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E m ° iti D U 4'.1't kb,: E Ci ,T_ t ; . s t . . 0 F II a Q' 6 $ Z H E 3 0 O . W E ? 1- a -°m q5 WW g § 1m au m t• m Z = E • c mo w oc N wgom'w aQ• Imo b �� ZO ilfl C w co 0 A Q alyo €psri N N Q Q a J O y h 0 z z INN a • N - •i 3 F s 4 V i3 1: E. 4 ................�✓ 5 . 'fi a n 4 -b rt 3 • = i -2 s - a O'P« 1 8 n 8 E:5 - „i i ,. a d Y _ ,_ Q,, r -6¢ a e I _- . � q 4 2_ . 40 _ 1a as ii g741 �: s $ d dG. a° tgs^ y V w a m 0 I F Z m E O rnw X m- m,� K LE° • i s i a n C n E= 8 c Y m .P Q �r W m _T $ W O 3 N R L f c o o _ E .o sw a � a ' 2 N Q '> E i T- . n ® Saar g O U .- H ro- tit--- imill It • to $ c u�+0 4 f oil o rI- o a.vs E 1 a c u. E-a N O _ a •v j ._ u 1 d ®wi 2 IN 5 4 p- 4q u gas A CCOREP CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) 06/08/2021 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 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 CHRISTINE NAME: LEIB INSURANCE AGENCY Al N,Extk 508 792 0411 AX (A/C,No): 537 PARK AVE E-MAILADDRESS: WORCESTER MA - INSURER(S)AFFORDING COVERAGE NAIC# INSURER A: NAUTILUS INSURED INSURER B: SOLAR WOLF ENERGY INSURER C: 771 WASHINGTON ST INSURER D: AUBURN MA INSURER E: LIBERTY MUTUAL INSURER F: COVERAGES CERTIFICATE NUMBER: 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. ILICY IDCP LTR TYPE OF INSURANCE ADDLN WV PR POLICY NUMBER NNIIDDY/YYYY) (FF NMIDDIYYYY) LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 AMAGTO X COMMERCIAL GENERAL LIABILITY PREMISES(EaENTED occurrence) $ 100,000 CLAIMS-MADE OCCUR MED EXP(Any one person) $ 5,000 A N NN1119891 06/08/2021 06/08/2022 PERSONALS ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 _ GEN'LAGGREGATE LIMIT APPUES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 l POLICY n JPER n LOC AUTOMOBILE UABIUTY COMBINED SINGLE LIMIT (Ea accident) $ ___ ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ __ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE HIRED AUTOS AUTOS. (Per accident) UMBRELLA UAB _OCCUR EACH OCCURRENCE $ EXCESS UAB CLAIMS-MADE AGGREGATE $ DED RETENTIONS $ WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS'UABIUTY TORY LIMITS ER E OFFICER/MEMBER EXCLUDANY ED?ECUTIVE YY N I A WC2-31 S-614936-020 08/10/2020 08/10/2021 EL.EACH ACCIDENT $ 1,000,000 (Mandatory In NH) - E.LDISEASE-EAEMPLOYEE $ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below EL.DISEASE-POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,If more apace Is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE TOWN OF YARMOUTH THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 1146 ROUTE 28 ACCORDANCE WITH THE POUCY PROVISIONS. SOUTH YARMOUTH MA 02664 AUTHORIZED REPRESENTA ACORD 25(2010/05) O 1988-201 A CORPORATIO . All rights reserved. The ACORD name and logo are registered marks of ACORD The Commonwealth of Massachusetts Department of Industrial Accidents __ ,`, Office of Investigations Lafayette City Center 4 2Avenue de Lafayette, Boston,MA 02111-1750 www.mass.gov/dia Workers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): Solar Wolf Energy Address: 771 Washington St City/State/Zip: Auburn, Ma 01501 Phone#: 508-839-2222 Are you an employer?Check the appropriate box: Type of project(required): 1.1:/ I am a employer with 6 4. ❑ I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. employees and have workers' [No workers' comp.insurance comp.insurance.= 9. ❑Building addition required.] 5. ❑ We are a corporation and its 10.❑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 insurance required.]t c. 152,§1(4),and we have no 12.0 Roof repairs employees. [No workers' 13.®otherSolar Installation comp.insurance required.] *Any applicant that checks box#I 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: Leib Insurance Policy#or Self-ins. Lic.#: WC2-31S-614936-020 Expiration Date: 08/10/2021 Job Site Address: 20 Turtle Cove Rd city/state/zip:S. Yarmouth, Ma 02664 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$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 certify under the pains a realties of perjury that the information provided above is true and correct. Signature: Date: 6/21/21 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(check one): 1DBoard of Health 20 Building Department 312City/Town Clerk 4.1:1 Electrical Inspector 5E1Plumbing Inspector 6.0Other Contact Person: Phone#: • -:COMMONWEALTH OF M • CHUS DIVISION OF PROFESSIONAL LICENSURE BOAm OF E•LEC I`ItICIANS .. ISSUES.THE FOLLOWING LICENSE • REGISTERED MASTER.EtECTRICIAN KYLE ZUIDEMA . SOLAR WOLF ENERGY,INC 99 DUDLEY IRD SUTTON,MA 01590 22593 A 0713112022. 726517 LICENSE NUMBER EXPIRATION DATE SERIAL NUMBER ?1,X b,sry _ SunPower° X21 -335-BLK-D-AC I Residential AC Module Series Design-Driven Advantages #1 module aesthetics and efficiency' 02 1 • Unmatched module reliability' , F • No electrolytic capacitors SERIES • 25-year Combined Power and Product s Warranty : • California Rule 21 Phase 1 compliant Maximize Value for Roof '. - Size system for roof, not string inverter • Optimize performance of each module Expand Deployment Options • Complex roofs and partial shading • • Small systems Optimize System and Installation Efficiency • System expandability SunPower'AC modules,which include a factory-integrated SunPower Simplify& Speed Installation microinverter, provide a revolutionary combination of high efficiency, high • Factory-integrated microinverter reliability,and module-level DC-to-AC power conversion. Designed • Robust,double-locking AC connectors • Design flexibility offsite and onsite specifically for use with SunPower InvisiMountT"and the SunPower • No DC string sizing process Monitoring System,SunPower AC modules enable rapid installation, best • Fewer installation steps than competing in-class system aesthetics,and intuitive visibility into system performance. systems • Intuitive commissioning All this comes with the best Combined Power and Product Warranty in the industry. Component of Complete System • Built for use with SunPower®InvisiMountTM and the SunPower Monitoring System(PVS5x) Grid Support Utility-Interactive Smart Inverter • Superior system reliability and aesthetics SunPower's new Type D AC module is UL tested and certified to UL 1741 SA and provides advanced smart inverter functions. SunPower Type D AC /^ modules are fully compliant with the California Rule 21 Phase 1 n fl11f11 requirements, and the Rule 21 grid profile is easily set during with SunPower S commissioning u over PVS5x monitoring hardware. ."'f ite A sunpower.com Da'ashePt SUNP WER® 7 Customer: Nancy Douttiel SOLAR WOLF Address: 20 Turtle Cove Rd ENERGY inc. South Yarmouth,MA 02664 System size: 6.03 kW Yr 1 Production: 5,051 kWh Designer: Solar Wolf Energy Site Assessment Date: April 20th,2021 w r. �� ih,„„.. • . , .„ r, ., , ..„,, . 0 . ... , .r ,. ..,„ , ,, , , . , ,, .., , .,,,_. , , . . ,,,,,i, .. , ,, IL , -r a g . 14, fl • powered by aurora Site Assessment Customer: Nancy Douttiel Address: 20 Turtle Cove Rd South Yarmouth,MA 02664 Component List Manufacturer Model Quantity Sunpower Corp. SPR-X21-335-BLK 18 111 0 Enphase Energy Inc. IQ 7+ 18 +A..r 1 , Notes: powered by aurora - - rr a s t A r ,ti � , ,a$ AV" ,,1 1 , ,1. 4.. ; SunPower° X21 -335-BLK-D-AC I Residential AC Module Series AC Electrical Data3 IEEE ,12011 i SRD Profile (default ,eftingn; CA Rue?1 min./no ..r rnax. min./nw r 13 Frequency(I-1) 59.10 60.0 r 1 , 5S.5 iii bt /60.5 1 Power Factor 0.99/1 00. 1 00 0 85 lead. 1 00/0 85 lag. 1 1 ±169 Var 1 • Reactive Power Volt VAr I Voltage @240 V 211.2/240/264 V @208V 183/208/228.8V 2 Max.Current @ 208 V 1.54 A rDC/AC CEC Conversion Efficiency @240 V 96-0°io @208 V 95.540 4240 V 12(single phase) I 1 Max.Units Per 20 A Branch Circuit @208 V 10(two pole)wye I PcAver 320 W,320 VA I No active phase balanc mg for 3 phase Installations DC Power Data Warranties and Certifications SPR-X21-335-BLK-D-AC SPR-X20 327-D-AC 25 year limited power warranty Vva mitres Nominal Power'(Pnorn) - 335 W 327 W - 25-year limited product warranty Power Tolerance +5/-0% +5.-0` L 1741 SA o v i° UL listed to U Avg.Panel Efficiency• 21.0°ro 20.4°o •SRDs:IEEE 1547-2003,IEEE 1547a-20'14,CA I Temp-Coe.(Power) -0.2.93/0,n1C Rule 21 Phase I •Three bypass diodes i PV Rapid Shutdown Equipment Shade Tolerance •Integrated module-level maximum power point • Equipment Grounding tracking ( • UL 6703,UL 9703 Connectors and cables (load break disconnection) Tested Operating Conditions • UL 1741 AC Module(Type 2 fire rating) Operating Ternp. 40 F to+185°F(-40°C to+85°C) Certifications Enables Installation in accordance with: Max Ambient Temp 1 22°F(50° C) ; • NEC 690.6 Wind:62 psi,3000 Pa,305 kg m2 front&back • NEC 690.12 Rapid Shutdown(inside and Max.Load Snow:125 psf,6000 Pa,611 kg/m1 front outside the array) Impact Resistance 1 lien(25 mm)diameter hail at 52 mph(23 i71/s)j . NEC 690.15 AC Connectors,690.33(A)-(El(11 FCC and ICES-003 Class B I Mechanical Data When used with InvisiMount racking(UL2703). I1 Solar Cells 96 Monocrystalline E01axeon Gen.III • Integrated grounding a d bonding I Front Glass •High-transmission tempered glass with anti Class A fire rated efective coating PID Test Poten' tial-induced degradation free E ivironmental Rating_Outdoor rated A ,._1 Frame Class 1 black anodized(highest AAMA rating) 280mm Weight 45 5 lbs '0 u gg Recommended Max ! `III 13 in.(33 min) Module Spacing ��� 1=107 min m [43.61n] inn 1046mm WE.' f for . ih of nIerF r I I. ton Module FUry eb. 1-I F. • [412In] I ��, + I m Ir d 1 ire rr t III Ir t tl lbhr eport. r tic Y of I t et l Diva oilt01 -, rr 1 eight rr. tti r r r,-.Note tested poru et Sur n E r d� .rl IIII ' .30mm 1 IN [121n] t r -etto FCC 7 i 1 F,i Ilt trre A d I I t dt tii,ys pr-dil Ord rub '�� r wr tie t1 t - rr ,?f r r uYt rr n 1558 men �_ ® aroumn tdria t,el 0 cl dratl ,,I .,i /A. -, acdl,nc CV 1 , Ct r•S Illr leer,4r lord', i---- -► rn&cm� UA'Smrr: t C i yuldevee.,All DC vorr ,e I,tall„ teinoti math rho module. EGNMENT USTED EOsaao ._cdOf' _i., _otr. W.dpo,.e ..:IP d/IF1',4Gr17d,1.1101- -leasoI 111e3atet.andinstall lon rretr3dtrunstordetails. Molds Fire Performance:Type 2 .,tart 3 r I t ler.ca for I r'I ef,r,l CE II t orl^-anon. .,I are thetarie,see e t'r.ded it-Add-toed eve,e,sdrootver.corntdatedsheets. _.` 3 !i err SUNP WER® I ,laded it -dtasl r e,db) _ ,,.; ,r 4 Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL 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 construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152,§25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary, supply sub-contractor(s)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers' compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned 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 law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has 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 the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (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 permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents. Office of Investigations Lafayette City Center, 2 Avenue de Lafayette Boston,MA 02111-1750 Tel. (617) 727-4900 or 1-877-MASSAFE Fax(617)727-7749 Revised 7-2019 www.mass.gov/dia 1 a 'j o . E x a ct 3 R AZ I— 8 8 = I E,2 : i! .71!" :is -------1,..,,, > 8 N a c. -12= . '-1 „-3 1.81 rLE (35 = =t et .63 ''''•e I- r- .w 11- gl Q ,1112g `"1 , * , dill... ; , - ' ." . Cl- -7 A"- D u - (.1) ''..,, a . — ' u `-' rt i= 2 0:3 21 .2 T. 'Z' t 2i2 I 2 ,-- CX =:; , • .. ... - ... - f.,- 0 / d ,± ,., _____• ,,,,-,. I r .. ii. . > _ ,• S. J 7f ce LU , r ...= up , > , - Z . 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