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An application was received from Linda Slauenwhite, representing Starbucks, requesting permission for a projecting sign at the premises numbered 11 First Street approval has been received from Inspectional Services, Department of Public Works, Community Development Department and no abutter response proof of mailing has been provided

APP 2021 #33·Council meeting Jun 21, 2021·44 pages·📄 Original PDF (city portal)
General Information Cambridge City Council approval may be required. Sign Information Contractor Sign/Awning Permit 122688 Submitted On: May 24, 2021 Applicant Linda Slauenwhite [phone removed] [email removed] Location 11 First St Unit D Cambridge, MA 02141 What option best describes this application? Sign(s) Description of Proposed Work Installation of (1) 24" Blade sign Estimated Cost of Sign(s) in dollars 900.00 Describe any existing signs or awnings that will remain (including the size of the remaining signs/awnings). (2) existing awning will be staying, no other signs. Both awnings are 2'6" x 17'-4". Has nothing to do with us. Will one or more of the proposed signs extend six (6) inches into the public sidewalk? Yes You must submit a Projected Sign Application and Abutter's Form (https://viewpointcloud.blob.core.windows.net/profile- pictures/City_Clerk_Sign_Awning_Application_Wed_Jan_02_2019_15:28:46_G (Coordinated_Universal_Time).pdf) to the City Clerk's Office. Sign Text No text only Siren logo Type of Sign Projecting Illumination Natural Height of Sign (feet) 2 Width of Sign (feet) 2 Area of Sign (square feet) 4 Height from the ground to the top of the sign (feet) 13 Height from the ground to bottom of the sign (feet) 11 Sign Material .063 aluminum returns painted black with .177 white polycarbonate Weight of the sign (lbs) 40 Projection from the Building (inches) 27 Width of Building Facade for Associated Use (feet) 39 Is the sign an accessory to a first floor store? Yes Contractor Name ANDREW M SERRATO Address 1 Salisbury Blvd Page 1 of 2 6/17/2021 https://cambridgema.viewpointcloud.io/
Contractor's Signature E-mail [email removed] Telephone [phone removed] License Number CS-078124 License Expiration Date 07/25/2022 Signature of Licensed Contractor Andrew M. Serrato Date 05/24/2021 Page 2 of 2 6/17/2021 https://cambridgema.viewpointcloud.io/
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. INSURER(S) AFFORDING COVERAGE INSURER F : INSURER E : INSURER D : INSURER C : INSURER B : INSURER A : NAIC # NAME: CONTACT (A/C, No): FAX E-MAIL ADDRESS: PRODUCER (A/C, No, Ext): PHONE INSURED REVISION NUMBER: CERTIFICATE NUMBER: COVERAGES 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). 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. OTHER: (Per accident) (Ea accident) $ $ N / A SUBR WVD ADDL INSD 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. $ $ $ $ PROPERTY DAMAGE BODILY INJURY (Per accident) BODILY INJURY (Per person) COMBINED SINGLE LIMIT AUTOS ONLY AUTOS AUTOS ONLY NON-OWNED SCHEDULED OWNED ANY AUTO AUTOMOBILE LIABILITY Y / N WORKERS COMPENSATION AND EMPLOYERS' LIABILITY OFFICER/MEMBER EXCLUDED? (Mandatory in NH) DESCRIPTION OF OPERATIONS below If yes, describe under ANY PROPRIETOR/PARTNER/EXECUTIVE $ $ $ E.L. DISEASE - POLICY LIMIT E.L. DISEASE - EA EMPLOYEE E.L. EACH ACCIDENT ER OTH- STATUTE PER LIMITS (MM/DD/YYYY) POLICY EXP (MM/DD/YYYY) POLICY EFF POLICY NUMBER TYPE OF INSURANCE LTR INSR DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) EXCESS LIAB UMBRELLA LIAB $ EACH OCCURRENCE $ AGGREGATE $ OCCUR CLAIMS-MADE DED RETENTION $ $ PRODUCTS - COMP/OP AGG $ GENERAL AGGREGATE $ PERSONAL & ADV INJURY $ MED EXP (Any one person) $ EACH OCCURRENCE DAMAGE TO RENTED $ PREMISES (Ea occurrence) COMMERCIAL GENERAL LIABILITY CLAIMS-MADE OCCUR GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PRO- JECT LOC CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) CANCELLATION AUTHORIZED REPRESENTATIVE ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved. CERTIFICATE HOLDER The ACORD name and logo are registered marks of ACORD HIRED AUTOS ONLY 6/16/2021 Herlihy Insurance Group 51 Pullman Street Worcester MA 01606 Pat Hudson [phone removed] [phone removed] [email removed] The Hartford SERRSIG-01 Sentry Insurance Serrato Signs, LLC 13-15 Dewey Street Worcester MA 01609 1424862 B X 1,000,000 X 500,000 10,000 1,000,000 3,000,000 X Y Y A0123260003 3/12/2021 3/12/2022 2,000,000 B 1,000,000 X Y Y A0123260004 3/12/2021 3/12/2022 B X X 1,000,000 Y A0123260005 3/12/2021 Y 3/12/2022 1,000,000 X 10,000 A X Y Y 08WECEL6364 4/2/2021 4/2/2022 1,000,000 1,000,000 1,000,000 Subject to policy terms, forms and conditions. Certificate holder, and any person or organization requested is included as an Additional Insured on a primary and non-contributory basis as required by a written contract, per form CG2010 (04/13) and Completed Operations per form CG2037 (04/13) on the General Liability, Auto Liability and Umbrella policy. A Waiver of Subrogation applies on the General Liability, Automobile Liability, Umbrella and Worker's Compensation when required by written contract. **Susan Serrato is excluded from the Workers Comp** Additional Insured: City of Cambridge City of Cambridge 795 Massachusetts Ave Cambridge MA 02139
Page 1 of 1 MM 99 50 10 13 © Automobile Insurers Bureau, 1998 03/01/2019 A0123260 Middlesex Insurance Company COMMERCIAL AUTO MM 99 50 10 13 ADDITIONAL INSURED - MASSACHUSETTS This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM AUTO DEALERS COVERAGE FORM MOTOR CARRIER COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by the endorsement. Changes In Covered Auto Liability Coverage: Who Is An Insured is changed to include the person or organization named in this endorsement, but only for "bodily injury" or "property damage" resulting from the acts or omissions of: 1. You, while using a covered "auto". 2. Any other person, while using a covered "auto" with your permission. Additional Insured: Description of Auto THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. © Automobile Insurers Bureau, 1998 POLICY NUMBER: 00001 0000000000 19060 0 N 1 2de72868-528d-498b-88a6-52eeaa02a915 2de72868-528d-498b-88a6-52eeaa02a915 0027020044348986347701606331051
ADDITIONAL INTEREST SUPPLEMENTAL DECLARATIONS POLICY NUMBER: A0123260004 The following additional interests apply to this policy. Any person or organization you are required to add as an additional insured under a written contract or agreement in effect prior to any loss or damage 15 Dewey St Worcester, MA 01609 MM 99 50 10 13 Additional Insured - Massachusetts Description of Auto: On file with company CA 76 01 06 15 Designated Insured - Primary and Noncontributory - Covered Autos Liability Coverage Page 1 of 1 CA 89 04 10 14 03/01/2019 A0123260 Middlesex Insurance Company 00001 0000000000 19060 0 N 1 1a262c29-29f2-4be5-b7f4-971546425e4f 1a262c29-29f2-4be5-b7f4-971546425e4f 0027020044348986347701606331051
POLICY NUMBER: SCHEDULE COMMERCIAL AUTO CA 76 01 06 15 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. DESIGNATED INSURED - PRIMARY AND NONCONTRIBUTORY - COVERED AUTOS LIABILITY COVERAGE This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM AUTO DEALERS COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by this endorsement. This endorsement identifies person(s) or organization(s) who are "insureds" for Covered Autos Liability Coverage under the Who Is An Insured provision of the Coverage Form. This endorsement changes the policy effective on the inception date of the policy unless another date is indicated. Named Insured: Endorsement Effective Date: Name Of Person(s) Or Organization(s): Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Each person or organization shown in the Schedule is an "insured" for Covered Autos Liability Coverage, but only to the extent that person or organization qualifies as an "insured" under the Who Is An Insured provision contained in: (1) Paragraph A.1. of Section II - Covered Autos Liability Coverage in the Business Auto and Motor Carrier Coverage Forms; or (2) Paragraph D.2. of Section I - Covered Autos Coverages of the Auto Dealers Coverage Form. B. Primary And Noncontributory Insurance This insurance is primary to and will not seek contribution from any other auto insurance issued to the person or organization in the schedule under your policy provided that: (1) The person or organization is a Named Insured under such other insurance; and (2) Prior to the “accident” you have agreed in writing in a contract or agreement that this insurance would be primary and would not seek contribution from any other insurance available to the person or organization. Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 1 of 1 CA 76 01 06 15 03/01/2019 A0123260 Middlesex Insurance Company 00001 0000000000 19060 0 N 1 d2fb57db-1583-4f9d-acfb-37fda4e09ea3 d2fb57db-1583-4f9d-acfb-37fda4e09ea3 0027020044348986347701606331051
COMMERCIAL AUTO CA 76 16 06 18 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CA 76 16 06 18 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 1 of 1 BLANKET WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US (WAIVER OF SUBROGATION) This endorsement modifies insurance provided under the following: AUTO DEALERS COVERAGE FORM BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by the endorsement. This endorsement changes the policy effective on the inception date of the policy unless another date is indicated below. Named Insured: Serrato Signs LLC Endorsement Effective Date: 03/12/2019 The Transfer Of Rights Of Recovery Against Others To Us condition does not apply to a person(s) or an organization(s), but only to the extent that subrogation is waived prior to the "accident" or the "loss" under a written contract with that person or organization.
POLICY NUMBER: A0123260003 ADDITIONAL INSURED - SUPPLEMENTAL DECLARATIONS The following persons or organizations are included as Additional Insureds, but only to the extent provided in the listed endorsement: Any person or organization from whom you are required to waive your right to recover under a written contract or agreement in effect prior to any loss or damage. Endorsement CG 24 04 05 09, Waiver Of Transfer Of Rights Of Recovery Against Others To Us, applies to this additional insured. The person or organization indicated above is included as an additional insured under the following endorsement(s): Additional Insured - Owners, Lessees Or Contractors - Scheduled Person Or Organization CG 20 10 04 13 Location of Covered Operations: On file with company Job Description: On file with company Any person or organization you are required to add as an additional insured under a written contract or agreement in effect prior to any loss or damage The person or organization indicated above is included as an additional insured under the following endorsement(s): Additional Insured - Owners, Lessees Or Contractors - Completed Operations CG 20 37 04 13 Location and Description of Completed Operations: On file with company Additional Insured - Owners, Lessees Or Contractors - Scheduled Person Or Organization CG 20 10 04 13 Location of Covered Operations: On file with company CG 89 05 10 14 Page 1 of 2 03/01/2019 A0123260 Middlesex Insurance Company 00001 0000000000 19060 0 N 1 ce4b539c-2672-473a-86ac-8f1f2d924788 ce4b539c-2672-473a-86ac-8f1f2d924788 0027020044348986348901606331051
Page 1 of 1 CG 24 04 05 09 03/01/2019 A0123260 Middlesex Insurance Company © Insurance Services Office, Inc., 2008 POLICY NUMBER: Name Of Person Or Organization: Information required to complete this Schedule, if not shown above, will be shown in the Declarations. COMMERCIAL GENERAL LIABILITY CG 24 04 05 09 WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE The following is added to Paragraph 8. Transfer Of Rights Of Recovery Against Others To Us of Section IV - Conditions: We waive any right of recovery we may have against the person or organization shown in the Schedule above because of payments we make for injury or damage arising out of your ongoing operations or "your work" done under a contract with that person or organization and included in the "products-completed operations hazard". This waiver applies only to the person or organization shown in the Schedule above. 00001 0000000000 19060 0 N 1 d6bc18ac-a06d-409a-a963-7b7cc523e586 d6bc18ac-a06d-409a-a963-7b7cc523e586 0027020044348986348901606331051
COMMERCIAL GENERAL LIABILITY CG 20 01 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. PRIMARY AND NONCONTRIBUTORY - OTHER INSURANCE CONDITION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART The following is added to the Other Insurance Condition and supersedes any provision to the contrary: Primary And Noncontributory Insurance This insurance is primary to and will not seek contribution from any other insurance available to an additional insured under your policy provided that: (1) The additional insured is a Named Insured under such other insurance; and (2) You have agreed in writing in a contract or agreement that this insurance would be primary and would not seek contribution from any other insurance available to the additional insured. © Insurance Services Office, Inc., 2012 Page 1 of 1 CG 20 01 04 13 03/01/2019 A0123260 Middlesex Insurance Company 00001 0000000000 19060 0 N 1 7bfbd538-e876-4b4d-b419-db0200dfc22a 7bfbd538-e876-4b4d-b419-db0200dfc22a 0027020044348986348901606331051
Page 1 of 2 CG 20 10 04 13 03/01/2019 A0123260 Middlesex Insurance Company © Insurance Services Office, Inc., 2012 POLICY NUMBER: COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE CG 20 10 04 13 Name Of Additional Insured Person(s) Or Organization(s) Location(s) Of Covered Operations Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section II - Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by: 1. Your acts or omissions; or 2. The acts or omissions of those acting on your behalf; in the performance of your ongoing operations for the additional insured(s) at the location(s) designated above. However: 1. The insurance afforded to such additional insured only applies to the extent permitted by law; and 2. If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. B. With respect to the insurance afforded to these additional insureds, the following additional exclusions apply: This insurance does not apply to "bodily injury" or "property damage" occurring after: 1. All work, including materials, parts or equipment furnished in connection with such work, on the project (other than service, maintenance or repairs) to be performed by or on behalf of the additional insured(s) at the location of the covered operations has been completed; or 2. That portion of "your work" out of which the injury or damage arises has been put to its intended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a principal as a part of the same project. 00001 0000000000 19060 0 N 1 fdaf2f52-1db7-4c97-886e-8500389c4287 fdaf2f52-1db7-4c97-886e-8500389c4287 0027020044348986348901606331051
C. With respect to the insurance afforded to these additional insureds, the following is added to Section III - Limits Of Insurance: If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance: 1. Required by the contract or agreement; or 2. Available under the applicable Limits of Insurance shown in the Declarations; whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. © Insurance Services Office, Inc., 2012 CG 20 10 04 13 Page 2 of 2 03/01/2019 A0123260 Middlesex Insurance Company
Page 1 of 1 CG 20 37 04 13 03/01/2019 A0123260 Middlesex Insurance Company © Insurance Services Office, Inc., 2012 POLICY NUMBER: COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - COMPLETED OPERATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE CG 20 37 04 13 Name Of Additional Insured Person(s) Or Organization(s) Location And Description Of Completed Operations Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section II - Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury" or "property damage" caused, in whole or in part, by "your work" at the location designated and described in the Schedule of this endorsement performed for that additional insured and included in the "products-completed operations hazard". However: 1. The insurance afforded to such additional insured only applies to the extent permitted by law; and 2. If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. B. With respect to the insurance afforded to these additional insureds, the following is added to Section III - Limits Of Insurance: If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance: 1. Required by the contract or agreement; or 2. Available under the applicable Limits of Insurance shown in the Declarations; whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. 00001 0000000000 19060 0 N 1 86824e84-7ba2-46ac-a922-b3fe722317bf 86824e84-7ba2-46ac-a922-b3fe722317bf 0027020044348986348901606331051
Purchase Order No. 148198 Vendor Code SERRSIG PURCHASE ORDER Job Site: To: STARBUCKS #64875 SERRATO SIGNS 11 FIRST STREET 15 DEWEY ST. CAMBRIDGE , MA 02141 WORCESTER, MA 01609 Confirming To Buyer Req. Date Vendor Terms P.O. Date ANDY SERRATO CCARSON 04/30/2021 Net 60 04/26/2021 ***All invoices for services rendered must be emailed to [email removed], or hard copies must be mailed to 125 Hillside Dr. Greenville, SC 29607 to the attention of Accounts Payable. Failure to comply will result in delayed payment of invoices. *** Extended Cost Cost Ea. Description UM Part Id Qty EA $350.00 $350.00 1 SUB SUBCONTRACT LABOR/SERVICE PROJECT MGR: NOLASCO DESCRIPTION OF WORK TO BE PERFORMED: PROCURE PERMITS FOR STARBUCKS SIGN PACKAGE (1) LOGO BLADE SIGN $900.00 (1) HANGING WINDOW PICKUP SIGN $1,500.00 PERMITS BILLED AT COST PLUS STAFF TIME CONTACT JOE NOLASCO [phone removed] WITH ANY QUESTIONS. EMAIL COPY OF PERMITS TO [email removed] ABSOLUTELY NO ADDITIONAL CHARGES INCLUDING EXTRA TRIP CHARGES DUE TO WEATHER OR CONDITIONS OUTSIDE THE CONTROL OF HILTON DISPLAYS WILL BE PAID WITHOUT PRIOR WRITTEN AUTHORIZATION FROM A HILTON DISPLAYS REPRESENTATIVE. SEND INVOICE, COMPLETION CERTIFICATE, PHOTOS AND LEIN WAIVER WITHIN 5 DAYS OF COMPLETION. IF THESE ITEMS ARE NOT PROVIDED WITHIN 5 DAYS, HILTON DISPLAYS RESERVES THE RIGHT TO CONTRACT ANOTHER VENDOR TO OBTAIN THE NECESSARY ITEMS AND THIS EXPENSE MAY BE SUBTRACTED FROM YOUR INVOICE. IF YOUR INVOICE HAS NOT BEEN RECEIVED AFTER 10 DAYS, THE JOB WILL BE CLOSED AND NO PAYMENTS, AUTHORIZED OR NOT, EXCEEDING THE ORIGINAL PO AMOUNT WILL BE PAID. PLEASE SEND ANY UNUSED OR BAD BALLASTS BACK TO HILTON DISPLAYS, INC. Authorized Signature By Joe Nolasco at 12:51 pm, May 26, 2021
Purchase Order No. 148198 Vendor Code SERRSIG PURCHASE ORDER Job Site: To: STARBUCKS #64875 SERRATO SIGNS 11 FIRST STREET 15 DEWEY ST. CAMBRIDGE , MA 02141 WORCESTER, MA 01609 Confirming To Buyer Req. Date Vendor Terms P.O. Date ANDY SERRATO CCARSON 04/30/2021 Net 60 04/26/2021 ***All invoices for services rendered must be emailed to [email removed], or hard copies must be mailed to 125 Hillside Dr. Greenville, SC 29607 to the attention of Accounts Payable. Failure to comply will result in delayed payment of invoices. *** Extended Cost Cost Ea. Description UM Part Id Qty INSTALL PRICE: $350.00 Used by W20-52171/2 Op# 10 ____________ Total: $350.00 Authorized Signature
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. INSURER(S) AFFORDING COVERAGE INSURER F : INSURER E : INSURER D : INSURER C : INSURER B : INSURER A : NAIC # NAME: CONTACT (A/C, No): FAX E-MAIL ADDRESS: PRODUCER (A/C, No, Ext): PHONE INSURED REVISION NUMBER: CERTIFICATE NUMBER: COVERAGES 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). 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. OTHER: (Per accident) (Ea accident) $ $ N / A SUBR WVD ADDL INSD 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. $ $ $ $ PROPERTY DAMAGE BODILY INJURY (Per accident) BODILY INJURY (Per person) COMBINED SINGLE LIMIT AUTOS ONLY AUTOS AUTOS ONLY NON-OWNED SCHEDULED OWNED ANY AUTO AUTOMOBILE LIABILITY Y / N WORKERS COMPENSATION AND EMPLOYERS' LIABILITY OFFICER/MEMBER EXCLUDED? (Mandatory in NH) DESCRIPTION OF OPERATIONS below If yes, describe under ANY PROPRIETOR/PARTNER/EXECUTIVE $ $ $ E.L. DISEASE - POLICY LIMIT E.L. DISEASE - EA EMPLOYEE E.L. EACH ACCIDENT ER OTH- STATUTE PER LIMITS (MM/DD/YYYY) POLICY EXP (MM/DD/YYYY) POLICY EFF POLICY NUMBER TYPE OF INSURANCE LTR INSR DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) EXCESS LIAB UMBRELLA LIAB $ EACH OCCURRENCE $ AGGREGATE $ OCCUR CLAIMS-MADE DED RETENTION $ $ PRODUCTS - COMP/OP AGG $ GENERAL AGGREGATE $ PERSONAL & ADV INJURY $ MED EXP (Any one person) $ EACH OCCURRENCE DAMAGE TO RENTED $ PREMISES (Ea occurrence) COMMERCIAL GENERAL LIABILITY CLAIMS-MADE OCCUR GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PRO- JECT LOC CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) CANCELLATION AUTHORIZED REPRESENTATIVE ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved. CERTIFICATE HOLDER The ACORD name and logo are registered marks of ACORD HIRED AUTOS ONLY 4/27/2021 Herlihy Insurance Group 51 Pullman Street Worcester MA 01606 Pat Hudson [phone removed] [phone removed] [email removed] The Hartford SERRSIG-01 Sentry Insurance Serrato Signs, LLC 13-15 Dewey Street Worcester MA 01609 393499357 B X 1,000,000 X 500,000 10,000 1,000,000 3,000,000 X Y Y A0123260 3/12/2021 3/12/2022 2,000,000 B 1,000,000 X Y Y A0123260004 3/12/2021 3/12/2022 B X X 1,000,000 Y A0123260005 3/12/2021 Y 3/12/2022 1,000,000 X 10,000 A X Y Y 08WECEL6364 4/2/2021 4/2/2022 1,000,000 1,000,000 1,000,000 Subject to policy terms, forms and conditions. Certificate holder, and any person or organization requested is included as an Additional Insured on a primary and non-contributory basis as required by a written contract, per form CG2010 (04/13) and Completed Operations per form CG2037 (04/13) on the General Liability, Auto Liability and Umbrella policy. A Waiver of Subrogation applies on the General Liability, Automobile Liability, Umbrella and Worker's Compensation when required by written contract. **Andrew Serrato & Susan Serrato are excluded from the Workers Comp** City of Cambridge 795 Massachusetts Ave Cambridge MA 02139
Page 1 of 1 MM 99 50 10 13 © Automobile Insurers Bureau, 1998 03/01/2019 A0123260 Middlesex Insurance Company COMMERCIAL AUTO MM 99 50 10 13 ADDITIONAL INSURED - MASSACHUSETTS This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM AUTO DEALERS COVERAGE FORM MOTOR CARRIER COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by the endorsement. Changes In Covered Auto Liability Coverage: Who Is An Insured is changed to include the person or organization named in this endorsement, but only for "bodily injury" or "property damage" resulting from the acts or omissions of: 1. You, while using a covered "auto". 2. Any other person, while using a covered "auto" with your permission. Additional Insured: Description of Auto THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. © Automobile Insurers Bureau, 1998 POLICY NUMBER: 00001 0000000000 19060 0 N 1 2de72868-528d-498b-88a6-52eeaa02a915 2de72868-528d-498b-88a6-52eeaa02a915 0027020044348986347701606331051
ADDITIONAL INTEREST SUPPLEMENTAL DECLARATIONS POLICY NUMBER: A0123260004 The following additional interests apply to this policy. Any person or organization you are required to add as an additional insured under a written contract or agreement in effect prior to any loss or damage 15 Dewey St Worcester, MA 01609 MM 99 50 10 13 Additional Insured - Massachusetts Description of Auto: On file with company CA 76 01 06 15 Designated Insured - Primary and Noncontributory - Covered Autos Liability Coverage Page 1 of 1 CA 89 04 10 14 03/01/2019 A0123260 Middlesex Insurance Company 00001 0000000000 19060 0 N 1 1a262c29-29f2-4be5-b7f4-971546425e4f 1a262c29-29f2-4be5-b7f4-971546425e4f 0027020044348986347701606331051
POLICY NUMBER: SCHEDULE COMMERCIAL AUTO CA 76 01 06 15 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. DESIGNATED INSURED - PRIMARY AND NONCONTRIBUTORY - COVERED AUTOS LIABILITY COVERAGE This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM AUTO DEALERS COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by this endorsement. This endorsement identifies person(s) or organization(s) who are "insureds" for Covered Autos Liability Coverage under the Who Is An Insured provision of the Coverage Form. This endorsement changes the policy effective on the inception date of the policy unless another date is indicated. Named Insured: Endorsement Effective Date: Name Of Person(s) Or Organization(s): Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Each person or organization shown in the Schedule is an "insured" for Covered Autos Liability Coverage, but only to the extent that person or organization qualifies as an "insured" under the Who Is An Insured provision contained in: (1) Paragraph A.1. of Section II - Covered Autos Liability Coverage in the Business Auto and Motor Carrier Coverage Forms; or (2) Paragraph D.2. of Section I - Covered Autos Coverages of the Auto Dealers Coverage Form. B. Primary And Noncontributory Insurance This insurance is primary to and will not seek contribution from any other auto insurance issued to the person or organization in the schedule under your policy provided that: (1) The person or organization is a Named Insured under such other insurance; and (2) Prior to the “accident” you have agreed in writing in a contract or agreement that this insurance would be primary and would not seek contribution from any other insurance available to the person or organization. Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 1 of 1 CA 76 01 06 15 03/01/2019 A0123260 Middlesex Insurance Company 00001 0000000000 19060 0 N 1 d2fb57db-1583-4f9d-acfb-37fda4e09ea3 d2fb57db-1583-4f9d-acfb-37fda4e09ea3 0027020044348986347701606331051
COMMERCIAL AUTO CA 76 16 06 18 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CA 76 16 06 18 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 1 of 1 BLANKET WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US (WAIVER OF SUBROGATION) This endorsement modifies insurance provided under the following: AUTO DEALERS COVERAGE FORM BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by the endorsement. This endorsement changes the policy effective on the inception date of the policy unless another date is indicated below. Named Insured: Serrato Signs LLC Endorsement Effective Date: 03/12/2019 The Transfer Of Rights Of Recovery Against Others To Us condition does not apply to a person(s) or an organization(s), but only to the extent that subrogation is waived prior to the "accident" or the "loss" under a written contract with that person or organization.
POLICY NUMBER: A0123260003 ADDITIONAL INSURED - SUPPLEMENTAL DECLARATIONS The following persons or organizations are included as Additional Insureds, but only to the extent provided in the listed endorsement: Any person or organization from whom you are required to waive your right to recover under a written contract or agreement in effect prior to any loss or damage. Endorsement CG 24 04 05 09, Waiver Of Transfer Of Rights Of Recovery Against Others To Us, applies to this additional insured. The person or organization indicated above is included as an additional insured under the following endorsement(s): Additional Insured - Owners, Lessees Or Contractors - Scheduled Person Or Organization CG 20 10 04 13 Location of Covered Operations: On file with company Job Description: On file with company Any person or organization you are required to add as an additional insured under a written contract or agreement in effect prior to any loss or damage The person or organization indicated above is included as an additional insured under the following endorsement(s): Additional Insured - Owners, Lessees Or Contractors - Completed Operations CG 20 37 04 13 Location and Description of Completed Operations: On file with company Additional Insured - Owners, Lessees Or Contractors - Scheduled Person Or Organization CG 20 10 04 13 Location of Covered Operations: On file with company CG 89 05 10 14 Page 1 of 2 03/01/2019 A0123260 Middlesex Insurance Company 00001 0000000000 19060 0 N 1 ce4b539c-2672-473a-86ac-8f1f2d924788 ce4b539c-2672-473a-86ac-8f1f2d924788 0027020044348986348901606331051
Page 1 of 1 CG 24 04 05 09 03/01/2019 A0123260 Middlesex Insurance Company © Insurance Services Office, Inc., 2008 POLICY NUMBER: Name Of Person Or Organization: Information required to complete this Schedule, if not shown above, will be shown in the Declarations. COMMERCIAL GENERAL LIABILITY CG 24 04 05 09 WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE The following is added to Paragraph 8. Transfer Of Rights Of Recovery Against Others To Us of Section IV - Conditions: We waive any right of recovery we may have against the person or organization shown in the Schedule above because of payments we make for injury or damage arising out of your ongoing operations or "your work" done under a contract with that person or organization and included in the "products-completed operations hazard". This waiver applies only to the person or organization shown in the Schedule above. 00001 0000000000 19060 0 N 1 d6bc18ac-a06d-409a-a963-7b7cc523e586 d6bc18ac-a06d-409a-a963-7b7cc523e586 0027020044348986348901606331051
COMMERCIAL GENERAL LIABILITY CG 20 01 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. PRIMARY AND NONCONTRIBUTORY - OTHER INSURANCE CONDITION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART The following is added to the Other Insurance Condition and supersedes any provision to the contrary: Primary And Noncontributory Insurance This insurance is primary to and will not seek contribution from any other insurance available to an additional insured under your policy provided that: (1) The additional insured is a Named Insured under such other insurance; and (2) You have agreed in writing in a contract or agreement that this insurance would be primary and would not seek contribution from any other insurance available to the additional insured. © Insurance Services Office, Inc., 2012 Page 1 of 1 CG 20 01 04 13 03/01/2019 A0123260 Middlesex Insurance Company 00001 0000000000 19060 0 N 1 7bfbd538-e876-4b4d-b419-db0200dfc22a 7bfbd538-e876-4b4d-b419-db0200dfc22a 0027020044348986348901606331051
Page 1 of 2 CG 20 10 04 13 03/01/2019 A0123260 Middlesex Insurance Company © Insurance Services Office, Inc., 2012 POLICY NUMBER: COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE CG 20 10 04 13 Name Of Additional Insured Person(s) Or Organization(s) Location(s) Of Covered Operations Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section II - Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by: 1. Your acts or omissions; or 2. The acts or omissions of those acting on your behalf; in the performance of your ongoing operations for the additional insured(s) at the location(s) designated above. However: 1. The insurance afforded to such additional insured only applies to the extent permitted by law; and 2. If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. B. With respect to the insurance afforded to these additional insureds, the following additional exclusions apply: This insurance does not apply to "bodily injury" or "property damage" occurring after: 1. All work, including materials, parts or equipment furnished in connection with such work, on the project (other than service, maintenance or repairs) to be performed by or on behalf of the additional insured(s) at the location of the covered operations has been completed; or 2. That portion of "your work" out of which the injury or damage arises has been put to its intended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a principal as a part of the same project. 00001 0000000000 19060 0 N 1 fdaf2f52-1db7-4c97-886e-8500389c4287 fdaf2f52-1db7-4c97-886e-8500389c4287 0027020044348986348901606331051
C. With respect to the insurance afforded to these additional insureds, the following is added to Section III - Limits Of Insurance: If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance: 1. Required by the contract or agreement; or 2. Available under the applicable Limits of Insurance shown in the Declarations; whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. © Insurance Services Office, Inc., 2012 CG 20 10 04 13 Page 2 of 2 03/01/2019 A0123260 Middlesex Insurance Company
Page 1 of 1 CG 20 37 04 13 03/01/2019 A0123260 Middlesex Insurance Company © Insurance Services Office, Inc., 2012 POLICY NUMBER: COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - COMPLETED OPERATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE CG 20 37 04 13 Name Of Additional Insured Person(s) Or Organization(s) Location And Description Of Completed Operations Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section II - Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury" or "property damage" caused, in whole or in part, by "your work" at the location designated and described in the Schedule of this endorsement performed for that additional insured and included in the "products-completed operations hazard". However: 1. The insurance afforded to such additional insured only applies to the extent permitted by law; and 2. If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. B. With respect to the insurance afforded to these additional insureds, the following is added to Section III - Limits Of Insurance: If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance: 1. Required by the contract or agreement; or 2. Available under the applicable Limits of Insurance shown in the Declarations; whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. 00001 0000000000 19060 0 N 1 86824e84-7ba2-46ac-a922-b3fe722317bf 86824e84-7ba2-46ac-a922-b3fe722317bf 0027020044348986348901606331051