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HomeMy WebLinkAboutBLDCI-23-001187 The C o rnonwealth of Massachusetts City\Town of YARMOUTH • New and Renewal Certificate of Inspection In accordance with the Massachusetts State Building Code, Section 110.7 Identify Name of Establishment Certificate No. Issued to Business Name: Citizen Bank BLDCI-23-001187 Trade Name: Citizen Bank Identify property address including street number, name, city or town and county Certificate Expiration Located at 1106 ROUTE 28 09/29/2023 SOUTH YARMOUTH, MA 02664 Use Group Floor Occupancy Use Group Other Classifications(s) A-3 01st Floor A-3 Amusement/Church/Gym/Library/Museum Meeting Room 72 Person Allowable - Occupant Load This certificate of inspection is hereby issued by the undersigned to certify that the premise,structure or portion thereof as herein specified has been inspected for general fire and life safety features. This certificate shall be framed behind glass and/or laminated and posted in a conspicuous place within the space as directed by the undersigned. Failure to pose or tampering with the contents of the certificate is strictly prohibited. Name of Municipal Name of Municipal Mark G, s Date of Building Commissioner Inspection F. -5- "Ag Signature of Municipal Signature of Municipal Date of Building Commissioner Issuance 14//4Z f Fee: $100.00 BLD Certoflnsoection.rat RECEIVED TOWN OF YARMOUTH --A !(:) BUILDING DEPARTMENt SEP 012022 ;��.....:-{ 1146 Route 28, South Yarmouth, \R 02664 508-398-4?2_ - BUILDING DEPARTMENT By APPLICATION FOR CERTIFICATE OF INSPECTION C 1N(04'3/1 August 1,2022 PAYABLE UPON RECEIPT (X) Fee Required $100.00 ( ) No Fee Required In accordance with the provisions of the Massachusetts State Building Code, Section 110.7, I hereby apply for a Certificate of Inspection for the below-named premises located at the following address: Street and Number: 11,6 g.4"07 q S 1//4-0u1-1„, W- 0,2 (; / Name of Premises: n't;Zra-i S Al a 14 v c- iti// Tel: ' '- 7 l -C) 5? / Purpose for which permit is used: CI.;I /6`1, License(s) or Permit(s)required for the premises by other governme�l agencies: License or Permit Agency Certificate to be issued to C1 � rct-� s 1,1 c-� �� Tel: S Cog- 3%c?-03g7/ Address: ///& K 4- S� fi ter•-,.� L / G. Y Owner of Record of Building Y,.,�,G ,4 c ', ,L ,,4 �, . s4-- Address Ga 6( (/ Present Holder of Certi cate /CAI S gnature of person tow om Title rtificate is issued or his agent g 727 3 a 3 Date Email Address: e5, S �c�( c urY e�i��i'Z:Prr Instructions: Make check payable to: Town of Yarmouth 1146 Route 28, South Yarmouth, MA 02664 Return this application to: Building Inspector's Office Please note: Application form with accompanying fee must be submitted for each building or structure or part thereof to be certified. Application must be received before the certificate will be issued. The building official shall be notified within ten (10) days of any change in the above information. PLEASE SEND US A COPY OF YOUR WORKER'S COMPENSATION INSURANCE FORM WITH THIS APPLICATION OR WE CANNOT ISSUE YOUR CERTIFICATE OF INSPECTION. Certificate of Inspection# 09/29/2022-09/29/2023 p� ® Page 1 of 2 ACn Q DATE(MMIDD/YYYY) �.�VR CERTIFICATE OF LIABILITY INSURANCE 03/30/2022 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(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(s). PRODUCER CONTACT Willis Towers Watson Certificate Center NAME: Willis Towers Watson Northeast, Inc. PHONE c/o 26 Century Blvd (A/C.No.Ext): 1-677-945-7378 FAX No): 1-888-467-2378 P.O. Box 305191 ADDRESS: certificates@willis.com Nashville, TN 372305191 USA INSURER(S)AFFORDINGCOVERAGE NAIC# INSURERA: Liberty Mutual Fire Insurance Company 23035 INSURED INSURERS: American Guarantee and Liability Insurance 26247 Citizens Financial Group, Inc. and Citizens Capital Markets, Inc. Citizens Bank, N.A. INSURER C: LM Insurance Corporation 33600 One Citizens Bank Way INSURER D: Liberty Insurance Corporation 42404 Mailstop: JCCL45 Johnston, RI 02919 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:W24344355 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 SUER POLICY EFF POLICY EXP LIMITS LTR INSD WVD POLICY NUMBER (MM/DD/YYYY) (MOD/MY) X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 2,000,000 DAMAGE RENTED CLAIMS-MADE X OCCUR PREMISESO(Ea occurrence) $ 1,000,000 A MED EXP(Any one person) $ 0 TB2-611-004526-032 03/31/2022 03/31/2023 PERSONAL BADVINJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY JECT PRO X LOC PRODUCTS-COMP/OPAGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 2,000,000 (Ea accident) X ANY AUTO BODILY INJURY(Per person) $ A OWNED SCHEDULED AS6-611-004526-022 03/31/2022 03/31/2023 BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY (Per accident) . B — X UMBRELLALIAB X OCCUR EACH OCCURRENCE $ 5,000,000 EXCESSLIAB CLAIMS-MADE AUC-9482541-11 03/31/2022 03/31/2023 AGGREGATE $ 5,000,000 DED RETENTION$ $ WORKERS COMPENSATION X PER OTH- AND EMPLOYERS'LIABILITY STATUTE ER YIN C ANYPROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBEREXCLUDED? No NIA WAS-61D-004526-102 03/31/2022 03/31/2023 1,000,000 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ C Workers Compensation and WC5-611-004526-152 03/31/2022 03/31/2023 EL-Each Accident $1,000,000 Employers Liability EL-Disease-Pol. Limit$1,000,000 Work Comp: Per Statute EL-Disease Each Emp. $1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) All terms and coverages evidenced on this certificate will only apply to the extent of the requirements within the written agreement or lease. SEE ATTACHED 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. AUTHORIZED�'�`^REPRESENTATIVE �E P R E S E N TAT I V E V Evidence of Insurance /�- ©1988-2016 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD SR ID: 22393273 BATCH: 2466882 AGENCY CUSTOMER ID: LOC#: ACRE® ADDITIONAL REMARKS SCHEDULE Page 2 of 2 AGENCY NAMED INSURED Willis Towers Watson Northeast, Inc. Citizens Financial Group, Inc. and Citizens Capital Markets, Inc. Citizens Bank, N.A. POLICY NUMBER One Citizens Bank Way See Page 1 Mailstop: JCCL45 - Johnston, RI 02919 CARRIER NAIC CODE See Page 1 See Page 1 EFFECTIVE DATE: See Page 1 ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: Certificate of Liability Insurance Per Location is included under General Liability INSURER AFFORDING COVERAGE: Liberty Insurance Corporation NAIC#: 42404 POLICY NUMBER: WA7-61D-004526-172 EFF DATE: 03/31/2022 EXP DATE: 03/31/2023 TYPE OF INSURANCE: LIMIT DESCRIPTION: LIMIT AMOUNT: Workers Compensation and EL-Each Accident $1,000,000 Employers Liability EL-Disease-Pol. Limit $1,000,000 Work Comp: Per Statute EL-Disease Each Emp. $1,000,000 INSURER AFFORDING COVERAGE: American Guarantee and Liability Insurance Company NAIC#: 26247 POLICY NUMBER: ERP0507947-03 EFF DATE: 03/31/2022 EXP DATE: 03/31/2023 TYPE OF INSURANCE: LIMIT DESCRIPTION: LIMIT AMOUNT: Real & Personal Property Limit: $100,000,000 Replacement Cost ACORD 101 (2008/01) ©2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD SR ID: 22393273 BATCH: 2466882 CERT: W24344355