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Home My WebLink AboutMiscellaneous - 29 HEPATICA DRIVE 4/30/2018VKJ low 29 Hepatica Dr North Andover, MA 01845 5 Stars Plus Confinned U Worm Energy Rating System Energy Efficient I Star 1 Star Plus 2 Stars 2 Stars Plus 3 Stars �4 StersPlus 5 St 5 1 400-301 1 300-251 250,-201 200-151 loo -91 90-86 85-71 1 70 or Lessj HERS Index: 54 General Information Conditioned Area: 3147 sq. ft. HouseType: Single-family detached Conditioned Volume: 26768 cubic ft Foundation: More than one type Bedrooms: 3 Mechanical Systems Features Heating: Fuel -fired air distribution, Propane, 96.1 AFUE. Cooling: AJr conditioner, Electric, 13.0 SEER. Water Heating: Conventional, Propane, 0.67 EF, 50.0 Gal. Duct Leakage to Outside: 28.00 CFM25. Ventilation System: Exhaust Only: 61 cfm, 9.0 watts. Programmable Thermostat: Heating: Yes Cooling: Yes Bulijing Shell Features Ceiling Flat: R-40, R-38 Slab: R-0.0 Edge, R-0.0 Under Sealed Attic: NA Exposed Floor. R-30 Vaulted Ceiling: NA Window Type: U:0.30, SHGC:0.29 Above Grade Walls: R-2 1, R-1 5 Infiltration Rate: Htg: 1130 Clg: 1130 CFM50 Foundation Walls: R-2 1.0, R-0.0, R-1 2.0 Metho d: Blower doortest Lights and Appliance Features Percent Interior Lighting: 91.00 Range/Oven Fuel: Propane Percent Garage Lighting: 100.00 Clothes Dryer Fuel: Electric Refrigerator (kWhlyr): 569.00 Clothes Dryer EF: 3.01 Dishwasher Energy Facton 0.78 Ceiling Fan (cfmMatt): 0.00 The Home Energy Rating Standard Disclosure for this home is available from the rating provider. REMIRate - Residential Energy Analysis and Rating Software v14.3 This information does not constitute any warranty of energy cost or savings. C 1985-2013 Architectural Energy Corporation, Boulder, Colorado. ,ze / . ---� q oil C7 lkopw A lc#� bel"IlIff— Registry ID: 700367751 RatingNumber: ABA5303-12-2 Certified Energy Rater: MichaelA.Browne RatingDate: 2-113-2014 Rating Ordered For: Key Lime, Inc- Ben Osgood Estimated Annual Energy Cost Confirmed Use MMBtu Cost Percent Heating 66.8 $2233 53% Cooling 2.4 $123 3% Hot Water 20.2 $664 16% Lights/Appliances 24.3 $1203 28% Photovoltaics -0.0 $_0 -0% Service Charges $0 0% Total 113.6 $4223 100% This home meets or exceeds the minimum criteria for all of the following: IECC Air Sealing Mandatory Requirement- Infiltration < 7AC 2009 IECC Duct Leakage Mandatory Requirement* 2014 MA Residential New Construction - Tier 1 * MA Base Code HERS Rating Performance requirement* Compliance with criteria for this program is determined by the rater. Advanced Building Analysis, LLC 2 Woodlawn St Amesbury, MA 0 1913 www.advancedbuildinganalysis.com Rater RESNET HERS Index Certificate 29 Hepatica Dr Index HERS* North Andover, MA01845 Rater: MichaelA Browne More Energy ISO Registry ID: 700367751 Ann al Estimates' 110 Eluectric(kWh): 7641 Existing 130 Propane(Gallons): 959 Homes 120 CO2 emissions(Tons): 10 Energy Savings ($)*� 5074 0 Tased on standard operating conditions Standard 100 **Based on U.S. DOE designation of a HERS New Home Index of 130 as the Typical Existing Home' 00 so 70 Advanced Building Analysis, LLC 00 2 Woodlawn St so Amesbury MA 01913 40 www.advancedkxjildinganalysis.com 30 rl Zero Ene ;y This home has been inspected and performance tested in Home 0 accordance with Chapter 3 of REVET -4?=jk- Less Energy the RESNET standards. vwAv resnet.us �C\ Commonwealth of massachuse . tts official Use Only : . Permit No. Department of Fire Services Occupancy and Fee Checked BOARD OF FIRE PREVENTION REOULATIONS [Rev.]/071 (leaveblank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All�iv6rk to be performed in accordance with the Massachusetts Electrical Code (MEC), 527 CMR 12.00 (PLEASE AlNii]�JNK OR TYPEALL INFORALMON) Date: City or Town of: NOA7-14 /� N.2> a y jC-�� To the Inspector of Wires: By this applii; -6r—her intention to perform the electrical work described below. ,,ation the undersigned gives notice of his Location (Street & Number)l �A-7'--16,4 -D elephone N 7 WAME 01 11C- IQ 1?414 Owner'sAddress 15--3tq 12 1\1A1A<,E SZ— 41,M r/-/ 4WZ12 Is this permit in conjunction with A building permit? Yes Purpose of Building 51R&& Y 1-100W Existing Service Amps New Service Amps Number of Feeders and Ampacity No [] (Check Appropriate Box) Utility Authorization No. Volts Overhead[] Volts Overhead 11 Undgrd*[:] UndgrdE:l No. of Meters No. of Meters Location and Nature of Proposed Electrical Work: W I (L I t)( r, mav be waived by the Inspector of Wires. Date . .................... TOWN OF NORTH ANDOVER - PERMIT FOR WIRINGk- 1-e "z, This certifies that `� 0 C-- .......................................................................................................... has permission to perform ............... ............ wiring in the buil of ........ /V,-9 . ..... --tr- i . ................................... .......................................................................... at ... 29 f\.14 C A ................................... r ........................................ 0 ,> . ................ N rthAndover, ass. North Andover, a& . ............ Lic. NoAn.�. ...... 1i . ......... .. ee E cAL INspEc-ro C eck# 12052 (2,jP 4 KVA KVA ng ry Units �ALARMS No. of Zones f Detection and Inlitiating Devices f Alerting Devices f Self-CoMained :tion/Alerting Devices El Mun'c'pal EJ Other Connection o. of lVelices; or Equivalent Wiring: o. of Devices or Eauivalent of Devices or )r as required by the Inspector of Wires. icy.) e 10, and upon completion. of electrical work may issue unless )r its substantial equivalent. The iermit issuing oflice. CHECK ONE: INSURANCE BOND [:] OTHER El (Specify:) I certify, under thepains andpenalties ofperjury, that the information on this application is true and complete. FIRMNAME: CQNTTNQ RT.RrTRTr P. C-IART.R- TNr- 0, LIC. NO.;A 119 8 3 Licensee: T.OIJTq rQNTTN0 Signature LIC. NO.*p �2g788 (If applicable, enter "exempt" in the license number line) V U Bus. Tel. No.:978-361-q4 0 Address: I nC)Nr)VAN DR - T-lv-qry NVWR41RV MA 01925 Alt. Tel. No.: *Per M.G.L c. 147, s. 57-6 1, security v�ork requires Depart- mek of Public Safety "S" License: Lic, No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below, I hereby waive this requirement. I am the (check one)E:l owner E] owner's agent. Owner/Agent -$ * Signature Telephone No. T FEE. Z, 2" I�ILIOJ C Date .... .......... TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that .... (.1 M4"NL) CI -e QU e- ...................................... I .............................................................................. has permission to perform . ..... 6/�,A . .......................................................... wiring in the building of... at ......... . ..... 3:7Ngm ....................... �o Andover, Mass. 6* Lic. No. ....... H.0 ................................................................ Fee ... 15 ..... —.. ELEcmcAL MpEcrm Check # .11 .41. (IN " f ; 0- n I ! 11: %'- j pi--, 2-1 I Commonwealth of Massachusetts Department of Fire Services' BOARD OF FIRE PREVENTION REQULATIONS Official Use Only. Perri! it No. occupancy and Fee Checked 'Rev. 1/071 (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code (PlEC) 7 MR 12.60 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: (21,16 / City or Town of: VCV( To the �nfspectoi -of Wires: By this application the undersiglle�`Iv ives no ice of his'-o—rher inte t . to perform the electrical work described below. ion Location (Street & Number),? 9 h 4e � AA I - - - .^- — Telephone No. Owner or Tenant C. I ) & , # 0 J Owner's Address V25-&? AIMM aW&Uk,42 Is this permit in conjunction with a tuilding permit. Yes 54 No (Check Appropriate Box) Purpose of Buildingdl�(41e -Z_X&�a Utility Authorization No. d�� Yo Existing Service Amps Volts Overhead Undgrdf] No. of Meters Amps New Service 4aao_ 2MVolts Overhead Undgrd No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Elec tricalWork: wj)ela? lk In V 1/. COMDletion ofthe followiniz table may be waived by the Inspector of Wires. No. of Recessed Luminaires No. of Ceil.-Susp. (Paddle) Fans No. of Total Transformers KVA No. of Luminaire Outlets No. of Hot Tubs Generators JKVA No. of Luminaires Swimming Pool Above o In- grnd. grnd. No. of Emergency Lighting Battery Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS I No. of Zones No. of Switches No. of Gas Burners 1Vo_._oTr)etection and Initiating Devices No. of Ranges No. of Air Cond. Total Tons No. of Alerting Devices No. of Waste Disposers Heat Pu p Totals: YT !esr.tT9.ns [K...- No. of Self-CoMined Detection/Ale rting Devices No. of Dishwashers Space/Area Heating KW Loc-a,Ei M.unicPli I [J Other Connection No. of Dryers Heating Appliances KW Security Systems:* No. of Devices or Equivalent No. of Water JKW 0. of No. of Data Wiring: Heaters Signs Ballasts No. of Devices or Equivalent No. Hydromassage Bathtubs No. of Motors Total HP Telecommunications Wiring: No. of Devices or Equivalent OTHER: Attach additional detail i(desired, or as required by the Inspector of Wires. Estimated Value of Electrical Work: (When required by municipal policy.) Work to Start: Inspections to be requested in accordance with MEC Rule 10, and upon completion. INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including "completed operation" coverage or its substantial equivalent. The undersigned certifies that such coverage is in force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE a BOND [] OTHER E] (Specify:) I certify, under the pains andpenallies ofperjury, that Ilse information on this application is true and complete. FIRMNAME: CONTTNn PT.PrrPRTr x rART.R. TMr LIC. NO.:A1 1983 Licensee: LOUTS CONTTNO Signature LIC_ NO.*p,2g7gS (If applicable, enter "exempt" in. the license number line) V Bus. Tel. No.:978-36-4—r;4 0 Address: n()NnIZAN nR Wrqrr Ig -p _ygp11]Ry MA 01—CLas —Alt. Tel. No.: *Per M.G.L c. 147, s. 57-6 1, security -work requires DepartmeAt di5ub[ic Safety "S" License: Lic. NoAM!:=y7/P/,7 OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below, I hereby waive this requirement. I am the (check one) [Jowner El owne 's agent. Owner/Agent Signature Telephone No. T FEE.- $ - I -A 'C - C, 4 �-14 -/,3' Z, /, )-2- - Iq /�� "4 C)A, pp, 0 A lk Division of Professional Licensure: License Search The Official Website of the Office of Consumer Affairs and Business Regulation (OCABR) Division of Professional Licensure Mass.GovHome StateAgencies A-ZTopics Home ) Division of Professional Licensure ) Check A Professional License By the Division of Professional Licensure LICENSEE Name:LOUIS CONTINO Business: CONTINO ELECTRIC W NEWBURY, MA 11111113=11 ..This Licensee has additional Licenses, ctick here to view them.** Licensing Board: ELECTRICIANS License Type: MASTER ELECTRICIAN TYPE CLASS: A License Number: 11983 Status: CURRENT Expiration Date: 7/31/2016 Issue Date: 9/28/1987 Exam Date: 8/1/1987 School: This web site disptays disciplinary actions dating back to 1993. This license has had no disciplinary actions taken during this time. The page above has been generated by the Division of Professional Licensure web server on Monday, September 16, 2013 at 10:02:44 AM. @ 2007-2011 Commonwealth of Massachusetts Page I of I Mass.Gov ONLINE SERVICES Check a License Locate a Licensed Professional Online Address Change Contact the Agency More... REFERENCES & RELATEDINFO Disclaimer Regarding Website License Searches Enforcement Process Glossary Glossary of License Status Codes More... Site Policies Contact Us http://license.reg.state.ma.uslpubliclpubLicenseQ.asp?board—code=EL&type—class=—A&li... 9/16/2013 CX The Commonwealth ofMassachusetts Department ofIndustrialAccidints Office of Investigations 600 Washington Street Boston, MA 02111 VF www'.mass.govIdla Workers' Compensation Insurance Affidavit: Bunders/Contractors/ElectriciansfPlumbers Ad&ess: (7 WO \16Lff ZW City/State/Ziy ,-?& 5 -_ Are you an employer? Check the appropriate box: - Typo of project (required): TI am a employer with c,9 ) 4. El I am a general contractor and 1 6. W Now construction employees (fall and/or part-time).* 2. El I am a sole. proprietor or partner- have hired the sub -contractors listed on the attached sheet. I 7. E].Remodeling ship and'have no employees These sub -contractors have 8. E] Demolition working for me in any capacity. workers' comp. insurance 9. E] Building addition [No workers' comp. insurance 5. El We are a corporation and its 10.n Electrical repairs or additions required.] 3111 am a homeowner, doing all work officers have exercised their right of exemption per MGL ILF1 Plumbing repairs or additions myself. [No workers' comp. c. 152, § 1(4), and we have no 12.[] Roofrepairs . 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 hire doing all work and then hire outside contractors must submit anew afridavit indicating such. tContractors that checkthis box must attached an additional sheet sbowingthe name of the sub -contractors and their workers' comp. policy information. I am an employer that isproviding workers I compensation insurancefor my employees. Below is Mepolley andiob site information. /I r, /9-1 Insurance Company Name:. 77Z;&'/I/ 67OC/L,/ (-A 14�Y I— L/ Policy# or Self -ins. Lic. #: Expiration Date: Job Site Address Pity/State/Zip:AAC2� "&o Attach a copy of the workers' compensation -policy declaration page (showing the policy number and expiration date). Failure to secure coverage as requiredundor Section 25A ofMGL c. 152 can lead to the imposition of criminal penalties o ' fa fine, up to $1,500.00 and/or onc�year imprisonment, as well as civil penalties in the form of a STORWORK ORDER and a fine ofup 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. - Idohere'byeertifvvndert7zepainsan pe alh�F�Perjury that the informationprovided above is true and correct. Official use only. Do not write in this areez, to he completed by cl(v or town offilcial City or Town: -Permit/Ucense 0 Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Vn-nfnv.fPP.r.,Qnn! , -.- Phone#:, Information and Instruction's 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 ofhire,. express or implied, oral or written.,, Ail On a 01 in, orprtin the 0 1 nti or any two or more wkeijs defined as "an individual, partnership, sso at 0 c o a o or o r I ga e f3� Of the, foregoing engaged in ajoint 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 lo'cal licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to constiruct buildings in the commonwealth for any applicant who has not produced -acceptable evidence of compliance with the insurance coverage requ.1red." Additionally, MGL chapter 152', §25C(7) states "Neither the commonwealth nor any ofits political subdivisions shall enter into any contract for the performance ofpublic work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please 01 out the workers, compensation affidavit completely, by checking ffie 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 (LLQ or Limited Liability Partnerships (LLP) with no employees other than the members or partners, are not required to carry workers' compensation insurance. If anLLC orLLP does have employees, a policy is required. Be advised that this affidavit maybe submitted to the Department of Industrial Accidents for confirmationof insurance coverage. Also be sure to sign and datethe affldavit. Theaffidavitsbould be retumedto 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' cOmperisationpolicy, please call the Department at the number listed below. Self-insured companies should enter their Id -insurance license number on�je appropriate Eno. City or Town Officials Please be sure that the affidavit is complete and printedlegibly. 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. Pleas ' a be sure to fill in the permit/lie e*nse number which will be used as a reference number. In addition, an applicant that must submit multiple permit/liceiise applications "in any given year, need only'submit one, affidavit indicating current policy information (ifnecessary) and under "Job Site Address"' the applicant should write "all locations in—(city or town)." A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is� on file for future permits or licenses. Anew affidavit must be filled out each year. Mere a home owner or citizen is obtaining a license or' -permit not related to any business or commercial venture (i.e. a dog license or permit to bum leaves etc.) said person is NOT required to complete this affidavit.' The Office of Investigations . would like to thank you in advance -for your cooperation and should you have any �Uestions, please do not hesitate to give us a call. The Department's address, telephone and fax number: The Comm onw. Da Ith of Dapattweut offadustijal Accidants OfAce offlivestigations 600 Wasbingm Street Bostp, MA 02111 TO, # 617-727-4900 at 406 or 1-877,MASSAFE Revised 5-26-05 Fax# 617-727-7749 ------- : . F — Date .... �qAh TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION This certifies that/^.� ',A � q ... ... .................................... ............................. * ................. has permission for gas installati IA -A .......... on ........ f� . . ..... ............. ..... ... ...... in the buildings of at .... :92 ............ 4 0 V.Z9 .................................................... ...................... .................. . North Andover, Mass. Fee-.�Y--� ..... Lic. No. ...... . & ............ .... . ........................................................ Check # / 0 d C�, GASINSPECTOR VO, 0 113 nA op'/ '_W'. � J, A 10 I L1,11 - j V V I- -I Fy� Z MASSACHUSETTS UN . IFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK PERMITo 9 0 CITY: NORTH ANDOVER MA. DATE: 12/07/2013 JOBSITE ADDRESS: 29 HEPATICA DR OWNER'S NAME: KEYLIME INC GOWNER ADDRESS: TEL: 508-328-4630 FAX: TYPE OR OCCUPANCY TYPE: COMMERCIAL EDUCATIONAL RESIDENTIAL PRINT CLEARLY NEW: RENOVATION: REPLACEMENT: PLANS SUBMITTED: YES El NO R-_' APPLIANCES FLOOR Bsmt 2 3 4 1 5_ 6 7 8 1 9 10 11 1 12 13 14 BOILER BOOSTER CONVERSION BURNER COOK STOVE DIRECT VENT HEATER DRYER FIREPLACE FRYOLATOR FURNACE GENERATOR GRILLE INFRARED HEATER LABORATORY COCK MAKEUP AIR UNIT OVEN POOL HEATER ROOM/SPACE HEATER ROOF TOP UNIT TEST UNIT HEATER UNVENTED ROOM HEATER WATER HEATER INSURANCE COVERAGE I have a current UoLty insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 YES No If you have checked YES, please indicate the type of coverage by checking the appropriate box below. LIABILITY INSURANCE POLICY OTHER TYPE INDEMNITY BOND El OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws, and that my signature on this permit application waives this requirement. CHECKONEONLY: OWNER EIAGENT F-1 SIGNATURE OF OWNER OR AGENT I hereby Certify that all of the details and information I have submitted (or entered) regarding this permit application is true and accurate to the best of my Knowledge. I certify that all plumbing work and installations performed under the permit issued, will be in compliance W all Pertinent provisions of the Massachusetts Uniform State Plumbing Code, and Chapter 142 of the General Laws. PLUMBER/GAS FITTER NAME 47_`lCENSE e13 SIGNATURE 1p_/'_C423:��LICENSE# , —:5 - COMPANY NAME: OSTERMAN PROPANE LLC ADDRESS: 321A Merdmack St CITY: Methuen STATE: MA 0 P: 01844 FAX: 978-738-0118 TEL: 800-368-9956 -CELL EMAIL: INFOft_OSTERMANGAS.COM MASTER El JOURNEYMAN OLPINSTALLER-0$20/RPORATION [:]#__PARTNERSHIP d��CQ WV1515 . V6J 6-11 1 Zo q t � U_'6e_ I 4 \ 4 - . C ACORL)r CERTIFICATE OF LIABILITY INSURANCE DATE (MM1DDNYYY) 6/26/2013 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES "OW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED WRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER Cutler Segerstrom Insurance Agency License #0495772 CONTACT NAME: Angela Bacon PHONE FAX, LIL_�9) 532-6951 (A/C No): (209)532-1997 E-MAIL ADDRESS:angelab@cutseg.com 1030 Greenley Rd. Sonora CA 95370 INSURER(S) AFFORDING COVERAGE NAIC # INSURERA-.Aspen Specialty INSURED INSURER B:AIG Osterman Propane, LLC INSURER C: P.O. Box 29 INSURERD: INSURER E : Whitinsville MA 01588 INSURER F - COVERAGES CERTIFICATE NUMBER:Osterman REVISION NUMBER - THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE -INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR I TYPE OF INSURANCE ADDLSUBR INSR WVn POLICY NUMBER POLICY EFF (MMIDDNYYY) POUCY EXP (MMIDDIYYYY) LIMITS GENERALLIABILITY — EACH OCCURRENCE $ 2,000,000 7. COMMERCIAL GENERAL LIABILITY TA—MAGE rO RENTr=,D PREMISES (Ea occu nce) $ 2 000,000 A CLAIMS -MADE FOOCCUR EAMNG0113 6/3 0/2013 6/3 0/2014 MED EXP (Any one . person) $ 100,000 PERSONAL & ADV INJURY $ 2,000,000 GENERAL AGGREGATE $ 2,000,000 GENL AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMPIOP AGG $ 2,000,000 PRO- LOC X POLICYF_]JECT F $ Ln AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (E, accident) 2,000,000 B X ANY AUTO BODILY INJURY (Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS 1954068 5/3 0/2013 6/3 0/2014 BODILY INJURY (Per accident) $ NON -OWNED HIRED AUTOS AUTOS 1 PROPER DAMAGE (Per cc1dZ I) $ $ UMBRELLA IJAB OCCUR EACH OCCURRENCE $ 4EXCESS LIAB CLAIMS -MADE AGGREGATE $ DED I I RETENTION$ $ WORKERS COMPENSATION STATU- H- I ANY I AND EMPLOYERSLIABILITY YIN ,,,TS I _0ETR E.L. EACH ACCIDENT $ ANY PROPRIETORtPARTNERIEXECUTCVE OFFICERIMEMBER EXCLIJDED? NIA E.L. DISEASE - EA EMPLOYEE $. (Mandatory In NH) describe Ifps under E.L. DISEASE - POLICY LIMIT, $ ID S6 RIPTION OF OPERATIONS below DESCRIPTION OF OPERAT*IONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, ff more space Is required) Town of North Andover 146 Main Street North Andover, MA 01842 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Pete Kleinert/ANGELA ' �Re_� Af;URL) 25 (ZU1W05) 0 1988-2010 ACORD CORPORATION. All rights reserved. INS025(2oioos).oi The ACORD name and logo are registered marks of ACORD .1; A ��Dr CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DDNYYY) 1 06/26/2013 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement, A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER 1-630-773-3800 CONTACT NAME: Allison Spadaro Arthur J. Gallagher Risk Management Services, Inc. PHONE FAX. -285-4006 (AIC. No. Ext); 630-285-4456 fA1C Not: 630 GENERAL LIABILITY Two Pierce Place E-MAIL ADDRESS: allison spadaro@ajg - com INSURER(S)AFFORDI GCOVERAGE NAIC # Itasca , IL 60143-3141 Mary Beaver - INSURERA: INSURANCE CO OF THE STATE OF PA 19429 INSURED Osterman Propane, LLC INSURER B: INSURER C: 6120 S. Yale Ave. INSURER D: Ste 805 INSURER E: Tulsa, OK 74136 INSURER F: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSIR LTR . TYPE OF INSURANCE ADDLISUBff INSR wyn — POLICY NUMBER —07OLICY—EFF (MMIDD/YYYYJ -POLICY EXP fMMIDDfYYYY) LIMITS GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY MAGE TO RENTE'D F PREMISES (Ea occurrence) $ MED EXP (Any one person) $ C CL IMS_M LAIMS-MADE OCCUR R ONAL&ADVINJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: -] PRODUCTS - COMP/OP AGG $ POLICY F PRO- JECT [_� LOC $' AUTOMOBILE LIABILITY CORBINED —SINGLE LIMIT (Ea accident) $ BODILY INJURY (Per person) $ — ANY AUTO ALL OWNED SCHEDULED BODILY INJURY (Per accident) $ — AUTOS — AUTOS HIRED AUTOS NON -OWNED AUTOS PROPcE tDAMAGE I c,d $ P are RZ I — — UMBRELLA LIAB EACH OCCURRENCE $ EXCESS LIAB AGGREGATE $ DED I I RETENTION$ $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY 15883775 06/30/ 1� 06/30/14 )TH- X ER A Y/N ANY PROPRIETOR/PARTNER/EXECUTIVE r--7 79331530 06/30/1-- 06/30/14 E.L. OFFICER/MEMBER EXCLUDED? IN I N/A EACH ACCIDENT $ 1,000,000 (Mandatory In NH) if yes, describe under E.L. DISEASE - EA EMPLOY $ 1,000,000 E.L. DISEASE - POLIC= 1,000,000 DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) 978-688-9542 %IQLA-M I JUN SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town of North Andover THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Attn: Mary 146 Main St AUTHORIZED REPRESENTATIVE North Andover, MA 01845 USA _,.j r ';?. 'P (0 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD ankurita 34415543