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282 DERBY ST REAR - SIGN PERMIT as < < Amo 0 N �t� P - far Z �n N v y o � K(�1 , l,�n(tpt ��9ns �11g� �'f5' ��°� N m N A d n� O O � j 0 oto0 i"4., —_' - ESnTH(ER�MARIN `nIHq10 Inc. 282 Derby St. •Salem.MA 01970 •978.745.9436 • Fax 978.745 9439 emorinkcilontrocilantro.corri •WWW,CilCntrocilantro.com An Exco.agonm GraoC Inc.C�mponv 0282 DERBY STREET REAR 1024-2004 COMMONWEALTH OF MASSACHUSETTS CITY OF SALEM GIS#: 0128 - Map: 35 — Bloakc--- SIGN PERMIT Lot: 0267 Permit: Sign — Category: SIGN Permit# 1024-2004 I PERMISSION IS HEREBY GRANTED TO: Project t! JS-2004-1433 Contractor: License: Est. Cost: 1$800.00 Fee: $20.00 Concept Signs #of Fixtures: Owner: OSGOOD GEORGE K Applicant: ESTHER MARIN AT: 0282 DERBY STREET REAR ISSUED ON. 28-May-2004 AMENDED ON: EXPIRES ON.- To N:TO PERFORM THE FOLLOWING WORK: 1024-2004 SIGN PERMIT TJS THIS PERMIT MAY BE REVOKED BY THE CITY OF SALEM UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. mok- Signatu ./" e.lt�r��• Fee Type: Receipt No: Date Paid: Check No: Amount: SIGN REC-2004-001541 28-May-04 3180 520.00 GeoTMS®2004 Des Lauriers Municipal Solutions,Inc. � '� � 1 ` i ,� � �- �.��`. � _.,�� � � �pY 7 ,�.���awr oes•� wwr� ars _ _ �L�a I _YrtAl�!•lA�if_S�� 1 1'� •�., -..: �. -s ������r���+�Z � w � o � �,�� �i-�� ��a�� �� �'� i � �Y�� � rL��� ���� �w � � S� �ii � �i.�i�iii .� ® rs+ � �LTiiTi' � -= s - - �_�._-- ���.�s.v� ------- � � ��� e _ __ �_ tt ���.�s .������������ �� � ���a�� �� ���'v����� Y �T II+ m r' II li �� a , CITY OF SALEM DEPARTMENT OF PLANNING AND COMMUNITY DEVELOPMENT MEMORANDUM TO: Denise McClure, Deputy Director FROM: Frank Taormina, Planner SUBJECT: Sign Application - Taste of Cilantro DATE: May 17, 2004 Location: Urban Renewal Area Address: 282 Derby Street Date Received: 4/22/04 Building Frontage: 20 linear ft Maximum allowed: 25 sq ft Proposed Signage: The proposal includes the installation of one 20"x 60"wood hanging sign with a white background, red lettering spelling "TASTE OF CILANTRO" with green accents; a green canvas awning with the Cilantro logo in white lettering" Total Area of Sign: 20 sq ft DRB Approval: 5/5/04 SRA Approval: 5/12/04 Recommendation: This application has been approved by the Design Review Board and approved with the DRB recommendations by the SRA. I recommend approval as approved by the SRA. Please let me know if you would like more information regarding this topic. eSalem ® Redevelopment Authority DESIGN REVIEW BOARD PROPOSAL 282-Rear Derby Street (Taste of Cilantro) - Proposed signage and storefront improvements PROPOSAL: The proposal includes the installation of a 20" x 60"wood hanging sign with a white background, red lettering with green accents; a green canvas awning with the Cilantro logo in white lettering; and a new door exactly the same as the Cilantro door on Derby Street. 120 Washington Street • Salem, Massachusetts 01970 • (978) 745-9595, Ext 311 • Fax (978) 740-0404 Permit Numbets �V'--1 0 APPLICATION FOR PERMIT TO ERECT A SIGN . 1 a PERMIT MUST BE OBTAINED BEFORE SIGN IS ERECTED Location, Ownership and Detail Must be Correct,Complete, and Legible SALEM,MASSACHUSETTS TO THE BUILDING INSPECTOR: The undersigned hereby applies for a permit to nErect_Alter, Repair a sign on the following described buildings: Location and No. Z b ST S Zoning/District Name of Property Owner C SCK fr� lJ SCrd�7 Name of Sign Owner e;t 1} /�P— V V 1¢ L,,) Address Z�Bz D6�' 3Y ST- If Owner is a corporate body, name of responsible officer �TI f�(L ✓ lA(1 I�l Name of Licensed Sign Erector wof/ Nc-f—=t7 S16-1J Salem License No. 2 000 —z Off f Address 68 (-0e-1P-K— Atli • SA;av K4A U1-170 Use of Building: 1st Flogrr 3,d Floor 2^d Floor 4th Floor Frontage: Building 70 ' linear ft Property /SU linear ft Type of Sign Proposed: Surface © Right Angles to Building ❑ Free Standing Awning Other(specify) Proposed Sign Materials (n7007 l (I>j V gqrgAj,1C=, i Proposed Sign Dimensions zo 6 D° Sign Area /0 sq ft 4Lw'o,7'. (eh�j red / Existing Signs: Surface: Sign Area sq ft Right Angles: Sign Area sq ft Free Standing: Sign Area sq ft Other: Sign Area sq ft Signs to be Removed: Type Sign Area sq ft Signature of Owner ej l7/7= Estimated Cost of Net Work Signature of Owner's Autliorized Representative Address 2Pz J f Telephone 3te.6 c il,4 DISCC 7 U Signature of Property Owner APPROVALS (Department Use Only): PLANNI G&COMMUNITY DEVELOPMENT HISTORICAL COMMISSION B LDING INSPECT A 04/04/2004 18:39 9787459439 CILANTRO RESTAURANT PAGE 01 ,� Y s�01LY•Y�' — �.- — ` APR 2 2 2004 � Permit Number APPLICAT FOR PE MT TO ERECT A SIGN I� n PERMIT MUST BE OBTAINED BEFORE SIGN IS ERECT-ED " y - Location,Ownership and Detail Must be Correct, Complete, and I.eeble SALF—%I,MASSAClivserrs TO THE BUILDING INSPECTOR: _ The undersigned hereby applies for a permit to�Erect—Alter, kepair a sign vI. tl-t fullow,ng,casibrd b1.Liints: Location and No, 2A6 z.- k, (tiV� T F—E _ ,_.-Luning/District 4—__ Name of Property Owner Name of Sign Owners-T I E� Y L/ '6` ressDzz ----- - If Owner is a corporate body,name of-responsible officer / -.- �'�•�,R ('p�gl ,l�; Name of Licensed Sign Erector Net PT Salun License No. CXXs - Y O Address ??i Lc I AVIGG . SthA "l°'11 - - --' (i Use of Building: I•Flo , aro Floor y _ -- --- 214 Floor .IIh Floor — Frontage: Building -7p' linear ft Property /$^(: linear ft Type of Sign Proposed ❑ Surface © Right Angles to Building ❑ Free Standing ❑ Awnlug ❑ Other specify) Proposed Sign Materials W U" i7 h4C�N-D V .1Yt ANtri' __ - -----`-y---`-_• Proposed Sign Dimensions zG) X Sign Area %0 — s ft Existing Signs: Surface-, Sign .Area / s ft Right Angles: Sign Area-- '—_ sq ft Free Standing: Sign Area_ _z sq ft Other: Sign Area s ft Signs to be Removed: Type Sign Arra _sq ft J Signature of Owners r it Estimated Cost of Net Work Signature of Owner's Aut orized Representative _- s 4 Address .r"6 c Telephone Signature of Property Owner_ APPROVALS (Department Use Only): PtANN1NG&COMMU.'WYy DEVELOPMENT khSioRICALCOMMISSION - -- BL7LbtNG INSPFI I'Uk syr--.��„' ,�+"^ <'-:. ..\ �R � n _ - .. sv,- � ..__-_ .� - _ _ � r ��: _o _ �- -__�-=`= �- ___ I -- _ �..r .�- - _ �� _ `C4� - _ �`` - � _ _ "ate, - a•� al _ i `4 4"+�iKL1 �� '1 �_ .- 1� �. +T 11. �_( _ � I_ . .. _ _t,� f �`� S i l AL -�i� Permit Number PERMIT MUST BE OBTAINED BEFORE BEGINNING WORK APPLICATION MUST BE SUBMITTED IN DUPLICATE, ONE SET TO BE FILED WITH THE PLANNING DEPARTMENT, AND ONE SET(BEARING THE APPROVAL OF THE PLANNING DEPARTMENT) TO BE FILED WITH THE BUILDING INSPECTOR. L0`m` Location, Ownership and.Detail Must be Correct, Complete and Legible. Separate Application Required for Every Sign. Y Application for Permit to Erect a Sign `"'n"` Salem, Massachusetts lo IN F9-LL— TO THE BUILDING INSPECTOR: The undersigned hereby-applies for a permit toy/ Erect,_Alter,_Repair a sign on the following described building: t Location and No. aha �xb� Zoning/District Name of Property Owner Name of Sign Owner °�taw�o &� Address { " ^ � If Owner is a corporate body, name of responsible officer Name of Licensed Sign Erector U.u3w Address TOtex �t�f Salem License No. Use of Building: Ist Floor V/ 3rd Floor 2nd Floor 4th Floor Type of Sign: _Surface, V/ Right Angles to Building, _Free Standing Other (specify) Height: Sign Materials Lei- S (A�wvt Sign Dimensions -W k 3-�4 '� Sign Area (,4 S, SF n ly'i r awh^ �� 3rtl C4 V, �) J Existing Signs: Surface: "— Sign Area SF Right Angles: Sign Area SF Free Standing: Sign Area SF Other: Sign Area SF Signs to be Removed: Type Sign Area SF i Frontage: Building VJ FT Property f� FT Signature of Owner `- Signature,.pf ner's Authorized Representative Address 3', 2 { Estimated Cost Telephone 10'6- of New Work $ Signature of Property Owner APPROVALS: S� P nni Department Superintendent of Streets Historical Commission ON r.VERSF SIDE PLEASE SHOW SIGN SIZE, COLOR, LOCATION; LOCATION OF OTHER SIGNS AND BUILDING FN' '•N('F BEVERLY NATIONAL BANK 12955 UNITED SIGN COMPANY, INC. 33 TOZER ROAD P.O. BOX 3106 53-276/113 BEVERLY, MA 01915 PAY TO THE OF cY�^'�` bI U� $ �o•eC� ORDER OF CL T ` (CID DOLLARS r LILI N 8 MEMO AUTH IZEDSIGWA IE J hp 11501295Sii' 1:0 1 1 30 2 7681: 28000 106 2 21" UUU��1 HARTFORD FIRE INSURANCE COMPANY Hartford,Connecticut POWER OF ATTORNEY Know all men by these Presents,That HARTFORD FIRE INSURANCE COMPANY,a corporation duly organized under the laws of the State of Connecticut,and having its rincipal office in the City of Hartford.County of Hartford.State Of Connecticut,does hereby make,constitute and appoint RICHARD P.JONES and/or DAVID L.RAY of BEVERLY,MASSACHUSETTS its We and lawful Attomey(s)4n-Fad,with full power and authority to each of said Attorney(s)-in-Fad,in their separate capacity if more than one is named above,to sign,execute and acknowledge any and all bonds and undertakings and other writings obligatory in the nature thereof on behalf of the Company in Ila business of guaranteeing the fidelity of persons holding places of public or private trust;guaranteeing the performance of contracts other than insurance policies;guaranteeing the performance of insurance contracts where surety bonds are accepted by states and municipalities,and executing or guaranteeing bonds and undertakings required or permitted In all actions or proceedings or by law allowed.and to bind HARTFORD FIRE INSURANCE COMPANY thereby as fully and to the same extent as if such bonds and undertakings and other writings obligatory in the nature thereof were signed by an Executive Officer of HARTFORD FIRE INSURANCE COMPANY and sealed and attested by one other of such Officers,and hereby rmfies and confirms all that its said Attomey(s).in-Fact may do in pursuance hereof. This Power of Attorney is granted under and by authority of the By-Laws of HARTFORD FIRE INSURANCE COMPANY,(the Company')as amended by the Board of Directors at a meeting duly called and held on July 9,1997,as follows: ARTICLE IV SECTION 7.The President or any Vice President or Assistant Vice-President,acting with any Secretary or Assistant Secretary shall have power and authority to sign and execute and attach the seal of the Company to bonds and undertakings,recongnizances,contracts of indemnity and other writings obligatory in the nature thereof,and such instruments so signed and executed.with or without the common seal,shall be valid and binding upon the Company. SECTION a.The President or any Vice-President or any Assistant Vice President acting with any Secretary or Assistant Secretary,shall have power and authority to appoint, for purposes only of executing and attesting bonds and undertakings and other writings obligatory in the nature thereof,one or more resident Vice Presidents, resident Assistant Secretaries and Attorneys-in-Fact and at any time to remove any such resident Vice-President.resident Assistant Secretary,or Attomey-in-Fact,and revoke the power and authority given to Nm. Resolved,that the signatures of such Officers and the seal of the Company may be affixed to any such power of attorney or to any cerificate relating thereto by facsimile,and any such power of attorney or certificate bearing such facsimile signatures or facsimile seal shall be valid and binding upon the Company and any such power so executed and certified by facsimile signatures and facsimile seal shall be valid and binding upon the Company in the future with respect to any bond or undertaking to which it is attached. In Witness Whereol, HARTFORD FIRE INSURANCE COMPANY has mused these presents to be signed by its Assistant Vice-President, and its corporate seal to be hereto atfuced,duly attested by Its Secretary,this 14th day of May,1999. HARTFORD ✓FIRE INSURANCE COMPANY SEAL � o car Paul A. Bergenholtz,Assistant Secretary Robert L.Post,Assistant Vice President STATE OF CONNECTICUT I 55. Hartford COUNTY OF HARTFORD On this 14th day of May,AD. 1999,before me personally came Robert L.Post,to me known,who being by me duly swom. did depose and say that he resides in the County of Hartford,Slate of Connecticut; that he is the Assistant Vice-President of HARTFORD FIRE INSURANCE COMPANY, the corporation described In and which executed the above instrument;that he knows the seal of the mid corporation;that the seal affixed to the said Instrument is such corporate seal;that it was so affixed by order of the Board of Directors of said corporation and that he signed his name thereto by like order. 110TMY • rUbLyc, Jean H Wozniak Notary Public CERTIFICATE My Commission Expires June 10,2004 I,the undersigned,Secretary of HARTFORD FIRE INSURANCE COMPANY,a Connecticut Corporation.DO HEREBY CERTIFY that the foregoing and attached POWER OF ATTORNEY remains in full force and has not been revoked;and furthermore,that Article IV,Sections 7 and 8 of the By-Laws of HARTFORD FIRE INSURANCE COMPANY.set forth in the Power of Attorney,are now in force. Signed and sealed at the City of Hartford. Dated the 2nd day of J n l y 2001 Richard L.Marshall,Jr.,Assistant Secretary J.Dennis Lane.Assistant Vice President Form S-3507-9 (HF) Printed in U.S.A. ALLMERICA FINANCIAL® 100 North Parkway HANOVER INSURANCE® Worcester, MA 01605 License or Permit Bond KTThe Hanover Insurance Company ❑ Massachusetts Bay Insurance Company Bond No. BLN1696438 KNOW ALL MEN BY THESE PRESENTS, that we, Cilantro, Inc. 282 Derby Street of Salem, MA 01970 as Principal, and Mhe Hanover Insurance Company (A New Hampshire Corporation)0 Massachusetts Bay Insurance Company(A New Hampshire Corporation)as Surety, are held and firmly bound unto City of Salem, MA as Obligee, in the penal sum of One Thousand ( $ 1 onn) Dollars, good and lawful money of the United States, for the payment of which sum well and truly to be made, we bind ourselves, and our heirs, executors, administrators,jointly and severally, firmly by these presents. WHEREAS the said Principal has applied to said Obligee for a license to . .Erect. A .Si.gn. .£or. . . . . . . . . . . . . . . The City, ,Of: Salem,,, M} , .4t. ,292. ,Dezby. .Str.eet. .Salem.,. .MA . . . . . . . . . . . . . . . . . . NOW, THEREFORE, THE CONDITION OF THIS OBLIGATION IS SUCH, That if Principal shall faithfully observe and honestly comply with the provisions of all Laws or Ordinances of Obligee regulating the business for which license is issued, then this obligation shall be void; otherwise to be and remain in full force and virtue. PROVIDED, THE LIABILITY OF THE SURETY upon this bond shall be and remain in full force and effect for the full period of the license, and renewals thereof, issued to the principal above named, or until ten days after receipt by the Obligee of a written notice signed by such Surety, or its authorized agent, stating that the liability of such Surety is thereby terminated and canceled; and provided further, that nothing herein shall affect any rights or liabilities which shall have accrued under this bond prior to the date of such termination. 2nd . . . . . . . day of Ju lY. . . . . . . . . . . . . . . .200.1. . . . Signed, sealed and dated the . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7t/f/ . . . Principal =STYF@ /qAM ne BY:... .................................................................................... (seal) ❑ MASSACHUSETTS BAY INSURANCE COMPANY U THE H INS MPANY F... .`. .. . . . . . . . . . . . . . . . . . . . . . . Attorney-in-Fad 141-0761(9/99) Permit Number PERMIT MUST BE OBTAINED BEFORE BEGINNING WORK APPLICATION MUST BE SUBMITTED IN DUPLICATE, ONE SET TO BE FILED WITH THE PLANNING DEPARTMENT, AND ONE SET (BEARING THE APPROVAL OF THE PLANNING DEPARTMENT) TO BE FILED WITH THE BUILDING INSPECTOR. Location, Ownership and Detail Must be Correct, Complete and Legible. Separate Application Required forEvery Sign. *i Application for Permit to Erect a Sign ;T g ,S��uaraE Salem, Massachusetts 19 TO THE BUILDING INSPECTOR: The undersigned hereby applies for a permit to_Erect, Alter,_Repair a sign on the following described building: /� --�� Location and No. � $ :2 �`C -Deol6jl .S Zoning/District T Name of Property Owner P, rr).(76 061 Name of Sign Owner �C2�S / J �2iiinll Joe/ %J Address3S /"(7�j If Owner is a corporate body, name of responsible officer�z m)S —/DP-0//7P, Name of Licensed Sign Erector Address /e7 / �lG P �� /E Salem License No. Use of Building: Ist Floor / 3rd Floor 2nd Floor 4th Floor Type of Sign: _Surface, Right Angles to Building, _Free Standing _ Other (specify) 1 Height: G Sign Materials / Z 112 L2 L Sign Dimensions y X r Sign Area t/o SF Existing Signs: Surface: Sign Area 9 SF Right Angles: Sign Area SF Free Standing: Sign Area SF Other: Sign Area SF Signs to be Removed: Type <5-Lt r fif c- Sign Area SF Frontage: Building FT Property /f FT Signature of Owner, � Xg9��, Signature of Owner's Authorized Representative / Address Estimated Cost Telephone of New Work $ Signature of Property Owner APPROVALS: Salem Planning Depatt?rrent Superintendent of Streets Historical Commission ON REVERSE SIDE PLEASE SHAW SIGN SIZE, COLOR, LOCATION; LOCATION OF OTHER SIGNS AND BUILDING ENTRANCE. Applicant not to write in this space. c o � mA sa O x Z5 r" 0 .o CbC a ►v K I C _ i O 2 N n O rn G R O �� r...:.......... . ..: . .. i x -q . J ' m • m rn . Cu --I m m �� • . G i — o CA > z O O \ z z ' � i , • ; m Ca z o , , r � I G IL A t 'aimi - �_.t. NINA MIN { err �ir•��� t LEASE 51��909fl -A �YrfEai_ r ZEAL ESTATE & HARDWARE 5GROLL 51GN WALL BRACKETS HANGERS BRACKETS These attractive scroll Stocking sizes: For masonite, plywood, or #301 wall brackets. Made brackets are made of an all 12•. metal swing signs. Made of of hot galvanized steel.90 steel construction and 181, zinc plated steel. degree angle. Hole 5/8", come with a black enamel 24•• Size 1/8" x 3" long x 1" slot 9/16" x 1 ". finish. They will accommo- 30^ wide. Approximate weight 22 lbs date a panel size up to 28" 36" horizontally and the base 42„ Stocking sizes: Stocking size: plate has predrilled holes 48'• 1/2" opening 3/16" x 2" x 2". for mounting the frame 54 3/4" opening directly onto.the side of the Sold individually and in building. This bracket is Sold individually. Sold individually and in boxes of cn better syitad-for lighter cases of 50. weight panels. These brackets are sure to enhance any structure. _N HOU5ING SOCKET CUTAWL@ ?UNCHE5 PUNCH L Model K-11. The Cutawl The Cutawl starts cutting j Cutting Tool gives you anywhere you choose and Standard manual sheet HM (Lamp Holder) For hole free- dom of design. Almost any cuts quickly and precisely metal punches. size 1-1/32". Diameter design, letter, or logo with a clean edge and litt across flat 7/8 which can be drawn or material waste. Cutawl LARGE HOUSING traced on a flat surface can even cuts duplicate layers PUNCH- Sold individually. be cut with the Cutawl. and simplifies inlay work. For hole sizes 1/2" to Straight lines, curves, zig- The Cutawl is portable, 1-7/16". zags, perfect circles, intri- compact and built to last. SMALL HOUSING cate designs, large shapes Comes complete with a PUNCH- or details too small for a 115V 1/5HP 50-60 Hz, AC For hole sizes 1-1/2" to router and saber, jig or only motor. 1 7/8" band saw can all be easily cut with a Cutawl. Cuts the In stock. Sold individually. most modern and popular Also available: Cutawl materials such as plastics, blades, Cutawl Oil, foam boards, wood, rub- Lubricant, and all other ber, leather, cloth, etc. Cutawl accessories. •�© -w�f MANCHEST (203)649-9626 NATIONWIDE(800)966-9626 FAX(203)646-8602 WILMINGTON.MN,MA (508)658-7448 NATIONWIDE(800)328-7775 FAX(508)657-6622 ROCHESTER,NY (716)254-6840 NATIONWIDE(800)825-8808 FAX(716)254-6075 GROUP _:--�Eumbermens Mutual Casualty Company An Illinois Coryaratian American Motorists Insurance Company An Illi.is Couonticn American Manufacturers Mutual Insurance Company Bond No------------------_. An lllimis Corpontion Know all men by these presents, that___Nat1,go 1 s r-—2,82_R--_Da_rby --- (\am<and Addncss) ._—_------ as Principal and The undersigned Surety, are held and firmly bound unto---------- of...5a--em _--_^—___-- as Obligee, in the ---------------- penal sum of...... -fhf2211Sand —____Dollars lawful money of the united States, for which payment, well and truly to be made, we bind ourselves, our heirs, e-c- ecutors, administrators, successors and assigns, jointly and severally, firmly by these presents. Whereas, the Principal has applied to the Obligee for a license as a (or permit __Sign Permit-Bond__ Now, therefore, the condition of this obligation is such, that if said Principal shall faithfully perform the duties of such licensee or permitee, and in all things comply with the ordinances, rules and regulations -; appertaining thereto, then this obligation shall be void; otherwise to remain in full force and effect, until.—_.— nntnhpr' 'in _ 19.._9_9. ' This bond may be terminated at any time by the Surety upon sending notice in writing, by certified mail, to the clerk of the municipality with whom this bond is filed and at the expiration of thirty (30) days from the mailing of said notice,the liability of such Surety is thereby terminated and cancelled;and provided further,that nothing,herein shall affect any right or liability which shall have accrued under this bond prior to the date of such termination. SIGNED, sealed and dated this 30th day of Oct2ber Principal:..__ 't7 Countersigned: American Manufacturers Mutual Ins . en -' Ar.. r�ftfS,i3rety:.----------------------------- —_- _ Yamc of Company Rnidmt Agent _ — O BY: _ Important: Accounting Information Producer Name)�_A S.1i2.Y.�L1SCSL.-�XLC.:—_—_� Address...-..._ Fiox--188_Malden-,--_T¢A;-_0214.8 AFFIX CORPORATE Producer Code.....__._.61.-.E191 -- SEAL HERE Send one copy of the bond to ywr sumr- vising office an the some dOY executed. FK733-1 12-06 7M MW tv 1. U.S.A. NO CARBON REQUIRED One Tower Square, Hartford, Connecticut 06183 T1e1, COMMERCIAL BUILDING COMMON POLICY DECLARATIONS ISSUE DATE : 01 /24/96 POLICY NUMBER : I-660-103X9229-COF-95 1 . NAMED INSURED AND MAILING ADDRESS : GEORGE OSGOOD 100 NAUGUS AVENUE MARBLEHEAD, MA 01945 2 . POLICY PERIOD: From 12/23/95 to 12/23/96 12:01 A .M. Standard Time at your mailing address . 3 . LOCATIONS Premises Bldg. Loc. No. No. Occupancy Address SEE IL TO 03 07 86 a COVERAGE PARTS FORMING PART OF THIS POLICY AND INSURING COMPANIES: COMMERCIAL PROPERTY COV PART DECLARATIONS CP TO 01 02 94 COF COMMERCIAL GENERAL LIABILITY COV PART DECLARATIONS CG TO 01 03 94 COF 5 . NUMBERS OF FORMS AND ENDORSEMENTS FORMING A PART OF THIS POLICY: SEE IL T8 01 10 93 6 . SUPPLEMENTAL POLICIES : Each of the following is a separate policy containing its complete provisions : Policy Policy No. Insuring Company DIRECT BILL 7 . PREMIUM SUMMARY: Provisional Premium $ 5,764 Due at Inception $ Due at Each $ NAME AND ADDRESS OF AGENT OR BROKER: RSIGNED BY: {� E A STEVENS CO INC (D2128) /7 yc— P 0 BOX 188 MALDEN, MA 02148 Authori d Repr sentati DATE : IL TO' 02 11 89 PAGE 1 OF 1 OFFIC97 HUDSON MA -N773 One Tower Square, Hartford, Connecticut 06183 The, COMMERCIALBUILDING COMMON POLICY DECLARATIONS ISSUE DATE : 01 /24/96 POLICY NUMBER: I-660-103X9229-COF-95 1 . NAMED INSURED AND MAILING ADDRESS : GEORGE OSGOOD 100 NAUGUS AVENUE MARBLEHEAD, MA 01945 2. POLICY PERIOD: From 12/23/95 to 12/23/96 12 :01 A .M. Standard Time at your mailing address . 3 . LOCATIONS Premises Bldg. Loc. No. No. Occupancy Address SEE IL TO 03 07 86 4 . COVERAGE PARTS FORMING PART OF THIS POLICY AND INSURING COMPANIES: COMMERCIAL PROPERTY COV PART DECLARATIONS CP TO 01 02 94 COF COMMERCIAL GENERAL LIABILITY COV PART DECLARATIONS CG TO 01 03 94 COF 5 . NUMBERS OF FORMS AND ENDORSEMENTS FORMING A PART OF THIS POLICY: SEE IL T8 01 10 93 6 . SUPPLEMENTAL POLICIES : Each of the following is a separate policy containing its complete provisions: Policy Policy No. Insuring Company DIRECT BILL 7 . PREMIUM SUMMARY : Provisional Premium S 5,764 Due at Inception $ Due at Each $ NAME AND ADDRESS OF AGENT OR BROKER : r��µJ7'ERSIGNED BY: C E A STEVENS CO INC (D2128 ) P 0 BOX 188 MALDEN, MA 02148 Authori d Repr sentati e,_ DATE : IL TO 02 11 89 PAGE 1 OF 1 OFFIC HUDSON MA 0J:'] 1 i '• TheTravelersA POLICY NUM BER: i-660-103X9229-COF-95 EFFECTIVE DATE: 12-23-95 ISSUE DATE: 01 -24-96 LISTING OF FORMS, ENDORSEMENTS AND SCHEDULE NUMBERS THIS LISTING SHOWS THE NUMBER OF FORMS, SCHEDULES AND ENDORSEMENTS BY LINE OF BUSINESS . INTERLINE IL TO 02 11 89 COMMON POLICY DECLARATIONS IL T8 01 10 93 FORMS, ENDORSEMENTS AND SCHEDULE NUMBERS IL TO 01 12 94 COMMON POLICY CONDITIONS IL TO 03 07 86 LOCATION SCHEDULE COMMERCIAL PROPERTY CP TO 01 02 94 COMMERCIAL PROPERTY DECLARATIONS CP TO 05 04 94 MORTGAGEE SCHEDULE CP TO 00 08 92 TABLE OF CONTENTS CP 00 90 07 88 COMMERCIAL PROPERTY CONDITIONS CP T1 00 10 90 BUILDING & PERSONAL PROPERTY COV FORM CP T1 08 10 90 CAUSES OF LOSS-SPECIAL FORM CP T3 01 12 86 AMENDATORY PROVISIONS CP T3 29 10 91 TRAVELERS OPTIONAL PROPERTY ENDT CP T3 11 07 86 MASSACHUSETTS CHANGES COMMERCIAL GENERAL LIABILITY CG TO 01 03 94 COMM'L GENERAL LIABILITY DEC CG TO 07 09 87 DECLARATIONS PREMIUM SCHEDULE CG TO 08 07 86 KEY TO DECLARATIONS PREMIUM SCHEDULE CG TO 34 10 93 TABLE OF CONTENTS CG 00 01 10 93 COMMERCIAL GENERAL LIABILITY COV FORM O� = CG 21 34 01 87 EXCLUSION-DESIGNATED WORK CG 21 47 10 93 EMPLOYMENT-RELATED PRACTICES EXCLUSION CG 21 51 09 89 AMEND LIOUOR LIAR EXCL EXCEPT SCHED ACT CG T4 78 02 90 EXCLUSION-ASBESTOS CG T3 33 12 88 LIMIT WHEN TWO OR MORE POLICIES APPLY INTERLINE ENDORSEMENTS IL 00 21 11 94 NUCLEAR ENERGY LIAR EXCL END-BROAD FORM a IL TO 11 04 94 LENDERS' CERTIFICATE OF INSURANCE-FORM B IL T8 01 10 93 PAGE : 1 OF 1 004774 COMMERCIAL PROPERTY BUILDING AND PERSONAL PROPERTY COVERAGE FORM Various provisions in this policy restrict coverage. Read the entire policy carefully to determine rights, duties and what is and is not covered. refer Throughout the policy the words "you' and "you words"we," "us" and ,our refer to the company providing the nsuo the aan emeaning.med insured shown in the Declarations. e Refer to SECTION H—DEFINI- Other words and phrases that appear in quotation marks have special TIONS. tions, alterations or repairs to the A. COVERAGE building or structure. We will pay for direct physical loss of or damage Personal to Covered Property at the premises described in b. Your Gated Busmen thess e building de cribedl n the Declarations caused by or resulting from a the Declarations or in the open (or in a Covered Cause of Loss. vehicle) within 500 feet of the described 1- Covered Property premises, consisting of the following un- Covered Property, as used in this Coverage less otherwise specified in the Declara- Part, means the following types of property tions or on the Your Business Personal for which a Limit of Insurance is shown in the Property-Separation of Coverage form: Declarations: ' (1) Furniture and fixtures: a. Building, meaning the building or struc- (2) Machinery and equipment; ture described in the Declarations, in- (3) 'Stock' cluding: (4) All other personal property owned by (1) Completed additions: you and used in your business; (2) Permanently installed: (5) Labor, materials or services fur- (a) Fixtures; nished or arranged by you on per, (b) Machinery; and sonal property of others; (c) Equipment; (6) Your use interest as tenant in im- (3) Outdoor fixtures; provements and betterments. Im- �= (4) Personal property owned by you that provements and betterments are fix- is used to maintain or seryice the tures, alterations, installations or ad- building or structure or its premises, ditions: including: (a) Made a part of the building donot structure you occupy (a) Fire extinguishing equipment; own; and (b) Outdoor furniture; (b) You acquired or made at your (c) Floor coverings; and expense but cannot legally (d) Appliances used for refrigerating, remove. ventilating, cooking, dishwashing or laundering; (7) Leased personal property for which you have a contractual responsibility (5) If not covered by other insurance: to insure unless otherwise provided (a) Additions under construction, al- for under Personal Property of terstlons and repairs to the build- Others. ing or structure: c- Personal Property of Others that Is: (b) Materials, equipment, supplies and temporary structures, on or (1) In your care, custody or control; an described (2) Located in or on the building des- within 500 feet of the crlbed in the Declarations or In the premises, used for making addl- Pa e1 of 10 CP T1 00 10 90 Includes copyrighted matenal of Insurance Services Ofilce, Inc. with its permission g copyright, Insurance Services Office, Inc.. 1983, 1989 C04T8, COMMERCIAL PROPERTY you may waive your rights against another party a. Someone insured by this insurance; in writing: b. A business firm: 1. Prior to a loss to your Covered Property or Covered Income. (1) Owned or controlled by you; or 2. After a loss to your Covered Property or (2) That owns or controls you; or Covered Income only if, at time of loss, that c. Your tenant. party is one of the following: This will not restrict your insurance. r Page 2 of 2 Copyright, ISO Commercial Risk Services, Inc. 1983, 1987 CP 00 90 07 88 - - App. ic , cn or ger~. _. e a Salem. 'assa_cr ccc= 191 �_r__.. - -- c. . __ a ger- _ _' - — Alter , — Repair -_-titn ane ::0. 7292 Vh _ 7 Prnoerc-,- _.vner �s �l/� (� ♦ n 'Same ..;Y ;cress Lcluln Owner70h1 n -_ or res:onsible ficer 'lame of Licensed Sign Fr^_ctor S a Yem L i c.nse No. .Jdre;s X ?rd .'se cr Bvii .linn: est 'nor 2nd = -'or ,` Ri nt -m . ales to '_ildinc , Free Standin , Type of Sign. _ Surface . 9 Other (;;;ecify) Height : Sian riaterials �,) Sign Dimensions - `�' Sian Area Sian area SF =xiscina Sians: Surface : Sign Area SF Right •,naics : SF Free-- tanainr Sian Area Sign reg SF Other Sion Area SF ;ia_ns co oe Removed: _,0C Frontage: Building ?roper FT r FT Signature of Owner Signature of Owners authorized ReoreS ntative ,ddress stimateo Cost 8 )f New t;ork L g OD aieonone APPROVALS: Signature of Property Owner rl� storical ommission _^n,n, -eoarc ent Suoerincengenc or sc cets ON REVERSE PLEASE SHOW SIGN SIZE. COLOR. LOCATION', 'LOCATION OF OTHER SIGNS AND ?UILDING ENTRANCE. 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