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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 of ci r 4 h:, b� 1 21 P ... .... IC Ulf C 0 hC n( bt-c P. L t 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