37 BARR ST - BPA-2005-568 EXTERIOR WORK \ y
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1 am a sole proprkrar and have no one working fir me V anry opacky.
() i am a sole prepriamr, general contractor or homeowner (drde otae) and hove lied tin
colic ora listed below who-have the following workers' compstsasdee ponchos
' Cower Inwranis Compasry/*o Nunatler
Contraaer Insurance Compasry/Fe N wr
Coa>sraaor Insurance Company/toft Number
() 1 am a homeowner performing all the work myself.
wwaOn,w am a aq of 06 aubomw we at fwwrowa a ar Ofke Si lw"knov of der M ar .e..rare ww kedw w On 6M bo bowl
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Signed this , 6, day of .L�(f
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Selectmen Office
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