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HomeMy WebLinkAboutMiscellaneous - 74 WILLOW RIDGE ROAD 4/30/2018r v1 t Date . ..... jvy. .................. TOWN OF NORTH ANDOVER PERMIT FOR WIRING Thiscertifies that ..... ....i..v�.......................e......................................................... ���has permission to perform..........:.......:................................................ ............................. wiring in the building of........! `� p ! � � �� }}......................................................................................... at ... ........� �.!.n.�^r?....�. e O ............. . North Andover, Mass. Fee..... . !�55.'":..... Lic. No. Z ?52 ...................................................... :...................... :...... ELECTRICAL INSPECTOR Check# ��32_ ��!/ n �%/f L o fielal Use Only _ -- COIYIin Oit�lilOa�LL�rL Ot"/I/R 06a G�11(dl3 EL6 l„ ^ ^ l c� c-� Permit No '`�I{ya'(�/(A Apartment ol... im Sendves _ Occupancy and Pee Checked t BOARD OF FIRE PREVENTION REGULATIONS [Rev, ]/071 (leave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code (MEC), 527 CMR 12,00 (PLEASE, PRINT IN INK OR TYPE ALL XFOR]hAIYON) Da te:u City or Town of: Vjc -rN kd c,-Jc,✓'L- To the Inspe for of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location (Street & Number) Owner or Tenant Owner's Address I 1 vial • R Telephone No. 50,9 — 39-0 -06 yy Is this permit in conjunction with a building permit? Yes [z No ❑ (Check Appropriate Box) Purpose of Building (ZLeS t'PkV.Jr � Utility Authorization No. Existing Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters New Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Worlr. IB i i -t e�jcyz4 % ;wp t-/e>o Com letioli O the follorvin table ina y be waived b y the ins ector of Wires. No. of Recessed Luminaires Sus Fans No. of Ceil: . (Paddle) ) s Tota of Trsformers KVA Tran No. of Luminaire Outlets No. of Hot Tubs Generators KVA No, of Luminaires Swimmin Pool g, ove Elu- ❑ g rnd. rnd. o. o nrergencyLighting Batter Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS No. of Zones of Switches No. of Gas Burners M—oNo. o, IDetection vi InDevices No. of Ran es g No. of Air Cond. Tota Tons No. of Alerting Devices No. of Waste Disposers eat Pump Totals: Namucr. 1 Tons 1 KW ........... No. of Se f -Contained Detection/Alerting Devices No. of Dishwashers S ace/Area Heating KW P g Local alIunrcipal ❑ Other ❑Connection No. of Dryers Heating Appliances KW Security Systems:* No. of Devices or, Equivalent No. of atero, Heaters KW of o. of Signs Ballasts Data Wiring: No. of Devices or Equivalent No. Hydromassage Bathtubs No. of Motors Total HP Telecommunications firing: No. of Devices or E quivalent OTHER: pet" a -00M Attach additional detail if desired, or as required by 1he 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 ❑ BOND ❑ OTHER. ❑ (Specify:) 1 certify, trader the pains mrd penalties of perjury, that the information ort this application is trite and complete. FIRM NAME: LIC. NO.: Licensee: .T01661PA ?< . Fr" 7/Z Siguat u•e2�.� -2 LIC. NO.: (lfapplicable, enter "caen)pt" in the license 1 lanber line) Bus. Tel. No.: yir Address: / 4 t h e Y ^✓clam. P-0)1 p :rPSwi t h /MA- 6193 k Alt. Tel. No.:, 'Per M.G.L. c. 147, s. 57-61, security work requires Department of Public Safety "S" License: Lie. No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability ins nee coverage normally required by law. By my sign ure below, I hereby waive this requirement. I am the (check one owner El owner's agent. Owner/Agent ure Tele Agent Si ��� 1 drone No.Q 3 k,2. ?G `1 k I PERMIT FEE: $ 4. pJr � t � I 7 E The Commonwealth ofMassachusetis Departinent oflndustrial.Accidents V_,J Office of Investigations 600 Washington Street Boston, MA 02111 wwfit. niass govldia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): Jos,cr k tT/L Address: l l-1 �F L., r.,, f?>v-oca Ic_ P,6,A-d City/State/Zi : Ps f v cc h. M1'1- 0/1� 3 V Phone #: 61 , 3�,L 6 — 5 •-f" 7 Are you an employer? Check the appropriate box: Type of project (required): 1. ❑ I am a employer with 4. 0 I am a general contractor and 1 6. 0 New construction employees (full and/or part-time).* 2. 1 am a sole proprietor or partner- have hired the sub -contractors listed on the attached sheet. 7. P Remodeling ship and have no employees These sub -contractors have g. Demolition working for me in any capacity. employees and have workers' comp. insurance. q Building addition [No workers' comp. insurance required.] 5. E] We are a corporation and its 10.0 Electrical repairs or additions 3. ❑ I am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions myself. (No workers' comp. right of exemption per MGL 12.0 Roof repairs insurance required.] t c. 152, § 1(4), and we have no 1311 Other employees. [No workers' comp. insurance required.] *Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. #Contractors that check this box must attached an additional sheet showing the name of the sub -contractors and state whether or not those entities have employees. If the sub -contractors have employees, they must provide their workers' comp, policy number. I am an employer that is providing workers' conipensadon insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy # or Self -ins. Lic. #: Expiration Date: Job Site Address: 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 dohereby certify render thCe-paiinn�s and penalties of perjury that the information provided above is true and correct. Siettatttre: I; 7 �l f Date Y// Z/ Phone #: l Official use only. Do not write in this area, to be courpleted by city or town offrcial City or Town: Permit/License # Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector S. Plumbing Inspector 6. Other Contact Person: Phone #: V COMMONWEALTH OF MASSACHUSETTS BOARD OF ELECTRICIANS f ISSUES THE FOLLOWING LICENSE AS A REG JOURNEYMAN ELECTRICIAN m z JOSEPH E FREY JR '? ts i 148 LINEBROOK RD } IPSWICH MA 01938-2906 .. 7252 EE .___.07/31/16` .0268 �, •: [.,.+} �lil'1:1�'y-(`7r.Y4;if t'S9t:Y'�, - k'i.;,fj�'tU .'fiTfrTT�:7 Date........� .................. TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies thatRA.�........-K\ ................................ ..................................................................... has permission to perform.. �' ... `1....... ''� wiringm the building of ... ....... ............n.................�.nQ...................................................................... at ......�.. .... �11.�.....�.�. .....^.�.'........., Norah Andover, Mass. Fee...... 1.3 ..:........... Lic. No. ... ����..�K....l......... ..................... ELECTRICAL INSPECTOR Check # Official Use Only cX� / o/ c7im JnWic� Permit No. ?i� % ..0 ..t Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/071 leave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code (MEC), 27 CMR 12.00 (PLEASE PRINT IN INK OR TYPEALL TIOPP Date: T I Cj City or Town of: r,\�� To the Inspector of Wires: By this application the undersigned gives notice of hr or her inte 'on to perform electrical work described below. Location (Street & Number) �) Owner or Tenant Owner's Address Is this permit in conjunction with a building permit? Yes ❑ No Telephone No (Check Appropriate Box) Purpose of Building Utility Authorization No. r' C Existing Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters New Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters Number of Feeders and Ampacity C Location and Nature of Proposed Electrical Work:ti5 Completion of the followine table be waived bv the Inspector of Wires. No. of Recessed Luminaires No. of Ceil: Susp. (Paddle) Fans °' ° °� Transformers KVA No. of Luminaire Outlets No. of Hot Tubs Generators KXA bove In- O. o mergency rg ng No. of Luminaires Swimming Pool rnd. ❑ rnd. ❑ lBaftery Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS No. of Zones C� No. of Switches No. of Gas Burners o. of Detection an Total Initiating Devices No. of Ranges No. of Air Cond. Tons No. of Alerting Devices No. of Waste Disposers eat mp _ Number _. ons o. o ontam Totals•"-' Detection/Alertin Devices No. of Dishwashers Space/Area Heating KW Local ❑Connecuncapshon C3Other No. of Dryers Heating Appliancesy unty ems:s No. of eviceor Equivalent 5 No. of Water , o. o o. o Heaters Si Data Wiring: s Ballasts No. of Devices or E uivalent \� No. Hydromassage Bathtubs No. of Motors Total HP Telecommunications tnng: No. of Devices or E uivalent �\ OTHER: $ Attach additional detail if desired, or as required by the Inspector of Wires Estimated Value of Electrical Work: I f OCA (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 ❑x BOND ❑ OTHER ❑ (Specify:) I certify, under thepains andpenalties ofperjury, that the information on this application is true and complete- FIRM omplete FIRM NAME: Ni htwatch Protection Inc. on .go a LIC. NO.: 7024C Licensee: Paul Delsignor Signature ' LIC. NO.: 7024C (Iapplicable, enter "exempt" in the license monber line.) Bus. Tel. No.* 888-722-9282 Address: 22 Briarwood Drive, Westford, MA 01886 Alt. Tel. No.: *Per M.G.L. c. 147, s. 57-61, security work requires Department of Public Safety "S" License: Lic. No. SS -001696 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[ check one ❑ owner ❑ owner's a ent. Owner/Agent Signature Telephone No. PERMIT FEE: $ The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations I Congress Street, Suite 100 Boston, MA 02114-2017 lkwi www mass gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): Address: 504 W`r h V&ff) b In ? Sc Q, City/State/Zip: Sq' Qfr-) , k)A ON)` 9 Phone #:'R9 R` -%�)AJ q V t Are you an employer? Check the appropriate box: 1.:29 I am a employer with 13 4. ❑ I am a general contractor and I employees (full and/or part-time).* have hired the sub -contractors 2. ❑ I am a sole proprietor or partner- listed on the attached sheet. ship and have no employees These sub -contractors have working for me in any capacity. employees and have workers' [No workers' comp. insurance comp. insurance.: required.] 5. ❑ We are a corporation and its 3. ❑ 1 am a homeowner doing all work officers have exercised their myself. [No workers' comp. right of exemption per MGL insurance required.] t c. 152, §1(4), and we have no employees. [No workers' comp. insurance required.] Type of project (required): 6. ❑ New construction 7. ❑ Remodeling 8. ❑ Demolition 9. ❑ Building addition 10. ❑ Electrical repairs or additions 11.❑ Plumbing repairs or additions 12.❑ Roof repairs 13Z Other (i` Q�' vy► 6 E'+Q`S S S-c.urca�a <u.c� *Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. #Cont actors that check this box must attached an additional sheet showing the name of the sub -contractors and state whether or not those entities have employees. If the 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 policy and job site information. Insurance Company Name: GUARD INSURANCE COMPANY Policy # or Self -ins. Lic. #: NIWC531842 Expiration Date: 12/10/2015 Job Site Address. City/State/Zip: 1y � 3�(�aoIJ�Q(',.M 6� 6) Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify frttder the pains and penalties of perjury that the information provided above is true and correct 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 Commonwealth of Massachusetts Department of Public Safety Security Systems- S- License License: SS -001696 PAUL DELS 22 BRIARWOD Westford MA *1 Commissioner Expiration: 01125)2016 Fold, Than Detach Along AN PeforaWrs 'POMMONMALTH OF MASSACHM iTV P EL V -T1 C I ANS .ISSUES THE. FOLLOWING LICRSE AS P, R-EMSTERED SYSTER CONTRACTOR NIGRWATCH PROTECTION INC I PAUL J DE,LSISKVR 22 BRIAMMOD DRIVE WESTFORD MA oi886-ii65 7024 C 07/31/14 50372 AUTHOFUZEo Nightwatch DEAMELER Protection, Inc. 60A Northwestern Dr., Suite 9 Salem, NH 03079 Kevin Gilligan 15 Holly St., Suite 208 Scarborough, ME 04074 President toll free (888) 722-9282 x121 kg*nightwatchprotecbon.com www.nightwatchpmtection.com Commonwealth of Massachusetts Department of Public Safety Security Systems- S- License License: SS -001696 PAUL DELS 22 BRIARWOD Westford MA *1 Commissioner Expiration: 01125)2016 Fold, Than Detach Along AN PeforaWrs 'POMMONMALTH OF MASSACHM iTV P EL V -T1 C I ANS .ISSUES THE. FOLLOWING LICRSE AS P, R-EMSTERED SYSTER CONTRACTOR NIGRWATCH PROTECTION INC I PAUL J DE,LSISKVR 22 BRIAMMOD DRIVE WESTFORD MA oi886-ii65 7024 C 07/31/14 50372 .4% O CERTIFICATE OF LIABILITY INSURANCEF12/10/2014 �� D/0 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(les) 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 Mackintire Insurance Agency Inc NONEACT melissa Pflug PHONE (508)366-6161 F°X (508)366-5202 11 West Main Street E-MAILADDRESS:melisoap@mackintire.com INSURERS AFFORDING COVERAGE NAIC 0 Westborough MA 01581-1931 INSURER A:Steadfast Insurance INSURED INSURERB:The Hartford Nightwatch Protection Inc INSURERC:Guard Insurance Group 50 A Northwestern Dr. INSURER D: Ste 9 INSURERE: Salem NH 03079 INSURERF: 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 ADDLSUBR POLICY NUMBER POLICY EFF MM/DD/YYYY) POLICY EXP (MMfDDNYYYj LIMITS GENERAL LIABILITY EACH OCCURRENCE $ . 1, 000, 000 A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE OCCUR OL9836125-00 /1/2014 /1/2015 PREMI AMA E T RENTED ES occurr ce $ 100,000 MED EXP (Any one person) $ 51000 PERSONAL &ADV INJURY $ 11000,000 GENERAL AGGREGATE $ 2,000,000 GEITL AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 2,000,000 X POLICY PRO- RO LOC1 JECT 1 $ AUTOMOBILE LIABILITY - EOMaBINccidED SINGLE LIMIT 1,000,000 B X ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS 0SUEChX2967 9/1/2014 /1/2015 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ NON -OWNED HIRED AUTOS AUTOS PROPERTY DAMAGE Per accident $ Uninsured motorist combined $ 300,000 X UMBRELLA LIABOCCUR HCLAIMS-MADE EACH OCCURRENCE $ 51000,000 A EXCESS LIAR AGGREGATE $ 5,000,000 DED RETENTION $ UC0135250-00 /1/2014 9/1/2015 C ' WORKERS COMPENSATIONX AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE F OFFICER/MEMBER EXCLUDED? (Mandatory In NH) If yes, ESCRIPTIOeunder DESCRIPTION OF OPERATIONS below N / A IWC531842 2/10/2014 2/10/2015 WC STATU- OTH- E.L. EACH ACCIDENT $ 500,000 E.L. DISEASE - EA EMPLOYEE $ 500,000 E.L. DISEASE - POLICY LIMIT $ 500,000 A Brrors a Ommissions OL9836125-00 /1/2014 /1/2015 each occurrence $1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, H more space Is required) {..NIYI, CLLR 1 1 V ry I SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN To Whom It May Concern ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE imothy Moynagh/MEL —+ Wrxv �u tw rvrva) W 1Vtlt)-z070 ACORD CORPORATION. All rights reserved. INS025 r9mnnsi m The Ar npn name and Inn^ aro ranicfara,t mnrlrc of Af nRn '4C40R EP CERTIFICATE OF LIABILITY INSURANCE 1U�3/2U14rr) 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 Mackintire Insurance Agency Inc 11 West Main Street Westborough MA 01581-1931 CONTACT Melissa Pflug g PHONE , (508)366-6161 FAX Nol,(508)366-5202 EAD-MAIL meliss@mackintire.coDRES a p m INSURERS AFFORDING COVERAGE NAIC # INSURER A:Steadfast Insurance INSURED Nightwatch Protection Inc 50 A Northwestern Dr. Ste 9 Salem NH 03079 INSURER B INSURER C: INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:14-15 Master 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 ADL VD POLICY NUMBER MM/DDNYYY POLICYDEXP LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 11000,000 A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE OCCUR OL9836125-00 9/1/2014 9/1/2015 DAMAGE T RENTED ccurrence $ 100,000 PREMISES Ea occurrence) MED EXP (Any one person) $ 51000 PERSONAL &ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 2,000,000 X POLICY PRO- ircT F-1 LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea ..ident BODILY INJURY (Per person) $ ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Per accident) $ HIRED AUTOS NON -OWNED AUTOS PROPERTY DAMAGE $ Per accident Uninsured motorist combined $ X UMBRELLA LIAB HCLAIMS-MADE OCCUR EACH OCCURRENCE $ 51000,000 AGGREGATE $ 51000,000 A EXCESS LIAB DED I X I RETENTION$ 10,00 $ IIC0135250-00 9/1/2014 9/1/2015 WORKERS COMPENSATION WC STATU- I OTH- AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICERIMEMBEREXCLUDED? r NIA TORY LIMITS FEL E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYE $ (Mandatory In NH) If yes, describe under E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS below A Errors & Ommissions OL9836125-00 9/1/2014 9/1/2015 EACH OCCURRENCE $1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space is required) Town of North Andover 1600 Osgood Street North Andover, MA 01845 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 Timothy Moynagh/MEL ALUKU 25 (21J1U/U5) ©1988-2010 ACORD CORPORATION. All rights reserved. INS025 mmnnst m Tho ArnRn name anri Inn^ aro ronicfororl mance of ar:npn