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B-19-1307 - 0042 BROAD STREET - Building Permit S L G 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) Bu .ilding Permit Number Date Applied Building Official \ SECTION 1:LOCATION(Please,indicate Block#and Lot#for'..locations for which a street address is riot available) q2- 64 ST IN 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❑ Alteration ❑ 1 Addition❑ 1 Demolition ❑ (Please fill out and submit Appendix 1) Change of Use ❑ Change of Occupancy ❑ Other ❑ Specify: Are building plans and/or construction documents being supplied as part of this permit application? Yes No ❑ Is an Independent Structural Engineering Peer Review required? Yes ❑ No N_ Brief Description of Proposed Work: Z%a s!T41( Y Et 0 b ) ILT n 14-004464 F L✓i K p 6 tom/C SECTION 3 COMPLETE THIS SECTIONIF EXISTING BUILDING UNDERGOING RENOVATION,ADD ,Olt,') CHANGE IN-USE OR OCCUPANCY f ' 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 Prg>osed w"'T a No.of Floors/Stories(include basement levels)&Area Per Floor(sq.ft.) x Total Area(sq.ft.)and Total Height(ft.) SECTION 5i USE GROUP(Check asapplicable) A: Assembly A-1❑ A-2❑ Nightclub ❑ A-3 ❑ A4❑ A-5❑ B: Business ❑ E: Educational ❑ F. Facto F-1❑ F2❑ H: High Hazard H-1❑ H-2❑ H-3 ❑ H4❑ H-5❑ I: Institutional I-1❑ 1-2❑ 1-3❑ I-4❑ M: Mercantile❑ R. Residential R-10 R-Lk R-3❑ R-4❑ S: Storage S-1❑ S-2❑ U: Utility❑ Special Use❑and please describe below: Special Use: SECTION 6:CO1vSTRUCTION TYPE(Check as applicable) IA ❑ IB ❑ IIA ❑ IIB ❑ IIIA ❑ 1111; ❑ IV ❑ VA ❑ VB ❑ SECTI,ON 7:STTE INFORMATION(refer to 780,CMR 111.0 for details.on each, item) Water Supply: Flood Zone Information: Sewage Disposal: Trench Permit: Debris Removal: A trench will not be Licensed Disposal Site❑ Public Check if outside Flood Zone❑ Indicate municipal EY required4or trench or specify: AY ❑Private or indentify Zone: or on site system❑ permit is enclosed❑ XW 'I)e rq Railroad right-of-way: Hazards to Air Navigation: MA Historic Commission Review Process: Not Applicable CK Is Structure within airport approach area? Is their review completed? or Consent to Build enclosed❑ Yes❑ or Nox Ye No ❑ SECTION 8i 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 ?&-i d VUs kd i/i C 12-- 6",4 s i Name(Print) No.and Street City/Town Zip Property Owner Contact Information: Title Telephone No.(business) Telephone No. (cell) e-mail address If applicable,the property owner hereby authorizes �t�arr� A si'. cVO-4 r l I �,�q C u C,., 5ALa l Y q 3v 5 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 10:CONSTRUCTION CONTROL(Please fill out Appendix 2) If buildin is less than 35;000 cu:ft:of of s ace.and/of riot under Construction Control then'check here` nd ski Section 101 10.1 Registered Professional Res onsible 1or Constructiori:Control Name(Registrant) Telephone No. e-mail address Registration Number Street Address City/Town State Zip Discipline Expiration Date 10.2--;General Contractor. Compan Name Name of Person Responsible for Construction License No. and Type if Applicable 10 (71l At u Cr- A-( e1,••A r 0 0 3911 Street Address City/Town State Zip �Z 210 _1� � c�c.,r� e K �n1�L . (0►t4 Telephone No.(business) Telephone No. cell e-mail address if SECTION 11:WORKERS'.COMPENSATION INSURANCE AE IDAyrr 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❑ No 0 SECTIONs12.CONSTRUCTION'COSTS AND PERMIT FEE �,. Item Estimated Costs:(Labor and Materials) Total Construction Cost(from Item 6) 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 $ ;3b f (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 and accurate to the best of my knowledge and understanding. l) Please print and sign name Title Telephone No. Date Street Address City/Town State Zip Municipal Inspector to fill out this sectionupon applrcatran approval Date 1 BARTCO INSTALLATION & SERVICE 15 El Q ■ 22 Millville Circle, Salem, NH 03079-2214 617-828-7888 moo SO Windows, Doors, Siding, Trim Coverage 0 c IL l QUOTATION/PROPOSAL Co. OwnerAlbert Barton Mass., Reg. 114423 License: CSSL-101217 f BUYER/OWNER f / Ad ress f Phone Number 40 Addre&s IF Phone Number DETAILED DESCRIPTION OF WORK TO BE PERFORMED DETAILED DESCRIPTION OF MATERIALS TO BE USED I A 100 L S D L. ap.i S ccoyse alI n5il&UM&Jh �3eo's kl l/ecQ Pax 1 f TOTAL PRICE 1/3 TOTAL PRICE UPON SIGNING $ �/ S BALANCE ON 50%COMPLETION $ i----� ote-d- PR 1, FINAL PAYMENT OF $ 33Cp� Est. Start t.Comp — TO BE PAID UPON COMPLETION Nothing else to be done unless agreed upon in writing by both "es,barring delays caused by circumstances beyond BARTCO'S control.Material and labor to be supplied approximately T 5 weeks from measuring. WARRANTIES The Contractor warrants that the work fumished hereunder shall be free from defects in materials and workmanship for a period of following completion and shall comply with the requirements of this agreement. CONDITIONS:All materials are guaranteed by manufacturer ONLY.BARTCO will guarantee installation where BARTCO installs AND NO OTHER WARRANTIES OR GUARANTIES,EXPRESS OR IMPLIED ARE AUTHORIZED UNLESS IN ACCORDANCE WITH'A STANDARD WRITTEN WARRANTY HELD BY A PURCHASER.The materials and items listed above are to be built to order for the purchaser and therefore this agreement cannot be changed,varied,cancelled, modified or discharged or rescinded in whole or in part by the purchaser except without express written consent of the seller.Seller does not guarantee performance in case of strikes,floods or other conditions beyond its control nor does any salesman or agent of the Seller have any authority to change,in any manner,any conditions of this agreement as herein stated. Not responsible for any item in existing openings where BARTCO windows are to be installed,or any painting or conditions or circumstances beyond its control resulting from or due to pre-existing conditions. Buyer agrees to pay for any and all legal fees required for collection of non payment. DO NOT SIGN THIS Contractor's Sig natur Date IF THERE ARE ANY BLANK SPACES f X Owner's Signature 77) Date —LU1 / / Owner's Signature Date ------------------------------------------------------------------------------------------------------------------------------------- NOTICE OF CANCELLATION Date of Transaction '� To cancel this transaction,mail or deliver a signed and dated copy of this You may cancel this transaction,without any penalty or obligation, cancellation notice or any other written notice,or send a telegram to: within three business days from the above date. BARTCO INSTALLATION &SERVICE If you cancel any property traded in,any payments made by you 22 Millville Circle,Salem,NH 03079-2214 under the contract or sale,and any negotiable instrument executed by you will be returned within ten business days following receipt /�+ _�� by the seller of your cancellation notice,and any security interest not later than midnight of f40 arising out of the transaction will be cancelled. Date I hereby cancel this transaction. Buyer's Signature Date The cancellation date filled in on this notice is three days after the date of the transaction.In figuring the cancellation date:Sunday,New Year's Day,Washington's Birthday, Memorial Day,Independence Day,Labor Day,Columbus Day,Veterans Day,Thanksgiving Day and Christmas Day should not be counted. Salem historical Commission 98 WA.SHINGTON STREET; SALEM, MASSACHUSETTS 01970 (978)619-5685 CERTIFICATE OF APPROPRIATENESS It is hereby certified that the Salem Historical Commission has determined that the proposed: ✓ Construction ❑ Moving ❑ Reconstruction ❑ Alteration ❑ Demolition ✓ Painting ❑ Signage ❑ Other work as described below will be appropriate to the preservation of said Historic District, as per the requirements set forth in the Historic District's Act(M.G.L. Ch.40C)and the Salem Historic Districts Ordinance. District: McIntire District Address of Prope ad 51=1 Name of Record Owner: Paio Vuikovic-Cviiin Description of Approval of Work: Replace existing windows in unit with new Harvey Majesty aluminum clad SDL windows to match existing 8/1 configuration with the following conditions: ■ Exterior of windows to be brush painted in white to match existing trim color; ■ All trim at brick molding to be preserved intact; • Any gaps at muntins to be filled and painted; ■ Windows to be installed per details shown on attached drawing detail. This approval.is based on the age,materials and location of the subject building. Upon completion of work,please notify Historical Commission staff as final sign-off is required to document compliance with this Certificate. Dated: Jule 18.2019 SALEM HISTORICAL COMMISSION By'� s V F' The homeowner has the option not to commence the work(unless it relates to resolving an outstanding violation). All work commenced must be completed within one year from this date unless otherwise indicated. THIS IS NOT A BUILDING PERMIT. Please be sure to obtain the appropriate permits from the Inspector of Buildings (or any other necessary permits or approvals)prior to commencing work. • _ ,.; of �;; • � .. c. _. elf : �/ ITT/. t. Q ti S IQ s sA .A - p t "Ic -JLJL� it - r DepA �' ` ' in • -- ' F nse `■E■EUion S. j,A��`v u � { # 5 d a-—'14 s F �• { MY Clo; rya' MR. �Fl43.g45 "t WA- INK 1,0381 COMMISSIO Consumer�A aim & Business Regulation NT ppp T gyp R TO In di idUal 3 # FEX rpta. 091221202G.. RENJ-DAR . 5, b 111— VA .q 3 A N3 WF� it f^NJ ji��EMers Und 3 } `y S f q _ $X1O t�. CITY OF SM ENIV N, A.SS.,xCHUSE"ITS • BUILDLNG DEPAR-marr ` 120 WASHINGTON STREET,r FLOOR TEL (978)745-9595 FAX(978)740.9846 KnIBERLEY DRISCOLL MAYOR Tlo"ST.Pm m DIRECTOR OF PUBLIC PROPERTY/BUILDLNG COMMMIONER Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Busim-ssiorganization/Individttaf): 7)A-S 1'e %\ Address: 100 t=,l *t J C f City/State/Zip: SA-lem 4-A4 03n--T5 Phone#: 1 - y1-3 - '-1 Z 1 Are y_Qu an employer?Check the appropriate box: Type of project(required): 1.Z am a employer with 'L' 4. [] I am a general contractor and 1 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ 1 am a sole proprietor or partner- listed on the attached sheet.: ?• ❑Remodeling ship and have no employees These sub-contractors have & ❑Demolition working for me in any capacity, workers'comp.insurance. 9, ❑Building addition [Ho 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 I I.❑Plumbing repairs or additions myself.[No workers'comp. c. 152,§1(4),and we have no 12.❑Roof repairs insurance required.)t employees.[No workers' 13.®'0ther ��'�l' comp.insurance required.) •Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information, t l imncownets who submit this affidavit indicating they ape doing all work and then hire outside cantracum;must submit a new affidavit indicating such. :Conum-tors that check this box must attached an additional sheet showing the tame of rho subcontractors and their workms'camp.policy information. I um an employer that Is providing workers'compensation lnsur once for my employeex Below Is the pollcy and fob site information Insurance Company dame: C f I e I+d 2 U t GLA_ Policy#or Self-ins.Lic.#:—(*Z Zv 1 1 13 b Expiration Date: Job Site Address: Y Z. f5r,6/40 S! � City/State/Zip: 5,44-ev►, 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 S 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 up to S250.00 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 do hereby certify under the pains and penahles of perjury that the informadon provided above is true and correct Sis:nature: Date: 9 13 — 9-Z.I J OJjchd use only. Do not write in this area,to be completed by city or town ofcimL City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Ilealth 2.Building;Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other, Contact Person: Phone#: sOOR& CERTIFICATE OF LIABILITY INSURANCE DATE(MMMD/YVYV) THIS CERTIFICATE IS 04/19/2019 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 be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. Al certificate holder In Ileu of such endorsemen s. statement on this certificate does not confer rights to the PRODUCER CONTACT MONICA INSURANCE AGENCY PHONE Monica S4vaida 978 454-2577I Fax A/C No 19 MILL ST aDMnaas: monirainsurancel@aol.com LOWEINSURERS----DING COVERAGE NAICd INSURED SURED MA 01852 INSURER A: AMERICAN ZURICH INSURANCE COMPANY 40142 STURTEVANT DARREN J INSURER B-: INSURER C: 25 ADAMS TERRACE INSURER D: INSURER E: LOWELL MA 01852 INSURERF: COVERAGES CERTIFICATE NUMBER: 392437 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 POLICY EFF POLICY EXP T TYPEOFItdSURANCE POI:ICYNUMBER LIMITS i COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS-MADE 71 OCCUR REM S S a ence $ MED EXP one person $ N/A PERSONAL&ADVINJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: POLICY❑PRO- GENERAL AGGREGATE $ ❑ i JECT LOG. PRODUCTS-COMP/OP AGG $ HOTHER: $ AUTOMOBILE COMBINED SINGLE LIMIT $ Ea accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOS JAUTOS N/A BODILY INJURY(Per accident) $ HIREDAUTOS AUTOS EO PROPERTY DAMAGE AUTOS Per accident $ $ LIAB EXCESS UMBRELLA EXCESS OCCUR I EACH OCCURRENCE $ LIA CLAIMS-MADE N/A AGGREGATE $ 1 DED RETENTION$ $ WORKERS COMPENSATION AND EMPLOYERS'LIABILITY Y/N X STATUTE ER JANYPROPRIETOR/PARTNERIEXECUTIIECERIMMBERXCLUD E.L.EACH ACCIDENT $ 1 OOO,OOO A O(Mandatory In N/A N/A wA 6ZZUBIK91138019 63/2212019 03/22/2020(Mandatory in'NH) E.L.DISEASE-EA EMPLOYEE S 1,000.000 If yyes,d asenbe under DESCRIPTION OF OPERATIONS below E.L DISEASE-POLICY LIMIT $ 1;000,000 I N/A DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Sct+edule,may be attached It mom spoor is mqulred) 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 data 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.govflwdANorkers-compensatioMnvestigations/. 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 DARREN STURTEVANT ACCORDANCE WITH THE POLICY PROVISIONS. 25 ADAMS TERRACE AUTHORIZED REPRESENTATIVE. LOWELL MA 01852 Daniel M.Croy,CPCU.Vice President—Residual Market—WCRIBMA ©1988-2014 ACORD.CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD ACC>RV® CERTIFICATE OF LIABILITY INSURANCE DATE(MMmnmvx) 1' W2142019 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFOPtMATION 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 OF-LOW.. 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 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(,,). ;PRODUCER CONTACT MONICA.INSURANCE AGENCY ip"c°��'yo xti;_(978)454_2577__ ___ ._ tac,Noj._ (976 41 --- 19 Mill St A gEss�mo uranc@ nlcainse aoi.corn uranc - Lowell,MA 01$52 UREI�S),AFFOROINGCOVERAGE NAIC_ti,-,__ INSURERA ACCEPTANCE INDEMNITY INSURANCE COMPANY INSURED DARREN STURTEVANT INSURER B_ AMERICAN ZURICH INSURANCE COMPANY INSURER C: I 25 ADAM TERRACE INSURER_E_ -'----- L.O',WELL MIA 01852 INSURER F COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: I 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. POLICY POUCY Is"JCP LTR TYPE OF INSURANCE POLICY NUMBER. ; M 1L0D/YYYY i MMiD01YYY _LIMITS ` X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S 1 OOQ 000 ' v �-DAMAG�TOI2EhiED�--� CLAIMS-MADE vX`OCCUR PREMISES IEa accvrrencet_Y_,.5. __ 100,000 5i000.. . CL00238.859 912812019 s e►2e12020 ;PERSONAL s AhV it.NRY s 1,000,0a4- GFNL AGGREGATE LIMIT APPLIES PER; t FtiERALAGGREGATG {{{ . JCC7,POUC`� PRO-. _ LOC PRODUCT CO"�PrOPAGG $ Z OQOOOO„ OTHER_ AUTOMOBILE LIABILITY ° {. COMBINED SINGLE UNIT -`:ANY AUTO 's BODILY INJURY(Per person) .S.—._.__.�..__...�..,.___. OWNED --SCHEnULEO 'BODILY INJURY(Per aWdent)I 5 AUTOS ONLY ;AUTOS HIRED NON-04�INEG .PROPERTY DAMAGE S AUTOS ONLY AUTOS ONLY Peracaden��,_.• is UMBRELLA LIAB OCCUR ;EACH OCCURRENCE -_ 5 -I ._. EXCESS LIAB ;CLAIMS MADE' AGGREGATE -. Dell WORKERS COMPENSATION PTATUTE _ERH AND EMPLOYERS'LIABILITY Y i N I ,.ANY PROPRETORIPARTNEREXECUTNE I i E.L EACH ACCIDENT OFFICERIMEMBER EXCLULED7 — (Mandatory in NH) E.L_DISEIvSE.--EA EM LOYEE S_ ..._..u. It yes,describe under DESCRIPTION OF OPERATIONS—below _ E_L..DISEASE POLICY LIMIT:S 4 1 3 I DESCRIPTION OF OPERATIONS I LOCATIONS I vEHICLES(ACORD 101,Adihtlonal Remarks Schedule,may be attached It more space is required) 0 r I CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE INSURED COPY. THE EXPIRATION DATE,, THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE'w T^H�THi POLICY PROVISIONS. .f 'I AUTHORIZED REP SENT 'a 95 ACORD CORPORATION. All rights reserved. ACORD 25(2016103) The ACORD name a.nd`logo are registered markg'of ACORD