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Home My WebLink AboutBCOI-23-1720 2025 The Commonwealth of Massachusetts N--- , Town of .og.•;Y T) YARMOUTH � ';°� ``�c0'PPORATE0 0V New and Renewal Certification of Inspection In accordance with the Massachusetts State Building Code, Section 110.7 Identify Name of Establishment Certificate No. Issued to Business Name: Hampton Inn & Suites Trade Name: Hampton Inn&Suites BCOI-23 1720 Identify property address including street number, name, city or town, and county Certificate Expiration Located at 99 ROUTE 28 WEST YARMOUTH, MA 02673 June 29, 2025 Floor Occupancy_ Use Group Other 01st Floor 64 A-2 Restaurants, Night Clubs,or Breakfast Room/Lobby Use Group Classification(s) similar uses 01st Floor 150 A-2 Restaurants, Night Clubs,or Nantucket Room-150 Allowable Occupant Load similar uses Seating/Standing 72-Tables&Chairs 01st Floor 44 Exterior Pool 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 line safety features.This certificate shall be framed behind clear glass and/or laminated and posted in a conspicuous place within the space as directed by the undersigned. Failure to post or tampering with the contents of the certificate is strictly prohibited. Name of Municipal Chief Name of Municipal Building Commissioner Mark G to of Inspection ri Lt Signature of Municipal Fire Signature of Municipal Building I Chief CommissionerOZ-€6'- Date of Issuance -� f/z y TOWN OF YARMOUTH o -y BUILDING DEPARTMENT ••�'� $ 1146 Route 28, South Yarmouth, MA 02664 508-398-2231 ext. 1260 APPLICATION FOR CERTIFICATE OF INSPECTION May 01, 2024 PAYABLE UPON RECEIPT (X) Fee Required $478.00 ( ) 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: CP Street and Number: I't i a+ Name of Premises: 4 i m pt)(1 ann Cz u ) Tel: Purpose for which permit is used: frfte t l TTEiVE1 License(s)or Permit(s)required fby other governmental agencies: D License or Permit Agency JUN 06 2024 Lic un - L tairi e BUILDING DEPARTMENT By- Certificatento be issued to 2n fjl �G Yit ) Tel: —2,�1 +6L1410 Address: 6 rncdn Owner of Record of Buildin LL Address 1 M 1 c�( � �.(Y 1( p �� (it( Present Holder of Certificate t pn i i n . J'u J an YlCloficipaI O i cat.--j C Signature of person to whom Title zL' Certificate is issued or his agent Date Email Address: G bo K8 e0 wron• I _C)rY 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#4 1-- -/ AD 06/29/2024-06/29/2025 Client#: 144654 DARLIDEV ACORD,., CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD,YYYY) 4/04/2024 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 any rights to the certificate holder in lieu of such endorsement(s). PRODUCER I ACT Dawn M.Pare,AIS Starkweather&Shepley PHONE FAX j_A/CLNo,Ext):401 435-3600 (A/c,No): 401-735-1059 PO Box 549 E-MAIL Providence, RI 02901-0549 ADDRESS: dpare@starshep.com 401 Providence, INSURER(S)AFFORDING COVERAGE NAIL# INSURER A:Travelers Propty Casualty Co of America 25674 INSURED INSURER e:MemicGroup FED Hotel Properties LLC _ 99 Main Street INSURER C:Firemans Fund Insurance Co 21873 West Yarmouth, MA 02673 INSURER D:Chubb Custom Insurance Company 38989 INSURER E:Beazley Insurance Company,Inc. A1340J I 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. LTR TYPE OF INSURANCE INSR y VD POLICY NUMBER POLICY EFYT POLICY EXP LIMITS (MM/DD/YYYY) (MM/OD/YVVY) A -X COMMERCIAL GENERAL LIABILITY Y Y P6308X407200PHX2 03/31/2024 03/31/2025 EACH OCCURRENCE $1,000,000 DAMAGE TO RENTED ___i CLAIMS-MADE I X OCCUR I PREMISES(Ea occurrence) $500,000 X Liquor Liability MED EXP(Any one person) $5,000 _ __ j PERSONAL 8 ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER. GENERAL AGGREGATE �$2,000,000 -, - i PRO- '-1 ------.._ POI ICY I JECT I X 1 LOC PRODUCTS-COMP/OPAGG $2,000,000 niFiER: Per Loc.Agg $$2,000,000 COMBINED SINGLE LIMIT 1,000,000 (Ea ac X ANY AUTO j BODILY INJURY(Per person) $ OWNED I SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY I AUTOS F-- NON-OWN PROPERTY DAMAGE HIRED ED ..-X. AUTOS ONLY X AUTOS ONLY (Per accident) $ $ A X UMBRELLA LIAB X OCCUR Y CUP7X81574424NF 03/31/2024 03/31/2025 EACH OCCURRENCE $5,000000 EXCESS LIAB L._ I CLAIMS-MADE AGGREGATE $5,000,000 DEO ' X RETENTION$10000 $ B WORKERS COMPENSATION 3102810469 03/31/2024 03/31/2025 X STATUTE ERH AND EMPLOYERS'LIABILITY V/N ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $1,000,000 OFFICER/MEMBER EXCLUDED? N N I A -- - (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $1,000,000 If yes,describe under DrSCRIPTIONOF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,000 C Excess Liability USC035698242 03/31/2024 03/31/2025 $5,000,000 D Employee Theft BINDER1517316 03/31/2024 03/31/2025 $1,000,000; $10,000 Ded 1 E ;Cyber Liability I BINDER1517310 03/31/2024 03/31/2025 $2,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Additional Insured and Waiver of Subrogation per policy terms and conditions as listed above. Umbrella Liability and Excess Liability extend over General Liability, Liquor Liability,Automobile Liability and Employers Liability. RE: Hampton Inn&Suites,99 Main Street,West Yarmouth,MA 02673. CERTIFICATE HOLDER CANCELLATION Town of Yarmouth SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 1146 Route 28 ACCORDANCE WITH THE POLICY PROVISIONS. South Yarmouth, MA 02664 AUTHORIZED REPRESENTATIVE 1988-2015 ACORD CORPORATION.All rights reserved. ACORD 25(2016/03) 1 of 1 The ACORD name and logo are registered marks of ACORD #S2359515/M2336345 DMP