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HomeMy WebLinkAboutBuilding Permit # 6/9/2015 -- 1 BUILDING PERMIT o` %Ao oTI 06 TOWN OF NORTH ANDOVER. 0 APPLICATION FOR PLAN EXAMINATION' IL Permit No#: � f Date Received Date Issued: ;� / ssgctaus� IMPORTANT:Applicant must complete all items on'this page i,/ r, ( spl r f " r !!N f 81"„�r,!!I,l iii %l/ I11J Y�J //f///�;,IYJ/ I/J,(I/ r(r/��ij�%,J (!�1f,f/!1 f,( /�%11 If �Ir 1(f f� if f f ,i f r,✓ / //�///�''/;% / ;I �� I' I /, ri, ✓J(>y9 J��l �; �l 11/ji„ � '1 � � � � /�/ 7 �l, 1 r N r / � ra r ualmapar u;✓a7{,wa..Vm w4e.l I f,a 1 Y.II II h h U r//, ��.,.^' ( ( „r, n'm(� �., r !/-✓r -,.., r' r .� X11� � >J � r� l JJ I !,.�/r�.. 'i TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑Addition ❑ Two or more family ❑ Industrial Iteration No. of units: XCommercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other �✓////r J,, �,r�,a,,l 1murs f1rI;.Un U,rii�a1�l�r1rrri re,.Vaic,d�„nI.lal�S,rrI e,�r�ani�.�W'e�/��,lr;�,frN,.lc../l l�iAr,',/,�r ir;�>'/��10 �(/lV�rl//�I/`�K,.,„rI,lJ f,/ad//,,..,. 1,,.,,,.,/%/,��/,%//�,/..❑,..;�,�,./,r/I r,/,.W,../( ate%r, 1 trt,c,,t,✓%�,r/,{/%// ,„G✓/f!//./„i ;roa ,/. ,.. �1 DESCRIPTION OFWP K TO BE PERFORMED: cm Identification- Please Type-or Print Clearly OWNER: Name: arc o f J Phone: b (`7 _(� _ P r Address: 1 cf .130 'r�U, '4�QtGyCil 00 How L l l ii r , /;�/ � J -rc� a , /�, �i ,, ii ry , / 1,///✓/ ,// /// r,,,/ /// r ,/ /// / // ll r- !y / G-, / 1/ r/// 'n , ( r. ✓., r// Illi/ r�r/ ll,;' �,... �D,.11 /�/ rrr /r� �r� ,/ / „ , � ri I �r� r / r // r � r r / i / ,.�'. i r.. , r,,, .I .I.-., , iV r. ➢ � I. ,. ,r.., ,/l,:... (Jt .frl.. r,r,v, -IVB ,lfi,V,Awmatl7tirram (�o� !_a�//Ha+,W//GoJPD+a�lw/oN,�rrVircarVlu��il6�llmr�VSro�/��Am�oGMiurDLim�P7,,, ,,.. ,...rwwav> SuA/ltil�aa�fba�r�ia.u.,�,liN... _.-1 ARCHITECT/ENGINEER—'2)&V0 iA c-rTi (+n k 1 Phone: Address: Reg:;No. FEE SCHEDULE:BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTI ATED COST BASED ON$125.00 PER S.F. Total Proje Cost: $ �'` ,1 FEE: $"" ~ Check No.: Receipt No.: , .. NOTE: Persons contracting witli unregistered contractors do;not have.access to tlae guaranty fund Signature of Agent/Owner' turea,,of contraeto _`;" �oRTH Town of 2 E ndover ® 0? , :� _ - _ h ver, Mass, j ou COCMIC"t WICK 4 S U - BOARD OF HEALTH Food/Kitchen PERMIT T LD Septic System �' BUILDING INSPECTOR THIS CERTIFIES THAT ......... �........... ..............::.........................................�Y...�..:........�.. -�..�:�. Iva 7 5�4. Foundation has permission to erect .......................... buildings on94 171- 74. ...-.. '................................................................. Rough tobe occupied as ................. ............................................................. ............................ 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 IT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR LESS CONSTRUCTION STARTS Rough /f/�/77 .............. Service Final BUILDING INSPECTOR 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 Until Inspected and Approved by the Building Inspector. Burner Street No. Smoke Det. Standard Form of Agreement between Owner and RCG LLC where the basis of payment is the Cost of the Work Plus a Fee without a Guaranteed Maximum Price Date: s ad y{a �a � a � t Owner: � _ 0 tom , . w Contractor: � ��� � Architect: ' `* M Project Name: The Owner and Contractor agree to the terms stated by this contract. This contract supersedes any prior agreements, representations, or negotiations, oral or written. No liquidated damages shall apply to this agreement. This contract consists of the following documents: 1. Obligations of the Parties 2. Contract Sum 3. Project Schedule 4. Signatures Exhibits Exhibit A: Estimated Cost of Work Exhibit B: Project Schedule Exhibit C: Drawings Page 1 of 6 1. Obligations of the Parties Obligations of the Contractor: The Contractor accepts the relationship of trust and confidence established by this Agreement and covenants with the Owner to cooperate with the Architect and exercise the Contractor's skill and judgment in furthering the interests of the Owner; to furnish efficient business administration and supervision; to furnish at all times an adequate supply of workers and materials; and to perform the Work in an expeditious and economical manner consistent with the Owner's interests and in compliance with all applicable governmental codes and regulations. The Contractor shall keep full and detailed accounts and exercise such controls as may be necessary for proper financial management under this Contract. The Contractor shall keep full and detailed records of all books, records, permits, licenses, correspondence, receipts, instructions, data, and drawings associated with the Project including all Subcontractor contracts, invoices, vouchers, insurances, lien waivers, and other correspondence. The Owner and Owner's Accountants shall have access to review, audit, and copy all Contractor documentation. The Contractor shall retain these documents for a period of three years after final payment. The Contractor shall maintain insurance at the following levels with the Owner listed as a co- insured: T e of Insurance Limit of Liability �.. ,> „ a X3. 1111 1�1Y y_ c� f ss '-s, r;. -..'.a ;;c,,. Upon request, and at the cost of the Owner, the Contractor shall obtain a performance bond up to the total Cost of Work. Such costs shall be added to the Construction Volume. The Contractor understands that the Project will be financed by a construction lender and, then, by a permanent lender. The Owner may assign any of its rights under this Contract to the construction lender and the Contractor hereby consents to any such transfer provided no such assignment shall relieve the Owner of any of its obligations under this Contract, unless agreed to in writing by the Contractor. The Contractor shall execute any certificates, lien waivers, releases, receipts, and other documents as may be reasonably required by the construction lender or permanent lender including a subordination of its mechanic's lien rights to the construction lender's and permanent lender's mortgage or deed of trust. The construction lender for the Project will be: k� Obligations of the Owner: The Owner agrees to furnish or approve, in a timely manner, information required by the Contractor and to make payments to the Contractor in accordance with the requirements of this Agreement. Dispute Resolution: Claims, disputes or other matters in question between the parties to this Agreement shall be resolved by mediation or by arbitration. Prior to arbitration, the parties shall endeavor to reach settlement by mediation. Page 2 of 6 2. Contract Sum Cost of Work: The Contractor shall provide a detailed estimated Cost of Work to the Owner(see Exhibit A). The sum of these costs, including the fee is as shown below: 3 Change Orders: The Contractor does not guarantee the Contract Sum in any form. In the event of changes to the Contract Sum, the Contractor will present written changes to the owner for costs that exceed the Contract Sum in the form of a Change Order. The Contractor will review all Subcontractor Change Orders before submittal to the Owner and Architect and make a recommendation for payment or non-payment. The Contractor's Fee will be calculated including any approved Change Orders. The Owner, Architect and Contractor will negotiate disputed Change Orders in good faith. Contractor's Fee: 10% of total construction volume. This includes pre-construction and project management services, and field personnel and associated management overhead. The fee is based on actual costs incurred, with final true up, and is billed monthly in arrears. Total Construction Volume excludes permits and fees, which shall be paid directly by the Owner. Construction management labor, standard tools and equipment, and labor-related overhead are covered within the fee. Specialty tools or equipment and any trade labor supplied by J&K personnel shall be charged separately. If a project is terminated or suspended by the Owner prior to completion, J&K shall be compensated for the actual cost of services provided prior to receipt of notice of termination or suspension from the Owner. Subcontractors: The Contractor plans to hire Subcontractors to perform the majority of construction associated with this project. The Contractor shall provide the Owner and Architect information on all of the bids received by Subcontractors and the names of the Subcontractors selected. Owner shall have the right to reject a proposed Subcontractor; however, in the event that this leads to a higher Cost of Work, the Owner shall pay for the difference. The Contractor reserves the right to reject any Subcontractor, even if it is the lowest bid, and to dismiss Subcontractors from the job that have been previously approved by the Owner. Payments: The Owner shall make progress payments on the Contract Sum according to the Requisition process described below. The Contractor shall, at the conclusion of each calendar month on the project, present to the Owner an application for payment(Requisition)for costs incurred during that month. The Requisition shall include all invoices, vouchers, partial releases of liens, expense reports, and any other evidence to support the validity of the Requisition amount. The Contractor may requisition for completed, but unpaid work based on an expectation of payment upon receipt of funds. The Owner, the Architect, or their representatives shall be afforded five (5) business days to review such application and question the Contractor about its contents. In the event there are no disputes, the Owner shall pay the Contractor within 10 business days of receipt of the Requisition. Payment by the Owner does not represent that the Owner or Architect have made a detailed examination of the documentation, inspection of the work, or verification of the accounting. Page 3 of 6 At the completion of the project, the Owner shall make a final payment to the Contractor based on a final Cost of Work with a truing up of fees. If further corrections to work are required that are not covered under warranties with Subcontractors, or that are not the outcome of negligence or poor workmanship by the Contractor, the Owner shall pay the Contractor for any work associated with performing the corrections based on the hourly rate agreed to in this contract. Retainage: The Owner shall not hold back any fees to the Contractor to ensure completion of the work. The Contractor will be expected to hold back fees from Subcontractors to ensure their performance based on the terms below: pp6 r r 77Yf �•, ? s,�.� ., :T' A f ..11 ...aF. „l�_u. _ r.....,, Termination of Contract: The Owner shall reserve the right to terminate or suspend the Contract at its sole discretion. Within 15 days of termination or suspension, the Contractor shall present an accounting of all its costs incurred for reimbursement by the Owner. If the Owner elects to proceed with the project without the Contractor, the Owner shall have the right to assume the Subcontracts and agreements related to the Project. 3. Project Schedule Date of Commencement: The Contract Time shall be measured from the date of commencement. The date of commencement of the Work shall be the date of this Agreement, unless a different date is stated below or provision is made for the date to be fixed in a notice to proceed issued by the Owner. - 0101111%-Vow '911 ...�' -011 � Contract Time: The Contractor shall provide to the Owner a Project Schedule (see Exhibit B). This Schedule is based on assumptions reached prior to the signing of this contract, which assumptions the Contractor shall attempt to clarify in the Schedule. However, the Schedule always assumes the Owner and the Architect respond promptly to requests for information and do not request any significant changes to the construction program. In the event that the Owner or Architect find any discrepancies with the Schedule or its Assumptions, they will promptly notify the Contractor, who shall make adjustments to the Schedule as necessary. According to the attached Schedule, the Contractor shall achieve Substantial Completion of the entire Work as follows: .C+SSF... The Contractor does not guarantee the date of completion. However, the Contractor shall not be entitled to additional fees based on delays in the project unless those delays can be shown to incur extra costs for the Contractor and were caused by the actions or requests of the Owner or Architect. The Contractor shall present an updated Project Schedule to the Owner and Architect on a weekly basis for their review. Page 4 of 6 4. Signatures The Owner's representative is: fas, '•b3� .>.h f § 14.4 The Contractor's representative is: r _ This agreement is entered into as of the day and year first written above and is executed in at least three original copies, one for the Owner, one for the Contractor, and one for the Architect. Owner Contractor Si nature Si nature Printed Name and Title Printed Name and Title iiZ h c ►'� 1 Page 5 of 6 Schedule of Values Estimated Cost General Conditions $ 4,500.00 Demolition $ 4,500.00 Frame walls and workstations $ 9,500.00 Phone Booths $ 8,500.00 Insulation $ 1,500.00 Drywall &tape $ 5,000.00 Prime and Paint $ 9,000.00 Doors&Windows $ 5,500.00 Installation of carpet tiles and underlayment $ 7,768.00 Specialty gym flooring supply and install $ 2,500.00 Sprinkler Work $ 3,000.00 Electrical $ 7,770.00 HVAC $ 22,075.00 Subtotal $ 91,113.00 A Contracting Fee $ 9,111.30 Total $ 100,224.30 Page 6 of 6 ;. OFFICE OF BUILDING INSPECTOR TOWN OF NORTH ANDOVER • CONSTRUCTION CONTROL PROJECT NUMBER: 14-0682 A PROJECT TITLE: ERS - 1V PROJECT LOCATION: 120 Water Street, N. Andover, MA NAME OF BUILDING: East Mill NATURE OF PROJECT: Tenant improvement/fit out IN ACCORDANCE WITH ARTICLE 116 OF THE MASSACHUSETTS STATE BUILDING CODE, 1, REGISTRATION NO. BEING A REGISTERED PROFESSIONAL ENGINEER/ARCHITECH HEREBY CERTIFY THAT I HAVE PREPARED OR DIRECTLY SUPERVISED THE PREPARATION OF ALL DESIGN PLANS, COMPUTATIONS AND SPECIFICATIONS CONCERNING: ENTIRE PROJECT ' ARCHITECTURAL STRUCTURAL ' MECHANICAL ' FIRE PROTECTION ' ELECTRICAL ' OTHER(SPECIFY) FOR THE ABOVE NAMED PROJECT AND THAT,TO THE BEST OF MY KNOWLEGE, SUCH PLANS, COMPUTATIONS AND SPECIFICATIONS MEET THE APPLICABLE PROVISION OF THE MASSACHUSETTS STATE BUILDING CODE, ALL ACCEPTABLE ENGINEERING PRATICES. AND APPLICABLE LAWS AND ORDINANCES FOR THE PROPOSED USE AND OCCUPANCY. I FURTHER CERTIFY THAT I SHALL PERFORM THE NECESSARY PROFESSIONAL SERVICES AND B EPRESENT ON THE CONSTRUCTION SITE ON A REGULAR AND PERIODIC BASIS TO DETERMINE THAT THE WORK IS PROCEEEDING IN ACCORDANCE WITH THE DOCUMENTS APPROVED FOR THE BUILDING PERMIT AND SHALL BE RESPONSIBLE FOR THE FOLLOWING AS SPECIFIED IN SECTION 116.0 1. Review,for conformance to the design concept, shop drawings, samples and other submittals which are submitted by the contractor in accordance with the requirements of the construction documents. 2. Review and approval of the quality control procedures for all code-required controlled materials. 3. Be present at intervals appropriate to the stage of construction to become, generally familiar r. D R�\ with6the progress and quality of the work and to determine, in general, if the work is being, M. �G�S performed in a manner consistent with the construction documents. i * PURSUANT TO SECTION 116.2 .2 1 SHALL SUBMIT WEEKLY , A PROGRESS REPORT. o S o• 5T6 % TOGETHER WITH PERTINENT COMMENTS TO THE NORTH ANDOVER BUILDING INSP O2� GAJ UPON COMPLETION OF THE WORK, I SHALL SUBMIT A FINAL REPORT AS TO THE F �y Fops �f SATISFACTORY COMPLETION AND READINESS OF THE PROJECT FOR OCCUPANCY. SIGNATURE �- SUBSCRIBED AND SWORM TO BEFORE ME THIS DAY OF lrL 201 CHERYL L. LR�{KIIN�cSHAW NOTA PUBLIC @ a:XV6�rN{al���;o My Commission Expires March 7, 2019 3/3/2015 7:22:03 AM PST (GMT-8) FROM: 100005-TO: 16174799121 Page: 2 of 2 A4+R® DATE(MMIDDA'Y1'17 CERTIFICATE OF LIABILITY INSURANCE 3/3/2015 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 poliay(iss)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 endorseme s. PRODUCER DUPONT INSURANCE AGENCY INC 18 COPELAND ST PHONEMo. FAX No QUINCY, MA 02169 EaIAIII. ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC tl NSURERA: Liberty Mutual Fire Insurance 23035 INSURED INSURER B: JK CONTRACTING LLC NSURERC: 31 RICHMOND STREET WEYMOUTH MA 02188 NSURERD: INSURER E: KSURER F' COVERAGES CERTIFICATE NUMBER: 23677622 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. - ADDL SUBLTR TYPE OF INSURANCE R POLICY NUMBER MOLIDI EFF M0 EXP LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ DAMAGE TO RENTE15— CLAIMS-MADE FIOCCUR rencel $ MED EXP(Any one person $ PERSONAL B ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE S POLICY❑=GT F LOC PRODUCTS-COMP/OPAGG $ S OTHER: 00"MINGLE LIMIT S AUTOMOBILE UABIM 10 s t BODILY INJURY(Per person) S ANY AUTO ALL OWNED SCHEDULED BODILY INJURY(Per ecddent) $ AUTOS NON-OWNED PRO DAMAGE $ HIRED AUTOS AUTOS Per ecdd UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS Like HOLAIM"ADE AGGREGATE $ DED I I RETENTION$ S A wORKERB COMPENSATION WC2.31 S-601698-015 2H 712015 2/17/2016 SRR _ AND EMFI.OYERB'LUIBtlJTI' 100000 ANY PROPRIETORIPARTNERIEXECUTNE YIN E.L.EACH ACCIDENT $ OFFICERIMEMBEREXCLUDED7 Y❑NIA (Myyaeenssdatory in NH) E.L.DISEASE-EA EMPLOY $ 100000 DES escribTION OF OPERATIONS below E.L.DISEASE•POLICY LIMIT $ 500000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be stlachad if more space is requined) Workers compensation insurance coverage applies only to the workers compensation laws of the state of MA. This certificate cancels and supersedes all previously issued certificates,only as they relate to workers compensation coverage. 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 POLICY PROVISIONS. �r- •:'A*"+*'�< ..• AUTHORIZED REPRESENTATIVE Liberty Mutual Fire Insurance ®1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD CERT NO.: 23677622 CLIENT CODE: 1644469 Lucy Garfield 3/3/2015 10:19:07 AM (EST) Page 1 of 1 WYM A&COR& CERTIFICATE OF LIABILITY INSURANCE M%'E` 'ID ) 3 2 15 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 CERTIRCATE 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 endorsemen s. CO PRODUCER NA T Maria Dupont Insurance Agency, Inc. PHONE617 376-0795 (617) 479-9121 18 Copeland Street antes: me@du ontinsurancea en .com Quincy, MA 02169 INSURERS)AFFORDING COVERAGE NAICO INSURERA:Main Street America INSURED INSURER 8: JK Contracting, LLC INSURE C- 31 Richmond Street INSURERD: Weymouth, MA 02188 1NSUREtE: INSURER F: 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. AML SUER L R TYPE OF INSURANCE POLICY NUMBER MICD/Y MYIIDPOLIDrDrY EY UMTS A GENEtALLIABILITY MPT7794M 2/10/15 2/10/16 EACH OCCURRENCE E 1,000,000 DAMAGE TO RENTED X COMMERCIAL GENERAL LIABILITY MISES(Eaoacurtenr $ 500,000 C':LAIMSMADE 7 OCCUR MED EXP(Ary one Person) $ 10,000 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2 000,000 GEN'LAGGREGATELIMTAPPUESPER PRODUCTS-OOMP/OPAGG $ 2.000.000 POLICY PRO LOC LE LIMITS AUTOMOBILE LIABILITY aecddart $ ANYAUTO BODILY INJURY(Par Pe mon) $ PLLOWNED SCHEDULED BODILY INJURY(Per acddent) $ HIREDAUTOS NOTOSWNED TOS AUTOS PROPERTY DAMAGE $ eracddeM $ UIYBRELLALIAS OCCUR EACH OCCURRENCE $ MCCESSUA13 CLAIMS-MADE AGGREGATE $ DED RETENTION WORKERS COMPENSATION WC STATU OTH- AND EMPLOYERS LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y N/A E.L.EACH ACO CENT OFFICERMIEMBER EXCLUDED? (Mandalory In NH) E.L.DISEASE-EA EMPLOYE Ifyyees describe under DESdRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT I$ DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(Athch ACORD 10i,Additional Remarks Set*",If mora space Isregtlred) 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 POLICY PROVISIONS. AUTHOR2ED REPRESENTATIVE Bridget McGowan ©1988,2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD Phone: Fax: E-Mail: apedranti@crowninshield.com Massachusetts -Department of Pub[:.-::Safety Board of Building Regulations and Stanc:ards Con%truction Superri+or License: CS-066334 IQERAN T wHELAN 31 RICHMOND ST WEYMOUTH MA lxpiration Cornmissioner 09/26/2015