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118 WASHINGTON ST - BUILDING INSPECTION (3) CITY OF SALEM PUBLIC PROPRERTY DEPARTMENT XUBEa18Y Datcai NAYM M WAstmvGMN SMW a SAL104 MAXACHUW IS 01970 Tb_WI.745-9595 a FA%9M740.9" Workers' Compensation Insurance Affidavit: Builders/Contractorsi/mectrtciaasn%mbera Applicant Information / Plea se Print Leffib Name(Busians/Orpniauodrnmv;Awly. �L b vl LlL Address:— / 7 -T v ad vv lt;f_ ��„-� c /oa c�ayn Pr y�'�Ce ✓tiy� �Z7 City/StRWMP: 2—�am-P✓> v,)Ze ✓J y 2-J �j %ne 0- 6, r '7 b Z 7< Are you in employer?Check the appropria"m Type of project(reqWreQ: LEI I am a employer with 4. ® I an a;meeal contractor and I � �Now construction employees(W and/or part-am).• have hired the subcontaetma 2.0 I am a sale proprietor or partner. listed on the attached sheet.t 7. M Remodeling ship and have no employees Them mb-contacmn have 8. 0 Demolition working far me in any capacity, workers'comp,insurance. [No workers'comp.it ammes 5. 0 We are a corporation and its 9. 0 Building addition required.] onicent have exercised their 10.0 Electrical repairs or additions 3.0 1 am a homeowner doing all work right of exemption per MGL 11.0 Plumbing repairs or additions myself.[No workers'comp. a 152,§1(4),and we have no 12.0 Roof repsin 1 insurance required.]t employees[No workers' 13.[j Other GQ comp.hmmu a required.] fAay WPl aua ere chain boa 01 mart Was am tut the aaetra blow&mine thatrwaatwa Hamrowama who auhmr tar andwk mdksftg fty era Aotar au wa toe&aa ton atsai GO=made at6 h "tarn atddavit lka rC atanaa "that chxh thin but RUNS atmend as addf =W spat tnwmr tlo can of tar aubeamaetan ape tntr wen'comp m sdaa xx /am am enrpltryer that V provUlns workers'eompenseden hLswuwe for try rmployea Below 4 the policy andJol sMr injormatiaa Insurance Company Name: 1 rIS v rm r! �zyy, �Q�n G�g Policy M or Self-ins.Lie. Y G Z bo of ! ! v Expirstioa Dan: 3 f o Job Site Address r/� i�a-°� S Ciry/State/Zip: �e�A,y✓/ }')ypQ Attach a copy of the workers'compensation policy declaration page(showing the policy number said e: Failure to secure coven as p4sdoa )'8e required under Section 25A of MGL o. i 52 can lead to the imposition of criminal penalties of a fine up to S 1,500.00 and/or ewe-year imprisonment,as well as civil Paw a is the form of a STOP WORK ORDER and a Nee of up to S250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the ORDER a Investigations of the DIA for insurance coverage verification /do kereby cerdJjt wader t/!u palru/and pen ajperfary that the lajoaaadon provided above Is aura and camres DaCJ Phonc#6 Z- S g' -� J 5 O,Q?efef ass on/3t Donor write in th4 area,to ke eomp/etsd by city ar fawn oJ)?eiaL City or Town PermitiLicense N Issuing Authority(circle one): 1. Board of Health 2.Building Department 3.CIry?own Clark 4.Electrical Inspector S.Plumbing Inspector ti.Other Contact Person: Phone#: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their emPWYM& [tact of him, ursi to this statute.an dmPfoyse is defined as"...every person in the service of another under any express or implied,oral or written." kd^corporation of other legal entity.or any two of mom oAn f the n defined d i a irdividuttl.par and inc. the legal representatives of a deceased employer,ttr the of the foregoing engaged is a joist entespriee.and utehding to cM However the association a other legal entity,tanployiog emp Y receiver or trusbo of an individtssl.Peren and who resides therein,a the om qma of the owner of a dwelling hours having not am than thtse apartinenb ersons to do maintenance.enmatneti�or repair wadi m such dwelling hotw or of di Inoue of another build who WIMM thereto shall not because of such employment be deemed to be an empklyer-" or on the grounds err building appurteneru MGL chapter 152.$2SQ6)also stain that"ever'state or local fleeashag agescy cling withhold tM i6suss"or nsevasl of•m ores or paw to a business or to eosudraet building in the common lth wea for eq aee able evideaee of eomptluea with the iosursum coverage rMulrcIL aPPUe who has not pry states Neither the commonwealth nor any political 132,$23t:.Cn of its litical subdivisions shan Additionally.MGL chapter of public work until aeeepmble evidence of compliance with the insurance enter into any cantmct for the performance to the contracting cc authority." requirements of this chapter have bean presented Applieasb completely.Please fill out the wodwe compensation affidaviticompletely.by checking the boxy that apply to your situatitin and.it necessary.supply sub-con°>wtor(a)name(&),addrow(es)and phone numbe (s)along with their certi8eatds)of eves . Limited Liability lea(LLc)or Limited Liability pa�ershtps(LLP)with no employees other than the members orpattmn,are not required to carry workers'compensation insurance. If an LLC or LLP dos have a policy is Be advised that this affidavit may be submitted to the Department of Industrial ld �i�for confirmation of insurance coverage. Abe i be e sue to sign a is date the u9st4�� Hof barons to the city or town that the application for the permit a licenser is being equested, ba ronssl pmidtmb Should you have any questions regarding die law or if you are required to obtain a worker' compensation policy.please call the Departm as amsf number listed,below. Self-insutad companies should enter their self-insurance hcoun member on the City or Tows Ofi>elad lete and printed legibly. The Dapartment has provided s space at the bottom Please be sure that the affidavit is comp to contact you of the affidavit for you to fill rite number whichent the �°f investigations will be used as ahreference numbers is addition,an applicant Please be sum to fill in the egarding the aPPlkM3L Partin applications in any given year,aced only submit one affidavit indicating correas that must submit multiple ptermutlltcense aPP the applicant should write"all locations in__(city er policy information(if nwxuarY)and under"Job Site Address" the city or town may be provided to the town)."A copy of the affidavit that has bum officially stamped or marked by ty u on file for Raise permits or licenses. Anew afudrvir mast be filled out each year.where proof that s valid affidavit a license or[>�not related to any business or commercial vanmss year.Whew a home Parer err citizen a obtaining is NOT required to complete this affidavit (i.e. a dog license or permit to bum leaves ere.)said person The Office of Investigations would like to thank you in advance for your cooperation and should You have any queadons, please An nat hesitate to give us a call. The Deparuacot's address,telephone and fax number. TM Commonwealth of Massachtuetts DepaMust of In&dnd Accidents O®ce of InvesdPlions 600 washjngton SttVd Boston,MA 021 It Tel. #617-727-4900 Wd 406 of 1-877-MASSAFE Fax#617-727-7749 Revised 5-26.03 www.mega,g0V1&1 IP17 572 2g( EI`PY-OF'gXtE� —- PUBLIC PROPERTY DEPARTMEINT KIMSEX FV oRMCLUL .MAvot 13D WASMNGmN NrREEC &Atty,NnssAaHLstl'rsOt970 _ TEL-97l-70.9599•FAx:979-7J0-9u6 APPLICATION FOR THE REPAIR, RENOVATION, CONSTRUCTION, DEMOLITION. OR CHANGE OF USE OR OCCUPANCY, FOR ANY EXISTING STRUCTURE OR BUILDING 1.0 SITE INFORMATION Location Name: %/�S Building: - - Property-Address.—y-(-g- P�� 4-24 - ---- — --- -- , Property Is located in a: Conservation Area Y/N Historic Disfrid Y/N T 2.0 OWNERSHIP INFORMATION 2.1 Owner of Land 7 _ Name: Address: C7 iZ L LC r7 �mjao_ 072 Telephone: (o ) ,? 2 S 3.0 COMPLETE THIS SECTION FOR WORK IN FYiaTING BUILDINGS ONLY Addition Existing Z Renovation f Number of Stories Renovated Change in Use New Demolition Existing Approximate year of Area per floor (sf) Renovated construction or renovation ) Gj c z of existing building New B&I Description of Proposed Work: L-��'� r Ge i �r Yam) �in�\ '2-: -------Mail Permit to: _ - - --- --- What is the current use of the Building? Material of Building?S"?I! � If dwelling. how many units? Will the Building Conforrn to Law? �g'e_ e, Asbestos? Archites Name � ' S ct' v), n 0 z�y 3 Address and Phone C�,Ro ?G� ca s�i t S6g� Mechanic's Name 6;, 1,82 Address and Phone a✓� 10� S% �*� v 1l< az� Sq ! g Construction Supervisors License# e- 6 I L 3 HIC Registration# Estimated Cost o,�ff Project permit Fee CalculeWn Permit Fee$��� b H7,15(P1 Estimated Cost X$71$1000 Residential I -- -- - — �: -- _-- - - Estimated Cost X$111$1000 Commercial----- ---. 0 S •• _ An Additional $5.00 is added as an Administrative charge. Make sure that all fields are property and legibly written to avoid delays in processing. The undersigned does hereby apply for a Building Permit to buildto the above stated specifications. Signed under penalty of perjury X Date ! o 0 to 0 y� � N C� x us �k-- d� - t Client#,35588 RCGBU CORD. CERTIFICATE OF LIABILITY INSURANCE10113106 MWO°"Y"Y A PRODee� THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION INSURANCE MARKETING AGENCIES ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR 306'MAIN STREET ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. WORCESTER,MA 01608 508 753-7233 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A: Crum&Forster 42471 RCG Builders LLC INSURER B: Associated Employers Insurance Co. dO RCG-LLC INSURER C' 17 Ivaloo Street,Suite 100 INSURER D: Somerville,MA 02143 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. POLICY EFFECTIVE POLICY EXPIRATION LIMITS F�ALM YPE OF INSURANCE POLICYNUMBER DATE MMIDDIYY DATE MMIDD LIABILITY GLOO91105 03/31/06 03/31/07 EACH OCCURRENCE S1000000 MERCIAL GENERAL LIABILITY DAMAGE TO RENTED $SO DDD PREMISES CLAIMS MADE OOCCUR - MEDEXP(Anyone Person) S PD Ded:15000 PERSONAL&ADV INJURY $1 00O 000 GENERAL AGGREGATE s2 00O 000 GREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGG $1000000 CY J LOCILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accldenU AUTOWNEDAUTOS BODILY INJURY $ DULED AUTOS (Per Person) D AUTOS BODILY INJURY $ -OWNED AUTOS (Per amtlenU PROPERTY DAMAGE $ (Per acadent) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY. AGG $ EXCESSIUMBRELLA WABIUTY EACH OCCURRENCE S OCCUR CLAIMS MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ B WORKERS COMPENSATION AND WCC5005531012006 05/10/06 05/10/07 X Ir EMPLOYERS LIABILITY E.L.EACH ACCIDENT $500,000 ANY PROPMETORIPARTNERIEXECUTIVE OFFICERIMEMBER EXCLUDED? EL.DISEASE-EA EMPLOYEE s500,000 K yee,describe order SPECIAL PROVISIONS be. E.LDISEASE-POLICY LIMIT $500,000 OTHER DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS Peabody Block LLC and RCG LLC are named as an additional insureds where required by contract or written agreement with respects to general liability coverage for the project know as Peabody Block(encompassing 120 Washington Street,247 Essex Street,8-10 Barton Square),Salem,MA. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION Peabody Block LLC DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL _1n_ DAYS WRITTEN C/O RCG LLC NOTICE TO THE CERTIFICATE HOLDER NAMED TO ME LEFT.BUT FAILURE TO DO SO SHALL 17 lvaloo Street,Suite 100 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR Somerville,MA 02143 REPRESENTATIVES. AUTHORIZED REPRESENTATIVE ACORD 25(2001108),1 of 2 #127562 GCE 0 ACORD CORPORATION 1988 118 Washington Gulu Assumptions # Units 1 Gross Square Feet 1,665 Net Square Feet 1,665 Construction $/NSF $ 28.56 Cost per Unit Division Label Division 1 General Requirements $ 2,094 4% Division 2 Site Work/Demo $ 2,900 6% Division 3 Concrete $ - 0% Division 4 Masonry $ 0% Divion 5 Metals $ - 0% Division 6 Wood and Plastics $ 4,820 10% Division 7 Thermal/Moisture Protection $ 6,007 13% Division 8 Doors and Windows $ 4,945 10% Division 9 Finishes $ 11,104 23% Division 10 Construction Specialties $ 990 2% Division 11 Equipment $ - 0% Division 12 Furnishings $ - 0% Division 13 Special Construction Systems $ - 0% Division 14 Conveying Systems $ - 0% Division 15 Mechanical $ 11,800 25% Division 16 Electrical $ 2,900 6% Construction Subtotal $ 47,561 120 Washington St Construction Estimal $ 47,561 47561 100% 00774045q DRIVER'S LICENSE - - -Q6-'I9SG D xecxr -0+Y-Q)-7QQ;T BERNIER MICHAEL 16 CHANDLER ST NEt4'tON,MA 02458 ti ,_ Mtn �rvnr�ra„;zum..¢l/./L af'✓�fm::o�,/w.ae%Ye . BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR Number: CS 086143 ;9a Birthdate: 11/01/1964 x Expires: 11/01/2007 Tr.no: 86143 Restricted: 00 MICHAEL G BERNIER 16 CHANDLER ST NEWTON, MA 02458 Atlministratorhrafor BUILDERS Standard Form of Agreement between Owner and RCG Builders LLC where the basis of payment is the Cost of the Work Plus a Fee without a Guaranteed Maximum Price Date: March 1 1 2007 4 , Is Owner: Peabody Block LLCy I 'C/o RCG LLC �'al� 17 Ivaloo Street, Suite 10D ' All MA 02143 s Contractor: RCG Builders LLC u Egg" .17dIvaloo$treet,TSuite{100 G Somerville, MA 02143rl „ � m � Architect: Khalsa pesign �� � 17 Ira o Street Somerville MA'021�"'Is Project Name: Gulu,Gulu;Salem;MA'-" �Y ' �yg� 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 Budget 3. Project Schedule 4. Signatures Exhibits Exhibit A: Estimated Cost of Work Exhibit B: Hourly Billing Rates Exhibit C: Project Schedule Exhibit D: Drawings Page 1 of 7 e BUILDERS 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. 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, 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: T e of Insurance Limit of Liability ;Commercial General Liabilityir ..$„�—>a6aG. ?I�?a.-.i.& ?s tt.,;..m +cuk.:_�,.'n'+�;.a� ;, '6t,.h"�e .._r.L h . 1 "" .k��,,.dl..- .,6 .. i,+T��R'�.'.'.,...,;`` ,.' 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 Total Construction Volume. 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 7 BUILDERS 2. Contract Budget 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 Contractor's Fee is as shown below and shall be referred to as ll the Contract Budget: �CG nji,,;(o('e�y Cost Plus Estimated at$47561.00 see schedule of Change Orders. M9 The Contractor does not guarantee the Contract Budget in any form. In the event of c anges to the Contract Budget, the Contractor will present changes to the owner for costs that exceed the Contract Budget 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: The Contractor shall charge a fee of 15% of Construction Volume up to $1 million, and 10% of Construction Volume over$1 million. Construction Volume includes all construction trades, general requirements, insurance, bonds and miscellaneous costs deemed necessary to perform the construction of the project, but excludes permits and fees. Permits and fees shall be paid directly by the Owner. The Contractor's Fee covers pre-construction and project management services and field personnel and associated management overhead. The Total Construction Volume and Contractor's Fee combine to equal the Cost of Work. The Contractor's Fee is charged on actual costs incurred, with final true up, and is booked monthly in arrears. Specifically, 1. The cost of pre-construction and construction management services provided by Contractor personnel is booked monthly in arrears based on the hours reported by each employee. 2. Hours are billed at the standard hourly billing rate established from time-to-time for each employee. See Exhibit B for RCG Builders LLC billing rates. 3. The cost of pre-construction and construction management services provided by independent contractors is booked when invoiced and carried within the Fee. 4. If the Project is terminated or suspended by the Owner prior to completion, the Contractor will be compensated for the actual cost of services provided prior to receipt of notice of termination or suspension from the Owner. 5. Construction management labor and associated overhead are covered within the Fee. Specialty tools or equipment, trade labor supplied by Contractor personnel and approved transportation and meals costs shall be charged directly to the Owner without a fee. Contractor personnel functioning as tradesmen outside their management duties will be charged according to their hourly billing rate. 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 higher Cost of Page 3 of 7 I BUILDERS 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 Budget 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 apply for payment of 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. 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: 10°A of billed costs,`unless otherwise a proved lij the Owner z'wmr"„r;f, 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, including all its costs of labor and overhead without a true up to the Fee. 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. Working Capital: The Contractor shall not bear the costs of Working Capital for the project. If the Owner would like the Contractor to gain beneficial pricing on its behalf by paying Subcontractors ahead of the Requisition schedule, the Owner shall either(1) put on deposit with the Contractor a sufficient amount of Working Capital for the Contractor to pay these Subcontractors, or(2) make payments upon request from the Contractor outside of the normal Requisition process. Provision of Working Capital shall entitle the provider to all discounts and savings associated with that capital. Page 4 of 7 BUILDERS 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. ;March 2012007 5or such time that Notification to Proceed is `Ivan b Ouirner --' ' Contract Time: The Contractor shall provide to the Owner a Project Schedule (see Exhibit C). 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 June 7,2007 or six(6) calenda�fr months s�. aw }it .mnn V..e„i 4...._vuy..* 3�u.`�SA frorri'Date�of C&nmencement.� .'�..z " ' �' k �4 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. Page 5 of 7 BUILDERS 4. Signatures The Owner's representative is: Peatiodl Block LLt Go RCG LLG Matthe_w',Piaa sic 17 ivaloo StreeLpSuitey100 Somer4i116, MA 02143 § 14.4 The Contractor's representative is: David Steinberg►i RCG 8uiCders LLC; 17,Ivaloo Street Suite 100 Somerville,XMk02141 This agreement is entered into as of the day and year first written above and is executed in at least thre original copies, one for the Owner, one for the Contractor, and one for the Architect. Owner Contractor Signature Signature L. YY14-yr4 J�;e e b y S v Printed Name and Title pN- A-t , Printed Name and Tit/ Page 6 of 7 BUILDERS Exhibits Exhibit A: Estimated Cost of Work Exhibit B: Hourly Billing Rates Exhibit C: Project Schedule Exhibit D: Drawings Employee Rate David Steinber h $125/hr Skip Rose $125/hr Mike Bernier $125/hr Kieran Whelan $125/hr Ken Shea $100/hr Jason Downing $50/hr Page 7 of 7 o CITY OF SM ,EN'WSACHUSETTS BVILDLNG DEPARTM&NT 120 WASHINGTON STREET, 3' FLOOR TEL (978) 745-9595 Fnx(978) 740-9846 KUt(BERLSY DRISCOIL -'MAYOR THO"ST.PmRRE DIREC70R OF PuBLic PROPERTY/BL'uzngG cO%missIO,iER 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 c 40, S 54; gBuilding Permit# - is issued with the condition that the debris resulting from this work shall be disposed of in a properly licensed waste disposal facility as defined by MGL c 111, S 150A. The debris will be transported by: (name of hauler) The debris will be disposed of in s , (name of facility) (address of facility) 4-3 signature of permit applicant date /