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HomeMy WebLinkAboutBuilding Permit #63 - Bldg 5 7/24/2007BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit N0: (,0,17 Date Received O� � Aclll Date Issued: ' 1 DESCRIPTION OF WORK TO E PREFORMED: Pall i VtS Out 0"w-& V)6r V Identification Please Type or Print Clearly) OWNER: Name: Phone: Address: 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: $ d FEE: $ 2 Check No.: Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guar mty ad Signature of Agent/Owner Signature of contractor it Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT ❑ ❑ COMMENTS DATE REJECTED DATE APPROVED CONSERVATION ❑ ❑ COMMENTS HEALTH ❑ COMMENTS DATE REJECTED DATE APPROVED TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ❑ Seng Pools ❑ Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private (septic tank, etc. ❑ Permanent Dumpster on Site ❑ .r, Zoning' )ard of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Connection/Signature & Date Driveway Permit Located at 384 Osgood Street Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: ELECTRICAL: Movement of Meter location, mast or service drop requires approval of Electrical Inspector Yes No DANGER ZONE LITERATURE: Yes No MGL Chapter 166 Section 21A —F and G min.$100-$1000 fine 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 ❑ Floor Plan Or Proposed Interior Work ❑ Engineering Affidavits for Engineered products 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) ❑ Engineering Affidavits for Engineered products 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 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: INSPECTIONAL SERVICES DEPARTMENT:BPFORM07 Revised 2.2007 Location aY:!-f "I No. eo, Date j01tT#j TOWN OF NORTH ANDOVER Certificate of Occupancy $ Fee $ CH S Building/Frame Permit Foundation Permit Fee $ 4 Other Permit Fee $ TOTAL so Check # / 5-60,r 2 0 Ce,— j 07� Building Inspector CITY OF BOSTON LiC. 'N0 B t 8753 BOARD OF EXAMINERS MAYOR °-i IV T�.. ,�y 4 P`V 00 { Regal Design Construction Corp. 5224 Washington Street Phone 781-858-6005 West Roxbury, MA 02132 Fax 617-325-6543 Schneider Electric /Automation Date: April 12, 2007 One High Street North Andover. NIA 01845-2699 Mr. Scott Fairbanks - Facilities Manager (1-978-975-9515) In Re: Contract For Phase 1 Masonry Restoration Work: Dear Mr. Fairbanks: Per your request we at Regal Design have include the three Masonry Restoration Items that are to be Performed under Phase 1 of The Masonry Restoration Work. Please review all data and note that the Contract Price for these foto- work items amounts to Thirty Nine Thousand Two Hundred Dollars ($ 39,200.00). Below you will find these areas of work individually itemized; Prioritized Scope of Work For Repointing - Purchase Order No. 1: 1) Building No. 5E: Lower Brick Wall just below cafe window wall system — wall requires 100% Masonry Repointing & Chemical Cleaning Work (Approx 90' x 8') TOTAL COST = $8,600.00 2) Building No. 7 Front Elevation @ High Street: This Front Elevation requires major Repointing & Chemical Cleaning to 90(7: of the entire Elevation TOTAL COST = $16,200.00 3) Building No. 5E Elevator Shaft Building: The Elevator Shaft Building requires major Repointing and Chemical cleaning work. TOTAL COST = $ 7,000.00 4) Building No. 7 inner Court Yard Area: Spot Pointing (300 Sgft*) Repoint Granite Sills & Replace Missing Bricks as needed. TOTAL COST = $ 7,400.00 Schneider Electric Cont.: Revised 4/12/07 Masonry Restoration Phase I Palle 2 of 3 Itemized Scone of Work & Cost Summary: 1) Building No. 5E: Lower portion of Brick Wall located just below the Caf6 Aluminum Window \k'all System (Approx 90' x 8'). including Stairwell requires the Repointing & Chemical Cleaning; Caution Tape Off All Work Area from pedestrians - Provide & Maintain Pipe Staging & Planking as needed Power Wash & Chemically Clean Entire Brick & Concrete Surfaces using a Heavy Duty Rest. Clean by Prosoco Products (Approx 750 Sqft). There is an abundance of green algae like material stuck onto exiting wall surfaces, most notably where Building 5E abuts to Building No. 37 — Gutter above is leaking and needs repair work. Rake Out & Repoint All Brick Joints (100% / Approx 750 Sqft) New Mortar Joints to be colored to match adjacent surfaces. (Sample Panel to be approved by Owner) l -TOTAL TO COMPLETE CLEANING & REPOINTING WORK = $ 8,600.00 Note — AnY Additional or Deleted Repoinuing Wok, hili be Biller( Out @ $ /2.00 Sc//1 2) Building No. 7 — High Street Elevation: The Front Elevation located at High Street requires major restoration work. This particular scope of work was not included in our original proposal dated 1/29/07. with the exception of the lower right hand corner of the elevation all the Brick Joints require Cleaning & Repointing. (90%n of Elevation or Approx 1350 Sqft.) - Caution Off Work Area - Erect & Maintain Pipe Staging & Completely Decked Off Area @ Entrance Way to allow Pedestrian Access to Building. Mechanical Condor Lift may be utilized along w/ Staging. Power Wash & Chemically Clean Entire Elevation (Heavy Duty Restoration Cleaner) Rake Out & Repoint All Joints 100%, - excluding lower right hand corner of Building that was recently pointed (Brick Mortar to Match Color of existing dye — Pinkish/Red) Repoint All Granite Sills & Archt. Stone Work (100%) Dismantle Staging & Equipment TOTAL COST TO COMPLETE RESOTRATION WORK = $ 16,200.00 3) Building No, 5E— Elevator Shaft Walls: The "L" Shaped Walls Brick Tower at Elevator Shaft adjacent to the Cafe Entrance Double Doors and connects to Building No. 6 — There two walls for the first 3 floors then it becomes four walls once the Tower Extends above roof line at both Building. These Wall Require 5017(, of Repointing (500 Soft Carried). - Caution off Ali Work Areas — Must be Staged Planked & Fully Decked & Debris Netting Must be installed in order to protect All Pedestrian Traffic going in & out of Entrances Power Wash & Chemically Clean Entire Elevations (All Walls) - Saw Cut Out Brick Joints & Repoint (50%r of Walls or 500 Sqft.) - Replace any Broken or Missing Bricks (Approx 10 Brick Missing) - Remove & Dispose of Debris & Equipment �Q - TOTAL TO COMPLETE RESTORATION AT ELEVATOR SHAFT = $ 7,000.00 Schneider Electric Cont: Paine 3 of 3 4/12/07 4) Building No. 7 Inner Portion of Court Yard Elevation: This elevation has a few bricks missing from the %%all (Approx. 10 Bricks) and they need to be replaced & relayed. Several Granite Sills (Qty =15) need to be Re -pointed + the Brick Wall Requires Spot Pointing (Carried 300 Sqft of Chemical Cleaning & Repointing Work). Repointing located mostly just below window sills. - Caution Off Work Areas - Provide & Maintain Pipe Staging & Mechanical Condor Lifts As Needed Furnish &Install New Bricks where missing l - Power Wash & Chemically Clean Sills & Brick that are to be Re -pointed - Rake Out & Repoint Granite Sills (qty = 15) Spot Point & Chemical Clean (300 Sqft Carried ) Dismantle & Remove All Equipment & Debris TOTAL COST TO COMPLETE RESTORATION WORK = $ 7,400.00 Note — Any Additional Work Added to be Billed Out @ - Repointing = .$ 12.00 Sqft - Chemical Cleaning = $ 1.50 Sqft. In closing, after your office has reviewed and approved these particular Masonry Restoration Work items we request that your office generate a Purchase Order reflecting the same. Once we have a signed Purchase Order it is our intention to commence with the Repointing & Chemical Cleaning Work at The Cafe Wall 1". "Phis area is ideal because there is hardly any pedestrian traffic and not much scaffolding is required. As in past projects we request that an Initial Deposit of Half the Contract Value ($ 4,300.00) be issued at mobilization phase. The remaining balance should be paid at completion of said work. We estimate that this cafe wall work should take 7-10 days to complete. Upon review should you have any questions or comments with respect to this particular proposal feel free to call. We await your actions. s JMf3/jb: Respectfully Submitted; Jeff M. Brait President Regal Design Construction Corp. CC: File NO' "Regal — Schneider Electric —Masonry Phase I" Serra Pira hn (/ -978-97<-2986; & liuiailed .cr oN.lnirhunx.r rens'.srhneider-e lrrrric.r orn Reviewed & Approved By; Regal Design Construction Corp. 5224 Washington Street Phone 781-858-6005 West Roxbury, MA 02132 Fax 617-325-6543 Schneider Electric Co. Date: April 12, 2007 One Hi0h Street North Andover. MA 0 1845 -2 699 Mr. Scott Fairbanks — Facilities Manager (1-978-975-9515) In Re: Revised Proposal For Concrete Restoration & Flat Work Repairs: Dear Mr. Fairbanks: Per our meeting held on site earlier this week we at Regal Design have reviewed the prioritized items for the Concrete Sidewalks and Flat Work Restoration at several locations throughout the site. At this time we are pleased to quote a price of Sixteen Thousand Four Hundred Dollars ($ 16,400.00) to complete the following scope of work; 1) Building 6&7 - New Portion of Sidewalk @ beginning of Courtyard Walkway; adjacent to city sidewalk (Approx 25' x 10')*this area is deteriorated and lifting and requires removal and replacement of concrete & brick accent bands. - Caution off work area from all pedestrians - Jackhammer. Remove & Dispose of all concrete (Approx 25' x 10 x 4") - Chip Off Brick an salvage as many for re -installation (Replace w/ New as Needed) - Prep existing sub -base & Compact thoroughly - Form & Pour new Concrete Sidewalk - Lay Brick Accent Bands in bed of mortar to match existing patterns (Color = Pink/Red) - Install Self LevelingCaulking (Color Grey) where ever Brick abuts to concrete - TOTAL TO COMPLETE SIDEWALK @ COURTYARD AREA B-6/7 = $ 4,200.00 2) Ramp @ Building No. 6 — Concrete Restoration Work: Concrete has major crack in middle & side need Repointing & patch work Caution Off Work area from all pedestrians Saw Cut, Jackhammer, Remove & Dispose center of deteriorated concrete ramp (Approx 2' x 15' x 6") Dowel in Re -bar 16" o.c.for reinforcement of newly poured concrete & add wire mesh Install compressible filler on all sides that the new concrete abut to existing Pour Float & Finish new Concrete (Approx 15' x 2' x 6") Install Self Leveling Caulking around perimeter of new pour & at existing control joint Clean Site free of our equipment & Debris Remove Deteriorated Concrete & Install new along left hand sidewall adjacent to brick TOTAL TO COMPLETE RAMP RESOTRATION WORK = $ 1,400.00 (1) I r F Schneider Electric Cont; Revised Flat Work Proposal Page 2 (4/12/07) 3) Sidewalk from High Street Leading back to beginning of Ramp @ Building No. 6: this walkway is deteriorated and lifting and has many trip hazards & must be replaced entirely from City's Sidewalk @ High Street all the way back to beginning of Ramp @ Building No. 6 Caution off Work Area from Pedestrian Traffic Chip off all brick accent panels & salvage for re -installation (Supply Brick As Needed) Jackhammer, Remove & Dispose of existing Walkway.(Approx 46' x 6' x 4") Prep & Compact existing subsurface Form & Pour & Float New Concrete Lay Brick Accent Panels in Bed of Colored Mortar to match existing layouts Install new Self Leveling Caulking where ever the brick abuts to concrete pads - Clean Site free of all equipment & debris TOTAL TO COMPLETE NEW WALKWAY @ BUILDING 6 = $ 4,800.00 4) Building No. 5 Concrete @ Main Entrance Walkway; This concrete pad has major cracking and a major portion of this pad must be removed & replaced (Approx 14' x 23' x 4") w/ Brick Accent Panel in middle of pad. caution off work area from all pedestrian traffic SaW Cut straight line at concrete pad that is to remain (Approx 23' back fi-om asphalt) Jackhammer, Remove & Dispose of deteriorated & cracking concrete Chip away brick accent Panel and Salvage for re -installation - Dowel in Rebar to existing portion of concrete walk (16" o.c.) Form, Pour Float & Finish New Concrete where removed Lay New Brick Accent Panel in same location where removed TOTAL TO COMPLETE CONCRETE WORK @ Building 5 Entrance = $ 3,800.00 5) Building No. 37 — Concrete infill: The existing curb has settled and a trip hazard has occurred at the end of the walkway from Building 37 entrance area. Caution off Work area from Pedestrians Clean Area to receive concrete infill (Approx 4" x 20') Apply Bonding Adhesive over infill area (Bond -All Adhesive) Form & Pour & Finish Concrete Infill — feather down sides so no trip hazards Clean Site free of our equipment & debris. TOTAL TO COMPLETE INFIL WORK @ BLDG NO. 37 WALKWAY = $ 400.00 (2) It . Schneider Electrical Cont: Concrete Flat Work Proposal Page No. 3 (4/12107) 6) Building No. 37 —Settled Catch Basin Work in Horse -Shoe Road Area The concrete around the Catch basin has major cracks and has settled on both sides and needs to be replaced. Caution off Work Area Saw Cut Clean Line around Catch Basin Jackhammer, Remove & Dispose of Settled Concrete all around basin (Approx 3' x 6') Relay missing brick around basin frame as needed (Block all Holes) Dowel in Re -Bar to existing concrete around perimeter of basin POUT New Concrete where removed (6" Min thickness) Clean Site free of debris & equipment TOTAL TO COMPLETE CATCH BASIN REPAIR WORK = $1,100.00 7) Building No. 14 — Re -Stucco Concrete Risers ,@ Main Stairs: Upon visual inspection of the concrete risers it was noted that a majority have either missing stucco of loose stucco that needs to be replaced. - Caution off half of stair to allow pedestrian traffic down un -worked side of stairs - Chip away all loose & deteriorated stucco of risers as needed to get down to solid substriaght - Apply Bonding Agent over all areas that is to receive new stucco - Apply Repair Mortar over all areas of risers missing stucco & finish - Clean Site & repeat on other side of stairs after on side has cured - TOTAL COST TO COMPLETE RISER STUCCO WORK = $ 700.00 Upon review and approval we request that your office generate a Purchase Order for this particular scope of work. We will schedule all the work accordingly and give you ample notice so all work areas can be cautioned off of each designated dates & times agreed upon. We would request that an initial deposit be requisitioned for once the work schedule has been approved. Feel free to call with any questions or comments you might have. We thank you for the opportunity and await your actions. JMB/jb; Respectfully Submitted; Jeff M. Brait President Regal Design Const Corp. CC: File No. "Renal —Schneider -Flat Work -P2" Sent Via Email scottfairbanks@ usschneider-electric.com �ZN- The Commonwealth of Massachusetts ' Impartment of Industrial Accidents Office of Investigations 600 Washington Street -In N ° Boston MA 02111 ; 0. www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): Address: e6, cc)r City/State/Zip: dc�j'� ci iGJ (M G Phone #: j 0 ��� 6 aM- Are an employer? Check tie appropriate box: 1. I am a employer with J/ 4. ❑ I am a general contractor and I employees (full and/or part-time).* have hired the sub -contractors 2. ❑ I 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. [No workers' comp. insurance required.] 3. ❑ I am a homeowner doing all work myself. [No workers' comp. insurance required.] t workers' comp. insurance. ❑ We are a corporation and its officers have exercised their right of exemption per MGL c. 152, § 1(4), and we have no employees. [No workers' comp. insurance required.] Type of project (required): 6. ❑ New construction 7. ❑ Remodeling 8. ❑ Demolition 9. ❑ Building addition 10. F1 Electrical repairs or additions 11.❑ Plumbing repairs or additions 12.❑ Roof repairs 13.❑ Other *Any applicant that checks boz # 1 must also fill out the section below showing their workers' compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $Contractors that check this box must attached an additional sheet showing the name of the sub -contractors and 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: Policy # or Self -ins. Lic. #: 2b Job Site Address: 6 (570Pa o W4 Expiration Date: 3 City/State/Zip: &&A 61&YA RA t 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 certify under the pains and penalties of perjury that the information provided above is true and correct Signature: Date: 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 #: Information and Instructions 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 buildingsin 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 of public 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 cavy 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. Also 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 pen-nit/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 (if necessary) 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 burn 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 Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE Revised 5-26-05 Fax # 617-727-7749 www.mass.gov/dia ACOND CERTIFICATE OF LIABILITY INSURANCE DA7/16/07 Y) PRODUCER THIS CERTIFICATE IS ISSUED ASA MATTER OF INFORMATION Anawan Insurance Agency, Inc. ONLYAND CONFERS NO RIGHTS UPON T HECERTIFICATE 4 Anawan Avenue HOLDER. THIS CERTIFICATEDOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. West Roxbury, MA 02132 INSURERS AFFORDING COVERAGE NAI INSURED INSURER A: Norfolk & Dedham _ JEFFREY M. BRAIT DBA 1 INSURER B: WC Assigned Risk Pool _ REGAL DESIGN CONSTRUCTION CORP INSURER C: 5224 WASHINGTON ST —. -- - — -_" INSURER D: WEST ROXBURY, MA 02132 - 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 CONDITION 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 LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSRADD'L POUCYEFFECTIVE POUCYEXPIRATION L R I SRL TYPEOF R POLICYNUMBER A E IDD D T LIMITS GENERAL LIABILITY EACH OCCURRENCE S 1,000,000 - -- A X COMMERCIAL GENERAL LIABILITY R0634306A 3/14/07 3/14/08. DA WAGETOlrENTED­_- PREMISES�occmence) _$ 50,000 --- - CLAMS MADE OCCUR MED EXP (Anyone person) S 5,000 PERSONAL&ADV INJURY S GENERALAGGREGATE S 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OPAGG 5 2,000,000 -- POLICY - PRO• _ LOC JECT AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT S ANY AUTO (Ea accident) ALL OWNED AUTOS BODILYiNJURY S (Per person) SCHEDULEDAUTOS HIRED AUTOS BODILY INJURY S (Per accident) NON -OWNED AUTOS _ --_ , PROPERTY DAMAGE S — (Per accident) GARAGELIABILITY _AUTO ONLY - EAACCIDENT S - ANYAUTO OTHER THAN EAACC $` — AUTOONLY: AGG S EXCESSIUMBRELLALIABILITY EACH OCCURRENCE S OCCUR CLAIMS MADE AGGREGATE $ DEDUCTIBLE S RETENTION S S A U• OT WORKERS COMPENSATION AND WC -224-68-34 330/07 330/08.E.L. _TORYUMRS ER ,- 1,000,000 B EMFLOYERS'LIABILITY EACH ACCIDENT $ ANY PROFRIETORIPARTNERE(ECUTM 1,000,000 OFFICERIMEMBEREXCLUDED? E.L. DISEASE -EA EMPLOYEE S If yes descd be under E.L. DISEASE • POLICY LIMIT S 1,000,000 SPECIAL PROVIS ON S below OTHE R D ESC RIPTIO N OF 0 FERATIONS I LOCATIONS I VEH IC LES I EXC L USIONS ADDED BY EN D ORSEM ENT I SPECIAL PROVISIO NS WORK USUAL TO A CONTRACTOR ■• oMA SCHNEIDER AUTOMATION INC ONE HIGH STREET NORTH ANDOVER, MA 01845-2699 ACORD 25 (2001/08) L,AI41,rLLA 1 I VIV SHOULD ANY OF THE ABOVE OESCRI BED DATE THEREOF, THE ISSUING INSURER W NOTIC ETO THE CERTIFICATE HOLDER W I MPOS E NO OBLIGATION OR LIABILITY OF REPRESENTATIVES. AUTHORIZED REPRESENTATIVE F CANCELLED BEFORE THE EXPIRATION iRTOMAIL 30 DAYSWRITTEN LEFT, BUT FAILURE TO DOSO SHALL TTHE INSURER, ITS AGENTS OR © ACORD CORPORATION 1988 • ' w IMPORTANT If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement on this certificate does not confer rights b the certificate holderin lieu of such endorsement(s). If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain po I icies may require an endorsement.A state mentonthis certificate does not confer rights to the certificate holder in lieu of such endorsement(s). DISCLAIM ER The C ertificate of Insurance on the reverse side ofthi s form does not constitute a contract between the issuing insurer(s), authorized re presentative or producer, and the certificate holder, nor does it affrmativelyor negativelyamend, extend oralterthe coverage afforded bythe policies listed thereon. 4CORD 25 (2001/08) • 0� 44 o w U) A U) cz o W w w m w v U w W �' ,� bo w in x a O a w W w U) w a O to cG in w z w v 4 m � cn v 0 cn M 6 z c� o c � o � C H O C VO V O, C O ea m C ;= O EQ CF mo CD OIL y E c J0 CD E� 'vim cm CD E CL= • h � m ;Lo a o 0 3 z c m N = 44 H O O co c cm cm0 y O m cr. C! 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