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0003-0025 PARADISE ROAD - BPA-14-1804
--Ft3-14 cCI Eo s The Commonweal*99902chusetts Department ofpublic Safe b e 3 r Massachusetts State Buiuilt'MWdMj78 NI ) Building Permit Application for any Building o er than a One-or Two-Family Dwelling (This Section For Official Use Onl ) Building Permit Number: Date Applied: I Building Official: SECTION 1:LOCATION(Please indicate Block N and Lot k for locations for which a street address is not available) i L LI1A I PRfnatSi- X11-4 No.and Street City/Town Zip Code Name of Building(if applicable) 3 SECTION 2 PROPOSED WORK Edition of NA State Code used_ If New Construction check here❑or check all that apply in the two rows below I Existing Building❑ Repair❑ 1 Alteration ❑ 1 Addition❑ 1 Demolition ❑ (Please fill out and submit Appendix l) Change of Use ❑ Change of Occupancy ❑ her ❑ Specify: C t<,r}+ N J Are building plans end/or construction documents being supplied as part of this permit application? Yes ❑ No IT Is an Independent Structural Engineering Peer Review r qu red? Yes ❑ No (� Ctk Brief Description of Proposer Work: i flSQIr4('f' ShPrah,(.S �ts.-�'GrLSH-rGId Oiup fd� hC `r`rfilC. r fnAi- ffrGGNfccl.n.rf SH N6 /65 r SECTION 3:COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATION,ADDITION,OR CHANGE IN USE OR OCCUPANCY Check here if an Existing Building Investigation and Evaluation is enclosed(See 780 CM1134) ❑ Existing Use Group(s); I Proposed Use Group(s): SECTION 4:BUILDING HEIGHT AND AREA Existing Proposed No.of Floors/Stories(include basement levels)&Area Per Floor(stl. ft.) Total Area(sq. ft.)and Total Height(ft.) SECTION 5:USE GROUP(Check as applicable) A: Assembly A•I ❑ A-2❑ Nightclub ❑ A-3 ❑ A4❑ A-5❑ 1 B: Business ❑ E: Educational ❑ F: Facto F-I ❑ F2❑ H F[: h Hazard H-1 ❑ H-2❑ H-3 ❑ H-4❑ H-5❑ l: Institutional 1-1 ❑ 1-2❑ 1-3❑ 1-4❑ M: Niercantile❑ R: Residential R-10 R-2❑ R-3❑ R4❑ S: Storage S-I ❑ 5-2❑ U: Utility❑ Special Use❑and please describe below: Special Use: SECTION 6:CONSTRUCTION TYPE(Check as a licable) IA IB ❑ IIA ❑ IIB ❑ IIIA ❑ Hill ❑ 1 IV ❑ 1 VA ❑ VB ❑ SECTION 7:SITE INFORMATION(refer to 780 CMR 111.0 for details on each item) Water Supply: Flood Zone Information: Sewage Disposal: Trench Permit: Debris Removal: Public❑ Check if outside Flood Zone❑ Indicate municipal❑ A trench will not be Licensed Disposal Site❑ required❑or trench or specify: Private❑ or indentify Zone: or on site system❑ permit is enclosed ❑ Railroad right-of-way: Ilazards to Air Navigation: )t t I. t �ri�_; n.iij .wn' <, ., inn,.,.c Not Applicable❑ Is Structure within airport approach area? Is their review completed? or Consent to Build enclosed❑ 1 Yes❑ or No❑ Yes❑ No ❑ SECTION 8:CONTENT OF CERTIFICATE OF OCCUPANCY Edition of Code: _Usc Gnntp(s):_ Type of Construction: _ Occupant Load per Flour: Does the building contain an Sprinkler System?: Special Stipulations: SI00 T 61 61B SECTION 9: PROPERTY OWNER AUTFIORIZATION Name and Address of Property, Owner".7- "; & [zlzr-V ll Ll.: Z nlc.al�t�"�Xiwl :�? Pdr �- �Jl�+ IrD Kt"-4m Ph 0 Name(Print) i n h No.and Street-"" City/Town Zip �P)roperty Owner Contact Information:m Title Telephone No. (business) Telephone No. (cell) a-mail address If applicable, the property owner hereby authorizes Name Street Address City/Town State Zip to act on the property owner's behalf, mail matters relative to work authorized by this building permit application. SECTION 10:CONSTRUCTION CONTROL(Please fill out Appendix 2) If building is less than 33,000 cu.ft.of enclosed space and/or not under Construction Control then check here O and skip Section 10.1 10.1 Registered Professional Responsible for Construction Control PA-ei A Ilan p 9? a/q Name(Registntp Telephone No- e-mail address Registration Number Z CA✓ r rt; S� L?f JGK-I.ar 0/9/S— / Street Address City/ own State Zip Discipline xpir tion Date 10.2 General Contractor - 13WIJI o% (Mt9 of AwAMO (ADY-ja b6A- - US fen �r'h C mpariy Name (f1 64td fA W Wtr.'J �- Da 7/&34 CSL- A14C Name of Person Responsible for Construction ��-11 License No. and Type if Applicable 5 4`Id6F S s� " t2Ajf.arr_,c_. V44- , eq-ot* 0 Street Address City/Town State Zip ' 7k53Q 04-6-3 _ Tele hone No. business Telephone No. cell e-mail address SECTION 11: VV0RKEIS'COMPIlNSA I ION INSUVA:NCE AITIDAVIF M.G.L.c.152.§25C 6 A Workers'Compensation Insurance Affidavit from the MA Department of Industrial Accidents must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. Is a signed Affidavit submitted with this application? Yes 13 No ❑ SECTION 12 CONSTRUCTION COSTS AND PERMIT FEE' Item Estimated Costs: (Labor and Materials) Total Construction Cost(from Item 6)_$ I. Building $ Building Permit Fee=Total Construction Cost x_(Insert here 2. Electrical $ appropriate municipal factor)_$ 3. Plumbing $ 4. Mechanical (FIVAC) $ Note: Minimum fee=$ (contact municipality) 5. Mechanical Other - $ Enclose check payable to 6.Total Cos[ $ 31 qLa , 90 (contact municipality)and write check number here SECTION 13:SIGNATURE OF BUILDING PERMIT APPLICANT By entering my name below, 1 hereby attest under the pains and penalties of perjury that all of the information contained in this ❑pplication istme and accurate.t.00 t/he bestoff my knowle a and understanding. �kjW cow VA1"oAJ —/ ed�<t Mn✓.raca g�� S�o - o4S � f4Al�u o1� Please,^1�Tint and sign name 'Ti�el - Telephone No. Date t S S�' JYN 6 hic.c ¢sYza— Street Address City/Town State Zip Municipal Inspector to fill cut this section upon application approval: ' 1 17 Pq Name Date CITY OF SALEK MASSAQHUSEM a BUILDING DEPARTMENT 120 WASHINGTON STREET,31D FLooR TEL. (978) 745-9595 KIMBERLEY DRISCOLL FAX(978)740-9846 MAYOR THomAs ST.PIERRE DIRECTOR OF PUBLIC PROPERTY/BUILDING CONSUSSIONER Construction Debris Disposal Affidavit (required for all demolition and renovation work) In accordance with the sixth edition of the State Building Code, 780 CMR, Section 111.5 Debris, and the provisions of MGL c40, 5 54; Building Permit# is issued with the condition that the debris resulting from this work shall be disposed of in a properly licensed waste deposit facility as defined by MGL c 111, S 150A. The debris will be transported by: (A� )- S bi 50 e$IV/ (name of hauler) The debris will be disposed of in: 4VA)41Q /Atil 6�4, /I (name of facility) (address of facility) Signature of applicant Date T° Q-I-Y OF SALEM, lL1SS.ICHL'SETIS BL'ILDI,�IG DEP.ARTntE.\T ail 120 %V.%5HLNGTON STREET, 3"FLOOR TEL (978) 745-9595 F.Ax(978) 7.10-98.36 KINI13E FFY DR]SCOLL t NLkYOR THontuST.PIERRE DIRECTOR OF PUBLIC PROPERTY/BCB.DCNIG CO\LMISSfONER 1Vorkers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Annlieant lnformetinn 1 Please Print Lealbly NarnO lnusitxss.OrganirariaNlndividu:J):9Ui j,,Jh 1MR+ i(L `p OCp — boo tuts Address: Pb 3F 90- //��qi City/State/Zip: R * 6 Uri 0/`9&0 PhoneN: Arc you an employer'!Check the appropriate box: Type of project(required): I.(5k'I'am a employer with_0 4• ❑ 1 am a general contractor and 1 6. ❑New construction employees(full and/or part-time).* _ have hired the sub-contractors 2.❑ lain a sole proprietor or partner. listed on the attached shecL t �• ❑Remodeling ship and have no employees These sub-contractors have (t. ❑ Demolition working for me in any capacity. workers'comp. insurance. 9. ❑Building addition [No workcrv'camp. insurance 5. ❑ We are a corporation and its rcquireJ.] officers have exercised their 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 11.0 Plumbing repairs or udditions myself.(No workers'Bump. c. 152,y 1(4),and we have no 12.❑ Roof repairs insurance required.l t employees. (No workers 13.0 Other comp. insurance required.j -Any upplivunt IIuT chucka bus Of must also fill uui the section bulaw,hawing their w°rken'cumpensadon policy infmnatton. '1 Lvncuwnrn+rho eul+mit this alrldavil indicating 1hcy are doing all work and thca Kira wisida cantnctma mml mhmil a raw 1lndavil indicating such. 4'umrxwn that chuck this bus mml anachod an addiltunal ahml showing the natna of the sub•uromngon and Theis workers'camp.pullry information. /am Tin eurpluyer rAu1 k pravidlnK Tvorkers'rumpmrsarlun i+rruruace jar my employers. Belot,/s rite po/!cy and Jab rile iujururarinn. /� Insurance Company Name: ✓ Policy 4 or Self-ins. Lien. IT: /gam — (p61 g031 - 7i013,71' Expiration Date:LZ 2'3 '�-O f Job Site Adtkess�X P.164 or3C ./FJ L City/State/Zip;ssM/f vs- l�'w0- Attach a cupy of the workers'compensation pulley declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of fine up to S1,500.00 und/ur one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and u line of up to S-'SO.00 a day against The violator. Ile advised that a copy of this statement may be furwurdcd to the OI lice of Invrsligmionr'ul'lhe DIA for insurance coverage verification. !do hereby rerrijy under lire putts and penulder uj rrjury that the hViirntudan provided above is rrue and correct. Sicn,nnre; n /'p d Date: Phone 1: A- Of icial use anly. Do nor tvrire in ibis area, to he coaipleleJ.by rfty a toxin a/jh/ut City ne Mown: _ .. Permitfl.lconse p . .--- Lssuing Aut hurily (circle Tine): 1. Board of IIeallh E. nuildlnq Departntc•ut 1.Cityfrown Clerk J. Electrical Inspector 5. Plumbing xnspeclnr 6. Other i Cunlud I'crtun: Phnnc a: l Massachusetts -Department of Public Safety Board of Building Regulations and Standards Construction Supervisor License: CS-099551 PETER D ALLARO 2 CARVER ST Beverly MA 01913 ' �„C,,,, " "'�• Expiration Commissioner 03/25/2016 NEW CREEK II LLC, A DELAWARE LIMITED LIABILITY COMPANY 2 Newton Executive Park, Suite 100 Newton, MA 02462 PURCHASE ORDER FOR CONTRACTORS DATE: November 3,2014 PURCHASE ORDER#: 6756 SITE M SMAS1735/-Paradise Plaza PURCHASER/OWNER: NEW CREEK II LLC,a Delaware limited liability company By: New Creek Manager, LLC, its Manager By:KRCX Mufti-State Holdings,LLC,its Sole Member VENDOR#: VBUILMA03 CONTRACTOR/SELLER: Building Maintenance Corporation d/b/a U.S. Roofing PO BOX 3118 Peabody, MA 01960 SCOPE OF WORK: Shingle Facade Repair Fascia repairs to an area of 12,000 ft shingle portions using a quality shingle material installed to published manufacturers specifications. ❑Procure necessary Permit from Town of S alem ❑Access all roof sections with LULL forklift for stocking and disposal purposes ❑Remove existing shingle layers including to exposed roof sheathing inspecting for rot;replacing as necessary ❑Dispose of all debris in a legal landfill ❑Install S tormguard®Ice and Water Shield at all leading edges; including all valleys and roof penetrations ❑Install 8"aluminum drip edge to all applicable rakes and roof perimeters ❑ Replace with GAFtm Timberline®HD Architectural shingles; storm nailing each (sic nails per shingle) ❑Flash all applicable roof penetrations including providing and installing new plumbing vent pipe flanges according to National Roofing Standards ❑Cap applicable ridges with GAF TM Timbertex®Architectural Hip &Ridge shingles ❑Flash all domer sidewalls according to National Roofing Standards ❑Secure and clean all existing gutters at completion of project ❑Provide for a safe non-disruptive job-site ensuring appropriate access and disposal lanes including appropriate dress for all US Roofing personnel onsite that includes uniform dress clearly marked with company insignia ❑Work environment to be clean and safe for roof mechanics, building residents and public per OSHA safety standards ❑Dispose of all debris in an approved facility in accordance with all local, state and federal regulations ❑U.S. Roofing will acquire all permits and schedule inspections ❑Clean all grounds daily and at completion of project Contractor's work shall be completed by no later than November 28,2014. TOTAL: $39,420.00 Includes Tax Purchaser may, in its sole discretion and without liability to Seller, cancel this order(or any portion hereof)at any time, for any reason, upon written notification. In the event Seller fails to send Purchaser a written invoice for the work which is the subject of this agreement within ninety(90)days after the completion of the work then Seller shall forever relinquish and forfeit its right to receive payment for same. Initial: Purchaser/Owner: Contractor/Seller: 14rl 1 NEW CREEK II LLC. A DELAWARE LIMITED LIABILITY COMPANY Seller to furnish us with a Certificate of Insurance PRIOR TO COMMENCEMENT OF ABOVE NOTED WORK, in accordance to requirements outlined in Exhibit A. INSURANCE CERTIFICATE TO BE FORWARDED TO: Liza Baiza Kimco Realty Corporation Two Newton Executive Park Suite 100 Newton, MA 02462 KIMCO REALTY CORPORATION AND ITS OFFICERS AND DIRECTORS, AS WELL AS ALL RELATED SUBSIDIARIES, ENTITIES AND OPERATIONS SHALL BE NAMED AS ADDITIONAL INSURED AS WELL AS CERTIFICATE HOLDER. Hold Harmless Agreement to be executed by Contractor/Seller. The Purchaser/Owner and Contractor/Seller will not discriminate against any employee or applicant for employment because of race, color, religion, sex or national origin. The Purchaser/Owner and Contractor/Seller will take affirmative action to ensure that applicants are employed, and that employees are treated during employment without regard to their race, color, religion, sex or national origin. Such actions, shall include, but not be limited to the following: Employment, upgrading, demotion or transfer, recruitment, or recruitment advertising; layoff or termination; rates of pay or other forms of compensation; and selection for training, including apprenticeship. Purchaser/Owner is an equal employment opportunity employer and is a federal contractor. Consequently, the parties agree that, to the extent applicable, they will comply with Executive Order 11246,the Vietnam Era Veterans Readjustment Assistance Act of 1974 and Section 503 of the Vocational Rehabilitation Act of 1973 and also agree that these laws are incorporated herein by this reference. Any vendor with questions regarding appropriate business conduct or to report a matter of concern may contact any of the following parties: • Leah Landro, Vice President of Human Resources, at 516-869-7135 or at LLandro(a)_Kimcorealtv.com • Bruce Rubenstein, General Counsel, at 516-869-7221 or at BRubensteinCcDKimcorealtv.com • Ethics Helpline at 1-866-511-5866 or at httos://kimcorealty.atertline.com. Administered by Global Compliance, a third party vendor,the Ethics Helpline provides an avenue to report concerns anonymously Counterparts. This instrument may be executed in one or more counterparts, each of which shall be deemed to constitute an original, but all of which,when taken together, shall constitute one and the same instrument. Facsimile and Electronic PDF Signatures: Facsimile or scanned signatures (e.g. e-mailed in PDF format) are acceptable to effectuate the terms of this instrument. The persons signing this document on behalf of the Owner and Contractor represents by such signature that he or she has been duly authorized by such party to execute this document and that such signature creates a binding obligation of such party. Initial: Purchaser/Owner: Contractor/Seller: Y ' /)2 NEW CREEK II LLC A DELAWARE LIMITED LIABILITY COMPANY IN WITNESS WHEREOF, the undersigned parties hereto have set their hands and affixed their seals to this Agreement as of the day and year first above written. PURCHASER/ OWNER: NEW CREEK If LLC,a Delaware limited liability company By: New Creek Manager, LLC, its Manager jAhorized u '-State oldings, LLC, its Sole Member SIGNE nter R s SIGNED BY: obert S� I m TITLE: A ant TITLE: Authorized Agent DATED: DATED: i ` ._ S CONTRACTOR/ SELLER: Building Maintenance Corporation d/b/a U.S. Roofing SIGNED BY• TITLE: rr7l> SIDyA.r DATE: 1/6 /1 Initial: Purchaser/Owner: — Contractor/Seller. 3 NEW CREEK II LLC A DELAWARE LIMITED LIABILITY COMPANY MINIMUM INSURANCE RE UIfREM NTS FOR CONTRACTORS 1. Workers Compensation and EmDlo ers Liability Coverage • Statutory Workers Compensation coverage • Employers Liability-$1,000,000 • 30 days notice of cancellation 2. General Liability Coverage Limits of Liability: $1 million combined single limit for bodily injury, personal injury or property damage per occurrence "Occurrence"forth including? • Premises/Operations Liability • Blanket Contractual Liability, including coverage for all liability assumed under this contract • Products &Completed Operations • Pollution coverage for losses arising out of a hostile fire • "XCU"Hazards must be covered • 30 days notice of cancellation to owner as a condition of cancellation 2. Business Automobile Coverage • Limit of Liability: $1 million combined single limit per accident for bodily injury or property damage • Business Auto policy form, including: • Coverage for"any auto"which includes autos owned, hired, and non-owned autos • 30 days notice of cancellation 3. Umbrella Liability Coverage • Limit of Liability: Not less than $2 million • 30 days notice of cancellation 4. Property Insurance All contractors and subcontractors shall be responsible for all loss or damage to contractors'tools, equipment sheds, and any other materials or supplies,which do not become part of the finished project. The owner and its agents take no responsibility for said equipment. Additional Requirements • Insurances specified in items 2, 3, and 4 shall name Kimco Realty Corporation, and its officers and directors, as well as all related subsidiaries, entities and operations as additional insured. • All insurances shall contain a provision allowing insured to waive subrogation rights against other parties prior to loss. • All insurances shall be secured from financially responsible insurance carriers qualified to do business in the state in which this operation is located. • Certificates of insurance in forth and substance acceptable to owner and Kimco Realty Corp. and evidencing all insurances must be presented to the owner prior to the commencement of any work of operations at the project and upon request. Such certificates shall provide that the insurer shall not cancel or terminate coverage without thirty days prior written notice to the owner and Kimco Realty Corp. Initial: Purchaser/Owner: _ Contractor/Seller: 14 M 4 NEW CREEK II LLC, A DELAWARE LIMITED LIABILITY COMPANY EXHIBIT B TER SNf AAU-C--ONDITIONS DEFINITIONS: The word'Contractor/Seller"when used herein means the party who furnishes the material or performs the work escd�on t ie face of this order. The word"Purchaser/Owner shall mean NEW CREEK 11 LLC,a Delaware limited liability company. ACCEPTANCE: This order shall not be binding on Purchaser or Seller unless accepted in writing by Seller and returned to Buyer within ten(TOTTays of the date hereof. QUALITY: All materials furnished and work done hereunder shall be in first-class order and in strict accordance with the Plans, peci cations and General Conditions of contracts referred to herein. Payment to Seller will be subject to inspection by and approval of Owner. PROPOSALS PLANS SPECIFICATIONS AND GENERAL CONDITIONS: Any Proposals, Plans, Specifications and General Conditions o contracts referred to in this order are hereby made a part hereof as if fully set forth herein. DELIVERY AND COMPLETION: Both this order and the work are subject to the approval of Owner. CONTINGENCIES: In the event of fire,labor troubles, accident,flood or other casualty,Governmental regulations or any cause or con rtioon eycon tTie reasonable control of Purchaser,the materials and/or work herein described may be rescheduled by mutual consent or failing mutual consent., Purchaser may in its sole discretion and without liability to Seller reduce,suspend or cancel the work. LIABILITY FOR DAMAGES: Seller does hereby agree to indemnify,save harmless and defend Purchaser from all liability for loss, amage or in)ury to person or property in any manner arising out of or in incident to the performance of this order(including all expenses relating thereto). PROPRIETARY RIGHTS: Seller warrants that the materials and work herein described do not infringe upon any letters, patent, licenses or other proprietary rights,and agrees to defend any suit that may arise in respect thereto and to indemnify,defend and save Purchaser harmless from any loss and expense which may be incurred by the assertion of any claim of infringement. WAIVER OF LIENS: Seller waives the right to file mechanic's liens for materials furnished or work done. Seller further agrees that if e or anyone claiming through him files such a lien,Seller will immediately at his own expense take all action necessary to remove it from the record. SELLER'S RISK: All materials furnished and work performed under this order shall remain at Seller's risk until final acceptance of the comp a work by Owner. LABOR: Seller agrees that all work will be done by labor which is acceptable in quality and affiliation to Purchaser. Seller will save urn c IF aser harmless from loss by reason of Seller's failure to comply with this condition. COMPLIANCE: Seller will comply with all applicable Federal,State and local laws and regulations including but not limited to those concerning prices,work permits and security requirements. Seller agrees that prices charged under this order are complete and final for the materials to be furnished and the work to be performed and include every Federal, State and local tax in effect at time of delivery or performance. PAYMENT: Subject always to due performance and compliance by Seller hereunder,payment to Seller for work done shall be on the customary basis of once a month. Each Application shall be accompanied by notarized lien waivers(see Exhibit D)by Seller in said form,as well as a completed Subcontractor Log and copies of notarized lien waivers from every entity which has supplied labor and/or material and/or services to the work as of the date of each application. In the event Seller fails to send Purchaser a written invoice for the work which is the subject of this agreement within ninety(90)days after the completion of the work then Seller shall forever relinquish and forfeit its right to receive payment for same. CANCELLATION: Purchaser may, in its sole discretion and without liability to Seller, cancel this order(or any portion hereof)at any hm—e—, r any reason, upon written notification. This contract shall be subject to the approval of the Board of Directors of Owner and in the event that within ten(10)business days from the date hereof the Board determines that this contract is not in the best interest Of Owner,this contract shall be cancelable forthwith on notice to Seller within such ten(10)day period. No modifications,waivers, alterations or other changes in or to this contract,the Contract Documents or work shall be binding or valid unless effected expressly in writing by the party against whom the same shall be asserted. RIGHTS: Enumeration herein of certain legal rights shall not exclude other such rights given by law. BILLING: Unless otherwise stated,bills to Purchaser are to be sent to the address listed on the order. ADVERTISING: Any and all advertising concerning work or materials furnished under this order, including signs at the site of the work, publication ADVERTISING: trade journals or other media must be submitted to Purchaser and approved by Purchaser prior to its use. GOVERNING LAW: This Agreement shall be governed by and construed and enforced in accordance with the laws of the State which the materials are furnished and work performed. Seller hereby agrees to submit to the personal jurisdiction of the state and federal courts located in the State which the materials are furnished and work performed with respect to any dispute arising hereunder and hereby irrevocably designates the Secretary of State of the State which the materials are furnished and work performed as its agent to accept and acknowledge on its behalf service of process as valid service of process upon Seller. CONFLICT CLAUSE: If there are conflicts between this agreement and any Proposals, Plans, Specifications and General Conditions 0 ocumen re ire to in this order,the terms and conditions of this agreement will be the controlling and final contract document Initial: Purchaser/Owner: Contractor/Seller: MM 5 Ac R10�® CERTIFICATE OF LIABILITY INSURANCE `�`MW°°"""" ,2 20/2013 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(tes)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 CONTACT NAME: The Driscoll Agency, Inc. PHONE FAx 93 Longwater Circle laNL NO' P.O. Box 9120 ADDRESS: Norwell MA 02061 INSURERS AFFORDING COVERAGE NAIC 0 INSURER A INSURED 3327 INSURERI3:Exce1sqor Insurance Company 11045 Buildingg Maintenance Corp. iNsuaEac.A.I.M Mutual Insurance Company dba U.S Roofing INSURER D: rl Insurance Company41 PO Box 3118 Peabody MA 01961 INSURER E INSURER F:: COVERAGES CERTIFICATE NUMBER:1278486783 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. IR AD TYPE OF INSURANCE R POLICY NUMBER MPWDDYEFF MPMBDIYYY CY EXP LTR 1A LIMITS LT A GENERAL LIABILITY MACGL000000279003 1212312013 2232014 EACH OCCURRENCE $1,000,000 X COMMERCIAL GENERAL LIABILITY PREMISES CE.oau.. $50,000 CLAIMS-MADE OCCUR MED EXP(Any one person) $5,000 X X,C,U PERSONAL&ADV INJURY $1,000,000 X Inc Contractual GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-CAMP/OPAGG $2,000,000 17 POLICY X PRO- LOC $ B AUTOMOBILE LIABILITY BA8730382 2232013 2232014 NGLE LIMIT Es actldeM 1000000 ANY AUTO BODILY INJURY(Per person) $ ALL OWNED X SCHEDULED BODILY INJURY(Per eoddeM) $ X HIRED AUTOS X ANOTO WNED PPERDAMAGE $ $ A X UMBRELLA LIAR X OCCUR MAEX000003723101 2232013 2232014 EACH OCCURRENCE $5,000,000 EXCESS LIAR CLAIMS-MADE AGGREGATE $5,000,000 DED I X I RETENTION$0 $ C WORKERS COMPENSATION o be issued by WCAR 2232013 2232014 OR STATU- OTH- AND EMPLOYERS LMSILTY Y/N ANY PROPRIETORIPARTNER/EXECUTIVE ❑ NIA EL EACH ACCIDENT $ OFFICERMIEMBER EXCLUDED? (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ It yes,desaibe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ C Installation BP8732582 2232013 2232014 Job Site Limit $100,000 Floater Leased Rented Equip $75,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attecll ACORD 101,Additional Remarb Scbedute,N more space Is required) RE: Latitude Condominiums, 281 Essex Street, Salem, MA&all other projects in the city. Notice of cancellation provision is 30 days, except 10 days applies for non-payment of premium. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Salem Massachusetts ACCORDANCE WITH THE POLICY PROVISIONS. Attn: Public Properties Dept. 120 Washington Street,3rd Floor AUTHORIZED REPRESENTATIVE Salem MA 01970 ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010106) The ACORD name and logo are registered marks of ACORD v�u CERTIFICATE.OF LIABILITY INSURANCE. °A0111412014 01/1472014 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER_ THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND, OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER($); AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED,the polfcy(tes)must be endorsed. If SUBROGATION IS WANED,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 endorsemert(s). PRODUCER 00746 001 WRACT Peggy -The Driscoll Agency Inc WMEM (781)681."% IM N .: (781)881.6686 P O Box 9120 jgahas.. CImal@ddsoo0agency.com Norwell,MA 02061-9120 - - - A A.I.M.Mutual Insurance Company 33758 INSURED INSURER 11 Building Mairnenarroe Corp INMRE US Roofing P O BOx3118 INSURER a Peabody,MA 01981 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- TYPE OF INSURANCE I POUCT NUIBER LINTS GENERAL LIABILITY EACH OCCURRENCE E COI RCMGENERALLNSILDY Sf E CLAIMS-MADE OCCUR WD EW(AW PERSONAL B ADV INJURY 5 GENERALAGGREGATE E ENL AGGREGATE LIMIT APPLIES PER PRODUCTS-COMPIOPAGG s F]Poucy R4 OC AUTOMOBILE LIABILITY (EH'v*EDSINGLE n E ANYAUTO BODILY INJURY(Pa Person) It ALL OWNED S(SIETXR® SODLYINJURY(PW=de 0 E HHRED AUTOS NON-OYMED PROPERTY DAMAGE $ AUTOS E UMBRELLA LIAB OCCUR FACN OCCURRENCE E EXCESS LIAR- occu MADE - AGGREGATE E DED RETENTION E 5 WAVE 1A X T"bft3l MW p AffZNU&RMKRErUT1VEL= NIA. ACCIDENT s 500,000.00 VWC.100-6018031-2013A 1212312013 1212312014 �'�I (MVMatory In NH) E.L.DISEASE-FA EWLQYEE $ 500,000.00 6MAW&&p5PEkAT10NSbd. El.DISFASE-POLICY LIMN E 508,000.00 DESCRIPTION OF OPERATIONS/LOCATIONS)VEHICLES(AM611 ACORD Rat,AOE S0nR'Romano Scl,alUI%1r rise spats b Mqv" ) . CERTIFICATE HOLDER CANCELLATION City Of Salem Attention:Public Properties Dept SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 120 Washington Street-3nd Floor THE EXPIRATION DATE THEREOF. NOTICE WILL BE DELIVERED IN Salem;MA 01970 ACCORDANCE WITH THE POIJCYPROVIS=. AumowzfOREPRESEHrATIVE M 1988-2Q10ACORDD UORPORATION.A0 rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD