Loading...
HomeMy WebLinkAboutDick Morse Excavating, Inc. -12/31/2009Commonwealth of Massachusetts Town of Mansfield Town of Mansfield 6 Park Row Mansfield, MA 02048 Board of Health Disposal Works Installer's Permit This is to certify that DICK MORSE Doing business as: DICK MORSE EXCAVATING, INC. 351 MOUNTAIN STREET SHARON MA 02067 is hereby granted a DISPOSAL WORKS INSTALLER PERMIT to construct, alter, install, or repair individual sewage disposal systems. This permit is granted in conformity with the STATE ENVIRONMENTAL CODE., 310 CMR 15.02(2) and expires December 31, 2009 unless sooner suspended or revoked. LICENSE NUMBER: 34 FEE: $25.00 BOARD OF HEALTH Dr. Raymond Martin, Chairman Town of Mansfield Town of Mansfield - Board of Health 6 Park Row Mansfield, MA 02048 Disposal Works Installer Application LICENSE NUMBER 34 APPLICANT: DICK MORSE BUSINESS NAME: DICK MORSE EXCAVATING, INC. � I MAIL ADDRESS: 351 MOUNTAIN ST. CITY/TOWN: SHARON STATE: MA ZIP CODE 02067 BUSINESS PHONE: (781) 784-3136 BUSINESS CELL: 781-467-8810 BUSINESS FAX: (781) 784-7176 FEDERAL ID/SS NUMBER 04-3515477 LICENSE HELD: Town _of, Shar—n __ _____ Year Licensed — 1985 LICENSE HELD: Town of Foxboro_ Year Licensed 1987 LICENSE HELD: Town of Stoughton _ Year Licensed 1987 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 Satndards 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: $ 25.00 SIGNATURE: Qj flip .i--v DATE: 12/2/08 Please make appropriate changes. Sign, date, and enclose check for $25.00 payable to Town of Mansfield. Mail to: Board of Health, Town of Mansfield, Six Park Row, Mansfield, MA 02048 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. Dick Morse Excavating, Inc. Signature of Individual or Corporate Name (Mandatory) By: Corporate Officer (Mandatory, if applicable) Fed. I.D. o4-3515477 ** Social Security Number (Voluntary) or Federal Identification Number * This license will not be issued unless the 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 Mass. General Laws, Chapter 62C, Section 49A. AC-ORD.CERTIFICATE OF LIABILITY INSURANCE DATE u/lz/2ooe THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION PRODUCER ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Patterson Insurance Agency HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 190 Washington Street ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. P.O. Box 36 INSURERS AFFORDING COVERAGE Westwood MA 02090- INSURERA:ONE BEACON INS. CO. INSURED Dick Morse Excavating, Inc. wsURERB:SAFETY INSURANCE CO DM Equipment Inc. INSURER C: AMERICAN HOME ASSURANCE (AIG) 351 Mountain Street INSURER D' Sharon MA 02067— INSURER E: COVERAGES 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR POLICY NUMBER DAIEJEFFECTIVE POLICYEXPIRATYI LIMITS TYPE OF DATE MMIDDM' DATE MM/DDM' LTR A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS MADE aOCCUR 710-01-85-13-0000 04/03/2008 / 04/03/2009 EACH OCCURRENCE $ 1_000, 000 FIRE DAMAGE one fire) $_ 100,000 MED EXP (Any one person $ 5, 000 PERSONAL INJURY $ 1,000,000 GENERALAGGREGATE $ 2,000,000 PRODUCTS-COMP/OP AGG $ 1,000,000 B 1609744 / / 04/17/2008 / / 04/17/2009 GENT AGGREGATE LIMIT APPLIES PER: PRO- POLICY JECT LOG AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accldenl) $ 1,000,000 AUTO OWNED AUTOS EDULEDAUTOS ED AUTOS N-OWNEDAUTOS / / / / / / / / BODILY INJURY (Per person) $ BODILY INJURY (Per awiden() $ PROPERTYDAMAGE (Per accident) $ AUTO ON LY-EA ACCIDENT $ EA ACC AGO $ LIABILITY Y AUTO / / / / $ LIABILITY CUR CLAIMS MADE LEMPLOYERS'LIABILITY 710-01-85-13-0000 04/03/2008 04/03/2009 NCE $ 1,000,000 $ 1,000,000 MC $ _DUCTIBLE $TENTION $10,000 RSCOMPENSATIONAND ERS' LIABILITY WC641-24-91 05/27/2008 05/27/2009 - OTH- S ER E.L. EACHACCIUEN'f 500,000 $E.L. DISEASE -EA EMPLOYEE$ 500,000 E.L. DISEASE -POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONSILOCATIONSNEHICLESIEXCLUSIONS ADDED BY ENDORSEMENTISPECIAL PROVISIONS TOWN OF MANSFIELD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 20 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILUNB9'D;­ff0 SO�SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE 02048- 25-S 171971 qre INS025S(99fn).01 ELECTRONIC LASER FURMs, iNc.- Iauulmrowa ©ACORDCUKPUKAIIUN IBDD