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HomeMy WebLinkAboutHayes Excavating - 12/31/2021'R_ 510 q io LICENSE NUMBER: % t d-....L� APPLICANT: R i C BUSINESS NAME: �� fo c P �cc i :� Lvir. MAIL ADDRESS: 3 S O 1 C7 _Pk4 r nU__A h Town of Mansfield 6 Park Row Mansfield, MA 02048 CITY/TOWN: Sa nct rya _BQ 2 c-� STATE: 1v t to ZIP CODE: C7 cL Co '1 BUSINESS PHONE: BUSINESS FAX: BUSINESS CELL: E-mail: CCClu-Pc eXCa.�1a"i'i'h cti.kbQ (Orrt Alt E-mail: ID/SS NUMBER: 03"3 - 5G— C17. LICENSE HELD: Town Ait�_I1V1 `poto LICENSE HELD: Town 1�V_�, LICENSE HELD: Town _S� Year Licensed aLED"14-u Year Licensed __Vz� 11)_b Year Licensed 2a Please submit a copy of the licenses held along with a contact name and phone number for each town. References will be checked. I have read 310 CMR 15.00, the State Environmental code; Title 5, Minimum Requirements for the subsurface Disposal of Sanitary Sewage and the Board of Health regulation titled "Minimum Standards for the Subsurface Disposal of Sanitary Sewage". I understand that deviation from them may be cause for revocation of this permit. Permit Expires December 31st yearly. FEE: $ 100.00 SIGNATURE: DATE:�� Please make appropriate changes. Sign, date, and enclose check for $100.00 payable to Town of Mansfield. Mail to: Board of Health, Town of Mansfield, Six Park Row, Mansfield, MA 02048 RICHHAY-01 AKAHANOWITZ ,4cofz1A CERTIFICATE OF LIABILITY INSURANCE `-� DATE(MMIDDIYYYY) 9/23/2020 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 R. S. Gilmore Insurance 27 Elm St North Attleboro, MA 02760 CONTA E:CT HCONr o, E:t : (508) 699-7511 nAic , Nol:(508) 695-3597 E-MAILADDRESS- INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: Mahn Street America Assurance 29939 INSURED INSURER B:Safe Insurance Co. 39454 INSURERC: Richard Hayes DBA Hayes Excavating INSURER D : PO Box 93 Foxboro, MA 02035 INSURER E INSURER F COVERAGES CERTIFICATE NUMBER: RFVISION NIIMRFR- 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 INSD SUBR MD POLICY NUMBER POLICY EFF POLICY EXPJJJL LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE � OCCUR MPP0445H 5/1012020 5/101202, EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED PREMISES Ea occurrence $ MED EXP (Any one arson $ 10,000 PERSONAL &AOV INJURY 1 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PED LOD OTHER: GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP/OP AGO $ 2,000,000 B AUTOMOBILE LIABILITY ANYAUTO OWNED X SCHEDULED AUTOS ONLY AUTOS AUTOS ONLY X AUTOS ONLY 5909662 7/2/2020 712/2021 COMBINED SINGLE LIMIT a acc d, e BODILY INJURY Perperson) $ 100,000 BODILYBODILY INJURY Per accident 300,000 $ X Pori aaaZ AMAGE $ 100,000 UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DED I I RETENTION$ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIIETORIPARTNEWEXECUTIVE ❑ (mandatory In NE&, EXCLUDED? If yes, describe under DESCRIPTION OF OPERATIONS below N / A PER ER E.L. EACH ACCIDENT $ E. L. DISEASE EA EMPLOYE $ E.L. DISEASE - POLICY LIMIT DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD tat, Addltlonal Remarks Schedule, may be attached if more space Is requlmd) Town of Mansfield 6 Park Row 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 REPRESENTATIVE ys �4# '° ACORD 25 (2016103) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD THE COMMONWEALTH OF NU4BER: MASSACHUSETTS D132-2020 FEE: $150.00 Town of Franklin Health Department 355 East Central Street DISPOSAL WORKS INSTALLER'S PERMIT Is hereby granted to HAYES EXCAVATIING 35 OLD PLYMOUTH ROAD SAGAMORE, MA 02562 This permit is granted in conformity with the State Sanitary Code Title V, Regulation 2.2, and expires December 31, 2020, unless sooner suspended or revoked. Date issued: July 15, 2020 6IF&km ?909& Director of Public Health