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B-19-804 - 0064 BEAVER STREET - Building Permit The Commonwealth of Massachusetts CITY OF Board of Building Regulations and Standards SALEM W Massachusetts State Building Code,780 CMR Revised Mar 2011 Building Permit Application To Construct,Repair,Renovate Or Demolish a One-or Two-Family Dwelling This Section For Official Use Orily Building Permit Number: D`ate.Apphed:. 011 Building Official(Print Name) "Sign.11ttli Date LPL SECTION 1 `SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map&Parcel Numbers — W &6.1VzKSf 1.1 a Is this an accepted street?yes V 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 Wapter Supply: (M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Public 13 Private❑ Zone: _ Outside Flood Zone?Check if yes❑ Municipal❑ On site disposal system ❑ e t-SECTION 2: PROPERTY OWNERSHIP., . 2.1 Owner'of Rec rd:, E_-M Name(Print) City,State,ZIP -(IL3 b ao 5-5 H g- y 3-7 6 No.and Street Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORKZ'(check all.tliat apply.) New Construction❑ Existing Building❑ Owner-Occupied ❑ Repairs(s) ❑ Alteration(s) Addition ❑ Demolition ❑ Accessory Bldg.❑ Number of Units Other ❑ Specify: Brief Descriptionof Proposed Work2: 5 f\p G1V1C� fY1S� o� 5 - S�VA V:e SECTION 4:ESTIMATED,CONSTRUCTION,COSTS Estimated Costs: Item Official Use Only , x Labor and Materials --. 1.Building $ `7 �j 1 Buildmg Permtt Fee $ _ Indicate how fee is.de term'tamed ❑Statidard City/Town Appltcatton Fee ra 2.Electrical $ s y D Total Project Cost (Item 6)x multiplier x'^ � t , 3.Plumbing $ I "Oilier Fees: $ a 'a _ 4.Mechanical (HVAC) $ List „r=,~ A11 :. 5.Mechanical (Fire $ oaAllF $Su ression ees: x Check No. Check Amount Cash Amount: : ,� F 6.Total Project Cost: $ `7-7 ( S D Paid in Full ❑Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) 01��17 3 � '24 I�Z License Number ;Exc�piration Dat Name of CSL Hold List CSL Type(see below) Type Description o.and greetU Unrestricted(Buildings u to 35,000 cu.ft. IR Restricted 1&2 FamilyT'DwelI C, /Town,,State,Z , , M Masonry x < - RC -RobfingCovering. ` t WS Window and Siding Construction Supervisor Signatule or(Electronic Signature) SF Solid Fuel Burning Appliances l_ a( I Insulation Tel hone' Email address D Demolition 5:2 Re istered Home Improvement Contractor(HIC) (0 � 14 +�� ) P Delon ' n ber E irati Date HIC Co pany Name or HIC strant Name 1 - 9nL� No. treet _ (y —of /�l J HIC egistrant' Signature City/Town. to e,ZIP. Telephone V']� 7 SECTION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.152.§25C(6)) Workers Compensation Insurance affidavit must be comp] ted and submitted with this application. Failure to provide this affidavit will result in the denial of the Issuance.o e building.permit. Signed Affidavit Attached? Yes.......... No,.. •••.•❑ SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT 1,as Owner of the subject property,hereby authorize ` Pr12 to act on my behalf,in all matters relative to work authorized by this building permh application. Owner's Signature or(Electronic Signature) ate SECTION 7b:OWNEW 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 application is true and accurate to the best of my knowledge and understanding. r � 7 Owner's or Au orq­edkAgent's Name or(Electrdnic 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 MC Program can be found at www.mass.eov/oca Information on the Construction Supervisor License can be found at www.inass. ove /dns 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"may be substituted for"Total Project Cost" BUILDING PLANNING • HEALTH • ELECTRICAL • GAS • . PLUMBING MAINTENANCE k s t Page 1 of AGrade ruse Since 1� Phone: 978-741-042 Fax: 978-741-2012 www.a-aservices.com 115 North Street ® IMI' I • ii Salem, MA 01970 Date: Work Specifications for Asphalt Roofing Project Name: f%t-kk _.r 5L—I TT Address:. t4 &--*JrVL_. mac" City: 51� State: Zip Code: Cat q-7o Areas to Be Re-Roofed: rkc-r-- Ao'o�-IIGOJ b'-)UY A 1 2 >< tG- Roof Are-is Excluded from Re-Roofing: -r�hn�G LUG 77Pclll Permit with Community as Required. C3 Waste disposal is included using either dump truck or dumpster. If dumpster is utilized (site location: as agreed to by the home owner), it will have plank stock put under dumpster as property protection. t�.m-� t� � (n S1LIJN S-r Q'Tarp house from bottom of roof to ground and beyond to protect house from falling roof shingles. A&A Services makes every attempt to protect home, decks, driveways, landscaping, and shrubs. Due to the heavy weight of roofing shingles coming off the home we cannot be responsible for damage to landscaping and shrubs. Strip roof of _layers of roofing shingles. Note: If additional layers'of roofing need to be removed there will be an additional cost). In;;pect roof deck after removal of shingles for any rotted wood. If any replacement is needed, the first 32 sq.ft. is included. For any other repairs: 4x8 sheets of plywood removal and replacement will be billed at$�\�per sheet. The charge for re-sheathing deck with 1/2" of plywood (go over existing roof deck), if needed will be $ per sheet. Planking replacement is Jbilled at$ per linear ft., and carpentry repairs at$'_per hour. �, I cb°b Install Owe gWeather Lock Flex, Ice and Water Barrier `>�p roof from edge of fascia board (code calls for X). Wrap Weather Lock Flex onto fascia board to seal up any gap between roof deck and fascia board. A&A Services is dedicated to using extra ice dam protection in our unpredictable New England weather. Owens Corning Weather Lock Flex Ice and Water barrier/ice dam protection material is a flexible membrane that sticks to the roof deck to prevent it from moving when shingles are installed over it. This membrane self-seals when nails are driven through so water cannot leak through it. ❑ Install Owens Corning Weather Lock Flex, Ice and Water Barrier 18" in from edge of rake (eave areas of the home).This prevents wind-driven rain from penetrating the edge of your roof and causing leaks. Buyer lnitial4 A f �-Date:? 1 1� x z:\a&a common folder\lud's forms jan.2017\asphalt roofing specifications sheet-rev 2-21-19.docx Page Zof f - AG" Above Phone: 978-741-042 Since 1%2 . Fax: 978-741-2012 ®®ICES www.a-aservices.com A&ASM115 North Street reffln IN I M I a 31TOITASalem, MA 01970 ❑ Install Owens Corning Weather Lock Flex Ice and Water Barrier 36" in valleys of home and at any roof penetration such as chimneys, exhaust vents, vent pipes and skylights for added p tection against leaks. Install F-8" drip edge to perimeter of the roof deck. Drip edge helps support the roofing shingle at all edges of the roof, manages water flow off roof and into gutters, and also protects against wind-driven raw-penetrating the edge of the roof. Available in 3 colors: Mill (Aluminum), Brown, an. Wh}te- ❑ Install Owens Corning Deck Defense.High Performance under layment to remaining area of the roof that is not covered with Owens Corning Weather Lock Flex Ice and Water Barrier. Owens Corning Deck Defense adds another layer of protection against leaks from wind-driven 'Install. starter strip shingles at perimeter of roof. This is important because the starter shingle has additional adhesive which prevents the first row of shingles from blowing upward in heavy winds and to catch water coming between first row of shingles. ❑ Re-flash chimney: remove and dispose of old flashing, cut into mortar with grinder approximately 8" up chimney, feed new lead into newly cut mortar joints, install lead in a step- flashing manner, and run approximately 4 onto roof deck. Seal all edges with Geocell sealant. Lead is used as a flashing material on chimneys because it is very pliable. Lead flashing molds to uneven surfaces and stays in place for years. ❑ Install aluminum vent pipe boot.with rubber gasket around all vent pipes and then seal with Geocell sealant. This application prevents leaking around vent pipes. ❑ Replace or ❑ Cut in for and Install Broan Roof Bathroom Exhaust vent(s)with Adapter and Seal with GeoCell. Connect to existing bath vent. 3'me Ventilation is a requirement for long-term roof performance and warrantee validation. It will reduce energy consumption and create a healthier and more comfortable home environment for you. i Buyer Initials& ate: 7 I 1 z:\a&a common folder\lud's forms jan.2017\asphalt roofing specifications sheet-rev 2-21-19.docx Pa e3 of A Cva& aeon Phone: 978-741-042 sinmi9w Fax: 978-741-2012 vvww.a-aservices.com A&ASMMCES115 North Street ® • • • MIN Salem, MA 01970 A&A Services will utilize the following type of ventilations stem for your home: Gable Vents: Add: • Utilize Existing: 71 • Expand Existing: Soffit Vents (as intake) C� • Add: T pe: • Utilize existing • Inflow Vent Location: Type: Ridge�Vent (as exhaust)Cut in as require dd Owen ming Vent u`re Baffled Ridge Vent to ridge(s). • Location: Aluminum Slant Static Roof Vents: # • Location: Color: • Cut in#_Replace# Mechanical Ventilation Electrician Not Included • Type: Locati ---- 2/install Oweg- Roof Color: �-szrt- • Nail locations vary by shingle and roof slope. It is critical to fasten the shingle in the proper csPPP-sL, locations in order to achieve desired performance and meet warranty requirements. • In most applications, shingles will receive 6 nails (corrosion resistant roofing nails)and all nails will be long enough to penetrate min. 3/4" into the roofing deck(NOTE: Using Owens coming System, your new roof will be rated for up to 130 mph wind load.) 01In;3tall Gw(e/mfi-Corniag-ridge cap shingles. These shingles add the finishing touch to the peak and/or ridges of your home. They are also designed to handle some of the toughest areas of roof protection. Ridge cap shingles are much thicker and have self-sealing adhesive that seals each shingle tightly and helps reduce ;the rik f blow-off. o-Type: ❑Dura Ridge (8" exposure) ed a (6" exposure) osure) ❑Other Buyer Initial6�ate: (7/11 z:\a&a common folder\lud's forms jan.2017\asphalt roofing specifications sheet-rev 2-21-19.docx f r �Z Page r�'of Above Phone: 978-741-042 Since 1%2 i0e1%2 Fax: 978-741-2012 www.a-aservices.comA&ASMVICES . 115 North Street • • Salem, MA 01970 C7 Clean off roof with blower to remove an debris. Clean out utters of an roofing debris. Rake Y 9 Y g clean all work areas. Leaf-Blow the perimeter of work,areas. Go over grounds with magnetic rake to pick up any loose nails. Please note: you may want to cover your attic belongings due to roofing debris sometimes falling through the gaps in,the roof deck. That cleanup is not inc ded. Th' is a safety equipment project. We value our help and are concerned for your liability. Supply owner with partial leftover bundle of,shingles/caps to have in the future if needed. '❑ A&A Services is a certified Owens Corning installer. We follow all Massachusetts building codes and Owens Corning manufacturer's installation requirements. By doing so, your roof qualifies for a 50 year non-prorated warranty from Owens Corning. See warranty for more dd Hs. E2' Massachusetts Law requires contractors to warranty their work for 1 year against installation defects. A&A Services offers warranties for their roofing work for 10 years against installation defects. If any problems occur at any time, A&A Services will come out free of charge to evaluate and help our customer through any manufacturer's warranty claim. Miscellaneous: -r S %A,"r Av4n V�l(LL la tPL4,1y i,-�6 A5 A4w?.PrUm--P_- , Bu`yersiinatureU man Signature U Pr f Z- Date: Date: I� Ig Buyer Print Salesman Print z:\a&a common folder\lud's forms jan.2017\asphalt roofing specifications sheet-rev 2-21-19.docx wee A & A:SERVICES,INC. _'�2 115 NORTH STREET,SALEM,MA 01970 AAA SERVICES Telephone:(978)741-0424 Fax:(978)741=2012 Contractor Registration No.'101609 Federal EIN:04-3090162 Construction.Supervisor No.CS057733 CUSTOM REMODELING AND IMPROVEMENT AGREEMENT Buyer(s)Name Date of Contract Buyer(s)Street Address,City,State and ZIP Code �O. 3e- eoak ST 5a,: 1AA ©1g�rd Daytime Telephone Number Evening Telephone Number Mobile Telephone Number E=Mail Address a� 8'�`�3-r S�ri'�gwCtL� C��jN1ML.cv.�1 he Buyer(s)listed above herebyjointly and severally agree to purchase the goods and/or services listed on the accompanying specification sheets,in accordance with the prices and terms described on the,front ant the reverse of this Agreement and any specification sheets(this"Agreement"),and Buyer(s)have requested that such goods or services he installed or provided at Buyer's address listed above. A&A Services,Inc.("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.This Agreement represents a cash sale of goods and services. The Buyer(s)agree to pay in cash the cost of the goods and services purchased as described herein,regardless of timing or approval of any financing Buyer(s) may seek for their purchase. �1 Purchase Price: 2��/ 2�b-5— Est.Starting Date: Down Payment:_L'�✓ ��1 Est.Completion Date:P a0 ❑Cash �y Ok \ Amount Due on Start of Job: ����- redit Card Amount Due on of Completion: - No. Amount Due on of Completion: Expiration Date: Balance Due Upon Completion: _ CVC Code: It Is agreed and understood by and between the parties that this Agreement,front back and any aildendurn,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 acknowl- edge that Buyer(s)has read the front-and reverse of this Agreement and has received a completed,signed and dated copy of this Agreement,in- cluding the two attached Notice of Cancellation forms,on the date first written above. Buyer(s)also(1)acknowledge that they were orally Informed of their right to cancel,this transaction;and(11)request that they be contacted via their telephone numbers or email,as listed above,in the event Contractor believes Buyers)would be interested in,any additional quality products or services of Contractor. DO NOT SIGN THIS CONTRACT IF IT CONTAINS ANY BLANK SPACES. A&A Ser ' ne. Buyer(s) By: (� _— Si a Signature OV h`l I S I 7- PrinYNa Print Name Signature. Print Name You,'the Buyer(s),may cancel this transaction at any time prior to midnight of the third business day after the date of this transaction. See the following Notice of Cancellation form for an explanation of this right. ARBITRATION:The Contractor and the Homeowner hereby mutually res in advance that in the event either parry has a dispute concerning this contract,either party may submit such dispute to a private arbitration service which has been approved by therSecret f the Executive Office of Consumer Affairs and Business Regulations and the other party shall be required to submit to such arbitration as proved by M.G.L.Y..142A. Contractor Initials: Buyer's Initials: Date: 1 Date: 7 !- /'7 NOTICE OF CAN ELLATION NOTICE OF CANCELLATION Date of Transaction - You may cancel this transaction,without penalty or. Date of Transaction . You may cancel this transaction,without penalty or obligation,within three busm+ays from the above date. If you cancel,any property'- obligation;within three 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. _ traded in,any payments made by you under.the Contract or Safe,and any negotiable instrument executed by you will be returned Within 10 days Contract, receipt by the Seller instrument executed by you will be returned within 10 days following receipt by the Seller of your cancellation notice,and any security interest arising out of the transaction will be of your cancellation notice,and any security interest arising out of the transaction will be cancelled. If you cancel,you must make available to the Seller at your residence,and cancelled. If you cancel,you must make available to the Seller at your residence,,and substantially in as good condition as when received,any goods delivered to you under this substantially in 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 instructions of the Seller regarding 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 expense and risk.If you do make the goods. the return shipment of the goods at the Seller's expense and risk.If you do make the goods available to the Seller and the Seller does not pick them up within 20 days of the date of your available to the Seller•and the Seller does not pick them up within 20 days of the date of your Notice of Cancellation,you may retain or dispose of the goods without any further obligation. Notice of Cancellation,you may retain or dispose of the goods without any further obligation. If you fail to make the goods available to the Seller,or if you agree to return the goods to the It you fail to make the goods available to the Seller,or if you agree to return the goods to the Seller and fail to do so,then you remain liable for.pedormance of all obligations under the Seller and fail to do so,then you remain liable for performance of all obligations under the Contract.To cancel this transaction,mail or deliver a signed and dated copy of the cancella- Contract.To cancel this transaction,mail or deliver a signed and dated copy of the cancella- tion notice or any other written notice,or send a telegram,to rvices,115 North Street, tion notice or any other written notice,or send a telegram,to A&A Services,115 North Street, Salem,MA 01970,NOT LATER THAN MIDNIGHT OF 8A Salem,MA 01970,NOT LATER THAN MIDNIGHT OF ( te) (Date) I HEREBY CANCEL THIS TRANSACTION I HEREBY CANCEL THIS TRANSACTION Consumer's Signature Date: Consumer's Signature Date: The Commonweakh of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 www mass gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(susinessk?rganization/Individual):_A (7� y�!�S �h C Address: / (,6- &+. City/State/Zip:_ c�Cr L2 w\, M �� CO Phone Are you an employer?Check the appropriate box: Type of project(required): :1. I am a employer with_� 4. �I am a general contractor and I employees(full and/or part-time).' have hired the sub-contractors 6 New construction 1. I am a sole proprietor or partner- listed on the attached sheet.t 7. Blikemodeling ship and have no employees These sub-contractors have. g. []Demolition working.for me in any capacity. workers'comp.insurance. o workers'co 9. ❑Building addition [1`l comp.insurance 5. ❑We are a corporation and its required.] officers have exercised their 10•❑Electrical repairs or additions 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.Q Roof repairs insurance required.]t employees_[No workers' comp.insurance required.] 13.❑Other Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and than hire outside coto�s must submit a new affidavit indicating such 'Contractors that cheek this box must attached as additional sheet showing the name of the sub-contractors and their worker;'comp,policy information. I am an employer that is providing workers'eompensadon insurance for my employees. Below is tke policy and job site information. Insurance Company Name:�1t^U 1/(�-`-e f s Policy#or Self-ins.Lid. C) K0 Expiration Date: -( Job Site Address: ` '"J e tQx JA City/State/Zip., c�Q Q V]/� �(l/1 xpi 61�7�i Atitach a copy of the workers'compensation policy declaration page(showing the Policy number and eration date): Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fins;up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of pp to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I du hereby certify n r e pains and penalties of perjury[liar the information provided above is true and correct �—� Si tur : Date: --7 Phone#: (� Official use only. Do not write in[Iris area,to he completed by city or town ofJleiai City or Town:. Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Fdectrical Inspector 5.Plumbing Inspector 6.Other (.'ontact Person: Phone#: 012012d Phone: 978-741-0424 Fax: 978-741-2012 a Er www.a-aservices.com A&A& SERV 115 North Street IM 8 Salem,MA 01970 DISPOSAL OF DEBRIS AFFIDAVIT In acpordance with the provisions of M.G.L.c.40, Sec. 54, a condition of Building Permit Number is that the debris resulting from this work shall be disposed of in a property licensed facility as defined by M.G.L.c. 111, Sec. 150a. The debris will be disposed at: Waste Management 877-515-2845 c/o Melrose Transfer Station 740 Broadway Melrose, MA 02176 or Waste Management, Dumpster Service at 115 North Street Salem, MA 01970 1 Y'� Signature of rmit Applicant Christopher Zorzy, President Name of Permit Applicant Date rtS�s i;enmcaleNO: AU44bZb - THE COMMONWEALTH OP MASSACHUSETTS EXFCUTIVE OFFICF OF LABOR AND I ORICFORCE•DEVELOPMENT • � a% Fw 1 (' ri DEPARTMENT ON LABOR STANDARDS 1 19 STANIFoRt)STREET,BosTo\,t.MA$5ACHI1.5FTTS 02114 1 i LEAD-SAFE RENOVATION CONTRACTOR LICENSE i AA A SERVICES,INC. 115 NORTH STREET ; SALEM MA 01970 LICENSE: LR002749 EXPIRES: Thursday,August 20,2020 IN ACCORDANCE WITH M.G.L.C. 111,§ 1978(b)AND 454 CMR 22.04,THIS LICENSE IS ISSUED BY THE DEPARTMENT OF LABOR STANDARDS TO THE CONTRACTOR ABOVE FOR THE PURPOSE OF ! ENGAGING IN LEAD-SAFE RENOVATION. j I THIS LICENSE IS VALID FOR A PERIOD OF FIVE(5)YEARS. ' THIS LICENSE MUST BE MAINTAINED BY THE CONTRACTOR IN ACCORDANCE WITH M.G.L.C. 111. j § 197B(b)(2)AND 454 CMR 22.04 WHEN ENGAGED IN LEAD-SAFE RENOVATION AND.!OR MODERATE-RISK DELEADING WORK.LEAD SAFE RENOVATION CONTRACTORS MAY NOT j ?ERFORM MODERATE RISK DELEADING WORK UNLESS THEY EMPLOY A SUPERVISOR,WHO HAS TAKEN THE REQUISITE TRAINING AS REQUIRED BY 454 CMR 22.00,TO OVERSEE.THE WORK. 1 i f � WILLIAM D. kkINNEv,DIR 'r¢, c+unxrxuea(/� i���o �+S.a+of�s Commonwealth of Massachusetts ORtceo/ConsunNrARatre Butbuss"p vldon Division of Professional Licensure HOME IMPROVEMENT CONTRACTOR Board of Building Regulations and Standards TYPE:Corowatkn jkrvisor eammupa 101B09 oQRS/P020 �' „i_ ' AAA SERVICES,INC j CS-057733 04Pires:05/3612t)21 CHRIST.OPHW ' ,`f n 115 NORTH S(f R 115 N TOPHER Z ET d �-c� i SALEM MA 115 NORTH STREET "-`"`"d_ SALEM,MA 01970 Undtcietary - OlSS[30�a Commissioner s • , r 'AC V CERTIFICATE OF LIABILITY INSURANCE °" `""s 17 8 THIS CER71FICATIE 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(iss)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsemenlL A statement on this cerdflcate doers not confer rights to the certificate holder In lieu of such endorsements). PRODUCER The John M.Sullivan Insurance Agen PNONE FAx No _ P.O.Box 920047 sullivan.insadv@verizon.net Needham,MA 02492 INSURE AFFORDING COVERAGE NAIL Ir INSURER A:The Travelers Indemnity Co 11347 INSURED INSURER 8 A&A Services, Inc INSURER C: 115 North Street INSURER D: Salem,MA 01970 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 TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF J�UCY EXP LIMITS LIMCOMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS-MADE OCCUR PREMISES(Ea wourrencO $ MED EXP(Any,one parson $ PERSONAL B ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY a"o- El LOC PRODUCTS-COMP/OP AGG $ OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea c � ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per ac ident) $ AUTOS ONLY AUTOS HIRED ^�NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per ent --� $ UMBRELLA LIMB I OCCUR EACH OCCURRENCE $ EXCESSLIAB 11 CLAIMS-MADE AGGREGATE $ i DED r RETENTION$ _ $ WORKERSCOMPEN�ATION PER E AND EMPLOYERS'LIABILITY YIN 9/1312018 9/13/2019 ANY PROPRIETOR/PARTNERIF.XECUnVE ❑ NIA BHLIB-0243MJBT-518 E.L.EACH ACCIDENT $ 500000 A (Ma iat�inNH)E:,cauoeo? EL DISEASE-EA EMPLOYEE E If yes,dese ibe wider r DESCRIPTION OF OPERATIONS below -T EL DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,AddMmuf ftww a SchL kft may be attached It more apace Is m**ed) CERTIFICATE HOLDER CANCELLATION City of Salem SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, 120 Washington Street#4 ACCORDANCE WITH THE POLICY PROVISIONS.E WILL BE DELIVERED IN Salem,MA 01970 AUTHORRED RE ATIVE ©1913 • 015 ACORD CORPO—RATION, All rights reserved. ACORD 25(2016I0,)) The ACORD name and logo are registered marks of ACORD i t i