B-19-975 - 0023 BEACH AVENUE - Building Permit 1A
The Commonwealth of Massachusetts
Department of Public Safety
Massachusetts State Building Code(780 CMR)
Building Permit Application for any Building other than a One-or Two-Family Dwelling
(This Section For Official Use Only)
Building Permit Number. Date Applied: Building Official:
SECTIOil 1:LOCATION(Please indicate A I Block�#and Lot#for locations for which a street address is not available)
6r 3 L nd\ Ave. A Lee . f-1-
No.and Street City/Town Zip Code Name of Building(if applicable)
SECTION 2 PROPOSED WORK
Edition of MA State Code used If New Construction check here❑or check all that apply in the two rows below
' Existing Building❑ Repair Z Alteration ❑ Addition❑ Demolition ❑ (Please fill out and submit Appendix 1)
Change of Use ❑ Change of Occupancy ❑ Other t$( S pecif y:Are building plans and/or construction documents being supplied as part of this permit application? Yes ❑ No
Is an Independent Structural Engineern�g Peer Review required? Yes ❑ No �, ,4 _
Brief Description of Proposed Work: K, 1 TG-'L' h ,., 2 L
l •';'6
e
t •IC''""4Y'lia_ _ _
i f� ;e' --
SECTION 3:COMPLETE THIS SECTION IF•EXISTING BUILDING-UNDERGOING RENOVATION,AD W� ON, R
CHANGE IN USE OR OCCUPANCY
Check here if an Existing Building Investigation and Evaluation is enclosed(See 780 CMR 34) ❑
Existing Use Group(s): Proposed Use Group(s): !: _
SECTION 4:BUILDING HEIGHT AND AREA
Existing Proposed
No.of Floors/Stories(include basement levels)&Area Per Floor(sq.ft.)
Total Area(sq.ft.)and Total Height(ft.)
SECTION 5:USE GROUP(Check as a plicable)
A. Assembly A-1❑ A-2❑ Nightclub ❑ A-3 ❑ A4❑ A-5❑ 1 B: Business ❑ E: Educational ❑
R Facto F-1❑ F2❑ H. High Hazard H-1❑ H-2❑ H-3 ❑ H-4❑ H-5❑
L• Institutional 1-1❑ I-2❑ I-3❑ I-4❑ M: Mercantile❑ R: Residential R-14� R-2❑ R-3❑ R-4❑
S: Storage S-1❑ S-2❑ U. Utility❑ Special Use❑and please describe below:
Special Use:
SECTION 6:CONSTRUCTION TYPE(Check as applicable)
IA ❑ IB ❑ IIA ❑ ' IIB ❑ IIIA ❑ IIIB ❑ IV ❑ VA ❑ • VB ❑
SECTION 7:SITE INFORMATION(refer to 780 CMR 111.0 for details on each item)
Water Supply Flood Zone Information: Sewage Disposal• Trench Permit: Debris Removal:
Public❑ Check if outside Flood Zone❑ Indicate municipal❑ A trench will not Licensed Disposal Site❑
Private❑ or indentify Zone: or on site system❑ required❑or trench or specify:
permit is enclosed❑
Railroad right-of-way: Hazards to Air Navigation: MA Historic Commission Review Process:
+ Not Applicable❑ Is Structure within airport approach area? Is their review completed?
or Consent to Build enclosed❑ Yes❑ or No❑ Yes❑ - No ❑
SECTION 8:CONTENT OF CERTIFICATE OF OCCUPANCY
Edition of Code: Use Group(s): Type of Construction: Occupant Load per Floor:
' *' Does the building contain an Sprinkler System?: Special Stipulations:
SECTION 9: PROPERTY OWNER AUTHORIZATION
Name and Address of Property Owner
Name(Print) U No.and Street City/Town Zip
Property Owner Contact Information:
t-bVVI-C-d\Nk:1V _ _ - Of 5�
Title Telephone No. (business) Telephone No. (cell) e-mail address
If applicable,the property owner hereby authorizes
J-,U,e,kwV-,6 ,� 2 3►, Ley+-Y. V12A �W I w , j�\A S�f
Name Street Address City/Town State Zip
to act on the property owner's behalf,in all matters relative to work authorized by this building permit application.
SECTION 1&CONSTRUCTION CONTROL(Please fill out Appendix 2)
(ff building is less than 35,000 cu.ft.of enclosed space and/or not under Construction Control then check here❑and skip Section 10.1)
10.1 Registered Professional Responsible for Construction Control
Name(Registrant) Telephone No. e-mail address Registration Number
Street Address City/Town State Zip Discipline Expiration Date
10.2GQDeneeCral Contractor
Company Name
CIS_ 43AOS �
Name of�3f`�
Person Responsible for Construction License No. and Type if Applicable
/ 0VV-1 t2 MIS&4-ovLoo Q/-\ M& d1z'u ,
Street Address City/Town State Zip
Telephone No.(business) Telephone No.(cell) e-mail address
SECTION 11:WORKERS'COMPENSATION INSURANCE AFFIDAVIT: M.G.L.c.152.§25C 6
A Workers'Compensation Insurance Affidavit from the MA Department of Industrial Accidents must be completed and
submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit.
Is a signed Affidavit submitted with this application? Yes e9' No ❑
SECTION 12:CONSTRUCTION COSTS AND PERMIT FEE
Item Estimated Costs: (Labor \^\``
and Materials) Total Construction Cost(from Item 6)_$ W
1.Building $ Building Permit Fee=Total Construction Cost x (Insert here
2 Electrical $ appropriate municipal factor)=$
3.Plumbing $
4.Mechanical (HVAC) $ Note:Minimum fee=$ (contact municipality)
5.Mechanical (Other) $ Enclose check payable to
6.Total Cost $ U, (contact municipality)and write check number here
SECTION 13:SIGNATURE OF BUILDING PERMIT APPLICANT
By entering my name below,I hereby attest under the pains and penalties of perjury that all of the information contained in this
application is true wid accurate to the best of my knowledge and understanding.
oqlfo �.
ease rint and sifm name Title Telephone Date
'Street Address r� City/Town State Zip
Municipal Inspector to fill out this section upon application approval•
a e Date
CITY of S.��t, . LxsSACHusETI'S
BUMDLNG DEPARTS&NT
' 120 WASHINGTON STREET,r FLOOR
'fit a''r TEL (978)745-9595
FAX(978)740-9846
KI«ERi.EY DRISCOLL
MAYOR T HomAs ST.PWIM
DIRECTOR OF PUBLIC PROPERTY/Bt,' MING CON51ISSIONIER
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Lerliblj
Name(Bus;itnssiOrganizatioNladividual): VIC
Addressj 3 al G Y
City/State/Zip: 1�A � one#:
Are you an tmplayer?Check the appropria a box: Type of project(required):
1.❑ i am a o-mployer with 4. WI am a general contractor and 1 6. ❑New construction
employees(full and/or part-time).' have hired the sub-contractors
2.❑ 1 am a role proprietor or partner-
listed on the attached sheet.: '• ❑Remodeling
ship and have:no employees These sub-contractors have 8. ❑Demolition
working for me in any capacity. workers'comp.insurance. 9. ❑Building addition
[No workers'comp. insurance S. ❑ We are a corporation and its 10❑Electrical repairs or additions
required.] officers have exercised their
3.❑ i am a homeowner doing all work right of exemption per MGL 11.❑Plumbing repairs or additions
myself.[No workers'comp. C. 152,§1(4),and we have no 12.0 Roof repairs
insurance required.]f employees.[No workers' 13.aOther
comp.insurance required.]
*Any applicant that chodw box#1 must also fill out the section below showing their workets'compensuion policy infurmation
t t inmeovaim wl,to submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
Contractors that t:heek this box must attached an additional sheet showing the name of the subcontractors and their workers'comp.policy infomtation.
am an employer that Is providing workers'compensation Insurance for my employees Below is the policy and job site
information. _
Insurance Company Name: J11L�NT-6C
Policy#or Self-ins.Lic.#:�0 e?(,� J�` �� Expiration Date:
Job Site Address: 1 c-I)ck NV, City/State/Zip:..
Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration bate).
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 S1,500.00 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 advi..wd that a copy of this statement may be forwarded to the Office of
investigations of the DiA for insurance coverage verification.
I do hereby •errdfy underlhe pains an�/penalties of perjury that the informaden provided above is true and correct
. n r ire• v�'� �I' Ce IS 1/0
5 Date:
" Phone#: -
° Ojjcial use only. Do not write in this area,to be completed by city or town of iciaL
City or'Toi4n: Permit/I,icense#
lssuing Authority(circle one):
1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5. Plumbing Inspector
6.Other—
Contaet Person: Phone#:
y /� ° yam{■,.; ■y 3y �' ! /WL/' 41i/�€Va'R'F!✓'7"✓a'v4^.'+4 �-^J" l/G4'G/"✓(iw'L.+(LA4L"i"rFK(/'
f._ Comm ?n'Y5realth of Massachu� its �y y•y R � I.
'Division of Professional 'seensure Y . � � ' , . ��. Office of Consumer Affairs &Business Reauiation
Board of Building Regulations and Standards i HOME IMPROVEMENT CONTRACTOR
Consstr ti�up r ris r E TYPE:�±Corporabon
ExpirAtign
CS� fl; �q{ �� Wes
05/101202,1 ��0 *�Q5123/ZQ2'f
vj� to 2+.i Y l
ARTS HOME IMP , 0 Ni JNC.
x
23 BALCOM ROA[}
MARLBOROUGH,MA 01762 LUCIANO ALV� �
2313ALCOM ROAD n
A. MARL ORO, MA 01762 Undersecretary
Y m rnissroner
0
zonvnonweaftholMassaettusotts
Board of Building Re ((rlabons and•Standilrds Registration valid for individual use only
X
�astt "rvisot before the expiration date. If found return to:
Office of Consumer Affairs and Business Regulation
CS-111056 ires: 05/1�0/2021 �. 1000 Washington Street - Suite 710
ti Boston, MA 02118
LUCIANO ALVES
.23 +8ALCOM RBAD.
MARLROROUGMMA 01752
Not valid without si9
nature
'•� vtnissioner
QTY OF SALE
{ � K MASSAMUSE'I'I'S
BUILDING DEPARTWNT
120 WASH[NGTONSTREET,3"0FLOOR
TEL.(978)745-9595
KD BERLEYDRISODLL FAX(978)740-9846
MAYOR THOMM STIP ERRS
DIRECTOR OF PUBLICPROPERTY/BUILDING OpIu ESSIONER
Construction Debris Disposal Affidavit
(required for 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,S54;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:
S
(narine of hauler)
The debris will be disposed of in:
(name of facility)
(address of facility)
Zlignature of applicant
/j
(today's date)
LARTIAI�
a o y
Ce iinTeetl®.
SRIFGLEHASFER SEL E C T
e o w v w w v SHINGLE ROOFER'
Office 781-935-3150 Cell_ Address 9 Clinton St
CELL 978-339-3975 Woburn Ma
Price Quote Breakdown
DATE 7119119 Terms 30 Days
PREPARED BY Elias oliveira CONTACT Mike Neligon LOCATION 23 Beach av
ESTIMATE# Salem me
Sales Main# Elias oliveira PHONE MAILING
SUBJECT strip and reroof CELL 617-797-0154 ADDRESS
FAX
Desc' tion ol W rkUlm I Cost
Removal and disposal of old roofing materials(all layers)
and thorough inspection of roofing surface.Nail down any
and all louse boards. 29.0 SQ
Underla ments Decking and Edge Metals
installation of synteticfelt paper 2 RL
Installation of drip edge on all rakes and eaves. 37 PC
6 ft of ice water protection where the roof begins 8 RL
Shingles
Installation of cap shingles. 3 BDL
Installation of starter shingles. 4 BDL
Installation of timberline gat archtetural shingles life time j
warranty 29.0 SQ
Ventilatlon
Installation of Air Vent ridge vent. 3 PC
Other Roofing Accessories
pipe boots 3-W - 14' EA
Ice/Water Guard,Step Flash,and re-lead chimney(s) 1 EA
Roofing Nails 2 BX
dx
installation of 51 it of new facia at rigth side of the house
Total cost total price $11.770,00
"Gutters cleaned free of charge. Tarps installed free of charge if contract is signed.
All loose boards tightened free of charge.
10 years warranty of labor
100%dean-up when work is complete.
Any damage incurred during roof installation repaired/replaced at an equal or greater value.
—80 Linipr foot of boards replaced free of charge if necessary. If more is needed the cost is$5.00 per linier foot installed.
"Three pieces of plywood free.Additional plywood installed$55 per sheet.
Payment 113 down,1/3 due upon start of work,final 1/3 due upon completion and customer satisfaction in compliance with this contract. Deposits
are non-efu Sta ee e�+xe er permissible.
Start Date
Authorized Signature from to
Ageiis Cu or Color
Choice
stom r Si re Date/
Customer'Name Print
1rI%.#A 1 C UrLIA01LI 1 T IIV:3U1'CHIVL+C
8/2212019
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 policy(ies) must have ADDITIONAL INSURED provisions or be endorsed.
If SUBROGATION IS VVAIVED, 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 endorsements .
` PRODUCER CONTACT
NAME: _
MONICA INSURANCE,.AGENCY PHONEc E q_L978)454-2577 _,lac, _ (978)441-1282
EMAIL
19 MITI St ADDRESS: monicairisuraricel OCaol.com
Lowell,MA 01852 'INSURERS)AFFORDING COVERAGE NAIC#
INSURER A: ATLANTIC CASUALTY INS CO 42846
INSURED INSURER B: TRAVELERS INDEMNITY CO OF AMERICAA ( 25666
AGELIS CONTRACTOR �`—
r INSURER C
9 CLINTON ST INSURER0:
I INSURER E: I
WOBURN MA.01801 1 INSURER F: S i
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 1 ADDL SUBR POLICY EFF �' POLICY EXP yy
LTR I TYPE OF INSURANCE ^ POLICY NUMBER MPMIDDIYYYY t MMIODNYYY 1«l LIMITS
COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE k
X l !_$ 1,000,000
E,, DAMAGE TO RENTED
CLAIMS-MADE 1 x 1 OCCUR i j PREMISES(Ea occurrence) v'$ 100,000
(( MED EXP(Anyone person) j$ 5000
A ( 1 L307000316-0 11/29/201 s 11129/2019 r PERSONAL&ADV INJURY ii$ (1000,000
I GEN'L AGGREGATE LIMIT APPLIES PER: f GENERAL AGGREGATE I $ 2,0_00,000
POLICY PRO LOC Itlt I PRODUCTS-COMP/OP AGG j$ 2 000 000
JECT y I r. r.
t
I OTHER: I i is
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT
$
(1 .{-jEa accidonq�
i ANY AUTO f E t BODILY INJURY(Per person) I$
OWNED SCHEDULED BODILY INJURY(Per accident)I$
{— AUTOS ONLY AT
t
I 4 HIRED i NON-OWNED i 1 PROPDAMAGE _^
I AUTOS ONLY I AUTOS ONLY I I i(Per accident) - -
UMBRELLAUAB i OCCUR ' i. �(�EACHOCCURRENCE _#$
C EXCESS LIAR F!CLAIMS-MADE I I AGGREGATE` Is
II DIED $ -_
DEb t RETEN''fION$ 1
1ii WORKERS COMPENSATION f PER H. i
AND EMPLOYERS'LIAeILITY l X.I STATUTE 1' 1 ER _ t _
ZANY PROPRIETORJPARTNER/EXECUTIVE I N x I I:E.L.EACH ACCIDENT- f s 100,000
OFFICER/MEMBER EXCLUDED? N 1 A 6114/2019 6/14/2020 -
B { ❑ 6HUB6B05262519
(Mandatory in NH) I E.L.DISEASE•EA EMPLOYE$ I00,000_
1(It yes,describe under l
1 DESCRIPTION OF OPERATIONS below i 41.DISEASE-POLICY LIMIT $ 500,000
I
DESCRIPTION OF OPERATIONS i LOCATIONS I VEHICLES (ACORO 101.Additional Remarks Schedule,may be attached If more space is required)
REMODELING/ROOFING CONTRACTOR
a
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
BEACH CONDO ASSOCIATION THE EXPIRATION DATE THEREO NOTICE WILL BE DELIVERED IN
23 BEACH AVE ACCORDANCE WITH THE POLICY P VISIONS.
SALEM IAA 01970 AUTHORIZED REPRESENTATIVE
A -
O 1988-20 5 8P CORPORATION. All rights reserved.
ACORD 25(2016/03) w The ACORD name and logo are registered marks of A RD
ACORO CERTIFICATE OF LIABILITY INSURANCE WAtttmarukv.°"'
�..�i 08/22(2019
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES 140T 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 OFF PRODUCER,AND THE CERTIFICATE HOLDER.
IMPORTANT: If the c6rtiflcate holder is an ADDITIONAL INSURED,the pollcy(les) 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).
PRODUCER CONTACT Monica Swaida
MONICA INSURANCE AGENCY PHONe (978)454-2577 a ,:
ADDRESS. monicainsuranoel@aol.com
@aol.com
19 MILL ST INSURERS AFFORDING COVERAGE NAIL#
LOWELL MA 01852 INSURER A: TRAVELERS INDEMNITY CO OF AMERICA 25666
INSURED INSURER 6:
DASILVA VALDUMIRO R INSURERC:
DBA AGELIS CONTRACTOR CO INSURERD:
9 CLITON ST INSURER E:
WOBURN MA 01801 INSURERF:
COVERAGES CERTIFICATE NUMBER: 440484 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.
ILTR TYPE OF INSURANCE A DL SUBR POLICY NUMBER POLICY EFF MP EXP 1WDD1 LIMITS
COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $
DAMAGE TO RENTE-9-
CLAIMS-MADE FlOCCUR PREMISES Ea occurrence $
MED EXP(Any one person) $
N/A PERSONAL&ADV INJURY $
GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $
POLICY El PRO- LOC PRODUCTS-COMP/OP AGG $
OTHER: $
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $
Ea accident
ANY AUTO BODILY INJURY(Per person) $
ALL OWNED SCHEDULED N/A BODILY INJURY(Per accident) $
AUTOS AUTOS PROPERTY DAMAGE $
NNON-OWNEDD
Per accident
HIRED AUTOS AUTOS
UMBRELLALIIB OCCUR EACH OCCURRENCE $
EXCESS LIAB CLAIMS-MADE N/A AGGREGATE $
DED RETENTION$ $
WORKERS COMPENSATION X I
STATUTE ER
AND EMPLOYERS'LIABILITY
ANYPROPRIETORIPARTNER/EXECUTIVE YIN E.L.EACH ACCIDENT $ 100,000
A OFFICER/MEMBEREXCLUDED7 WA WA NIA 6HUB6B05262519 06/14/2019 06/14/2020
(Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 100,000
ff yes,describe under
DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000
NIA
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space Is required)
Workers'Compensation benefits will be paid to Massachusetts employees only.Pursuant to Endorsement WC 20 03 06 B,no authorization is given to pay claims for benefits to
employees in states other than Massachusetts if the insured hires,or has hired those employees outside of Massachusetts.
This certificate of insurance shows the policy in force on the date that this certificate was issued(unless the expiration date on the above policy precedes the issue date of this
certificate of insurance). The status of this coverage can be monitored daily by accessing the Proof of Coverage-Coverage Verification Search tool at
www.mass.gov/lwd/worker5-compensation/investgations/.
Sole proprietor has not elected coverage.
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
BEACH CONDO ASSOCIATION ACCORDANCE WITH THE POLICY PROVISIONS.
.23 BEACH AVE
AUTHORIZED REPRESENTATIVE
SALEM MA 01970
Daniel M.CrC y,CPCU,Vice President—Residual Market—WCRIBMA
@ 1988-2014 ACORD CORPORATION. All rights reserved.
AtInan og r9n1AIA11 Tha Ar-nan name and Innn ara ranlefamd martre of Ar nan