18 MARLBOROUGH RD - BUILDING INSPECTION }
- iL4 -
---- --- RECEIVED
--7, The C'onunonw'e:dth of MassachusetlslN AL SE VICES
Board of Building Regulations and Standards 1'OF
Massachusetts State Building Cade. 730 C NIJBI4 MAY Is 3: OLEM
Building Permit Application To Construct, Repair. Renovate Or Demolish a Revised 1 kv'ql
One-or Tuvr-Funriin Dovltin{tic
This Section For Official Use only
Building Permit Number: Date Applied:
Umlding Olhcial(Print N�unc) Signature
Ualc
SECTION I:SITE INFOR�tAT1ON
I.1 Property ddre p 1.2 Assessors slap& Parcel Numbers
I.la Is this an accepted street?y s no l Map Numhcr Tureen Numhcr
1.3 Zoning Information- 1.4 Property Dimensions:
Zoning District Pr„puscJ Bse Lot Area(sq 11) Frontage(II)
1.5 Building Setbacks(R)
Front Yard Side Yards Rear Yard
Required Provided Required Provided Required '
4 Provided
1.6 Water upply:(M.G.L c.40.§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Public Private❑ Zone: — Outside Flood Zone?
Chock if es❑ Municipal❑ On site Jispusul system ❑
SECTION2: PROPERTY OWNERSHIPI
2.1 Ownerl of Record:
,
f !21 'eyI&i7Ii x O
Name IPnnl) City.State.ZIP
17LZ V-0 No.and Street _ --Gr Telephone - Email pdanNS
SECTION J: DESCRIPTION OF PROPOSED WORK r(check all that apply)
New Construction❑ Existing Building❑ Owner-Occupied ❑ Repairs(s) ❑ Alteration(s) ❑ Addition ❑
Demolition ❑ 1 Accessory Bldg.❑ Number of Units_ Other ❑ .Specify:
Brief De ription of Proposed Work': r
5�zcrnXalcscf
SECTION a: ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs:
(Labor and \laterials) Official Use Only
I. Building S 1. Building Permit Fee: S htdicate how fee is determined:
2. Electrical S Cl Standard City,Totvn Application Fee
� ❑Total Project Costt Item 6)x multiplier _._ x i. Plumbing g � ( _ _----
'. Other Fees: S
4. .Mechanical (II\'AC) S List:
'Sit,tressionl S Total :\II Fees: S — — — -- — —
v. Total Project Cust: S Check No. __0eck Amount: - __--- C',uh Amount. .
7 ❑PeiJ in Full ❑Outstanding BJlmtce Due:
�OY7'l�d'- - `_ 1 M I-�t L.L�� QU �•O r 5 L 2�
_SEC'HON .5: CONS'fItti TIONSF.RVICES
5.1 Construction Supenisor License(C'SL)
License Nwnhcr Pspiration Ualc
N':unc of CSI. Holder
List CSI.1)pc Isec below!— �.__
raft.—L '.CI_G1 a 1--- - ----------- f}pe Description
No. and Sirect
y) I I Inresmicled(Iluildill n Lin to 35.000 cu tl.)
R Restricted Lr3 Famil MwIlin
.. ++ S I • LIP Masonry
Citalo n. I,Ic.
R00fing C'oecrin
'S Winduw;md Siding
t .'F Solid Fuel !turning Appliances
J7p-531 G360 I Insululian
I etc hone Fnmil address ka' ct D Demolition
5.2 Registered llome Improvement Cmttrticta (HIC)
2 �h� t�� .iL/li4 I IIC' Rcgistrmm�Num—her F\piratlon Dute
I IIC'Compun5 N;une or I IIC' Regislmnt Nance
/Ll0 GF�rn �✓ o eP� L.HiYlivanGDihfle F/wfs-e Lri
No. and Sueel L'mail aJJss
A2 ni —
Ci /Town,State,ZIP relc hone
SECTION 6: WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L c. 152.1 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 Issuance of the building permit.
Signed Affidavit Attached? Yes .......... No........... E
SECTION 7s:OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I, as Owner of the subject property,hereby authorize r L
to act on my behalf,in all platters relative to work authorized by this building permit application.
TM �L��F✓/� d .�yl�n�
Print Owner's Nwne(Elcctmnic Si nature) DUIC
SECTION 7b:OWNERI 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 Ltd of my knowledge and understanding.
f s ws 43
Print 0++ner's or AuthorivvdAge6f s Nance I h1ccnunlc Signature) Date
NOTES:
I. An Owner whu obtains a building permit to do his,her own work,or an owner who hires an unregistered contractor
(nut registered in the Hume Improvement Contractor(HIC) Program),will nu have access to the arbitration
program or guaranty fund under M.G.L.c. 142A.Other important information on the HIC Program can be round at
w1+a m t-,,�o1 Information on the Construction Supervisor License can be found at 1+++y.nia.:�.� •.li+.
2. When substantial work is planned,provide the information below:
,. ,•ks or porch)
Total floor area(s . R.I I including garage, finished basenlent'nties,d�� p
q
Gross living area(sq. It.l _ - Habitable room count
Number of lirci laces _.. Number of bedrooms
Number of bathromtu _ Number of half baths
I)lie of heating s)steml Number of decks, porches.
l\Pe Od ct+1+1111g s\stelil _ _ - l!IKlosed Opelt
1, ''fold Project Square Foolagc- In:n he suhstimmed for"fotal Project Cost-
a
CITYOFS.UZNf, Akss.kcjjUSETTS
3L'ILDLNG I)EPA) MLENT
110 W.1s}tLVGTON STRFST, Y°FLOOt
TEL (978) 743-759s
KOMER1 V DRMOLL F.Vc(978) 740.9844
.1IAY01! T1go.W!SLPM&"
DIRECrat OP PL SLIC PROPltTY/BLQ,DL%4G COJLNISSIONEt
.Construction Debris Disposal Atflda.vit
(required for all demolition and renovation work)
In accordance with the sixth edition orthe State Building Code,
Debris, and the provisions of MGL c 40, S 34; 780 CMR section 1 l 1.3
Building Permit At is issued with the condition that the debris resulting from
I If. S 1 JOA.
this work shall be disposed of in a properly licensed waste disposal facility as defined by MGL c
The debris will be transported by:
1GLYLLZlL��,/
(n:une of hauler)
The debris will be disposed of in
(name of fudily)
(�ddreee ar rud �y)
+ yn.rnueofpermifapphcanr a
a,a/
dife -�
\bll ylr '.�
Tout Kulcvich
From: lames Currier<bunncoinc1996@yahoo.com>
Serra Monday, March 10,201411:18 PM
i To- torn@iri-city-sales.com
subject Fw Proposal and conlract
Follow Up Flag: Follow up
Flag Sile#rM Flagged
On Friday, February 7.8, 2014 10:18 PM, James Currier<bonncoinc1996(d,)vahoo.com>wrote:
Bonn Rooling Co. Bnc. Turn Kuledich
100 Femcroft Rd Unit 204 18 Marlborough Rd.
Danvers Ma 01923 Salem Me 01923
Proposal-Contract-revised
Atin:Tom
Re:Two Site: sarne as above Salem Ma
Dear Sir or'llo.Whom it may Concern,
We herby propose to furnish materials and labor cempletu accordance with specifications.
Below for the following sums: Estimate for existing shingles and fascia and gutter:,
1_ Remove existing shingles down to here wood ,replarp any rotted wood up tc 50 lineal feet.
some areas have 2-3 layers .
2.Apply Ice and wager shield to all eaves,valleys, around chimneys,etc .
Wnstall 30 lb.felt papas for a vapor barrier, Install 8 inch aluminum drip edge to rakes and cave
4.1n."Il new ridge vent for proper ventilation .Install new pipe flanges to all vent stacks.
5.[nstall new CertainTeed life time wuhilec:t style shingles in a pyrarnid fashion for proper
installation.>Install new lead an the existing chimney........
6. RE-plate and install new fascia boards as needed.-
7. On the back lower flat roof we will install new rubber back, roll moting all scams are cemented
8.0ean:all debris into on site durrrpsters.All permits are pulled by Sonn Co.Inc
9.All workers will have on safety harnesses and ropes for fall protection ,other salciy devices will be used .We are OSHA
wmplainant,All workmanship is guaranteed for 5 years on Icaks and blow offs. ice dams are not guaranteed .
10. Bonn Co Inc. reserves the right for extra charges for changes that are made by others as
the project progress fnrward.
>Cost for materials and labor on the entire roof&garage-shingle tear off..............$ 10,795.00
>Cost for gutter and down spouts front&back...........................................................$ 1 ,495.00
One third of the balance Mll be needed prior to the project.starts:
F.I.U.#04-3336347-H.I.C.#140520-Constriction Supervisors license#99357
All our workers are covered by Workers Compensation Insurance&Liability Insurance
Certificates of Insurance are available upon request:
V Thank you l om Kuledich /Home owner
.games I_Currier/Owner/President Sartre Nla 01910
Bonn Construction Co.lnc.
100 Femc Tuft Rd Unit 204
f)anvcrs Ma 01923
Shop# 9782150-8881
i
Massachusetts -Department of Public Safety c-�(110 wr .�...•....•. /i/.�^-/I�.....��...,.at.
Board of Building Regulations and Standards 2L\ Office of Consumer Affairs R Business Regulation
Construction Supervisor Specialt% r M IMPROVEMENT CONTRACTOR
License CSSL-099357kv.1"T.".siltration: 140520 Type:
piration 10/23/2015 Private Corporatic
DAMES L CUPJUgk '- ��s BONN CONSTRUCTION CO INC
20 Krochmal Road
Peabody MA 01930
- DAMES CURRIER _
> 100 FERNCROFT ROAD UNIT 204 �46_}.�„•�__ .
954— Expiration DANVERS,MA 01923 Undersecretary
Commissioner 1 211 7/2 01 5
SAFETY OSHA 10 Member in Good Standing of the
EQUIPPED, INC. Aetialift BUILDING TRADES ASSOCIATION
Training&Consulting Services Forklift
Authorized OSHA Outreach Trainer - For Additional Information and Verification
'Call Toll Free 1-800-326-7800
Bill Kershaw Tel.: 508-332-8959
Fax: 508-567-6743 BONN CONSTRUCTION, INC.
Safety Consultant 61 Eisenhower Rd.,Swansea,MA 02777
E-Mail:safetyequipped@wmcast.net From I I/00 - To 10/01
Member of ASSE www.safelyequippedcom
y .i...... ....."-_- ......_._ ._�.,-- -.T._._.. .._.."..mesas
—._ ate• .:. � .,. .y r�:r, ..-..,. - • _..�.,
(,jV c1TYOFSALEM f1834 � ' BBB Accredited Business
BUILDIN&LICENSEReferral Card
.. `
This is to certify That - '�. For free information on services
DAMES L. CURRIER from Accredited Businesses in
276 NEWBURY 'STREET St.,v A� ROnv ,Mau,
r 0 your area
I
I -'Has beanyranted a license by the Building Ins ec#or as a �a
HOliIP SPECIALTY /ROOFING—S Txr - Check Out a Business at:
L r�io aias BBB.
Attest:
OCTOBER 23, 1998 I i bbb.Org
lsauedl Buil mg Inspector
!2 t c:
OSHA 002330883 �� "• Sar�afi/�n�
I Ir, .Certificate 6f hnical Pmficiemcy
U.S.Department of labor _ y ,•
occupational Saferyand Health
Adm^inistration �t „<, .JAM�S L. CURRIER'.-
- _James CUrfIUr �a •tiasegpceW611y cempl6led a two-day,Sarnafilo lntiodUctofy
u =Training Course forSarnafil Installers under the supervrsiofi
of a-5arnafil instructor
has su essfuay completed a tUhour occupational Salety and Health f During the training session,the bearer showed a proficiency In
Training Course in s: 'heat welding and demonstrated practical application prove
- A ''djes using Sarnafil materials m simulated job site conditions t ;,
Construction Safety 8 Health "7 rt 4t•
. I .T'Date 4/1r'nswctor W�a.IdE .i'�f�lY�ltf e.
William Kershaw-NE01009 - -
(Trainer) - (Date) _ .... . .._ . .. ._.
2Ke t'oYnrreon7vealth of'llddssdchusetts I _LJ __!I
� �'-.-. AJepart�nento�lridusts^aal�eczdents
Of flee of Tnvesti ataons
=: 600 Wrashington street
Boston,M 02111
j wwlv.Ynass gov1dia
Worbrs' Compensation.InsuranceAsfzdavflt:�uiidex�/Confxactoxsl Iec xicians/Plumbers
NaMa(Business/Organizatan/individual):
Address:
City/State/Zip: ay Phone#: 7 — 7
Are yrya an employex?Cheek the appropriate box: Type of project(required):
I. I am a employer with _tom_ C]S am a general contractor and S d New consh=tiou
employees(full and/or park time).` have hired the sub-conftectors
2.0Iama sole proprietor orpartner- listed on the attached sheet. 7. []Remodeling
ship and have po employe es These sub-contractors have S. []Demolition
working for me in any capacity. employees and have workers' 9. []Building addition
[No workers'comp.insurance comp.insurance.?
required.] 5. [] We are a corporation audit 10.❑Electrical xegairs or additions
3. 1 am a homeowner doing all work officers have exercised their 11.[]Plumbing,repain or additions
myself.[No workers'comp, right ofexemptioaperMOL 12❑Roof repa :s
insurancerequired.]i o.152,§1(4),andwehaveno 13.[],Other' C�Iitl(/Yy �J�,�
employees.LNo workers' r
comp.insurance required.]
yAny applicant That ehccks box#I must also filt out the section below showing their workers'compensatioppglicy informatjon.
t 1iomeowners who submit this affidavitindioarag theyam doing allwork and then hire outside contractop mustsubmitanew,affidavitindicating such.
rContractom that checkthis boxmust attached an additional short shoving the name of the sub-contractors and stain whether osnot those entities have
employees. Wtho sub-confractors have employees,theymustprovide their workers'comp.policy number.
X iris an employer thatispraviding worlrers'compensation insurance for ray employes $eloW is YhBpoZicy ttndjab site
information. /J
Insurance CompanyName: /y
Policy#or Self ins.Lie,#: I(S G 2 U3 / 9b—ft Expiration Date:
Job Site Address:l� Ad" D � City/State/Zip:_ /�, ��V
Attach,a copy of the workers'comp e)cLsation p oliey declaration page(showing the policy number and expiration date).
Failure to secure coverage asrequiredunder Section25A ofMGL c. 152 canleadto thoimposition,of criminalpenalties of a
fine up to$1,500.00 and/or one-year imprisonmeut,as well a@ civil penalties in the form.of a STOP WORK ORDER and a fze
of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the OJEce of
Investigations of the DSA for insurance coverage verification.
X do hereby certi" rider thepains andpenatties ofperju-ry that the infamladonpiovided above 19tyve and correct.
Si atme: Date:
Phone ` y9V -ewy
I
icialuseonly. Do notwrite N this area,,to be completedby city or town officialy or Town: PermitfUcense,#uingAuthority(circle one):
oardofgealth 2.BuiIdingDepartment 3,City/TovvuClerk 4.Elect-ricalInspector 5.PIumbingfuspector
3iu r
Contact Person: $hone#:
Massachusetts General Laws chapter 152 requires all employers to provide wozkers'compensation for'their employees.
Pursuant to this statute,an employee is defined as"..,everypemon is the service of another under any contract of hire,
express or implied,oral or written."
An e nploye-r is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more
—ofihe-f e
receiver or tmsiee of an individual,partnership,association or other legal entity,employing employees. However the
owner of a dwelling house having notmore than three apartments and who resides thezein,or the occupant of the
dwelling house of another who employs persons to do maintenance construction or repair work on such dwelling oo n£e
— —M-MMthe gzounds or building appurtenautthereto shall not bacause of such employmentbe deemedto be an employer."
MGM chapter 152,§25C(6)also states that"every state or local licensing agency shall withhold the issuance or
renewal of a license or permit to operate a business or to coustructbuildinga in the commonwealth for any
applicant who has not produced acceptable evidence of compliance wHa the insurance coverage required."
Additionally,MGL chapter 152,§25C(7)states"Neither the commonwealthnor any of its political subdivisions shall
enter info any confzactfor the performancee of public work until acceptable evidence of compliance withthe insurance
requirements of this chapter have been presentcdto the contracting authority."
Applicants
Please fill out the workers'compensation afd, davit completely,by checking the boxes that apply to your situation and,if
necessary,supply sub-contiactor(s)name(s),addresses)andphonanumber(s)along with their certiffeate,(s)of
insurance. Limited Liability Companies(LEC)or Limited LiabilityParfuciships(LLP)with no employees other than the;
members or partners,are notrequired to cauy workers'compensation insurance. If an LLC or LLP does have
employees,a policy is required. Be advised that this affidavit maybe submitted to the Department of Industrial
Accidents fox confirmation of insurance coverage. Also be sure to sign and date the affdavit. The affidavit should
be retumed to the city or town that the application for the permit or license is being requested,not the Department of
Industrial Accidents, Should you have,any questions regarding the lave or if you are required to obtain a workers'
compensationpolicy,Please can the Depattmentatthe number lstedbelow. SeItLiusmodcompaniesshouldentertheir
self-insmanco licensenumbex on the appropriato line.
City or Town Officials
Please be sure that the affidavit is complete andptintedleg&y, The,Departmenthas provided a space at the bottom
of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant.
Please be sure to fill in hepemit/licensenumberwhich will be used asareferencenember. Inadditiou,an applicant
that must submit multiple pemaitilicense applications in any given year,need only submit one affidavit indicating current
polfcy information,(ifnecdssaty and under"lob Site Address"the applicant should Write"all lo cations n (city or
town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the
applicant as proof that a valid affidavit is on file for future per its orlioenses. A new affidavit mustbe filled out each
year.Where a home owner or citizen is obtain
ing a license or permit to an business or commercial
g raI
P Y
(i.e.a dog license orpernit to bum leaves etc,)saidperson is NOT required to complete this affidavit.
The Office of Investigations would like to thank you in advance for your cooperatiott and should you have any questions,
please do not hesitate to give us a call,
The Department's address,telephone and fax nmuber:
�a�a�vz�a�t��zIYSa�Sao�uS4s
BCTRIMMIt ofWlMal Aixz�t�nts
o qo of rnvea-UgA(m.
600 washimgwD Steewt
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Revised4-24-07 t�
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Rightfax CZ-2
A& CERTIFICATE OF LIABILITY INSURANCE E24.2014
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
AFFORDTHE ISSUING N URER(SS By THE )AUTHOES LOW. THIS ccR-nncATE OF INSURANCE DOES NOT RDEDREPRESENTATIVEORPRODUCER,ANDTHECERTIFCAT EH ITUTE A CONTRACT BETWEEN
OLDER
IMPORTANT: N the certificate holder is an ADDITIONAL INSURED,the policyGes)must be endorsed. N 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).
CONTACT
PRODUCER NAME:
PARENT INS AGENCY INC - PHONE Fax
AIL No Eat AC No
94 LYNN STREET E-MAIL
PEABODY.MA 01460
MSIAiERlS)AFFORDING COVERAGE NAICe
INSURERA:ACE A JERICAN INSURANCE COMPANY
DIy.D�D INSURER B:
BONN CONSTRUCTION CO INC INSURER C
CO INC MSURER D:
100 FERNCROFT RD
UNIT 204 INSURER E:
DANVERS.MA01923 INSURERF:
COVE A CERTIFIC E NUMBER: REVISION U
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 AD SUB POLICY EFP POt1CY EXP LIMITS
LTR TYPEOFINSURANCE INSR YiVO POLICYNUMeER M WDUn'YYY
GENERAL LIABILITY EACH OCCURRENCE S
COMMERCIAL UENERAL LIABILITY D0. GE TOE ENTER S
MAW
CLAVASMADE J OCCUR MED EXP(Any one p:A1en) S
PERSONAL A ADV INJURY S
GENERAL AGGREGATE S
GENLAGGREGATE LIMIT APPLIES PER PRODUCTS-COMP.'OPAGG S
POLICY JECT. LOC $
AUTOMOBILE LIABSITY t�iB�I&D
D SINGLE LIMIT S
ANY AO BODILYIICNJURY(Pof PoWn) S
ALLOYea:D SCHEDULED BOOILYINJURY(Peraeedw) S
AUTOS NONOWNED PEf�TY PANGE S,
HIRED AUTOS AUTOS Innri eN
5
UMBRELAUAB OCCUR EACH OCCURRENM S
EXCPSS W1e ( MSi OE AGGREGATE S
DED RETENTIONS S
Vm MSCOMPENSATION x we sTATO- oTH-
AND ENIPLOYIERN LIABRLTY N IORY LIlAI ER
My PROPRIETORMARTNEREXECUT EJ—EACH ACCIDENT $100.000
OFTICERAIIEMBER EXCLUDED' N NIA 6S62U5 04-10-2014 04-10-2015
(M woq m.1 5B32195A El.DISEASE-EA EMPLOYEE I 5100,000
1 yes dalllbe under El-DISEASE-POLICY LIMIT $500,000
DESCRI ON OF OPERATIONS I .
DESCRVWNOFOPERATIONSI LOCATIONS I VEHICLES(Anach ACORD 101,Additional Remallm SchadNb,N nwreapace Is m uUed)
ER'nFICATE HOLDER CANCELLATION
JAMES L CURRISRIOWNERIPRESIDENT BONIN SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE
CONSTRUCTION CO INC CANCELLED BEFORE THE EXPIRATION DATE THEREOF,
20KROCHMALRD NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE
PEABODY,MA 01960 POLICY PROVISIONS.
AUTHORIZED REPRESl3JTATNE
9198E-2010 ACORD CORPORATION.All rights reserved.
ACORD 25(2D70105) The ACORD name and logo are registered marks of ACORD
ACRip O (MMNWY
LJ CERTIFICATE OF LIABILITY INSURANCE 10/0/S/2013
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 COVERAOE 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 cerdRcete holder Is an ADDITIONAL INSURED,the policy(les)must be endorsed. If SUBROGATION IS WANED, subject to
the terms and 0ondilons of the policy,certain policies may require an endorsement, A statorrant on this Certificate does not confer rights to the -
certificate holder In llsu of such endorsemenNs.
PAODUceR Nally Valdes, CSC CTSR
EA Stevens Company, Inc. PRONE;R,,. (781)322-2324 ---- II ,R .lyEl)391-96'1R
389 Main St. as.wa-llyv@esatavena ins.con - -
P. 0. Sox 188 04UPZMSI AFFORD"COVERAGE yac f
Malden MA 02148 APeerleee Insurance C2Many
INSURED � eta RB:
James Lee Currier, ORA: Bonn Construction INSURERC, ,
20 Xrochmal Road
INSURER E L-„_-,-,^„ ._.
Peabod MA 01960 Issu P;
COVERAGES CERTIFICATE NUMBER2013-2014 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.
INrR rYPa OF MSURANCaAVUL Ru PD LaMTB
iP
GEN4AAL LIABILITY ([ACH OCCURnENC 1,000,000
X coMMERcwL GENERAL LIABILITY _ 1L�,ODO
A LZAwwMAOE OCCUR P3898ass /11/2013 /11/2014 MEO p orva E 3.5,000
rERaoNALa,vrv» Uw f 1,000,000
oENERAL AGGREGATE s .2,000,000
GEN%AOORECATE UMn APPL(Ea MR PRODUCTS-coMtOP AGO S 2,1-OC,000
X p01,ICv 0' LOC E
AUTDYOBRE LIABILITY
AWAUTO BObLLY RIIURY(Pw canon) E
ALL OWNED SCHEMkED away INJURY jpw oomwq s
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UMBRELLA I" OCCUR EACH OCCURRENCE S
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DESCRIF'*MON 110N Or OPERATIONS telOM EL.DISEASE-POLICY LIMIT 9
DESCRIPTION OF OPFRATa1N8I LOCAT04/VEIICLEB (AIIseN ACORD 101,AMRUensl A*m%*,B h.& .N moro soma Ir I- Wtad)
Job Site: - MA 019.10
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,
AUTHORRaO REPREaEMTAnVE
Thomas Cares, Jr/NV
ACORD 25(2010106) - 0190-2010 ACORD CORPORATION, All rights rosamed.
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