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HomeMy WebLinkAboutBLD-19-3538 = r :61,0 s, 9 i: 0 10-1 AS aaninanagj `�. Orpiment 4JncpecteonafStakes — 0fe I. e gac &m 4aona 1146 Route 28, Soadi Paun«ig, OE&02664 S ...CCCCCC���� APPLICATION FOR FIRE PROTECTION PERMIT '"`- 1— r Date 0-K I le" PERMIT NUMBER MO -/9• (n) 353 rt , L Ili c' Date of issue r o Projected Start Date: i 'o't I I Q LI t I4 accordance with the provisions of 780 CMR and M.G.L. Chapter 148,as provided in __, I ? S ction w ;_ ff ' 'Pus application is hereby made 1. � _ .._` 64, IAoi .D ISP, IA of SEc -1/4t (Full name of person,Firm o Corporation) Address ?-.45 mei. S(n4 C( SC(..n00 Pus cc kV! (Contact#) ) gl-9'Q1- )-'h3 Email K6titeioStKvi 4 a<rr, ea,,,,,, Owner of property ZM -1-{4h)14,0-1.1, 14`L Job Location 1 1 Sf tt St 4 LA 1.4' , (Street&City or Town) For permission to (state clearly purpose for which permit is requested) tA.Qr,E,L Pcn II S re,— For- Pit-t ,an- S0 0 L- -1 , Name of competent operator(if applicable) Cert. or License No. i-7'- C Estimated Cost of Construction: ':nater ofA:.lican Bui:;; icia : i ve Date: 11- 11./7 _ . FEE: $50.00 _ _ ___ ___ _ - -_- .. 000 970/0/7O/ Narration for Sandy Tannozzini 17 Saturn Ln South Yarmouth MA 02664 ADT will be installing a SWPRO HW control panel and indoor sirens for a primary smoke and CO system at 17 Saturn Ln, South Yarmouth, MA 02664. The control panel will have a back up battery. There will be smokes located in the basement, first floor at the front of the house by the stairs, one in the Master Bedroom on first floor, a smoke detector at the landing on the second floor and one in each bedroom. CO detectors will be located one in basement,by the kitchen and one in living room for the fireplace, one on the landing of the second floor. • Residential Fire Alarm System Plan 1IIVI i[tJtIJ 1111111 / 5505UE00 Customer Information Branch Information Install Completion Date: Name: eD umei its ti Name: Sc%_s/7 I ct/IN U-1.77I4i1 Phone#: &1116-1A7-9 Address: 13. 4,4",, (� Certificate of Registration#: ACR-1460 l City/ZIP:S' YofmM-it, ,AA 02G 6y T5 A #�'W G k -o l Legend: Use the following symbols to create the customer's fire alarm system plan. CP PK EK © O 8E Sa Control Heat Smoke • Existing Battery • • Panel Keypad Sounder Strobe Smoke Smoke Detector Detector Detector Detector • G 2 --- • �� 0(lei C4 S11"1/4C Goa ;nil,11 ADT Representative Name: '"�ut5 APS/RAS Licensee Name: • - License#: • APS/RAS Licensee Signature: 22012 ADT LLC dba ADT Security Services.All tights reserved.(06/12) Original(ADT) isni Residential Fire Alarm System Plan [II!! 11111111I.IVI Il11111 Il II • 5505UE00 Customer lnformation Branch Information D Install Completion Date: Name: /us VI on1 I Name: Syr) 1cmitdee;hi Phone#: (p/ q- 516F-Gofiy Address II- S.,4-fu',, l-n Certificate of Registration#: ACR-1460 I City/ZIP: .St..l- ywnt,,.41, ,4 • U3/464( SJb W tdv6 WO/ Legend: Use the following symbols to create the customer's fire alarm system plan. • CP P [TIC © O SE Sa Control Heat Smoke • Existing Battery Panel Keypad Sounder Strobe Detector Detector Smoke Smoke Detector Detector • sj • :+- _ 11 ,s4c- Kir l _ 1 • • r Pty a � s&-dFc . 1 • ADT Representative Name: '"7-> /as c/0t-1t APS/RAS Licensee Name: License#: ' APS/RAS Licensee Signature: 92012 ADT LLC dba ADT Security Services.AO rights reserved.(06/12) Original(ADD ij,4i Residential Fire Alarm System Plan [1ll'JJ iIIII 11 111 II III II / • 5505UE00 Customer Information Branch Information n//� Install Completion Date: Name: r 1 r ie✓ oy Name: S.,CNzt-I 1 ane o fl in; Phone*: I g'�i' — c a 1- 7 Address: ('} I„ l Certificate of Registration It: ACR-1460 I City/ZIP: CiAin / cr tThirn, Legend: Use the following symbols to create the customer's (fire alarm system plan. • CP P © OS 9E 0 Control �< Heat Smoke ' Existing Battery • • Panel Keypad Sounder Strobe Smoke Smoke Detector Detector Detector Detector • • • I .,Aft- t At.r III 11111111 IIIIi 1111111{11 • ADT Representative Name: r- G9/n 00,49 APS/RAS Licensee Name: License*: ' APS/RAS Licensee Signature: Y2012 ADT LLC dba ADT Security Services.All rights reserved.(06/12) Original (ADT) `r n �'.y: 5. nxa C®�71.ht ImeaWY ., IECOMRY‘ :.xx0 11 MONO' NP14TMY Anw.1010IS.f);..n ,TrAnmI { iIMCdMicMl .. Aror !-� °' x t w I a. , t tm; Y o. I {1 a ir. ri4 I. .'mnw.ei. ua —c *wtyLst • .esti E'."'2. °' ae 9uonawPua r.. i; I a s Macau�`. 13 diml,..0 u B�.O �.I� � wawcdi'i'"ivnnrt MAMA,S slrwau.Or 1)13- .ede mi° to p N � wn.*u.¢n w Y I V m..w st �E yy �- my i e .r (� bi,mAdx,oiN.a.xogmm �� t h -Ve fro P1Yi� oA. sPf a0 7. ' c... ..,,,,---... ....��� : c —"DOWIo lam.m.v.a o'1 II k, F 1. roaw, w.y 6wes.wrotkei anGN }g, a 1 in; k IP j F ' ' T ,..f` -'v c...on 1p'q , g . ,..« ydanpt�npPna _ _ _ _ _ _ .' XuLdxir,,,tm PNar ® O O;'O O 0: O\ O Oram m m..i:,m�® m Q3. i m m4— I. "."a © © '" 1.71,1--,-,:. aw NpfOR.LL W4061:i :MlNt1G �ainlOOMmlalNllWlNl ® ! S aq _c •'d•° 1 tI ,t w . , e + .. #1? • ° nw.w wn w`I am le'''''` , � "• µ.qua . —oa '\: IL:: P ttt o,.. ,, II IOMutatss �t a \ ... 4 d tifFOR MOCwG fQML1fOlY UtM mnyi !nM' TNaC�IW� 1tlttI taaaK kg ! I WARNING:,,illtvart llx"SMOCK !r 1, ! INd11IPNL Kq a ?''.1;r3.':, �' �I 4SCO E 1R! ONSU l TIILCP _ C 94F p 1 t,ACS,..s.°l\41 G Oi If V'N,.•f. LA:Lily,. i .`a itcuttx.4.w „ 14 i ,! 1R S it! rl ryax 1 moo '+pyo j If me ,F! . r.---r..:,-.1.......Nn..+ e4p" e'' '� =uN,OTT\i ".r.r } qW W rf its, W Il I�joe1 CU#! mrv"ENC4 dNmw r A '°�"° ,^ism, .,, , �]{{ ay(,yg Iy r psewl rruNm,' tlnrllmvnml' 'd4 'WARNING:ALARM VERIFICATION.IFUSED.DEEMS. Axl...a 4n F.i a..13. .wuO,a lxib l'{I6l` a P 1 IYW dMWMl9 4Wl•11Y.WNi11 oica16+1o11oixdb.N wusomnw lwdouim ja.. t 1 .o a, rlG orwta I. 'ALARM SIO NAISFRomTREXCEED IN50 SECODSOfl wndddundac Zeas ,a '� l ..,"telO°°a"r.dn'': CIRCUITS. NNCT EXCEEDS SMOKE ETECTOTALir\ xiromu Mt -nxua,aiaaa ad. odu I ',.adiayn�ld:wwdnli;. 00NOCONNEC UNRFLLI3 SMOKE DEVICESTS) .„.„t,,, ..4.. °Pc Pali ' I I.-.a.6° I I x'rtic xFl"tmI.C.."-90NOTCONNESfNLESS INRIATINO DEVKTESTOI . " w od,_ onad dmuf � !n � L Punrv.x/. .. LOCAL CIRCURSUNLESS APPMOKE DEN.. 1 , ,,o Awa °Hoa11tran e r caladl. s ! II 1 ""ppiiei1 LIRCUIT C0 LiYNAVINO JURISDICTION. IO. °xoawNa dmw f s aund!xc icr ^I i`�m°'n°m�a \• CIRCUIT CONTROL.UNIT SMOKEDETECTOR a ma coma":11: wnn. { .`1aRrsi " awnoox ! V.vMUM"' Mum Ao flt1"°A �y dn,i (ZONE( DELAY-SEC MODEL DELAYSEO, Aialn°a.".." I. 65 6C" ViM' 1lCI lmlmitl9MSa S ,Pdtgx Tw nWNumvwM] 11 gga..Iiauxwi .awmv q�nnµvriml iwliNndoxe.. iYnuwnuwe and dim gnllrt V ed¢iuNpoul# penis1Well.iatc4LJ ucuwmMi a vvwxvixlaxdnaval r I USETH7 1 MEMA I I`1V a T •yI N I ( x ,'5,,,;.,...,,,,,,,... .,s,k :A mn W wA b YI T 1 .Ij i� �i DEE- - 11,;;5,-5,,:',.t, 1,VTIME MMI(ED ON THE MSTaLEO El �� - -ionmlamrdwaPw mtd+� �CO r+,,,. T \f7I '1 ixwlq wiwm+ iI dwua.ewix $jStITRP ENEUR 3000EN a - 7''.. nI { t 4441'' ii�� Hnia_slant, '.ENTREPRENEUR 3000EN : �ua w.mwwuo��f :i aul�'�Il�lulll�lll1'1�I�` !I', C IRw0. ! 7 e '� anx,mNxr SECURITY MANAGER 3000EN ry -3 IR,min,FL33MS L. -' °\ • * r^ I ° SUMMARY OF CONNECTIONS ';'•'32.'f, • SafewatchPro®3000 Security Manager 3000 Security Systems Installation and Set-Up Guide — 3hM Ca If' 1 � £ 0 • K5305 3/01 - Mode SASW3000B Mounting and Wiring the Control Backup Battery Notes - LPlantheliwitbeckup battery in the cabinet. •Refer MtMCallrernla Stan gin Marshal and I 2.Altsar all nnadlee to the control are aanplatel, UL Residential Fin requirements statement canned the red and black flying leads on the tonna' below.It applicable. -board to the battery.Do not attach these leads to the battery temlmlauntil all mrardlonsare competed UL Use awl battery or Stgerb UI. YwnM6unne. Earth Ground Notes Natal Cold Weet Wpm •This product has been designed and laboratory. Use a nrlsmaetsi metal strap Zapper h ramnmlended) Mated to rain W reeiennce a damage Dam firmly eared to the pipe to which the gond India generally expected levels M lightning and electrically connected and secured. electrical discharge,and don not normally AC Power Outlet Ground: require an earth ground. Available Dom 3.prang,120VAC power outlets only.To •Uan earth ground Is desired for additional test the Integrity of the ground tridsaw•sera terminal 25 0n the of board,•r the cabinet. dreult teeal with rem lamp Indicators,aids as the UL Listed Ideal Model 61-035,or equivalent.available et may be iwed este ground convection paint.The suet electrical supply stores. eamnples of ble ood at want grounds lisa. rdaM are available at come b W llations. AUXILIARY DEVICE CURRENT DRAW WORKSHEET DEVICE CURRENT I UNITS TOTAL CURRENT 61378 Touclead SMA 61396 Truclpsd 100 nA 608145882 RF Reuba 35mA 4210 Zone Expander 15nN 4204 Relay UNI i6N0pMt 4220 Zaw ExpeaWmSay lee $5/18onA1 4285 Phone Module 160 A 1286 Kona Module 300 A • • TOTAL. fOnt a••eb Wan Aa.%TMM•e00 TOA isnot • 6 uS9 M1abi•dean SIX n PRN,Sr kr toe padfaW-tor EW macaw were owed Mw T bat s,owSaan aaiw1 draw len tie Pamaly Oupt M M Aram Output aenbined met at crawl 7700 rA(500 m1 max Ins Amaay Oupq. $ Flues we hr relays DFFheSte ON. • zs ` RECOMMENDATIONS FOR PROPER PROTECTION The Fofowing Recommendations for the Location of Fire and Burglary Detection Devices Help Provide Proper Coverage for the Protected Premises. Recommendations For Smoke And Heat Detectors With regard to the number and placement afsmoke/heat detectors,we subscribe to the recommendations • contained In the National Fire Protection Associations NEPA)Standard 172 noted below. Early warning fire detection is best achieved by the installation of fire detection equipment In all moms and areas of the household as follows For minimum protection a smoke detector should be installed outside of each aepama sleeping arta,and on each additional floor of a multi-floor family living unit, Including basements The Installation of smoke detectors In kitchens,attics(finished or unfinishap.or In pemges Is not namely recommended. For additional protection the NFPA recommends that you Install heat or smoke detectors In the living mom,dining mom,bedroom(s),kitchen,hallway(s),attic,furnace room utility and storage rooms, basements and attached garages. In addition,we recommend the following • Install a smoke detector Inside every bedroom where a smoker sleeps. • Install a smoke detector inside every bedroom where someone sleeps with the door partly or completely dosed.Smoke could be blocked by the closed dor.Also,an alarm In the hallway outside may not wake up the sleeper If the door is closed. • Install a smoke detector Inside bedrooms i - where electrical appliances(such is - portable heaters,air conditioners or e e e �R humidifiers)are used � e,. •le • install a smoke detector at both ends efa •I• hallway tithe hallway is more than 40 1 feet(12 meters)long. • Install smoke detectors In any morn where e rrwhw..rr alarm control r l located.or any morn a a�^•��`ate sourcewhere ralarm control ar made. I'ten AC rms.�• + trs tephone so lcaemade.lf ' detectors arenotpmlotted,a tro within the room could prevent the control from reporting a fire or en intrusion. • THIS CONTROL COMPUES WITH NFPA REQUIREMENTS FOR TEMPORAL PULSE SOUNOING OF FIRE NOTIFICATION i APPLIANCES. Recommendations Recommendations For Proper Intrusion Protection For proper Intrusion coverage,senors should be located at every possible point of entry toe home or commercial premise This would include any skylights that may be present,and the upper windows in a vluld-kvd NNding. In addition,we recommend that radio backup be used in a security system so that alarm signals con still be sent to the alarm monitoring station in the event that the telephone lines are out of order(alarm signals en normally sent over the phone linesif connected to an alarm monitoring station). • ii • • • tSYSTEM V SENSOR' :w >Y • 'a C01224 � Carbon Monoxide Detector .: e read 4e4r System Sensors C01224 provides early warning when Its electrochemical sensing technology accurately measures carbon manodde levels In the air. �^'"_`• _ E Cadman warwalda ken adaIesatlarlen tasteless end hiahlY Features tads got that as produced When fuels such as woo gawiln4 .yl Cafadaha with Lk 207S charcoal and at tee burned with Insufficient at..ne myaay& •Aad<repYndeabk May eddee S admmawN faomksaised from Mese fuels came from heating systems.power born and Cha2Wl grE •MArrg supervision with SEWS terminals It carbon s' de as detec¢QUe 0122awn alert'Scents 'Astir-yeaedafAlkdnM by sounding and flashing atmos signal amnia Protection Is •IYHWC guaranteed 247 by a central anion,regardless at whether residents •A ahem draw ol 20M In standby aid 4OmA In alarm are away ham lane seeping a alreadyaMig From the effects .,insane mounting bwal and Mag al Ca •eectxlenvra semkrg aemsoogy The C01224 k specifically designed for system operalmmk mans the detects Is fully lasted to ltt 2075.caste a code ueguied bauble May,with rends a sorsa failure aaiddafe*2n5 to the , control and the central aon.as eel as SFMSajpe terminal MMpslead aaewiwatkh pmlde a guider and nae poWe wag caaamn and axle rented wiring nae lsbv Also the C01224 ansa a law Docent draw*ming mote detectors to be connected to the panel without hang to purchase a more Caperwe pard ce an ease pose tail,.. Beane the 001224 Is a 12/24 W C detect%avail operate on most man/wintry or fire alarm control Panels. Agency Listings • �L (� MEA us= aeornel 1 Honeywell 5193 Series V-PLEX•ADDRESSABLE SMOKE DETECTOR Tihs, • m® Ibneywe'a V-Plat Addressable RModecXc Endre Oereaas se died to padde open aee pdsd i and to be used ere,ea.gdfle LL ee UGated Haavywel Calm'pa as that appal V-Rac tedndcgy.The detectors YNporale a stated-fiaat aptLet aaeh0 dernba and an advanced rrboprocessor.M-h O.m Damnation algorithm - sea.stlmW maintain proper operation at factory[abated caecum leas,elan when aaetMy Is altered duet the amerce of contaminates satug Into the unto chamber.The 5193SOT/A atsotaehres ar[taebb,bMJR tad amanitas(135/57.2Q Sand daub. FEATURES •Easy dnataaatlorc hafabtbn b dnylted by the use of •wrestle Maadi,gt Abuatp b made ahpb MOM the •mots g base tat may be prewired to lie astern, Included heavens aid the age nlang pale abet abwtg the debma b be easy Installed or'around tar eomrmadate cereal endo for easy surface mounting. maintenance or seats.Pee figure 1). L-See RPM l} •LED Status bldcatas Two LEDs(peal and cod)peuide •Tamper Potation and Taper Resietwicom The detector lecd Vaal Inclballon of the detec1as Metbe-hating conte a bolt-In toner switch that can Q nntricPte moa<aernon,alarm,out of ee[Nwly and bath baric to the control peril h the avant Qat detector is ( amdlae. woad ton Its base.For Si aided hal of smutty, •TW bosom Tab button Blows to beer b Pedant Peke to detects Mao Mrtlee a tarps masa trona*tet tasting of to detectors civilly and wary tat to deals [Femme fan the base about the use a tools. bweNn toaaerody Fib Fee °1] owarater (Alk t 11/ • nem rata Pose I;Tanp•M•d•ad Teea•er l*ig • • The Commonwealth of Massachusetts , (k • Department oflndustrialAccidents t l Office of Investigations aina iz600 Washington Street . • iw3 11 t Boston, MA 02111 "' www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): A sY LLt_ JRA A a 1 Se CtaRRC)I Address: a (-t 5 W<l.l're P.- sneer , 516-Qe,,.Le i✓ Loo`s ' City/State/Zip: .. ; . s a ..._ „ .. S. Phone#: ; — if 9 7— a Are you an employer? Check the appropriate box: Type of project(required): 1.0i4 am a employer with g5 4. 0 I am a general contractor and I employees (full and/or part-time).* have hired the sub-contractors 6. ❑New construction • • listed on the attached sheet 7. 0 Remodeling 2.❑ I am a sole proprietor or partner- ship and have no employees These sub-contractors have g. ❑ Demolition working for me in any capacity. employees and have workers' 9. El Building addition [No workers' comp.insurance comp.insurance.: required.] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑ Plumbing repairs or additions myself. [No workers'comp. right of exemption per MGL 12.❑Roof repairs insurance required.] t c. 152, §1(4),and we have no • employees. [No workers' 13.1XOther'fl tvbZ.w.. comp.insurance required.] •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 then hire outside contractors must submit a new affidavit indicating such. :Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: OLD ge.fLt,$LCC.. p4-SUSA l-LCE, C°cFnfri%-/-1 Policy#or Self-ins.Llc.#: m C t3 I1#3 17 0 0 Expiration Date: f 0/O I ' / 9 Job Site Address: 17 Th 1 wti,J L A,,C City/State/Zip: /A N-l,.bw'g-b 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 MOL c. 152 can lead to the imposition of criminal penalties of a fine 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 up 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 do hereby cerci wide he ains s.:,',lane ' : 'er' / ,-rmVent provided above is true and correct. Siu a re: !/ r / Date: lc ; i Phone#: Official use only. Do not write in this area, to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6. Other Contact Person: Phone#: (� A`^ ® • DATE(MM/DD/YYYY) /' CC CERTIFICATE OF LIABILITY INSURANCE ,0,0„20,6 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(les)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(s). PRODUCER CONTACT Marsh USA Inc. PHON: 1560 Sawgrass Corporate Pkwy,Suite 300 talc No.MO: (A/C.No): _ Sunrise,FL 33323 EMAIL Attn:FB.auderdale.Certs©marsh.com ADDRESS: • INSURER(S)AFFORDING COVERAGE NAIC 9 CN109418288-ADT-GAW-18-19 INSURER Al Old Republic Insurance Co 24147 INSURED RLLC INSURER B:ADT – ADT Security SeMces INSURER C: 245 Winter Street Suite 200 INSURER D: Waltham,MA 02451 – INSURER E: INSURER F: _ COVERAGES CERTIFICATE NUMBER: ATL-004803800-07 REVISION NUMBER: 3 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 UE TYPE OF ADOL SR POLICY EFF POLICY EXP LIMITS LTR INSD WVD POLICY NUMBER (MM/DD/YYYY) (MMIOD/YYYY) A X COMMERCIAL GENERALLIABILITY MWZY314318 10/01/2018 10/01/2019 EACH OCCURRENCE $ 2,000,000 DAMAGE TO RENTED CLAIMS-MADE n OCCUR PREMISES(Ea occurrence) $ 1,000,000 X SIR:$500,000 MED EXP(Any one person) $ X Professional Liab Included PERSONAL&ADV INJURY $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: _GENERAL AGGREGATE $ 4,000,000 X POLICY n T n LOC PRODUCTS-COMP/OP AGG $ 4,000,000 OTHER: $ A AUTOMOBILE LIABILRY MWTB314319 • 10/01/2018 10/01/2019 COMBINED SINGLE LIMIT $ 1,000,000 (Eaeccldent) , X ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY _ AUTOS ONLY (Per accident) $ UMBRELLALIAB OCCUR EACH OCCURRENCE $ _ EXCESS UAB CLAIMS-MADE AGGREGATE $ DED RETENTIONS $ A WORKERS COMPENSATION MWC31431700 10/01/2018 10/01/2019 x SPER OTH- TATUTE ER AND EMPLOYERS'LIABILITY ANYPROPRIETORIPARTNER/EXECUTIVE —i NIA E.L.EACH ACCIDENT $ 2,000,000 OFFICER/MEMBER EXCLUDED? ` (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 2,000,000 If yes,describe under 2,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) CERTIFICATE HOLDER CANCELLATION ADT LLC dba ADT Security • SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 245 Winter Street Second Floor THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Waltham,MA 02451 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE of Marsh USA Inc. Vincent Zollo ---,A” n '3. C O c-r " ©1988-2016 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and Togo are registered marks of ACORD • • • • • • • • • • 4 H38WflMTil839 8 N . witN • • £LLZZL rQ(oZIL£fzD u.s.. ZLL irtts m £ -1gDZa vw aoom am, . ' ' 4 .avM f10L6 • :. :;;-t': ''- • •• • 3Lr svwottt $\ 4aMS riuHI ri s n s" ftwdO • .sNvlol 3 • .• 3£IrISNI .o)7 VNolss330ad 40(�IOIslllla: relpSCiH3 S 'W 30'H_LX4AANOWWOp v . • • ./ 1,.. • • • • //// • • / ' • • • • • • C- Commonwealth of Massachusetts I \ Division of Professional Licensure Security sie WW63 License • 1 SS-001779 "j ';Xpires: 05/16/2020 THOfylAS J LEEi' l� '-• p ,A •,4,:\ , Employed f .1 E; I -(: ADT SECURITY, `� -,. Flt( "Ic\ 1:411. 1\s • L.Commissioner • • • • • • _ . . .. _.