Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
Building Permit #178 - Bldg 6-Groupe Schneider 9/10/2008
pORTH BUILDING PERMIT o�tt,.o ,baa TOWN OF NORTH ANDOVER 02 APPLICATION FOR PLAN EXAMINATION * _ 7 /�• � p # Permit NO: Date Received (/ 0 �qS gA7eC�,pP�,�g I y SACHUS� Date Issued: e ap MPORTANT:Applicant must complete all items on this page LOCATION x Print' � )],Y PROPERTY OWNER S��\69_t 10C M 1` 1 A-nlll La. , 9oJ� `Gbae, Pnnt MAP NO: J�" PARCEL:0001 ONING3DISTR CT: Historic District ' yes no. 4 -Village'Machine.Sh`op yes- TYPE TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building One family Addition Two or more family Industrial Alteration ✓ No. of units: Commercial ✓ Repair, replacement Assessory Bldg Others: Demolition Other Septic Wel] Floodplain Wetlands ' 1lllatershed District " .. Water/Sewer DESCRIPTION OF WORK TO BE PREFORMED: J;AefZ10-a- L�-eNo.,�+►�LS I nC�J a�n°� d2^lw�(.(�. �Fhn/t�n PC h ��l i` Identification Please Type or Print Clearly) OWNER: Name: � Q� ctr (�.�1or•r�-I,� cL �c�J�crCcaQPhone:Q7$-q�5�9y7`l Address: 4ah ST N.Atid-ea- o1p, CONTRACTOR Name; et, tc. u °t . Phone: -?$'�.Sb�Ck1� Address; �` 1 MQ1� �' . INtrP25� Kt ©lyZ3 n Supervisor's Construction;License*,,'a ' Exp: Date: n Hoene Irnprovernent License: Exp., Dade; ARCHITECT/ENGINEER 1wCtT x,11 Phone: (ol7- `i?,3- *Sz Address: ?'� (fP, S-- Lomj Reg. No. 00$D FEE SCHEDULE:BULDING PERMIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ I/Z-©, 300. oo FEE: $ Check No.: l � � Receipt No.: -`21 y 1i NOTE: Persons contracting with unregistered contractors do not have access to theuaranty fund lgnature,off Agent/Owhor Signature of contractor -z..--- Plans Submitted Plans Waived Certified Plot Plan Stamped Plans TYPE OF SEWERAGE DISPOSAL Public Sewer Tanning/Massage/Body Art Swimming Pools Well Tobacco Sales Food Packaging/Sales Private(septic tank,etc. Permanent Dumpster on Site THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT COMMENTS DATE REJECTED DATE APPROVED CONSERVATION COMMENTS DATE REJECTED DATE APPROVED ` HEALTH - - 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 Located at 384 Osgood Street FIRE"DEPARTMENT lTemp Dun Aster on site yes no Located.at 124 Main Street Fire,Department signature/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 4 PP 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 2007 Building Department The following is a list of the required forms to be filled out for the appropriate permit to be obtained. Roofing, Siding, Interior Rehabilitation Permits ❑ Building Permit Application ❑ Workers Comp Affidavit ❑ Photo Copy Of H.I.C. And/Or C.S.L. Licenses ❑ Copy of Contract ❑ Floor Plan Or Proposed Interior Work ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks ❑ Building Permit Application ❑ Certified Surveyed Plot Plan ❑ Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses ❑ Copy Of Contract ❑ Floor/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) ❑ Building Permit Application ❑ Certified Proposed Plot Plan ❑ Photo of H.I.C. And C.S.L. Licenses ❑ Workers Comp Affidavit ❑ Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Copy of Contract ❑ Mass check Energy Compliance Report ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department-prior to issuance of Bldg Permit In all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals that the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be submitted with the building application Doc:INSPECTIONAL SERVICES DEPARTMENT:BPFORM07 Revised 2.2007 � 1 LocationswANc ' No. Date a Moa,N TOWN OF NORTH ANDOVER . �? � - _•SOL 41 +79 F p .. 1 Certificate of Occupancy $ 'SJgcMust< Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 21 498. Building Inspector V40RTH over TONM of And .. ..... ... No. LA o7 over, Mass.,— 5?1z1—'z6k 0 COCHICHEWICK Or'?ATED C2 BOARD OF HEALTH Food/Kitchen PERMIT . T D Septic System BUILDING INSPECTOR THISCERTIFIES THAT........................Y. ............................................................................................................................. Foundation has permission to erect........................................ buildings on ...... ..................................................... Rough Chimney to be occupied as................ ........................................................................................................................ 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 N ,6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTION STARTS Rough Service BUILDING INSPECTOR Final Occupancy Permit Required to Omipy Building GAS INSPECTOR 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. SEE REVERSE SIDE Smoke Dei Schneider Electric September 5, 2008 i Ms. Dina Yorke c/o TAC, LLC One High Street North Andover, MA 01845 Re:Consent to Renovations to Building 6, of One High Stree# Dear Dina: Schneider Automation Inc. ("Schneider") is the Tenant of the complex at One High Street, under a Master Lease with HDG Mansur Investment Services, Inc. ("Mansur"). Schneider sub-lets a portion of this property to TAC, LLC. ("TAC"). TAC has proposed making certain renovations and alterations to the first and second floors of Building 6 of the One High Street Complex, as outlined in the attached schematic prepared by Burt Hill labeled "Project Number 08802.000, Drawing Number A200," and dated 7/28/08. We approve of the renovations and alterations as outlined in this schematic. If you should have any questions or require additional documentation from us in this matter, please contact me at (978) 975-9451. Thank you for you consideration in this matter. Sincerely, SCHNEIDER AUTOMATION INC. Robert W. Bell, Corporate Secretary Schneider Automation Inc. One High Street North Andover,MA 01845-2899 Tei. (1)978-794-0800 Fax (1)978.975-9400 ® i www.modicon.com a gig a ' E� "mill � t [ .t �aE9 fl �r i 22. l� i z EO i I to s to =o IL so �o go to t0...�........_ s'o B jo to 1i wx EQ E® n v uA Document A101TM - 2007 Standard Form of Agreement Between Owner and Contractor where the basis of payment is a Stipulated Sum AGREEMENT made as of the Fourth day of September in the year Two Thousand and Eight ADDITIONS AND DELETIONS: (In words, indicate day,month.and year) The author of this document has added information needed for its BETWEEN the Owner: completion.The author may also (Name,address and other information) have revised the text of the original AIA standard form.An Additions and TAC,LLC Deletions Report that notes added One High Street information as well as revisions to North Andover,MA 01845 the standard form text is available from the author and should be and the Contractor: reviewed.A vertical line in the left (Name,address and other information) margin of this document indicates where the author has added Republic Building Contractors,Inc. necessary information and where 491 Maple Street,Suite 103 the author has added to or deleted Danvers,MA 01923 from the original AIA text. This document has important legal for the following project: consequences.Consultation with an (Name., location, and detailed description,) attorney is encouraged with respect to its completion or modification. TAC Building 6 Renovations AIA Document A201 TM-2007, One High Street General Conditions of the Contract North Andover,MA 01810 for Construction,is adopted in this RBC Project No.08-704 document by reference.Do not use with other general conditions unless The Architect: this document is modified. (Name,address and other information) Burt Hill 303 Congress Street,6`s Floor Boston,MA 02210 The Owner and Contractor agree as follows. AIA Document A1111 TM—2007.Copyright Q 1915.1918,1925,1937,1951,1958,1961.1963,1967,1974.1977,1987,1991,1997 and 2007 by The (nit. American Institute of Architects. All rights reserved. WARNING:This AIA"Document is protected by U.S.Copyright Law and international Treaties. Unauthorized reproduction or distribution of this AIO Document,or any portion at if,may result in severe civil and criminal penalties,and will be 1 r prosecuted to the maximum extent possible under the law.This document was produced by AIA software at 15:06:50 on 09/0512008 under Order No.1000329137_1 which expires on 11!512008,and isnot for resale. User Notes: (1755395847) TABLE OF ARTICLES I THE CONTRACT DOCUMENTS 2 THE WORK OF THIS CONTRACT 3 DATE OF COMMENCEMENT AND SUBSTANTIAL COMPLETION 4 CONTRACT SUM 5 PAYMENTS 6 DISPUTE RESOLUTION 7 TERMINATION OR SUSPENSION 8 MISCELLANEOUS PROVISIONS 9 ENUMERATION OF CONTRACT DOCUMENTS 10 INSURANCE AND BONDS ARTICLE I THE CONTRACT DOCUMENTS The Contract Documents consist of this Agreement,Conditions of the Contract(General,Supplementary and other Conditions),Drawings,Specifications,Addenda issued prior to execution of this Agreement,other documents listed in this Agreement and Modifications issued after execution of this Agreement,all of which form the Contract,and are as fully a part of the Contract as if attached to this Agreement or repeated he-rein.The Contract represents the entire and integrated agreement between the parties hereto and supersedes prior negotiations,representations or agreements,either written or oral. An enumeration of the Contract Documents,other than a Modification,appears in Article 9. ARTICLE THE WORK OF THIS CONTRACT The Contractor shall fully execute the Work described in the Contract Documents,except as specifically indicated in the Contract Documents to be the responsibility of others. ARTICLE DATE OF COMMENCEMENT AND SUBSTANTIAL COMPLETION §3.1 The date of commencement of the Work shall be the date of this Agreement unless a different date is stated below or provision is made for the date to be fixed in a notice to proceed issued by the Owner. (Insert the date of coninienceinent if it differs from the date of this Agreentent or, if applicable,state that the(late will befi-.Ted in a notice to proceed.) Project to commence upon receipt of an executed contract and building permit. If,prior to the cornmencenient of the Work-,the Owner requires time to file mortgages and other security interests, the Owner's time requirement shall be as follows: §3.2 The Contract Time shall be measured from the date of commencement. §3.3 The Contractor shall achieve Substantial Completion of the entire Work not later than days from the date of cornmencernent,or as follows: (Insert number of calendar days.Alternatively, y, a calendar date may be used when coordinated with the date 1.-)J' coininencenient.If appropriate, insert requirements for earlierSubstantial Completion of certain portions of the Work-.) AIA Document A1101TM—2007.Copyright @ 1915,1918,1925,1937,1951 1958 1961 1963.1967,1974.1977.1987.1991,1997 and 2007 by The Init. American Institute of Architects. All rights reserved. WARNING:This AIA'!Document* 'is protected by U.S.Copyright Law and International Treaties. 2 Unauthorized reproduction or distribution of this AlAa Document,or any portion of It,may result in severe civil and criminal penalties,and will be prosecuted to the maximum extent possible under the law.This document was produced by ALA software at 15:06:50 on 0910512008 under Order No.1000329137_1 which expires on 11/5/2008,and is not for resale. User Notes: (1755395847) 1 , Phase I and II to be completed not later than November 1,2008 provided that a contract and permitting is in place not later that September 12,2008.Phase III will commence mid December 2008 or early January 2009 as directed by the owner.Phase I and Phase II completion date(November 1,2008)and Phase 11.1 shall be extended by not more than one business day for each business day of delay beyond September 12,2008 for securing of permit and contract. Portion of Work Substantial Completion Date See above See above subject to adjustments of thus Contract Time as provided in the Contract Documents. (Insert provisions, if an y,for liquidated damages relolin.g to failure to achieve Substantial Completion on time:or for bonus payments far early completion elf the lVork.) ARTICLE 4 CONTRACT SUM §4.1 The Owner shall pay the Contractor the Contract Sum in current funds for the Contractor's performance of the Contract.The Contract Sum shall be One Hundred Twenty Thousand Three Hundred Dollars ($ 120,300.00 ), subject to additions and deductions as provided in the Contract Documents. §4.2 The Contract Sum is based upon the following alternates,if any,which are described in the Contract. Documents and are hereby accepted by the Owner: (State the numbers or other iden.tijication of accepted alternates. If the bidding or proposal documents permit the Ot+mer to accept other alternates subsequent to the execution of this Agreement, attach a schedule of such other alternates showing the amount for each and the date when that amount expires.) The contract sum does not include any alternates. §4.3 Unit prices,if any: (Identify and state the unit price;state quantity limitations, if any,to which(the unit price will be applicable.) item Units and Limitations Price Per Unit §4.4 Allowances included in the Contract Sum,if any: (Identify allowance and state exclusions, if any,from the allowance price.) Item Price Roofing $500.00 ARTICLE 5 PAYMENTS §5.1 PROGRESS PAYMENTS §5,1.1 Based upon Applications for.Payment submitted to the Architect by the Contractor and Certificates for Payment issued by the Architect,the Owner shall make progress payments on account of the Contract Sum to the Contractor as provided below and elsewhere in the Contract Documents. §5.1.2 The period covered by each Application for Payment shall be one calendar month ending on the last day of the month,or as follows: §5.1.3 Provided that an Application for Payment is received by the.Architect not later than the Thirtieth day of a month,the Owner shall make payment of the certified amount to the Contractor not later than the Thirtieth day of the following month.If an Application for Payment is received by the Architect after the application date fixed above,payment shall be made by the Owner not later than Thirty ( 30 )days after the Architect receives the Application for Payment. (Federal,state or local laws may require pa}yrnent within a certain period of time.) AIA Document A101T -2007.Copyright Q 1915,1918,1925,1937.1951,1958,1961,1963,1967,1974,1977,1987,1991,1997 and 2007 by The [nit. American Institute of Architects. All rights reserved. WARNING:This AIA$Document is protected by U.S.Copyright Law and International Treaties. 3 Unauthorized reproduction or distribution of this AIAe'Document,or any portion of It,may result in severe civil and criminal penalties,and will be t prosecuted to the maximum extent possible under the law. This document was produced by AIA software at 15:06:50 on 09/05/2008 under Order No.1 0003291 37_1 which expires on 11!5/2008,and is not for resale. User Notes: (1755395847) §5.1.4 Each Application for Payment shall be based on the most recent schedule of values submitted by the Contractor in accordance with the Contract Documents.The schedule of values shall allocate the entire Contract Sum among the various portions of the Work.The schedule of values shall be prepared in such form and supported by such data to substantiate its accuracy as the Architect may require.This schedule, unless objected to by the Architect,shall be used as a basis for reviewing the Contractor's Applications for Payment.Each application or payment shall be accompanied by the contractors waiver for said payment and any and all subcontractor waivers for labor and materials included in the preceding application for payment. §5.1.5 Applications for Payment shall show the percentage of completion of each portion of the Work as of the end of the period covered by the Application for Payment, §5.1,6 Subject to other provisions of the Contract Documents,the amount of each progress payment shall be computed as follows: .1 Take that portion of the Conti-act Sum properly allocable to completed Work as determined by multiplying the percentage completion of each portion of the Work by the share of the Contract Sum allocated to that portion of the Work in the schedule of values,less retainage of Tell percent 10.00% ).Pending final determination of cost to the Owner of changes in the Work,amounts not in dispute shall be included as provided in Section 7.3.9 of AIA Document A2011",1-2007,General Conditions of the Contract for Construction; .2 Add that portion of the Contract Sum properly allocable to materials and equipment delivered and suitably stored at the site for subsequent incorporation in the completed construction(or,if approved in advance by the Owner, suitably stored off the site at a location agreed upon ill writing), less C, 10 retainage of Ten percent ( 10.00% ): .3 Subtract the aggregate of previous payments made by the Owner;and A Subtract amounts,if any,for which the Architect has withheld or nullified a Certificate for Payment as provided in Section 9.5 of AIA Document A201-2007. §5.1.7 The progress payment amount determined in accordance with Section 5.1.6 shall be further modified under the following circumstances: .1 Add,upon Substantial Completion of the Work,a sum sufficient to increase the total payments to the full amount of the,Contract Sum,less such amounts as the Architect shall determine for incomplete Work,retainage applicable to such work and unsettled claims;and (Section 9.8.5 of AIA Document A201-2007 requires release of applicable retainage upon Substantial Completion oj'Work-ivith consent of surety, if any.) v.) .2 Add,if final completion of the Work is thereafter materially delayed through no fault of the Contractor,any additional amounts payable in accordance with Section 9.10.3 of AIA Document A201-2007. §5.1.8 Reduction or limitation of retainage,if any,shall be as follows: (If it is intended,prior to Substantial Completion of the entire Work, to reduce or limit the retainage resulting front the percentages inserted in Sections 5.1.6 1 and 5.1.6.2 above, and this is not explained elsewhere in the Contract Documents, insert here provisions for such reduction or limitation.) §5.1.9 Except with the Owner's prior approval,the Contractor shall not make advance payments to suppliers for materials or equipment which havenot been delivered and stored at the site. §5.2 FINAL PAYMENT §5.2.1 Final payment,constituting the entire unpaid balance of the Contract Sum,shall be made by the Owner to the Contractor when .1 the Contractor has fully performed the Contract except for the Contractor's responsibility to correct Work as provided in Section 12.2.2 of AIA Document A201-2007,and to satisfy other requirements., if any, which extend beyond final payment;and .2 afinal Certificate for Payment has been issued by the Architect. AIA Document A1011m—2007.Copyright@ 1915,1918,1925,1937,1951,1958,1961,1963,1967,1974,1977,1987,1991,1997 and 2007 by The [nit. American Institute of Architects. Ail rights reserved. WARNING:This AIA6 Document Is protected by U.S.Copyright Law and International Treaties. 4 Unauthorized reproduction or distribution of this AIA" Document,or any portion of it,may result In severe civil and criminal penalties,and Will be prosecuted to the maximum extent possible under the law. This document was produced by AIA software at 15:06:50 on 09/05/2008 under Order No.1 000329137_1 which expires on 1 115?2008,and is not for resale. User Notes: (1755395847) 5.2.2 The Owner's final payment to the Contractor shall be made no later than 30 days after the issuance of the Architect's final Certificate for Payment,or as follows: §5.2.3 Final application for payment shall be accompanied by the contractor's final waiver and any all subcontractors' final waivers. ARTICLE 6 DISPUTE RESOLUTION §6.1 INITIAL DECISION MAKER The Architect will serve as Initial Decision Maker pursuant to Section 15.2 of AIA Document A20.1-2007,unless the parties appoint below another individual,not a party to this Agreement,to serve as Initial Decision Maker. (If the pat-ties mutually agree, insert the name, address and other contact information of the Initial Decision Maker, if other than the Architect.) 6.2 BINDING DISPUTE RESOLUTION For any Claim subject to, but not resolved by,mediation pursuant to Section 15.3 of AIA Document A201-2007,the method of binding dispute resolution shall be as follows: (Check the appropriate box.If the Owner and Contractor do not select a method of binding dispute resolution below, or do not subsequently agree in writing to a binding dispute resolution inethod other than litigation, Claims will be resolved by litigation in a court of competent jurisdiction) X] Arbitration pursuant to Section 15.4 of AIA Document A20.1-2007 Litigation in a court of competent jurisdiction ] Other(Specify) ARTICLE 7 TERMINATION OR SUSPENSION §7.1 The Contract may be,terminated by the Owner or the Contractor as provided in Article 14 of AIA Document A201-2007. §7.2 The Work may be suspended by the Owner as provided in Article 14 of AIA Document A201-2007. ARTICLE 8 MISCELLANEOUS PROVISIONS §8.1 Where reference is made in this Agreement to a provision of AIA Document A201-2007 or another Contract Document,the reference refers to that provision as amended or supplemented by other provisions of the Contract Documents. §8.2 Payments due and unpaid under the Contract shall bear interest from the date payment is due at the rate stated below,or in the absence thereof,at the legal rate prevailing from time to time at the place where the Project is located. (Insert rate of interest agreed upon, if any.) Bank of America prime rate 8.3 The Owner's representative,: (Name, address and other information) David Forni TAC,Inc. One High Street North Andover,MA 0.1.845 AIA Document A101TM-2007.Copyright Q 1915,1918,1925,1937,1951,1958,1961,1963.1967,1974,1977,1987,1991,1997 and 2007 by The Init. American Institute of Architects. All rights reserved. WARNING:This A,As'Document is protected by U.S.Copyright Law and International Treaties. Unauthorized reproduction or distribution of this AIA"Document,or any portion of It,may result in severe civil and criminal penalties,and will be 5 prosecuted to the maximum extent possible under the law. This document was produced by AIA software at 15:06:50 on 09/05/2008 under Order No.1 000329137_1 which expires on 1115/2008,and is not for resale. User Notes: (1755395847) Phone: (978)975-9474 Email:david.forni@tac.com §8.4 The Contractor's representative: (Name, address and other information) James J.Ward Republic Building Contractors,Inc. 49.1 Maple Street.,Suite 103 Danvers,MA 01923 Phone: (978)750-0099 Fax: (978)750-8893 Mobile: (508)962-0477 Entail:jward@republicbuilding.com §8.5 Neither the Owner's nor the Contractor's representative shall be changed without ten days written.notice to the other party. §8.6 Other provisions: ARTICLE ENUMERATION OF CONTRACT DOCUMENTS §9.1 The Contract Documents,except for Modifications issued after execution of this Agreement,are enumerated in the sections below. §9.1.1 The Agreement is this executed ATA Document A10.1-2007,Standard Form of AgreementBetween Owner and Contractor. §9.1.2 The General Conditions are AIA Document A201-2007,General Conditions of the Contract for Construction. §9.13 The Supplementary and other Conditions of the Contract: Document Title Date Pages §9.1.4 The Specifications: (Either list the Specifications here or refer to art exhibit attached to this Agreement.) Not applicable (Table deleted) §9.1.5 The Drawings: (Either list the Drawings here or refer to an exhibit attached to this Al;reement.) Reference Republic's proposal dated August 12,2008. (Table deleted) §9.1.6 The Addenda,if any: Number Date Pages Portions of Addenda relating to bidding requirements are not part of the Contract Documents unless the bidding requirements are also enumerated in this Article 9. 9.1.7 Additional documents,if any, forming part of the Contract Documents: C, .1 ATA Document E20 ITM—')007,Digital Data Protocol Exhibit,if completed by the parties,or the following: AIA Document A101 1"—2007,Copyright ©1915,1918,1921,1931*1951 1958 1961,1963,1967,1914,1977,1987,1 99 1,1117 and 2007 by The Init. American Institute of Architects. All rights reserved. WARNING:This AlAi Document Is protected by U.S.Copyright Low and International Treaties. Unauthorized reproduction or distribution of this AIO Document,or any portion of it,may result In severe civil and criminal penalties,and will be 6 prosecuted to the maximum extent possible under the low.This document was produced by AIA software at 15:06:50 on 09/05/2008 under Order No.1 000329137_1 which expires on 11/5/2008,and is not for resale. User Notes: (1755395847) .2 Other documents,if any, listed below: (List here any additional documents that are intended to form part of the Contract Documents.AIA Document A201-2007 provides that bidding requirements such as advertisement or invitation to bid, Instructions to Bidders,sample forms and the Contractor's bid are not part of the Contract Documents unless enumerated in this Agreement. They should be listed here only if intended to be part of the Contract Documents.) Proposal prepared by Republic Building Contractors,Inc.dated August 12,2008. ARTICLE 10 INSURANCE AND BONDS The Contractor shall purchase and maintain insurance and provide bonds as set forth in Article I I of AIA Document A201-2007. (State bonding requirements, if any, and limits of liability,for insurance required in Article 1.1 of AIA Document A20.1-2007.) Type of insurance or bond Limit of liability or bond amount($0.00) This Agreement entered into as of the day and year first written above. �k L-\nj OWNER(,Signature) trie) NT CTOR(Signatr e) J.Ward,President (Printed name and title) (Printed name and title) AIA Document A10iTM—2007.Copyright©1915,1918,1925,1937,1951 1958,1961,1963,1967,1974,1977.1987,1991,1997 and 2007 by The Init. American Institute of Architects. All rights reserved. WARNING:This AIA;`Document isprotected by U.S.Copyright Law and International Treaties. Unauthorized reproduction or distribution of this AIA$°Document,or any portion of it,may result in severe civil and criminal penaitles,and will be 7 t prosecuted to the maximum extent possible under the law. This document was produced by AIA software at 15:06:50 on 09/05/2008 under Order No.1000329137_1 which expires on 111512008,and is not for resale. User Notes: (1755395847) Additions and Deletions Report for AIA®Document A 10 I'm—2007 This Additions and Deletions Report,as defined on page 1 of the associated document,reproduces below all text the author has added to the standard form AIA document in order to complete it,as well as any text the author may have added to or deleted from the original AIA text.Added text is shown underlined.Deleted text is indicated with a horizontal line through the original AIA text. Note: This Additions and Deletions Report is provided for information purposes only and is not incorporated into or constitute any part of the associated AIA document.This Additions and Deletions Report and its associated document were generated simultaneously by AIA software at 15:06:50 on 09/05/2008. PAGE AGREEMENT made as of the Fourth day of September in the year Two Thousand and Fight TAC,LLC One High Street North Andover MA 01845 Republic Building Contractors.Inc. 491 Maple Street.Suite 103 Danvers,MA 01923 TAC Building 6 Renovations One High Street North Andover MA 0 18 10 RBC Project No.08-704 Burt'Hill 303 Congress Street, 6u'Floor Boston.MA 02210 PAGE 2 Proiect to commence upon receipt of an executed contract.and building Permit. PAGE 3 Phase I and I.I to be completed not later than November 1,2008 provided that a contract and permitting is in place not later that September 12.2008.Phase III will commence mid December 2008 or early January 2009 as directed by the owner.Phase I and Phase 1I completion date(November 1,2008)and Phase III shall be extended by not more than one business day for each business day of delay beyond September 12,2008 for securing of permit and Contract. Additions and Deletions Report for AIA Document A101 Tu—2007.Copyright ©1915,1918,1925,1937,1951,1958,1961,1963,1967,1974.1977,1987, 1991.1997 and 2007 by The American Institute of Architects. Alf rights reserved. WARNING:This AIRF Document is protected by U.S.Copyright Law and International Treaties.Unauthorized reproduction or distribution of this A1Ar Document,or any portion of it,may result in severe civil and criminal penalties,and will be prosecuted to the maximum extent possible under the law, This document was produced by ALA software at 15:06:50 on 09/05+2008 under Order No.1000329137_1 which expires on 111512008,and is not for resale. User Notes: (1755395847) See above See above §4.1 The Owner shall pay the Contractor the Contract Sum in current funds for the Contractor's performance of the Contract.The Contract.Sum shall be One Hundred Twenty Thousand Three Hundred Dollars (S 120.300.00 subject to additions and deductions as provided in the Contract Documents. The contract sum does not include any alternates. Roofing $500.00 §51.3 Provided that an App]i cation for Payment is received by the Architect not later than the Thirtieth day of a month,the Owner shall make payment of the certified amount to the Contractor not later than the Thirtieth day of the following month.If an Application for Payment is received by the Architect after the application date fixed above,payment shall be made by the Owner not later than Thirty ( .30 )days after the Architect receives the Application for Payment. PAGE 4 §5.1.4 Each Application for Payment shall be based on the most recent schedule of values submitted by the Contractor in accordance with the Contract Documents.The schedule of values shall allocate the entire Contract Sum among the various portions of the Work.The schedule of values shall be prepared in such form and supported by such data to substantiate its accuracy as the Architect may require.This schedule,unless objected to by the Architect,shall be used as a basis for reviewing the Contractor's Applications for Payment.Each application or payment shall be accompanied by the contractors waiver for said Davment and any and all subcontractor waivers for labor and materials included in the preceding application for payment. .1 Take that portion of the Contract Sum properly allocable to completed Work as detennined by multiplying the percentage completion of each portion of the Work by the share of the Contract Sunn allocated to that portion of the Work in the schedule of values.less retainage of Ten percent 10.00% ).Pending final determination of cost to the Owner of changes in the Work,amounts not in dispute shall be included as provided in Section 7.3.9 of AIA Document A201PIM-2007,General Conditions of the Contract for Construction, .2 Add that portion of the Contract Sum properly allocable to materials and equipment delivered and suitably stored at the site for subsequent incorporation in the completed construction(or, if approved in advance by the Owner, suitably stored off the site at a location agreed Upon in writing), less retainage of Ten percent 6% - 4- ( -10.0 ), PAGE 5 4 5.2.3 Final application for payment shall be accompanied by the contractor's final waiver and any all subcontractors' final waivers, X I Arbitration pursuant to Section 15.4 of AIA Document A201-2007 Additions and Deletions Report for AIA Document A101Tm-2007.Copyright 9)1915,1918,1925,1937, 1951,1958,1961,1963,1967,1974,1977,1987, 1991,1997 and 2007 by The American Institute of Architects. All rights reserved. WARNING:This AIO Document is protected by U.S.Copyright Law 2 and International Treaties.Unauthorized reproduction or distribution of this AlAn Document,or any portion of It,may result in severe civil and criminal penalties,and will be prosecuted to the maximum extent possible under the law.This document was produced by AIA sottware at 15:06:50 on 09,105/2008 under Order No.1 000329137_1 which expires on 11/5/2008,and is not for resale. User Notes: (1755395847) Bank of America prime rate David Forni TAC,Inc. One High Street North Andover,MA 01845 Phone: (978)975-9474 Email: david,fomi@tac.com PAGE 6 James J.Ward Republic Building Contractors, Inc. 491 Maple Street,Suite 103 Danvers,MA 01.923 Phone: (978)750-0099 Fax:(978)750-8893 Mobile:(508)962-0477 Email iward@republidbuildinp,.coni Not applicable SestieR Mlle Date P"" Reference Republic's proposal dated Au,(gust 12,2008. NUFRbe T4 4e Date PAGE 7 Proposal prepared by Republic,Building Contractors, Inc.dated August 12.2008. James J.Wud.President Additions and Deletions Report for AIA Document A101114-2007.Copyright 0 1915,1918,1925,1937,1951,1958,1961,1963,1967.1974,1977,1987, 1991,1997 and 2007 by The American Institute of Architects. All rights reserved. WARNING:This Ale"Document Is protected by U.S,Copyright Law 3 and International Treaties.Unauthorized reproduction or distribution of this Ale Document,or any portion of it,may result In severe civil and criminal penalties,and will be prosecuted to the maximum extent possible under the law. This document was produced by AIA software at 15:06:50 on 09/05/2008 under Order No.1 000329137_1 which expires on 11,1512008,and is not for resale. User Notes: (1755395847) Certification of Document's Authenticity A!A®Document D40 1 TM —2003 1,James J.Ward,hereby certify,to the best of my knowledge, information and belief,that I created the attached final document simultaneously with its associated Additions and Deletions Report and this certification at 15:06:50 on 09/05/2008 under Order No. 10003291371 from AIA Contract Documents software and that in preparing the attached.final document I made no changes to the original text of AIAO Document A]OITrl—2007-Standard Form of Agreement Between Owner and Contractor where,the basis of payment is a Stipulated Sum,as published by the AIA in its software,other than those additions and deletions shown in the associated Additions and Deletions Report. 0-1, (Signed) (Title) /ou (Dated) AlA Document D401111—2003.Copyright 1992 and 2003 by The American Institute of Architects. All rights reserved. WARNING:This AIA8 Document is protected by U.&Copyright Law and International Treaties.Unauthorized reproduction or distribution of this AIA" Document,or any portion of it, may result in severe civil and criminal penalties,and will be prosecuted to the maximum extent possible under the law,This document was produced by AIA software at 15:06:50 on 09/05/2008 under Order No.10003291371 which expires on 111512008,and is not for resale. User Notes* (1755395847) OFFICE OF BUILDING INSPECTOR t? TOWN OF NORTH ANDOVER f f '''s • F; CONSTRUCTION CONTROL PROJECT NUMBER, 08802.00 PROJECT TITLE: t.a.c. PROJECT LOCATION: One High Street NAME OF BUILDING: Building Six NATURE OF PROJECT; Renovations to office space IN ACCORDANCE WITH ARTICLE 116 OF THE MASSACHUSETTS STATE BUILDING CODE, i, Linda Smiley REGISTRATION NO. 10080 BEING A:REGISTERED PROFESSIONAL ENGINEERIARCHITECH HEREBY CERTIFY THAT i HAVE PREPARED OR DIRECTLY SUPERVISED THE PREPARATION OF ALL DESIGN PLANS, COMPUTATIONS AND SPECIFICATIONS CONCERNING. ENTIRE PROJECT ❑ ARCHITECTURAL ® STRUCTURAL ❑ MECHANICAL ❑ FIRE PROTECTION ❑ ELECTRICAL ❑ OTHER(SPECIFY) FOR THE ABOVE NAMED PROJECT AND THAT,TO THE BEST OF MY KNOWLEGE, SUCH PLANS, ` COMPUTATIONS AND SPECIFICATIONS MEET THE APPLICABLE PROVISION OF THE MASSACHUSETTS STATE BUILDING CODE,ALL ACCEPTABLE ENGINEERING PRATICES. AND APPLICABLE LAWS AND ORDINANCES FOR THE PROPOSED USE AND OCCUPANCY. I FURTHER CERTIFY THAT I SHALL PERFORM THE NECESSARY PROFESSIONAL SERVICES AND B EPRESENT ON THE CONSTRUCTION SITE ON A REGULAR AND PERIODIC BASIS TO DETERMINE THAT THE WORK IS PROCEEEDING IN ACCORDANCE WITH THE DOCUMENTS APPROVED FOR THE BUILDING PERMIT AND SHALL BE RESPONSIBLE FOR THE FOLLOWING AS SPECIFIED IN SECTION 116.0 1. Review,for conformance to the design Concept,shop drawings,samples and other submittals which are submitted by the contractor in accordance with the requirements of the construction documents. 2. Review and approval of the.quality control pmcedures for all code-required controlled materials. 3. Be present at intervals appropriate to the stage of construction to become,generally familiar witMhe progress-and quality of the work and to determine, in general,if the work is being performed in a manner consistent with the construction documents. PURSUANT TO SECTION 116.2 .2 I SHALL SUBMIT WEEKLY, A PROGRESS REPORT TOGETHER WITH PERTINENT COMMENTS TO THE NORTH ANDOVER BUILDING INSPECTOR. UPON COMPLETION OF THE WORK, I SHALL SUBMIT A FINAL REPORT AS TO THE SATISFACTORY COMPLETION AND READINESS OF THE PROJECT FOR OCC ANCY. IC3NATURE SUBSCRIBED AND SWORN TO BEFORE ME THIS Z DAY OF NOTARY PUBLIC MY COMMISSION EXPIRES ed .. ,y OFFICE OF BUILDING INSPECTOR �' <.' ..: • „ TOWN OF NORTH ANDOVER �.� ._: CONSTRUCTION CONTROL PROJECT NUMBED; PROJECT TITLE: TAC at North Andover PROJECT LOCATION: One High Street NAME OF BUILDING: Building 6 NATURE OF PROJECT: Tenant changes IN ACCORDANCE WITH ARTICLE 116 OF THE MASSACHUSETTS STATE BUILDING CODE, i, William T. Reffner, III, P.E. REGISTRATION NO. 45360 BEING A,REGISTERED PROFESSIONAL ENGINEER!AR§*%9 HEREBY CERTIFY THAT I HAVE PREPARED OR DIRECTLY SUPERVISED THE P'REPARATI N OF ALL DESIGN PLANS, COMPUTATIONS AND SPECIFICATIONS CONCERNING: ENTIRE PROJECT ARCHITECTURAL STRUCTURAL MECHANICAL FIRE PROTECTION ❑ ELECTRICAL OTHER(SPECIFY} FOR THE ABOVE NAMED PROJECT AND THAT,TO THE BEST OF MY KNOWLEDGE,SUCH PLANS, COMPUTATIONS AND SPECIFICATIONS MEET THE APPLICABLE PROVISION OF THE MASSACHUSETTS STATE BUILDING CODE, ALL ACCEPTABLE ENGINEERING PRACTICES. AND APPLICABLE LAWS AND ORDINANCES FOR THE PROPOSED USE AND OCCUPANCY. I FURTHER CERTIFY THAT I SHALL PERFORM THE NECESSARY PROFESSIONAL SERVICES AND BE PRESENT ON THE CONSTRUCTION SITE ON A REGULAR AND PERIODIC BASIS TO DETERMINE THAT THE WORK IS PROCEEDING IN ACCORDANCE WITH THE DOCUMENTS APPROVED FOR THE BUILDING PERMIT AND SHALL BE RESPONSIBLE FOR THE FOLLOWING AS SPECIFIED IN SECTION 116.0. 1. Review,for conformance to the design concept,shop drawings,samples and other submittals which are submitted by the contractor in accordance with the requirements of the construction documents. 2. Review and approval of the quality control procedures for all code-required controlled materials. 3. Be present at intervals appropriate to the stage of construction to become,generally familiar with the progress and quality of the work and to determine, in general, if the work being performed in a manner consistent with the construction documents. PURSUANT TO SECTION 1162.21 SHALL SUBMIT AFTER EACH SITE VISIT,A PROGRESS REPORT TOGETHER WITH PERTINENT COMMENTS TO THE NORTH ANDOVER BUILDING INSPECTOR. UPON COMPLETION OF THE WORK, I SHALL SUBMIT A FINAL REPORT AS TO THE SATISFACTORY COMPLETION AND READINESS OF THE PROJECT FOR OCCUPANCY. ^ SIGNATURE SUBSL_ IBED AND SWORN -O BEFORE ME THIS DAY OF u_44 COMMtMVtALH OF PENNSYLVANIA Notarial Seal Maryann L.Cover,Notary Public _ NCO,T .RMY COMMISSION EXPIRES WMdMBoro,SomeWtCounty _yCRfiffii ion Expires July 13,2010 Member,Pennsylvania Association of Notal OFFICE OF BUILDING INSPECTOR a TOWN OF NORTH ANDOVER `•`�' CONSTRUCTION CONTROL PROJECT NUMBER: PROJECT TITLE: TAC at North Andover PROJECT LOCATION: One High Street NAME OF BUILDING: Building 6 NATURE OF PROJECT, Tenant Changes IN ACCORDANCE WITH ARTICLE 116 OF THE MASSACHUSETTS STATE BUILDING CODE, I, William R. McGhee, P.E. REGISTRATION NO. 35320 BEING A REGISTERED PROFESSIONAL ENGINEER q HEREBY CERTIFY THAT I HAVE PREPARED OR DIRECTLY SUPERVISED THE PREPARATION OF ALL DESIGN PLANS, COMPUTATIONS AND SPECIFICATIONS CONCERNING: ENTIRE PROJECT ARCHITECTURAL El STRUCTURAL MECHANICAL FIRE PROTECTION D ELECTRICAL Q OTHER(SPECIFY) FOR THE ABOVE NAMED PROJECT AND THAT,TO THE BEST OF MY KNOWLEDGE,SUCH PLANS, COMPUTATIONS AND SPECIFICATIONS MEET THE APPLICABLE PROVISION OF THE MASSACHUSETTS STATE BUILDING CODE, ALL ACCEPTABLE ENGINEERING PRACTICES. AND APPLICABLE LAWS AND ORDINANCES FOR THE PROPOSED USE AND OCCUPANCY. I FURTHER CERTIFY THAT I SHALL PERFORM THE NECESSARY PROFESSIONAL SERVICES AND BE PRESENT ON THE CONSTRUCTION SITE ON A REGULAR AND PERIODIC BASIS TO DETERMINE THAT THE WORK IS PROCEEDING IN ACCORDANCE WITH THE DOCUMENTS APPROVED FOR THE BUILDING PERMIT AND SHALL BE RESPONSIBLE FOR THE FOLLOWING AS SPECIFIED IN SECTION 116.0. 1. Review,for conformance to the design concept,shop drawings,samples and other submittals which are submitted by the contractor in accordance with the requirements of the construction documents. 2. Review and approval of the quality control procedures for all code-required controlled materials. 3. Be present at intervals appropriate to the stage of construction to become,generally familiar with the progress and quality of the work and to determine, in general, if the work being performed in a manner consistent with the construction documents. PURSUANT TO SECTION 1162.21 SHALL SUBMIT AFTER EACH SITE VISIT,A PROGRESS REPORT TOGETHER WITH PERTINENT COMMENTS TO THE NORTH ANDOVER BUILDING INSPECTOR. UPON^COMPLETION OF THE WORK, I SHALL SUBMIT A FINAL REPORT AS TO THE ATI FACTORY COMPLE. 101P4.AND READINESS OF THE PROJECT FOR OCCUPANCY. SIGNATURE SUB iBED'A D SWORLOBEFOREMETHISP96LIDAYOF J41111 OF PENNSYLVANIA Notarial Seal NO ARY U LIC MY COMMISSION EXPIRE rdrh otaryPublic �Mt county My Commission Fires July 13,2010 Member,Pennsylvania Association of Notaries The Commonwealth of Massachusetts iI Department of Industrial Accidents k' ~; L Office of Investigations 600 Washington Street ` ; = Boston, MA 02111 f w www.ma ss.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/individual): PJ L 101.1 ZA/G Address: L101 I tv,0I"Q 5T ip; City/State/Zip: 619L Phone #: 7 Are you an employer?Check the appropriate box: Type of project(required): 1.�4 1 am a employer with I Z— 4. ❑ I am a general contractor and 1 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. I ? Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. workers' comp. insurance. 9. ❑ Building addition [No workers' comp. insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10-ElElectrical 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 12.7 Roof repairs insurance required.] t employees. [No workers' 13.❑ Other comp. insurance required.] *Any applicant that checks box#I must also fill out the section below showing their workers'compensation policy information. Homeowners who submit.tbis of iidav it indicating they are doii-ig all work and then hire outside comraciors 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. 1 am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. l Insurance Company Name: E"f"tD Policy#or Self-ins. Lic.#:—W&62 lb Expiration Date: Job Site Address L 1t&Ik S t N. tW Jt 2 Ml-I City/State/Zip- Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certif unDate: der the ns and penalties of perjury that the information provided above is true and correct Si ature: — j - p 1B Phone#: ���' — Q L- �Z 1� /0 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#: I 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 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 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 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. 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 permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/hcense applicationsin 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. # 617-7274900 ext 406 or 1-877-MASSAFE Revised 5-26-05 Fax# 617-727-7749 www.mass.gov/dia ACORD CERTIFICATE OF LIABILITY INSURANCE s DATE(MMlDD REPUBPUB-1 1 11/07/07/07 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE McLaughlin Insurance Agency HOLDER.,THIS CERTIFICATE DOES NOT AMEND,EXTEND OR 828 Lynn Fells Parkway ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Melrose MA 02176 Phone: 781-66S-2775 Fax:781-665-0295 INSURERS AFFORDING COVERAGE NAIC4 INSURED INSURER A: Ohio Casualty Group INSURER B: St. PaulTravelers Ins. Co. Republic Building Contractors, INSURER Inc. Amazican Intatnat'1 Companies 491 Maple St #103 & #104 INSURER D: Danvers MA 01923 INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INURED 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 CONDITION OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR NSR TYPE OF MSURANCE POLICY NUMBER DATE(MMIDDIYY) DATE(MWDDIYY) LIMITS GENERAL LIABILITY EACH OCCURRENCE $1,000,000 A X COMMERCIAL GENERAL LIABILITY PREMISES(Ea occurence) $ 100,000 CLAIMS MADE �OCCUR MED EXP(Any one person) $ 10,000 BKW0852520527 10/01/07 10/01/08 PERSONAL&ADV INJURY $1,000,000 GENERAL AGGREGATE s2,000,000 GENL AGGREGATE LIMB APPLIES PER: PRODUCTS-COMP/OP AGS s2,000,000 POLICY JE LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $1,000,000 ANY AUTO (Ee ecedent) ALL OWNED AUTOS BODILY INJURY B X SCHEDULED AUTOS BA2079C445-07 10/01/07 10/01/08 (Per person) $ B X HIRED AUTOS BODILY INJURY $ B X NON-OWNED AUTOS (Per accident) PROPERTY DAMAGE $ (Per acaderd) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ FANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESSIUMBRELLALIABILITY EACH OCCURRENCE $],0,000,000 A X OCCUR ❑CLAIMSMADE USO0852520527 10/01/07 10/01/08 AGGREGATE $10,000,000 DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION AND X I TORY LIMITS ER G EMPLOYERS'LIABILITY NC6888552 10/01/07 10/01/08 E.L.EACH ACCIDENT $5QQ QQQ ANY PROPRIETOR/PARTNER/EXECUTIVE , OFFICER/MEMBER EXCLUDED? E.L.DISEASE-EA EMPLOYEE $500,000 If yes,describe under SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT $500,000 OTHER A LEASED EQUIPMENT BKW0852520527 10/01/07 10/01/08 Limit $25,000. . Special Form REPLACEMENT COST Deductibl $500. DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS Evidence of insurance for operations usual to named insured CERTIFICATE HOLDER CANCELLATION FORIN-1 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION FOR INFORMATION ONLY DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRTI TEN Republic Building Contractors NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL Inc. IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR MA REPRESENTATIVES. AUTHO PRE ATI ACORD 25(2001/08) ®ACORD CORPORATION 1988 elil jLl6�LIb Board of Building Regulations and Standards Const'ruct�on Supervisor License Llc� CS 45457 I"' Birthdate:-3/8/1964 Expiration: 3/$009 Tr# 13097 _tee JAMES H BURNS,,L l' 22 PARISH LN BOXFORD,MA 01921 Commissioner a