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HomeMy WebLinkAboutBuilding Permit #771 - One High Street 5/23/2007Permit NO: -%% Date Issued: BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Date Received / v' �t�eo •ry 6'6 OL °� 9_ TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑ Addition ❑ Two or more family ❑ Industrial ❑ Alteration No. of units: ommercial ❑ Others: epair, replacement ❑ Assessory Bldg ❑ Demolition ❑ Other Septic D Well ❑ Floodplain Dt1/etlands' 1'Watershed DIriCt Q Water/Sewer ,, UtaUrar i 1UN Ur wUKK I O BE PREFORMED: I— P Identification Please Type or Print Clearly) OWNER: Name: b: D Cna AA4WL&k Phone: 3 17 %5 17741 Address: I Cl UJ, 1!YlfY7Yr IZZi ' G.1 1 .P I1rv� �i N �A A I .1.11 7-, , Exp Da' Fon Inatr� ARCHITECT/ENGINEER YV Phone: V 4G Address: Reg. No. FEE SCHEDULE: BULDING PERMIT: $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COST S.F. SED ON $125.00 PER S Total Project Cost: $ L4 6S- oo Q FEE: $� Check No.: S Receipt No.: �O Z 3� NOTE: Persons contracting w' unregistered contractors do not have access to the uaranty fund Signature of Agent/Own tt Signature of confracto .-' .. Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ❑ Swimming Pools ❑ Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑' Private (septic tank, etc. ❑ Permanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM PLANNING & DEVELOPMENT COMMENTS DATE REJECTED DATE APPROVED ❑ ❑ DATE REJECTED DATE APPROVED CONSERVATION ❑ ❑ COMMENTS DATE REJECTED DATE APPROVED HEALTH ❑ ❑ COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Connection/Signature & Date Driveway Permit Located at 384 Osgood Street FIRE DEPARTMENT -Temp Dumpster° un site yes- a;�`_na ell Located at.1'24 Main Street Fire. Department signaturefdate u r r o ? IOMMENT M„ m m Dimension Number of Stories:_ Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: ELECTRICAL: Movement of Meter location, mast or service drop requires approval of Electrical Inspector Yes No DANGER ZONE LITERATURE: Yes No MGL Chapter 166 Section 21A —F and G min.$100-$1000 fine NOTES and DATA — For department use ❑ Notified for pickup - Date ..........................................................................................---.............................................................................................................................................................................................................................................................................._.................................. _ _..._................................... : ...................... ... . Doc.Building Permit Revised 2007 Building Department The following is a list of the required forms to be filled out for the appropriate permit to be obtained Roofing, Siding, Interior Rehabilitation Permits L/ Building Permit Application o/Workers Comp Affidavit q/ Photo Copy Of H.I.C. And/Or C.S.L. Licenses Copy of Contract ❑ Floor Plan Or Proposed Interior Work ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks o Building Permit Application ❑ Certified Surveyed Plot Plan ❑ Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses ❑ Copy Of Contract ❑ Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Mass check Energy Compliance Report (If Applicable) ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit New Construction (Single and Two Family) ❑ Building Permit Application ❑ Certified Proposed Plot Plan ❑ Photo of H.I.C. And C.S.L. Licenses ❑ Workers Comp Affidavit ❑ Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Copy of Contract ❑ Mass check Energy Compliance Report o Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit In all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals that the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be submitted with the building application Doc: INSPECTIONAL SERVICES DEPARTMENT:BPFORM07 Revised 2.2007 Location pto4re— No. Date 5"; r — '- TOWN OF NORTH ANDOVER 9 Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ 1 TOTAL $ Check # r/o? 5- / & L.�JV Building Inspector D 0 b UR V� n CC, ILo W :a wv .a .ac :A Cam : A � Ea � w 40 N CD Om .C` E c :gym z .mc E C q � O CIO y.. cm C C � � • = C q � f� �.q O O g U c� : o ro ac3 I.: m qmm °C ^,~ c W moo m ar Z O 0 .CLCm ' C = o a41003 1.0 z •w CL c Z C.3 m C4 q al q� C z sa..m' CAN; f PL - 42 0 v 0 Z 0 y y E ID0 r� 6L CA) O .Its y 0 C CL W 0 N ce W LLI 19 W Ch a a a oo w zo cn a a cq w aG c u x w a"b w w" w Db w w" a w ir, w w G as cn v o cn n CC, ILo W :a wv .a .ac :A Cam : A � Ea � w 40 N CD Om .C` E c :gym z .mc E C q � O CIO y.. cm C C � � • = C q � f� �.q O O g U c� : o ro ac3 I.: m qmm °C ^,~ c W moo m ar Z O 0 .CLCm ' C = o a41003 1.0 z •w CL c Z C.3 m C4 q al q� C z sa..m' CAN; f PL - 42 0 v 0 Z 0 y y E ID0 r� 6L CA) O .Its y 0 C CL W 0 N ce W LLI 19 W Ch INDUSTRIAL & COMMERCIAL RESTORATION CONTRACTORS April 19,20(Y7 24 River Street • Dedham, Massachusetts 02026 781-751-9000 9 Fax 781-751-9001 HDG Mansur Inc. Services Re: Roof Replacement/Schneider Electric Attn: Mr. David Clapper Building #14 (Converse) 10. West Market St., Suite 1200 One High Street Indianapolis, IN 46204 North Andover, MA (Revised- 2/14/07) We hereby propose to furnish the necessary labor, materials and equipment to complete the following: This work shall be conducted in strict compliance with OSHA Standards Public Law 91-596 / December 1970. 1. Mobilize equipment and materials. 2, Erect and dismantle (1) debris chute on the exterior of the building in the designated area. 3. Remove existing roof systems dowp to the existing built-up tar and gravel roofing on the main roof and (2) penthouse roofs. The original tar and gravel roofing will not be removed. 4. Deck replacement if required shall be at the owners discretion on a time and material basis. 5. Install new Carlisle Sure -Seal 3.3't polyisocyanurate (R-20) rigid roof insulation and 1/4" pre - primed Carlisle DensDeck conforming to ASTM specification C518 and Federal specification :HH -1-1972 JEN mechanically attached to existing wood plank. 6. The existing antennas and satellite dishes will be disconnected by the owner's or tenant's representative and new pavers will be provided at the base supports. The owner or tenant will be responsible for all recalibration required when reinstalling the antennas and dishes. 7. Install new Carlisle .060 EPDM Design "A" Fully Adhered Roof System per the Manufacturer's latest written specifications with an 80 mph extended wind warranty. 8. Install: new'Zitrn Z-2150 retrofit drains or equal. 9. Flash all'penetrations, curbs and perimeter walls according to the Manufacturer's latest written specifications. 10. Install new Carlisle walkway pads at all serviceable rooftop equipment and at the penthouse door. 11. Install new .040 mill finish aluminum hook strip or concealed nailers to all edges. 12. Fabricate & install new .032 aluminum bronze finish edge cleat to all perimeter roof edges. All sheet metal shall be fabricated and installed using Sheet Metal & Air Conditioners National Associations (SMACNA) recommended practices. 11" Clean all grounds and legally dispose of all debris in accordance to State & Municipal codes. i1 . Acquire all necessary building permits. 15. Issue a 15 year Carlisle SynTec Systems Warranty upon payment in full. Terms: Total cost for all labor, materials and equipment is: 5.356,3, 3.00 (Three hundred f tYy six thousand three hundred forty three dollars) payable upon requisition. Notes: 1.) The cost to remove and dispose of the existing tar and gravel roofing and asbestos abatement would be an additional $118.746.00 to the base bid. 2.) The cost for the interior protection would be an additional $48M.00 to the base bid. This proposal is subject to revision or withdrawal by Contractor for any reason until communication of acceptance, and -b evtsed after communication of acceptance where an inadvertent error by Contractor has occurred. This proposal expires (30) days after the date stated above if not earlier.�d-revi3�r1 or�cithdrawn. The undersigned, repres ting that he/she is the Owner/Customer's agent and has the authority to enter t contract, here -ts this proposal and, intending to be legally bound hereby, agrees that is wri ng shall be a binding contract and shall constitute the entire contract bet wne>��Contractor. _ /J M.J. AMBROSE ENTERPRISES, INC. TERMS AND CONDITIONS 1. Nature of Work. M.J. Ambrose Enterprises, Inc. ("Contractor"), shall furnish the labor and material necessary to perform the work described herein or in the referenced contract documents. Contractor does not provide engineering, consulting or architectural services. It is.'the Owner's responsibility to retain a licensed architect or engi- neer to determine proper design and code compliance. Contractor is not responsible for structural integrity, building code compliance, or design. If plans, specifications or other design documents have been furnished to Contractor, Customer warrants that they are sufficient and conform to applicable laws and building codes. Contractor is not responsible for loss, damage or expense due to defects in plans or specifications or building code violations unless such damage results from a deviation by Contractor from the contract documents. Cus- tomer warrants all structures to be in sound condition capable of with- standing normal activities of roofing construction equipment and op- erations. Contractor is not responsible for location of roof drains, adequacy of drainage or ponding on the roof. 2. Asbestos and Toxic Materials. This proposal and contract is based upon the work to be performed by Contractor not involving asbestos -containing or toxic materials and that such materials will not be encountered or disturbed during the course of performing the roofing work. Contractor is not responsible for expenses, claims or damages arising out of the presence, disturbance or removal of as- bestos -containing or toxic material. In the event that such materials are encountered, Contractor shall be entitled to reasonable compen- sation for all additional expenses incurred as a result of the presence of asbestos -containing or toxic materials. 3. Payment. Unless stated otherwise on the face of this proposal, Customer shall pay the contract price plus any additional charges for changed or extra work no later than ten (10) days after substantial completion of the Work. If completion of the Work extends beyond one month, Customer shall make monthly progress payments to Con- tractor by or before the fifth (5th) day of each month for the value of Work completed during the preceding month. Final payment shall be made to Contractor within ten (10) days after substantial completion of the Work. All sums not paid in full. when due shall earn interest at the rate of 1-1/2% per month until paid. If Customer does not make payment, Contractor shall be entitled to recover from Customer all costs of collection incurred by Contractor, including attorney's fees and litigation expenses. Collection matters may be processed through litigation or arbitration at the discretion of the Contractor. 4, Insurance. Contractor shall carry worker's compensation, auto- mobile liability, commercial general liability and such other insur- ance as required by law. Contractor will furnish a Certificate of In- surance, evidencing the types and amounts of its coverages, upon request. Customer shall purchase and maintain builder's risk and prop- erty insurance upon the full value of the entire Project, including the labor, material and equipment furnished by Contractor, covering fire, extended coverage, malicious mischief, vandalism and theft. 5. Additional Insured. If Customer requires and Contractor agrees to name Customer or others as an additional insured on Contractor's liability insurance policy, Customer and Contractor agree that the naming of Customer or other parties as an additional insured is in- tended to apply to claims made against the additional insured to the extent the claim is due to the negligence of Contractor and is not intended to make the Contractor's insurer liable for claims that are due to the fault of the additional insured. 6. Changes in the Work and Extra Work. Customer shall be en- titled to order changes in the Work and the total contact price ad- justed accordingly. Contractor shall not be required to perform any changed or additional work without a written request. Any penetra- tions through the roofing to be installed by Contractor not shown on the plans provided to Contractor prior to submittal of this proposal shall be considered an order for extra work, and Contractor shall be compensated at its customary time and material rates for performing such additional work. 7. Availability of Site and Utilities. Contractor shall be provided with direct access to the work site for the passage of trucks and ma- terials and direct access to the roof, electricity, water and sanitary facilities. Contractor shall not be required to begin work until under- lying areas are ready and acceptable to receive Contractor's work and sufficient areas of roof deck are available and free from dirt, water, snow or debris to allow continuous full operation until job completion. The expense of any extra trips by Contractor to and from the job as a result of the job not being ready for roof application after Contractor has been notified to proceed will be charged as an extra. 8. Site Conditions. Contractor shall not be responsible for addi- tional costs required due to the existence of utilities, wet insulation, snow or water on the roof, deteriorated deck or other subsurface, hidden or latent conditions that are not disclosed in writing to Con- tractor. The raising, disconnection, re -connection or relocation of any mechanical equipment on the roof that may be necessary for Con- tractor to perform the roofing work shall be performed by others or treated as an extra. 9. Working Hours. This proposal is based upon the performance of all work during Contractor's regular working hours. Extra charges will be made for overtime and all work performed other than during Contractor's regular working hours, if required by Customer. 10. Electrical Conduit. Contractor's price is based upon there not being electrical conduit or other materials embedded within the roof assembly unless expressly identified on the face of this proposal. Cus- tomer will indemnify Contractor from any personal injury, damage, claim, or expense due to the presence of electrical conduit, shall ren- der the conduit harmless so as to avoid injury to Contractor's person- nel, and shall compensate Contractor for additional time and expense resulting from the presence of such materials. 11. Lnterlor4Protection. Customer acknowledges that re -roofing of an existing building may cause disturbance, dust or debris to fall into the interior and possibly, if hot asphalt is used, may result in asphalt drippage depending upon deck conditions. Customer agrees to re- move or protect property directly below the roof in order to mini- mize potential interior damage. Contractor shall not be responsible for disturbance, damage, clean-up or loss to interior property that Customer did not remove or protect prior to commencement of roof- ing operations. Customer shall notify tenants of re -roofing and the need to provide protection underneath areas being re -roofed. Cus- tomer agrees to hold Contractor harmless from claims of tenants who were not so notified and did not provide protection. 12. Warranty. Contractor's work will be warranted by Contractor in accordance with its standard warranty, which is incorporated by reference. A copy of Contractor's standard warranty is attached or, if not, will be furnished upon request. Contractor SHALL NOT BE LIABLE FOR SPECIAL, PUNITIVE, INCIDENTAL OR CONSE- QUENTIAL DAMAGES OR LOST PROFITS. The acceptance of this proposal by the Customer signifies his agreement that this war- ranty shall be and is the exclusive remedy against Contractor per- taining to the roof installation. The liability of Contractor shall not exceed the Contract Price. A manufacturer's warranty shall be furnished to Customer if a manufacturer's warranty is called for on the face of this proposal. It is expressly agreed that in the event of any defects in the materials furnished pursuant to this contract, Customer shall have recourse only against the manufacturer of such material. 13. Right to Stop Work. The failure of Customer to make proper payment to Contractor when due shall, in addition to all other rights, constitute a material breach of contract and shall entitle Contractor, at its discretion, to suspend all work and shipments, including fur- nishing warranty, until full payment is made or terminate this con- tract. The contract sum to be paid Contractor shall be increased by the amount of Contractor's reasonable costs of shut -down, delay and start-up. 14. Damages and Delays. Contractor will not be responsible for damage done to Contractor's work by others. Any repairing of the same by Contractor will be charged at regular scheduled rates over and above the amount of this proposal. Contractor shall not be liable for damages based upon delay or liquidated damages or penalties resulting frorn any delay in completion of the Project. Contractor shall not be responsible for loss, damage or delay caused by circum- stances beyond its reasonable control, including but not limited to acts of God, weather, accidents, fire, vandalism, strikes, jurisdictional disputes, failure or delay of transportation, shortage of or inability to obtain materials, equipment or labor; changes in the work and delays caused by others. In the event of these occurrences, Contractor's time for performance under this proposal shall be extended for a time suf- ficient to permit completion of the Work. 15. Tolerances. All materials and work shall be furnished in accor- rlanrA .11141 C...• ....1 .« .. ... .: ♦h: 1.« size, weight, amount, finish, texture and performance standards. Speci- fied quantities are intended to represent an average Byer the entire roof area. 16. Fumes and Emissions. Customer acknowledges that odors and emissions from roofing products will be released and noise will be generated as part of the roofing operations to be performed by Con- tractor. Customer shall be responsible for interior air quality, includ- ing controlling mechanical equipment, HVAC units, intake vents, wall vents, windows, doors and other openings to prevent fumes and odors from entering the building. Customer is aware that roofing products emit fumes, vapors and odors during the application process. Some people are more sensitive to these emissions than others. Customer shall hold Contractor harmless from claims from third parties relat- ing to fumes and odors that are emitted during the normal roofing process. 17. Mold. Contractor and Owner are committed to acting promptly so that roof leaks are not a source of potential interior mold growth. Customer will make periodic inspections for signs of water intrusion and act promptly, including notice to Contractor if Customer believes there are roof leaks, to correct the condition. Upon receiving notice, Contractor will make repairs promptly so that water entry through the roofing installed by Contractor is not a source of moisture. Con- tractor is not responsible for indoor air quality. Owner shall hold harmless and indemnify Contractor from claims due to indoor air quality and resulting from a failure by Owner to maintain the build- ing in a manner to avoid growth of mold. 18. Notice of Complaint. Customer shall notify Contractor of any complaints concerning the performance of this contract within ten (10) days after conclusion of work by the Contractor; absent such notification, the work shall be deemed to have been completed in a satisfactory manner. Furthermore, Customer must notify Contractor within ten (10) days of learning of any problems before any progress or final payment is withheld or reduced in value. 19. Arbitration. If a dispute shall arise between Contractor and Customer with respect to any matters or questions arising out of or relating to this Agreement or the breach thereof, such dispute, other than collection matters, shall be decided by arbitration administered by and in accordance with the Construction industry Arbitration Rules of the American Arbitration Association. This Agreement to arbitrate shall be specifically enforceable under the prevailing arbitration law. The award rendered by the arbitrators shall be final, and judgment may be entered upon it in any Court having jurisdiction thereof. Any legal claim against Contractor, including a claim alleging any breach of this contract or negligence by Contractor must be initiated no later than two (2) years after Contractor completed work. 20. Material References. Contractor is not responsible for the ac- tual verification of technical specifications of product manufactur- ers; i.e., R value or ASTM or UL compliance, but rather the materi- als used are represented as such by the material manufacturer. The Commonwealth of Massachusetts DePartment of Industrial Accidents Office of Invesdgations 600 Washington Street klip Boston, MA 02111 r Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers policant Information Name (Business/Organization/Individual): Address: � City/State/Zip: Phone #: Are ou an e t mp oyer. Check the appropriate box: 1 I am a employer with (j 4. ❑ I am a general contractor 2. ❑employees (full and/or part-time).* 1 am a sole proprietor or and I have hired the sub -contractors listed partner- ship and have no employees on the attached sheet. t These sub -contractors have working for me in any capacity. [No workers' comp. insurance workers' comp, insurance. 5. ❑ We are a corporation 3. ❑required.] I am a homeowner doing all and its officers have exercised their work myself. [No workers' comp, right of exemption per MGL c. 152, § 1(4), and we have no insurance required.] t employees. [No workers' comp insuranc Type of project (required): 6. ❑ New construction 7• ❑ Remodeling 8. ❑ Demolition 9• ❑ Building addition 10-❑ Electrical repairs or additions 11.❑ Plumbing repairs or additions 12•❑ Roof repairs e 1equired.] l 13.❑ Other "Any applicant that checks box # I must also fill out the section below showing their workers' compensation policy information. t Homeownas who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicatin such. iContractors that check this box must attached an additional sheet showing the name of the sub -contractors and their workpm' r �__. !_�_ B .. r -- �••• �n emptoyer Mat is providing workers' compensation in information. surance for my employees.Below is the policy and job site Insurance Company Name: Policy # or Self -ins. Lic. #: �} C 9, 3 g Expiration Date: �0 % G Job Site Address: i;�� :Va Attach a copy of the workers' compen ton policy declarat City/State/Zip: ,0 Y S"� ng licy number and Failure to secure coverage as required under Section 25A of MGL . 52 can lead to the impositi n of criminal pen on datea fine up to $1,500.00 and/or one-year imprisonment, as well as civil penalties of a of up to $250.00 a day against the violator. Be, advised Penalties in the form of a STOP WORD ORDER and a fine Investigations of the DIA for insurances co-M°f -this statement _m_= be forwarded to the Office of a verifi ' n. Ido hereby ceung n penalties ofP J erry that the information provided _ ve is due and correct Si Date: ^ DD_ Phone #: OJ)'icial use only. Do not write in this area, to be completed by city or town offlciaL City or Town: Permit/License # Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone #: ^,� ✓iie �omrmtoouuealdi a�✓�ivaoaciu.�ae%ta DEPARTMENT OF PUBLIC SAFETY HOISTING ENGINEER LICENSE Number.-. HE, 069343 {.. irthdate 05L1-4 i = Exptr_ OSl14420(39 Tr. no: 18668 - estncted� MICHAEL J AMBRbSE 209 WALNUT ST DEDHAM, MA 02026 h C Commissioner - T1 ,pp�� Ge &amvnwxurealtiz a�✓�aaaac�uca 'X Board of Building Regulations and Standards _ HOME IMPROVEMENT CONTRACTOR k1pi Registration: 100530 Expiration:: 6/19/2008 i YType- Primate Corporation M.J. AMBROSES' ENTERPRfS.ES, INC. z; Michael Ambrose - 209 Walnut St.�-` Dedham, MA 02026 Deputy Administrator ffie l°anv�axureal!% ���� BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR Number: CS 044602 Birthdate: 05/14/1956 Expires:, 05/14/2008 Tr. no: 21806 Restricted: 00 MICHAEL J AMBROSE 209 WALNUT ST G- { DEDHAM, MA 02026 Commissioner c� CERTIFICATE OF TE LIABILITY INSURANCE °"'"'°°"" : loom PRODUCER SCHORTM ANN INSURANCE AGENCY THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CODERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 901 HIGH STREET ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. P 0 BOX 347 DEDHAM MA 02026 COMPANIES AFFORDING COVERAGE COMPANY A Ameftm Intl Group INSURED COMPANY M J Ambrose Ethel rhm k B 209 WWrd St COMPANY Dedham MA 02028 C COMPANY D COVERAGES': THIS IS 70 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. LR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE IMMIDOn POLICY EXPIRATION DATE (MM/DD/YY) LIMfC8 GENERAL LIABILITY GENERAL AGGREGATE $ COMMERCIAL GENERAL UABILTTY CLAIMS MADE F] OCCUR PRODUCTS • COMPIOP AGG $ PERSONAL A ADV INJURY S OWNERS 8 CONTRACTORS PROT EACH OCCURRENCE $ FIRE DAMAGE (Any ane fire) $ MED EXP (Arty ane person) $ AUTOMOBILE LIABILITY ANY AUTO COMBINED SINGLE LIAR $ ALL OWNED AUTOS SCHEDULED AUTOS BODILY INJURY $ (Per person) HIRED AUTOS NON-OWNED AUTOS BODILY INJURY = (Per &W680) PROPERTY DAMAGE $ GARAGE LIABILITY AUTO ONLY - EA ACCIDENT S ANY AUTO OTHER THAN AUTO ONLY: EACH ACCIDENT $ AGGREGATE $ EXCESS LIABUTY EACH OCCURRENCE E UMBRELLA FORM AGGREGATE E OTHER THAN UMBRELLA FORM 3 WORKERS COMPENSATION AND A EMPLOYERS LIABILITY THE PROPRIETOR/ INCL PARTNERS/EXECUTNE REXCL WC 279-36-01 10121106 10121/07 EL EACH ACCIDENT $ 500,000 EL DISEASE •POLICY LIMIT5 500,000 EL DISEASE • EA EMPLOYEE E 500,000 OFFICERS ARE: OTHER RkWIOI ORP flM H TIONSIVEHICLESWECIAL ITEMS CERTFi�ATE:HOLDER° /.������n vwTvcu SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL 3D DAYS WRrTTEN NOTICE TO THE CERTIFICATE HOLOER NAMED TO THE LEFT, conNr BUT FAILURE TO MAL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIASnEY OF ANY /IND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES AUT140F ZED RE PRE8B1TATIVE ROY M BOURELL �D'25s.{illis7 . . ® ACOAD'�CORPORATION'1988"..