0050 ST PETER STREET BPA-13-491Gl a c
y C, T.c .
The Commonwealth of Massachusetts
1 Department of Public Safety
Massachusetts State Building Code(780 CMR)
Building Permit Application for any Building other than a One-or Two-Family Dwelling
a. n. (This'.$ecdon Fo Official Us.'e Qnly)° ",::; .-; ..s, .
BuildingPermitNumber: ' ''- Da[e.Applied BuildingOff c alf.'`. `'''"
SECTION 1:LOCATION(Please indicate Block#and Lot#for locations for which a stieet addre'ss is 'not availab(e) .:-:
No.and Street City/Town Zip Code I Iame of Building(if applicable)
b 'BEC ION-2:PROP09fiD WORK'"= x
EcliHon of MA State Code used if New ConstrucHon check here O or check all that apply in the two rows below
Existing Building Repair Alteradon AddiHon Demolition (Please fill out and submit Appendix 1)
Change of Use Change of Occupancy Other Specify:
Are building plans and/or construcHon documents being supplied as part of this permit application? Yes No
Is an Independent Structural Engineering Peer Review required? Yes No
6rief Description of Proposed Work:A.LL / G'"'l.q liLQt -
i.(//A/Y 1 -
7
SECTION 3:-.COMPLETE THIS SECTTON,IF.EXISTING BUILDING UNDERGOING RENOVATIOPI;:ADDITION,OR'
CH ANGE'IN USE OR OCCUPANCY`:`. ,s „ Y ' =
Check here if an Existing Building Investigation and Evaluation is enclosed(See980 CMR 34)
Existing Use Group(s): Proposed Use Group(s):
SECTION 4:BUILDING HEIGHT ANI?;'AIrEA '`.'= .:;': '-.
Existing Proposed
No.of Floors/Stories(include basement levels)&Area Per Floor(sq.ft.)
Total Area(sq. ft.) and Total Height(ft.)
SECTIONS:.USE'GRQUP(ChecKas applicable): "^ .::. ' .4,. , '_:
A: Assembly A-1 A-2 O Nightclub A-3 A-4 A-5 B: Business E: EducaHonal
F: Facto F-1 F2 H: Hi h Hazud H-1 H-2 H-3 H-4 H-5
I: Institutional I-1 I-2 .I-3 [-4 M: Meccantile R: Residential R-1 R-2 R-3 R-4
S: Storage Sl S-2 U: Utility Special Use O and please describe below:
Special Use:
SEC'TION6iiCONSTRUCTION T'YPE.(Checkasapplicable)-': ,
IA IB IIA IIB IIIA IIIB IV VA VB
SECTION.7i SITE INFORMATION (refer to 7S0 CMR 111A foc details on each item)J'', - -
Trench Permit: Debris Removal:
Water Supply: Flood Zone Information:Sewage Disposal:
Licensed Dis osal Site
Public Check if outside Flood Zone Indicate municipal A trench will not be P
Private or icidehtify Zone: or on site system
required O or trench or specify:
permit is enclosed
Railioad right-oF-way: Hazazds to Ai[Navigation: hlA Historic Ci,mmission P.eview Process:-
Not Applicable Is Structure within airport approach area?Is their review completed?
or Consent to Build enclosed Yes or No Yes No
SECTION 8:CONTENT OF CERTIFICATE OF OCCUPANCY
Edition of Code: Use Group(s): Type of Conshvction: Occupant Load per FLoor:
Does the building contain an Sprinkler System?: Special Stipulations:
1 C t a: f 6.2(.
g/ .,; -" a
l/ / n oT 'Yk..i.,.y (9/oi
r ,'. ;" . ,, .,:j, , ; , „ SECTION,9:,PROPERTY 04VNER AUTI30RIZA.TI N E'Q , yy,t i y
Name and Address of Proper Owner
C L L2 J Sig/d T. . _ .. , .. 34
N2me(Print) No.and Street City/Town Zip
Property Owner Contact Information:
j -1 5"s L---- _
Title Telephone No. (business) Telephone No. (cell) e-mail address
If applicable,the property owner hereby authorizes
Name StreetAddress City/Town State Zip
to act on the ro er owner's behalf,in all matters relative to work authorized b this buildin ermit a lication.
r ' SECTIQNIO CONSTRUCTION CONTROL(Please fil}out Q.ppendix 2)
a.,
f buildin s lese_ttfmi 36,000 eu:ft_of endosed a'ace and%or notundecConetiuct on Conteolkhemefieckfie`ie and'ski" Sechon 10:1, -`
10.1 Re 'stered Pcofessional`Res onsible foi Construction Controt- . 3 . .::r, ,3.,,.,,. .,, ,4...,,r .. . , ...
VJ . 2 n -i-a 3/j 3 h 1
Name(Re i tra /
l'
T ho j / e-mail a dress Registration Num r
D B/
Street Address _ City/Town State Zip Discipline ExpirationDate
10.2 GeneraD Co'ntractor 3 . .,, .,.,... ` ,z: . N :^-;:' p n .
J `_ 'j.0 cfi2u c rc/'
Comp ({e
l 75 3 r
Name of Pe s Responsible or Co cHon icense No. and Type if Applicable
lj L e, - D'3y
Street Address City/Town State Zip
3
Tele hone No. business Tele hone No. cell e-mail address
ECTION.11:.l1'URKGP.S'•Cpb1['G iS.4TION NSli 2ANCL=AFP[DAVIT' M1G.L.c.152i 25C 6 r
A Workers'Compensation Insurance Affidavit from the MA Deparhnent of Industrial Accidents must be mmpleted and
submitted with this applicaHon. Failure to provide this affidavit will result in the denial of the issuance of tkte building permit.
Is a si ed Affidavit submitted with this a IicaHon? Yes No O
r„-. , t R„. .`- , ,,;-S ECTION 12:CON9TRUCTIONC08TS AND,PERMIT FSE - ;'".':
Item
EsHmated Costs: (Labor
and Matecials) Total Consh-uction Cost(from Item 6)_$
1. Building J ' Building Permit Fee=Totai ConstrucHon Cost x_(Insert here
2.Electrical appropriate municipal factor)_$
3.Plumbing
Mechanical (HVAC)
Note:Minimum fe =$ contact municipality)
5.Mechanical Other
Enclose check payable t
6.Total Cost yn contact municipality)and rite check number here
a S CTION 13:SIGNA.TUR;E OF BUILDING PERMIT'AP ICANT ^
6y entering my name below,I hereby attest under the pains and penaltles of perjury that a of the informaHom m tained in this
applicaHon is true and accurate[o the best of my knowledge and understanding.
Please print and sign name Title Telephone No. Date
Street Address City/Town S Zip
Mumc pal Inspeetoc to fill out tlusseetion upon appl eation approval
Name D
CITY OE S.1LE,I, l L-1SS.-1CHL;5ETI'S
BtiiLD[NG DEP R'C(E iT
s • l?O W.SHGVGTON STR£ET, 3'O FLOOR
1 L (978} 735-9595
F.{x(978) 7 50-98-t6
KI BERL.E,Y DRISCOLL
1AYOR Tl ort1 s ST.FtERxB
DIREC[OR OF PCBUC PROPEAiY/BCII,DLVG GO L IISSIONER
Wurkers' Compensation Insuranca Aftidavit: Duitders/ContructorslElectricians/Plumbero
4 iltcant infi rmaNnn P ease Pr1nt Le ibt
V;1t11C(13usin S.wOr anizmiory ividuaq: S
Address: u 'S S
Ciry/Statc/Zip: CJ Phone l: / s /
Are yo employer?Cheek the app opdata box: Pype of proJect(requlred):
1. 1 am a cmployer wi[h 4. 0 I arn a gencrri contcactot and 1
have hinni he subconnacWrs
6. New conatructian
employep(tLil aadlor paet-time).
2.O am a sole propdetar or partm:r- lis[ed on ha attachcd vhe¢t t 7. Remadeling
xhip and havn no employeea iliesa sub-contrac[ors havo 8. pemolition
wur&ing for me in any capaciry. workers'comp, insurnnce. 9. Duilding addition
No workeri comp.ineurance S. 0 We are a eorporation and itn
requireJ.) orYcers havn exercised theu IO.Q Elecrcical repairs or addicions
3. 1 am a homcuwnor doing all work right of exemption per MGL I I.Q Plumbing rcpnirs or udJitioro
myxlf.[No workcrs'cump. c. 152, q I(4),and we have no Z.Q 2aaf n.pnuy
insuranct royuiced.j i umployaes.[No wor@ers'
Q Olhetcump.in.wrance rcquircd.J
nny upplie:un hW ch kt bmcAl mus al;w 011 aul ha uwtiuo bclow+howiny tha'a wprkus'rnmpenudun Jwli y infurmalloa
IM1imvuwnen who Mdimit thia at7ldnvi indiwing ihry aro doiny oil woh and ihrn hiro outlids wmmetpf musl au6mit a xw alflJavit indioliny auch
C rmrm:iow hal chak ihi 6o7c m mt ailuhed an nJAitiuwl xh:t shuwiny ha numc of tAe,ub.;mm tton ond hcir wuhm'mmp.puliry InfamuNon.
um an employe that Ja provlding ivo ke t'companaadon Lrraranes for my ampluyeu.x Beluw/thi po!(cy und Jab s!h
ii jormulloa
Inwranw Cumpany?lmne:
Yulicy H ur Self-i u.Lic.H: Ecpiration Date:
Jub Site AdJresx: Ciry/Statr/Zip:
ttach n copy of IBe irorker'compensatloa palley deciaratton prga(howfng the policy num6or and explrattoe datey.
F iluro to securu covnrnga required unJer Section 25A aCMGL c. 132 can lead to tha imposition of criminal prnaltiea of a
tine up to S I,S00.00 uneVar one-year imprisonmen4 as wcll aa civil ponalties in thn focm uf q STOP WORK ORDER anJ n fine
of up to S?50.00 a Juy against rhe violaror. le adviscd hat rnpy of thix atuumenl may be forwazdud ta he Olfice of
Invcs igmioav uf't6e DIA for insunnet c rveroge v¢ritic iun.
do her c u der hr puinjj 7tl peiiul let ojprr/ury t/rut/ro L junuuNon providrJ ubuvs is true aird coirrc4
Si•nat_ure:_ L22s-z 1 if—— I)ato•
Phono,i:
OJJirru!use m ly. Ou imt rvrile irc dtlr uiru m bs cu up/eled by ciry u Iow s i JJ)rluL
Cityar'fawn:Ycrmitll.lcenreq
I suingAWharily(circlounc):
1. Uu•rrJ uf Ife l h 2. DuildtnL Departmcn .i.Citylforvn Clcrk A. Electrtc l Inspector 5. Plumbing In.specror
b.O lur___
Contact Penon: Phone tl:
Arbella Protection
Insurance Company
lA R B E L LA 1100 Crown Colony Drive COMMERC I AL PACKAGE POL 1 CY
o.,.. Quincy, MA 02269-9174 RENEWAL DECLARAT I ONS
DIRECT BILL - INSURED
PDLIGYIiUMBBR PRIDRpOLICYt9UMBER FRpPA;:W 7p ::
8540U52283 10/1B/2012 10/1B/201 12 :01 AM STANDARD TIME 2
i+3AMECllNSUI b AIUD AbbR 55 AGEN1'
JF GENERAL CONTRACTING INC WOODWARD & HIGGS INS AGCV INC
58 PULASKI ST UNIT 3B 156 BROAD ST
PEABODV, MA 01960 SUITE 202
LVNN, MA 01901
410
NAMED INSURED AND BUSINESS ENTITY ARE AMENDED
ANNIIAL PREMIIIM:
1,264
FORM OF BIISINESS: CORPORATION
BUSINES3 DESCRIPTION: CARPENTRY , TILE WORK & PAINTING
WE AGREE WITH YOII TO PROVIDE THE INSURANCE AS STATED IN THIS POLICY.
THIS POLICY CONSISTS OF TFIE FOLLOWING COVERAGE PARTS .
COVERAGES P M=Comrrercia roperty Coverage 229
Commercial General Liability Coverage 1, 055
TOTAL 1,284
FORMS AND ENDORSEMENTS MADE PART OF THIS POLICY AT TIME OF ISSIIE
28AP1161 01-08 IMPORTANT NOTICE - OFFER OF TERRORISM
30AP1001 01-96 COMMERCIAL POLICY JACKET
31AP1001 10-09 MAIN SAIL PROPERTY COVERAGE ENDORSEB NT
CP0090 07-88 COMMERCIAL PROPERTY CONDITIONS
CP0109 10-00 MA CHANGES
CP0176 09-06 MA EXCL VIRIIS BACTERIA
CPP006 09-06 MA EXCL VIRIIS OR BACTERIA PHN
IL0017 11-98 COMMON POLICY CONDITIONS
30AP1093 02-02 ASBESTOS EXCLUSION
CG0062 12 -02 WAR EXCLUSION
CG0063 12-02 WAR EXCLIISION
CG2149 09-99 TOTAL POLLIITION E%CLIISION ENDORSEMENT
CG2196 03-OS SILICA OR SILICA-RELATED DIIST EXCLUSION
CG2426 07-04 AMENDMENT OF INSIIRED CONTRACT DEFINITION
Continued on Next Page . . . PAGE 1
nsure opv
Arbella Protection
Ir surance Company
11 R B E L LA 1100 Crown Colony Drive COMMERC I AL PACKAGE POL I CY
Quincy, MA 02269-9174 RENEWAL DECLARAT I ONS
DIRECT BILL - INSURED
POLIGV ttUNiBER PRIOR POLICY tqUMBER pR?.POLiCy pEq{pp a _:
8540052283 io/ie/2oi2 1o/1e/2o1 i2 :oi AM STANDARD TIME 2NanrirusunaNnanntssaNr
JF GENERAL CONTRACTING INC WOODWARD & HIGGS INS AGCV INC58PULASKISTUNIT36156BROADST
PEABODV, MA 01960 SUITE 202
LYNN, MA 01901
410
FORMS AND ENDORSEMENTS MADE PART OF THIS POLICY AT TIME OF ISSUE
CG3370 03-05 SILICA OR SILICA-RELATED DIIST EXCLIISION
IL0021 04-98 N[TCLEAR ENERGY LIABILITY ERCLIISION
AGENCY AT LYNN MA
DATE 09/24/ 12
PAGE 2 insure .nnv
i
Arbella Protection
Insurance Company
11 R B E L LA 1100 Crown Colony Drive COMMERC I AL PROPERTY POL I CY
o..... Quincy, MA 02269-9174 RENEWAL DECLARAT I ONS
Direct Bill - Insured
POLIGY Nk1N1BER Pk(CR POLICYHUMBER pR ::PDUCY pERtOp r ::_
85UOD52283 lo/1e/2o12 io/ia/2oi iz :oi rsa sTumnx.o Tlet 2r4aiAMtfINSUFtDANDllt1L?R SS A6ENT
JF GENERAL CONTRACTING INC WOODWARD & HIGGS INS AGCV INC
58 PULASKI ST UNIT 38 156 BROAD ST
PEABODY, MA 07960 SUITE 202
LVNN, MA 01901
410
NAMED INSURED AND BUSINESS ENTITY ARE AMENDED
ANNIJAL PREMIDM:
229
FORM OF BUSINESS: CORPORATION
BIISINESS DESCRIPTION: CARPENTRY , TILE WORK & PAINTING
DESCRIBED PREMISES:
LOCATION: 1 BIIILDING: 1
58 PULASKI ST UNIT 36
PEABODV , MA 01960
SUBJECT TO ALL THE TERMS OF THIS POLICY , INSURANCE IS PROVIDED AS SHOWN .
COVERAGES PROVIDED:
COVERAGE LIMIT OF DED.COV CAIISES
LOC BLG DESCRIPTION INSURANCE AMOIINT VAL. OF LOSS COIN% PR11ersrop6 —C -—
FORMS AND ENDORSEMENTS MADE PART OF THIS POLICY AT TIME OF ISSUE
30AP1078 03-02 EQUIPMENT BREAKDOWN ENDORSEMENT
31AP1079 07-02 ARTISAN CONTRACTORS ' TOOL & INSTALLATION ENDT 200CP001004-02 BIIILDING & PERSONAL PROPERTY COV FORM
CP1030 04-02 CAIISES OF LOSS - SPECIAL FORM
CP1064 09-06 MA FUNGUS ROT BACTERIA E%CL & LIMITATION END
CPP005 09-06 ADVISORY NOTICE MA LTD COVG FUNGUS/MOLD, ROT.
IL0953 01-08 EXCLIISION OF CERTIFIED ACTS OF TERRORISM
AGENCY AT LYNN MA DATE 09/24/ 12
PAGE 1
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Arbella Protection
Ihsurance Company
A R B E L LA 1100 Crown Colony Drive COMMERC I AL GENERAL L I AB 1 L I TY
e..... Quincy, MA 02269-9174 RENEWAL DECLARAT IONS
DIRECT BILL - INSURED
POLIGY:NUM9 R PRIORPOLICYNUM6ER FROM::POLICYP£7ttOD F .:
85a fl522$3 10/18/2012 10/1B/201 12 :01 AM STANDARD TIME 2
tUAM b 1N3til t1 41iID AC1Df2E5S AGENT
JF GENERAL CONTRACTING INC WOODWARD & HIGGS INS AGCV INC
56 PULASKI ST UNIT 38 156 BROAD ST
PEABODY, MA 01960 SUITE 202
LVNN, MA 07907
410
NAMED INSURED AND BUSINESS ENTITY ARE AMENDED
ANNOAI' PREMZIIM° 1, 055
FORM OF BIISINESS : CORPORATION
BIISINESS DESCRIPTION: CARPENTRV , TILE WORK & PAINTING
DESCRISED PREMISES :
LOCATION: 1
58 PULASKI ST UNIT 3B
PEABODV , MA 01960
SUBJECT TO ALL THE TERMS OF THIS POLICV , INSURANCE IS PROVIDED AS SHOWN .
LIMITS OF INSIIRANCE
GENERAL A6GREGATE LIMIT
OTHER THAN PRODUCTS/COMPLETED OPERATIONS) 2 , 000 , 000
PRODUCTS - COMPLETED OPERATIONS AGGREGATE LIM 2 , 000 , 000
PERSONAL & ADVERTISING INJURY LIMIT 1 , 000 , 000
EACH OCCURRENCE LIMIT 1 , 000 , 000
FIRE DAMAGE LIMIT 100 , 000 PER FIRE
MEDICAL EXPENSE LIMIT 5 , 000 PER PERSON
PREMIUM
CLASSIFICATION CLASS PREM PREM/ PROD/
LOC# BLDG# DESCRIPTION CODE BASIS ID OPS COMP OPS
1 1 Carpentry—interior 91341 4,300 (P) 17q
7 7 Carpentry—interior 91341 4,300 (P) 31
7 1 Painting—interior 96305 28 ,600 (PJ 547
7 1 Painting—interior 98305 528 ,600 (P) gg7
1 1 Tile , Stone , Marble , Moseic 99746 4,300 (p)ggp
1 1 Tile , Stone , Marble , Mosaic 99746 4,300 (p) 16
7 1 Contractors—Subcntrct work 91585 0 (C) 0
Continued on Next Page . . .PAGE 1
nsure onv
Arbella Protection
Insurance Company
A R B E L LA 1100 Crown Colony Drive COMMERC 1 AL GENERAL L I AB I L I TY
Quincy, MA 02269-9174 RENEWAL DECLARATIONS
DIRECT BILL - INSURED
Pf311CY[iE1MBER Pk1OR PDLICYI?ItJMBER FR ::PDLfiGYpEq[Op ia ::
5Q00522$3 ' 10/18/2012 10/16/201 12 :01 AM STANDARD TIME 2 1+IAINEn NSU t b kNb At)Df2 SS ':; A NT
JF GENERAL CONTRACTING INC WOODWARD & HIGGS INS AGCV INC
5B PULASKI ST UNIT 3B 156 BROAD ST
PEABODV, MA 01960 SUITE 202
LVNN, MA 01901
410
PREMIIIM
CLASSIFICATION CLASS PREM PREM/ PROD/LOC# BLDG# DESCRIPTION CODE BASIS ID OPS COMP OPS11Tile , Stone , Marble , Moseie 99746 0 (C) SO
ID DEFINITION: (P) = Payroll Per $ 1, 000
ID DEFINITION: (C) = Total Cost Per $1, 000
FORMS AND ENDORSEMENTS MADE PART OF THIS POLICY AT TIME OF ISSIIE
CG0001 10-01 CGL COVERAGE FORM-OCCURRENCE
CG2010 07-04 ADD'L INSURED-OWNERS, LESSEES, OR CONTRACTORS 100
SEE FORM
CG2147 07-98 EMPLOYMENT-REI,paTED PRACTICES EXCLUSION
CG2151 09-89 LIQIIOR LIABILITY E%CLIISION - EXCEPTION FOR SC
CG2167 04 -02 FIINGI OR BACTERIA EXCLUSION
CG2169 01-02 WAR OR TERRORISM E%CLIISION
CG2173 01-08 EBCLUSION OF CERTIFIED ACTS OF TERRORISM
CG3142 01-02 WAR OR TERRORISM EXCLUSION
A ENCY AT LYNN MA DATE 09/24/ 12
PAGE 2
nsurr .nnv
Arbella Agent Compensation Disclosure
Thank you for purchasing insurance with a licensed agent ofthe Arbella Insurance Group
Arbella). Arbella partners with agents like yours to ensure your insurance experience is
personal, local and neighbor(y. We have found that local agents can provide the right
advice and counsel when you need it because your agent knows the ins and outs of
insurance and New England.
Arbella member companies generally pay compensation to their agents (also called
producers), and may have paid compensation in connection with your policy. Only
certain licensed producers are allowed to sell business on behalf of Arbella. These
producers earn compensation which is usually paid in the form of commissions. Base
commissions are usually a fixed percentage of the policy premium while contingent
commissions are paid after Arbella evaluates the quantity and quality of the policies sold
on its behalf. Eligibility for, and the amount of, contingent commission earned or paid
depend upon an agent's ability to meet certain production, growth, profitability or other
quality and quantity perfonnance objectives established by Arbella. Producers can also
earn individual incentive awards. lf you want more details please go to www.Arbella.com
or ask your agent for more information.
28AP1205 (06/09)
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IS YOUR BUSINESS PREPARED FOR A DATA BREACH7
A business laptop is stolen, a back-up drive is missing and paper files are lost. What do you do? I
Now Arbella Insurance Group has data risk management services to help you stand up to the risks of a data breach. These new
services are your first line of defense in data breach preparation, damage control and resolution. For as little as$80.00 you
could purchase protection for this risk. i
All companies that handle or store any private business,customer or I
employee information are vulnereble.The risk of a breach is especially J UST TH E FACTS
high when you routinely deal with credit cards, Social Security numbers Steadily rising costs ro resolve a breach averaged
and other sensitive information. Business owners that typically don't store 7.2 million per company and$214 per
sensitive information electronically are not immune.compromised cuscomer record in 2010.
Personally identifiable information can be exposed during a wide range of More chan S 15 million records were exposed in
everyday business situations. Existing security measures, such as a firewall, breaches from 2005—i1*
can't protect against breaches caused by employee error, a lost laptop, a privacy Rights C/esring House,Ponemon lnstitute
misplaced smart phone, stolen papervvork or data mistakenly left on old
office copiers, printers and fax machines
When a data breach happens, businesses are required by law to noti,
IDentityTheftaffectedcustomersandgovernmentauthoritiesorfacethepossibilityof n'.•Rotectingih titiesEnlunc'vgrepuhtlo. ' fines and other penalties.
DATA RISK MANAGEMENT SERVICE INCLUDES:
Access to a secure breach preparedness website
Professional assistance to help you confidently handle a breach crisis.
Breach Expense Coverage
You can be confident that Arbella will provide swift solutions to help safeguard and restore your businesses' reputation, and
provide you, your customers and employees with help and protection before and after a breach.
For more information on these services, contact your Arbella agent.
Arbella Insurance Gmu is com rised of insurers doin busine in th
I
P p g ss e states of Connecticut,Massachusetts,New Hampshire,and Rhode Island.These materials are not intended to
constitute an advertisemen,solicitation or oHer for sale in any jurisdiction where our companies are not licensed o do 6usiness.These marketing materials do not provide a completedescriptionotallcoverages,exclusions and cbnditions in the policy.Policy terms may be changed by Ihe insurer Gom time to time.Anyone interested in our pmducts should seekmoreinformationlromoneofourprofessionalinsuranceagenis.Our local agents can review your particular circumstances and explain the details o1 any coverages for which you areeligible.Issuance of coverage is su6ject to undarwriting.
28AP1255 07/7 1
Disclaimer May 201 7 All Rights Reserved
Arbella Protection
Insurance Company
11 R B E L LA 1100 Crown Colony Drive COMMERC I AL PACKAGE POL I CY
o.,.,o.,....„.o.... Quincy, MA 02269-9174 RENEWAL DECLARAT I ONS
DIRECT BILL - INSURED
PQLIC P&1M9EfR PRIOR POLIGY NUMBER FRDH9 X p TO
8;50 052283 io/ie/zoiz io/ia/aoi iz :oi aM smasmr.xn TIME 2
t31N Gl i bAND1lbQFt 55 At+G 1T::
JF GENERAL CONTRACTING INC WOODWARD & HIGGS INS AGCV INC
58 PULASKI ST UNIT 3B 156 BROAD ST .
PEABODV, MA 01960 SUITE 202
LVNN , MA 01901
410
NAMED INSURED AND BUSINESS ENTITY ARE AMENDED
ANNQAL PREMIIIM: 1,284
FORM oF BUSINESS: CORPORATION
BUSINESS DESCRIPTION: CARPENTRY , TILE WORK & PAINTING
WE AGREE WITH YOII TO PROVIDE TIiE INSIIRANCE AS STATED IN THIS POLICY.
THIS POLICY CONSISTS OF THE FOLLOWING COVERAGE PARTS .
COVERAGES PREMIUM
Commercia roper,ty Coverage 229
Commercial General Liability Coverage 1, 055
f
TOTAL 1,284
FORMS AND ENDORSEMENTS MADE PART OF THIS POLICY AT TIME OF ISSIIE
26AP1161 O1-08 IMPORTANT NOTICE - OFFER OF TERRORISM
30AP1001 01-96 COMMERCIAL POLICY JACKET
31AP1001 10-09 MAIN SAIL PROPERTY COVERAGE ENDORSEMENT
CP0090 . 07-88 COMMERCIAL PROPERTY CONDITIONS
CP0109 10-00 .MA CHANGES
CP0176 09-06 MA EXCL VIRIIS BACTERIA
CPP006 09-06 MA EXCL VIRIIS OR BACTERIA PHN
IL0017 11-98 COMMON POLICY CONDITIONS
30AP1093 02-02 ASBESTOS EXCLIISION
CG0062 12-02 WAR EXCLUSION
CG0063 12-02 WAR EXCLUSION
CG2149 09-99 TOTAL POLLUTION EXCLUSION ENDORSEMENT
CG2196 03-OS SILICA OR SILICA-RELATED DUST EXCLUSION
CG2426 07-04 AMENDMENT OF INSIIRED CONTRACT DEFINITION
lContinued on Next Page . . .PAGE 1
nsure opy
Arbella Protection
Insurance Company
l R B E L LA 1100 Crown Colony Drive COMMERC I AL PACKAGE POL I CY
o.,.,o.......o.... Quincy, MA 02269-9174 RENEWAL DECLARATIONS
DIRECT BILL - INSURED
POE.ICY t M9EiR PRIOR ROLIGY NUMBER pq P.CK#C1{PER{OD {,Y
85II 522 3 io/ie/2oiz io/ie/zoi iz:oi smarmaxn TIME 2
M1iA14 i)INSt91 b A 1,4t?f f2 35 A+G N7':;:
JF GENERAL CONTRACTING INC WOODWARD & HIGGS INS AGCV INC
58 PULASKI ST UNIT 3B 156 BROAD ST
PEABODV, MA 01960 SUITE 202
LVNN, MA 01901
410
FORMS AND ENDORSEMENTS MADE PART OF THIS POLICY AT TIME OF ISSIIE
CG3370 03-OS SILICA OR SILICA-RELATED DIIST EXCLIISION
IL0021 04-98 NIICLEAR ENERGY LIABILITY EXCLIISION
AGENCY AT LYNN MA DATE 09/24/ 12
PAGE 2
nsure opy
P.rbella Protection
Insurance Company
l i R B E L LA 1100 Crown Colony Drive COMMERC I AL PROPERTY POL I CV
o..,o.,....„.o..,.. Quincy, MA 02269-9174 RENEWAL DECLARAT IONS
Direct Bill - Insured
fiSiLICYl 1MBER PRIDRPDLICYHUb16Eli p p F'AL.iCYPERiqB £{y
g5 3UD522$3 1o/ie/2oi2 io/ie/2oi iz :oi ua sT.a,rmr.xn rx[2
C31N3CUI[AM111 1a f RE85 A G NT:
JF GENERAL CONTRACTING INC WOODWARD & HIGGS INS AGCV INC
58 PULASKI ST UNIT 36 156 BROAD ST
PEABODV, MA 01960 SUITE 202
LVNN , MA 01901
410
NAMED INSURED AND BUSINESS ENTITV ARE AMENDED
ANNQAL PREMIIIM: 229
FORM oF BIISINESS: CORPORATION
BIISINESS DESCRIPTION: CARPENTRY , TILE WORK & PAINTING
DESCRIBED PREMISES:
LOCATION: 1 BUILDING: 1
58 PULASKI ST UNIT 36
PEABODY , MA 01960
SUBJECT TO ALL THE TERMS OF THIS POLICY , INSURANCE IS PROVIDED AS SHOWN .
COVERAGES PROVIDED:
COVERAGE LIMIT OF DED.COV CAUSES
LOC' BLG DESCRIPTION INSURANCE AMOIINT VAL. OF LOSS COINS % PREMIUM
1 1 e r s o p 0 00 C S E-`17 0°r 2T
FORMS AND ENDORSEMENTS MADE PART OF THIS POLICY AT TIME OF ISSIIE
30AP1078 03-02 EQUIPMENT BREAKDOWN ENDORSEMENT
31AP1079 07-02 ARTISAN CONTRACTORS' TOOL & INSTALLATION ENDT 200
CP0010 04-02 BUILDING & PERSONAL PROPERTY COV FORM
CP1030 04-02 CAIISES OF LOSS - SPECIAL FORM
CP1064 09-06 MA FUNGIIS ROT BACTERIA E%CL & LIMITATION END
CPP005 09-06 ADVISORY NOTICE MA LTD COVG FUNGIIS/MOLD, ROT.
IL0953 O1-OB E%CLIISION OF CERTIFIED ACTS OF TERRORISM
AGENCY AT LYNN MA DATE 09/24/ 12
PAGE 1
nsure opy
Arbella Protection
Insurance Company
A R B E L LA 1100 Crown Colony Drive COMMERC I AL GENERAL L I AB I L I TY
o,..,o.,.....,o.... Quincy, MA 02269-9174 RENEWAL DECLARAT IONS
DIRECT BILL - INSURED
pOLiGY i MOER PRIOR PDLICY NUit78ER pqp P.QIiCY PER{00 g
5Q00522$3 10/18/2012 10/16/201 12 :01 AM STANDARD TIME 2
C fAM I3 11t..U T3 AN1/1[7Clf't Sr$ 4Cs C+1'1':::
JF GENERAL CONTRACTING INC WOODWARD & HIGGS INS AGCV INC
56 PULASKI ST UNIT 36 156 BROAD ST
PEABODV, MA 01960 SUITE 202
LVNN, MA 07901
410
NAMED INSURED AND BUSINESS ENTITV ARE AMENDED
ANNQAL PREMIUM: 1, 055
FORM OF BIISINESS: CORPORATION
BIISINESS DESCRIPTION: CARPENTRY , TILE WORK & PAINTING
DESCRIBED PREMISES :
LOCATION: 1
58 PULASKI ST UNIT 3B
PEABODY , MA 01960
SUB.JECT TO ALL THE TERMS OF THIS POLICY , INSURANCE IS PROVIDED AS SHOWN .
LIMITS OF INSIIRANCE
GENr RAL AG6REGATE LIMIT
OTHER THAN PRODUCTS/COMPLETED OPERATIONS) 2 , 000 , 000
PRODUCTS - COMPLETED OPERATIONS AGC REGATE LIM 2 , 000 , 000
PERSONAL & ADVERTISING INJURY LIMIT 1 , 000 , 000
EACH OCCURRENCE LIMIT 1 , 000 , 000
FIRE DAMAGE LIMIT 100 , 000 PER FIRE
MEDICAL EXPENSE LIMIT 5 , 000 PER PERSON
PREMIUM
CLASSIFICATION CLASS PREM PREM/ PROD/
LOC# BLDG# DESCRIPTION CODE BASIS ID OPS COMP OPS
1 1 Carpentry—interior 91341 4,300 (P) 174
1 1 Carpentry—interior 91341 4,300 (P) 31
1 1 Painting—interior 98305 28 ,600 (P) 547
1 1 Painting—interior 98305 28 ,600 (P) 97
1 1 Tile , Stone , Marble , Mosaic 99746 4,300 (P)90
1 1 Tile , Stone , Marble , Mosaic 99746 4,300 (P) 16
1 1 Contractors—Subcntrct work 97585 0 (C) 0
Continued on Next Page . . .PAGE 1
nsure opy
Arbella Protection
Insurance Company
A R B E L LA 1100 Crown Colony Drive COMMERC 1 AL GENERAL L I AB I L I TV
o...,o.,......o..... Quincy, MA 02269-9174 RENEWAL UECLARAT IONS
DIRECT BILL - INSURED
PALIGY f M9ER PRIDR ROLICYM{h418ER pRp{ j'P' a
850 0522$3 10/18/2012 10/18/201 12 :01 AM STANDARD TIME 2
NAtUf t3 FM1 U I t3 AN1'/tbC R 58 A+IT:::
JF GENERAL CONTRACTING INC WOODWARD & HIGGS INS AGCV INC
58 PULASKI ST UNIT 38 156 BROAD ST
PEABODV, MA 01960 SUITE 202
LVNN, MA 01901
410
PREMIIIM
CLASSIFICATION CLASS PREM PREM/ PROD/
LOC# BLDG# DESCRIPTION CODE BASIS ID OPS COMP OPS
1 1 Tile , Stone , Marble , Mosaio 99746 0 (C) 0
ID DEFINITION: (P) = Payroll Per $ 1, 000
ID DEFINITION: (C) = Total Cost Per $1, 000
FORMS AND ENDORSEMENTS MADE PART OF THIS POLICY AT TIME OF ISSIIE
CG0001 10-01 CGL COVERAGE FORM-OCCIIRRENCE
CG2010 07-04 ADD'L INSIIRED-OWNERS, LESSEES, OR CONTRACTORS 100
SEE FORM
CG2147 07-98 EMPLOYMENT-RELATED PRACTICES EXCLIISION
CG2151 09-89 LIQIIOR LIABILITY E%CLIISION - E%CEPTION FOR SC
CG2167 04-02 FIINGI OR BACTERIA EXCLIISION
CG2169 01-02 WAR OR TERRORISM EXCLIISION
CG2173 O1-08 EXCLUSION OF CERTIFIED ACTS OF TERRORISM
CG3142 01-02 WAR OR TERRORISM EXCLUSION
AGENCY AT LYNN MA DATE 09/24/12
PAGE 2
usure opy
Arbella Agent Compensation Disclosure
Thank you for purchasing insurance with a licensed agent of the Arbella Insurance Group
Arbella). Arbella partners with agents like yours to ensure your insurance experience is
personal, local and neighborly. We have found that local agents can provide the right
advice and counsel when you need it because your agent knows the ins and outs of
insurance and New England.
Arbella member companies generally pay compensation to their agents (also called
producers), and may have paid compensation in connection with your policy. Only .
certain licensed producers are allowed to sell business on behalf of Arbella. These
producers earn compensation which is usually paid in the form of commissions. Base
commissions are usually a fixed percentage ofthe policy premium while contingent
commissions are paid after Arbella evaluates the quantity and quality ofthe policies sold
on its behal£ Eligibility for, and the amount of, contingent commission earned or paid
depend upon an agent's ability to meet certain production, growth, profitability or other
quality and quantity performance objectives established by Arbella. Producers can also
earn individual incentive awards. If you want more details please go to www.Arbella.com
or ask your agent for more information.
zsAP zos (06/09)
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IS YOUR BUSINESS PREPARED FOR A DATA BREACH?
A business laptop is stolen, a back-up drive is missing and paper files are lost. What do you do?
Now Arbella Insurance Group has data risk management services to help you stand up to the risks of a data breach.These new
services are your first line of defense in data breach preparation, damage control and resolution. For as little as$80.00 you
could purchase protection for this risk.
All companies that handle or store any private business,customer or ' ' ' " '
employee information are vulnerable.The risk of a breach is especially J UST TH E FACTS i
high when you routinely deal with credit cards, Social Security numbers Steadily rising costs to resolve a breach averaged
and other sensitive information. Business owners that typically don't store 7.2 million per company and$214 per
sensitive information electronically are not immune. compromised cuscomer record in 2010.
Personally identifiable information can be exposed during a wide range of
I
More chan 515 million records were exposed in
everyday business situations. Existing security measures, such as a firewall, breaches from 2005-11*
can't protect against breaches caused by employee error, a lost laptop H p¢cy Righfs Clearing House,Ponemon lnstitute
misplaced smart phone, stolen paperwork or data mistakenly left on old I
4_,—_.
office copiers, printers and fau machines.
When a data breach happens, businesses are required by law to notify I Dentit TheftafFectedcustomersandgovernmentauthoritiesorfacethepossibilityofY n
Rotxtingi(kn[itiesEnhanci yrepulatiort. '
fines and other penalties.
DATA RISK MANAGEMENT SERVICE INCLUDES:
Access to a secure breach preparedness website
Professional assistance to help you confidently handle a breach crisis.
Breach Expense Coverage
You can be confident that Arbella will provide swift solutions to help safeguard and restore your businesses' reputation, and
provide you, your customers and employees with help and protection before and after a breach.
For more information on these services,contact your Arbella agent.
Arbella Insurance Group is comprised of insurers doing husiness in the states of Connecticut,Massachusetts,New Hampshire,and Rhode Island.These materials are not intended to
constitute an advertisement,solicitation or offer for sale in any jurisdiction where our companies are not licensed ro do business.These marketing materials do not provide a complete
description of all coverages,exclusions and conditions in the policy.Policy terms may be changed hy the insurer from time to time.Anyone interested in our producis should seek
more information from one of our professional insurance agents.Our local agents can review your particular circumstances and explain ihe details of any coverages for which you are
eligible.Issuance of coverage is subject to underwriting.
28AP1255 07/11 Disclaimer O May 2011 All Rights Reserved
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