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B-19-660 - 0025 BARSTOW STREET - Building Permit o Vv a 36 4 R 9 C\` �Q.v v S C, 0� The Commonwealth of Massachusetts Board of Building Regulations and Standards FOR Massachusetts State Building Code, 780 CUR MUNICIPALITY USE Building Permit Application To Construct,Repair,Renovate Or Demolish a Revised Mar 2011 One or Two-Family Dwelling This.Section For Official Use Only - S Building Permit Number Date Applied: t Building Official(Print Name) Signature Date SECTION l:SITE INFORMATI 1.1 P operty ddress 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) 7777 .r 1.5 Building Setbacks(ft) r ,� Front Yard Side Yards Rear Yard : Required Provided Required Provided Required Provide 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?Check if ❑ Municipal❑ On site disposal system ❑ yes SECTION 2: PROPERTY OWNERSIHPJ 2.1 On'of RecQr�d: u u Name(Print) City,State,Z1P No.and Street Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply) New Construction❑ Existing Building❑ Owner-Occupied ❑ 1 Repairs(s) ❑ Alteration(s) Addition ❑ Demolition ❑ 1 Accessory Bldg. ❑ N r of Units 1 Other ❑ Specify: Brief Description of Proposed Work2: r SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials I.Building $ 1 of 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: vf/ 5.Mechanical (Fire $ Suppression) Total All Fees:$ Check No. Check Amount: Cash Amount: 6.Total Project Cost: $ `�d�� 0 Paid in Full 11 Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Constru ti n TeMSI��L[A!7nse4CSL) av License Number Expiration Date Name of CSL Holder �g List CSL Type(see below) -Z� �1rn Type. Description No.and Street U Unrestricted(Buildings to 35,000 cu.R R Restricted 1&2 Family Dwelling City/Town,State,ZIP F M Masonry RC RoofingCovering WS Window and Siding ` SF Solid Fuel Burning Appliances Insulation Tel hone Email Odress D Demolition 5.2 Registered Ho Imp vement Contractor(HIC) ��.51 D 7�tJr 0fl `'n 0 HIC Registration Number ,expiration Date HIC Comp �4 y or HIC Regi Nam NM%t p� m 1 dres City/Town,State ZIP �J V Telephone tab 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 Issuanc the building permit. Signed Affidavit Attached? Yes .......... No...........O ad s SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING MIRMIT I,as Owner of the subject property,hereby authorize to act on my behalf in all matt-��Um ers relative to work authorized by b 'lding permit a is ion. � rCk\(--) c V � Print Owner's Name(Electronic Signature) Date SECTION 7b:OWNER'OR AUTHORIZED AGENT DECLARATION By entering my name below,I hereby attest under the pains and penalties of perjury that all of the information contained in this ap,��'/p�/tion is a an acc to the best ofmy knowledge and understanding. c Print Owner's or Authorized Agent's Name(Electronic Si ature) a e NOTES: l. 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 RIC Program can be found at www.mass.gov/oca Information on the Construction Supervisor License can be found at www.g&g.gov/dps 2. When substantial work is planned,provide the information below: Total floor area(sq.ft.) (including garage,finished basement/attics,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"maybe substituted for"Total Project Cost" The Commonwealth ofMassachusetts Department of Industrial Accidents Office oflnvesdgations 600 Washington Street Boston,MA 02111 www mas&gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information /� Please Print 'bl Name(Busmess/cvgatvzation4ndividmi): Lo`(1 V b ," TL Address: City/State/bp: U J Phone Are you an employer?Check the approp a box: Type of project(required): 1.[1I am a employer with 4. E31 am a general contractor and I employees(full and/or part-time).' have hired the sub-contractors 6. ❑Ne construction 2.❑ pr oprietor I am a sole ro rietor 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' t 9. [3 Building addition [No workers'tromp.insurance comp•mice required] 5. We are a corporation and its 10.❑Electrical repairs or additions 3.❑ 1 am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions myself.[No workers'comp. right of exemption per MGL 12.❑Roof repairs insurance required.]t c. 152,§1(4),and we have no employees.[No workers' 13.❑Other comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing then-workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. =Contractors 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 provide their,workers'comp.policy number. I am an employer that is providing w leers'compensation insurance for my employees Below is the policy and job site information. — Insurance Company Name: �� 3— _ Qn(�� ()_�rt\_Ca Policy#or Self-ins.Lic.M bJ�U 50 Expiration Date: ` l i Job Site Address: \ City/State/Zip: "1 O 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/ one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day aga' t the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the fo cc coverage verification. I do hereby certify d e and penalties of perjury that the information provided above is true and correct Signature: r Date: ` Phone#: Official use only. Do not write in this area,to be completed by city or town ojfmial City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health d.Building Department 3.City/Town Clerk 4.Electrical Inspector S.Plumbing Inspector 6.Other Contact Person: Phone#: CITY OF SALEK MASSACHUSET'I'S BZELDM DEPARTAENf 1 120 WASHNGTONSTREET,PFLOOR IkL(978)745-9595 FAX(978)740.9846 KAMERLEYDRISOOLL MAYOR THDmAs STAERRE DIRECTOR OF PUBLIC PROPERTy/Bia.DIl (--ODMOSSIOMR Construction Debris Disposal Affidavit (requiredfor all demolition & renovation work) In accordance with the sixth edition of the State Building Code, 780 CMR,Section 111.5 Debris, and the provisions of MGL c40,554;Building Permit# is issued with the condition that the debris resulting from this work shall be disposed of in a properly licenses waste deposit facility as defined by MGL c 111,S150A. The debris will be transported by: (name of hauler) The debris will be isposed of in: (name of facility) (address of facility) Signature of applicant (today's date) r A TRUSTED NAME SINCE 1945 Long Roofing,LLC 960 Turnpike St.,#3C,Canton,MA 02021 MA HIC#187510/RI HIC#41201 1 1 1 844-317-5664•LongRoofing.corn We build ntoevTrust yL Peace gRooflwind HOME REMODELING SALE Tinto every Long Roof. & INSTALLATION AGREEMENT BUYER#1 NAME DATE OF AGREEMENT Ellen Kieran 06/11/19 BUYER#1 IOME PHONE BUYER#1 CELL PHONE BUYER#1 EMAIL ADDRESS 978 744-0770 1 1 emkieran@msn.com INSTALLATION STREET ADDRESS CITY,STATE AND ZIP CODE 25 Barstow St Salem Ma 01970 BUYER#2 NAME BUYER#2 CELL PHONE BUYER#2 EMAIL ADDRESS The Buyer(s) listed above hereby jointly and severally agree to purchase the goods and/or services listed below and on the Q fL' accompanying addendum, in accordance with the prices and terms described on the front and reverse of this Agreement, and Buyer(s)have requested that such goods or services be installed or provided at Buyer's address listed above. Long Roofing,LLC i ("Contractor"), hereby agrees to install or cause to be installed the products or services listed in this Agreement at the Buyer(s) address written above. Buyer(s)agree to sign a completion certificate upon completion of the installation of goods. Detailed ` descript ons for all products are contained in the accompanying addendum to this Agreement. Total Purchase Price $ 13,048.00 Method of Payment: Deposit with Order $ 4,344.00 0 Cash 0 Check O Money Order 0 Credit Card Amount Due on Start of Work $ 0.00 Amount Due on Substantial Completion $ 8,704.00 Credit Card Exp Date 11 / 22 Amount Financed $ 0.00 CV2# 4305870402' Last 4 Digits of CC# 511 Estimated Starting Date 4-6 weeks Estimated Completion Date 1-3 days Do not aign this agreement if blank. You are entitled to a copy of this agreement at the time you sign it. It is agreed and understood by and between the parties that this Agreement,front and back and any addendum,constitute the entire understanding between the parties,and there are no verbal understandings,changing or modifying any of the terms of this Agreement. Buyer(s)hereby acknowledge that Buyer(s)has read the front and the reverse of this Agreement and has received a completed,signed and dated copy of this Agreement,including the two attached Notice of Cancellation forms, on the(fate first written above. Buyer(s)acknowledge that they were orally informed of their right to cancel this transaction. THIS AGREEMENT IS SUBJECT TO ARBITRATION Long Roofing,LLC Buyer(s) By._ Signature em reran CUP msn.com 11 June 2019 Signature Ellen Kieran y Stephen Adams Print Name FQew Kiernw,. Print Name(Address listed on top of Agreement) Signatur Product Specialist's Lic.Number(if applicable) Print Name You,the buyer, may cancel this transaction at any time prior to midnight of the third business day after the date of this transaction See the attached notice of cancellation form for an explanation of this right. NOTICE.OF CANCELLATION Date of Transaction 06/11/19 NOTICE OF CANCELLATION Date of Transaction 06/11/19 You may CANCEL this transaction,without any Penalty or Obligation,within THREE You may CANCEL this transaction,without any Penalty or Obligation,within THREE BUSINESS DAYS from the above date.If you cancel,any property traded in,any BUSINESS DAYS from the above date.If you cancel,any property traded in,any payments made by you under the contract or sale,and any negotiable instrument payments made by you under the contract or sale,and any negotiable instrument executed by you will be returned within TEN BUSINESS DAYS following receipt by executed by you will be returned within TEN BUSINESS DAYS following receipt by the seller of your cancellation notice,and any security interest arising out of the the seller of your cancellation notice,and any security interest arising out of the transaction will be canceled.If you cancel,you must make available to the seller transaction will be canceled.If you cancel,you must make available to the seller at your residence,in substantially as good condition as when received,any goods at your residence,in substantially as good condition as when received,any goods delivered to you under this contract or sale;or you may,if you wish,comply with the delivered to you under this contract or sale;or you may,if you wish,comply with the instructions of the seller regarding the return shipment of the goods at the seller's instructions of the seller regarding the return shipment of the goods at the seller's expense€nd risk.H you do make the goods available to the seller and the seller expense and risk.If you do make the goods available to the seller and the seller does does not pick them up within 20 days of the date of your notice of cancellation,you not pick them up within 20 days of the date of your notice of cancellation,you may may retain or dispose of the goods without any further obligation.If you fail to make retain or dispose of the goods without any further obligation.H you fail to make the the goods available to the seller,or if you agree to return the goods to the seller goods available to the seller,or if you agree to return the goods to the seller and and fail tii do so,then you remain liable for performance of all obligations under the fail to do so,then you remain liable for performance of all obligations under the contract.'fo cancel this transaction,mail or deliver a signed and dated copy of this contract.To cancel this transaction,mail or deliver a signed and dated copy of this cancellation notice or any other written notice,or send a telegram,to Long Roofing cancellation notice or any other written notice, or send a telegram, to LLC, at 960 Turnpike St, #3C, Canton, MA 02021, NOT LATER THAN Long Roofing LLC,at 960 Turnpike St.,#3C,Canton,MA 02021 NOT LATER THAN MIDNIGHT OF a MIDNIGHT OF 01, Client Signature Date Client Signature Date Long Roofing,LLC 960 Turnpike St.,#3C,Canton,MA 02021 MA HIC#18751 O/RI HIC#41201 844-317-5664•LongRoofing.com ROOFING ADDENDUM BUYER#1 NAME DATE OF AGREEMENT Ellen(Kieran 06/11/19 BUYER#1 HOME PHONE BUYER#1 CELL PHONE BUYER#1 EMAIL ADDRESS (978)744-0770 emkieran@msn.com INSTALLATION STREET ADDRESS CITY STATE AND ZIP CODE 25 Barstow St Salem Ma 01970 BUYER#2 NAME BUYER#2 CELL PHONE BUYER#2 EMAIL ADDRESS The Buyers)listed above hereby jointly and severally agree to purchase the goods and/or services listed below,in accordance with the prices and terms described on this Addendum and the front and reverse of the accompanying Home Remodeling Sale and Instalaltion Agreement,of which this Addendum is a part. Long Roofing,LLC(herein called"Seller")proposes to furnish,deliver and install for the above Buyer(s)(whether one or more herein called'Buyer")all materials necessary to improve the premises located at the above address("Property")according to the following specifications: 01.Obtain all necessary insurance 0 6.Install roofing on specified areas 08.Long Roofing is not responsible for: 0 2.Arrange for pre-installation measure 0 7.Clean up and dispose of all job-related a.Any interior trim work surrounding skylights 0 3.Deliver all materials to project site debris.(Note:Roof removal can cause b.Any post installation dipping,bowing or sloping 0 4.Remove existing roof considerable dust in attic area.Please due to existing structural conditions of the roof 0 5.Inspect for wood rot that cannot be cover or remove attic items as necessary c.Satellite reception once reinstalled. Please be found during initial inspection. as Long Roofing is not responsible for prepared to contact your satellite provider post n r—� damage or attic clean up.) installation. Access to Driveway: �.� Yes —L No Shingle Brand/Color/Details:Landmark Charcoal Black Satellite:II Remove/Dispose or❑Remove/Reinstall Attic Fan: Remove/Dispose or fRRemove/Replace � I. #of Stories Above Ground _ Warranty:Il 20 YP -0 20 YNP r 50 YNP Surface areas NOT to be covered: Front porch not included, garage and back roof is included Tear off existing shingles ✓ Yes No #of layers 1 Install Underlayment JI/I Yes _LLNo Type Diamond d ck Install Drip Edge ✓ Yes No Color White Ridge Vent Yes No Intake Vent �Existing (see Accessory All Linear feet g �_Add Addendum) Pipe Collars #of collars 1 Chimney Flashing Color Silver #of Chimneys 1 Apron Flashing Color Replace Deck Sheathing Yes �/ No Thickness #of Sheets Replace Skylight Fixed If homeowner chooses NOT to replace existing skylight, Yes E_No Operable LFH can reseal with Winterguard but cannot be liable for any future leakage. Initial Er,r<z— emMemn®men.mm 11 June 2018 Any wood other than sheathing will be replaced at$14/foot. Sheathing is a cost of$70/sheet. Initial ff—K.— THERE ARE NO ORAL AGREEMENTS. ALL details must be included on this agreement or addendum thereto. Inital Additio-lal Information or Remarks: Total Purchase Price $ 13,048.00 (If multiple products,list breakdown here) Deposit with Order $ 4,344.00 Replace rotted sheathing no charge Amount Due on Start of Work $ 0.00 Amt.Due on Substantial Completion $ 8,704.00 Amount Financed $ 0.00 The estimated date of commencement of the work is 4-6 weeksand the estimated completion date is 1-3 days The project is contingent upon obtaining[]approved financing ❑permits OHOA approval p within days. It is agreed and understood by and between the parties that this Addendum, along with the Home Remodeling Sale and Installation Agreement,constitues the entire understanding between the parties,and upon signing,this document becomes a binding contract under law.Unless otherwise noted within this document,the contract shall not imply that any lien or other security interest has been placed on the residence.There are no verbal understandings, changing or modifying any of the terms. 'This agreement may not be changed or its terms modified or varied in any way unless such changes are in writing and signed by both the Buyer(s)and the Contractor. Buyer(s)hereby acknowledge that Buyer(s)has read this Addendum. Long Roofing,LLC Buyer(s) ss By. 6'9,. Kzw. Signature SignatuWkieran@msn.com 11 June 2019 Stephen Adams Printed Name Lic.Number Signature Long Roofing,LLC 960 Turnpike St.,#3C,Canton,MA 02021 ACCESSORY ADDENDUM MA HIC#18751 O/RI HIC#41201 844-317-5664•LongRoofing.com BUYER#1 NAME DATE OF AGREEMENT Ellen Kieran1 06/11/19 BUYER#1 HOME PHONE BUYER#1 CELL PHONE BUYER#1 EMAIL ADDRESS 978 '744-0770 1 emkieran@msn.com INSTALLATION STREET ADDRESS CITY,STATE AND ZIP CODE 25 Barstow St Salem Ma 01970 BUYER#2 NAME BUYER#2 CELL PHONE BUYER#2 EMAIL ADDRESS The Buyer(s)listed above hereby jointly and severally agree to purchase the goods and/or services listed below,in accordance with the prices and terms described on this Addendum and the front and reverse of the accompanying Home Remodeling Sale and Instalaltion Agreement,of which this Addendum is a part. Long Roofing,LLC(herein called"Seller")proposes to furnish,deliver and install for the above Buyer(s)(whether one or more herein called`Buyer")all materials necessary to improve the premises located at the above address('Property")according to the following specifications: 1211)Obtain all necessary insurance ®3) Clean up and dispose of job-related debris 12212) Arrange for Pre-Installation Inspection if necessary ®4) Long Roofing is not responsible for any electrical work. VENTILATION n✓ N/A SmartVent Yes F-1_No Linear ff. GUTTERS jo NO GUTTER WORK TO BE DONE 05"Gutters 2"x 3"downs FT Color Gutter Cover ❑Yes ONO FT [16"Gutters 3"x 4"downs FT Color Rain Diverters - F-1-Yes F_No (If yes)OTY TRIM _Z NO TRIM WORK TO BE DONE Replace Fascia ❑Yes ❑No FT Size Replace Rake ❑Yes ❑No FT Size Replace Frieze ❑Yes ❑No FT Size Wrap Fascia ❑Yes ❑No FT Size Color Wrap Rake ❑Yes ❑No FT Size Color Wrap Frieze []Yes ❑No FT Size Color Install Vented Soffit []Yes ❑No FT Size Color Porch Ceiling Soffit El Yes [:]No Squares Color INSUU\TION J✓ NO INSULATION TO BE DONE Remove Existing ❑Yes ❑No ❑7.5 inch ❑12 inch ❑15 inch ❑18.5 inch EXISTING GUTTER AND GUARD SYSTEMS:LONG ROOFING IS NOT LIABLE FOR ANY GUTTERS/GUARD SYSTEMS INSTALLED BY ANOTHER COMPANY AND NOT TAKEN DOWN PRIOR TO INSTALLATION OF THE NEW ROOF. Initial �. Additional Information or Remarks: Total Purchase Price $ 13,048.00 (If multiple products,list breakdown here) Deposit with Order $ 4,344.00 Amount Due on Start of Work $ 0.00 Amt.Due on Substantial Completion $ 8,704.00 Amount Financed $ 0.00 The estimated date of commencement of the work is 4 6 wee ksand the estimated completion date is 1-3 days The project is contingent upon obtaining❑approved financing ppermits❑'IOA approval ❑ within days. Long Roofing,LLC Buyer(s) ssee Signature Ignat4Fnkieran@msn.com 11 June 2019 Stephen Adams Printed Name Lic.Number Signature A TRUSTED NAME SINCE 1945 Long Roofing,LLC 960 Turnpike Street,#3C, Canton, MA 02021 1 MA HIC Reg.#187510 • 844-317-5664•LongRoofing.com We build Trust and Peace of Mind into every Long Roof. HOME REMODELING SALE&INSTALLATION AGREEMENT BUYER(S)NAME 7777 RDER# Ellen Kieran BUYER(S)'STREET ADDRESS INSTALLATION STREET ADDRESS 25 Barstow St Same BUYER(S),CITY,STATE AND ZIP CODE INSTALLATION CITY,STATE AND ZIP CODE Salem,Ma 02970 Same BUYER(S)HOME TELEPHONE# BUYER(S)WORK TELEPHONE# BUYER(S)EMAIL ADDRESS DATE OF CONTRACT (978)744-0770 06/11/19 This Amendment ("Amendment") is to the CUSTOM REMODELING AGREEMENT ("Agreement") by and between Long Roofing, LLC ("Contractor") and Ellen Kieran ("Buyer(s)") Contractor and Buyer(s) hereby agree to amend and modify the Agreement as indicated below.Other than as specifically indicated below,all the terms and conditions of the Agreement will remain in full force and effect.This Amendment is subject to the terms and conditions of the Agreement. The following additions,alterations,or deletions to the products and services Buyer(s)ordered are being made: If homeowner chooses NOT to replace existing skylight(s),Long Roofing will reseal with WinterGuard and reflash but will not be liable for any future leakage. If homeowner chooses to replace skylight(s),Long Roofing is not responsible for any interior trim work,painting or drywall. Debris can sometimes fall below during the replacement of your roof and/or skylights. Please be aware of any items below that may need to be moved and or/covered. Long Roofing is not responsible for any items inside your home (including attic). The dLmpster is for install-related debris ONLY. The homeowner is not to use for any reason.On the day that the dumpster will be delivered—please do not park in your driveway. Long Roofing,LLC is not responsible for any driveway damage.Dumpster will be placed on wood blocks to minimize likelihood of damage.When the town allows for a street permit customer can choose to do so for an additional charge. As a result of these changes,the following terms of the Agreement are also changing(if there is no change,an item will be left blank or marked as"N/N',indicating that no change applies): PLEASE PAY OUR INSTALLER Additional Information or Remarks: Ifmulti le mducts list breakdown below Total Purchase Price 13,048.00 Deposit with Order 4,344.00 Amount Due on Substantial Completion 8,704.00 Amount to be Financed CIM The estimated date of commencement of the work is 4-6 weeks and the estimated completion date is 1-3 days This projection is contingent upon obtaining ❑approved financing ❑permits O HOA approval ❑ within days. It is agreed and understood by and between the parties that this Amendment and the original Agreement constitute the entire understanding between the parties,and there are no verbal understandings changing or modifying any of the terms of this Amendment Buyer(s)hereby acknowledges that Buyer(s)has read this Amendment and has received a completed,signed,and dated copy of this Amendment on the date written below. Long Hoofing,LLC Buyer(s). By: . ��k!--SignatureSignature StS Ellen Kieran ephen Adams Print Name Print Name (Address listed at top of Agreement) Signature Product specialist's License Number(If Applicable) Print Name MOW • ase j� - may,' pj, z: " ¢ + `` 1 } $r Wili ` n1 5 Aw t x , 41 r ; .. � 46, All COMMISSione Office of Consumer Affairs and Business Regulation 1000 Washington Street - Suite 710 Boston, Massachusetts 02118 Home Improvement Contractor Registration Type: Supplement Ci LONG I-ROOFING OF MASSACHUSETTS LLC Registration: 187510 10236 113OUTHARD DR. Expiration: 04/20/2021 BELTSVILLE, MD 20705 Update Address and Ref Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only TYPE: Supplement Card before the expiration date. If found return to: Reaistt°ation Expiration Office of Consumer Affairs and Business Regulation 187510 04/20/2021 1000 Washington Street -Suite 710 LONG ROOFING OF MASSACHUSETTS LLC Boston,MA 02118� GERRY PATRIQUIN 10236 SOUTHARD DR. BELTSVILLE, MD 20705 Undersecretary Not td m4thout signature CCMLY A CERTIFICATE OF LIABILITY INSURANCE DATE / ) A��: zsa34s, 10111/11/20182018 THIS CERTIFICATE I1 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 Oil PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the Policy(ids)must have ADDITIONAL INSURED provisions or be endorsed.If SUBROGATION IS WANED,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). PRODUCER CONTACTBgg-g28$365 Lockton Companies,LLC; NAME: 5847 San Felipe,Suite 320 PHONE FAX A/C No): Houston,TX 77057 E-MAIL ADDRESS: INSURERS AFFORDING COVERAGE NAIC# INSURER A: Indemnity Insurance Co.of North America 43575 INSURED Insperity,Inc. INSURER B: 19001 Crescent Springs Drive INSURER c Kingwood,TX 77339 'SEE BELOW INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 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 ADDL SUBR LTR TYPE OF INSURANCE wvnPOLICY NUMBER POLICY EFF POLICY EXP MM/DD MM/DD LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S CLAIMS-MADE OCCUR DAMAGE TO RENTED PREMISES Ea occurrence) $ MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GEN'LAGGREGATELIMI'r APPLIES PER: GENERAL AGGREGATE $ POLICY❑ PRO- ❑ JECI' LOC PRODUCTS-COMP/OP AGG $ 'rAN $ LIABILITY COMBINED SINGLE LIMIT $ Ea accident O BODILY INJURY(Per person) $ ED SCHEDULED AUTOS BODILY INJURY(Per accident) $ TOS NON-OWNED PROPERTY DAMAGE AUTOS Per accident $ $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS MADE AGGREGATE $ OED RETENTION S WORKERS COMPENSATION $ AND EMPLOYERS'LIABILITY Y/N X PER TUTE ERHANY - A OFFICER/ME BER EXCLUDED? ❑N/A X E.L.EACH ACCIDENT $ 1,000,000 C65801504 10/1/2018 10/1l2019 (Mandatory In If yes,describe under E.L.DISEASE-EA EMPLOYEE $ 1.000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(ACORD 1D1,Additional Remarks Schedule,may be attached If more space is required) LONG ROOFING.LLC(4086200)IS INCLUDED AS A NAMED INSURED THROUGH ENDORSEMENT. WAIVER OF SUBROGATION IN FAVOR OF Long Roofing,LLC WHEN REQUIRED BY WRITTEN CONTRACT. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. LONG ROOFING,LLC AUTHORIZED REPRESENTATIVE BELT VILLE, I D 070 BELTSVILLE,MD 20705 �—'�- 01988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD