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HomeMy WebLinkAboutB-P Trucking 12/31/2018Commonwealth 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 in conformity with the Statue and Ordinances relating thereto, and expires December 31, 2018 unless suspended or revoked REGISTRATION No: 11174 FEE PER TRUCK: $25.00 BOARD OF HEALTH MlchaeCMCCCean, Chairman Town of Mansfield Town of Mansfield - Board of Health 6 Park Row Mansfield, MA 02048 i � r Hauler's ApplicationDEC 02017 PERMIT NUMBER: 2 TOTAL FEE: BUSINESS NAME: B-P TRUCKING, INC. BUSINESS ADDRESS: P.O. BOX 386 TOWN I STATE I ZIP: ASHLAND, MA 01721 NAME OF OWNER: JOSEPH DEPAOLO TELEPHONE NO: (508) 231-1000 CELL NO: (774) 279-0902 FAX NO: (508) 881-6123 E-mail: SALES@BPTRUCKING.COM Alt E-mail: FED ID/SS NO: 04-2595703 REGISTRATION NO: 11174 NO OF TRUCK(S): 1 FEE PER TRUCK: $25.00 SIGNATURE: <UQY__ _ Permit Expires December 31st yearly. DATE: I /-28_-_17 Please mAko,16ppropriate changes. Sign, date and enclose check payable to Town of Mansfield. Mail to: Board of Health, Town of Mansfield, Six Park Row, Mansfield, MA 02048, TAX CERTIFICATION FORM I certify under the penalties of perjury that I, to my best knowledge and belief, have filed all state tax returns and paid all state taxes required under law. Signature of Individual or Corporate Na e By of orate fficer (Mandatory, if Applicable) 6 k/ 0 5- 9,&� 7o .S **Social Security No. (Voluntary) or Federal Identification Number *This license will not be issued unless this certification clause is signed by the applicant. ** Your social security number will be furnished to the Massachusetts Department of Revenue to determine whether you have met tax filing or tax payment obligations. Licensees who fail to correct their non -filing or delinquency will be subject to license suspension or revocation. This request is made under the authority of Massachusetts General Law Chapter 62C, section 49A. CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYM 2/6/2017 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 policypes) 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 coNrnC Christina Dennehy NA E: The Getchell Companies PHONE (978)897-7773 FAX 183 Great Road, Unit 15 E-MAIL q/ No; (978) 897-1553 PO Box 844 AD RE s:christina@getchellcompanies.com INSURERS AFFORDING COVERAGE NAIC e Stow MA 01775 INSURERAACadia Insurance INSURED - __ it 17S B P TRUCKING, INC. INSURERD PO BOX 386 ABHLAND I INSURERS: MA 01721 IINSURERF COVERAGES CERTIFICATE NUMBER.2017-2oi.a I THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW REVISION NUMBER: HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY POLICY PERIOD CONTRACT CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE INSR BEEN REDUCED BY PAID CLAIMS. ADD UBR LTR TYPEL INSURANCE POLICYNUMBER MM/IDV EFF PM/D yEXP X COMMERCIAL GENERAL IIABIDTY LIMITS A CLAIMS EACH OCCURRENCE $ 11000,000 -MADE X OCCUR DAMAGE TO RENTED X contractual liability CPA5023806-15 2/7/2017 PREMIS S Ea oaur ence $ 2/7/2018 250,000 MED EXP (Any One person) $ 51000 GEML AGGREGATE LIMIT APPLIES PER: PERSONAL&ADVINJURY $ 21000,000 POLICY PR [ L] GENERAL AGGREGATE $ 2,000,000 OTHER: PRODUCTS-COMP/OPAGG $ 2,000,000 AUTOMOBILE LIABILITY Employee Benents $ 11000,000 CO SIN D SINGLE LIMIT Ea accitled $ 11000,000 A ANY AUTO AU OS ED X SCHEDULED BODILY INJURY (Per parson) $ AUTOS AUTOS MAA5023808-15 2/7/2017 X NON -OWNED 2/7/2018 BODILYINJURY PeracGtlenl $ ( ) HIRED AUTOS X AUTOS pollution liability PROPERTYAMAGE X MM9855 X MCS90 d enl $ included X UMBRELLA LIAB X OCCUR $ A EXCESS LIAR CLAIMS -MADE EACH OCCURRENCE $ 5, 000, 000 DED RETENTION CUA5080331-14 2/7/2017 AGGREGATE $ 2/7/2018 51000,000 WORKERS COMPENSATION $ AND EMPLOYERS' LIABILITY YIN UB-5046P652-17 ANY PROPRIETOR/ STATUTE PER ERH OFFICER/MEMBER EXCLUDED? NIA EXCLUDED? B (Mandatory In NH) E.L. EACH ACCIDENT $ 11000,000 COMPANY WILL FORWARD 2/7/2017 If es,describe, under 2/7/2018`" EA EMPLOYE $ E.L. DISEASE- DESCRIPTION OF OPERATIONS below 11000,000 A Business Personal Property EL DISEASE -POLICY LIMIT $ 31,000 000 CPA5023806-15 2/7/17 2/7/18 All Risk DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, AddlOonal Remark. Schedule, may be attached If more space is required) Insured Ar.nBn 99 Nn4d N143 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 �1�� •ri ' ' Christina Dennehy/CRD Ck-ol:4-i"o.,. �Qrc•a ____ ©1988-2014ACORD CORPORATION. Allriahts INS0251701an11 • ••- are regiscerea marks of ACORD A� o® CERTIFICATE OF LIABILITY INSURANCE DATEI06201YYYY) 02/O6/2018 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 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 The Getchell Companies 183 Great Road, Unit 15 PO Box 844 Slow MA 01775 CONTACT Christina Dennehy NAME: AICNNO Eel: (978)897-7773 FAXNo: (978)e97-1553 E-MAIL christina@gelchellcompanies.com ADDRESS: INSURERIS) AFFORDING COVERAGE NAIC % INSURER A: Acadia Insurance 31325 INSURED B PTrucking Inc P O Box 386 Ashland MA 01721 INSURER B: The Travelers Indemnity Company ofAmerica INSURER C : INSURER D: INSURER E: INSURER F: CnvFRer,Fc CERTIFICATE NUMBER. 2018-2019 REVISION NUMBER: THIS IS TO CERTIFY THATTHE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAME (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 ADGLSUsR INSD VIVID POLICY NUMBER POLICY Err MMIODNYYY POLICYEXP MM/DDNYYY LIMITS X OOMMERCIALGENERALLIABILITY EACH OCCURRENCE $ 1.000,000 CLAIMS X OCCUR G o PREMISES Ea occurrence 3 300,000 MED EXP(Any one arson) $ 5,000 X CONTRACTUAL LIABILITY PERSONAL& ADV INJURY $ 1,000,000 A CPA5023806-16 02/07/2018 02/07/2019 GEN'L AGGREGATE LIMIT APPLIES PER GENERALAGGREGATE $ 2,000.000 PRODUCTS-COMPIOPAGG $ 2,000,000 POLICY IFX�l jEC 19 LOG $ OTHER AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea..Wenl $ 1,000,000 BODILY INJURY(Perpersan) $ ANYAUTO A SCHEDULED AUTOS ONLY AUTOS HIRED NON -OWNED OWNED PX X AUTOS ONLY AUTOS ONLY MAA5023808-17 02/07/2018 02/07/2019 BODILY INJURY (Per rimider10 s PROPERTYDAMAGE Peraccidenf § included $ X Poll. Liab. MCS 90 X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 5,000,000 AGGREGATE $ 5,000,000 A EXCESS LIAR CLAIMS -MADE CUA5080331-15 02/07/2018 02/07/2019 DED I I RETENTION $ $ e WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN YIN CUTIVE ANY OFFICE MEMBEREXCL EXCLUDED? (MandatoryIn NH) Excl.uoeov (Mantlatory in NH) rv/a COMPANY WILL FORWARD 02/07/2018 02/07/2019 PER OTH ER EL EACH ACCIDENT $ 1,000,000 E. L. DISEASE - EA EMPLOYEE $ 1,000,000 E. L. DISEASE -POLICY LIMIT $ 1,000,000 Ifyes, describe under DESCRIPTION OF OPERATIONS below A Business Personal Property CPA5023806-16 02/07/2018 02/07/2019 All Risk DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be aaached if more space is required) CERTIFICATE HOLDER CANCFI 1 ATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Town of Mansfield ACCORDANCE WITH THE POLICY PROVISIONS, 6 Park Row AUTHORIZED REPRESENTATIVE Town Hall - 1st Floor Mansfield MA 02048 r `a 4-1 II-'" [', _ ZIA-A-, ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD