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13B GRISWALD DR - BUILDING INSPECTION (2) The Commonwealth of Massachusetts ECEf;YEL1 Board of Building Regulations CITY OF Massachusetts State Building Code, 780 CMR SALEM Revised Mar 2011 Building Permit Application To Construct,Repair?4nGC1te(5r AmDsH \ One-or Two-Family Dwelling ` This Section For Official Use Only Building Permit Number: Date Applied: tt� Building Official(Print Name) Signature Date {\ SECTION 1: SITE INFORMATION 1.1 Property A dre 1.2 Assessors Map&Parcel Numbers 1.1 a Is this an accepted street?yes no Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Area(sq ft) Frontage(ft) 1.5 Building Setbacks(ft) Front Yard Side Yards Rear Yard Required Provided Required Provided Required Provided 1.6 Water Supply: (M.G.L c.40, §54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Public❑ Private❑ Zone: _ Outside Flood Zone? Municipal❑ On site disposal system ❑ Check if yes[] SECTION 2: PROPERTY OWNERSHIP' 2.1 Ow t of Reco — rr� � f� SKI rnVJ Name(Prm1 I— ,G,:�''1�Dt City,State,ZIP No.and Stre�D� 9 " Telephone Email Address SECTION 3: DESCRIPTION OF PROPOSED WORW(check all that apply) New Construction❑ 1 Existing Building❑ Owner-Occupied ❑ Repairs(s) Alteration(s) ❑ Addition ❑ Demolition ❑ Accessory Bldg.❑ Number of Units_ Oher ❑ Specify: Brief Description of Proposed Work : Nil SECTION 4: ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: _ (Labor and Materials) Official Use Only 1. Building $ 1. Building Permit Fee: $_� _Indicate how fee is determined: 2. Electrical $ ❑Standard City/Town Application Fee ❑Total Project Cost' (Item 6)x multiplier_x 3.Plumbing $ 2. Other Fees: $ 4. Mechanical (HVAC) $ List: 5. Mechanical (Fire $ Suppression) Total All Fees: $ Check No. Check Amount: Cash Amount: 6.Total Project Cost: $ ❑Paid in Full ❑Outstanding Balance Due: (Y1T�t L t�D t 0 l I Z SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) License Number Exp ti Date Name of CSL Holder , A G� 5 List CSL Type(see below) W �- ��' 'Type Description No.and S et U Unrestricted(Buildings up to 35,000 cu,ft). LCi'I�Y?z1 R Restricted 1&2 Family Dwelling City/Town,State,ZIP M Masonry RC Roofing Covering WS Window and Siding SF Solid Fuel Burning Appliances I 1 Insulation Telephone Email address D Demolition 5.2 Registered flume ovemen�Contractor(HIC) r i 9 HIC Registration Number Expilati9fri Date is ant Name d e I rEF&— Email address Ci /Town, State,ZIP Telephone SECTION 6 WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.152.§.25C(6)) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the Issuance f the building permit. Signed Affidavit Attached? Yes .......... No...........❑ SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED'WHEN OWNER'S AGENT OR CONTRACTOR APPLIES 1FOR RBBUILDING PERMIT I,as Owner of the subject property,hereby authorize to act on my behalf,in all matters relative to work authorized by this building permit application. Print Owner's Name(Electronic Signature) Date SECTION 7b:OWNERt OR AUTHORIZED AGENT DECLARATION By entering no name below,I hereby attest under the pains and penalties of perjury that all of the information conta_16ined ' yisa plic 'on t true and accurate to the best of my knowledge and understanding. Print Owner' r Amthdrized Agent's Name(Electronic Signature) Date NOTES: 1. An Owner who obtains a building permit to do his/her own work,or an owner who hires an unregistered contractor (not registered in the Home Improvement Contractor(HIC)Program),will not have access to the arbitration program or guaranty fund under M.G.L.c. 142A.Other important information on the HIC Program can be found at www.mass.gov/oca Information on the Construction Supervisor License can be found at www.mass.gov/dps 2. When substantial work is planned,provide the information below: Total floor area(sq. ft.) (including garage,finished basementlattics,decks or porch) Gross living area(sq.ft.) Habitable room count Number of fireplaces Number of bedrooms Number of bathrooms Number of half/baths Type of heating system Number of decks/porches Type of cooling system Enclosed Open 3. "Total Project Square Footage"may be substituted for"Total Project Cost" CITY OF SM EM, iNLksSACHUSEITS 13UM DLNG DEPART'Niwr 120 W ASHLIIGTON STREET, Vo FLOOR TEL (978) 745-9595 FAX(978) 740-9846 Kl�iBERLEY DRISCOLL MAYOR THOMAS STYIERRE DIRECTOR OF PUBLIC PROPERTY/BUIIDLNG CO\f.\IISSIONER Construction Debris Disposal Affidavit (required for all demolition and renovation work) In accordance with the sixth edition of the State Building Code, 780 CMR section 111.5 Debris, and the provisions of MGL c 40, S 54; Building Permit# is issued with the condition that the debris resulting from this work shall be disposed of in a properly licensed waste disposal facility as defined by MGL c 111, S 150A. The debris will be transported by: 61 (name of hauler) The debris will be disposed of in : AAL* e 1 (name of acdity) (address of facility) o S signature of permit applicant date Jcbriwdrd�w CSSL-099699 t$ ROBERT POCZOBUT 172WHALERS LANE SALEM MA 01970 s: 02108!2018 AU ATE IMNN Dn'YfY1 ACOI 0? CERTIFICATE OF LIABILITY INSURAN , 0712112016 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHN THE CERTIFICATE HOLDER. THUS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATNELY AMEND, EXTEND OR ALTER THE GE AFFORDED BY THE POLS BELOW THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEISSUING INSUREII(S), AUTNO D REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: R the certificate holder [sail ADDITIONAL INSURED, the po0cy(ies) must(0 endorsUBROGATION IS WAIVED, sub) tothe terms and conditions of the policy,certain policies may require an endorsement. A statement ortHicate does not BOMer righb tolhecertificate holder in lieu of such eiMorsemen APROWLER NAME: Maryellen GoodwDAVID E. ZELLER INSURANCE AGENCY INC IALC,o, (761)595-2071Fc NaE�LSs: maryellen davidmINSURER(S)ACOVERAGE !W R370 LYNNWAYLYNN MA 01901 INSURERA: TRAVELERS INY CO OF AMERICA:: 2 INSURED INSURERS: I ROBICCO INC 1N8UR1ERa INSURER D: 172 WHALERS LANE INSURER E: SALEM MA 01970 INSURERF, COVERAGES CERTIFICATE NUMBER: 70815 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 SHIS 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. 'ADDeit LuaR POLICY EFF : POUCY IXP TVPEOFWSURANCE POLICY NUMBER COMMERCIALGENERALUARLnY i EACH OCCURRENCE S titCLAIMSMADE J OCCUR PREMISES(ES . _ MED EXP(Amy pm Parson) 3 N/A : PERSONAL BADV INJURY S GEN'L AGGREGATE LIMIT APPLIES PER: - ! GENERALAGGREGATE 3 �— " PRODUCTS-COMPIOP AGO:' S POLICY_ JECOT -LOC `—I I I 3 OTHER: C MBINED SING LE LIMIT AUTOMOBILE WBILT' Ea alaWenl BODILY INJURY(Per Pe I, s ANY AUfrO -- ALLOW EO SCHEDULED NIA SOOLY INJURY Psr amdelle�S J AUTOS — AUTOSNED I� ; : PROPITY DAMAGE I3 —I HIREDAUTOS AUTOS !I Per acciEenl s I -UMBRELLALUUI CUR . EACH OCCURRENCE S EXCESS LWBOC �; CLAIMSMAOE: 1 NIA AGGREGATE 3 DED RETENTIONS f PER OTH WORKERS COMPENSATION '�, /� STATUTE ER AND EMPLOYERS'LWNLmr YIN E.L.EACH ACCIDENT S 1,000,000 ANWROPRIETORIPARINERIEXECUTNE A 1OFFICERNEMBEREXCLUDED9 WAI WA WA 6HUB5B37400216 07@312016 07123/2017 E.L.DISEASE-EA EMPLOYEIE S 1,000,000 1MandatM In NH) 0 dswib undef ! E.L.DISEASE-POLICY LIMm.S 1,000.000 DESCRIPTION OF OPERATIONS Isl m NIAII DESCRIPTION OF WERATRMA I LOCATIONS 1 VEHICLES (ACORD 101,A&RUMAl Ram Sch %.may be alMehsd if man spew is m ii,ld) Workers'Compensation benefits will be paid to Massachusetts employees only.Pursuant to Endorsement WC 20 03 06 B,no authorization is given to pax claims for benefits to employees in states other than Massachusetts if the insured hires,or has hired those employees outside of Massactlusetts. This certificate of insurance shows the policy in force an the date that this certificate was issued(unless the expiration date on the above pdicy precedes the issue date of this certificate of insurance). The status of this coverage can be monitored dairy by accessing the Proof of Coverage-CovAi age Verfficatiod Search tool at www.mess.govAwdtworkers-compensationlinvestigationsl. I CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELNEREO IN THD At-Home Services Inc and The Home Depot ACCORDANCE WITH THE POLICY PROVISIONS. 269 Cumberland Parkway AUTHORMED REPRESENTATIVE Atlanta GA 30339 Daniel Mr CroNrr y,CPC_,VICs President–Residual rket–WCRIB ID 1988-2014 ACORD CORPORATION, All rights rved. arks of ACORD ACORD 25(2014101) The ACORD name and logo are registered m .:- - - ""`" R09fETY1PROVE'vtF•N'FL'0;,1"CitAi"'T t-> ,. PLEASEREAD THIS - .. SOid,Pim shad and Installed Branch Name:New ER&W Datint-q 1.A'Al Tem At-Home Serwiottl.NG ,. .%. idWa The Mane&Mx At•Hutdc Services Bramh Nttmtier: t 908 Doane TwmpiJ*%Unit 1,Shrewsbury.MA 01$45 Toil pm:$77-903t-3769 - - a - FadcaitD x75-i64�160;biE l,ic.aCfY1439:RTCont_lict+16J?7 • ` {_.� Ct'tie�HtG11463522:TfA Hm+e Lnpmucment CimruYu Rt;:-1t 12Ci893 InstalationAddre t, (7G£t✓a�! J�f �`ahm /f1(� ;.,,,,,0/970 City ai, .; .State. Zip. . Porehaseris}. Wok Phone: Nome Ph®e: _ Cell PboOc..... .Le2S on L l L97877yS19/93 L 1 Home Addrea`. . � ' (if different from iniWinion Addmss) b ,,.. City State Zap E•nmil Address(mreceive project cmmmanimtians and Home Dupes updatet)ryX ' (]iOO ROT wisNn tormeive nay markchag rrnwils:fromTte Homc Uepw Prniee4lt,£nrmatinn; Undenigned i-Cmtnmer^)„U,c owners of tfie located at the abode installation�stldress,agaS to bay, and THD At-Hone Services,Inc.C'Tbe Hem Depot")agrees to furni iverand arrango fix the indaRat)m TYnanilation )Of - all ma€eriaic described on the below and on the referenced Speo:Sh lads),all of u4ikir are incorporated low this Comma by this millrace,along with any applivOlc State Supplevtmt and Payment Summery aaachod l actp and any Change Ordeal(colleclfvdy. Cont Job#:firsar.,aP min• .. Prof Amaant whincam IT9N71�3'f it c , c ij Iftlda puo 86i59�/ 1,aJo2_ ng QSiding-0 Whadwws El Insulation -..0(lat<rs1Costo OFsntyDoors 0- 0-MA-1i R eN Sc.,.. g{ Windows 0 Insulation - [�ConReatCawaa[}FutupRoaes[] .' �. $ R ag Sim wiaarw:eEj Isolation` - �]CmrierslCewas E'lti+uypwrs CI $ SDdimua25'le ile{airk ofConoad Manual do%opnememome#dtianAamrap. ,Pohl Contract Amount $ d ��/�,fdtiatePmchasea mty Adepaao l mre Iha0tA04Nrd o10w CowaaAmouaL Customer agces that,immediately upon completion or the work for each Predut'L Customer will ececote a Compilation Certificate lore-tar each product at defined by an individual Spec Sheet)and pay arrd twlanrx duce Aa applicable,caner.Culamo r Under this „Contact agrees to beffintly and severally obligated and liable Immundcr. Tia.Home Drew reserves the riglif to issue,a Change Order or terminate this Contract or any indhidual Productis)included heron.mit its diseretun.it Tim Home Ocpo or its uwhatiasd service frrai&a denermiam that Or cannot perform ire obligations dote to a willomad -. problem wild the house,environmental harauds such as mold,asbestos or lead pum,otber solely omttms.pricing emxs tg because r work rcyured to complete ffif A was no[Included in the Contract, Pavmeut.;Rmmarvt The,Pavmem Summary tt—/a2.;G;9pt,s,,,,,,,,,,,,,, included as part aif'this Contract sate forth the teat Comtrartamountand••payments.required for thed*taita andfin4l payments by Prtduet{aiappiwaMei. •^�•,. xw : e NOTICE TO CUSTOMER , You are eftuded to a ennnppt1eetely filieddn cappof the Contract At the dawyou sign. Danetsipn a Conp3efloa CerdDcata(nate: - lhera Is;ow Completion Cerdihstefor each lWed Product rot defined by Individual Spee Sheets)before srty4 on that Precinct .. is complete.In the event of termination of thin Contract;Crsaomer agrees to pay The Home ttepbt the costs of materials,labor.expenses and services Provided:by The Home'..Depot or-Autha bed.Seertiiee Provider lhrogdt the date of termination,Pins my other >menamts set firth In MLS Agreement or afiOwed tender opplicable low. THE HOME DEPOT MAY WITHHOLD AMOt::NTS -. OWED T() THE NOME DEPOT FROM THE DE SIT PAYMENT OR OTHER PAY:4 ENTS MADF WTTHOVT LIMITING THE HOME DEPOT'S 07UER REMEDIES FOR RECOVERY OF SUCH AAIOU.NT$. Acr��t ne asirathn ,Customer agrees acct underuanda that this Agrttmem is the emlce agecomat between Custoomr and"a Home Delax wish regard to um Products and Installation services and supersedes all prior discussions amid agreements.cidia „ wal a,wrinrn.relating to said Products and Installation.This Agreement cannot be asr.igaed or Amended exeept by a writing signed by Cuatr mer and The Ilona Depot.Customer acknowledges sad agrees that Customer has read.undrxamtds,voluntarily accepts the terms of and has received a-copy of this Agteemcat Aea ted by: Submitted by Custouni Value Dae r Sales onsultam's Si tune Da e x Telephone Nb. 617 1611<0 HNy Custnmcr's Signature Date Salee Ctnsnitant l�ioxnse Na. CANCEu.A'FlOy: CUSTOMER MAY CANCEL THIS AGREEMENT VVTTROUT PENALTY OR OBLIGATION BY DEUVER)NG VVRCTTEN NOTICE TO THE HOME.: DEPOT BY MIDNIGHT ON THE .THIRD BUSINFSS DAY AFTER.'SIGNING THIS AGREEVIEN'r. THE.... STATE SUPPLP..V9Wr. .ATTACHED HERETO - CONTAINS A FORM TO USE IF ONE' IS. - SPF,C'TF'ICALI.Y PRESCRIBED BY. LAW IN - CUSTOMER'SSTATE NOTfCE:ADDITIONALMALS AND C0NInTIONSARESTAYE9 ONTtiE REVULSEIIDE AND ARE PART OPYrIIS COS'TRACr 01,113.15 W bee-Franco Faa'Va#ow-Gocnomat a. AUG-29-2016 11:25 FROM: T5:17815692657 P.1/1 Customer: Berry Comm HOME Job#: 9471634 SERVICES CONDO MANAGEMENT: American Properties Team, Inc. Ann: Jen Pappas 500 West Cummings Park, Suite 6050 Woburn, MA 01801 small: info@aptcondoteam,com fax; 781.935,4289 As: Approval for Replacement Windows Installation Address: 13-B Griswold Dr., Salem, MA 01970 Jen, Concerning the above Installation Address, The Home Depot Is approved to install: Number of windows: 2 Material/Style: vinyl;double-hung Manufacture.. American Craftsman by Andersen Color(interior/exteri0rl: White/White Factor of rFIS none; n/a;exterior trim undisturbed Grid.J.ocation/Configuratioon: none;n/a Installation Method: intorior roplacoment/Installatlon state these proposed w do a meet with the American Pro erties Team, Inc. approval. n Print/// �r J � American Properties Team, Inc. TO: 13B Griswold Drive FROM: Jennifer Pappas, Property Manager RE: Window/Slider Replacement DATE: August 29, 2016 *xxxxxxxx*xxxxxxxxxxx**x**x************x*******************xx*x******xxx Please be advised that the Board of Trustees for Pick man Park has approved replacement windows for the above referenced unit. This approval is contingent upon them matching the existing windows and that they fit in the existing opening. Installation of the windows must be completed from the interior of the unit and they must be the same in appearance from the exterior. The new windows are not to have grids, crank outs, etc. Please note that you will be responsible for any damage that your contractor might cause (this includes painting). Should you contractor find any rot or damage during the window/slider installation,please make sure that it is reported to my office immediately. We also require that permits be pulled in advance (regardless of what your contractor may tell you), and then a copy of the final approved permit once completed must be sent to APT for the unit file as well. We also recommend that owners obtain a certificate of insurance from the licensed contractor. You will need to bring a copy of this letter to the Salem Building Department in order to receive your permit. Should you have any questions or require additional information, please feel free to call me directly at(781)569-2675. cc: Unit File 500 WEST CUMMINGS PARK.SUITE 6050• WOBURN .MA •01801 .781-932-9229 •FAX 781-935-0289 ij a Type of project(requind): Me appropriate b r �.ra you an _,moloyar? Check 'L 4#T 1. const7.jctcn an general V71 -ovito. [L ral contracto .5. o I am 2 employe. have hired the sub-contractors R 7. L -,ruodeling employees (RIll andlorpart-tilre-)- listed on the attached sheer. �- 7� -m T) n, 'it, n I am I sole proprietor or partner- 3. ❑Demolition These sub-contactor ha re Shiro and,Ia:,/j no arnploYeel workers' comp.insurance- 9, puilding addition woriting for we in any capacity. 5. ❑ We ire a comoration,and its lfj.[] E, ctrical rtpainiraddition, fro workers, comp- insurance Le r-quired.1 oficer have extrt:ised their plumbing r-_pair;5c additions right of exemption per M01, LJ I am 3.homeowner doing all work artself. Cao Worker3, comp- G. ? .31(1),and we have no 12.E] Roof repair; To wor!czm, ,,Or, required.] comp.insurance requ ad.] MUSC115o fill out the�ection,)CIGW;hQwing their WQT!Cr-'-ompensation DoNgI information. dinting,;uch- 17 IPPlicanL 7hat'heck3 niraoutsid�,conaactorsm,,tsubrrit Ind'm iffidavtt,n , his 3-f' jiatirg they ire doing-alt and .hen Who;ubmi.- idrilt',n comp.joiicy.infamadon. ditional3he4�t3ho,ingthe.,�eof,h,;ub<ontmctom�duteirmorr.c��1 is.box.must attached 3a id mcractor that-he--.'<this ,anc- Company Name, Expire ion Data: Hcy,# or Self-ins.Lic. 4- Exp Site Address:_— City[State,(Zip: le�date - compensation policy declaration p - �60wijja the policy number and expiration Each a copy of the workers' compens age (showing the imposition of criminal penalties of a ilure to secure coverage as required under Section 25A of MOL c. 152 can lead to �zy,ORDEIK and a fine -year imprisonment, as well as civil penalties in the form of a STOP WORK F this 3tat ment may be,forwarded to the Officc,)f up to S 1,500.00 and/or one copy o Le 7 against the violator. '0-- advised that a c ,Y Z ,-to -01 $230.00 a da 'cation. ,estigations of the DIA for insurance coverage v--rift jurl that the informatfon provided above is true and correct 9 hereby ce nd r thf pains andpetralties afper Date- nature: me jdr j1hpatm,a,),dp, hereby ce 7naturev'y�--- _z )ne 0.fj-rciaj use only. Do not write in this area, to be compter2d by city or town officlaL ParmitiLicense 4 City 6r Totw'n: issuing Authority (circle one): L-3_C ctQr 5.plurabkngjns�twr iLytTown-Cler.k--4-Flectrical-lzsp�� L.Board of Health--Z-auild"L9 Departmen Other Phone 9:1—�— ontact Person: DA rE;MMIDOfPPfp ACC)R6 CERTIFICATE OF LIABILITY INSURANCE 912719 THIRTIFICATE 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 POLI LIES 3ELOW, THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder iCertta nDDol ci sAmay require Sthe n endolrsement.A statement oust be n this ce rtflcOGATION 15 ate doses notuconferDrightslto the the terms and conditions of the policy, � p ' 9 certificate holder in lieu of such endorsement(s). C NTACT PRODUCER NAME: AX MARSH USA,IMC. PHONE I pIC Na TWO ALLIANCE CE•9T�R -.MAIL 1560:-NOX ROAD.SUITE 24130 `ADDRESS: ATLANTA,GIA 30326 INSURERS AFFORDING COVERAGE NAIC a Steadies'Insurance Comoany x25787 100492-HomeD-GAIN'-16-17 INSURER A. 15535 INSURER S.Zurich American insurance CA INSURED ,27841 THO AT-HOME SER`/ICES,INC. INSURER C.Plew Hampshire:ns Co DBA THE HOME DEPOT AT-HOME SERVICES .Illinois National Insurance Camoany 123817 2690 CUMBERLANO PARKWAY,SUITE 3CO INSURER D. ATLANTA,GA 30739 INSURER E: INSURER F COVERAGES CERTIFICATE NUMBER: ATL-00374664614 REVISION NUMBER:6 THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOT`NITHSTANDING ANY REQUIREMENT.TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MA'( 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. uMrts AODL UBR POLICY EFF POLICY EXP INSR TYPE OF INSURANCE POLICY NUMBER MMIDOMlYY MMIDDMIYY LTR. I i 9,000.000 A d COMMERCIAL GENENI ABILITY I IOL048BT714-06 10310112816 10310112017 EACH OCCURRENCE > iI DAMAGE T RENTED 1,000,000 CLAIMS-NAGE OCCUR PREMISES'Ea nencel I EXCLUDED - �� II'LIMITS OF?OLiCY RS i MED EXP IAny ane pefsam i ICF SIR:31M?E3 JCC I I 1 PEPSONAL LAD`n11JUR'( 1 i 9a69.6Do HI I - 9.;00900 1 GENERAL AGGREGATE > ' SEN'L AGGREGAT=LIMIT APPLES PER: I 3,000.800 PRO � PRODUCTS.COMPIOP AGO i i '�POLICY ]ECT L- '-OC I i OTHER: i0391i2816 O7A11201' COMBINED iINGLEIMI 1i 1;,100!700 BAP 2938863 13 IE euleent 1 B AUTOMOBILE LIABILITY I 11 I I iI I a001L/INJURY iPer aenonl I i X ANY AUTO SCHE_ 3E ;I,&F DAUTD P4'!DMG 1 30011-/INJURY IP9faccident)ii AUTOS i AU70SPROPER. AL L J I '!DAMAGE 1 i NON-OWNED IPer acudenl 1 HIRED AUTOS AUTOS I UMBRELLA UAB 'I OCCUR I I EACH OCCURRENCE 3 AGGREGAT=_ EXCESS LIAS CLAIMS-MAOE' DED RETENTION i WC01551921SAO5 0710112016 0310112017 % ?ER prH i G WORKERS COMPENSATION I I 1 ) TATIJT ER AND EMPLOYERS'LIABILITY YIN WC015519217(AK,K'I,NH.Nd1I T) 0310112016 10310112017 EL EACH ACCIDENT > 1,000.000 C ANYPROPRIETORIPARTNERrE%ECUTIVE EN 071011016 2 0310112017 E.L. D OFFICERIMEMSER EXCLUDED? WCo15519216(FL) DISEASE -EA EMPLOYE i (Mandatary In NH) 1.000,000 IfyBa,descOw enc: Continued on Additional Page E.L.DISEASE POLICY LIMIT i DESCRIPTION OF OPERATIONS aelow 1 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES IACORD 101,AJdlKanal Remade Schedule,may no altichee if more apace Is nqulmd) EVIDENCE OF INSURANCE CERTIFICATE HOLDER CANCELLATION THD AT HOME SERVICES,MC. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE DBA THE HOME DEPOT AT-HOME SERVICES THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 2455 PACES FERRY ROAD ACCORDANCE WITH THE POLICY PROVISIONS. ATLANTA,GA 30339 AUTHORO.ED REPRESENTATIVE of Morah USA Inc. Manasni Mukherjeeaµ°O"� "�� ©1999.2014 ACORD CORPORATION. All Nghts reserved. ACORD 26(2014101) The ACORD name and logo are registered marks of ACORD o, ad all- M5170 7. 0+L 10 Park plaza Massachusetts 116 roves ontractor 140 me Rar . . 'isnvian- lar. Tqce: E4traqoM AT Hum�= SE \/ICES, cmc RICHARD ,—,-ERRY ROAD, DA-ES I M,r. nc'I gartL for f ait G 'mm 3()339 Cam —A — r — — address riijduaj,,�e 3;U7 -tratloa valid for In `71 License Or V`Vs If f0dul t'ecom to' 55 innan before she ts`P xftirs and Business f C,,,wner Affair" g 0 ce of Cal" CON-T-A ACTOR 3dte 5170 IMpS0,4qMEN'T Typal Lo Park Plaza Boston. Lk *,Nut Zor Ragislra!'M'M ma�-a�— 3uP6jem. 'f�t Card. 6ffgtco L T"-11)AT '40NI ��EvICE:s I MEDEPPO-rA —�a� - THE Ro -1 �— - tore FktCHASO at V3 wit FERRY�GAQ��,sc 2455 PACES ..Cade GA 30339