Search â–¸ Agenda item attachment
An application was received from Barlo Signs representing Wusong Road, requesting permission for a projecting illuminating sign at the premises numbered 2 Bennett Street. approval has been received from Inspectional Services, Department of Public Works, Community Development Department and abutter
OFFICE OF THE CITY CLERK
CAMBRIDGE CITY HALL, 795 MASSACHUSETTS AVENUE
CAMBRIDGE, MASSACHUSETTS 02139
PHONE [phone removed]
FAX [phone removed]
DONNA P. LOPEZ
PAULA M. CRANE
CITY CLERK
DEPUTY CITY CLERK
Cambridge, ___________________, 20________
To the Honorable, the City Council of the City of Cambridge:
EACH PETITION MUST BE ACCOMPANIED BY A DRAWING OF PROPOSED SIGN, INDICATING DESIGN AND
DIMENSIONS AND LOCATION ON PREMISES.
The undersigned respectfully prays that ______________________________________________________
(NAME OF BUSINESS)
be granted permit to erect a sign of the following specifications in front of premises located at
_______________________________________________________________________________________
(ADDRESS)
Type of Sign: ____________________________________________________________________________________
(state whether electric or otherwise and material used in construction)
Reading matter to go on Sign:
_______________________________________________________________________________________
___________________________________________________________________________________________
Size: _______________________________________
Weight: _____________________________________
Public Way
Obstruction: A.________________________________________ B._______________________________________
(Give exact distance sign is to extend over sidewalk) (Also exact distance from bottom of sign to sidewalk)
Height Above Grade: Bottom: ______________________________
Top: ___________________________________
NOTICE - REGULATIONS
[Section 12.08.010 Municipal Code – Encroachments onto Streets]
Section 1212.0 State Building Code – Projecting Signs]
x A projecting sign shall be constructed wholly of incombustible materials.
x All signs must meet requirements of Zoning Ordinances and Building Code.
x Note: Section 12.12.220 provides in part “every owner who maintains a . . . structure in or over a street. . . .shall do so only on
the condition that such maintenance shall be considered as an agreement on his part to keep the same and the covers thereof in
good repair and condition, at all times during his ownership, and to indemnify and save harmless the City against any and all
damages, cost or expenses which it may sustain, or be required to pay by reason of such. . .structure.”
PROPERTY OWNER OR AUTHORIZED AGENT HEREBY STATES THAT INFORMATION IS TRUE TO THE BEST OF HIS/HER
KNOWLEDGE AND UNDERSTANDING UNDER PAINS AND PENALTY OF PERJURY.
________________________________________________________________________________________/____________
(Property owner or authorized agent) (Address)
(Tel. No.)
_______________________________________________________________________________________/_____________
(Business owner) (Address)
(Tel. No.)
2 Bennett St. Cambridge MA 02138
[phone removed]
rope
pertrty y ow
owne
n r or
___
________
_ ___
i
ner)
WUSONG ROAD
2 BENNETT ST
FACE REPLACEMENT TO AN EXISTING PROJECTING SIGN/ALUMINUM
ELEC N/A
WUSONG ROAD
2'7'' X 10'
20 LBS
9'2''
19'2''
X
____
___
X
(Bus
u ininess s ow
owner)
BARLO SIGNS, JENN ROBICHAUD 158 GREELEY ST HUDSON NH 0305[phone removed]
2'7''
9'2''
NOV 18
21
City of Cambridge, Massachusetts
Bond ........................................
Know All Persons by These Presents,
That we...........................................................................................................................................................................................
..........................................................................................................................................................................................................
............................................................................. ........................................................................................ as principal and
......................................................................................................................................................................................................
............................................................................................................................................................... as surety are holden
and stand firmly bound unto the CITY OF CAMBRIDGE, in the sum of Five Thousand Dollars ($5000.00) to be
paid to the said CITY OF CAMBRIDGE; to which payment, well and truly to be made, we and each of us do
bind ourselves, our Heirs, Executors and Administrators, Successors and assigns, jointly and severally, firmly by
these presents.
The condition of this obligation is such that WHEREAS an application for a permit for use of sidewalks has been
made to the City Council of said City by the said
...................................................................................................................................................................................................
...................................................................................................................................................................................................
Now Therefore, if the said..............................................................................................................................................
.............................................................................................. shall faithfully observe and keep each and all the agreements,
stipulations, conditions, specifications, and provisions on his/her part to be kept and performed, contained in said permit
and in every and all such permits hereafter issued to the said
.........................................................................................................................................................................
and i n each and every extension of the same, according to the full intent and spirit of said permit and the
ordinances of said City n ow relating, or that m ay relate thereto and shall indemnify and save harmless the City of
Cambridge from all liabilities and expense whatsoever which the City may incur an d suffer arising out of the
issuing of such permits and all e xtensions of the same, and shall make no default therein;. then this obligation
shall be null and void; otherwise it shall be and remain in full force and effect,
IN WITNESS WHEREOF, we have here to set our hands and seals, this....................................... (Date)
Executed in the presence of......................................................................................................... (Principal)
......................................................................................................... (Witness)
The within named sureties are satisfactory................................................................................. (City Auditor)
Form of bond approved............................................................................................................... (City Solicitor)
A-frame sign / Sandwich Sign - Wusong Road, LLC.
Jason Doo and Thomas Brush
Owners of Wusong Road, LLC.
Traveler's Insurance 12 Month Term Bond - $5,000.00
Wusong Road, LLC
Sandwich Sign and/or A-Frame Sign
June, 20, 2021
Jason Doo
Thomas Morgan
Existing Overhanging Sign
LAN DLO RD AUTHORIZATIO N
FOR PERMTT(S), VARTANCE(S), HEARTNG(S)
< MUST BE SIGNED BY TANDLORD OR OWNER OF THE PROPERTV
ON WHICH SIGNAGE IS BEING INSTALLED >
This document verifies that you are authorizing BARLO SIGNS to install signage on your
property pursuant to the attached drawings as well as authorizing BARLO SIGNS to secure
all related permits required by the local municipalities.
Barlo Signs cannot apply for permits or hearings until we receive the LANDLORD or
PROPERW OWNER'S authorization to do so.
f I hereby
N.H., to
authorize dn Authorized Representative of Barlo Sians of Hudson,
APPLY FOR
PERMITS for this site and to APPEAR BEFORE THE
PLANNING BOARD and/or SrGru REVIEW BOARD
the ZBA for this site.
f
t tr"r"by authorize BARLO SIGNS to install signage on my property exactly as shown
in drawing #21o4ore1s 3
Date* 4130121
Sign location address: 2 Bennett St, Cambridge, MA 02138
Property Owner's Signature:
Printed Name:
Company Name:
Address:
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Phone number:
Date Signed:
We connot apply for permits or hearings until we receive your authorization. Thank you!
. Wusong Road
Job 4. 20180
Reference JOB NAME
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C I T Y O F C A M B R I D G E
Community Development Department
IRAM FAROOQ
Assistant City Manager for
Community Development
SANDRA CLARKE
Deputy Director
Chief of Administration
KHALIL MOGASSABI
Deputy Director
Chief of Planning
344 Broadway
Cambridge, MA 02139
Voice: [phone removed]
Fax: [phone removed]
TTY: [phone removed]
www.cambridgema.gov
To:
Board of Zoning Appeal
From: Harvard Square Advisory Committee
Date: September 7, 2021
Re:
2 Bennett Street - Exterior Improvements
Overview
The Harvard Square Advisory Committee (the “Committee”) met on Thursday, August
26, 2021 to discuss the application by Jason Doo of Wusong Road for various exterior
improvements. The meeting was conducted pursuant to the provisions of Section 20.50
of the Cambridge Zoning Ordinance in advance of the applicant’s request for a variance
from the Board of Zoning Appeal (BZA). Committee members present were Allison
Crosbie, Lauren Curry, Kari Kuelzer, Sara Li, Steven Ng, Alexandra Offiong, and Nicola
Williams. After discussion, the Committee decided unanimously to forward a report to
the BZA with a positive recommendation.
Proposal Description
The applicant proposes to install signage, a fence, bollards, and lighting on and around
the existing building at 2 Bennett Street. The project requires a variance from the BZA
because Section 20.55.1.1 of the Zoning Ordinance states that no sign on the outside of
a building may extend higher than 20 feet above grade; the applicant proposes one wall
sign that measures 24 feet 6 inches above grade. The project has already received a
Certificate of Appropriateness from the Cambridge Historical Commission, which is
attached. The use of the building will remain unchanged as it will continue to be a
restaurant.
Committee Comments
Members of the Committee were overwhelmingly supportive of the applicant’s overall
proposal. Many Committee members noted that the proposal shows a careful attention
to detail and is informed by the particular challenges of the site. They appreciated the
applicant’s decision to locate the entrance of the restaurant on Mt. Auburn Street and
found that the proposed exterior improvements will help draw people to the site.
Committee members found that the variance for the wall sign on Mt. Auburn Street
facing the garage was appropriate. They believed that locating the sign within the
architectural brickwork of the building is a sensitive solution and provides crucial
visibility for the business. Committee members noted that the scale and context of the
building necessitates the size and placement of the proposed sign. They also
appreciated that the lease restricts the use of illumination to business hours.
2 Bennett Street – Report to Board of Zoning Appeal
September 7, 2021
Page 2 of 2
Committee members suggested that the applicant revise their proposal to include additional materials
that show the necessity of granting zoning relief. Some members recommended including a
neighborhood-scale map, site plan, and/or aerial photograph to put the site in context. Others
recommended also including a key plan that identifies where all the proposed signs are located.
Given the Committee’s discussion, a motion was made and seconded to forward a report to the BZA
with a positive recommendation that the BZA grant the requested variance on the condition that
illumination is restricted to the hours of the business’s operation. All seven members present voted in
favor.
Respectfully submitted for the Committee,
Sarah Scott
Associate Zoning Planner
Community Development Department
CAMBRIDGE HISTORICAL COMMISSION
831 Massachusetts Avenue, 2nd Fl., Cambridge, Massachusetts 02139
Telephone: [phone removed] Fax: [phone removed] TTY: [phone removed]
E-mail: histcomm@cambridgema.gov URL: http://www.cambridgema.gov/Historic
Bruce A. Irving, Chair, Susannah Barton Tobin, Vice Chair; Charles M. Sullivan, Executive Director
Joseph V. Ferrara, Chandra Harrington, Elizabeth Lyster, Caroline Shannon, Jo M. Solet, Members
Gavin W. Kleespies, Paula A. Paris, Kyle Sheffield, Alternates
CERTIFICATE OF APPROPRIATENESS
Property:
112 Mt Auburn St / 2 Bennett St
Applicant:
Conductor’s Building LLC
20 University Rd.
Cambridge, Mass. 02138
Attention:
Jason Doo
Wusong Road
2 Bennett St
Cambridge, Mass. 02138
Thomas Brush
Felipes Taqueria
21 Brattle St
Cambridge, Mass. 02138
The Cambridge Historical Commission hereby certifies, pursuant to the
Massachusetts Historic Districts Act (MGL Ch. 40C) and the Cambridge
Historical Buildings and Landmarks Ordinance (Cambridge City Code,
Ch. 2.78), that the work described below is not incongruous to the
historic aspects or architectural character of the building or
district:
Install signs, fence, bollards, and lights for new Wusong
Road restaurant.
1. Install a cedar fence panel with sign, menu board, and
LED lights
2. Install an illuminated wall sign on the east wall of
the building, pending zoning approval
3. Re-face the existing projecting sign on the Bennett
Street end of the building, pending MBTA access to the
sign
4. Install 3 pagoda shaped bollards on the Mt Auburn
Street side of the building, set back from the busway
exit point.
5. Install lantern shaped lights on either side of the Mt
Auburn Street entry door
Case 4599: 112 Mt Auburn St / 2 Bennett St
Certificate of Appropriateness, page 2
Work is to be carried out as indicated in the drawings
titled, “Wusong Road – Sign Proposal,” and dated received
on July 1, 2021.
Approval was granted on the condition that construction
details and final location of signs be reviewed and
approved by Historical Commission staff.
All improvements shall be carried out as shown on the plans and
specifications submitted by the applicant, except as modified above.
Approved plans and specifications are incorporated by reference into
this certificate.
This certificate is granted upon the condition that the work
authorized herein is commenced within six months after the date of
issue. If the work authorized by this certificate is not commenced
within six months after the date of issue, or if such work is
suspended in significant part for a period of one year after the time
the work is commenced, then this certificate shall expire and be of no
further effect; provided that, for cause, one or more extensions of
time, for periods not exceeding six months each, may be allowed in
writing by the Chair.
Case Number: 4599
Date of Certificate: July 28, 2021
Attest: A true and correct copy of decision filed with the
offices of the City Clerk and the Cambridge Historical Commission
on July 28, 2021 .
By Bruce A. Irving/slb , Chair.
**********************************************************************
Twenty days have elapsed since the filing of this decision.
No appeal has been filed . Appeal has been filed .
Date , City Clerk
The Commonwealth of Massachusetts
Department of Industrial Accidents
1 Congress Street, Suite 100
Boston, MA 02114
www.mass.gov/dia
Workers’ Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers.
TO BE FILED WITH THE PERMITTING AUTHORITY.
Applicant Information
Please Print Legibly
Name (Business/Organization/Individual):______________________________________________________
Address:__________________________________________________________________________
City/State/Zip:_____________________________ Phone #:________________________________
*Any applicant that checks box #1 must also fill out the section below showing their workers’ compensation policy information.
†Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
‡Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have
employees. If the sub-contractors have employees, they must provide their workers’ comp. policy number.
I am an employer that is providing workers’ compensation insurance for my employees. Below is the policy and job site
information.
Insurance Company Name:____________________________________________________________________________
Policy # or Self-ins. Lic. #:__________________________________________ Expiration Date:____________________
Job Site Address:
City/State/Zip:______________________
Attach a copy of the workers’ compensation policy declaration page (showing the policy number and expiration date).
Failure to secure coverage as required under MGL c. 152, §25A is a criminal violation punishable by a fine up to $1,500.00
and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to $250.00 a
day against the violator. A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance
coverage verification.
I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct.
Signature: Date:
Phone #:
Official use only. Do not write in this area, to be completed by city or town official.
City or Town: ___________________________________ Permit/License #_________________________________
Issuing Authority (circle one):
1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector
6. Other ______________________________
Contact Person:_________________________________________ Phone #:_________________________________
Type of project (required):
7. New construction
8. Remodeling
9. Demolition
10 Building addition
11. Electrical repairs or additions
12. Plumbing repairs or additions
13. Roof repairs
14. Other____________________
1.
I am a employer with _________employees (full and/or part-time).*
2.
I am a sole proprietor or partnership and have no employees working for me in
any capacity. [No workers’ comp. insurance required.]
3.
I am a homeowner doing all work myself. [No workers’ comp. insurance required.] â€
4.
I am a homeowner and will be hiring contractors to conduct all work on my property. I will
ensure that all contractors either have workers’ compensation insurance or are sole
proprietors with no employees.
5.
I am a general contractor and I have hired the sub-contractors listed on the attached sheet.
These sub-contractors have employees and have workers’ comp. insurance.‡
6.
We are a corporation and its officers have exercised their right of exemption per MGL c.
152, §1(4), and we have no employees. [No workers’ comp. insurance required.]
Are you an employer? Check the appropriate box:
2 28 21
Barlo Signs International Inc
158 Greeley Street
Hudson, NH 0305[phone removed]
35
Signage
The Travelers Insurance Co
7PJIB 2E89553 2 18
04/28/2022
ALL JOBS LOCATED IN- CAMBRIDGE
MA
[phone removed]
Information and Instructions
Massachusetts General Laws chapter 152 requires all employers to provide workers’ compensation for their employees.
Pursuant to this statute, an employee is defined as “...every person in the service of another under any contract of hire,
express or implied, oral or written.”
An employer is defined as “an individual, partnership, association, corporation or other legal entity, or any two or more
of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the
receiver or trustee of an individual, partnership, association or other legal entity, employing employees. However the
owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the
dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house
or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer.”
MGL chapter 152, §25C(6) also states that “every state or local licensing agency shall withhold the issuance or
renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any
applicant who has not produced acceptable evidence of compliance with the insurance coverage required.”
Additionally, MGL chapter 152, §25C(7) states “Neither the commonwealth nor any of its political subdivisions shall
enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance
requirements of this chapter have been presented to the contracting authority.”
Applicants
Please fill out the workers’ compensation affidavit completely, by checking the boxes that apply to your situation and, if
necessary, supply sub-contractor(s) name(s), address(es) and phone number(s) along with their certificate(s) of
insurance. Limited Liability Companies (LLC) or Limited Liability Partnerships (LLP) with no employees other than the
members or partners, are not required to carry workers’ compensation insurance. If an LLC or LLP does have
employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial
Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should
be returned to the city or town that the application for the permit or license is being requested, not the Department of
Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers’
compensation policy, please call the Department at the number listed below. Self-insured companies should enter their
self-insurance license number on the appropriate line.
City or Town Officials
Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom
of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant.
Please be sure to fill in the permit/license number which will be used as a reference number. In addition, an applicant
that must submit multiple permit/license applications in any given year, need only submit one affidavit indicating current
policy information (if necessary) and under “Job Site Address” the applicant should write “all locations in ______(city or
town).” A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the
applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each
year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture
(i.e. a dog license or permit to burn leaves etc.) said person is NOT required to complete this affidavit.
The Department’s address, telephone and fax number:
The Commonwealth of Massachusetts
Department of Industrial Accidents
1 Congress Street, Suite 100
Boston, MA 02114
Tel. # [phone removed] ext. 7406 or 1-877-MASSAFE
Fax # [phone removed]
www.mass.gov/dia
Revised 02-23-15
06/14/2021
FIAI/Cross Insurance
1100 Elm Street
Manchester
NH 03101
Lynn Blanchard, CIC,CISR
[phone removed]
[phone removed]
[email removed]
Barlo Signs International, Inc.
158 Greeley Street
Hudson
NH 03051
Citizens Ins Co of America
31534
21-22 GL & BA
A
ZBVA186256
01/01/2021
01/01/2022
1,000,000
100,000
10,000
1,000,000
2,000,000
2,000,000
A
AWVA164300
01/01/2021
01/01/2022
1,000,000
Medical payments
5,000
For Permit Purposes Only. Refer to policy for exclusionary endorsements and special provisions.
City of Cambridge, MA
795 Massachusetts Avenue
Cambridge
MA 02139
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
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 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
AUTOS
AUTOS
NON-OWNED
HIRED AUTOS
SCHEDULED
ALL 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 (2014/01)
© 1988-2014 ACORD CORPORATION. All rights reserved.
CERTIFICATE HOLDER
The ACORD name and logo are registered marks of ACORD
N/A
N/A
06/14/2021
CROSS INSURANCE - MANCHESTER
1100 ELM ST
NH 03101
Jill Charnley
[phone removed]
[email removed]
MANCHESTER
BARLO SIGNS INTERNATIONAL INC
NH 03051
TRAVELERS PROPERTY CAS CO OF AM
25674
158 GREELEY STREET
HUDSON
665218
N/A
N/A
N/A
A
7PJUB2E89553221
04/28/2021
04/28/2022
1,000,000
1,000,000
1,000,000
N/A
Workers’ Compensation benefits will be paid to Massachusetts employees only. Pursuant to Endorsement WC 20 03 06 B, no authorization is given to pay
claims for benefits to employees in states other than Massachusetts if the insured hires, or has hired those employees outside of Massachusetts.
This certificate of insurance shows the policy in force on the date that this certificate was issued (unless the expiration date on the above policy precedes the
issue date of this certificate of insurance). The status of this coverage can be monitored daily by accessing the Proof of Coverage - Coverage Verification
Search tool at www.mass.gov/lwd/workers-compensation/investigations/.
City of Cambridge MA
795 Massachusetts Avenue
Cambridge
MA 02139
Daniel M. Crowley, CPCU, Vice President – Residual Market – WCRIBMA
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