2"x 12"Crema Marfil marble pencils for top and bottom of border tiles around the room #17 12"x 12"Cappucluno Mosaic tiles to be cut into 3"strips for the room border tiles and cut into 2"x 2" squares to be used on the diagonal as inserts in the upper half of the shower area #18 Metal Age Listellos to be used as the border tiles inside the shower area #19 Mastic to adhere the floor tiles #20 White Superflex Thin Set to adhere the glass tiles #21 Power grout for both the floor tiles and wall tiles #22 Matching caulking to be used where.needed #23 Delivery #24 Prices do not include: Crema Marfil marble pencils for the top and bottom of the border tiles inside the shower area,labor or any other tiles or accessories not listed above #25 Terms of payment: Full payment due upon signing of the proposal as delivery will be scheduled upon receipt of signed proposal and payment #26 Please sign and date below to confirm the information shown above and return a signed copy along your payment to Michael James Design,Inc.to place your order. Orders may not be cancelled since delivery will be scheduled upon receipt of signed proposal and payment. Thank you! #27 Si ature: / ? Date: 7 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 www.mass gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Le�><bly Name(Business/Organization/Individual): �'-E 1„J S2y C�� O t1,.J Address: Y City/State/Zip: rf dU I nL, 01Phone#: Q/7 4,Olt d Are you an employer?Check the appropriate box: L❑ I am a employer with ( 4. ❑ I am a general contractor and I Type of project(required): employees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 1 7• remodeling ship and have no employees These sub-contractors have 8. Demolition working for me in any capacity. workers'comp.insurance. [No workers' comp. insurance 5. 9. ❑Building addition p ❑ We are a corporation and its required.] officers have exercised their 10.❑Electrical repairs or additions 3.❑ 1 am a homeowner doing all work right of exemption per MGL 11..❑Plumbing repairs or additions myself [No workers' comp. c. 152, §1(4),and we have no insurance required.] t 12.[]Roof repairs q ] employees. [No workers' comp.insurance required.] 13.❑ Other *Any applicant that checks box#1 must also fill out the section below showing their workers'compensatior 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. $Contractors that check this box must attached an additional sheet showing the name of the sub-contractors z nd their workers'comp,policy information. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: 7riz tq Policy#or Self-ins. Lic.#: �j ��, (j0 +S 6D 702,x, _ Expiration Date: ►• ^ly Job Site Address:__ - 0 r�ER$ F 2A 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 maybe forwarded to the Office of Investigations of the DIA for insurance coverage verification. 1 do hereby cerqfy under the pains nd penalties of perjury that the info)mationrovided above ove zs true and correct Signature: /� r Date: J Phone#: [F6.O use only. Do not write in this area,to be completed by city or';town official Town: Permit/License# Authority(circle one): of Health 2.Building Department 3.City/Town Clerk 4 Electrical Inspector 5.Plumbing Inspector Contact Person: Pone#: Board of Building Re„ulatio»s and Standards Construction Supervisor License License: CS 76691 ROBERT A .KEEN. 12 E'WATER ST N ANDOVER, MA 01845 Expiration: 8/16/2013 ('umniisi mcr Tr#: 3772 Massachusetts -Department of Public Safety Board of Building Regulations and Standards Construction SuperN isur License: CS-058245 KENNETH 11,19EN 21 HE WITT N ANDOVEIj MA08r45t� =. yeti s Expiration Commissioner 03/24/2014 _, � C�tie (parrvrrra�uuecr,/�o�C�aa,�uaelta Office of Consumer Affairs&Business Regulation OME IMPROVEMENT CONTRACTOR — egistration: 1'08383 Type: xpiration:, 8f1 /2'0::14 DBA KEEN CONSTRUC�t©N J= Kenneth Keen ._ 21 Hewitt Ave ` No.Andover, MA 01845 �- Undersecretary U4/16/LU1J Ua:2ti 1,AA 751 842 222tf GILBERT INSURANCE 10001 A RCERTIFICATE OF LIABILITY INSURANCE D IDO 4//19/18/201133 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(les) 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 AC Barbara McDonough Gilbert Insurance Agency, Inc. PHONE (761)942-222$ FAX No (781)912-2226 137 Main Street Afl RIE :bmedonough@gilbortinsurance.com INSURERS AFFORDING COVERAGE NAIC 4 Reading MA 01867-3922 INSURER A-NORFOLK & DEDHAM INSURANCE 23965 INSURED INSURER a:Travelers Ins. Co. 0031 Keen Construction Company INSURERC: 21 Hewitt Avenue INSURER 0: INSURER E: North Andover MA 01845 INSURER F: COVERAGES CERTIFICATE NUMBER-CL1341800232 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 AFKORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAIO CLAIMS, INSR ADDL UOR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE POLICY NUMBER MMIDD]r-M) IMMIDDIYYYYI LIMITS GENERAL LIABILITY EACH OCCURRENCE S 1,000,000 �{ COMMERCIAL GENERAL LIABILITY RENTED A CLAIMS-MADE ❑% OCCUR -P-01007a/000 n $ 100,000 PREMSES(Fa /13/2013 /13/2014 MED EXP(Anyone person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEML AGGREGATE LIMrr APPLIES PER: PRODUCTS-COMP/OP AGO $ 2,000,000 X POLICY PRO LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ANY AUTO BODILY INJURY(Per person) S ALL AUTOS MED AUTOS BODILY INJURY(Pe/weldeA S NON-0WNED PROPERTY DAMAGE $ MIRED AUTOS AUTOS Para.cident 5 UMBRELLA LIAROCCUR EACH OCCURRENCE I S EXCESS LIAR HCLAIMS-MADE AGGREGATE1. S OF.O I I RETENTION S B WORKERS COMPENSATIONWC STATU- 0TH AND EMPLOYERS'LIABILITY Y I N ANT PAOPMETORMARTNERtEXECUTIVE E.LEACH ACCIDENT 5 100,000 OFFICERIMEMSER EXCLUDED? NIA (Mandatory In NH) 6KOB-5110126-A-12 /3/2012 /3/2013 E,L.DISEASE-EA EMPLOYEE S 100,000 11 yes.desaibe under DESCRIPTION OF OPERATIONS Oelgw E.L.DISEASE-POLICY LIMIT $ 500,000 I ! DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Addltlonal Remarks Scheduk,It more space Is required) Evidence of Coverage CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. ! Evidence Of Coverage AUTHORIZED REPRESENTATIVE M Gilbert, CIC/MARBAR i ACORD 25(2010105) ®1988-2010 ACORD CORPORATION. All rights reserved. INS025(ao1Dw),oi The ACORD name and logo are registered marks of ACORD