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Demo House 2008
Field Inspection Notice Town of Montville Building Department August 26, 2008 Address: 57 Pequot Road Job Description: Demo SFR Permit Number(s) D2008-0005 Permit Date: March 19,2008 Not Approved Approval INSPECTION Date: Deficiencies Special Date Conditions Final inspection for • • 8/26/08 CC certificate of approval Rev.Date: 1/18/06 Page 1 of 1 TOWN OF MONTVILLE Building Department 310 NORWICH-NEW LONDON TURNPIKE UNCASVILLE, CT 06382-2599 TEL. (860) 848-3030 X382 FAX. (860) 848-7231 DEMOLITION PERMIT Permit Number: D2008-0005 Date: 19-Mar-08 Map/Lot: 078/050-000 Owner ID: 5437000 Project Location: 57 PEQUOT ROAD Unit: Job Description: Demo Single Family Residence Owner Name: DW Holdings, LLC Tenant Name: N/A Careof: P.O. Box 462 Uncasville CT 06382- Telephone: Contractor Name: Property Owner Telephone: DBA: Lic/Reg Type: Lic/Reg No: 0 Exp Date: Conslkru t.Lo,II al.ve Permit Fees Construction Information Building Value: $8,500.00 Building Fee: $90.00 Use Group: IRC �_ W Plumbing Value: $0.00 Plumbing Fee: $0.00 Code: 2005 State Building Code Mechanical Value: $0.00 Mechanical Fee: $0.00 Electrical Value: $0.00 Electrical Fee: $0.00 Construction Type: IRC Total Value: $8,500.00 Penalty Fee: $0.00 Permit Code: M1 C of 0 Fee: $0.00 Comments: Plan Review Fee: $0.00 State Ed Fee: $0.00 Total Fee Paid: $90.00 It shall be the owners repsonsibilitv to schedule the following inspections a minimum of 2 business days in advance: Field set of approved construction documents shall be available onsite during all inspections. BUILDING PERMIT INSPECTIONS PLUMBING, MECHANICAL, ELECTRICAL PERMIT INSPECTIONS ❑ Footing - Prior to pouring concrete ❑ R Plumbing and leak test ❑ Deck Piers ❑ R Electrical ❑ Backfill- Footing drains and waterproofing ❑ Elec Trench-with conduit installed ❑ Concrete Slab- Prior to pouring concrete ❑ Pool Bonding ❑ Anchor Bolts-with sill plate and prior to floor framing ❑ Electrical Service CRS No: 0 ❑ Framing ❑ R HVAC ❑ Masonry Fireplace Throat or Chimney Thimble ❑ Gas Piping and leak test ❑ Fireblocking_Draftstopping INSPECTION • -OUIRED UPON COMPLETION ❑ Insulation Ceacat�f A.:•oval C- "fi . - .f Occupancy Building Official's Approval: l/ /f�ttirY A UNCAS HEALTH FIST. Fax:8608879538 Mar 19 2008 9:43 P.01 Towrt of Montville BBui dinodsnartment Tel. 860.848-3030, Ext c182 310 Norwich-New London Tpke, Uncasvilie, CT 06382 Fax. 860-848-7231 DEMOLITION APPLICATION FORM Permit No.: Job Address: Si P R IJ (Nurr ber) (street) Job Description: (Unit) Owner: ),Irt.l -=) ._,_ ' Address: -3_ 0_1 RIL City: iThr n ilLT State: � 7 , Telephone; G _"' `T e- i�� 2 4 Zip Cod®: 06 5. 4 Contractor: D til 7 'P0Q7 4—N.c0 LeR.'S«C, Address: 3 3 F C" 1 fit[ IU GT City: . mcik State: 0T. U -efephane: C _ - -- Zip Cade;,‹? g F.2Ce __ r License No,: j cel Expiration Date, LL I hereby certify that the proposedof Mo Work will .liris _ .emo tion Code, State Building Code and all other codes as adopted c the State Connecticut and the Town of Montville a,• applicat on for a permit for such work a- `. 17'- Pro!used work Is authorized by th® owner in fee and that I am authorized to ake Owner Signature: �/�;� /Apr Dater 3I!'x 0 T1Contractor Signature; I 7. V Date: /y Q Demolition Value: _ 1—, s /Damcition s re wiredDemolition Fee:contractor registration(Class A or B)(C.G,S,Sec, 29-402) • The following are exempt from'the registration requirements O Person engaged in the disassembling,transportation and reconstruction of historic bhilcings for historic purposes o Demolition of farm buildings 0 Renovation,alteration or reecrstruction of a single-family residence o Demolition of a singie•famlly residence or out building by an owner of such structure If it does not exceed a height of 30'-0',provided that the owner Mil be present on site while such demolition work Is in progress and the 9truct rre(g)have a clearance from other structures,roads, highways equal to or greater than the height of the structure subject to demolition Copy of certificate of insurance specifying demolition purposes and providing(CAS. Sec.29-406); • Liability Coverage for bodily injury$100,000 minimum • property damage$50,000 per accident with an aggregate ofratt least$100,000 gate of at least$300,000 Certificate shall provide that the Town of Montville and its agents shatl be saved harmless from any claim or Claims ailsing out of negligence of the applicant or his agents or employees In the Course of the demolition operations.(C,G,S. Sec.29.406) Certificate of notice by all public utilities having servioe connectiors within the premises proposed to be demolished,stating that such utilities have severed such connections and service.(C.G.S. Sec.2g-406) ❑ (C.O.S.Adjoining property owners have been notified by registered or certified mail at such owner's last address according to the records of the assessor, ( Sec.29-406) LTJ Unces Health District approva, , II ' 1 •i t '.rS' 3"'I J W0 0 he'vseef.xkeernberil,20W / J Town of Montville Building Department 310 Norwich-Now-Loudon Tpke. Tel. 860-848-3030, Ext 382 Uncasville, CT 06382 Fax. 860-848-7231 DEMOLITION APPLICATION FORM Permit No.: Job Address: S i P'QtjO7 R D. (Number) (Street) (Unit) Job Description: Scions 14 71)we-t..tt)C„,-. Owner: `E A) I bLD t t1/4(6-5 L L C . Address: S Peauc R D . city: U kic 4g V(LLE State: C7 / /� Zip Code: 06'9j $ 'L gf'p Telephone: a — B 4 8 - f 2 Contractor: D 10 TRAWS P d(Z7 A-cm'11 L (4S M,,6- l l\J DBA: /I-[i e Address: 33 (- eQ i()7 Po. City: U Mc.► - V I LLE State: 1 "7".. Zip Code: 06g- aZ Telephone: TA 5f-(692. Lice - ► pe: ff 41 License No.: ) )3Li 6 -,30 -a 8 Expiration Date: I hereby certify that the proposed work will onfo. . t,- St. : Demo tion Code, State Building Code and all other codes as adopted by the State of Connecticut and the Town of Montville a - u j-t t : - pro.osed work is authorized bythe owner in fee and that I am authorized to make application for a permit for such work a i- ".-, . FR- O Owner Signature: i( g tore: �/ Date: -3/t//$0 1/ Contractor Signature: 7 ` 3/(q �1Date: �1- Demolition Value: 2s.--y9-a, Demolition Fee: Items required for submission: /Demolition contractor registration(Class A or B)(C.G.S.Sec.29-402) • The following are exempt from the registration requirements o Person engaged in the disassembling,transportation and reconstruction of historic buildings for historic purposes o Demolition of farm buildings o Renovation,alteration or reconstruction of a single-family residence o Demolition of a single-family residence or out building by an owner of such structure if it does not exceed a height of 30'-0",provided that the owner will be present on site while such demolition work is in progress and the structure(s)have a clearance from other structures,roads,highways equal to or greater than the height of the structure subject to demolition d Copy of certificate of insurance specifying demolition purposes and providing(C.G.S.Sec.29-406); • Liability coverage for bodily injury$100,000 minimum per person with an aggregate of at least$300,000 • Property damage$50,000 per accident with an aggregate of at least$100,000 0 Certificate shall provide that the Town of Montville and its agents shall be saved harmless from any claim or claims arising out of negligence of the applicant or his agents or employees in the course of the demolition operations.(C.G.S.Sec.29-406) Certificate of notice by all public utilities having service connections within the premises proposed to be demolished,stating that such utilities have severed such connections and service.(C.G.S.Sec.29-406) ❑ Adjoining property owners have been notified by registered or certified mail at such owner's last address according to the records of the assessor. (C.G.S.Sec.29-406) o Uncas Health District approval wised December 31,2005 Fax: Sep 20 2007 12:37pm P004/023 ENVIRONMENTAL HAZARDS SERVICES, L.L.C. 7469 "• PINE - . , _ • . • � � � , 804-2754788 FAX 804-2754907 7 BULK ASBESTOS SAMPLE ANALYSIS SUMMARY CLIENT: Mystic Air Quality Consultants 1204 North.Road, Rt. 117 DATE OF RECEIPT; 19 Sep 2007 Groton, CT 06340 DATE OF ANALYSIS: 19 Sep 2007 DATE OF REPORT: 19 Sep 2007 CLIENT NUMBER: 7-2564 B EHS PROJECT#: 2007-09-1747 PROJECT: 57 Pequot Road UncasvilIe, CT ENS CLIENT SAMPLE#1 ° SAMPLE# LABORATORY GROSS DESCRIPTION �° ASBESTOS OTHER MATERIALS 01 1/ Off-White Chalky 3%° Chrysotile 97% Non Fibrous 3% Total Asbestos 02 2/ DID NOT ANALYZE 03 3/ DID NOT ANALYZE 04 4/ Brown Fib.;paint Like; OffWhite Powder NAD 10% Cellulose 90% Non-Fibrous 05 5/ Brown Paint-Like; Fib.; Off-White Powder NAD 10% Cellulose 90% Non-Fibrous 06 • 6/ Brown Paint-Like; Fib.; O££White Powder NAD 10% Cellulose 90%Non-Fibrous 07 71 Brown Gran.; Black Tar-Like NAD 15% Cellulose 85%Non-Fibrous 08 8/ Brown Gran.; Black Tar-Like NAD 15% Cellulose 85% Nom-Fibrous 09 9/ Brown Gran.; Black Tar-Like NAD 15% Cellulose 85%Non-Fibrous 10 10/ Gray/Brawn Fib. NAD 95% Cellulose 5% Non-Fibrous 11 11/ Gray/Brown Fib. NAD 95% Cellulose 5%Non-Fibrous 12 12/ Gray/Brown Fib. NAD 95% Cellulose \5%Non-Fibrous —PAGE 01 of 09-- ENCLOSURE PAGE 1 OF 9 Fax: ENVIRONMENTAL HAZARDS SER Sep 20 2007 12:37pm P005/023 CLIENT NUMBER: 7-2564 B VICES, L,�,.C, EHS PROJECT#; 2007-09-1747 PROJECT: 57 Pequot Road Uncasvjlle, CT EHS CLIENT SAMPLE#/ SAMPLE# LABORATORY GROSS DESCRIPTION %ASBESTOS OTHER MATERIALS 13 13/ Tan Gran.; Brown Fib.; White Chalk Trace, <1% Chrysotile 2%Hair Green Paint-Like �'' <1% Total Asbestos 98%Non-Fibrous *2%chrysotile present in the joint compound-like material. • 14 14/ Tan Gran.; Brown Fib.; Green/Yellow NAD 2% Cellulose Paint-Like 2% Hair 96%Non-Fibrous 15 15/ Tan Gran. NAD 2% Hair 98%Non-Fibrous • 16 16/ Tan Gram; Brown Fib. NAD 2% Cellulose 2% Hair 96%Non-Fibrous 17 17/ Tan Gran.; Blue Paint-Like NAD 2% Hair 98% Non-Fibrous 18 18/ Tan Gram NAD 2%Hair 98% Non-Fibrous 19 19/ TaGran. NAD 2%Hair 98% Non-Fibrous 20 20/ Tan Gram, NAD 2%Hair 98% Non-Fibrous 21 21/ Tan Gran_ NAD 92%Hair 98% Non-Fibrous 22 22/ NAD Tan Gran..; Brown Fib.; Gray Paint-Like 10% Cellulose 2%Hair 88% Non-Fibrous 23 23/ Tan Gran,; Beige Brittle NAD 2%Hair 98%Non-Fibrous 24 24/ Tan Gran.; Gray Brittle; Brown Fib. NAD 2% Cellulose 2%Hair 96% Non-Fibrous 25 25/ Tan Gran.; Chalky NAD 100%Non-Fibrous 26 26/ Tan Gran.; Chalky NAD 100% Non Fibrous --PAGE 02 of 09_ i ENCLOSURE L PAGE / OF 9 Fax: Sep 20 2007 12:37pm P006/023 ENVIRONMENTAL HAZARDS SERVICES L.L. CLIENT NUMBER: 7-2564 B ' C. EHS PROJECT#; 2007-09-1747 PROJECT: 57 Pequot Road Uncasville, CT EHS CLIENT SAMPLE#1 0 SAMPLE* LABORATORY GROSS DESCRIPTION �0 ASBESTOS OTHER MATERIALS 27 27/ Gray Chalky; Tan Gran. NAD 100% Non-Fibrous 28 28/ Tan Gran. NAD 100% Non-Fibrous 29 29/ Brown Fib. NAD 95% Cellulose 5%Non-Fibrous 30 30/ NAD Brown Fib. 95% Cellulose 5%Non-Fibrous 31 31/ Brown Paint-Like; Fib. NAD 90% Cellulose 10% Non-Fibrous 32 32/ Brown Gran.; Black Tar-Like 5% Chrysotile 10% Cellulose 5/o Total Asbestos 85% Non-Fibrous 33 33/ DID NOT ANALYZE 34 341 DID NOT ANALYZE 35 35/ Gray Gran.; Black Tar Like NAD 15% Cellulose 85% Non-Fibrous 36 36/ NAD Gray Gran.;Black Tar-Like 15% Cellulose 85% Non-Fibrous 37 37/ NAD Gray Gran.; Black Tar-Like 15% Cellulose 85% Non-Fibrous 38 38/ NAD Black Tar-Like; Brown Gran_ 85%15% Cellulose Non-Fibrous 39 39/ NAD Black Tar Like; Brown Gran. 15% Cellulose 85% Non-Fibrous 40 40/ NAD Black Tar-Like; Brown Gran, 85%15% Cellulose Non-Fibrous 41 411 NAD Black Tar-Like 20% Cellulose 80% Non-Fibrous 42 42/ NAD Black Tar-Like 20% Cellulose 80%Non-Fibrous 43 431 NAD Black Tar-Like 20% Cellulose 80% Non-Fibrous -- PAGE 03 of 09-- ENCLOSURE I FACE 3 OF q Fax; Sep 20 2007 12;38pm P007/023 ENVIRONMENTAL HAZARDS SERVICES, L.L.0 CLIENT NUMBER: 7-2564 B ` EHS PROJECT#: 2007-09-1747 PROJECT: 57 Pequot Road lJncasville, CT EHS CLIENT SAMPLE #/ SAMPLE# LABORATORY GROSS DESCRIPTION %ASBESTOS OTHER MATERIALS 44 44/ Black Fib- NAD 90% Cellulose 10%Non-Fibrous 45 45/ Black Fib, NAD 90% Cellulose 10%Non-Fibrous 46 46/ Black Fib. NAD 90% Cellulose 10%Non-Fibrous 47 47/ NAD Black Tar-Like 20% Cellulose 30%Non-Fibrous 48 4W Black Tar-LikeNAD 20% Cellulose 80%Non-Fibrous 49 49/ NAD Black Tar-Like 20% Cellulose 80%Non-Fibrous 50 50/ NAD Black/Brown Fib.; Red Chalky 5% Cellulose Synthetic 75%Non-Fibrous 51 51/ NAD Black/Brown Fib.; Green/Red Chalky 20% Cellulose 5% Synthetic 75%Non-Fibrous 52 52/ NAD Beige Chalky; Mack Fib. 25% Cellulose 75%Non-Fibrous 53A 53(a)-Linoleum) Lt. Beige Vinyl NAD 100% Non Fibrous 53B 53(b)-Mastic/ NAD Clear Adhes_ 100%Non Fibrous 54A 54(a)-Linoleum/ N AD Lt_ Beige/Gray Vinyl 100%Non Fibrous 54B 54(b)-Mastic/ NAD Clear Adhes_ 100%Non-Fibrous 55A 55(a)-Linoleum! NAD Off-White Vinyl 100% Non Fibrous 55B 55(b)-Mastic/ NAD Clear Adhes. 100%Non Fibrous --PAGE 04ofO9-- ENCLOSURE I PAGE Ll OF cl Fax: ENVIRONMENTAL HAZARDS SERVICES L,L. Sep 20 2007 12:38pm P008/023 CLIENT NUMBER: 7-2561 B C EHS PROJECT#; 2007-09-1747 PROJECT: 57 Pequot Road Uncasville, CT EHS CLIENT SAMPLE#1 SAMPLE# LABO- TORY GROSS DESCRIPTION %ASBESTOS OTHER MATERIALS 56A, 56(a)-Tile/ NAD Beige Vinyl 100%Non-Fibrous 56B 56(b)-Mastic/ NAD Clear Adhes. 100% Noxi-fibrous 57A 57(a)-Me/ Beige Vinyl NAD 100% Non Fibrous 57B 57(b)-Mastic/ Clear Adhes_ NAD 100% Non-Fibrous 58A 58(a)-Tile/ Beige Vinyl NAD 100% Non-Fibrous 58B 58(b)-Mastic/ NAD Cleat Adhes. 100% Nom fibrous 59 59/ Black Tar-Like NAD 15% Cellulose 85%Non-Fibrous 60 60/ NAD Black Tar-Like 20% Cellulose 80%Non-Fibrous 61 61/ NAD Black Tar-Like;Gram_ 15% Cellulose 85%Non-Fibrous 62 62/ NAD Brown Fib,; Black Fib. 30% Cellulose 70%Non-Fibrous 63 63/ NAD Brown Virkyl; Black Fib. 30% Cellulose 70% Non-Fibrous 64 64/ NAD Brown Vinyl; Black Fib. 30% Cellulose 70% Non-Fibrous 65 65/ NM) Brown Fib. 98% Cellulose 2%Non-Fibrous 66 67/ NAD Brown Fib. 98% Cellulose 2%Non-Fibrous 67 68/ NAD Brown Fib. 98% Cellulose 2%Non-Fibrous 68 69/ NAD Brown Vinyl; Fib, 15% Cellulose 5% Fibrous Glass 80%Non-Fibrous --PAGE 05 of 09-- S ENCLOSURE I PAGE OF Fax: Sep 20 2007 12:38pm P009/023 ENVIRONMENTAL HAZARDS SERVICES L.L.C. CLIENT NUMBER: 7-2564 B EHS PROJECT#: 2007-09-1747 PROJECT: 57 Pequot Road Uncasville, CT EHS CLIENT SAMPLE#/ ° SAMPLE# LABORATORY GROSS DESCRIPTION �° ASBESTOS OTHER MATERIALS 69 70/ Brown Vinyl;Fib. NAD 15% Cellulose 5%Fibrous Glass 80%Non-Fibrous 70 71/ MAD Brown Vinyl;Fit,, 15% Cellulose 5% Fibrdus Glass 80% Non-Fibrous 71 72/ Brown Vinyl; Black Fib. NAD 30% Cellulose 70%Non-Fibrous 72 73/ Brown Vinyl; Black Fib, NAD 30% Cellulose 70%Non-Fibrous 73 74/ Brown Vinyl; Black Fib. NAD 30% Cellulose 70%Non-Fibrous 74 75/ NAD Brown Vinyl; Black Fib. 30% Cellulose 70% Non-Fibrous 75 76/ Brown Vinyl; Black Fib. NAD 30% Cellulose 70% Non-Fibrous 76 77/ NAD Brown Vinyl; Black Fib. 30% Cellulose 70%Non-Fibrous 77 78/ HAD Red Vinyl; Black Fib. 30% Cellulose 70%Non-Fibrous 78 79/ Red Vinyl; Black Fib. NAD 30% Cellulose 70% Non-Fibrous 79 80/ Red Vinyl; Black Fib, NAD 30% Cellulose 70%Non-Fibrous 80 81/ NAD Brown Vinyl; Black Fib, 30% Cellulose 70% Non-Fibrous 81 82/ Brown Vinyl; Black Fib. NAD 30% Cellulose 70%Non-Fibrous 82 83/ NAD Brown Vinyl; Black Fib. 30% Cellulose 70% Non-Fibrous 83 84./ NAD Blue Vinyl; Black Fib. 30% Cellulose 70% Non-Fibrous 84 $51 Blue Vinyl; Black Fib. NAD 30% Cellulose --PAGE 06 of 09-- 70% Non-Fibrous ENCLOSURE 1 PAGE C OFj Fax; Sep 20 2007 12:38pm P010/023 _ENVIRONMENTAL HAZARDS SERVICES, L.L.C. CLIENT NUMBER: 7-2564 B EHS PROJECT#: 2007-09-1747 PROJECT: 57 Pequot Road Uncasville, CT EHS CLIENT SAMPLE#1 SAMPLE# LABORATORY G-OSS DESCRIPTION %ASBESTOS OTHER MATERIALS 85 g6 Brown Vinyl;Black Fib. NAD 30% Cellulose 70% Non-Fibrous 86 87/ Brown Vinyl; Black Fib. NAD 30% Cellulose 70% Non-Fibrous 87 88/ Brown Vinyl;Black Fib. NAD 30% Cellulose 70%Non-Fibrous 88 89/ Brown Vinyl;Black Fib. NAD 30% Cellulose 70% Non-Fibrous 89 90/ Brown Vinyl; Black Fib. NAD 30% Cellulose 70% Non-Fibrous 90 91/ Brown Vinyl; Black Fib. NAD 30% Cellulose 70% Non-Fibrous 91A 92(a)-Linoleum 1/ NAD Beige Vinyl; Fib. 20% Cellulose 80% Non-Fibrous 918 92(b)-Linoleum IU Green Vinyl; Black Fib. NAD 30% Cellulose 70% Non-Fibrous 92 94/ Brown Vinyl; Black Fib NA) 30% Cellulose 70%Non-Fibrous 93 95/ Brown Vinyl; Black Fib. NAD 30% Cellulose 70% Non-Fibrous 94 96/ NAD Brown Vinyl; Black Fib. 30% Cellulose 70%Nora.-Fibrous 95 97/ Brown Vinyl; Black Fib, NAD 30% Cellulose 70% Non-Fibrous 96 98/ NAD Brown Vinyl; Black Fib. 30% Cellulose 70% Non-Fibrous 97 99/ Brown Vinyl; Black Fib. NAD 30% Cellulose 70% Non-Fibrous 98A 100(a)-Tile/ Brown Vinyl NAD 2% Cellulose 98%Non-Fibrous 98B 100(b)-Mastic/ Clear Adhes. NAD100% Non-Fibrous —PAGE 070109— EtACLCSL; E I FILE C Fax: Sep 20 2007 12:38pm P011/023 ENVIRONMENTAL HAZARDS SERVICE CLIENT NUMBER: 7-2564 B Sr LLC. EHS PROJECT#: 2007-09-1747 PROJECT: 57 Pequot Road Uncasville, CT EHS CLIENT SAMPLE#1 SAMPLE# LABORATORY GROSS DESCRIPTION %ASBESTOS OTHER MATERIALS 99A. 101(a)-Tile/ Brown Vinyl NAD 2% Cellulose 98%Non-Fibrous 99B 101(b)-Mantic/ Clear Adhes, NAD 100%Non Fibrous 100A 102(0-Tile/ Brown Vinyl NAD 2% Cellulose 98%Non-Fibrous 100B 102(b)-Mastic/ Cleax Adhes. NAD100% Non Fibrous 101 103/ Tan/Gray Linoleum;Black Fib. NAD 25% Cellulose 75%Non-Fibrous 102 104/ Tan/Gray Linoleum;Black Fib. 75%NAD 25% Cellulose Non-Fibrous 103 105/ Tan/Gray Linoleum;Black Fib. NAD 25% Cellulose 75% Non-Fibrous 104 106/ Beige Linoleum; Black Fib. NAD 25% Cellulose 75% Non-Fibrous 105 107/ Yellow/Gray/Green Linoleum; Black Fib, NAD 25% Cellulose 75%Non-Fibrous 106 108/ NAD Gray Linoleum; Black Fib. 25% Cellulose 75%Non-Fibrous 107 109/ Beige/Orange NAD 25% Cellulose • Linoleum; Black Fib. 75%Non-Fibrous • ENCLOSURE I FACE g OF --PAGE 08 of 09-- • Fax; Sep 20 2007 12;3Bpm P012/023 ENVIRONMENTAL HAZARDS SERVICES, L.L.C. CLIENT NUMBER: 7-2564 E EHS PROJECT#: 2007-09-1747 PROJECT: 57 Pequot Road Uncasville, CT QC SAMPLE: M1-1998-4 M11997-4 QC BLANK: SRM 1866 Fiberglass REPORTING LIMIT: 1%Asbestos METHOD: Polarized Light Microscopy, EPA Method 600/R-93/116 ANALYST: Laura Holder Melissa Bogga Steiniger Reviewed By Authorized Signatory: sr °T ,0: Michael A Mueller, .MPH Laboratory Director Howard Varner, General Manager Irma Faazewski, Quality Assurance Coordinator The condition of the samples analyzed was acceptable upon receipt per laboratory protocol unless otherwise noted on this report. Results represent the analysis of samples submitted by the client. Sample location, description, area, volume, etc_, was provided by the client. This report cannot be used by the client to claim product endorsement by NVLAP or any agency of the U.S. Government. This report shall not be reproduced except in full, without the written consent of Environmental Hazards Services, L.L.C. California Certification #2319 NY ELAP #11714. Alt information concerning sampling location, date, and time can be found on Chain-of- Custody. Environmental Hazards Services, L.L.C.does not perform any sample collection, Environmental Hazards Services, L.L.C. recommends reanalysis by point count (for more accurate quantification) or Transmission Electron Microscopy (TEM), for enhanced detection capabilities) for materials regulated by the EPA NESHAP (National Emission Standards for Hazardous Air Pollutants) and found to contain less than ten percent (<10%) asbestos by polarized light microscopy (PLM). Both services are available for an additional fee. *Ail California samples analyzed by Polarized Light Microscopy, EPA Method 600/M4-82-020, Dec. 1982. LEGEND NAD no asbestos detected SCF=sus.ected ceramic fibers plml.dot/07MAR2006/REV2/MR/te --PAGE 09 of 09--END OF REPORT-- ENCLOSURE l FACE OF Fax: Sep 20 2007 12:38pm P013/023 7:J 21 x &'7'V ..._Q-70/, A-- co ci �' _0 i-p— o ..... ...... 0 0 m 0 c (% 6 CD :' zzi ♦ i 1 m ` '‘ 2'4 0111111mounme. _..... 0) r, . 0 4 li , „ •C:\ Annivis , . — ---4t..1 - N :� �iiiii� '11 -PD 111.1111.1111111111111.1 'CM Fiber Count >1 ■�iPLM Point Countto .N 0: ��Pt M Grauinietnc ccn 'i o •-1 pwinommriummennummunue ° INENIIIMIllainisimiminamiiisti, rapemigammimmininimummenn cn rn U, gv ��mussisR�,ss� • s� to ► I y ���Aairtt a.6 :- ? J(. A ?'1 m �i ��� so11�Paint PP . .. 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A ;sMytic Air Qtld1 , Comultantg, Inc. °nsuL�t',o - 1204 North Road (Rt. 117) Groton, Connecticut 06340 Asbestos Containing Suspect Materials Roster Site: S 7 1PEouUT IO D UN Cor5vkLL ( Li # Type Amount Condition - Specific Location Of - of - Material ' of of Suspect ACM Material Material at Site 1-3 wiNmow GAAtzipitj -ali'"1'"jow✓._5.. _ +(_ -�. 66114144 Sl{�t'.T(WG _ � WJtl2o�_-Fk�C. tan._�..� `1- SH���t,L li.rrrr LriatiAl2 1..1 d kovs6 Sip,-c6, Para&_.s -- _ ' '1l' '� UN'00l— ilDVse .51AL^1$ VID4�Ej w k�L ?1i1y Y02.__ - LAL?4a c.c .. t9-a1 ci�l��?lase- _ 3a ay c ileJ 1ir,,_ z J Ligg.3" ., „ a �usG Cr��,n1'r (c) Fri Ki . a9 - 31 _ toAcii_ i t.& tar, Fr°- miFl�.c,�r 3X I l 1;--,1.) .� ,ru � N c�1Z EPA considers the materials above as "suspect" asbestos- containing materials. : q • I5fri_54:-.:411________ Date: I • ti Inspector • ENCLOSURE 3 PAGE 1 OF 3 Telecommunications (24 hours): Office: '(203) 449-8903 _ CT Toil Free: 1 (800) 247-7746 CIALNA[rt Qll E /,its li ►; c Mystic 1 Qa1ity Conu1tnt ; /?suL-r� 1204 North Road (Rt. 117) Groton, Conn ecticut 06340 • ' Asbestos Containin Suspect Materials Roster Site: p egVo-r 9-ekD Type Amount Condition . Specific Location Of - of r of Material Material of Suspect ACM — _ Material at Site " _si(d I�{a� DTZ t y 35? - o• I�noi s Lir �� a2futez7C- MAIM (Lac 113 gO' S11LiJ4 l it 3,14 .1 ee v,v ihrh J-Koc 4 Li -/e), 12CCerj/k6 LE. Or/ N/2-1'C Lf�rcwurti FL`o ^'r. +j Sb Sa 6,4 po,ur yea•r -- F �vi r /, /,4 -AiogY A V�t� f Jt $ cry e-vre/Irvct. kgrr j<j cf{t/'/ p �..fr .— K A SI"(.0 —/_`:06..1_ if L 3o Q_ f" c y_p4 e v Potz.Gf11 - C`/ L/nroecVEtizaa, ver'`� fieder►-OtTpaaercc (e(o fob( ktMg. r J.fDaC. /nJCLrVp. W09N !.J rIW'r ESI'. LlnrbEVI, f-16itil414E, 1j41T 4Si' EPA considers the materials above as '"suspect" asbestos- containing materials. Date: c '/1.0-4" Inspector s 1 C. S F' rc)- Telecommunications (24 hours): Office: •(203) 449-8903 • CT Toll Free: 1 (800) 247-7746 `G ALr a s' - � Mytic �.1� QiaIityConultais, Inc. o�suLTPo 1204 North Road (Rt. 117) Groton, Connecticut 06340 • Asbestos Containincr Suspect Materials Roster Site: ? 'Qv �I Tpe _ Amount Condition - Specific Location of r of of Suspect ACM Material Material Material --- _ -_-- at Site ./Lvskk.MJ= 12.0 F"' �--- _(dN _ - 1ZJ .��ri«,ti,,, 1C-77 u�&w . ���. JLC ��' .litti r DP - ajj [7Q rn- l f 144 r P .i`stvvrt_ 7-19 t, t ,T a FO.UT �f laUnl1'T d _LS_r��7t-t��T�l Io3- la --�� � L„ r� V nn .YNJ1 F<rbc ef_WY' ' 12na EPA considers the materials above as "suspect" asbestos- containing materials. Date: 1. 1 b • Inspector ` r a -'.f 3 - F3 Telecommunications (24 hours): Office: (203) 449-8903 CT Toll Free: 1 (800) 247-7746 FAY- (7n4\ .f An oocn NI y , Y P ? _ tt oil c p �n n , 3. I ‘ - \'-'. i 1 Z i I ¢ -• jj11 T 1 li 1 r 1; a ' 1 ir. 1. J4 ( ' ,x i - ' , ___....._______ L. Z � Ak.1..— il st.- C ' , (�U rel , TLJ As_l_ NI_ \_._, E 41 ilil ENCLOSURE-Li PAGE 1 OF I • • c, AIR QG Mystic QualityConsultants InC. - - - 4, °°esu` �,o 1204 North Road (Rt. 117) Groton, Connecticut 06340 L October 1, 2007 Mr. Dave Waddington D. W. Transport&Leasing, Inc. 33 Pequot Avenue P.O. Box 462 Uncasville, Connecticut 06382 Re: Pre-Demolition Inspection 57 Pequot Road Uncasville, Connecticut Dear Mr. Waddington: As requested, Mystic Air Quality Consultants, Inc. conducted a survey of accessible areas prior to demolition at the address above on September 18, 2007. This survey was conducted by Christopher Eident; a Connecticut State licensed asbestos inspector(license#00015), to determine the presence of asbestos-containing materials. The samples were analyzed by polarized light microscopy at Environmental Hazards Services (1\1VLAP 101882-0) in Virginia. Summary of the findings: Upon testing by polarized light microscopy,the following materials were found to be asbestos containing: Based on Sample#s Material/Location Estimated Affected Area 1-3 Window Glazing/Exterior Windows 21 windows 13 Wall Plaster/Unit#1 >800 sq. ft. 32-34 Roof Flashing/Roof Penetrations 20 sq. ft. Special Considerations Any of the non-asbestos roofing materials with flashing attached will need to be treated as asbestos-contaminated and be cut out with the flashing when it is abated. Communications (24 hours): Office: (860) 449-8903 FAX: (860) 449-8860 Toll Free: 1 (800) 247-7746 website: www.mysticair.com e-mail:maqc2@aol.com , • . '`GAIR go a ��' ' ',�f Mystic Air ua1ityConu1tantg, Inc. c�onsu. -,N 1204 North Road (Rt. 117) Groton, Connecticut 06340 L Non-asbestos containing materials The materials tested and found to be without asbestos content were the wall and ceiling sheetrock, ceiling plaster, ceiling tile, roof felt and shingle, flue cement, linoleum flooring, tile and mastic, and vapor barriers/house siding. Implications of the findings As required by state and federal regulations prior to renovation or demolition, all the asbestos-containing materials that will be disturbed by renovation, will need to be removed by a licensed asbestos abatement contractor employing trained and certified personnel who follow all pertinent asbestos abatement regulations. Limitations of the survey Though every effort was made to examine wall cavities and other areas for pipe insulation and other PACM, this survey and report only deal with accessible areas of the building. Additionally, there may be other non-accessible materials above ceilings, behind walls, and below floors that become evident during your demolition activity. Should the requisite EPA/OSHA competent person working for the contractor discover such materials they will need to be tested for asbestos content so determinations of their abatement and disposal (if required) can be made. This survey only addresses asbestos and does not make any representations about other hazardous or potentially hazardous materials or regulated wastes that are typically considered during building demolition or renovation; such as PCBs in lighting ballasts, mercury in fluorescent lights or in thermostats, fuel oil tanks, electric and gas utilities, or lead in paint or any site specific items related to manufacturing or commercial processes or activities that were historically carried on at this location. • Please do not hesitate to contact us with questions relating to the sample results. We thank you for the opportunity to conduct this survey. Sincerely, Christopher J. Eident CIH, CSP, RS CEO Enclosure 1: Laboratory Results Enclosure 2: Chain of Custody Enclosure 3: Roster of Suspect Materials Enclosure 4: Inspector's Drawing of the Property Communications (24 hours): Office: (860) 449-8903 FAX: (860) 449-8860 Toll Free: 1 (800) 247-7746 website: www.mysticair.com e-mail:maqc2@aol.com • �`C, AIR qG f Mystic Air C�plitConsultants Inc. 1204 North Road (Rt. 117) Groton, Connecticut 06340 March 3,2008 Mr.David Waddington D.W.Transport and Leasing Inc. 33 Pequot Road P.O. Box 462 Uncasville,Connecticut 06382 Re: Post Abatement Inspection Pre-Demolition Review 57 Pequot Road Montville,Connecticut Locations: Interior—section#2 and Exterior Dear Mr. Waddington: On February 28,2008,our asbestos abatement project monitor,Robert Buckingham(monitor license#000453)completed a visual inspection at the locations above for fulfillment of criteria for inspection prior to demolition.This site review was for the purpose of determining whether the asbestos-containing materials sited in the asbestos inspection were completely removed in order to allow for demolition to go forward,with regard to asbestos issues.See Enclosure (1). ACM Materials At this time,all of the stipulated asbestos-containing materials are completely removed from the structure and property.There is no visible asbestos related dust or debris remaining from these materials in the building,as required by US EPA NESHAPS and the State of Connecticut regulations to allow demolition to proceed. As allowed for by State standards for asbestos abatement,there were no final air tests performed at this site.As such,there can be no entry into this building by any service contractors or other non-asbestos personnel. Should such entry be needed,you will need to contact Mystic Air to return to conduct air tests. Thank you for selecting Mystic Air Quality for these services. Sincerely, C opher J. Eident CIH,CSP,RS CEO Communications (24 hours): Office: (860) 449-8903 FAX: (860) 449-8860 Toll Free: 1 (800) 247-7746 website: www.mysticair.com e-mail:magc2@aol.com ,`,A1R 9� ` 9� Mystic �1�' Conultant 8 1204 North Road (Rt. 117) Groton, CT 06340 Report of Inspection of Asbestos Removal, 14 Final Renovation, and Demolition Project [] Interim Date: 10 Site Location: S7 Pe (/[i` _ , ,j Building Identification: t, � ` �D �II<'�C� Containment Location: © q /�Se- , ' ■c' r►^ 0 51 Final Inspection Passed Inspection Indicates More Work to be Done CHECKLIST: Residual dust on: YES NO YES NO a. Floor k....-- ---. e. Vertical b. Horizontalsurfaces surfaces t/ f. c. Pipes . Ducts d. Ventilation . Register �i� equipment // i. Lights —� FIELD NOTES: a 1../ %t r 4, I I 4 'l' A.10 O A-i'l" T f --- i e)1 O f-l'on FINAL AIR SAMPLE RESULTS: [] TEM to be Analyzed [] PCM Analyzed on Site Sample # Sample # Sample # Sample # Sample # INSPECTOR: 1?r)LI e RL4CK1njAw}t �7 4„f L4/�`_ Printed J Signature ENCLOSURE / PAGE / OFo2 AIRq y � Mystic 1�1�' ConultanLs 0��SutT"°� 1204 North Road (Rt. 117) Groton, CT 06340 Report of Inspection of Asbestos Removal, A Final Renovation, and Demolition Project [] Interim Date: 2 /nY Site Location: s7 Pequ� .Hr)41--v!//P� C� Building Identification: (� Containment Location: ��„ ,Y_-i o)(- [1 Final Inspection Passed Inspection Indicates More Work to be Done CHECKLIST: Residual dust on: YES NO YES NO a. Floor e. Vertical b. Horizontal / surfaces surfaces f. c. Pipes g. Ducts d. Ventilation h. Register equipment I. Lights FIELD NOS: : `�1 '� «s 1 r��0 r 1� 1�I-�/'1 #14-F.!'i'p fie, c y �,c71 rGr !i SUP ' 4lp A-1 r `7-PC4- - FA/prior > neiri- FINAL AIR SAMPLE RESULTS: [] TEM to be Analyzed [] PCM Analyzed on Site Sample # Sample # Sample # Sample # Sample # INSPECTOR: Po SuClinih 0_4 Aid irfrif' Printed ignature ENCLOSURE / PAGE OF — rr SEP 04 2007 10:03 FR TO 18608492669 P.01 • Ofweedhad l((.)ih' IN y • at8it • September 4, 2007 To Whom. It May Concern: This letter is to inform you that the telephone equipment, cables, wires and attachments have been removed and/or are not attached to the addresses listed below. 57 Pequot Road Uncasville, Ct. This job was performed prior to September 4, 2007 in response to a request to demolish the above address by: David Waddington DW Transport If you have any questions, please feel free to contact me. Sincerely, Laub General Office Associate .at &t; Network Dispatch Center; 84 Deerfield Lane -Room 2C2; Meriden, Connecticut 06450 Phone: (203)420-2857; Fax: (203)238-0434 ** TOTAL PAGE.01 ** Mefroast See the world and beyond... www.MetrocastCommunications.com 61 Myrock Avenue • P. 0. Box 6008 • Waterford, CT 06385 • 1-888-339-3605 David Waddington P 0 Box 462 Uncasville, CT 06382 To Whom It May Concern: In preparation for demolition, we have inspected 57 Pequot Rd, Uncasville, CT. We have removed wires or equipment at this address. If you have any question please call 860 442-5616 Ext 270. Sincerely, Vincent Larson Technical Ops. Supervisor MetroCast of Connecticut 10/04/2006 WED 13:15 FAX 860 447 5755 CUP WATERFORD ?001/001 ... .. 08/20/2007 16:26 FAX 16608482660 DIV TRANSPORT it 002 •-::•:-.::- ' ' i AUG-29-2007 YED• 94;18 PK CL&P FAX NO, 877 285 4448 P. III n X E LE(fiteLari P.1 1) Cmrinectieut 'Re-00%W of Sentice— Th.Niel.UtOttkv areaa Eitilltilng Cien1011t1011/COMITUCtion OFFirft)SW.5437 A3 thit wilhor of ftge,PrOPOrtY,Ian,requesting the motors/of the tatisting CT Light et Power Company • (CLI&P)Meetrk Service and meter(s)to 4110Wfor the ctemenseekeliettuetiee et ttio building in accallistice wilts all applicable CobilaCtiaUt General Statutes. I certify that the build leg is vacant. "rio.A.oNING NIJOBRR :;:" : iltamoveu..OA=maranto ..-_, 9U, YizA%, ' 4, 4149 trnEr ADeRgsze%mien El4CMC MACE t3 TO se Ramovro r.dt,AgElp.CROSS roxser 1'1 jot, ,;4_1 ,_./_____._.c..;,4 _____—• SI-6 i (....4:4,—c.._ C.itrc..A..3.) -tow _ ___L...mcog 0,...78_2..... 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D4fe•torvicit reM0404; ,Fiume Seld 21 jab note to STORMS Remarks thCkcatitta the • .+.: ctlatil and te whom this slit form met Flie Oils compieted ror__,L• this completed service removal work I order. IWO :I ft PktiNi N 6 Of eV.P RPM seNTATNE D;21• ..,,. . - -AEW.--. = kTirt- Owre :•El - . . _ itimistzwam - ,:scComptete Al °motion On This Form (le•f- la U.S.Postal: Overnight expreas: ,---— ...ft'- ? Mall To CL&p Clearing Desk Mail TO: CLAP Gleenrig Desk it4 P Connecticut Light&Power Co. Cennecticut Light iPov0er PO Box 206S . 107 Seddon Street • :::,:itii- -_ flartford,CT 06104,206$ erlfrt Cr 06037 AUG 29 za04,,Tita., Fax: 171 285-44. g Ct.:acing Endo Phone: 1440-644-4s2o • lel 1,.... '•!,i,t,-,". L-P4ARW-21 65,,,IIM: .--. COMMERCIAL PERMIT CALCULATION Address: PERMIT FEE Building $ Plumbing $ Mechanical $ _ Electrical $ _ N CO Fee $ _ Plan Review $ State Ed Fee Work Commenced before permit issuance $ _ Total Fees $ DEMOLITION PERMIT CALCULATION Address: PERMIT FEE Demolition $ 8,500 $ 90.00 Total Fees $ 90.00 CONNECTICUT Department of Public Safety, r ' h Division of Fire & Building Safety t411,4 h1 DEMOLITION CONTRACTORS CERTIFICATE NO: 1134 CLASS :A DATE ISSUED: 2007/07/01 EXPIRES : 2008/06/30 Certification as a Demolition Contractor is hereby granted to the person or firm named hereon. Name of Designated Technical Expert : David Waddington SIGNED (DTE) ISSUED TO: D.W. Transport & Leasing, Inc . P.O. Box 462 Uncasville, CT 06382 t, AUTHORIZED BY: t,: T '`�` SP-981-C • Client#:8390 1258972 •ACORDTM CERTIFICATE OF LIABILITY INSURANCE Q;12�;07° PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Helmsman Insurance Agency LLC ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 20 Riverside Rd HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Weston,MA 02493-2231 i 617 243-7926 INSURERS AFFORDING COVERAGE INSURED NAM# OW Transport$Leasing,Inc, INSURER A: Everest National Insurance Company 33 Pequot Road INSURER B: Uncasville,CT 06382 INSURER C: INSURER D: INSURER E: J COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR AUU EFFECTIVEY LTR NSR. TYPE OF INSURANCE POLICY NUMBER DITELMM/DD/YY)_ POLICYTI EXPIRATION LIMITS GENERAL LIABILITY EACH OCCURRENCE $ IIICOMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED P- i ISES Ea occurrence $ 1.11CLAIMS MADE OCCUR MED EXP(Any one person) $ 011■ ( PERSONAL&ADV INJURY $ GENERAL AGGREGATE $ • GENT AGGREGATE LIMIT APPLIES PER i PRODUCTS-COMP/OP AGO $ n I ECT POLICY I I LOC AUTOMOBILE LIABILITY ANY AUTO COMBINED SINGLE LIMIT $ (Ea accident) ALL OWNED AUTOS BODILY INJURY II SCHEDULED AUTOS (Per person) ■HIRED AUTOS NON-OWNED AUTOS BODILY INJURY $ (Per accident) PROPERTY DAMAGE $ (Per accident) GARAGE LIABIUTY AUTO ONLY-EA ACCIDENT $ ■ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGO $ A EXCESS/UMBRELLA LIABILITY 71G8000007071 04115/07 04/15/08 EACH OCCURRENCE $10 000 000 © OCCUR n CLAIMS MADE AGGREGATE $10 000 000 _ • ■ DEDUCTIBLE • $ RETENTION $ WORKERS COMPENSATION AND WC STATU- 10 • R- EMPLOYERS'UABIUTY TORY LIMITS I OER ANY PROPRIETOR/PARTNERIEXECUTIVE E.L.EACH ACCENT $ OFFICER/MEMBER EXCLUDED? tt yes,describe under El.DISEASE-EA EMPLOYEE $ SPECIAL PROVISIONS below E.L DISEASE-POLICY LIMIT $ OTHER DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES!EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POUCIES BE CANCELLED BEFORE THE EXPIRATION Sample DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL to DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. U77NOR¢ED REPRESENTATIVE • ACORD 252001!08 )1 of 2 #S220138/M219240 1VMN 0 ACORD CORPORATION 1988 I' This certificate is executed by Liberty Mutual Insurance Group as respects such insurance as is afforded by those companies. BM0068 Certificate of Insurance I This certificate is issued as a matter of information only and confers no rights upon you the certificate holder. This certificate is not an insurance policy and does not amend,extend,or alter the coverage afforded by the policies listed below. This is to certify that(Name and address of Insured) SOW D W Transport and Leasing,Inc.,CT Scrap t 33 Pequot Rd � �- Lib e Uncasville,CT 06382 ` Mutual. is,at the issue date of this certificate,insured by the Company under the policy(ies)listed below. The insurance afforded by the listed policy(ies)is subject to all their terns,exclusions and conditions and is not altered by any requirement,term or condition of any contract or other document with respect to which this certificate may be issued. Expiration Type Eff./Exp.Date(s) Policy Number(s) Limits of Liability Continuous* Coverage afforded under WC law of Employers Liability Extended the following states: Bodily Injury By Accident X Policy Term Each Accident Bodily Injury By Disease Policy Limit Workers Compensation Bodily Injury By Disease Each Person 04/15/2007/04/15/2008 YY2-1 11-258972-027 General Aggregate-Other than Prod/Completed Operations General Liability $2,000,000 I Products/Completed Operations Aggregate — Claims Made $1,000,000 X Occurrence Bodily Injury and Property Damage Liability Per 1 $1,000,000 Occurrence Retro Date Personal and Advertising Injury Per Person/ $1,000,000 Organization Other Liability Other Liability 04/15/2007/04/15/2008 AT2-111-258972-017 Each Accident-Single Limit-B.I.and P.D.Combined Automobile Liability $1,000,000 Each Person X Owned X Non-Owned Each Accident or Occurrence X Hired Each Accident or Occurrence • C 0 M M E N T S Notice of cancellation.(not applicable unless a nianber of days is entered below).Before the slated expiration date the company will not cancel or reduce the insurance afforded under the above policies until at least 30 days notice of such cancellation has been mailed to: Office: Providence,RI Phone: 401-351-2200 e +-- At R 2 1- � _- Certificate Holder: CHERYL Y PETERSON DW Transport & Leas ing Inc Authorized Representative 33 Pequot Rd PO Box 462 Uncasville, CT 06382-0462 Date Issued 10/05/2007 Prepared By: cp ACORD CERTIFICATE OF LIABILITY INSURANCE 1 DATE OD/YY) 101051 PRODUCER 10/05/2007 TYLER COMPANIES Serial# 101212 THIS ONLYCANDIFCONFERSCATE IS ISNO RIGHTS UPONUED AS A ROF THENCERT CERTIFICATE 330 ROBERTS STREET HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR E HARTFORD,CT 06108 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW, INSURERS AFFORDING COVERAGE NAIC# INSURED OEM AMERICA/DW TRANSPORT&LEASING INC INSURER A: AMERICAN INTERNATIONAL COMPANIES 330 ROBERTS STREET INSURER B: EAST HARTFORD, CT 06108 INSURER C: INSURER D: I INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDmONS OF SUCH POLICIES,AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, MR 'AWL .. __,-- --_,-- LTR NSRO PE OF INSURANCE POIJCY NUMBER POLICY EFFECTIVE POLICY EXPIRATION -"-" -- - --- - -- DATE{MM/DDfYYI DATE(MMIpD/YY) LIMITS GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED PREMISES (Ea occurence) $ CLAIMS MADE E OCCUR MED EXP (Any one person) S r• PERSONAL F.ADV INJURY _$ GENERAL AGGREGATE $ GEN.AGGREGATE LIMIT APPLIES PER 7 POLICY n JECCT n LOC PRODUCTS-COMP/OP AGG $ AUTOMOBILE LIABILITY ANY AUTO COMBINED SINGLE LIMIT $ (Ea accident) ALL OWNED AUTOS SCHEDULED AUTOS BODILY INJURY (Per person) $ ,,HIRED AUTOS NON-OWNED AUTOS BODILY INJURY $ (Per accident) - PROPPEciRdent)AMAGE S GARAGE LIABILITY - 71 ANY AUTO AUTO ONLY-EA ACCIDENT S OTHER THAN EA ACC $ AUTO ONLY: AGG S EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR n CLAIMS MADE -- _ AGGREGATE S DEDUCTIBLE S RETENTION 5 $ WORKER'S COMPENSATION AND 00196778200 03/15/07 03/15/08 X! ORSTATU- I 10TH- S A EMPLOYERS'LIABILITY TORY LIMITS 1 T ANY PROPRIETOR/PARTNER/EXECUTNE EL EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? Byes,describe under EL DISEASE-EA EMPLOYEE S 1,000,000 SPECIAL PROVISIONS below OTHER EL DISEASE-POLICY LIMIT S 1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION SHOULD ANY DF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DW TRANSPORT&LEASING INC DATE r OF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN 33 TRANS AVENUE NOME T THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL UNCASVILLE, CT 06382 IM-.SE O OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR PR ENTATIVES. A,THO-I DR PRESENT• IVE OFTYLERCOMPANIES I / ACORD 25(2001/08) / ©ACORD CORPORATION 1988