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HomeMy WebLinkAboutWire Permit 12450 Date...................... F?;•"';;';•.tioo� TOWN OF NORTH ANDOVER * PERMIT FOR WIRING 4,��'' '•'°��g CHUS� This certifies that ...... !.�.. '?'! s 4��/�DT I,^L ......... ............................................................. has permission to perform ..... �C n,!.. i s 7s�P-�1 wiring in the building of,..... �f✓ f ...................................................................................... at ...C121V... '` r^'``-f ................ rthAndover,Mass. ........................ ......... Fj�� Lic.No( �°Z-- �....-.'.......... ................. ELECTRICAL ZINSPECTOR Check# 5�15�'Z 7 24 �, �1 o' —6� BOA,RI)OFFIRFPREVL-:Ni[ONREGULA17fONS owupa-acy and Fea Checked e�w�bad 'rectlyawg cell 0.L11071 cados&L -Aconfraditabldgermif Off APPLICATION FOR PERM&TO PgRFO RM ELECTRICAL WORK • (TLEMP,2?"WNMKORTHBAIX-likyF'OB3MYO-k) Date: N�C\VES To th.e kpotor of MPes: (2-6 Yes EJ H, vous avmbeaarl uldv"D 1"re, ofivetem Volfg 07-ArAPSE! 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"V..'•may' s �.. �v CERTIFICATE OF LIABILITY INSURANCE DATE(MM/09/25/2013 Y) 013 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 tr_ certificate holder in lieu of such endorsement(s). PRODUCER CONTACT V NAME: Risk Services Northeast, Inc. PHONE 8 -7122 FAX -0105(A/C.No.EXt): ( 66) 283 ACN (800) 363 aMOrrlStOWD NJ Office 44 Whippany Road, Suite 220 E-MAIL p Morristown NJ 07960 USA ADDRESS: _ INSURER(S)AFFORDING COVERAGE NAIC# INSURED INSURER A: Zurich American Ins CO 16535 ADT LLC INSURER B: American Zurich Ins CO 40142 ADT Security Services 1501 Yamato Rd INSURER C: Boca Raton FL 33431-4408 USA INSURER D. INSURER E: INSURER F: --COVERAGES -- CERTIFICATE NUMBER:570051395419 _ 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. Limits shown are as requested ILTR TYPE OF INSURANCE INSR WVD POLICY NUMBER MAD MMfDD X LIMITS A GENERAL LIABILITY GLO EACH OCCURRENCE 12,000,000 X COMMERCIAL GENERAL LIABILITY AMA RENTED $1,OOO,OOO PREMISES Ea occurrence CLAIMS-MADE M OCCUR MED EXP(Any one person) S101 000 PERSONAL 6 ADV INJURY $2,000,000 �2 GENERAL AGGREGATE $4,000,006 a PRODUCTS-COMP/OP AGG S4,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: X POLICY PRO- LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 10 Ea aceiden ANY AUTO BODILY INJURY(Per person) 2 ALL OWNED SCHEDULED BODILY INJURY(Per accident) 41 AUTOS AUTOS PROPERTYDAMAGE HIREDAUTOS NON-OWNED Per acddent t� AUTOS t: N UMBRELLA LIAR HOCCUR EACH OCCURRENCE V EXCESS LIAB CLAIMS-MADE AGGREGATE DED I RETENTION B WORKERS COMPENSATION AND WC509589701 10 01/2013 10 O1 2014 WC STATU- OTH- A EMPLOYERS'LIABILITY Y/N WC509589801 10/01/2013 10/01/2014 X TORY LIMITS R ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $2,000,000 OFFICERMIEMBER EXCLUDED? N/A (Mandatory In NH) E.L DISEASE-EA EMPLOYEE $2,000,000 IT yes,describe under E.L.DISEASE-POLICY LIMIT $2,000,000 DESCRIPTION OF OPERATIONS below l� DESCRIPTION OF OPERATIONS!LOCATIONS/VEHICLES(Attach ACORD 101,Additlonal Remarks Schedule,If more space is required) - �iJ- CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE ti- POLICY PROVISIONS. TOWN OF NORTH ANDOVER AUTHORIZED REPRESENTATIVE INSPECTOR OF WIRES �--- 124 MAIN ST.NOR NORTH ANDOVER MA 01845 USA ©1988-2010 ACORD CORPORATION.All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD Y�T� [nft`ec!'lP_•c�sv�s tzs = u MA 0911 b ,'-1n 'k�4d• ��'t7fw�.�r"a157�i' 'd� a a_ Jog Hasa �0 ��' is clintan ®rove .. ' ®3®49 -ZI 1 J� Q3°tiu`#° lu� 3 C�115r fi e rX I� 1000. i AWL7. rI At JTITWO no MAWS law IV1--to adamm WIN,SHI word � MISA E �TMI A,c v-r 14,12,f1f,41,206WOIm,- 0 Voltage - T � � ' Is.. _ rigSecur!Lv S stern I ��7 i�ifi �7�c in,xA T¢ i�iof� ih�n� c 'eetc vns s 3i r a%arrow ` �F7a���7�=a�t� ��t�it�>3iEa�;cr:�•�h��a��€f�i��sTG��,a��a�t�:� an�i ��tes����t:��I����,�x.5i�:uda',tiz� ���i���r�'� t I• ���rn��s�r�:s�h��� ��i��� t����i.�iaH��sr-E�'�c����E1�fi.���m���Gr�c�a� ti#��i�,�n�S•t.>:�:���r �e�fi�7a�s�s�'�si�u4�t� } ' �tr�,T•G��� f�fifi„�¢"�3r�a�P>rr55;�mr�,i��y��,4Ti�}��n�Hg�Q•9'���31��Fe Q'�'�t'r5�e��'�:'P�� '�s°°bbgv. _ _ ; , c .�_ Zur%chAmerican Insurance Co. _.. _.,e��, - " WG50958970 9111U�509589801 ,, wail p ; I0/01/20 I4� , I OD Vol 211 to tgn iff DYE.fiar -- -• -- - BNELI 603•-S94-S9 _ arw,robe MY or Tam, i i I