Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
18 WILLIAMS ST - BUILDING INSPECTION (4)
ZA The Commonwealth of Massachusetts CITY OF n Board of Building Regulations and Standards �i Massachusetts State Building Code, 780 CMR Sd Revised 1far.blur 2011 Building Permit Application To Construct, Repair, Renovate Or Demolish a One-or Two-Family Dwelling This Section For Official Use Only, . BuildingPertnitNumber: - Date,Applieda Building Official(Pant Name). a Date SECTION ftSITEINFORNIA lON LI Peer Ate 77es,s: r v Z 1.2 Assessors:Map&Parcel Numbers M1 C�J I.la Is this an accepted street. yes no Map Number Parcel Number 1.3 Pnin Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Area(sy tt) Frontage(It) 1.5 Building Setbacks(ft) Front Yard Side Yards Rear Yard Required Provided Required Provided Required Provided 1.6 Water Supply:(M.O.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Public❑ Private❑ Zone: _ Outside Flood Zone? Municipal❑ On site disposal system ❑ Check if yes❑ 1 SECTION 2: PROPERTY OWNERSHIP` 2.1 fivr�r�t o ecprdv h �e eta I <i. h�i (eI 'r nl) 4L-. r City,State,ZIP m No.and Street Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORK=(check all that apply) r� New Construction❑ Existing Building❑ Owner-Occupied ❑ 1 Repairs(s) kv, Alteration(s)Ifff Addition ❑ Demolition ❑ Accessory Bldg.❑ Number of Units._— Other ❑ Specify: Brief Description of Propos d W rk': L U Pi '�- C f -S4l ✓ SECTION 4: ESTIMATED CONSTRUCTION COSTS Estimated Costs: Item Official Use Only Labor and Materials I. Building S f`7 I. Building Permit Fee:S Indicate how fee is determined: © � ❑.Standard City/Town Application Fee` 2. Electrical $ ❑Total Project Costa(Item 6)x multiplier' x 3. Plumbing 0 00 2. Other Fees: S 4. Mechanical (HVAC) S List: . 5. iNfechanical (Fire S Total All Fees:5 Su ression) Check No. Check Amount: Cash Amount: 6. Total Project Cost: $ t ❑paid in Full ❑Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 C/o^nstruction Supervisor License(CSL) /h % r �y / � & �&t r A 0 fi l/ 1 License Number Expiration Date Name of C L Holder 1 L t h&n List CSL Type(see below) No. and Street Type Description - O G / l/ U Unrestricted(Buildings u to 35,000 cu.It.) L (0 a ] R Restricted 1&2 Famil Dwelling City/Town,State,ZIP M Masonry /Y N�y D / Ll` / © RC RoofingCovering ' �' D (� WS Window and Siding SF Solid Fuel Burning Appliances Insulation Telephone Email address &A,0 .C14 D I Demolition 5.2 Registered Home Improvement Contractor(HIC) HIC Registration Number Expiration Date HIC Company Name or H e 'slmnt Name No.and Street 1A Email address City/Town, State,ZIP Telephone SECTION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c. 152.§ 25C(6)) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the Is§uance of the building permit. Signed Affidavit Attached. Yes .......... ❑ No...........❑ SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN, OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT h ' I, as Owner of the subject property,hereby authorize T' / 4 6, L [ {-.a to e/�!� -t4 act on my behalf,in all matters relative to work authorized by this ilding permit application. Pont Owners Nan (Electronic Signature) —�� T S Dale SECTION 7b:O W NE W OR AUTHORIZED AGENT DECLARATION By entering my name below, 1 hereby Rites n the pains and penalties of perjury that all of the information contained in this application is true and a ur o the best of my knowledge and understanding, (i U "at Owier's or Authorized a\gent's NaA IecVunic Signature Dale NOTES: I. An Owner who obtains a building permit to do his/her own work,or an owner who hires an unregistered contractor (not registered in the Home Improvement Contractor(HIC) Program),will not have access to the arbitration program or guaranty fund under M.G.L.c. 142A.Other important information on the HIC Program can be found at www.mnss gov'oca Information on the Construction Supervisor License can be found at Avww.mass.gov/dos 2. When substantial work is planned,provide the information below: Total floor area(sq. R.) (including garage, finished basement/attics,decks or porch) Gross living area(sq. ft.) Habitable room count Number of fireplaces Number of bedrooms Number of bathrooms Number of half/baths Type of heating system Number of decks/porches Type of cooling system Enclosed Open 3. "Total Project Square Footage"may be substituted for"Total Project Cost" i CITY OF S.-1LE Nl, N-DisSACHLSETTS • Bt.ILDNG DEPARTnIENT P 120 WASHNGTON STREET, 3w FLOOR -0 TH.L (978) 745-9595 FAx(978) 740-9846 KjN{BERLEY DRISCOLL MAYORTHonus Sr.PtERRs DIRECTOR OF PUBLIC PROPERTY/BCILDNG CONNISSIONER 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 I I L5 Debris, and the provisions of MGL c 40, S 54; Building 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: G (name of hauler) The debris will be disposed of in : C (name of facility) J a VigV q� �t IS LC (address of facility) i signature of permit applicant date tn �,y�rd,x NOTICE OF ASSIGNMENT ---- - _. ---EMPLOYER: ------- FIDUCIAL PROPERTIES INC COMBO I.D. STATUS OF EMPLOYER 961 BROADWAY 000969929 Corporation SAUGUS, MA 01906 COVERAGE GROUP 1021742 The Waiver of Our Right to Coverage under this assignment Recover from Others Endorsement applies to Massachusetts is available On P001 policies. operations only. For coverage Contact your agent for details. - outside of Massachusetts, contact the appropriate Pool or Plan for that state. �( --------------------------------------------------- AGENT COLUMBIA INSURANCE AGENCY INC INSURANCE COMPANY: PR JOHN OLSON AIM MUTUAL INS CO PRODUCER: 31 CENTRAL SQUARE Judith Barry LYNN, MA 01901 54 THIRD AVENUE P 0 BOX 4070 BURLINGTON, MA 01803-0970 AGENCY FEIN:042456114 (800) 876-2765, Ext: 8704 CLASSIFICATION OF OPERATION - -_ —_— ---------------------_________ CLASS ESTIMATED RATE CODE TOTAL ANNUAL ESTIMATED PREMIUM REMUNERATION _CARPENTRY NOC __________ ROOFING NOC & YARD EMP, DRIVERS 5403 $10,400 9.61 CARPENTRY-DETACHED ONE OR TWO FAMILY DWELLINGS 5545 45 $0 30. 99 $999 CARPENTRY-DWELLINGS - THREE STORIES OR LESS $0 8.68 $0 5645 EMPLOYERS LIABILITY 100/100/500 $0 868 $0. STANDARD PREMIUM 9845 $0 EXPENSE CONSTANT $999 TERRORISM CHARGE 0900 TOTAL POLICY MINIMUM PREMIUM 9740 $250 TOTAL ESTIMATED PREMIUM _ $3 DIA ASSESS. 4.2% $500 $1, 252 TOTAL EST. PREMIUM PLUS ASSESSMENT 42 INSTALLMENT BASIS: Annual $1,294 DEPOSIT PREMIUM: $1,294 THIS IS NOT A BILL COMMENTS - Coverage effective 12:01 AM on 02/02/13. Coverage under this Notice of Assignment applies coverage is required to the captioned entity only. If check for an additional entity, the employer must submit an application, , and an ERM to the Pool for the additional entity. DATE OF NOTICE: 0 2/0 7/13 PREPARED BY: Evelyn Cobb EXT 522 The Workers' Compensation Rating and Inspection Bureau Of Massachusetts 101 Arch Street • Boston, MA 02110 (617)439-9030 • FAX(617)439-6055 • WWW.Wcribma.org "tJsscichusetts - ')e,ojr'rre,r of o,b;lc Sorety Saard of Sui�ajng Requiat:ons and Sta�u,jrds moi 11,F)"ll —cellse: CS-032181 MICHAEL E ROSEN 23 LEBLANC Djt- WEST PEABODY MA 61966 gu. 03/17/2014 �c� r CITY Ov SALfm INLAXSSACHUSETI'S BUIMINIG DEPAATML&NT a ) ) 120 %V.{sHl;NGTON STREET, 3w ROOA TEr- (978) 745-9595 FAx(978) 740-9846 Ki\fBERf EY DRISCOLL THo.%w ST.PmRRa MAYOR DIREctOA OF PCOLIC PROPERTY/OCII.DL`IG CO1L11ISSIONEA Workers' Cmnpensation insurance AtTidavit: Builders/Contractors/ElectrfelansfPiumbers Alrpllcant in(ormatlon 1 Please Print Legibly Vat17C(nwiix,yG/r,�//niratiurulndividuul): �[ �(/t L /,-P/ )r T ul-k P Address: !b �Ir U�.� 1n14.�4 City/State/Zip: �GL [t �N .� Phone M: 19 / e/ � ig Are you an employer?Check the appropriate box: Type of project(required): 1.❑ Lam a employer with 4.0 1 am a general contractor and 1 6. ❑Now construction employees(fiall and/or part-time).* have hind the subcontractors 2.❑ 1 am a Bola proprietor or partner- listed on the attached sheet t 7• Remodeling ship and have no employees These sub-contractors have V. ❑ Demolition working fur 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 ME]Electrical repairs or additions 3.❑ 1 am a homeowner doing all work right of exemption per MGL 11.❑Plumbing repairs or additions myself.(No workers'comp. c. 152,0101.and we have no 12.[]Roof repairs insurance required.)t employees.(No workers' sump:insurance required.) l3.❑Other •Any appllcunt dot chucks box At must alto roll out the section below showing their waken'enmpaswiun polity inrinmatlom I Ltmuuu,m"who submit this stedavit indicating they an doing all work and then hit*outside contractors most submit a new anldavil indicting such �4mtmdoo that uh«k this box must aaached an additional shout showing the name of the subr mrsctors and their workers'ramp.put Icy Inromunon. fain an employer that is providing Ivorlran'compatsadon huuranee far my employees: Below/s the policy and fob sire infornrullat6 ,f1 Insurance Company Name., y/.G�J/ Policy 4 or Sclf-itm Lic. 4:: Expiration Date: — Job Site Address: U � 1-r�l Qom_City/statr/Zip. ,kttacb acuity of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 23A of MGL c. 152 can lead to the imposition of criminal penalties of a III fine up to 31,500.00 and/or one-year imprisonment,as welt as civil penalties in the form of STOP WORK ORDER and a tine of up to S230.00 a day against File violator. Ile advised that a copy of Chit statement may be forwarded to the Otfiea of Investigutiuns ol•dte MA for insurance coverage verification. /do hereby cert/fy ulnt surd p t eualdi of per/ury that the lu1funrradort provided ubove is true use carree4 Sien:nurc: IJtr OJJlcial ute only. Do sot write in t/fir urra,to be cuarpleled by city or town aJJ=Plumbing City or Town: _ __ Permiu7.lccnee.pL,suingAutllurity(circlo unc): 1. Board of Ileallh 1. Iluildlnti Department J.Cilyifown Clerk d. Eiectric 6.0ther i Contact Pcrsnn: ... _-_- -._ I'hona 4• 1 rv) '''CIO CERTIFICATE OF LIABILITY INSURANCE °�810 2013 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLOER. 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 ISSUINO INSURERIB),AUTHORIZED REPRESENTATIVE OR PRODUCDI1r.AND THE CERTIFICATE HOLDER, ' IMPORTANT: If the De1lHloate W 1"Ie an ADDITIONAL INSURED,the poliey(les)must be endoreod. If SUBROGATION IS WAIVED,subJ to the terms and conditions of the ps8sy,derMhl policlss may require an endonismont. A statement on this DadMoeto does not confer rights to the carMcate holder In lieu of such andoraamen s. MDWokR ! Matthews Insurance Agency Inc oxE (878)881-1112 F 978 885e1868 102 Parker St ( ) Lawrence.MAGI843 x e AFFORvnmeoYD9ese xacr 11 YRRR A, Ath mic Casualty INSURED Miohasl Cepaless INSURER a; Arbsga 105 Tyler St INSUR R c Methuen,MA 01844 P D: INSURER R:WIV V- ..UR F. COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:THIS IS TO CERTIFY 71-W THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN IS®UND TO THE INSURED NAMED ABOVE FOR THE POLICYPPIOD INDICATED. NDTIMTHSTANDINO 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 TILE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSION$AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. . wSR ADDL TIPEOF UPJNIOE R POUav NVMeart POM LINa19 aENURAL LIAR4ITY �¢ 3 1,000.000 MPIICIAL OINIRAL OABILITY L143000684 0010112013 UW0712014 EMIa€gAE4EeBA AJ� L 100,000 CLAUV.&MAU& 7 OCCUR IAMMP m mL L 1,0D0 PA NA A INJ{NY 3 1,00D,00D 1,000,000 'L ADOREDATE LIMIT APPLIES PER! PRODUCTS.CDMPICP ADD^ 1,000,ODb POLICY Lee 8 AUTW"La LIA11101Y NDI`E LIMIT joinANYA{/TO HCSS7357 6841012012 027301413 eoolLr lnJURr INaraHrnn7 a 300,000 AL OWNED ,wSGipagWLaD BODILY INJURYererPcddenit s 300.000 MIRED AUT06 A1DJT0» NSO one 3 300,0DD 8 UMPRELUUA9 OCCUR UCH opgURRENCIt } 1.000.O00 EXcessune CL MaMAoa 0111463 0212312013 OV2312014 ADDREDATE s 1. —00 N } W910MR9 COMPENSATION YrC TA� AND 9MFL*YERS'UAeUTY y HATS _ 0 PROPRIFTOWARCLU%ECU1Na NIA 890911-0937698 1IM7/2012 11/1712013 EL.RACNACCID Y �. 100,DOD IMPMbtaryrn HX) G.L.[N9 e E 3 100.000 P=438�ERATIn L,Y UMT r 500,000 dESCNIPnoN OFOPERAnONs l SDCAIIDPe IvaXrolae(Arena ACOkO Tin,AuMmal R mnot 6an3aata,a wM 3Preaa a rogbWdl Heating or combined heslMg and air conditioning systems of equipment,Installation,cervlalng or Repair,plumbing CERTIFICATE HOLDER CELLATION Altanhc Coast Homes 48 Shcool St$2 SHOY40 ANY OF THE ABOVE Ott96RR1ED POLIC16$BE CANCELLED BEFORE Salem,MA THE RXPMATIOM DATE THEREOF, NOTIDE WILL BB DELIVERED N ACCOMA=12,TwiH THE POLICY PROV191DNa. A1mIeMaO RGPgOG TW6 0 1888.201 D ACORO CORPORATION. All Hgma reserved. ACORO 20(2010NS) The ACORD name and loge am rogl tared marks of ACORD v `° fit CITY OF SALEM, MASSACHUSETTS BUILDING DEPARTMENT 120 WAS17UNGTON STREET,3" FLOOR TEL. (978) 745-9595 FAx(978) 740-9846 KIMBERLEY DRISCOLL MAYOR THomm ST.PIERRE DIRECTOR OF PUBLIC PROPERTY/BUILDING COMMISSIONER September 13, 2013 25 Rear Lynde Street Realty Trust Charissa Vitas-Trustee 25 Rear Lynde Street Salem Ma. 01970 Required Inspection- 18 Williams unit#2 Dear Owner, k This Department has received complaints about after hours construction being performed at your property. Unit #1 has building permits but we have no record of permits for your unit. Therefore ,per Mass. State Building Code 780 C.M.R -section 104.6 an inspection is required. You are directed to contact this office upon recf.ipt of this letter to arrange for an inspection. You are also directed to cease all construction activities until the inspection occurs. Failure to comply, will result in Municipal code tickets and further enforcement activities. If you have any questions, please contact me directly. Thomas St.Pierre Building Commissioner/Director of Inspectional Services ®ma c 0 // Fo i 8 w) iLLl S ST Z 5 Ly NOS, S-r- �L7 Sf\ ne and title if corporate officer) Residenfiai Address & Phone Number 1z Px x- � BY EXECUTOR/ADMINISTRATOR F (Name of Decedent) ereby request to ( ) Discontinue the business or Certificate. natures son(s) personally appeared before me and made an oath that Notary Public Date Commission Expires —..aam"s I e V v ( Lu r t S FIDUC-1 OP ID: NM °16 � CERTIFICATE OF LIABILITY INSURANCE O09/17I00�13 �,� 09I17l2013 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 RY THE POLICIES WOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED ESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER- IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED,the policy(ies) 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 endorsema s. 'RODUCER Phone:781-598-5000 wMTACT :olumbia Insurance Agency PHONE v� ;1 Central Square Fax:78159844A0 AfC Ne Efd: ._ AIC Ne: .ynn,MA 01901 40DRESS; INSURERS 4FFOROING COVERAOE.. NAIC A INSURER A A•LM Mutual Ins. Cc NSuREO 'Flducial.Properties, Inc. INSURERS: Dave Potter INSURERC: 961 Broadway Saugus,MA 01906 INsuRenD: INSURER E: _ INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES OESCRIREO HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES,LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. N TYPE OF INSURANCE NAP m, POLICY NUMBER 7PRODUCTS LIMITS GENERALLIABILITY EACH OCCURRENCE R COMMERCIAL GENERAL LIABILITY PREMISES EI CPI rWce F CLAIMS-MADE OCCUR MED EXP(An one ,eon) S FEASON_AL&AOV INJUR_V S _, GENERAL AGGREGATE -_� S_,..._...,-...___-. _GENL AGGREGATE LIMIT APPLIES PER: -COMPIOP AGO S POLICY 1-1 IpqI PRO, LOC S UTOMOBILE LIABILITY COMBINED 61NGLF-UMn' Ea accldenl ANY AUTO BODILY INJURY(Per po"r) $ ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY(Px Pcdden) 8 NON-OWNED PROPERTY DAMAGE S HIRED AUTOS AUTOS 8 UMBRELLA LIAR OCCUR EACH OCCURRENCE R EXCESS LIAR CLAIMS•MAOE AGGREGATE S _ DED RETENTIONS _ $ WORKERS COMPENSATION II WC STATU- I 10TH- ANDEMPLOYERSLIABILITY YIN 1_T.QBy ANY PROFRIETOR!PARTNERFXECUTIVE VWC10060171302013A 02/02/2013 02M212014 F.A.EACH ACCIDENT S 100,000 OFFICERIMEMBER EXCLUDED? NIA -- - �(Mandatory inNH) EL.DISEASE-EA EMPLOYE $ 100,000 - Ifyyee tleetribe under DESCRIPTI N OF OPERATH)N9 CebW EL.DISEASE•POLICY LIMIT R 500,000 DESCRIPTION OF OPERATIONS I LOCATION$I VEHICLES (Attach ACORD 101.AddltionAl Rerh rka Schedule,H men ape"Is nqulnd) rORMRS COMPENSATION INS, XbMLOYERIS LIABILITY INSURANCE AIM MUYTTAL 54 •BIRD AVE BDRLINGTON, MA 01803-0970 CERTIFICATE HOLDER CANCELLATION CITYOFS SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Cityof Salem THE: EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 13u Dept ACCORDANCE WITH THE POLICY PROVISIONS, Was• 120 Washington St AUTHORD ED PURE TAnVE Salem,MA 01970 01988 1 ORD CORPORATION. All ghts reserved. ACORD 25(2010105) The ACORD name and logo are registered mark of ACORD _ 09/17/2013 21:06 7813222995 VELTA TRAVEI. PAGE 01 lVJ Ir cia S DATE IMIaOOY NY) �► CERTIFICATE UF'': Ip►BILI AND TY INSURANCE a�18/2011 THIS CERTIFICATE CA ODES NOTUAFFIRABATIYELY OR N6GA7LY'.� NPONLYEXTEND qR ALHOLDE TfiR�7HE COV6RAO AFFOGHTS UPON THE RDED EID BY TH80 C EIS BELOW, THIS CERTIFICATE OF INSURANCE ROBS NOT GD B TUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPREBENTATNE OR PRDOUCER,AND THE CHRTIRCATE H R,a olic e11MBt IJB endenud. N SUBROOATIOH I5 ANED,sW+1RLt t0 IM RTAHT: li the ceftfleats holder Is an ADDITIONAL)NSU. 1h P YU4m1 the tsrma and if Its e6 of tho po0by,CeRaln P°IIc1oS R'aY an eLldorAsmsnt A statement on this uAi�iCate L10tl nOt Copier rtglln t0 the 00% CertIRCRte holder In Ilsu of such entloraemsn a' Commercial Linss lROWCER P n 1no. (978)532-2644 Aarr]k_Mnrtagka. SnatTSa11CA Age �, 30 Central street s e«Po C E ° NA 01960 Mau R Ila Protelotien Ina Co 1 60 naan4d7t e: INaVRE4 MaNRE 01 Stave Raruchis IN ,Rol 93 Central St NauR Peabody 1`1L 01960 1 P: COVERAGES CLRTIFICATENUMBER:CL 1817224 REVISION NUMBER: THIS 1@ TO CERTIFY THAT THE POLICIES OF IN$URAN TERM OR N I'TiQN OF ANNCDN'fRACY OR OTHER L10CRUMMEN WITH RESPECT TOLIWHICH THIS INDICATED, NOTWITHSYANpINQ ANY RERl' PERTAIN NT, CRISED EXCLUs DNS AND CONDITIONS OF SUCH PO CIE6.LIMITS SHOWN: HAVE 9OR14 REDUCED D THE INSURANCE A zFopiotb BY THE I BY PAD CLAIMS. HEREIN IS SUBJECT 70 ALL THE eY EFF P LINT N TMe bK INSURANCE U 1,DD0 000 EACH OCCUR KNCC QENEN LIAIMUTY 100 000 X COMMEAC1ALGiNERALUABILITY 9/12/2012 2/L2/2019 MEO E%P(A 0RY 3 5,00 A CLAIMS-6uoe ®mcvR so0e2eszs 1,000 000 PERSONAL&A INJuaY QENERALA TC 6 2 900,000 PROCUCTB•COMR/DPAGG 2,000,00 YIENt AGGREGATE LIMIT APPLIES PSR' i POLI PRO' LOD ED w AUTOMOBILE LIABILITY BODILY INJURY(iw Penal) C ANY AUTO SCHEDULED 5Q014N INJURY IPR woosN I;qLL OYMH7 AUTOS PERTY A 9 AUTOS ",_&PaBO HIAMAUTOS Al)r06 6 EACH DOC RREN E i um." A uAa DOWN 6 AGGREGATE EXCESS LJAII CLAIM5WAtlE 6 R TE OTH- RKERSCOMRN@ATIDN _ AND EMPLOYERR UA6IUTY E,L.MACH ACCI ENT ANY FROPRIGTORIPARTNER�%eOUTIVEY�w N/A 016EASE,EAEMPLOYE S OFMCCK/MEMBER VCL000O1 IIlOkA N V In NW) .L.pISEASE-ROLICY LIMIT Irv U69 om P,wr 0 6ORIPTI NOF OPE OESCRIPl1ONa01'CRATIONSILOFATIOM6IYEIO;La6(AEA9 ACORO 101,Aam, N RhIRONN&Mdpq elntn H4"IN.R~ CERTIFICATE HOLDER CANM IO (978)745-4 638 S"OULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DEUVEREO IN ACCORDANCE WITH THE POUPY PROVISIONS-- City Of Salem $leOtrlDieU+ AI R¢R012PRESENTATM 44 rafAyatta St Salem, 1Mh 01970 ACORD 25(2010106) 01088-2010 ACORD CORPORATION. All rights reserved. IN9025 Ths ACORD n&m&pf d logo ale r"Jetered melt of ACORD