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72A PROCTOR ST - BUILDING INSPECTION (2) j 4 N0. If •. _ 'A APPLICATTION FOR pI=RMff' 70 LOCATION PE MIT GRANTED 19 APPROVED INSPECTOR OF BUILDINGS _ CERTIFICATE OF OCCUPANCY YES NO DATE: �S-0 7 Cftp of caEM'. �ffla!55a PLANS MUST BE FILED AND APPROVED BY THE INSPECTOR PRIOR TO A PERMIT BEING GRANTED 7, n/�RR yot'DCM7' S f��e-� Buildiug Permi6Application For: Location of Building' Circle whichever applies) Roof, Reroof, Install Si ' truct Deck, Shed,Pool Addition Alteration epair/Replace undation Only, Wrecking Other. PLEASE FILL OUT LEGIBLY & COMPLETELY TO AVOID DELAYS IN PROCESSING To the Inspector of Buildings: The undersigned hereby applies for a permit to build according to the following specifications: Owners Name: 00 E lGL'�nY1P_Cat 1prG3/ Contractor. A e A 5erVICe5'CI1n_ vr71 Street_V,4 P_-1- City l 11e Street�l l_5 Nnr4h 5�. City—' j State•M - Phone (9q8)_;y5-6.4l f L State M A Phone Z DJ 1 ol Architect: City of Salem Lick—J H D5 Street City State Lit O57 HIP t< ©(to 09 State Phone ( ) Homeowners Exempt Form_yes /no Structure: (please circle Single Farnil Multi Family# Other Estimated Cost of job S_'V7D, Will building confirm to law?_yes no Asbestos?__yes ✓ no Description of work to be done: -Tr264A!l Jig)o /a- r4p1Gc2rn-e'-* A&A SERVICES, INC. Drawin u witted:_yes no Mail Permit to: 115 SALEMIMA_01970 q % ro7t3i 741-0424::_. X Signature o Ap nation,SIGNED UNDER THE PENALTY OF PERJURY CONSTRUCTION TO BE COMPLETED WITHIN SIX (6)MONTHS OF PERMIT ISSUED DATE The Coinmonivealth of Massachusetts WDepartment of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Le ibly Name(Business/Organization/Individual): A e� A je ro ca st -'n Address: I IS 1J 0 r+h �r if e+ City/State/Zip: n, M h] 01 c?7D Phone #: 1925 TA I —DH 9,W Arree�°u an employer?Check the appropriate box: Type of project(required): 1. v[� I am a employer with (�6"_ 4. ❑ I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. t 7• ❑Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. workers' comp.insurance. 9. ❑Building addition [No workers'comp. insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10.❑Electrical repairs or additions 3.❑ I am a.homeowner doing all work right of exemption per MGL I LE]Plumbing repairs or additions myself. [No workers'comp. c. 152, §1(4),and we have no 12.❑Roof repairs insurance required.] t employees. [No workers' E comp.insurance required.] 13. Other fAny applicant that checks box#] must also fill out the section below showing their workers'compensation polity intortnation. I lomeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContmctors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. I am an employer that is providing workers'compensation insurance for my employees:.Below is the policy and job site information. —t�" Insurance Company Name: _ I r te_ Tro y1p I P [c Policy#or Self-ins.Lic.#:_ W C Q aq X 1 2! Q Expiration Date: q 113 O� Job SiteAddress:_12A Tinf-1pr `h -oy-l- City/State/Zip: ,5d Attach a copy of the workers'compensation policy 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 a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of tip to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. 71do reby certify u d r the ains and penalties ofperjury that the information provided above is true and correct re: Date: D Phone#: (q'I$) 'M 1 - D AA a lJ Offrcial use only. Do not write in this area,to be completed by city or town official, 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#• Information. and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house_of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally, MGL chapter 152,§25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out.the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractor(s)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers'compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license-number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially_stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE Revised 5-26-05 Fax# 617-727-7749 www.mass.gov/dia DISPOSAL OF DEBRIS AFFIDAVIT In accordance with the provisions of M. G. L. c. 40, Sec. 54, a condition of Building Permit Number is that the debris resulting from this work shall be disposed of in a properly licensed facility as defined by M. G. L. c. 111, Sec. 150a. The debris will be disposed at: Salem Transfer Station owned by Northside Carting Signature of Permh Applicant .-11-,0 Date Christopher Zorzy Name of Permit Applicant A &A Services, Inc. Firm Name 115 North Street, Salem, MA 01970 Address, City, State, Zip Code 1 , . . i .: �/se�omvnxa�u.� o�./�aaaac/umelA a. ! Board of Building Regulations and Standards Construction Supervisor License I License: CS 57733 Birthdate-_5126/1958 ��_Exp tlo�n -516/2009 Tr# 13739 I ttPsfnctr„yion�.001 - � CHRISTOPHER Z,R ` 11.5 NORTH ST ���///� �"G-- SALEM,MA 01970 Commissioner Comdianwealth of Massachusetts Division of Occupational Safety .Robert J Prezioso,Coinmismoner Q 1, Deleader-Contractor plVh�rp CHRISTOPHER ZORZY y Ell.Date 02/09/06 Exp.Date 02/OB/07 D0000440 r - Member of C.O.N.E.S1 07 $BO NII I IIIIIIIIIII I IIII N I III I IIIIIII III III# ' ON RENEW ✓- Board o.r Building Regulations aad Standards HOME IMPROVEMENT CONT Registration 101609 E"Wit l o n: 6/26/2008 .. 'Type: Private Corporation A&A SERVICES,INC ; - Christopher Zorzy 71 - 115 North Street ;Salem,MA 01970 -0epaty Administrator 41 n A c '✓ A & A SERVICES, INC. A&A S7 Ci� 115 NORTH STREET,SALEM,MA 01970 a Telephone:(978)741-0424 Fax:(978)741-2012 Contractor Registration No. 101609 Federal EIN:04-3090162 Construction Supervisor No.CS057733 ENTRY DOOR SPECIFICATION SHEET Buyer(s)Name Date of Contract Buyer(s)Street Address,City,State and 2p Code 7�, i'rocfcl- Daytime Telephone Number Evening Telephone Number Mobile Telephone Number E-Mail Address 9 7g The Buyer(s)listed above hereby jointly and severally agree to purchase the goods and r-services listed below,in accordance with to prices and terms described on this Specification sheet and the front and the reverse of to accompanying CUSTOM REMODELING AND IMPROVEMENT AGREEMENT,of which this Specification Sheet is a pad. ENTRY DOORS ❑ Remove and dispose of# wD existing entry door units. - ❑ Install new entry doors# �wo Manufacturer -774ag-AAthY Location (eArT lam- tLo bAsy soj of v-pAr NA C'd to Br 44NA) Type: ❑Steel t6smoothStar ❑Fiberclassic ❑ClassicCrafl ❑Sliding Patio Door ❑French Hinged Patio Door Model# 5 Sidelights)# Sidelight(s)type/model# OP�TIONS:� 9'Adjuslable threshold for ThermaTru Door ❑Grids for patio doors: Style: ❑ Stain Kit: Supplied to owner - ❑ Expand or shrink the size of the opening Details ❑ Cover exterior thin with aluminum coil stock: Style Color Hardware: ffrt�Handelset I$16eadboll ❑Foolbolt ❑Mail Slot ❑Peepsite , ❑ Install oak strip at floor as ne da(fnM-n 8q;9-&WA-t eded. ' �F"�Caulk interior and exterior edges. P Insulate around new door unit where possible. ®' Painting is not included. V5itccluded in this proposal are set up and clean up. la �g6PRA1'f 1nG��( �1/ �$TORM DOOR a-�Remove and dispose of# ®/t'�� existing storm door(s). - W'finstall new storm doors# OAA'42 ++,^,Manufacturer e O,Style ve L.� Color WJ1(7� Type: ❑Aluminum olid Core cation: QaAf VRfd -to 13YTSeUPIi��MAm� SPECIAL INSTRUCTIONS: , Bu.�-,emu j hot fir' S�to /n n 2vina urxler,9ddi�j oN �'P/r�arouYGr •CJoc kSe�-o.yLy �iorl a4�il� d f� f11 Su/ 5/OSr [;I nov..'n *2 A/ll R/r"ic rf- n/i � /sG se} ` per( ff a od 4/I%kE eA;tdupTkrtl IrC4r 4 /sl itll /1/cul Pregi AlAtc f NWSonrq tuark Un-Ler to 1-'Ikjed onrH /epA1 // Rpr_&& au ,nsr It Is agreed oral understood by and between the Parties that this Specification Sial along with the CUSTOM REMODELING AND IMPROVEMENT AGREEMENT,cunef4 atlas the entire understanding common the padbs,and there are no verbal understandings changing or modifying any of the forme.This can tact may not be changed or Its mane modified or varied In any way unless such changes are In waling and signed by both the Buyers)and the Contractor. Buyene)hereby acknowledge that Buyer(s)has read this SpeU(ac�ation Sheet Contractor Initials: t1 L. Dater '7 Buyer's Initials: Date: fit(/ ='fany A & A SERVICES, INC. A&ASERVICES 115 NORTH STREET,SALEM,MSC 01970 e� a Telephone:(978)741-0424 Fax:(978)741-2012 Contractor Registration No.101609 Federal EIN:04-3090162 Construction Supervisor No.CS057733 CUSTOM REMODELING AND IMPROVEMENT AGREEMENT Buyers)Name Date of Contract d d 3 Buyers)Street Address,City,State and Zip Code 73.4 hoc ,51- itw, ofiffill7lad Daytime Telephone Nu ner Evening Telephone Number Mobile Telephone Number E-Mail Address! The Buyers)listed above hereby jointly and severally agree to purchase the goods anmor services listed an the accompanying specification sheets,in accordance with Me prices and terms described on the front Bad the reverse of this agreement and any specification sheets(this"Agreement"),and Buyers)have requested that such goods or services be instilled or provided at Buyer's address listed above.ABA Services,Inc.('COMractotl,hereby agrees to install or cause to be installed the products or services listed in this Agreement at the Buyers)address written above.This Agreement represents a cash sale of goods and services.The Buyer(s)agree to pay in casIn the cost of Me goads antl services purchased descn ed herein,regGo less of riming or approval of any financing Suni may seek for their purchase. o [[I� Purchase Price r Est.Starting Date: T7nP T Down Payment..'!.'��SdLm En.Completion Date: ❑Cash Amount Due on Start of Job: ❑Chack ❑Credit Card Amount due on of Completion: No. Amount Due on of Completion: Expiration Date: Balance Due on Upon Completion CVC Code: It Is agreed and understood by and between the parties that this Agreement,front and back and any addendum,constitute the entire understanding between the parties,and there are no verbal understandings changing or modifying any of the terms of this Agreement. - Buyer(s)hereby acknowledge that Buyer(s)has read the front and the reverse of this Agreement and has received a completed,signed and dated copy of this Agreement,Including the two attached Notice of Cancellation forms,on the date first written above. Buyer(s)also (i)acknowledge that they were orally informed of their right to cancel this trom action;and(ill request that they be contacted via their telephone numbers or a-mall,as listed above, In the event Contractor believes Buyer(s)would be Interested In any additional quality products or services of Contractor. DO NOT SIGN Thus CONTRACT IF IT CONTAINS ANY BLANK SPACES. Services Buyer(s) By: et': 7( Signtrfure Signature SO eA d L c t�s}i�— $C —';,;anU—o W4i Print Name Print Name Signature Print Name You,the Buyer(s),may cancel this transaction at any time prior to midnight of the third business day after the date of this transaction. See the following Notice of Cancellation form for an explanation of this right. AFBRH4TION:'a Wm9[b!are Me nomwwnar rcered,broadly apple in movance alai in be spent enter tarry hima dlapNe Wrceming Nb peaks ,enter pally may submit sain WBpW r0 e onors mutualiOn ae—whM1 has been eppru.ea by Me Goodman, 0r ry M Me Determine Ofll (Bummer AMare and us eineas no,odu tins and be Brrin pent'set be Damon,)b mount tomtll e mlbodomp as pro+ad in No L c.rJY. ConmMr uitieb: 9m ortimia": A� corn: beri Nmnr.F OF CMCELI ADON NODCE OF Cmi I ATON OarO OI TfaneSCtlOn YW may caMal MIS trmmcli0n,,nWur any penally or Dale 0f TransaNOn .You may cant Mh pareac�bn,wi rms any forms,or "it"'.oTrFMreeb ewer Meaeoredere.IryW once),a nywBpeMo-adedln, oblieadon,wmvn Mrm WHnmdryS mMeelnveaere.RymocanmLanypmneMtraded ln, mrpaymems novae by call aer Me eonmN Br sale,and any negotiable mwumem eaeWmd env wrm.mm�,aee Wyou undm Ma cBIMaN Br sale,and am Weaabm lrpWmem.l,mvma by you will be Dermot wanm 10 days Farmers recegl by me seller N yew arldeoabBn more, by you win be rewned worn ro deys mlumng remlpl"a seirerm ma mysewmr mrerem wine aN pl Me o-anmcuon whl ba mnreoed.nyouraWekyoumus m rermr Dal your cmcNmhan,wnn, a an not rlgurnoub Dnmpbopwtobawmoed.rcyWwrcN,—vi. make emseaeb Me BNmr udWrDmerm,m mbam,tiNha gakifyou Be,orap,van a, mare e.Nbaemme selleral,vurlvmree,MwbamrmalM aagBBdmnditionazvomphesum any goods distributionasookeauubkr Mia C1.i ti prromihe sali or may.if thon mmpy van and anygemons 0�eDdmr re,prer Mb romen dominant Sant orpumey,B mowW,wmpM wbe ed mt. 11youal makne breg�Rtlng Me DNm Nv,Sold, Me Sonedesbe egenee and linkbou It im do make Moddng Me reNm Die Senor ed gayaur does no eyenae9M risk. Ir de rip make Ma gross..I.e.m Me Stem,eM bay Ballot by oppose os pick Memup poo Ifrolldomaken.gnVa Notes m m Me SenorwMe onsm bxsnN pi1Neemup vdMln 2p,emor Medtlen.of fr W4xolmencallaWn,yllY mSy remineMe Sendori 1.a nods withousaereNMe detect s,Yvr NOYreMCdrcellgbn,yCu mayreWnddispose of Me goose M...nyWMercby amE.nyandal to doe Me an you ail .ifor ter,or ilyau aoDe uNqurn b NMerre toon.erbad of re be on, men you random ratio aMeor deralryW eorall m DWm Meg l9bommor TmMma me dam Men,pubil domain lw Podmmdntt oral) up return Me gmdsmoaee To padid bMm,Menymil ordsound for pMnd MW Nall of me ooperaer McCed or mar otor nosanLbnm&I a mean aligneda"ind wpy obliher- uMernre CmVe0.TpcarcMs none..da Mind a donagmasynedanddaba wpy N M Sudan Seen,Mea m any 0 wdnm Ohre,a mM a lelIDNIG m P8A—S✓BnS��/�/-��a(I��{`n��/�5 tln anmlmupn notis or arty other wrilmn NOT E Mind n MIDNIGHT m AM senlma,ns MOM atreel,Salem,MessaMuew at9]o.NOT UTEfl TIPN MIpNIGNT pF / N..Bdee4 Be MaOvtlmsetts 01970.NOT UTEfl TXPN MIDNIGHT OF (Deb) / ' (Dam) IHEPEBYCANLELTHISTMNBFCTION, f.u—'.Slgnabre Deb 1 HEREBY C.CELTHIS TRANSACTION. counumm%sgnamD Dare OF-SALEM PUBLIC PROPRERTY DEPARTMENT x,staeatnr nosooti u,,,roa uo Vm"N ceismW a&Mart.mmuz mMal 7o 'Isis 9W4543%o PA*WW4&%% Workers' Compeasadosi Issuance AllidsvW BailderslCo Aonfinst Inarmadon Namai Address: ' city/s- - zip Phone Am Yon an SOphayar?Chet tb appropriate ban i.❑ I as a*mp1c w wilt 4. ❑ 1 am a generel contester and i employees,(62 and/or past-tiers}e have hired the 6 13 N@w C°Oanedon 2.01 no awe proprietor or paetaeo- listed on the wronbW also t.t 7. (]Ramodsling ship and have so employees These 264000acom have S. ❑Demolidon working be me h any cyadty. workers'Comp,kVAIML (No workers'camp,tomaaoa S. ❑ We am a cerpon"end let 9. O Buildingaddition 3.011�am a h nr oBkera haw exa diaod their 10.[]Eleeerieal repairs or addidow doing an worst tight of amption per MGL 11.0 pktmeing tepaka or addidow mysaM(No workers'comp. L 132.§1(4}and we have no 12.13 Roof repairs insurance i t employees.INo We&=#cam 13.�Other Ca iannanoe requirS&I tAer YPMrn serer earrle Ina el rM eke ter eta ter asuoahalswrleatag stir�rrke,' ifmroeeOraan11�n1aYrAlaMa��MdeYtrlerlkwertbpwbort�q�p� a rCaAuecerw the stark tW lit rater ithehat r detlw rhsts reokr as serer ales nallerdy ri sak.ee.raaas w ark aotks•rq,peft Grjerwa �P's t a'eowpewwafowt huanwcila AW eta+ Befar Is theoo/k7 exlM sW Insurance Company Natty Polity M or Self ins.Lis Ak Expiration Darr. Job site Addras City/sttte2ip Attack a copy d the workara'Corponadon policy dec ars on Pop(showing the polity aamherace/exphrsdoa date} Failure to secure coverage As required under section 23A of Mt3L L 132 Can lead In the' fine up to S 1,500.00 and/or ono.yar imprisonment.as well as civil mpositiara°f crimioai Panamaof a of up to$230.00 a a penalties in the form of A STOP WORK ORDER and a Are tnvesri t vioistar advised that a copy of Chia sotetaent may be fonvertled to the Of!!ee of gado=of the DIA for insuranes Coveraer verification f do hereby ce'dAF under Ad pahm and pena/der o/oer/ruy tAas the/A/ormasian prowed above/e ow awl eantid Signature: Da� Phone M: O.DYe/d were oxIA Do nos wrlb in tkk are4 to be Complete!by dry or to ve ohkhd City or Town: Permilluesse M Issuing Authority(circle one): 1. Board o/Health 2.Building Department 3.City/rows Clerk 4. Eleetr(cal inspector S.Plumbing Iwpeat 6.Other or Contact Person Phone M __ CSR � DATE(MMIDD/YYY1') ACORD CERTIFICATE OF LIABILITY INSURANCE 9ASP805 12 28 06 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION .ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE John J Walsh Ins Agency, Inc HOLDER,THIS CERTIFICATE DOES NOT AMEND,EXTEND OR P 0 Box 4407 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Salem NA 01970-6407 Phone: 978-745-3300 1Pax:978-745-9557 INSURERS AFFORDING COVERAGE NAIC# INSURED: INSURERA: Penn-America Insurance Co. INSURERB: American =6=aciooal Gr p INSURER C: TMArelere Indemnity:Company As an Roofing Services Inc 4 31orence St #3 INSURER D: Salem 14A 01970 INSURER E' COVERAGES 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.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR NSR TYPE OF INSURANCE POLICY NUMBER DATE MWDD/Y DATE MAID ON LIMITS I GENERAL LIABILITY EACH OCCURRENCE $ SOOOOOO A i $ COMMERCIAL GENERAL LIABILITY IN ISSUR 12/31/06 12/31/07 pREM19ES Eaoccurence E100000 CLAIMS MADE X❑OCCUR MEOEXP(AnyOneperson) E 5000 PERSONALBADV INJURY ESOOOOOO I I GENERAL AGGREGATE E 2000000 Ej REGATELIMIT APPLIES PER : PRODUCTS-COMPlOPAGG E 2000000 Y PRO- LOC JECT ILE LIABILITY COMBINED SINGLE LIMIT E (Ea arzidwt) ANYUTO WNED AUTOS BODILY INJURY $ (Per person) DULED AUTOS AUTOS BODILY INJURY $ (Per accident) WNED AUTOS PROPERTY DAMAGE E (Per acddenq IABILITY AUTO ONLY-EA ACCIDENT $ UTO OTHER THAN EA ACC $ AUTO ONLY: AGG S MBRELLA LIABILITY EACH OCCURRENCE E OCCUR CLAIMS MADE AGGREGATE E I $ DEDUCTIBLE $ RETENTION $ $ I WORKERS COMPENSATION AND TORYUMITS 1 1 ER B EMPLOYERS'LIABILITY WC6932479 12/31/06 12/31/07 E.L.EACH ACCIDENT $1000000 ANY PROPRIETOR/PARTNER/EXECUT VE OFFICER/MEMBER EXCLUDED? I - E.L.DISEASE-EA EMPLOY $ 1000000 N yes,describe under E.L.DISEASE-POLICY LIMIT $1000000 SPECIAL PROVISIONS below OTHER DESCRIPTION OF OPERATIONS/LOCATIC NS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION 0001003 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER ITS AGENTS OR REPRESENTATIVES, I" ...:'..'"f .....:.:, AUTHORIZED REPRESENTATIVE . John J. Wals -- Ins. A c - , Inc ACORD 25(2001108) - -"' -O ACORD CORPORATION 1988