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HomeMy WebLinkAboutB-P Trucking - 12/31/2019Commonwealth of Massachusetts Town of Mansfield Town of Mansfield 6 Park Row Mansfield, MA 02048 This is to certify that Board of Health Hauler's Permit JOSEPH DEPAOLO B-P TRUCKING, INC. P.O. BOX 386 ASHLAND, MA 01721 PERMIT No: 2 is hereby granted a permit for a HAULER. This permit is granted inconformity with the Statues and Ordinances relating thereto, and expires December 31, 2019 unless suspended or revoked. REGISTRATION No: N20012 FEE PER TRUCK: $26.00 BOARD OF HEALTH Michael9HeaCey, Chairman BY: -- Town of Mansfield Town of Mansfield - Board of Health 8 Park Row Mansfield, MA 02048 Hauler Is Application PERMIT NUMBER: TOTAL FEE: BUSINESS NAME: b- P % g U L-t'�! N6 --U L BUSINESS ADDRESS: -P G 6e 0 y S "St-- sly %/ Z°41J7� /Y//1- TOWN I STATE / ZIP: 0/ 7 0 1 NAME OF OWNER: T65Pfoh �c t�%�U C u TELEPHONE NO: J (Jfj' a3 /--/0a o CELL NO: 77�1- n17 J•— C�90 FAXNO: 6-P8- E-mall: SAC,-s li '%PUe�!✓� Alt E-mail: FED ID/SS NO: 09 0S' REGISTRATION NO: ti r3 0 O 1 Z, NO OF TRUCK(S): 3 FEE PER TRUCK: $75.00 Permit Expires December 31st yearly. SIGNATURE:±changes. , �!J DATE: Please make ropSign, date and enclose check payable to Town of Mansfield. Mail to: Board of Health, Town of Mansfield, Six Park Row, Mansfield, MA 02048. CERTIFICATE OF COMPLIANCE WITH ALMACHUSETTS TAX LAWS Pursuant to Massachusetts General Law Chapter 62C, Section 49A, the undersigned acting on behalf of the Contractor", certify under penalties of perjury that to the best knowledge and belief, the Contractor* is in compliance with all laws of the Commonwealth relating to taxes, reporting of employee and contractors, and withholding and remitting child support. Individual Signature Date Name (please print or type) Social Security Number Corporate Corporate Name (please print or type) of Cdrporate Officer Identification Number As used in this certification, the word "Contractor" shall mean any natural person, business, partnership, corporation, union, committee, club, or other organization, entity, or group of individuals. The Conunonwealth of Alaysacilusetys Departjnent oflrrdustrialAceldents Office of Investigations I Congress Street, Sulte I00 VI- � www.ntassgoul4ia W01•lters' Colnpensation Insurance Affidavit, General Businesses Applicant Information Please Print Legibly Business/Organization Name B—P Trucking Inc 47-65 Nickerson Road, Ashland, MA 01721 P.O. Box 386 Ashland, NA Are you an employer? Check tine appropriate box: 1.19 I am a employer with 75 employees (full and/ or part-time). * 2. ❑ 1 am a sole proprietor or partnership and have no employees working for me in any capacity. [No work es' comp. Insurance regnbedj 3. 1 We are a corporntionand its officers have exercised their right of exemption per c. 152, § 1(4), and we have no employees. [No workers' comp, insurance required]' 4. ❑ We are a non-profit organization, staffed by volunteers, With 'to employees. [No workers' comp, insurance req.j "/otp applicant chat checks box #1 must also till out the notton below showing 1 a]e empomteofficershave exampled tb,vnselves, but ate cormmlimlim oil o,J:alllmll WI mum. c11CCK 00x Fl. Pbolle Business Type (required): S. []Retail 6. ❑ Restaurant/Bar/Eating Establishment 7. ❑ Office and/or Sales (incl. real estate, auto, etc.) S. [] Noll -profit 9. ❑ Entertainment 10.0 Maludacturhtg 11•0 Heald) Care 12.k]Other _Sali 1 rJ�ere I am rill employer that Is providing rpor6ers' compensatlai iusurmece, for nay employees. D¢laul Is the policy frtformaume. Insurance Company Name: The Travelers Idemnity Company Insurer's Address: Cily/State/zip: Policy #or Self -ins. Lie.# 08-5046P652-17 ExpirationDate: 02/07/2019 Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as required wider 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 agabrst 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 /grab ce ify, under the ins and enalties of perjury that the Ir forntadoe provided above is true and correct, '�r]atw•e; '.e Lti -- Date: // ^ / Z— ]oneM 508-231-1000 1 Ofj7d use only. Do 11of Ivrile in fleas area, to be completed by city or town official. City or Tonat: Permit/License 9 Issuing Authority (eircle one): 1. Board of Health 2. Building Department 3. Cityfrown Clerk 4• Licensing Board 5. Selectmen's Offiee 6.Other Contact Person: Pirone #: ` From: 12/14/2018 12:13 #640 P.001/001 ACORO CERTIFICATE OF LIABILITY INSURANCE DATE (MMeDEM") 02116/2018 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 13ETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER, IMPORTANT: If the ce1: fi le holder Is an ADDITIONAL INSURED, the policy(ies) moat have ADDITIONAL INSURED provisions or be endorsed, If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, ceHaln policies may require an endorsement. A main Policies statement on this certificate does not confer rights to the Certificate holder In II6U of Such endo PROWLER C NTACT NAME: Christina Dennehy The Catchall Companies PHONE E (g78)997-7773 (978)897-1553 183 Great Road, Unit nh; No) : ADORIEsa: ohri58na(dgetchellCompanles.com PO Box 844 INSURER S) AFFORDING COVERAGE NAICN Stay MA 01775 31325 INSURERA: Aced le Insurance INSURED INSURER B: Th¢Travelers Indemnity Company ofAmenca B P Trucking Inc INSURER C : INSURER D: P 0 Box 386 INSURER E: Ashland MA 01721 INSURER F: COVERAGES re __......_..._.._...__... __.___._ HtVINION 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 REOUIREMENT, 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, 1 R LTR TYPE OF INSURANCE X COMMERCIAL GENERALLIAHRITV INSD D POLICYNUMBER MMIDD� MMtrflE Y LIMITS E 1,000,000 CLAIMS -MADE CLAIMSADE ❑X OCCUR X CONTRACTUAL LIABILITY REMI ES Ee rtenc $ 300,000 MEDEXP An one arson) - 3 5,0 A CPA5023806-16 02/07/2018 02/07/2019 PERSONAL$ADV INJURY S 1,000,000 GENLAGGREGATE LIMITAPPLIESPEW POLICY [g PRO-JECT ❑ X LCC GENERALAGOREGATE $ 2,000,000 PRODUCTS -COMP/OPAGG $ 2.000,000 OTHER: E AUTOMOBILE LIABILITY 00 Ee e"I11 NGLE❑MIT $ 11000,000 ANYAUTO BOOILYINJURY(Perpnson) $ q OWNED AUTOS ONLY X SCHEDULED quio5 MAA5023B08-17 02107/2076 02107/2019 BWEYINJURY(Poraccldese $ X HIRED NON OWNED AUTOS ONLY X AUTOS ONLY pReO;IRTYDAMAGE $ included X Poll. Llab. MCS 90 E X DMBAMAB X OCCUR A E%LESS LuO CLAIMS-h1ADE CUA50B0931-15 02/07/2018 GRGCIJRRENCE $ 5,GD0,000 02/07/2019 AG AGGREGATE $ 5,000,000 DED RETENTION $ WORKERSCOMPENSATION $ No AND EMPLOYERS' LIABILITY PER Or SATIRE ER B OPPICEWMEMBEN EXCLUDEoiEcuTlvE ❑ N/A COMPANY WILL FORWARD 02/07/2010 02/07/2019. EL. EACHACc1DENr $ 1,000,000 (Mandalory In NH) Ifyes,davomouNer S.L. DISEASE - EA EMPLOYEE $ 1,000,000 DESCRIPTIONOFOPEPATIONSbrb EL.DISEASE - POLICY LIMIT E 1-000,000 Business Personal Properly A CPA5023806-16 02/07/2018 02/07/2019 All Risk DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACOR0101, Additional Remark Sebedule, may be muchm, If mare space Is required) r1ERTIFIrATA' Mn, SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Insured ACCORDANCE WITH THE POLICY PROVISIONS. ©19OB-2015 ACORD CORPORATION. All rights reserved. 1191111111 "TN5 Or ACORD Jane Doucette From: Stephen DePaolo <Stephen.DePaolo@bptrucking.com> Sent: Friday, January 11, 2019 12:42 PM To: Jane Doucette Subject: permit Attachments: DOC_20190111174119.pdf Hello, Here is the certificate you needed as well as the plate number for the truck is N20012. If you need anything else please let us know. Have a Good Weekend, Stephen Stephen DePaolo B-P Trucking, Inc. P.O. Box 386 47-65 Nickerson Road Ashland, MA 01721 (508) 231-1000 (508)881-6123-fax email: stet)hen.deoaolo(@br)truckin2.com web: www.botrucking.com t �o CERTIFICATE OF LIABILITY INSURANCE DATEIMlAigni YYY) Tkigs.aERTIFICATE 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 and endorsement. A statement on this certificate does not confer rights to the certificate holder In lieu of such endorsements . PRODUCER THE, GETCHELL COMPANIES PO BOX 844 STOW, MA 01775 29TFP CONTACT NAME: PHONE (AX, No, Ext): FAX (AID, No): P-MAIL ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC# INSURED B P TRUCKING INC PO BOX 386 ASHLAND, MA 01721 INSURER A: TRAVELERS INDEMNITY COMPANY OF AMERICA INSURER B: INSURER C: INSURER D: INSURER E: 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. INSR LTR TYPE OF INSURANCE ADD L SUB R POLICY NUMBER POLICY OFF DATE (MMIDDIYYYY) POLICY EXP DATE IMMIDDIYYYY) LIMITS GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY CLAIMS MADE OCCUR. zACH OCCURRENCE It DAMAGE TO RENTED PREMISES (Ea occurrence) $ MED EXP (Anyone person) $ PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: POLICY 0 PROJECT [:] LOG GENERAL AGGREGATE $ PRODUCTS - COMP/OP AGO $ AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULE AUTOS HIRED AUTOS NON -OWNED AUTOS COMBINED SINGLE LIMIT (Ea accident) $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ UMBRELLA LIAR EXCESS LIAB OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DEDUCTIBLE RETENTION $ $ $ A WORKER'S COMPENSATION AND EMPLOYER'S LIABILITY YIN ANY PROPERITORIPARTNER/EXECUTIVE OFFICERIMEMBER EXCLUDED? (Mandatory in NH) If yea, describe under DESCRIPTION OF OPERATIONS below NIA UB-5046P652-19 02/07/2019 02/07/2020 X WC STATUTORY LIMITS OTHER E. L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 E.L. DISEASE -POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONSILOCATIONSIVEHICLES/RESTRICTIONS/SPECIAL ITEMS THIS REPLACES ANY PRIOR CERTIFICATE ISSUED TO THE CERTIFICATE HOLDER AFFECTING WORKERS COMP COVERAGE. CERTIFICATE HOLDER CANCELLATION TOWN OF MANSFIELD 6 PARK ROW TOWN HALGI ST FLOOR MANSFIELD, MA 02048 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 REPRESENT VE / I � _ j�-, � ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD 1908-201U Al CORPORA I IUN. All rights reserved.