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Home My WebLink AboutBodioZ&J0/8 APPLICATION FOR DRAINLAYER'S LICENStu r.i 21 MANSFIELD, MA DATE: rp(2 95 95 J11121 Pik 2: 20 Name and/or Corporation -Prm10 $t713�ERS ING u .S & Address: �- $Ox �67 o2TN TF�N, F1Ak o k3 Emergency 24 hour telephone # 500 ,230 'tft Please attach the following: 1. Valid Heavy Equipment Operators License (copy); 2. Insurance Certificate (Town must be listed as additionally insured); 3. Performance Bond; 4. Three references who are familiar with your work with telephone numbers; 5. Application fee of $250.00. The undersigned hereby acknowledges receipt, understanding of the Drainlayer's Regulations, and that he/she has read the entire document. Signature:�tLDCY2S LNG DPW Approved: , �- •_ �/27�5 fl� 50 niSt: �2.�u.0 Date: TOM TRAN 097122 06/27/95 RECLIFT 167135 C42 Qi . BEMSDt-( EM"E2PI2tse-5 583- 5401 V -PM70Z iDEC��i2©LOVv�p $ Sf�NS Q ��.STbh{ 'PvoAiY2.t7 of 4}GAcLTIi -S39 -9Z12- wA0E 5A&VGt E2 P-5,0 3410 T40002 TRAN 097122 06/27/95 RECEIPT 167135 C42 $2 0.0! --------------- --------------- !A C 0 R D CERTIFICATE --------------------------------------------- OF INSURANCE ---------=---- Date06/14/95 ADDUCER CSR ;This certificate is issued as a matter of information only and confers no WAOUOIT INSURANCE AGENCY, INC. ;rights upon the certificate holder.This certificate does not amend,extend 516 WAOUOIT HWY.,P.O. BOX 3099 !or alter the coverage afforded by the policies below, WAOUOIT MA 02536- --------------------------------------------------1C 0 M P A N I E S A F F O R D I N G C O V E R A G E-----------------------! ;INSURED !COMPANY LETTER A: AETNA C & S ! BODIO BUILDERS, INC. !COMPANY LETTER B: ! P.O. BOX 457 ;COMPANY LETTER C: ! ! NO. EASTON MA 02356 !COMPANY LETTER D: ! !COMPANY LETTER E: !C O V E R A G E S--------------------------------------------------------------------------- This is to certify that 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.-----------------------------------------------------------------------------------! !CO LTR !TYPE OF INSURANCE !POLICY ----------------------------- NUMBER 1EFF DATE 1EXP DATE ;ALL LIMITS IN THOUSANDS ! !GENERAL LIABILITY !GENERAL AGGREGATE 1000 ! A ![XICOMMERCIAL GENERAL LIABILITY ! ACM24610123 02/07/95 ! 02/07/96 !PRODUCTS-COMP/OPS AGGREGATE 2000 , ![ J[ ]CLAIMS MADE [XIOCCURRENCE ! ! / / ! / / !PERSONAL&ADVERTISING INJURY 1000 A ![X)OWNER'S & CONTR. PROTECTIVE :EACH OCCURRENCE 1000 ![ I ADDN INSURED ! / / ! / / !FIRE DAMAGE(ANY ONE FIRE) 50 ! !( ) TOWN OF MANS I) i--------------------------------------------------------------------------------------------------------------------------------- / / ! / / 1MED EXPENSE(ANY ONE PERSON) 5 ! i !AUTOMOBILE LIABILITY ! !( )ANY AUTO ! FJ 0024610123 A !(XIALL:OWNED AUTOS ! A ![XISCHEDULED AUTOS ! ![ )HIRED AUTOS ! A !(X)NON-OWNED AUTOS ![ ]GARAGE LIABILITY ------------------------------------------------------- !EXCESS LIABILITY ![ )UMBRELLA FORM !( )OTHER THAN UMBRELLA FORM 04/02/95 02/07/96 ! 1000 ;BODILY INJURY(PER PERSON) !BODILY INJURY(PER ACCIDENT) ;PROPERTY DAMAGE !EACH OCCURRENCE !AGGREGATE ----------------------------------------------------------------- ! ! ! ! ! !STATUTORY ! !WORKER'S COMPENSATION ! ! ! ! 100 (EACH ACCIDENT) A ! AND ! C0024610123 TCF ! 02/07/95 ! 02/07/96 ! 500 (DISEASE -POLICY LIMIT) !EMPLOYER'S LIABILITY l--------------------------------------------------------------------------------------------------------------- ! ! / / ! / / ! 100 (DISEASE -EACH EMPLOYEE) :OTHER ! ! ! ! !DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/RESTRICTIONS/SPECIAL ITEMS----------------------------------------. ! CONSTRUCTION OF RESIDENTIAL PROPERTY NOT TO EXCEED 3 STORIES IN HEIGHT. !CERTIFICATE HOLDER -------------------- CANCELLATION -------------------------------------------------------------------------------! TOWN OF MANSFIELD ! Should any of the above described policies be cancelled before the expiration date thereof! ! ! the issuing company will endeavor to mail 10 days written 1 0ti to the certificate holder! TOWN HALL, BUILDING DEPT. ! named to the left,but failure to mail such notice shall impos ob 'vgation or liability ! ! MANSFIELD MA 02048 ! of any kind upon the company,its_agents or represents ' s. AUTHORIZED REPRESENTATIVE I __ /V �--ACORD 25-5(ll/85)==°=°°°°"°°'°_________________°'___________°____r__-----_'_"