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HomeMy WebLinkAboutMiscellaneous - 53 WELLINGTON WAY 4/30/2018Location No. 5" I Check #�_,I 31118 Date /"1Z /14" TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $3d a" Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Building nsl pector n I ,, Commonwealth of Massachusetts Sheet Metal Permit Date: �Z `� Permit # I I Estimated Job Cost: $ a3loa ® Plans Submitted: YES NO Business License # Business (Information: Name: Rx lma,;a� Street: l-fo/1�✓G�O ��; �" �i� City/Town: Telephone: 917* 3 7/ Photo I.D. required / Copy of Photo I.D. attached: J-1 -1-unrestricted lice Permit Fee: $ �� Plans Reviewed: YES NO Applicant License # L> Property Owner / Job Location Information: Name: (30b •�2$S/tom% Street: 3 City/Town: A'iX-7CICUlell" Telephone: '77k 9 3,, YES ✓ NO Staff Initial J -2/M -2 -restricted to dwellings 3 -stories or less and commercial up to 10,000 sq. ft. /2 -stories or less Residential: 1-2 family Multi -family Condo / Townhouses Other Commercial: Office Retail Industrial Educational Institutional _L Other Square Footage: under 10,000 sq. ft. �//over 10,000 sq. ft. Number of Stories: Z --- Sheet metal work to be completed: New Work: _4,��Renovation: HVAC JZ Metal Watershed Roofing Kitchen Exhaust System Metal Chimney / Vents Air Balancing Provide detailed description of work to be done: , INSURANCE COVERAGE: I have a current liability„insurance policy_ or its equivalent which meets the requirements of M.G.L. Ch. 112 Yes E�r/No ❑ If you have checked Yes, indicate th pe of coverage by checking the appropriate box below A liability insurance policy ` Other type of indemnity ❑ Bond ❑ 94WN19R'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 112 of the. Massachusetts General Laws, and that my signature on this permit application waives this requirement. Check One Only Owner ❑ Agent Signature of Owner or Owner's Agent By checking this boxCT, I hereby certify that all of the details and information I have submitted (or entered) regarding this application are true and accurate to the best of my knowledge and that all sheet metal work and installations performed under the permit issued for this application will be in compliance with all pertinent provision of the Massachusetts Building Code and Chapter 112 of the General Laws. Duct inspection required prior to insulation installation: YES NO Date Progress Insiections Comments Final Inspection Date Comments Inspector Signature of Permit. Approval �C Signature of Licensee License Number.. Check at www.mass.gov/dpl Type of License: By El/m"aster Title. ❑ Master -Restricted City/Town ❑Joumeyperson . Permit # ❑Journeyperson-Restricted Fee $ ❑ Inspector Signature of Permit. Approval �C Signature of Licensee License Number.. Check at www.mass.gov/dpl The. Commonwealth of Massachusetts - Department of Industrial Accidents Office of Investigations 600 Washington Street., Boston, 1tiU 02111 wlvw.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/ElectriciansiPlumbers ADalicant Information Please Print Le-ibly Nam, e (Bus; nessiOrzanizauonr?ndividuall: Pi:one 1. Are you an empiover° Check the appropriate box: Type of pro,iec ,reouiredl: ?.. -1_molover with I - — l ain a _ene:ai ':C ,or ir,d — _ ,_/. e-nciovees i i'uil and/or Dari ti.ae;. - Nave ,sired :he sub ,_orrrac:ors — _ = — m _ Die �roeretcr •x far: z iste.. on -he attached ..heel. _ cce inJ <<ic and ;;ave no-mr,1ovees these sub-conrrac:ors ,ave tee.^ci_iicn for en any :acacir.; vcr'tir.� .m empio�,ets and ',ave worsers �u !din_ c cu:cn �o wor'.:ers' comp. mslranc� -OMC. ;nsnrance.=- ;ve are a comoration and is :iG[Ilet�,`V7?1e: QClii� it �Ci:i JC?iCe:S :lame _,, :C:SeC C:P ��:: '�G '.vCC:•: Q'^: Ji ..e nDi1Cn er w(C; L — ._Jr^r orc. nszirancz -ecuir!,_ av-C'rlican :nal .:pec""s :Fox =. .must its') .`ill )L'[ :1C secClon diowm2 :"C:. 'wo G<BrS _:imoensacion -,011e': Homeowners - 10 _uomtt pis lifivavit .mica,.: - _1re alt .cr.< gnu ;ire .'ursice ._ ...rac: ,. .,. t sue^ ..._ ;ox :nus; Julacn_.. _�n-.._..:onai geet saowi no .ne name ....`e ;uo-•:O nirac:n is ::nu -. _...... CS 31. _ 3uc-con17%C'ors Nave ... -,coven_.:7:v must :,ov;ue .ne:r ':vorxers tomo. got ; 7,umoer r -am In eiriviover 'Fiat !s 7rovia.i.n workers' compe'.nsation insur,anC2 jOr my ; .7tolove s. Below is Jze 7oilc7 and wo' Size in iormatiori. i nsu:anc_ I Uriah Name: I .r: ; 7' - i — Pciic: =or �zii ns. L -c. _ -= 7 :ciradcn Date:_ j� f- :cb Siie address: � �J W�l�/n� i/� k1b City!S[ate; L.c:14' 411V0,11 -V �[t�cn a coov of the workers' comoensation poiicv declaration page tshowing the poiiev number and expiration date). Paiiure -.o secure ::overage as reauired under Section a of MGL c. li= 'can lead io the meosidon ci _-:;urinal renames or a Fine un f.o 51,.:00.00 and/or one -tear imprisonment. as Weil as civil penalties in the form of a STOP WORK ORDER and a fine of up to 5250.00 a day against rhe violator. Be advised :hat a copy of This statement may be forwarded io rhe Office of invesriQations of :he DIA for insurance coverase verification. 1 do hereby_�ertify,kznder the wins anq penalties of perjur.1 that the information provided above is true and correct. Phone 4- q 7 � - =' 3 3 -;S (., ? i use only. Do not write in this area, to City or Town: city or town officiaL Permit/License # 1."/ ---)- Issuing Authority (circle one): 1. Board of Health 3. Building Department I City/Town Cleric 4. Electrical Inspector -4. Plumbing Inspector b. Other Contact Person: Phone #- /�i RAMEC-1 OP ID: MI CERTIFICATE OF LIABILITY INSURANCE DATE02/19/201 Y) 02119/2016 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 Foster Sullivan Insurance 163 Main St CONTACT Lisa NAME: PnHiCNNo Ext : 978-686-2266 'C No): 978-686-6410 ss: certificates fostersullivangroup.com North Andover, MA 01845 Foster Sullivan Insurance LLC -ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # EACH OCCURRENCE S 1,000,00 INSURER A: MERCHANTS INSURANCE GROUP 112775 MED EXP (Any one person) S 5,00 INSURED R.A. Mechanical, Inc. INSURER s: GUARD INS COMPANY 16 Lomar Park Suite 1 I GEN'L AGGREGATE LIMIT APPLIES PER: I POLICY I 'PRO FI LOC Pepperell, MA 01463 INSURER C: AUTOMOBILE LIABILITY A ANY AUTO (ALL OWNEDX SCHEDULED AUTOS AUTOS X HIRED AUTOS I X NON -OWNED t--+ AUTOS I INSURER 0: INSURER E: 01/01/2016 aI INSURER F: COMBINED SINGLE LIMIT 1,000,00 Ea accident S COVERAGES CERTIFICATE NUMBER: 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 TYPE OF ADDL - i POLICY NUMBER POLICY EFF MMIDD POLICY ERP MMIDDI LIMITS A GENERAL LIABILITY X I COMMERCIAL GENERAL LIABILITY CLAIMS -MADE 1 X I OCCUR i �CMP9153434, I I 101/01/2016 I 01/01/2017 EACH OCCURRENCE S 1,000,00 tN "PREMISES Ea Occurrence)s 100,000 MED EXP (Any one person) S 5,00 PERSONAL & ADV INJURY S 1,000,00 GENERAL AGGREGATE S 2,000,000 I GEN'L AGGREGATE LIMIT APPLIES PER: I POLICY I 'PRO FI LOC PRODUCTS - COMP/OP AGGS 2,000,000 S AUTOMOBILE LIABILITY A ANY AUTO (ALL OWNEDX SCHEDULED AUTOS AUTOS X HIRED AUTOS I X NON -OWNED t--+ AUTOS I i IMCA0000008 I 01/01/2016 aI 01/01/2017 COMBINED SINGLE LIMIT 1,000,00 Ea accident S I BODILY INJURY (Per person) $ BODILYINJURY (Per accident) S I j PROPERTY DAMAGE S I (PER ACCIDENT) is A UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS-MAOE ( CUP9145434 i 01/01/2016 01/01/20171 EACH OCCURRENCE f s 1,000,00 AGGREGATE is 1,000,00 DED RETENTIONS I - is B I WORKERS COMPENSATION I AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below IN / A i IRAWC759194 I 01/01/2016 I 01/01/2017 WC STATU- ! IOTH- TORY LIMITS i ER E.L. EACH ACCIDENT s 500,000 E.L. DISEASE - EA EMPLOYED 5 500,000 E.L. DISEASE - POLICY LIMIT i S 500,000 � I i I DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) City of Haverhill 4 Summer Sreet Haverhill, MA 01830 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 ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD r�,�:_''.-'��.._a:..,:�<:u.!'+:}'t�::ii`{...fi�:.2•:'�..r.-.'.r._'...,�?:..._.;°�r.r�tr,:§''S_73i.x,.5a�+r,:z+..P:.�a`+S.#'C..�`LX'E`�i'�;.'w::'``c>•'Y.9;..��> ..�`�,^,°Szi t"..:?`�:'siert°..,�'':_.�+:`-'"..-__"".":.'^�.'°..:9�.�s.ww.��a�3s'su.�dk3u e COMMONWEALTH OF MASSACHUSE• .t11JAd1ti:v� ,.. DRIVERS ii q uLICENSE ISSUES THE FOLLOVVIIVG LICENSE ASSA MRtiSTER UNRESTRICTED is SEXkj 4 �s #arc e•.. pA4WILLARD �ttix ST LOWELL. MA 0185o.1325 LOVVELL.-,MA x1850-1325 COMMONWEALTH OF MASSACHUSE• .t11JAd1ti:v� ,.. SHEETMETAL WORK. ERS ISSUES THE FOLLOVVIIVG LICENSE ASSA MRtiSTER UNRESTRICTED DONALD J: OUELLETTE. 44 WILLARD.ST LOVVELL.-,MA x1850-1325 4;£ i 4688' tI/28120t8 $ 10$998 E, # s .. � - ...._ ... ....:ten- r w 3 F X N4 Bun Analysis Job: wrightsoft® ildig � Date: Aug 19, 2015 Entire House By: RA MECHANICAL INC 16 LOMAR PARK, PEPPERELL, MA 01463 Phone: 9784338671 Fax 9784334900 Email: ramechanical@aol.com Web: www.ramechanical.com For Location: Lawrence Muni, MA, US Elevation: 151 ft Latitude: 430N Outdoor: Dry bulb (°F) Daily range (°F) Wet bulb (°F) Wind speed (mph) -Project Information HANNSEN RESIDENCE, MESSINA DEVELOPMENT N.ANDOVER, MA F. e'atin Component Indoor: Heating % of load Indoor temperature (°F) 68 12533 Design TD (°F) 59 17.6 Relative humidity (%) 50 Heating Cooling Moisture difference (gr/Ib) 44.1 9 88 Infiltration: 1.5 - 18 ( M) Method Simplified 73 Construction quality Average 15.0 7.5 Fireplaces 1 (Tight) F. e'atin Component Btuh/ft' Btuh % of load Walls 3.8 12533 16.7 Glazing 17.6 17016 22.6 Doors 22.9 2541 3.4 Ceilings 1.5 5543 7.4 Floors 1.7 5953 7.9 Infiltration 4.7 20364 27.1 Ducts 11176 14.9 Piping 0 0 Humidification 0 0 Ventilation 0 0 Adjustments 0 Total 175125 48815 1 100.0 Component Btuh/ft2 Btuh % of load Walls 0.9 2978 6.1 Glazing 23.8 23017 47.2 Doors 9.8 1089 2.2 Ceilings 1.2 4212 8.6 Floors 0.4 1263 2.6 Infiltration 0.5 2280 4.7 Ducts 7435 15.2 Ventilation 0 0 Internal gains 6540 13.4 Blower 0 0 Ad'�ustments 0 Total 48815 100.0 Latent Cooling Load = 6493 Btuh Overall U -value = 0.066 Btuh/ft2-°F Data entries checked. -+ wrightsoft® Right-SufteO Universal 2017 17.0.08 RSU11207 ACCA ... ssina hannsen residence n andover 8-19-2015.rup Calc = MJ8 Front Door faces Cooling 75 13 50 31.2 SCOTT GOLDEN ARCHITECTURAL SERVICES RESIDENTIAL AND COMMERCIAL 9 Chestnut Street Danvers, MA 01923 978-578-1568 NOVEMBER 18, 2016 TO: Town of North Andover, MA Building Inspector RE: Hannsen Residence — 53 Wellington Way (Lot #3), North Andover AFFIDAVIT OF CONSTRUCTION In accordance with the provisions of Section 116.0 of the Massachusetts State Building Code, I hereby certify that to the best of my knowledge, belief and professional judgment, the Structural Steel and envelope components of the structure are in compliance with the approved plans and other approved documents. I also attest that to the best of my knowledge, belief and professional judgment the approved permit plans represent the as -built condition of the structure. Should you have any questions or need additional information, please do not hesitate to contact me. Sincerely, 'SCott n No. 20726 .n DANVERS %- }.Ty OF t � � �httprlh�artlmiiduvermatimwpoinhloud.eom/�Sraca d:R1L`1p�G %jl "plumbing Perm¢#21151-...X j ,tib' o-��� r� '"� ,,;. - _ Torun of North Andover, MA _C2 sea ti - 21151 -Plumbing Permit - in Conjunction with a Building Permit (Commercial or Residential) TIMMNE ®Submission received Aug 18, 2616 ac 8:29am —_ Plumbing Permit Review 1n vrog�s Permit Fee P�Y­'r 0 Perryflr l<s:3ance Your request Is in progress r Well letyou know ofany updates via email. Feel free to check the status at any time by coming back to this page. APF' f- Stephen Galinsky _ 53 WELLINGTON WAY, NORTH ANDOVER, MA 0— ­ Messina Attachments -OTG00FI0o1F Thu_Aup_18_2016_12:26:.PDF . __Fosd�A�Bust tG, _+:16ky S;_ :>>iinsky nttpc.:i northandciama: �icxpai2tdcudsomi-iTocatianc�Sio� . . Thursday, Aug 18, 2016 08:29 AM 10 L F Wf, JTn PermittQU52 - V.—P... x loxjr , 11, a r Town of North Andover, MA Q search... ® , n 21152 *Gas Permit - In conjunction with a Building Permit (Commercial or Residential) TIMEUNE Submission received Aug 18, 2016 m 83Urn 0 Gas Permit Review In Progn— Permit fee P2N-- Permit J";Suz:nce "' Thursday, Aug 18, 2016 08:34 AM Your request Is in progress Well let you know ofany updates via email. Feel free to check the status at any time by coming backto this page. C, 2. Ce .,i Appscen Stephen Galinsky 53 WELLINGTON WAY, NORTH i ANDOVER, MA Attachments The Commonwealth of Mlassaclzusetts Department oflizdustrialAccitlents I Congress Street, Suite 100 Workers' Compensation Insurance Affidavit: Builders/Contractors/Electi-icians/Plumbers. TO BE FILED WITH THE. PERMITTING ALITHO RITY. Applicant Information Please Print Legibly Name (Business/Organization/Individual):Gq 11; Address: U (s j� ,c j 1 b f City/State/Zip: � 1 _ W vk__ JlAp Are you an employer? Check the appropriate box: Phone##: q'7 F 3 7 y_ (i 4 3 I.[?"I am a employer with employees (full and/or part-time).* 2.0 1 am a sole proprietor or partnership and have no employees working for mein any capacity. [No workers' comp. insurance required.] 3.0 I am a homeowner doing all work myself. [No workers' comp. insurance required.]' 4.01 am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers' compensation insurance or are sole proprietors with no employees. 5.01 am a general contractor and I have (tired the sub -contractors listed on the attached sheet. These sub -contractors have employees and have workers' comp. insurance.; 6.O 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): 7. 0 New construction 8. 0 Remodeling 9. ❑ Demolition 10 0 Building addition 11.0 Electrical repairs or additions 12.OPlumbing repairs or additions 13.❑Roof repairs 14.00ther `Any applicant that checks box fll must also fill out the section belowshowing their workers' compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then (tire outside contractors must submit a new affidavit indicating such. +Contractors that check this boa must attached an additional sheet showing tire name of the sub -contractors and state whether or not those entities have employees. Ifthe sub -contractors have employees, they must provide their workers' comp. policy number., I am an employer that is providing workers' compensation insurance for my employees. Below is the poliep, andjob site information. Insurance Company Name: lj 6(L -Q Policy If or Self -ins. Lic. % 60 L 6 Expiration Date: c2-0 F - f7 Job Site Address: City/State/Zip: Attach.a copy of the worIcers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as required under MGL c. 152, §25A is a criminal violation punishable by 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. A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify rrndefr the pains andpenalties ofperjury tg1at the it formation provided above is tare and correct. C - Phone #: 3% L/ 7 Y3 Official use only. Do not write in this area, to be completed by city or town official. City or Town: Permit/License 4_. M Issuing Authority.(cirele one): 1. Board of Health 2. Building Department 3. City/Town Clerlt. 4. Electrical Inspector 5. Plumbing Inspector 6.Other Contact Person Phone GALIN-1 OP ID: JO '4� RAW CERTIFICATE OF LIABILITY INSURANCE DATE0610 /2016 06/08/2016 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 Foster Sullivan Insurance 163 Main St CT NAME: NAME: NTALisa Lariviere a/CONNo Ell: 978-686-2266 A/c No : 978-686-6410 North Andover, MA 01845 Foster Sullivan Insurance LLC E-MAIL certificates@fostersullivangroup.com ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # 09/01/2016 INSURER A: TRAVELERS INSURANCE CO 19046 DAMAGE TO REN D PREMISES Ea occurrence $ 300,00 INSURED Galinsky Plumbing & Heating INSURER B: GUARD INS COMPANY Inc GENERAL AGGREGATE $ 2,000,00 PO BOX 1701 INSURER C : INSURER D: Haverhill, MA 01831-2401 INSURER E: INSURER F: BA9381 N879 COVERAGES CERTIFICATE NUMBER: 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 TYpE OF INSURANCE DDL UBR POLICYNUMBER POLICY EFF MM/DD POLICY EXP MMIDD/YYYY LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE I OCCUR 6809371 N898 09/01/2015 09/01/2016 EACH OCCURRENCE $ 1,000,00 DAMAGE TO REN D PREMISES Ea occurrence $ 300,00 MED EXP (Any one person) $ 5,00 PERSONAL & ADV INJURY $ 1,000,00 GENERAL AGGREGATE $ 2,000,00 NLA R LIMIT APPLIES PER: POLICY PRO- LOC PRODUCTS - COMP/OP AGG $ 2,000,00 $ A AUTOMOBILE LIABILITY ANY AUTO ALL OWNED XSCHEDULED AUTOS AUTOS X HIRED AUTOS X NON -OWNED AUTOS BA9381 N879 09/01/2015 09/01/2016 COMBINED SINGLE LIMIT 1, OOO,OO Ea accident $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ - PROPERTY DAMAGE $ PER ACCIDENT $ A X UMBRELLA LIAB EXCESS LIAB HCLAIMS-MADE OCCUR CUP9385N424 09/01/2015 09/01/2016 EACH OCCURRENCE $ 2,000,00 AGGREGATE $ 2,000,00 DED I X I RETENTIONS 5000 $ B WORKERS COMPENSATIONWC AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y / NGAWC700106 OFFICERIMEMBER EXCLUDED? NI (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N / A 02/28/2016 02/28/2017 STATU- OTH- X T RY LI IT ER E.L. EACH ACCIDENT $ 500,00 E.L. DISEASE - EA EMPLOYE $ 500,00 E.L. DISEASE -POLICY LIMIT $ 500,00 A RENTED EQUIPMENT FROM OTHERS 6809371N898 09/01/2015 09/01/2016 LIMIT 40,00 DESCRIPTION OF OPERATIONS /LOCATIONS /VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) I.HIVI.CLL/i f IUFV 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 @ 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD