1 CANAL STREET - SIGN PERMIT 1 Canal Street
Freedom Communications
Commonwealth of Massachusetts
a City of Salem
120 W ashington St.3rd Floor Salem.MA 01970(978)745-9595 x5641
Return card to Building Division for Certificate of Occupancy
Permit No. B-14-1260 PERMIT TO BUILD
=EE PAID: $0.00
DATE ISSUED: 7/31/2014
This certifies that SAMARI GROUP LLC FRANCIS SUMMA, MANAGER
has permission to erect, alter, or demolish a building 1 CANAL STREET Map/Lot: 340300-0
as follows: Signs SIGN PERMIT AS APPROVED FOR:
FREEDOM COMMUNICATIONS
Contractor Name: BRIAN A. CHIPMAN
DBA: METRO SIGN &AWNING
Contractor License No: CS-089645
th 7/31/2014
Buildi rkf If K I f Date
This permit shall be deemed abandoned and invalid unless the work authorized by this permit is commenced within six months after issuance.The Building Official
may grant one or more extensions not to exceed six months each upon written request.
All work authorized by this permit shall conform to the approved application and the approved construction documents for which this permit has been granted.
All construction,alterations and changes of use of any building and structures shall be in compliance with the local zoning by-laws and codes.
This permit shall be displayed in a location clearly visible from access street or road and shall be maintained open for public inspection for the entire duration of the
work until the completion of the same.
The Certificate of Occupancy will not be issued until all applicable signatures by the Building and Fire Officials are provided on this permit.
H IC #: 'Persons contracting with unregistered contractors do not have access to the guaranty fund"(as set forth in MGL cA42A).
Restrictions:
Building plans are to be available on site.
All Permit Cards are the property of the PROPERTY OWNER.
City of Salem Sign Permit Application Worksheet
RECEIVED
INSPECTIONAL SERVICES
29-Jul-14
Freedom Communications 777�
1 Canal Street JUL 3 0 P 2 4 U
Zoning(reslnon-res) B5
Entrance Corridor(YIN) Y
Lot frontage 261 feet
Building frontage(combined) 92 feet
#of businesses on site 1
Bldng dist from street center 84
Multiplier 1
maximum area permitted 92.00 sq ft
total proposed sign area 73.42 sq ft
FRONT ELEVATION sign 1
43.75 SOFT length 150.00 inches
height 42.00 inches
sign 2
SIDE ELEVATION 1 length 89.00 inches
14.83 SOIFT height 24.00 inches
sign 3
SIDE ELEVATION 1 length 89.00 inches
14.83 SOFT height 24.00 inches
sign 4
length 0.00 inches
height 0.00 inches
sign 5
length 0.00 inches
he' ht 0.00 inches
maximum area permitted 0.00 sq ft(per side)
maximum#of signs permitted 0 signs
maximum height permitted 0.00 ft tall
sign 1
proposed sign area 0.00 sq ft
length 0.00 inches
height 0.00 inches
proposed sign height 0.00 ft(approx)
sign 2
proposed sign area 0.00 sq ft
length 0.00 inches
height 0.00 inches
proposed sign height It
Application meets guidelines set
forth in the Salem Sign Ordinance Yes
Recommend approval Yes
Proposed sigange will be backlit to create a halo effect behind the
typeface,which the City's Commercial Design Guidelines cites as a
recommended form of lighting for signage.
Parrrxl trtnrlber I B ' I '� - l 2(a C�
r`
APPLICATION FOR PERNUT TO ERE-cr A SIGN'
d
it NOTE:HVLDING PEtmrr MusT BE OBTAINED BEFORE SIGN IS ERECTED
S Location, Ownership and Detail Must Be Correct, Complete. and Legible
r ?PA I=� til , l_: 1 , Salem. Massachusetts
Date
To the Building Inspector.
The undersigned hereby applies for In permit to "fact, %_Alter, a Repair a sign on the following described buildings:
C Q l u Urban Renewal Area rdrance Corridor
Historic District *lmrr
• r® - �n
Telephone 1 floor
• 2 no0f
ibM I f•.rv.rvy r .t, r. fi - —
Address 3 floor
Telephone 4 Moor
H-malt How many businesses are In the building?
Na corporate body, name
tars sWis oficer
Building Rnear/ae
Oa>$uctionSup'slJcOMNO (A, Applicants Space(if multi-tenant) linear fee
Address Property Rnear tae
Telephone _g5)_
E-mail Sign Owner Sign Erector u Other.
S
ign ---- SSIyn 2--
ce a Surface L Surface
u.
Angle to Building Right Angle to Building 6 Right Angle to Building
Standing _Fres Scantling Free Standing
g �Awning :Awning
ble(A-Frame) L Portable(A-Frame) Portable(A-Frame)
(specify) (Other(spectry) )1COthof (spactiy)
Sign Matariaq s Slgn Mstarlets Sign Mstart S
Sign Dimensions sign DI anslone ign lintensiqrs
VgrfArea It, Sign Area I sq-ti Sign Area r ,` /t
. C sgf
Sign Height Cif free standing)t J l Sign Height(11 free standing) Sign Height(if free standing)
Estimated Cost of Net Work
$
Type Sign Area To Be Ramoved? Sign r
u Surface sq It yea no
• Right Angle to Building sq ft yas _no
u Free Standing sq ft yes •_no 5wjff,0mvjaes Authon epressntadve
•Awning sq ft _yes _no
Other(specify) t 1� sq R yes no
pe O ar
701a7ngomms a elopment Department Historical Commission
vLtyw.• s�
Building Inspector
T 'd dSOT-ObL-BL6 XH3 13rN3SH-I dH WdS0 :2 bIOZ SE Inr
n EXISTING FRONT ELEvATION
19
A
Y
--
OPTION #1 PROPOSED SIDE ELEy4TI0N PROPOSED SIDE ELEVATION,
rnldMl/bllNnbc �.tib T$`9„6 NbtlEuinWEWn flYYYmY:rnr.-n'tNf01 SSI:rr Nev Luo_I]03f1.15 , i
Freedom Communications �uYm.�1 Ynn,.rnt Y.yY rer: oYYlm� r1R ■M 4Yr b..w.
I Carel Stme1•Salem,AAA u.n.ai.r.. — _ 7nm Dunn lP oc nn00o 14-13030-513 i
Ver► �0�'1 wirel ess
OPTIONAL RED HALO LIT BACKER PANEL
S/P CABINET W/HALO LIT 6 DIMENSIONAL COPY
QTY.i
Cp61YR111/IllbC9lkR. dY&pele:J3.1R IlpbNp
IN I...,... �nFlI� M I.�N".v'. L 13J]V 15 •
Freedom Communications -
C,WSl I•S:Im i.MA epplont rebleO: MIWn vlApc WwIBNm NnIreN:
Tnm Ounn )P Oi' nnu00 14-13030-8 O`
I
Freedom1216
Vert Onwireless
/ /
"Verizon Wireless": rT.rls
HALO LIT CHANNEL LITTERS, '_ ALUMINUM PACEREWRx w,IUTEowxITEBPMs zooc.
IWEIDm COMPONENTS).
.
PAINTED WHITE Er PMS 200C. � LL � LER INTERIOR PAINTED wxrtE.
"Freedom Communications Premium Retailer". I,5SPACERS(LETTERS MOUNTED
.5-ACRYLIC(NON-ILLUMINATED)COPY, OFFSET 1.5 TO BUILDING WALL)
PAINTED WHITE 6 PMS 200C. vaz FABRICATED AWMINUM WIREWAY LOSS'I5i[y PAINTED BLACK.
ICEHo
I!/'CLFAA POLYCAASONATE BACK WITH
o�y TRANSLUCENT WHOLE DIFFUSER VINYL.
u BACK ATTACHED TO LETTER WITH#A
SEE TAP SCREWS THRU RETURN
\ A DIRECTLY INTO POLYCARB BACK.
�-le AWG AGTAIL WIRES
LED MODULES
ENCLOSURE FOR POWER SUPPLY BEHIND WALL
DRAW NOTES AT BOTTOM
Total Sq. Ft. =43.75 AM..FOR EATFAICA SIGNS)
- -SUDLMG WALL
n nI [, ISI nI .S'ACRYLIC COPY PAINTED WHILE B PMS IWC
Slf CABINETW/HAIO LIT U OIf�ENSIONA1 COPY $i"—eu="W °� FLUSH STUD MOUNTED TO PANEL
CITY.1
•
'O�sKeWWtlY\ Dxt ReIE' .. nelenxelovNeneuon III Ydnix. :m NI Lao13R 11
Freedom Communications - -
RI
1 Canal Street•Salem,MA SLI
l Do, I o r a C w00000 p-1303
.r UC 00000 Ta-13U30h2
I
71 64
i
Verf Onwireless
�1 Cott, Premium Retailer
'erizon wireless
HALO LIT CHANNEL LETTERS, / x-Is-1R AWMINUM FACE B RETURN PAINTEDWNREa PMS xe6C.
PAINTED WHITE B PMS 200C. J (WELDED COMPONENS).
"Freedom Communications Premium Retailer: LETTER INTERIOR PAINTED WALE.
.5"ACRYLIC(NON-ILLUMINATED)COPY, 1.5'SPACERS ILETIERS MoumEO
PAINTED WHITE B PMS 200C. 8126 g OFFSET 1.5To BUILDING WALL]
'dS'? FABRICATED ALUMINUM WIREWAT I.060'INrtYI PAINROBULK.
, g o I/A'CLEAR POLYCARBONATE BACK WITH
F e TRANSLUCENT WHNE DIFFUSER VINYL.
W t5 l aACT ATTACHED TO LEITER W11X 1G
SELF TAPPING SCREWS PULL RETURN
I So DIRECTLY INTO POLYCARB BACK.
-lA AWG PIGTAIL WIRES
5 LEO MODULES
.g ENCLOSURE FOR POWER SUPPLY I EHn0 WALL
DRAIN HOLES AT BOTTOM
Total Sq. Ft. = 14.8 lTYR FOR EKCERIOR SIGN51
BOLDING WALL
.5-ACRYLIC COPY PAINTED WHITE B PMS 200C
SlfCABINET WIHALO III 6DIMENSIONALCOPY llleV°�w ,) NRH STUD MOUNTED TO PANE
QTV.2
rnM�F/MIKOa! WTI Blli.1.J'1.I t Rfl[MEIEPNMN.u.0 "' '��'- TNR IMI:FPE_G9N0 Saim Now Lo[ 1J WO R • ,f
Freedom Communications smKRu rRLoa Pard 1�.nur:'.IRwm: -.
1 Canal Street•Salem,MA _ Tom Dunn JP DC ODOOD 14-13030 2r2
WALL
TOP VIEW
70... . . .. .. .. ......... -- Mid" Ell
i.i.a..1_I..
PERFORATED METAL,SQUARE PATTERN,PLAIN STEEL COLD ROLLED,16 GAUGE.
3/4"SQUARE ON P'CENTERS,STRAIGHT ROW HOLE PATTERN,56%OPEN AREA,MILL FINISH.
PERFORATED METAL ATTACHED TO 1"SGUARE STEEL TUBE FRAME,MILL FINISH. —
.25"THICK HOT-DIPPED METAL PANEL ATTACHED TO FRAME,COPY WATER JET CUT.
FRAME AND PANELS CURVED.ATTACHED TO BUILDING UTIUZING APPROPRIATE HARDWARE.
1 a
OECORAINE ADDRESS SIGN
CITY.1
ioFreed Yunopc o-xp nam neaaee ivemwnivo sl xoom i, psa"m rv"..ee.aaomx _ ,
I°CeBdOm Communications - -.
7 Canal$[fPPt•$dent,bld Sales Yep_ NJ-7 /PC NpIY00 Yp-lg13
_ _ _ _.-.,. _ I n. d? �C uo00o 14-i 30303rp
II II
alig Ngai
m
II
BLADEAWNINGS. /
BLACK SUNBRELLA FABRIC.-
flE0 PAINTED STRIPE. —
ATTACHMENT DETAILS TBD
BASED ON DETAILED FIELD SURVEY.
3 3
BLADE AWNINGS DPrIDN , OPTION#z
QTY.a
D '-' `•
Ce lllMlxage G'10 71 Aele¢elnlmtlwtlom gtlM�o[ nf-eDON e S rpe.
Freedom Communications tlool��� m.IRR, MW rrlp. Wekoa o Yl ra
1 Carel Sveel•Salem.MA ., lDm Dam ID =II: 1 urao i
City of Salem Department of Planning
Check/Cash Recei t and Community Development
P Tracking Form
t
Please complete form and make
Date ReceivedO copies,
7 36 2�1y
1 Amount Received , /
Form of Payment aL of .4-ti A/
Check �
�
Client Information ❑ Money Order
CASH PAYMENTS: ,' ev) x
client initials
Sign Permit Application Fee
❑
Payment received for what Conservation Commission Fee
❑
service? Planning Board Fee/ZBA
❑ SRA/DRB Fee
❑ Old Town Hall Rental Fee
❑ Other:
Name of Staff person receiving
payment 4 j;� rsi,A4o
Additional Notes
i 1500
C&D SIGNS, INC. o^NENTERPRISE
DBA METRO SIGN&AWNING
170 LORUM STREET 53-274!113
TEWKSBURY, MA 01876
PH.19781851-2424 pZ
9d
0 TO E A /� / _
ULIX(¢ $/95 Ufa
DOLLARS
VOID AFTER 90 DAYS
MEMO Q� � "` wurHoarzeo sIunwTuae
II900 i SO011' 1:0113027421: 5 L8 7 7011'
--Pr .: anent
L Copy_�: Application File
N
The Commonwealth of Massachusetts
— Department of Industrial Accidents
Office of Investigations
�'• � 600 Washington Street
Boston, MA 02111
L N7ww.nrass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Nat11e (Business/Organization/Individual): T/3�S'Gn� d it)ttl,'A)j�'
Address: / 7D zlvl?L,Ott cS'T _
City/State/Zip:EwKcs'BvR /n9 Phone #: `>7,F-
Are you
>7,F-Areyou an employer? Check the apprpfriate box: Type of project (required):
1.[El am a employer with c;?0 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. 7. ❑ Remodeling
ship and have no employees These sub-contractors have g, ❑ Demolition
working for me in any capacity. employees and have workers'
coo insurance.t 9. ❑ Building addition
[No workers' comp. insurance P�
required.] 5. ❑ We are a corporation and its 10.El Electrical repairs or additions
3 ❑ 1 am a homeowner doing all work officers have exercised their I l.❑ Plumbing repairs or additions
myself. (No workers' comp. right of exemption per MGL 12 ❑ Roof repairs
insurance required.] t c. 152, 2;1(4), and we have no 13 �ther siGW�I6�
employees. (No workers'
comp. insurance required.]
'Any applicant that checks box bl must also fill out the section below showing their workers'compensation policy information.
' Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submil a new afftdacu indicating such
�comraclors that check this box must attached an additional sheet showing the name of the sub contractors and state whether or not those entities have
employees. If the sub-contractors have employees,they must pro%ide their workers'comp.policy number.
1 am an emphr'er that is providing workers'compensation insurance for my employees. Below is the police and job site
information.
Insurance Company Name: 42/-10 L-tF :AcX 0� nGfsr r) GRq cy ''7—, Y-7,97e 1-Pos (nd
Policy # or Self-ins. Lic. #: [(/[t o O 3 Expiration Date:
Job Site Address: City/Slate/Zip:
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 up to S250.00 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.
I do herebt•certify milder the pains and penalties of perjury that the information provided above is true and correct.
Signature: Date:
Phone #:
Official use ottlr. Do not write in this area, to be completed br citta or town official
City or Town: Permit/License#
lcsuing Authoritc (circle one):
6. Other II
IIL Contact Person: Phone#:
,4c Ro De CERTIFICATE OF LIABILITY INSURANCE
6/18/14
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.
IMPORTANT: I the certificate holder is an ADDITIONAL. INSURED, the policy(i i i Rust be endorsed. IT SUBROGATION IS WAIVED,subject to
the terms and conditions of the policy,certain policies may require an endorsement. A statement an this certificate does not cooler rights to the
certificate holder in lieu of such endorsement(s).
PRODUCER CONTACT
Choice Insurance Agency, Inc. NAME, _ Peter C DiPaoli
376 Summer Street 978 343-4853 1="". (976) 3
-45-1007
Fitchburg, 11A 01420
Aooaess: eter'®choice-insurance.com
_ -- _ INSURERS)AFFORDINSCOVERAGE N_AIcF _
-- - — imsmes A.C i t a t l on
INSURED C 6 D Signe Inc. IN9)INsuREREC.
-
Re_Granite State IpBUrflnge COm�ian
a
168-170 Lorum Street __ - -- - - - - -- -
Tewebury, MA 01876 INSUBER D-: — - - - -- --
INSURER E
INSURER F:
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICES OF INSURANCE LISTED BELOW HAVE BEEN ISSUEDTO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR- AOSH WYa- —_ — _
MI _
LTR TYPE OF INSURANCE POLICY MIMBER
GENERAL LIASILm'
- EACH OCCURRENCE
G(X.MERGIAL GENEPALLIABILITY DAMAGE TO—RENTED - -
S
CUA6MADE I �OCCUR
AEOFXP(A,y ore Dasm, �
_ __— _-_- F1iR50NML1 AOVINAIRY '. S
- GENERAL AGGRE CITE
GENT AGGREGATE LIMI APPUES PER --
POLICY Ni& LOC PRODUCTS-COM/DPAGG b _--
AUTOMOBREIIAeIUTY' RWL401 12/26/:? 12/28/14
A _ E�!—A) eenIINGLEIIM 1,000,000
ANYAUTO BODIL Y INJURY(Pe,person)
ALLOWNED BCHEOUIED -- --
AUTOS X AUTOS BOOLYIMIURY(Por accgenq b
NON-OWNED
MIRED Alfi01 x AUTOS PROaETiTY ONMGE-- --
.�HaC6tlenlj_
'N RELLALIAB
OCCUR
- - eAGn OCCURRENCE E
IIL�1. EXCESS LIAB _ CLAIMS-MACE
DEC RETENTIONS
B NORNERS COMPENSATIDN =WCO039772=90r7/7/14 7/7/15 WC STATV OTM S
AND EMPLOYERS'LIABILITY YIN _Inftv lu TR X
ANYPROPRIET01WPARTNEREXECUTNE T—
OFRCEWi.EMBEREXCLLAED7 NIA E.L EACH ACCIDENT T5 1,000,000,
( .'61.In NH) EA EMPLOY EES_ . 000,000
U
as RIPTI NOFO EL_pISEASE
DESCRIPTION 6OPERATIONS DOIpa E.L.DISEASE.pOLICY LIMIT b 1,000,000
I
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHCLEB (AtMLM ACORD 101,AO]ItlonAl RerrPrMs SCMdUe,R mors s W v B re9U rtl)
****************FOR INFORMATIONAL PURPOSES ONLY**+**f+llfr\!a+♦#1t\##!!!!!}#!!#!!*+}!
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, N0710E WILL BE DELIVERED IN
#f\\f\#f\\\#}fx+lf!}\\!#!\}#1\ ACCORDANCE WITH THE POLICY PROVISIONS.
FOR INFORMATIONAL PURPOSES
ONLY - NO CERTIFICATE HOLDER AUTHORIZED RE PRESENTATIVE
NAMED f++f}1111}}1f#+}11111 l+!
lSbj ALUhU LURYUkAI IUN. All rights reser Ye O.
Phone: Fax: I Mad: Suec@metrOBlgn.net`
a oc Roe CERTIFICATE OF LIABILITY INSURANCE °"'12/13/2013 13/2013
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER-
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the poliey(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 endorsement(s).
PRODUCERNE=CT Maureen McDonnell
J. Williams Insurance PNONE!AIC N� (781)848-9192 FAx
.(1811848-9116
14 Wood Rd �raEss.maureen@jwillimsins=ance.com
Suite 4
INSURE 5)AFFDROINGCOVERAGE NAIC0
Braintree MA 02184 INSURER A$artford Casualty Insurance 9424
INSURED
INSURERS.Travelers Excese
C 6 D SIGNS, INC. DBA METRO SIGN 6 AWNING INSURER C:
170 LORUM STREET
INSURER D
NSURER E:
TEWKSBURY MA 01876 INSURER F:
COVERAGES CERTIFICATE NUMBER:CL13121301971 REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS.
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR ADOL 9w
LTR TYPE OF INSURANCE POLICY NUMBER M�DY EFF MO � LIMIT
GENEIRAL LIABILITY
EACH OCCURRENCE $ 1,000,000
X COMMERCIAL GENERAL LIABILITY PRAMA
MI rt $ 3OO,OGD
A CWMSLMAD[ OCCUR OSSAIJ4502 2/28/201312/28/2014 MED EXP(Myone pstsan) S 10,000
X PER PROJECT AGGREGATE PERSONI&LADVINJURY S 1,000,000
GENERAL AGGREGATE S 2,000,000
GENL AGGREGATE LIMIT APPLIES PER PRODUCTS COMP,OP PGG S 2,000,000
X POLICY JECTPRD Loc $
AUTOMOBILE LIABILITY COMBINED SINGLE LIMI1
Ea ac d.
ANY AUTO BODILY INJURY(Per person) S
ALL OWNED SCHEDULED
AUTOS AUTN-0OS BODLLYINJURY(PM aWtlenq 4
NOWNED
HIREO AUTOS AUTOS PROPERTY WIMGE
Par cciE $
S
X UMBRELLA LIAR R OCCUR
EACH OCCURRENCE $ 10,000,000
B EXCESS LIMB CLAIMS-MADE
AGGREGATE S 10,000,000
DED I X I RETENTION$ 10,00 D 2/28/2013 2/28/2011
WORKERS COMPENSATION S
AND EMPLOYERS'W BIMTY YIN WC STATU OTH
ANY PROPRIETORIPARTNERLEXECUTIVE
OFFICERIMEMBER EXCLUDED' NIA E.L.EACH ACCIDENT S
it S.digry M NH) E.L.DISEASE-EA EMPLOYE S
( S.Cas y In NH)
DESCRIPTION OF OPERATIONS 0abw El DISEASE
POLICY LIMIT I$
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (AIMch ACORD 101,AWitimal Remarks Sche ule,N more spsce Is requlr")
CONFIRMATION OF COVERAGE
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
FOR INFORMATIONAL ACCORDANCE WITH THE POLICY PROVISIONS.
PURPOSES ONLY
AUTHORIZED REPRESENTATIVE
IJI.Lu ILeI. np.is E:uEi e.L`:
ALOHU 26(2010/(i6) U 1988-2010 ACORD CORPORATION. All rights reserved.
Nsn25r. ,nn.,n.
Th. Arnpn A o,nHlnnn,.eenni<n.nH ,el<marnun
to
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Massachusetts De
PartMent Of Public S
Board of Building Regulations and Stand
License: CS.00,
,I
BRIAN A (1-flip",
151110SLEV
GARDN ROxD %
TS
Expiri
Con1missione,
.9 Massachusetts " 11,P311ment Of Public Safety
Board of Building Regulation, and Standards
NONE SM 964508
BRIAN A Cljlpltl4N
151 HOSLFV ROAD
GARDNER MA 01440
t 2S AGNES RO
LOWELL,MA 07803203
Expiration