Search ▸ Agenda item attachment
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
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
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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