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HomeMy WebLinkAboutBuilding Permit # 3/4/2015 0ORTy BUILDING PERMIT TOWN OF FORTH ANDOVER APPLICATION FOR PLAN EXAMINATION a Permit NO: � � � Date Received A COCNI{Nlwrcw Y' Too Date Issued: " EMPORTANT:Ap licant must complete all items on this page LOCATION % I AW . n CWh1IR , t , „, ' PROPERTY t KIM., MAP Nth PARGEI� ?GIN tITl1`CTI storrp,Clttr� # , jiffs n M aphrte hip Village :;y0' TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential n New Building ❑ One family F1 Addition ❑Two or more family ❑ Industrial F1 Alteration No. of units: ❑Commercial Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑Other ❑ eplic 0 Well � Floodplslri' i C Wetlands a Watershed District Wker`/"ewer y , � WAS y�e. 1 a„ w. +r , � Kr Identification Please Type or Print Clearly) OWNER: Name: � , r. 1,VPhone 1 . * , Address: JoH tvn *Je Ver 'iCC►tTRACTOR Name: c to M, P � h€� e Address u eruisor's Csr tr s uctNorn Lioserte Hone'"Mprov n 'icense" I t ARCHITECT/ENGINEER Phone: Address: Reg, No. FEE SCHEDULE:BULDING PERMIT:MOO PER$9000.00 OF THE TOTAL ESTIMATED COST RASED ON$125.00 PER S.F. Total Project Cost: $ I I w0 0 FEE: $ k Check No.: "" Receipt No.: '2�Z, °c NOTE: Persons contracting with unregistered contractors do not have access to the guaranty,fund 4�f mgnature of Agent/Own - ignature of contractor I _-__-. %AORT#i i own otAndover 1 ...,1', ®® .....- � " T 0 T _ y T % �A. ver, Mass, 11� �!- COCNICM[c.WICK 7A°RATED Jkly 5 •9S U BOARD OF HEALTH LD RAk �� ff = ff Food/Kitchen Septic System l THIS CERTIFIES THAT BUILDING INSPECTOR .................. ............. ... .!!14 ............ . .. .C... ......... //�� � has permission to erect .......................... buildings on ....1.M... ...... ...... .. ......................... Foundation Rough tobe occupied as ...... t.... .. ............ .. ............ IkLit,10AMMM................................................ Chimney provided that the person accepting this permit shall in every respect conform to the terms of the application Final on file in 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 IN 6 MO T ELECTRICAL INSPECTOR UNLESS CONSTRUCT S S Rough Service ............. . .. ...................... ....... ........................ BUILDING INSPECTOR Final GAS INSPECTOR Occupancy Permit Required to Occupy Building Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT U:ntil Inspected and Approved by the Building Inspector. Burner Street No. �� Smoke Det. BUILDING&REMODELING CONTRACTOR MASSACHUSETTS HOME IMPROVEMENTS CONTRACT This form satisfies all basic requirements of the state's Home Improvement Contractor Law(MGL chapter 142A),but does not include standard language to protect homeowners.Seek legal advice if necessary.Any person planning home improvements should first obtain a copy of"A Massachusetts Consumer Guide to Home Improvement"before agreeing to any work on your residence.You may obtain a free copy by calling the Office of Consumer Affairs and Business Regulation's Consumer Information Hotline at 617-973-8787 or 1-888-283.3757 or on our website. Homeowner Information Contractor Information Name Mr.&Mrs.McLeary Company Name Joscoon Management,dno Street Address(do not use a Post Office Box address) Contractor/Owner Name 104 Milk Street Jonaftn O'SWINan City/Town State Zip Code Business Address(must include a street address) North Andover,MA 01845 135 Atlantic AvK-we Daytime Phone Evening Phone 978-688-2223 City/Town State Zip Code dennis.mccleary@gg.com alisbwy,MA 01952 Mailing Address(It different from above) Business Phone Federal Employer ID or S.S.Number 603.489-1533 61-1433'121 Home Improvement Contractor Reg.Number 135444 Expiration date 4-30-2315 The Contractor agrees to do the following work for the Homeowner: Scope of Work The following scope of work is to renovate the existing second floor hall bathroom. The existing tub unit to remain. Several items below have Allowance amounts provided and will be adjusted accordingly once all materials have been selected. • Building permit per the Town of North Andover,MA ® Due to the age of the home Renovate Right Lead Safe Remodeling practices will be implemented unless tested by a 31d party to determine if lead is present.This is the Law and being a Lead certified licensed contractor I need to comply. Please visit ww,w,mass I@ for additional info. TBD • Temporary protection and daily cleanup throughout the remodeled area. Demolition work to include the following: Removal of the vanity cabinets,shower tub walls,file ceiling in shower and the bathroom flooring. Remove the tub wall on the opposite side of the shower valves for preparation for a new half wall with a clear glass panel to sit on. Remove the existing wall file and wall paper. Disposal of all construction related debris. Asbestos removal not included. • Soffit above the tub unit will be opened up to see if it can be eliminated. Further exploratory work is needed to determine what is above. • Rough carpentry to include building a half wall at the shower t tub area and framing adjustments at the existing shower/tub soffit. • Prepare the bathroom floor for new ceramic tile by installing file backer board throughout the floor area. Tile materials per the homeowner's selections and Allowance amount listed below. • Prepare the shower area for new ceramic file by installing new file backer board. Tile area has been figured on 2 full walls and the half wall on the opposite side of the shower valves. Tile labor has been figured on a basic pattern and no chair rail,boarder and diagonal patterns. Chair rail,boarders,diagonal patterns will be considered additional labor and will be priced accordingly. Wall tile to end at the ceiling area. No file on the ceiling. (1)4°boarder approx.11'has been figured. • Install new ceramic file throughout the bathroom floor area. Figured on a square pattern. Plumbing work to include the following: Remove/reinstall a new toilet,install new sink/faucet,install new shower trim and valve. Plumbing work has an allowance amount of$1,200.00. Allowance has been based on installing new fixtures at the existing locations. Any code upgrades,venting or fixture relocations may exceed the Allowance amount provided. Further exploratory work needed. • Electrical work to consist of any code upgrades and new lighting fixture installs. Electrical work has an allowance amount of$800.00 figured into the total below. Electrical work Allowance figured on installing new fixtures at the existing locations. Any code upgrades may exceed the Allowance amount provided. All lighting fixtures to be purchased by the homeowner. Further exploratory work is needed to determine if the existing electrical is to code in the bathroom area. • Install a new bathroom fan/light unit.Fan unit to be vented to the exterior of the house.Fixture to be purchased by the homeowner with Joscon's assistance. • Carpentry work to include the installation of b board approx.4'high off the floor along the walls approx.22'in length. B board system will include base board,b board panels and a chair rail • Vanity unit by others. • Drywall repairs as needed throughout the bathroom area including the ceiling above the shower I tub unit. • Painting throughout the bathroom area for the walls and ceilings. Prepare wall papered walls to be painted. • Install new homeowner supplied finishes. Towel bar,toilet paper holder and robe hooks. • Install a new shower glass enclosure along the front and install a glass panel on top of the shower/tub half wall. Half wall glass to sit on top of a marble cap. Final selection will determine the actual price. • Supply and install a new Anderson Woodwright Replacement window in the bathroom, Window to have a 2 over 1 grill pattern with divided light with spacer bars,white exterior and clear pine interior,high performance Low E and a white insect screen. Window at cost and no install charge. • Final post construction cleaning throughout the bathroom area. Allowances listed above: • Plumbing @$1,200.00 '.... • Electrical @$800.00 • Shower enclosure&half wall glass Allowance @$1,500.00 • Shower/tub walls including boarder,grout,half wall cap and the bathroom floor the material amount including tax @$2,342.00(Extra tile will be returned to Tony's Tile for a credit and will be credited back to the owner. • Shower valve and trim by others. Toilet by others. Sink and faucet by others '... • B board work @$750.00 • Vanity including the countertop by others • Medicine cabinet @$150.00 '.. Total for the above project scope of work and specifications: $15,912.00 Required Permits-The following building permits are required Proposed Start and Completion Schedule-The following And will be secured by the contractor as the homeowner's agent: Building permit schedule will be adhered to unless circumstances beyond the contractors control arise. (Owners who secure their own permits will be excluded from the Guaranty Fund provisions of 312/2015 Date when contractor will begin contracted work. MGL chapter 142A.) 3127/2015 Date when contracted work will be substantially completed. Shower glass enclosure install date to be longer due to template and install. Including the shower valve trim. Total Contract Price and Payment Schedule The Contractor agrees to perform the work,furnish the material and labor specified above for the total sum of:$15,912.00 (*) Payments will be made according to the following schedule: $4,773.60 30%Upon the signing of the contract and the start of the project $4,773.60 30%Upon the of the completion of demolition and rough ins $4,773.60 30%Upon the completion of file work $1,591.20 10%upon substantial completion of the contract. (Law forbids demanding full payment until contract is completed to both party's satisfaction) The following material/equipment must be special $0 to be paid for NIA ordered before the contracted work begins in order to meet the completion schedule. (**)$0 to be paid for NIA) NOTES:(*)Including all finance charges(**)Law requires that any deposit or down-payment required by the contractor before work begins may not exceed the greater of(a)one-third of the total contract price or(b)the actual cost of any special equipment or custom made material which must be special ordered in advance to meet the completion schedule. Express Warranty-Is an express warranty being provided by the contractor? oNo 0 Yes(all terms of the warranty must be attached to the contract)Subcontractors-The contractor agrees to be solely responsible for completion of the work described regardless of the actions of any third party/subcontractor utilized by the contractor.The contractor further agrees to be solely responsible for all payments to all subcontractors for materials and labor under this agreement. Contract Acceptance-Upon signing,this document becomes a binding contract under law.Unless otherwise noted within this document,the contract shall not imply that any lien or other security interest has been placed on the residence.Review the following cautions and notices carefully before signing this contract. Don't be pressured into signing the contract.Take time to read and fully understand it,Ask questions if something is unclear. Make sure the contractor has a valid Home Improvement Contractor Registration.The law requires most home improvement contractors and subcontractors to be registered with the Director of Home Improvement Contractor Registration.You may inquire about contractor registration by writing to the Director at 10 Park Plaza,Room 5170,Boston,MA 02116 or by calling 617.973-8787 or 888-283-3757. Does the contractor have insurance?Ask the Contractor for his insurance company information so that you can confirm coverage,or ask to see a copy of a'proof of insurance'document. Know your rights and responsibilities,Read the Important Information on the reverse side of this form and get a copy of the Consumer Guide to the Home Improvement Contractor Law. You may cancel this agreement if it has been signed at a place other than the contractor's normal place of business,provided you notify the contractor in writing at his/her main office or branch office by ordinary mail posted,by telegram sent or by delivery,not later than midnight of the third business day following the signing of this agreement.See the attached notice of cancellation form for an explanation of this right DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES Two identical copies of the contract must be completed and signed.One copy should go to the homeowner.The other copy should be kept by the contractor, 1) Contractors ignature to Date Contractor Arbitration The Home Improvement Contractor Law provides homeowners with th Date Contractor initiate an arbitration action(as an alternative to court action)if they have a dispute with a contractor.The same right is not automatically afforded to a contractor,however.The contractor would have to resolve any dispute he/she has with a homeowner in court unless both parties agree to the optional clause provided below.This clause would give the contractor the same right to arbitration as is afforded to the homeowner by the Home Improvement Contractor Law. The contractor and the homeowner hereby mutually agree in advance that in the event the contractor has a dispute concerning this contract,the contractor may submit the dispute to a private arbitration firm which has been approved by the Secretary of the Executive Office of Consumer Affairs and Business Regulation and the consumer shall be required to submit t s h arbitration as provided In Massachusetts General Laws, cha terJ4 T7= FIomeow rs Signature ContrAor's Signature NOTICE:The signatures of the parties above apply only to the agreement of the parties to alternative dispute resolution initiated by the contractor.The homeowner may initiate alternative dispute resolution even where this section is not separately signed by the parties. Homeowner's Rights A homeowners rights under the Home Improvement Contractor Law(MGL chapter 142A)and other consumer protection laws(i.e.MGL chapter 93A)may not be waived in any way,even by agreement.However,homeowners may be excluded from certain rights if the contractor they choose is not properly registered as prescribed by law.Homeowners who secure their own building permits are automatically excluded from all Guaranty Fund provisions of the Home Improvement Contractor Law.The contractor is responsible for completing the work as described,in a timely and workmanlike manner.Homeowners may be entitled to other specific legal rights if the contractor guarantees or provides an express warranty for workmanship or materials.In addition to guarantees or warranties provided by the contractor,all goods sold in Massachusetts carry an implied warranty of merchantability and fitness for a particular purpose.An enumeration of other matters on which the homeowner and contractor lawfully agree may be added to the terms of the contract as long as they do not restrict a homeowner's basic consumer rights.If you have questions about your consumer/homeowner rights,contact the Consumer Information Hotline(listed below), Execution of Contract The contract must be executed in duplicate and should not be signed until a copy of all exhibits and referenced documents have been attached. Parties are also advised not to sign the document until all blank sections have been filled in or marked as void,deleted,or not applicable.One original signed copy of the contract with attachments is to be given to the owner and the other kept by the contractor.Any modification to the original contract must be in writing and agreed to by both parties.Contracted work may not begin until both parties have received a fully executed copy of the contract,and the three day rescission period has expired. Accelerated Payments A contractor may not demand payments in advance of the dates specified on the payment schedule in cases where the homeowner deems him/herself to be financially insecure.However,in instances where a contractor deems him1herself to be financially insecure,the contractor may require that the balance of funds not yet due be placed in a joint escrow account as a prerequisite to continuing the contracted work.Withdrawal of funds from said account would require the signatures of both parties. Additional Information If you have general questions or need additional information about the Home Improvement Contractor Law or other consumer rights,or if you wish to obtain a free copy of"A Massachusetts Consumer Guide to Home Improvement'contact: Consumer Information Hotline Office of Consumer Affairs and Business Regulation 10 Park Plaza,Room 5170,Boston,MA 02116 617-973-8787,888-283-3757 or visit the OCABR website at tittp://www,mass.gov/ocabr/ If you want to verify the registration of a contractor or if you have questions or need additional information specifically about the contractor registration component of the Home Improvement Contractor Law,contact: Director of Home Improvement Contractor Registration Office of Consumer Affairs and Business Regulation 10 Park Plaza,Room 5170,Boston,MA 02116 617-973-8787,888-283-3757 or Visit the HIC website at tittp://www.inass,gov/wabr/ Go online to view the status of a Home Improvement Contractor's Registration:hftp://db,state.iia,us/horT)ein,proveinerifAicetise,elist.asp For assistance with informal mediation of disputes or to register formal complaints against a business,call: Consumer Complaint Section Office of the Attorney General 617-727-8400 AND/OR Better Business Bureau 508-652A800,508-755-2548 or 413-734-3114 The Commonwealth of Massachusetts Department of IndustrialAceidents I Congress Street,Suite 100 Boston,MA 02114-2017 www.mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE TILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legibly Name (Business/Organization/Individual): Address: 4-, PrCVJetic_e_ } J( City/State/Zip: /4hXS C, I iy HC)3 Y I Phone#: 66T 0q- Are q-Are you an employer?Check the appropriate box: Type of project(required): 1.[;�I am a employer with '�L employees(full and/or part-time).* 7. ❑New construction 2.n I am a sole proprietor or partnership and have no employees working for me in 8. [xRemodeling any capacity.[No workers'comp.insurance required.] 9. ❑Demolition 3.Q I am a homeowner doing all work myself.[No workers'comp.insurance required.]t 10E]Building addition 4,p I 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 I LE]Electrical repairs or additions proprietors with no employees. 12, Plumbing repairs or additions 5,E]I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.❑Roof repairs These sub-contractors have employees and have workers'comp.insurance.t 6.Q We are a corporation and its officers have exercised their right of'exemption per MGL c. 14.❑Other 152,§1(4),and we have no employees.[No workers'comp.insurance required.] *Any applicant that checks box#I 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. tContractors 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 a►tt art etttployer tltat is providing worltets'eotnpetisatioit iusuraiice for my employees. Below is the policy and job site information. Insurance Company Name: N�e ll c. Policy#or Self-ins.Lic,M \I (v i C Expiration Date: CIA/ , S ' Job Site Address: 104 P-1r City/State/Zip: rV, Attach a copy of the workers'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. Ido hereby cerlyy, under the pains andpenalties of petjrtty that the information provided above is trite and correct. Si nature: Date: m Phone#: v> 9 0 _ IS-66 offs l use only. Do not sprite in this area,to be completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): i 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone M / ffice of Consumer suerrAffairs&Business Regulation Y ME IMPROVEMENT CONTRACTOR gistration: 159444 Type: i xpiration: Ql3C1l2016 Private Corporatio JOSCON MANAGEMENT INC. JONATHAN O'SULLIVAN 21 72 PROVIDENCE HILL RD. ATKINSON,NH 03811 undersecretary b� i/ ,,,�w"wmw,w;G;w �inyrd'�. raFruawrcwrrN � .„marrwllGi»r,,. i Massachusetts _ Department of Pr bhc Safety Board of Building Regulations and Standards Construction suuper 'kor License: CS-070043P ✓* JONATHAN OSIJ [IV f%„ 185 Atlantic Ave#4 Salisbury MA 01952 PQM )1 0A `` 4 IE xpiration 0812612016' Corrnrrn sioner . Jan.29.2015 02:17 PM Advantage Insurance Agent 978 794 4833 PAGE. 1/ � CERTIFICATE OF LIABILITY INSURANCE bATA(MM/bW YYY) 2015 01/291 THIS CERTIFICATE 19 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. i It Tie &i cat* had-or le ;;"'ZD-1-T-[5—NAL 1N URIED, tha pollcy([ea mutt hs Attdoraad, (I TWORMATI591 a, vuqct to the kerma and condition& of the policy, Certain policies may requira an andarsamant, A ebtemant on this corlificwto does not confer rigitts to the coltlflcate hooter In lieu of such sndoraamant(s). PnonucrR NaN1;: PAUL 1JF3VIN AI?VANTA�i& =NSLIRliiTGhl AtBNG3C INC. PHONE ——-- - FAX Arp.NwExt: 9713-6B1�1055 Wc,N078-7914-4833 ;� 184 PLEASANT VAY STREET E4KAIL .__.._.___.._,__._.. ............_.... .. aaoREa$: bMT=14 M 01844 dNSURERIS)AFFORDINOCOVERADE RA)QG _ ffAUR9kA;AREgLLA 8R€7TEC` tot IN$URRNCEi COMPANY INURED INsmERa!MWELLk PROTECTION INSURMCM COMPANY JOSCON D ARAGEMENT INC, — ^^Y-•� IWIAT€R c: 72 PROVIDENCE HITT, ROAD INSURER - SURER O AWKINSON, = 03011 INSURER E: _ INSURER p COVERAGES CERTIFICATE NUMBER! REVISION NUMBER: THIS IS T6-wFFuTP?"TAAt TH[ POLICIES OF INSURANCE: L18TED BELOW HAVE SEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POOGY PERIUD INDICATED. NOTVdTHSTANDING ANY REQUIREMENT. TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO ViMICH THIS CFRTIF•ICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS ANI?CONDITIONS OF SUCH POLICIn.LIMITS SHOWN MAY HAVE BEEN REDUCED 9Y PAJD CLAIMS. M!49�YYJ _ LTR TYPE 6F INSURANCE IHSR 4WD poLlcr NUMBER (MMppdyY (wNuA/QDNyynmvnvrvl LIMI" '. X GENERAL LIABILITY 8500055690 05/30/201 05/30/2015 EACHOCGURRENOR S 1,{100,000 COMMERCIAL GENERAL LIABILITY PREMIBEe(ENeCCu,rerma 3 100,000 CLAIM&MAULI 1.1G IOGGUR _MEDE>iPiAnywepersonJ ,# 10,000 PEROONAL&ADV INJURY $ 1,000,000 GENERALAGGREGATE t 2,000,000 - GEN•I,AoaREGATEUMITAPPLIESPER; pRoDuoYS-COMP/OPAGG 3 2,000,000 17 ppuGY JET LOC ..... _. .._.._ $ AUTtMODILELULBILITY (EA 4C OND ANY AUTO BODILY INJURY(FW penan) R ALL OWNED SCHEDULED eDDILYINJURYiPereee{datll T --- ---- AUTO$ _ AUTOG HIRED AUTOS AUTOS NED (Per* PerITF7ITG'tSA7�FtrE"'-'_._—'. •� .. AUTOS (Paracdddlrt) UMPRELLINUAH OCCUR EAGHOCCURRENCE L PXCY"UAS CLAIMS,MADE MGREGArE' S -' PEI ReYENTiON 9• . ....— g VWRKQRSCDIVEMATION 9121461012 10/05/207A10/0g/2015 TORYuu1Te 7C E AND EUFLOYERS'LIABILIYY ANY PRQPRIETORFARTNEMEXECUTiVE YIN E,L.FI�GH ACCIDENT $ 1,OC70,004 OFFICERJMEMBER EXCLUDED? ❑ NTA -----••^•-••^• (MAMAlorrrhNH) EL DISEA5E-EAELIPLOYEE $ 1,o00r000 DV$0RIPTI0N0FOPERATI0NSWeI0W E.L.DISEASE.POLIGYLIMIT Is 1,000,000 DESCRIPTION OPDpERAPON$I LDGATR]NS/VEHICLE&{Att&M ACORR 10,Add[11411l RMI&Mg 19c144dale,11n apace is Mqul,vtll GENHRAL 4iARF�YCTFtX' CERTIFICATE HOLDER CANCELLATION TO'W'14 OF NORTH ANDOVER SHOULD ANY OF THE AAOVF DESCRIBED POIJ0196 BD 0ANC6LLE0 BEFORE HVILDING DEPT. THE EXPIRATION DATE THRAEOP, NOTICE WILL BE DRUVERFZ IN 1600 OSGOOD STREET ACCORDANCE WITH THE POLICY PROV191ONS. StXCLDING 20 SUITE 2035 AUTHORIZED REPR NORTH ANDOVER NA 41048 i 18811-2010 ACORD CORPCIRATIQU. Afl sights roselved, ACORD 25(2094145} Tho ACORD name and logo are registarad marks of ACORD