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HomeMy WebLinkAboutBuilding Permit # 9/18/2015 T(J)WN FDIC NQIVI. 11EI 110MCI'6 ER. APPLIC.A7FION F OR PIAN I X,,0J'D1A,.Tl0N PerrnNti o: q, L7atc;Received aa,,�„„;,,q Date Issued: i12 IN1POR,I,Alg1T, A �.licant rrrtl.st routpleste,all items on this a -e ►e�i fe PZ bo,) A ct LOCA TIC)N � t,+ &L r Print. PISOPERTY O'WNEi1CA,:�` - Print MAP NO, P'ARCEI,: Z0Nr1'',,1G :►IST11ICT: T'b'PE AND IJSE,DF BUILDING HIiSTC)WC DISTIUCT YES ❑ TYPE ,JP'IMPPtO'V�.PvI�sN'l — — PROPOSED Ul,I Fesidential Non-Ft(:sidential ❑New Buildirrg--- -----------_.`— 11 One family ❑Addition O TWvo or more farn.i.ly ❑In-dt:istiial ❑Alterata.on _ No.of units: ❑Repair,,replacement — �--�_ --❑Assessory E;Idg _.e .o��-- ❑Con)-mercial _❑De volition _ ❑Moving-(xelocatiou), —,------ _�.. thex ❑ Oth�,rs ❑Foundation only -- DFSCRIPTION OF WORK'TO BE PR EIFdi)Iwl'v E-1--) Irlen ilucatt OWNER: Nani(, N0 f�. — Location 56o I „� ee'e, Address:—)� � �-�� , No. � r � Date CONTRACTOR, Name. Address:­±t-�-4e TOWN OF NORTH ANDOVER Supex-visor's Construction License: Certificate of Occupancy $ Home lrnlproveni.�rtt Lie;ense. Building/Frame Permit Fee $ -�-�t Foundation Permit Fee $ A 5 � ARCHITEC /ENCrTNL;ER— _-_ w Other Permit Fee $ TOTAL $ Address:-- ._-- - C r o kal Pro ect Cost '� o Oz; check#LILL 17 Check No, .__� Building Inspector Page Iof4 FORTH fown of Anciover ® 0 161 I _.Mnm No. .,- ;01 C, LAKE h ver, ass, COC NICNCWICN A�4ATE BOARD OF HEALTH Food/Kitchen PEIIIIIIIIIIIIIIIIIl�� MIT T LD Septic System THIS CERTIFIES THAT �. ..�.. .. • BUILDING INSPECTOR . . . .... . ..... 60 Foundation has permission to erect .......................... buildings on . .. .. .. ........ .�.. ....... .......................... ' ,._ Rough to be occupied as ........ . .... .....................".08.V40.4...... . .......... .... ............ .. ........ Chimney provided that the person accepting this permit shall in every respect conform to the terms of the ap l!cation 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 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTIO ST Rough Service ................... .... ... ..... ...................................... Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required t® 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 Approvedthe Building Inspector. Burner Street No. Smoke Det. Initial Construction Control Document To be submitted with the building permit application by a d Registered Design Professional for work per the 8"edition of the Massachusetts State Building Code, 780 CMR, Section 107 Project Title:North Andover Pool Deck Date: 09.17.15 Property Address: 500 Great Pond Road,North Andover,Massachusetts 01845 Project: Check(x)one or both as applicable: x New construction Existing Construction Project description:Pre-Engineered Pool Deck Structure for wedding. I Jeff Reder,MA Registration Number: 48535, Expiration date: 06.30.16 , am a registered design professional, and I have prepared or directly supervised the preparation of all design plans, computations and specifications conceiving': Architectural x Structural Mechanical Fire Protection Electrical Other: for the above named project and that to the best of my knowledge,information,and belief such plans,computations and specifications meet the applicable provisions of the Massachusetts State Building Code, (780 CMR),and accepted engineering practices for the proposed project. I understand and agree that I(or my designee-SGH)shall perform the necessary professional services and be present on the construction site on a regular and periodic basis to: 1. Review,for conformance to this code and the design concept,shop drawings,samples and other submittals by the contractor in accordance with the requirements of the construction documents. 2. Perform the duties for registered design professionals in 780 CMR Chapter 17,as applicable. 3. Be present at intervals appropriate to the stage of construction to become generally familiar with the progress and quality of the work and to determine if the work is being performed in a manner consistent with the approved construction documents and this code. Nothing in this document relieves the contractor of its responsibility regarding the provisions of 780 CMR 107. When required by the building official,I shall submit field/progress reports(see item 3.)together with pertinent comments, in a form acceptable to the building official. Upon completion of the work,I shall submit to the building official a`Final Construction Control Document'. OF Enter in the space to the right a"wet"or JEFFRE-Y M. electronic signature and seal: EA A .15 Phone number: 513-851-1223 Email:jrcder@clarkreder.com jais, fc NAL E� Building Official Use Only Building Official Name: Permit No.: Date: Note 1.Indicate with an`x'project design plans,computations and specifications that you prepared or directly supervised.If`other'is chosen, provide a description. Version 06 11 2013 R 11. 0-. 0+ P. 603-570-4857 436 Shattuck Wap Unit A "hI r,u a rlrt t�7.rYtpt>t>�'t��usttiirttabrh�t; Newington, NH 03801 tear contr-attdis/IrirtL>l far (1l=clec(i<.,):t'7' S p E R R L TENTS S E A C O A S TI � 1t ems Can Viers aeAinxt baa " ,.,.� s Customer ID======================================================Contract Number 9784758395 - RESERVATION 0001-001863-10 09/16/15 Reed JoAnne North Andover Country Club North AndoverCountryClub Reed, JoAnne 500 Great Pond Road 500 Great Pond Road North Andover, MA 01845 North Andover, MA 01845 _ ____ Sales : Elizabeth Smayys Rsrvd: MON 06/23/14 Primary Contact: JoAnne (MOB) P: 975-475-8395 X Delvr: WED 09/30/15 Primary Email:mjmlreed@verizon.net Out: SAT 10/03/15 Alt Contact:Lauren (Bride) P: x Pickup: SUN 10/04/15 Event Start Time: 4pm End Time Lauren's Email Reed.Laurenl@gmail. com Steve is the GM of the club Jim Titos is the Superintendant Monique Johnson is the planner 978 .,771.1061 Deposit refundable is North Andover denies permit $7500 of $9000 initial deposit moved as cash deposit on 8/14 . Remainder on the reservation to pay for engineer ---------- ----------------- -- -- -- ------------- -- ----------------- =Item No.====Qty=Description================Rate Info===== ======Unit= Extended 9997-0006 1 -Dig Safe- Discount: ' afeDiscount: Your price: 0. 000 0. 00 Client is responsible for all underground utilities. Anchoring sta es go 42'" into gqround. You are required to contact Dig Safe At least 14 ,das prior to install. www.digsafe. com or 1-888-344-7233 I HAVE READ THE ICANSS&CONDIT16NS ON 30TH SIDES OF THIS AGAHMENTA DCMI f 9iAT THOSEPPINTEDCP THt OfHiRiDFARriAG>LE7 SlGRIATUR`E TO AS si°PRINTED ABOVE W$iGNATURE.TH'ERL AR€t7-O ORAL OR OTHER REP PCSI NU.-loPaa NOT INC_UDED;iFVEIN.DAMP-6f..A)VER .f yvu P", h:damag tt Ner charge Y,,pecified,s;bled to tl e f niltaron5 and txciustcr t ,"agree Zomodifv dl e Irrms of tr6s crnll,10 and it, elievr ru of Iia'i IYY under$2.SW of accidental damage bp the kerns ve r<nwd,under th s c tr t aid for io s o 7 n ) ir, r lis ori rd a .orm, Rset tnd � o> Nie m ode from the waiver,however,and loss or damage dee to niw-_ or,h se,thelt by ,onver un ,o.tis dernage,mysterious disappearante cP shotxege,disclosed on I-emory,lto,s ewit ng from ovedoadi ip o excrsf::c ng itis rbted capacity o3 rentals itltRs.tb<s csys,td 6Y+ffideitK¢of tfpU,yOUt e?(17IoyeCi Cr'(,£rian3 tosV)i0ii L r e i uSt.Efir items,IGs5 EYG to breat of i`e le(n)s of this a r.ri nY �' �•' ''': t om" "� ""., &I ogc to tires,finis rAuaed Dy blowt%t$,b.'UISes,Cllte.mad 1111?Ms and lhe 4e,Srutit Qc E 7 t OIii:�it s ft ng(foln overhiivd,side or r,at cl^aeanr£,or 0tfte7 iOSi dot t0 y0ilf falfure to tire for the tented k(:m dS a,on,dent rt+an Wotiid his pl'n ptUpC,tY Ei'121:5 W'apped ilt Uf;S.,G Y{.,;dtf5r,»dF,t,.�ano k:raK Jn i t e,iS,EV=Hi%Ifle tt e[i3 Ii?tea YG.fetUtned 4r feYUfned luta,mlldel'l or v14'i_ci'rLT t sElAi.. C'a.r.E4rEA bI,wed reyond.cleaning Will he charged VIP tepkcement zaiQe in addition to the';;ntal Cb Pige,It any SJ h toss indi etes a:Trite may ha'Je been o,9 mit(td a cvpdition of the waiver i5 that you must', 4SAY$Y1Hit{5 9_E tMEDy L .. to the , .i;f i ::(7Gfj1 ©�.pre'Er taw enf fCc`m'e7li al%ifloffY.5 and sJrr ls(ti t.$Vilih, 9r t6 YJpI��lt'!} ffj,$'(.(t,,�a,>c�a i`CSffiM't�y©)pint'i�S,(tail k i t P 4f Y$P I C:gF1£ V331 3rd 16 tj0/'Sl/,ii�ldy2�l�{yoUvr_Icn�S.0(i}fe,taI' It i DECONE: P 4 43 a 1¢l �t Yi ,�t pay an,dt 4 all fi(c Y?.dr,from So Ei if Ja trey i V UtU Hii 1G; tl:iFI Av Y )IY.2 1­ t f t y Jf in4 Y( }q•F Vl L 6k' 'l se yt to" D.14.(x. rot1�Thaaf .PI ,ke3rr fns�n;nsur„�et05,voa ,,0ifei'6i' ite�t;='aJSbAin �,i<ir:,, t,ytt,3�f n„ n..ufatic3001-001863=1-0—*-more*__; R 11 . 0 .0+ P, 603-570- 857 436 Shattuck Way Unit A "bf airgfil;-d u>su�a�lort.rtute4rrrabilitf;.-.- Nemington, NH 03801 11rr.,emllraa is 1,i,i1&d on w(;=<!<.t�ta;�rr _,,,..�woYrr11U1YIVl�1 S P E R R'Y' TENT F�na1 Pxent& P� Number rear ZZs ' orrt ' , S E A C 0 A S 7' `„leoems.Cane Tmsved..F art; h C�nar ?taYr w yrg :. Customer ID====___ __ -_- _=-`------- ==Contract Number 9784758395 --RESERVATION 0001-001863-10 -------------Receipts Summar-- -- -----Summary--------- - Date Seg Method Ref/P Amount RENTAL 27251 . 16 08/14/15 07 Cash 7500. 00 09/14/15 09 AX Credit Card 17000. 00 Pickup/Delivery 300. 00 MASS STATE 1703.20 Total 29254 . 36 Deposit 24500 00 I HAVE READ THE MAS Ys CONDITIONS ON BOW SIDS Of IHISAGUEMLN A D CF.0 y IHM THO L N!fv ikD C T 71'C pTF1E7 Sf3C ARC AGREED TO AS:G-PRIWT D ABOVE,td l3rG`tdAFUR[.THERE ARS tip O?.AL OR OT Wn RF R NTh�tUt r'CIT INC VC D HEREMid712�AGE!AI fER;f yo,,pay SIGNATtJR� theChin age W+iVer charge t•specifH14�subject to the f;inftatlonts and eY uslcr - tr5�; .Quo to mo,iffy thF 'Yi S GI hi CE'it:84t,U�t�a tp.rEIIpay of iia'ofi,ty under$1,500 ofactd4ptal damage to the tions rentcd under IN o rtta t r3 far So s 10c o ire Ii.a!I;wind.orro,,:-w52t and nt.W exd de f' otheft, cm the{vpiver;�f 4xevor,and Ions or damn o ace to of t-se; r u e teh hY er-on Se i1^€`�hargc,;rfenFeuat r1 m_ge,mysterious-titsIpPeo'ratst%'or shortege disclated on inventory,ions resubi tg fro e s?rka3i�p or exccd ng the rated capacity it mi L05s caned bvinfderty of you{ouhr'apltl}e 5 rper'on.tn wloyi yr_.cr( st ryitCims-iossd e76teaci,of the r@rnl3 oftbu.a€fecn 8afn_ge to f res,firm caui>-„by blowo.,ts,`orutses cut toad i atards and Ibe 4 ,z .r;^.t ti Phi e r su t!.g tion r5-t Lien+ova.fieF;i,stile dr r�r n;tarance,of other(ass due to yovi•?ai'aiie to caro for the rented Item as a Pn,dent man Would his aiy i�reperiy.Lt fa�<'r>per,It, .€€..nus=rn:dev:,and, efas^rI Fr'•e!fs:e:It rnideanti G; r c.eq.c.rs y.t.�- tt I ten. p ret[lCP.2d Pr tetilgSed turn,ml:ciewed,UC f NStlgA.%X:,RE'rrta 6urrvg,$eYonu clean r,will 6e charged Zhu reafac0ment roi;e n addazcrr to t`te ntul charge;i{ary'su a ir;ri,e may nave been corm's ted a enediitau o`t .E. vAYBYwn is utOINE D.w.c r hewdixar is tha,.Yoa{nost t e afj��cury , the prl 1 taut:nPrrcemrnf any ml a boil furnish is rii'r n or I.y+;r h rY u.as e o.cr�3y Yew tz,3z 2u ri F t r isa ch Y?gh?s au,�! yo•,under of insura ce,take eiI(� —` P s}*L7 ysy pt EG(�2 nay ar.}a»}a1r tcc.e. f n iu:it i �L m/ t a �jF� �i arfLsary to'aMINES r �ti�ttei .�:JHTQ'�C G' II�'i It S IS.IlL+2 y 14�It�-,fU li ltlkUrY 1 i .,dCAfF.t<:Lua.�(,i �,a .7'�[Lolri+f2d54fC!'?1 .tS,£ t7>,t[ap4.l,.US.`C JFf it f C fir di t[.,'i;±V4 J 4n'3Ef YtltAf n.,U'ati [ 1 111 C. CL CGi 1L t�9/16 R 11. 0. 0+ P. 603-570-4857 436 Shattuck Way Unit A "Int all�tvr-tort.�uviain"bibi t Newington, NH 03$OI- this c'r�wrev;f i'5vr`i,xlcx 0;1 t�ractc<f cr{rr�r„ Ccsnxrct +xzrz °ln hTn rerx�nbc� � €nza y S'PERRY TENTS x�al Prusnul. T#mbzs E A C O ?. S T Iteuiaan.8e. tzci.tc, zozn = z� za Customer ID===-=-=---==---=--===---=-=-----===-----=---=----=====Contract Number. 9784758395 RESERVATION 0001-001863-10 9997-0025 1 -Permitting- Discount: PermittingDiscount: Your price: 0. 000 0 . 00 Client is responsible for checking their town laws regarding tent/temp structure permits I'f required SperrTents offers the service of pullin permits for $h/hr for a minimum of 6 hours + cos of permit. 9997-0003 1 Delivery and Pickup- Discount: Your price: 0. 000 0 . 00 Delivery Delivery of tents is scheduled 1-5 days before your event. Pick-u is scheduled 1-3 days after. You will be no�ified of actual dates the week prior. Special arrangements can be made at additional costs. 9997-0007 1 **DAY-OF ONSITE ATTENDANT** Discount: Your price: 0 . 000 0 .00 For rentals over $10, 000, an on-site attendant will be provided for up to 4hrs . If the client requests the attendant stay longer, the client will be billed at the rate of $75/hr, for each additional hour. 5000-0160 1 46x105 Sperryy Sailcloth Tent 3718 . 75 3718 .75 5020-0010 14 Clear Sides (7 . 5'X20' ) 30 . 00 420 , 00 5020-0015 1 Clear Sides (7 . 5'X10 ) 15. 00 15 . 00 5030-0630 1 Perimeter Lights for 46X105' 288 . 20 288 .20 5530-0130 2 - Dimmer Switch 60 . 00 120 . 00 5080-0050 1 12x24 Band Stage 720. 0.0 720 . 00 5070-0340 1 48'X112' Leveled Floor (<4' Grade) 28066. 50 Discount: Your price: 20769. 210 20769 .21` -Includes Finished wood floor cover -PRICING FOR EMPTY POOL -Club is pulling required permitting 5560-0120 40 8' of Handrail for Engineered Floor 40. 00 Discount: Your price: 30 . 000 1200 . 00 9997-0004 1 --CONFIRMATION-- Thank you for your non-refundable deposit ! Your order is reserved. Please remember that; :final payment is due a minimum of two weeks priorto your event E HAVE RF tt#€'TEAMS EF Cfir7lSriloNs oN BOTH SIDES OF THJ1 At"M Ehf€NT At D CERiff r HT lat0 t P €T)CF tf t OTH SIDE ARE GC E19 fJ1 EN 4TU!�' 'i4 A,'.E'RRItyTsD ABOVE W?SfGINATURE.THERE ARC PTCI ORAL OR OTHER RE,Rf5r tTATIOh�30:NCC,JD_E,HF N.0AtA,GE„At PCR',f yo c prr �� the damage w aver rhargc as>peciflad,subject to Out Gmttarat s a td"clusirrs bekrn,,we Er*.e(r modify,the'o,irs of dlcoiitt;ict tinct to r.Neire you of RabifCy under$LSW cf accideritai damaRts to the heirs rented order thi ,r,.-itr,a and for los due to?,: O i ori,Wird r.n s{r ax`td>fr�r!i the waiver;hrrrever,and lois or 4amage csae to!f fa,u,a, 7buse,-f%iFfc by copier c t,tottig'cnaig ,a,tentan t dsfnage,'rny>terious-disappearance or shartsge disclosed on.inventory;+us,result ng:rant rntetleadfng.or excess ng vhi;ratted clip city of`rental ftiirnsr Loss catlied by inf44etity of you,yourtsr+ptayeesor Felsons to watc'dt}cu entaist any sebis,fos;au: to brsa6 of tf c teres s f ibis agreement, damage in tires,rims cauied by blmgovs,lir jbS c,wits.load hazards and the..{.e,damage to Lehi'-ie lesuiting from1 ;f.Lieh,o e-Ill t'd,aldv or r,@'at rf�afanC2,Gr�O.Fte.t..SS.^:ue to yodr faiRl S to t _ ',.. care for the renter)item as A predent man woold his aWn prop..ttY.Liners is i,c,. i .c�r.(a NOT f+c[,,.cr YF47ca ,,per,'tit pta3.cv. ryz i d sr,tarid tvaK c n t;r ns cgyrip+neatt anp 1 nFn iqt rctvrrea or returned 441 nu+delved or atat avarNOT SUPA:r eu.t: burned beyood tfearprg will be charged tbereplacema of va?ue'n add n'on10 the rental Chaise,tl at.y zu.h lois q�!aniNS,-r Me i,ay,nave�e_n co m €ted,g c Taft"inp o.the xaieer i ihd,`.yeti Rust Fac a pa''1 to the pno _r taw enfrLrcI ent aythorit es and furnish us Stith z ar.€.y ha e f=Wean e-1i—s r.?int;yPi r h :�i I t Es ruse i r gks au fl n-e to.qo i.nder/au7 imilra ce,tat e ail�yfrt(r2E5� i P c+� i 1�l P'Ao e nm '13 Fay anY of d all rc eed fr�r i Soni �r r8 j!sf u4 st�m silo ig i> v t il��[ Y r i.,.i;y it insata JtrK2 � r M Q4Sa y to,D.Y.G aorfl i haa' h ' t kred�a::rnsu�t,.riaaran_t. s. ���h0 t/e1.6_>l eed; � l ihet..,i,r:�_l,_Vi<,,� ry �r i u�r,.0001-001863=1-0._ . r1XIL"Iertif i Cate Of jrtame Rofiqtanre ---� Issued by: Manufacturer Number: 40 , , Ac,,,� d Sperry Sails, Inc. 842 r` 11 Marconi Lane e Marion, MA 02738 Date of Manufacture: 508.748.2581 20-Jul-11 FSM E F-60201 This is to certify that the materials described have been flame- retardant treated or are inherently non-flamable and were supplied to: Sperry Tents Seacoast 195 New Hampshire Ave Suite 110 Portsmouth NH 03801 Certification is hereby made that: The articles described on this certificate have been treated with a flame retardant approved chemical and that the application of said chemical was done in conformance California Fire Marshal Code equal to or exceeding NFPA 701, CPAI 84 Method of Application: Coated Lot Number: 0 Fabric Color, Type and Weight: Oyster Polyester 7.2 oz. Description of Item Certified: 46x105 ft. Pole Tent Flame-Retardant process used will not be removed by washing and is effective for the life of the fabric. Name of Applicator of FR Finish: Signed: Kolon { ; .zf-- ace group WORKERS COMPENSATION AND EMPLOYERS LIABILITY POLICY TYPE AR INFORMATION PAGE WC 00 00 01 ( A) POLICY NUMBER: (6S62UB-GB00721-2-15) RENEWAL OF (GS62UB-GB00721-2-14) INSURER: ACE AMERICAN INSURANCE COMPANY 1 NCCI CO CODE:50500 INSURED: PRODUCER: PORT CITY EVENTS INC DBA D B WARLICK AND CO SPERRY TENTS SEACOAST PO BOX 1260 436 SHATTUCK WAY NORTH HAMPTON NH 03$62-i260 NEWINGTON NH 03801 Insured is A CORPORATION Other work places and identification numbers are shown in the schedule(s) attached. 2. The policy period is from 05-21-15 to 05-21 -16 12:01 A.M. at the insured's mailing address. 3. A. WORKERS COMPENSATION INSURANCE: Part One of the policy applies to the Workers Compensation Law of the state(s) listed here: NH B. EMPLOYERS LIABILITY INSURANCE: Part Two of the policy applies to work in each state listed in item 3.A. The limits of our liability under Part Two are: Bodily Injury by Accident: $ 100000 Each Accident Bodily Injury by Disease: $ 500000 Policy Limit Bodily Injury by Disease: $ 100000 Each Employee C. OTHER STATES INSURANCE: Part Three of the policy applies to the states, if any, listed here: COVERAGE EXCLUDED - REFER TO RESIDUAL MARKET LIMITED OTHER STATES � - INSURANCE ENDORSEMENT WC 00 03 26 ate_ D. This policy includes these endorsements and schedules: o SEE LISTING OF ENDORSEMENTS - EXTENSION OF INFO PAGE o 4. The premium for this policy will be determined by our Manuals of Rules, Classifications, Rates and Rating �— Plans, All required information is subject to verification and change by audit to be made ANNUALLY. DATE OF ISSUE: 05-11-i 5 WC ST ASSIGN: NH OFFICE: ORLANDO DA ACE 24M PRODUCER: D B WARLICK AND CO 76KKP 018145 PORTC-1 OP ID:JDP ACOR®R CERTIFICATE OF LIABILITY INSURANCE DATE 05/211201 YY) � 05/2112015 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 CONTACT Foundation Insurance Group Inc PHONE Joe Potthast FAX PO Box 6326 A/c No Ell:703-527-8780 A/c No):703-532-8300 Falls Church,VA 22040 E-MAIL Joe Potthast ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Axis Insurance Company 37273 INSURED Port City Events, Inc. INSURER B: Mike Parkin INSURER C: 436A Shattuck Way Newington,NH 03801 INSURER D: INSURER E: 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. INSRTYPE OF INSURANCE ADD SUBR POLICY EFF POLICY EXP LIMITS LTR POLICY NUMBER MM/DD/YYYY MM/DD A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE Fx]OCCUR DD1348AO5 05/20/2015 05/20/2016 DAMAGEREMISES TOEa oRENTEDccurrence $ 100,000 P MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY❑JEC- 0 LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS HIRED AUTOS NON-OWNED PROPERTY DAMAGE $ AUTOS Per accident UMBRELLA LIAB OCCUR EACH OCCURRENCE $ 1,000,000 A EXCESS LIAB CLAIMS-MADE DD1348AOSUM 05/20/2015 05/20/2016 AGGREGATE $ 1,000,000 DED RETENTION$ $ WORKERS COMPENSATION PER DTH- AND EMPLOYERS'LIABILITY Y/NI STATUTE I ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ A DD1348A05 05/20/2015 05/20/2016 Equipment ALS DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space is required) '.. CERTIFICATE HOLDER CANCELLATION FORIN-1 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN FOR INFORMATION PURPOSES ONLY ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD PORTC-1 OP ID: EB ACORD" DATE( CERTIFICATE OF LIABILITY INSURANCE 09/MM/DDIYYYY) 17/2015 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 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 CONTACT NAME: Joe Potthast Foundation Insurance Group Inc PHONE FAX PO Box 6326 ac No Ell:703-527-8780 A/C,No):703-532-8300 Falls Church,VA 22040 EMAIL Joe Potthast ADDRESS: INSURERS AFFORDING COVERAGE NAIC# INSURER A:Axis Insurance Company 37273 INSURED Port City Events, Inc. INSURER B: Mike Parkin INSURERC: 436A Shattuck Way Newington, NH 03801 INSURER D: INSURER E: 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. INSR TYPE OF INSURANCE ADDL SUB POLICY NUMBER MM/DDYEFF MM%DDS LIMITS LTR A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 CLAIMS-MADE ❑X OCCUR X AIPONHO03-008495-01 05/20/2015 05/20/2016 DAMAGE"' O RE PREMISES Ea occurreTEnce $ 1,000,00 MED EXP(Any one person) $ 5,00 PERSONAL&ADV INJURY $ 1,000,00 GENT AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,00 X POLICY❑PRO- JECT [:] LOC PRODUCTS-COMP/OP AGG $ 2,000,00 OTHER: $ AUTOMOBILE LIABILITY COEaMBINED SINGLE LIMIT $ 1>000>OO accident AANY AUTO A2PONHO03-008496-01 05/20/2015 05/20/2016 BODILY INJURY(Per person) $ ALL OWNED X SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS Peraccident X Trailers $ UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 1,000,00 A X EXCESS LIAB CLAIMS-MADE A5PONHO03-008497-01 05/20/2015 05/20/2016 AGGREGATE $ 1,000,00 DED I X I RETENTION$ 0 $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER '........, ANY PROPRIETOR/PARTNERIEXECUTIVE ❑ E.L.EACH ACCIDENT $ OFFICERIMEMBER EXCLUDED? N/A ''... (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ A Blanket Equipment AIPONHO03-008495-01 05/20/2015 05/20/2016 Inventory Included DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Event: 9/24-10/07, The North Andover Country Club, 500 Great Pond Road, North Andover, MA 01845. Town of North Andover is added as an Additional Insured with regards to the General Liability Policy when required by written contract. CERTIFICATE HOLDER CANCELLATION TOWNON1 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Town of North Andover ACCORDANCE WITH THE POLICY PROVISIONS. 120 Main Street North Andover,MA 01845 AUTHORIZED REPRESENTATIVE ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD