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HomeMy WebLinkAboutBuilding Permit #112 - 88 ADAMS AVENUE 8/10/2009 I BUILDING PERMIT oNORT 6;°�0 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION * `. Permit NO: ! / Date Received ,7ED ri SSACHUSE Date Issued: IMPORTANT:Applicant must complete all items on this page LOCATIONC�rm� Sl�� Print PROPERTY OWNER. �a -, C, C�(_$ err Print 4 MAP NO: PARCEL: ZONING DISTRICT: Historic District yes no - �Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential I 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 PREFORMED: Identification Please Type or Print Clearly) OWNER: Name: �`�� Phone: Address: CONTRACTOR Name:l> Phone: . tom;,–+ \ �� (n. a SSG Address: Supervisor's Construction License: Exp. Date: �U Home Improvement License: (10 1 Exp. Date: 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. Total Project Cost: $ �� . ' FEE: $ �/ 6 .00 Check No.: g 0 /�1s7 Receipt No.: 2 NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund ignature of Agent/OwneraES: n F -'�'�6g tune of contract___, i I Location �� G� 4ylNs rJf No. 2 Date f//4 A 15 �aRTM TOWN OF NORTH ANDOVER 3? •. O a • s �o Certificate of Occupancy $ s�cHusEt�•' Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ a Check #-- �� r 225 �i' building Inspector I Plans Submitted Plans Waived Certified Plot Plan Stamped Plans TYPE OF SEWERAGE DISPOSAL i 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 DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT f COMMENTS CONSERVATION Reviewed on Signature COMMENTS HEALTHi Reviewed on Signature COMMENTS f 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 Town Engineer: Signature: � FIRE,DEPARTMENT -Temp Dumpster on site yes Located 384 Os ood Street no Located at 124 Main Street Fire Department signature/date COMMENTS I Dimension � Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: j 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 I I i t ❑ Notified for pickup - Date Doc.Building Permit Revised 2008 r s 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 I NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks ❑ Building Permit Application i. ❑ Certified Surveyed Plot Plan ❑ Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses o Copy Of Contract S o 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) o 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 Boardof 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 Application Revised 2.2008 NORTH Town of No. ori dower, Mass .,—<,> .> �1 COC MIC HE wICH ORATED P'Pa` S BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System BUILDING INSPECTOR THIS CERTIFIES THAT i ......... GnujF"' S ...... "" .. Foundation has permission to erect........................................ buildings on .... Rough tobe occupied as........................... .. .. ...«fC '�f(J .............................................................................................. Chimney provided that the person accepting this permit shall in every respect conform to the terms of the application on file in Final this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTION STARTS Rough ....................... .:--. Service BUILDING INS EC— Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Remove RoughFinal No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE SIDE Smoke Det. Renewal MA License#decal T (expires 8s 041/24/10)201 ;,, Rr'vEWAL BY ANDERSEN Federal Tax ID#83-0404201 byAndersen. 1� - WINDOW REPLACEMENT .An&a Co y OF GREATER MASSACHUSETTS AND NEW HAMPSHIRE 104 Otis Street•Northborough,MA 01532 Phone 508.919.0900•Fax 508.919.0903 CUSTOM WINDOW AND DOOR REMODELING AGREEMENT ' Buyerls) a - / _VdIO& , [ Date of Agree ant /n/ 17 2 Buyer(s)Sheet Address,City, tate,and Zip Code / r E-Mail Address H e Tele one Number %."Tlephone Number fin DV Buyer(s)hereby jointly and severally agrees to purchase the products and/or services of j&L Windows,Inc.dba Renewal by Andersen of Greater I Massachusetts and New Hampshire("Contractor"),in accordance with the terms and conditions described on the front and the reverse of this agreement and on the attached specification sheet(s)(collectively,this Agreement").Buyer(s)hereby agrees to sign a comple' certificate after Contractor has completed all work under this Agreement. 1 1�/'_ Method of Pymnt:O Cash eck ❑Mastercard ❑VISA Total Job Amount! / Es'mate Starting Da �� 0—/� ❑Discover C3 Financed,App Deposit Received(33%)L / Name on Credit Card: Balance at Start of job(33%):m imctedCompletion ate: Credit Card#: Balance on Substantial ��C/ll Completion of Job(33%): / CC Exp.Date: CC Security Code: By initialing here,you acknowledge that the Balance at Start of Job and the Balance on Substantial Completion Buyer ti s of job cannot be made by credit card and must be made by personal check,bank check,or cash. Buyer(s)agrees and understands that this Agreement constitutes the entire understanding between the parties,and that there are no verbal understandings changing or modifying any of the terms of this Agreement.No alteration to or deviation from this Agreement will be valid without the signed,written consent of both Buyer(s) and Contractor.Buyer(s) hereby acknowledges that Buyer(s) 1) has read this Agreement,understands the terms of this Agreement, and has received a completed,signed,and dated copy of this Agreement,including the two attached Notices of Cancellation,on the date first written above and 2)was orally informed of Buyer's right to cancel this Agreement.DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES. Renewal by dersen of Greater MA and NH Buyer(s Buy�r(s) B =Signatutre ; Sign re ro luct Manager S gnatur Print Name of P oduct Manager Print Name Print Name r 1 YOU, THE BUYER(S), MAY CANCEL THIS TRANSACTION AT ANY TIME PRIOR TO MIDNIGHT OF THE THIRD BUSINESS DAY AFTER THE DATE OF THIS TRANSACTION.SEE THE ATTACHED NOTICE OF CANCELLATION FORMS FOR AN EXPLANATION OF THIS RIGHT. - - - - - - - - - - - - - --- - - - - - - -- - - - - - - --- - - - - - - - - - - - - -- NOTICE OF -ANE N R NOTICE • CELEM N Date of Transaction -You may cancel I Date of Transaction .You may cancel this transaction,witho any p na ty or obligation,within I this transaction,with any p no or obligation,within three business days from the above date.If you cancel,any three business days from the above ate.If you cancel,any �roperty traded in,any payments made by you under the Iproperty traded in,any payments made by you under the ontract of Sale,and any negotiable instrument executed I Contract of Sale,and any negotiable instrument executed by you will be returned within 10 days following receipt I by you will be returned within 10 days following receipt by the Seller of your cancellation notice,and any security I by the Seller of your cancellation notice,and any security interest arising out of the transaction will be canceled. 1 interest arising out of the transaction will be canceled. If you cancel,you must make available to the Seller at If you cancel,you must make available to the Seller at your residence, in substantially as good condition as I your residence, in substantially as good condition as when received, any goods delivered to you under this I when received, any goods delivered to you under this Contract or Sale;or you may,if you wish,comply with the I Contract or Sale;or you may,if you wish,comply with the instructions of the Seller regarding the return shipment of instructions of the Seller regarding the return shipment of the goods at.the Seller's expense and risk.If you do make X the goods at the Seller's expense and risk.If you do make the goods available to the Seller and the Seller does not the goods available to the Seller and the Seller does not pick them up within 20 days of the date of your Notice I pick them up within 20 days of the dote of your Notice of Cancellation,you may retain or dispose of the goods I of Cancellation,you may retain or dispose of the goods without any further obligation. If you fail to make the I without any further obligation. If you fail to make the goods available to the Sefler,or if you agree to return the I goods available to the Seller,or if you agree to return the goods to the Seller and fail to do so,then you remain liable 1 oods to the Seller and fail to do so,then you remain liable for performance of all obligations under the Contract. for performance of all obligations under the Contract. To cancel this transaction, mail or deliver a signed and I To cancel this transaction, mail or deliver a signed and dated copy of this cancellation notice or any other written I dated copy of this cancellation notice or any other written notice, or send a telegram to Renewal by Andersen I notice, or send a telegram to Renewal by Andersen of Greater Massachusdttsad ew Hampshire, 104 1 of Greater Massachusetts and New Hampshire, 104 Otis Street,North 32,NOT LATER THAN I Otis Street,Nor 532,NOT LATER THAN MIDNIGHT OF Date) MIDNIGHT OF .(Date) I HEREBY CANCEL T S T SA TION. X 1 HEREBY CANCEL fHIST NSACTION. ' I Consumer's Signature Date I Consumer's Signature Date RbA Copy- White Customer Copy-Yellow Customer Copy-Pink Renewal ;•• RENEWAL BY L 1lYLERSEN MA License#149601(expires 1/24/10) byAndersen. %• Federal Tax ID# 83-0404201 WINDOW REPLACEMENT ..,A..d.,,a,ComP•ro OF GkzATER MASSACHUSETTS AND NEW HAMPSHIRE-- 104 Otis Street•Northborough,Massachusetts 01532 Phone 508.919.0900•Fax 508.919.0903 SPECIFICATION SHEET Buyer(s) Date of Agreem � The Buyer(s)listed above eby jointly and severally agree to purchase the goods and/or services listed below,in accordance with the prices and terms described on e Specification Sheet and the front and the reverse of the accompanying CUSTOM WINDOW AND DOOR REMODELING AGREEMENT,of which.this Specification Sheet is a part. l WINDOW DETAILS 1. ivrctor will Install a total of windows in Owner's home,using the following individual quantities: Double Hung(DB) �,&1'ual sash ❑ Cottage sash(1/3 top,2/3 bottom) ❑ Oriel sash(2/3 top.1/3 bottom) Casement(CW) ❑ Hinge right ❑Hinge left(as viewed from exterior): ❑ Standard handle ❑Metro handle Double Casement(CDW) ❑ Standard handle ❑Metro handle Casement/Picture/Casement(CPW) ❑ 1:1:1 or ❑ 1:2:1 ❑ Standard handle❑Metro handle 2 Lite Gliding Window(GW) Glider/Picture/Glider(GPM ❑ 1:1:1 or❑ 1:2:1 Awning Window(AW) Picture Window(PW) Bay or Bow Window —,Patio Doors(see separate Door Specification Sheet) 2. E34es ❑ No Qty of Windows to be Custom Fit Replacement: 3. ❑ Yes 5; Qty of Sills to be replaced by Contractor: 4. ❑ Yes [Z1,1146 Qty of Windows to be New Construction Full frame(includes new interior&exterior casings) Exterior c�Jas,in�g�s: Pine E] Maintenance-free material E] Factory applied 908 Fibrex brickmold I.I 5. Glazing to be: _'rr Low-E®SmartSunTM (TaxCYnStEGgible) ❑ Other If other,please specify: 6. Exterior color to be: 0,ER5ite❑ Sand ❑ Canvas ❑Terratone ❑ Cocoa Bean 7. Interior color to be: ite ❑ Sand ❑ Canvas Q Terratone❑ Pine❑Maple❑ Oak Note: Interior color can my be white,wood or same color as exterior. Wood'interiors need to finished by Owner. 8. Hardware: ❑ White one ❑ Canvas ❑ Brass Double Hung: 9.,�es ❑ No Install Lifts with Double Hung Windows 10. Screens: windows to have: ❑ Half or g�creens Screens to be: 1 erglass ❑ Aluminum ❑ TruScene \ GRILLE DETAILS 11.Windows have grilles: ❑ Yes ❑ No If yes.4 Grille Between Glass(GK)❑ Removable Interior wood aNTW)❑ Full Divided light(FDL) Qty: ! QtyQhs Qty: Qty: QtyQty, � I nDliDl' DH DH CW/ PicLL:reicLL:re1E:1 CPW or Draw grille patterns above `Use additional sheet if needed Owner approved ADDITIONAL WORK DETAILS 12.❑ Yeso,Contractor will remove metal frames of windows. Qty of Units: 13.❑ Yes [I; o Contractor will install new paint-ready or stain-ready casings. Interior c ng qty of openings: Exterior casings qty of openings: ❑ Pine E] Maintenance-free material 14.❑ Yes o Contractor will install new paint-ready or stain-ready inside or outside stops qty of openings: Int -or stops qty of openings: Exterior st o ❑ Pine❑ Maintenance-free material 15. Owp6r is aware that Contractor does not do any p � 16.ryes r7No Contractor will wrap exterior casings _ c of olor. _,Note: Wrapping may be required with storm window removal;removal of storm windows will leave screw holes in casing. 17. Yes ❑ No Contractor will insulate,caulk and seal windows with 3-point system to prevent water and air infiltration. 18.5"Yes ❑ No. A limited warranty shall be issued to Owner upon completion of the job and payment in full. 19.VY. ❑ No Building Permit—Contractor will secure any and all necessary permits. The fee for th p rmit(s)is not �*p included in the Contract Price and a separate check is required at the time of sale for this fee. V 20. Additional job details: 21.Vy. ❑ No Owner agrees to be present on the final day of installation for final inspection and to deliver final payment. No Final payment shall be demanded until the contract is completed to the satisfaction of all patties. It is agreed and understood by and between the parties that this Specification Sheet,along with the CUSTOM WINDOW AND DOOR REMODELING AGREEMENT,constitutes the entire understanding.between the parties,and there are no verbal understandings changing or modifying any of the terms. This Specification Sheet may not be changed or its terms modified or varied in any way unless such ch4nges are in writing and ' ed by both the Buyer(s)and Contractor. Buyer(s)hereby acknowledge that Buyer(s)has read this Specification SheeL ! Re deisZn of G NH Bu i r(s) Buyer( / tature of IyCt M4rtager Signature Signature l� WyMA1167 Print Nam of Product Manager Print Name Print Name RbA Copy- White Customer Copy-Yellow The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigqtions ' 600 Washington Street Boston,MA 02111 www.mass gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Aulicant Information Please Print Legibly Name(Business/Organizadon/Individual): Address: /D/� VH S S+ree-�- City/State/Zip: AlD(I,Ahol'o, A�4 �,)KJC2— Phone#: Are'you an employer?Check the appropriate box: Type of project (required): 1.&I.am a employer with Jo 4. ❑ I am a general contractor and I 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet.# 7• emodeling ship and have no employees These sub-contractors have 8. UDemolition working for me in any capacity. workers'comp.insurance: 9. ❑Building addition No workers' comp.insurance 5. ❑ We are a corporation and its 10.[]Electrical repairs or additions required.] officers have exercised their 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 12.❑Roof repairs insurance required.]t employees.[No workers' 13.0 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. tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and 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:_ . ' Ale &—o r)-P— L:�tl Ifa n C�' Policy#or Self-ins.Lic.#: �y� �r�� -?2 /Yy Expiration Date: Job Site Address: % ��1� LU�- City/State/Zip: , .� )l 19r m�r" 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 cer under the pains and pen alties,of perjury that the information provided above is ue and correct. Si mature: Date: CU Phone# Official use only. Do not write in this area,to be completed by city or town official City or To Am: 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#: I = '- fie �o9nmzmuaea�i a�✓�aeauc�ueel`ra ' I Board of Building Regulations and S,taudards _ Construction.Supervisor License., A. Licara en 95707 ' riae°'" 8'!1982 AEtttrd20 Tr# 95707 BRIAN DENNISO€V w " B6 CREST CIRCLE . • . WORCESTER,MA 01803 Commissioner RENEWAL BY ANDERSON BRIAN .DENNISON 104 OTIS STREET •NORTHBOROUGH, MA.01532 . DPS-CA1 0 SOM-07167•PC8490 -__• .• .: ...✓�re.-Pa,�nnonruea,�l�c�✓�aaaac�w.dect . Board'of Building Regulations and Standards HOME IMPROVEMENT CONTRACTOR Registr dOlt� 149601 _ E Fra io0:11124•/2010 - :` ypslpplement Card RENEWAL BY A`D;Ei., BRIAN DENNISON= 1t 104 OTIS STREET`Q;., , :- 'NORTHBOROUGH,MA 131532 Administrator A CORD. CERTIFICATE OF LIABILITYINSURANCE �FIN'010�RA 09 PRODucER THIS CERTIFICATE IS ISSUED AS A'MATTER ® Et9T10N Joseph MCKsone ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE R = ECATEE DOES TEIBDJP McKeone Insurcance Agency, Inc. ALEFtiC©VRAGEAFFORDED BY HPOLLCIEELOR OW. P.O. Box 333 Ann Arbor, MI 48106-0333. INSURERS AFFORDING COVERAGE INSURED Renewal by Anderson ;wsuRERA: Hartford Insurance Company._ J&L Windows,Inc. INSURERS: Hermitage 104 Otis St INSURER C: Northborough,MA 01532 INSURER D; I INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED..NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDrrION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMUS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. WSR' D'L POLICYEFFCTiHE POLICYE;.PIRATION TYMPFF POLICYNUNHER c LUKITS B GENERALLIABIuTY FRCP 507 404 09/07/2006 09107/2009EACHOCCURRENCE s 1 ()00.000 CAMMERCIALGENERAL WBIUTY PREMISES Ea G.=49 S 1OO ODO CLAIMS MADE ©OCCUR MED EXP( ane pe son! S _ 5000 PERSONAL BADV INJURY S 1 000 ODD GENERAL AGGREGATE S 2,000.000 GENLAGGREGAT'cLIMIT APPLIES PER:. PRODUCTS•COMPIOPAGG S 2.000000 POLICY P COT I I LOC A RXALL NostLLJAEuSTq 35 MCC XD 6390 10/01/2006 10/01/09 COMBINED SINGLE LIMIT ANY AUTO IED ecadant) S 1,000,000 OWNEDAUTCSBODILY INJURY CHEDULED AUTOS (Per pet=) S WRE0 UTOS BOO tLY["JURY- NON•OWNEDAUTOS IParaaddnt) S PROPERTY DAMAGE S IPsradtlanl) GARAGE LIABILITY AUTO ONLY-EAACGCENT I S ANY AUTO .. OTHER THAN E4ACC Is AUTO ONLY: AGO Is EXCESSIUMBREL LA LIABILITY EACH OCCURRENCE I S OCCUR a CLAIMS MADE AGGREGATE I S S i DEDUCTIBLE I S RETENTION . S I S A WORKERS COMPENSATION AND 35 WEC PP 1444 EMPLOYERS LIAHt_7TY 02/17!2009 02h7/2010 we sTAru- IorH- ANY PROPRL`TOR,PARTNERIE ECUTWE E.L.EACH ACCIDENT $' 500,000 OFFICERIMEMBER EXCLUOEDI. E.L DISEASE•EA EMPLOYEE I S SDC 000 If yyea,dascibo under _ SPECWL PROVISIONS below EL DISEASF.POLICY LIMIT S 500,000 OTHER DE=IPTICN OF OPERATIONS/LOCATIONS 1 VEHICLES I EIICLUSIONS ADDED BY ENDOPSMEMT I SPECIAL PROMSIONS CERTIFICATE HOLDER CANCELLATION S.ROULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCE 16n BEFORE THE E>:PIRATION INSURED COPY DATE TKERMOF,THE ISSUING INSURER VOLL ENDEAVOR TO MAIL 9O DA-s mrrr cN NOTICE TO THE CERTIFICATE HOL.DEIZ NAMED TO THE LEFT,BILE FAILURE TO DO"SHALL Ib,POSE NO OBLIGATION OR LIABILITY OF AAM KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATWES. /f AUTTiORL_-'D REPRFSEATTATrVE ACORD 25(2009!08) ©AEORD CORPORATION 1983 ' � e,,,%.s rou.._. -a?ry`: ?'M:�._e-�jtit -.'+. •,::�•-.,r+ ..: .��.�rNm1,?Vlr, •1 ��.r.�•�ii•=?•nr — ,•1. .�.•.ti.••+d'•M���. . ' •'.. •.. 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