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Home My WebLink AboutBuilding Permit # 9/23/2015 ORTH BUO ILDING PERMIT I.D TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION 0 Permit No#: Date Received Date Issued:.� IMPORTANT:Applicant must complete all items on this page < LOCATION PIT Q 2-- PROPERTY OWNER (L L Print 100 Year Structure yes no MAP PARCEL: ZONING DISTRICT: Historic District t-e�") no no Machine Shop Village (�Yiib TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential 0 New Building El One family El Industrial El Addition El Two or more family ,2;61teration No. of units: El Commercial 0 Repair, replacement [I Assessory Bldg 0 Others: 0 Demolition El Other DESCRIPTION OF WORK TO BE PERFORMED: C- 1GI:pl� IdentificatLocation c OWNER: Name: . . w No. 0"� Date Address: u n- Contractor Name: TOWN OF NORTH ANDOVER Email: VL�,Lj�4 67 Address: '-) I (L(C-K t,W NO Certificate of Occupancy $ Supervisor's Construction Licensi Building/Frame Permit Fee $ Foundation Permit Fee Home Improvement License: Other Permit Fee 4 ) TOTAL ARCHITECT/ENGINEER , Address: *2 -oy' FLk%kVn FEE SCHEDULE.BULDING PERMIT.$12. Total Project Cost: $ Building Inspector Check No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund r .. . .... . of, ti woet a Siqnature P F FORTH own of Andover 0 - a o h ver, ass, �•. COCMIC"t WICK ��ADRA'rED �S U BOARD OF HEALTH Food/Kitchen ERMIT T LU Septic System THIS CERTIFIES THAT ......... % f.�L� , BUILDING INSPECTOR ................. ............... ..�..................... has permission to erect .......................... buildings on ....... ... . .. ... j�'.��....2'® Foundation Rough tobe occupied as ..........tm . . ............................ ................................................................... Chimney provided that the person accepting this permit shall in every Pespect 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 E I E IN 6 MONTHS ELECTRICAL INSPECTOR LESS CONSTRUCTION STARTS Rough Service ........................... . ............................... Final BUILDING INSPECTOR GAS INSPECTOR ccupancy 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. OFFICE OF BUILDING INSPECTOR TOWN OF NORTH ANDOVER CONSTRUCTION CONTROL _All PROJECT NUMBER: 14-0683 D PROJECT TITLE: Corporate Benif its Audit - Tenant Fit Out PROJECT LOCATION: 21 High Sheet; N. Andover, MA NAME OF BUILDING: East Mlii NATURE OF PROJECT: Tenant Flt Out IN ACCORDANCE WITH ARTICLE 116 OF THE MASSACHUSETTS STATE BUILDING CODE, I, j)ONAL-D VJ AL--ye R RIEGISTRATION NO. �53L, 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. IST E R pad � 2. Review and approval of the quality control procedures for all code-required control)e Go M G 0 r � � 3. Be present at intervals appropriate to the stage of construction to become, general f�l iliarNo with6the progress and quality of the work and to determine, in general, if the work i lei g SC/T 536 performed in a manner consistent with the construction documents. PURSUANT TO SECTION 116.2 .2 1 SHALL SUBMIT WEEKLY , A PROGRESS REP Z�fT o- TOGETHER WITH PERTINENT COMMENTS TO THE NORTH ANDOVER BUILDING IN �® UPON COMPLETION OF THE WORK, I SHALL SUBMIT A FINAL REPORT AS TO THE SATISFACTORY COMPLETION AND READINESS OF THE PROJECT FOR OCCUPANCY. SIGNATURE SUBSCRIBED AND SWORM TO BEFORE ME THIS 15� DAY OF5EMF_M1M_a20 1 S CHERYL L. BURKINSHAW �Commongalth ry Public NOTA PUBLIC MY COMMISSION EXPIRE of Mossachusetl ission Expires March 7, 2019 Standard or ree nt between Owner an RCG LLC where the basis of payment is the Cost of the Work Plus a Fee without a Guaranteed Maximum rice Date: Septeml,er 18, 2015 Owner: RGG North Andover Mills LLC C/o RCG LLC 17 Ivaloo Street, quite 100 Somerville, NIA 02143 [Contractor: J & K Contracting LLC Architect: Dore &Whittier Project Name: Corporate'Bneit Audits 21 High Street Suite 202 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: Type of Insurance Limit of Liability Commercial General Liability '$1 040 OOQ.U0 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(ender. 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: 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: $80;118.50 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 nigher 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. Pace 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: 90°I°of billed costs,unless otherwise approved by the Owner 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. September 18,2015 or such time that Notification to Proceed is ' igen b` Owner 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: Date of Substantial Completion to be no later than November 1, 2015 y 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. I'age4of6 4. Signatures The Owner's representative is: Dared SteJtihetgh;Ma°naggr RGfl!= an 't Itr �o Sfreet�5�rte X14 S'o;rngr►fllg,t�lAA:02143 §14.4 The Contractor's representative is: Kibf.M '0, pr�ci� 1 3�} { o Street Weymgt��M`A 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 SignatureI X L 1 Printed Name and Titl - Prinfed Name and Title jaC)IKt, Page 5 of 6 Corporate Benefits Audits Construction Estimate 9/18/2015 Schedule of Values Estimated Cost General Conditions $ 3,400.00 Demolition $ 4,000.00 Frame walls $ 2,500.00 Move Glass Walls from Converse and install $ 2,500.00 Insulation $ 500.00 Drywall &tape $ 7,500.00 Prime and Paint $ 7,500.00 Cabinets and Countertops $ 3,500.00 Doors&Windows $ 4,000.00 Flooring $ 16,800.00 Sprinkler Work $ 900.00 Electrical $ 6,885.00 Plumbing $ 500.00 HVAC $ 12,350.00 Subtotal $ 72,835.00 JK Contracting Fee $ 7,283.50 Total $ 80,118.50 Page 6 of 6 The Commonwealth of Massachusetts Department oflndustrialAceldents M s 1 congress Street, Suite 100 w.- 14-2017 02 Boston,MA 1 W � www.mass.gov/dia Workers,Compensation Insurance Affidavit:Builders/Contractors/Eloctricians/Plumbexs. TO BE FILED WITH THG PERMITTING AUTHORITY. Please Print Le 'b1 A licant Information Name(Business/Organization/Iudividual): Address: 17 Phone#: City/State/Zip: Are you an employer?Checlt the appropriate box: Type of project(required): a employer with (fall full and/or part-time).* 7. El New construction 1 I am •� .,employees ees P y 2.QI am a sole proprietor or partnership and have no employees working for me in 8. u Remodeling any capacity.[No workers,comp.insurance required.] 9. ❑Demolition I Q I am a homeowner doing all work myself.[No workers'comp.insurance required.]t 10❑Building addition 4. 1 I am a homeowner and will be hiring contractors to conduct all work on my property. 1 will 11 ❑Electrical repairs or additions ensure that all contractors either have workers'compensation insurance or are sole 12 Plumbing repairs or additions proprietors with no employees. 5.❑1 am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.n Roof repairs These sub-contractors have employees and have workers'comp.insurance# 14 ❑Other 6.FJ We are a corporation and its officers have exercised their right of exemption per MGI,c. 152,§1(4),and we have na,employees.[No workers'comp.insurance required.] xAny fill out the section below showing their workers'compensation policy information. applicant that checks box 41 must alsa all work and then hire outside Homeowners wlrosubmit ij�s eckth s boxmust attached an additional avit indicating they are sheetshowing the name of the sub contractors and state whether eor hose entitaffidavit i s have ting ch: tContractors thatch employees. if the sub-contraefars have employees,rtiey must provide their workers'comp.policy number. X am an employer tliat is pi'dviding workers'compensation insurance for my employees.'Below is the policy and job site information. Insurance Company Name: i0 q ey ExpirationDate• Policy#or Self-in s.Lio.#: � lob Site Address: . i u�i"� "." st City/State/Zip: compensation policy declaration page(showing the policy number and expiration date). Attach a copy of the Failure to secure coveworkers' violation5A is a criminal rage as required nd r MGL .15 inthe ioim of STOPWORK ORDER and a fine of up to$2050.00 a and/or one-year imprisonment,as well penalties day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. —]-do Hereby certify under the pains and penalties ofperjury that the information provided above is it arzd correct. �.. Date: Signature: �.� .•�„,� ;;r ��,........,,..�� Phone#: Official use only. Do not write in this area,to be completed by city or town official.. Permit/License# City or Town: Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.CitylTown Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Phone#: Contact.Person: 3/3/2015 7:22:03 AM PST (GMT-8) FROM: 100005-TO: 16174799121 Page: 2 of 2 C®�t CERTIFICATE OF LIABILITY INSURANCE DATE�IDDI'"M 313!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,Re-policy(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 PHONE FAx Nol: QUINCY, MA 02169 ABB INSUR 8 AFFORDING COVERAGE NAIC I INSURERA: Liberty Mutual Fire Insurance 23035 INSURED INSURER B JK CONTRACTING LLC a4SURERC: 31 RICHMOND STREET WEYMOUTH MA 02188 INSURERD: NSURERE: SURER 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. FOOL WORK POLICYEFF POLICYEXP LuRS LLTTRR TYPE OF INSURANCE POLICY NUMBER N MMAD>YriY COMMERCIAL GENERAL LIABILITYEACH OCCURRENCE $ CLAIMS-MADE F1 OCCUR PREMIS10>sOfA $ MED EXP(My One pereOA $ PERSONAL&ADV INJURY S GENERAL AGGREGATE $ OEN'LAGGREGATE LIMAPPLIESPER: R •�CT F1 LOC PRODUCTS-COMPIOPAGG $ POLICY❑ OTHER: AUTOMOBILE LIABILITY BODILY $ BODILY INJURY(Per person) $ _ ANY AUTO -- ALL OWNED SCHEDULED BODILY INJURY(Per acciderd) $ AUTOS AUTOS UT NON-OWNED PPe�ec RTY DAMAGE $ HIRED AUTOS AUTOS $ UMBRELJALUIB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS4MADE AGGREGATE $ S DED I I RETENTION A wORHERS COMPENSATION WC2-31 S-601698-M 5 2/17/2015 2117!2016 H. AND EMPLOYERS'L1ANIUMYIN E.L.EACH ACCIDENT $ 100000 ANY PROPRIETORIPARTNERIEXECUTNE NIA OFFICERIMEMBER EXCLUDED? FYI E.L.DISEASE•EA EMPLOY $ 100000 (Mandafory in NH) 500000 If yes descPoe under E.L.DISEASE•POLICY UMIT $ DESCRIPTION OF OPERATIONS bebw DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be Beached If more space Is required) 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 MEMO ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORR73D 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) Paqe i of 1 DATE(MRN/DDIYYYY) A&C)R& CERTIFICATE OF LIABILITY INSURANCE 3215 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 policypes) 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. PROWLER CONTACT NAME: Maria Dupont Insurance Agency, Inc. PHONE 617 376-07 5 (617) 479-9121 18 Copeland Street MESS. me@dupontinsuranceaaency.com Quincy, MA 02169 INSURERS)AFFORDING COVERAGE NAIC0 INSURERA:Main Street America INSURED INSURER 0: JK Contracting, LLC INSURER C: 31 Richmond Street INSURER D: Weymouth, MA 02188 1NSURBRE: 1 NSURER 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. LTR ALD 15LON TYPE OF INSURANCE POLICY NUMBER Mlm MN/D�l1fYY UMTS A GENERALL1ABam MPT7794M 2/10/15 2/10/16 EACH OCCURRENCE $ 11000,000 }( COMMERCIAL GENEPAL LIABILIDAMAGE TO RENTED TY $ 500,000 CLAIMS-MADE 7 OCCUR MED EXP(Any one person) $ 10,000 PERSONALBADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'LAGGREGATELIMITAPPUESPER -PRODUCTS-COMP/OPAGG $ 2,000,000 POLICY I I PRO LOC GLELIMIT $ AUTOMOBILE UABILITY a accident $ ANYAUTO BODILY INJURY(Per Person) $ AUTOS?,ED SCHEDULED BODILY INJURY(Per accident) $ AUTOS NON-OWNED PROPERTY DAMAGE $ HIREDAUTOS _AUTOS eraeddent a UM13 ELLALLAB OCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS-MADE AGGREGATE $ DED RETENTION WORKERS COMPENSATION TWO STATU- 10TH AND EMPLOYERS'LIABLLRY Y/N AW PROPRIETOR/PARTNER/EXECUTNE = NIA E.L.EACH ACODENT OFFICERMIEMBER EXCLUDED? (Mandebry In NH) E.L.DISEASE-EA EMPLOYEE If yyees describe Under DESCRIPTION OF OPE RATIONS E.L.DIS EASE-POIJCYLIMR $ DESCRIPTION OF OPERATIONS/LOCATIONS/VENCLES (ACachACORD 101,AddhionalReim esSdo",HmonspeeIsm gUmd) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORED REPRESENTATNE Bridget McGowan ®1988,2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD Phone: Fax: E-Mail: apedranti@crowninshield.com Massachusetts Departmen�01011`; safetyRe Mations anstandards s Board of Building g ` (,>7,trurtion S.0erN r 66334 CS License: 311-21 iOND ST WEyIyIpUTH NIAExpiration, J� 0912612015 Cornmissione,