Subcontractor/Employee Master List
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SUBCONTRACTOR/EMPLOYEE MASTER LIST (RSA 21-I:81-a and 21-I:81-b) Revision Date: July 2014
Project Name: Acute Psychiatric Services Building Project Number: 80620 General Contractor: Covenant Fire Protection, Inc. 150 Zachary Road, Suite 6, Manchester, NH 03109 CEO: Raymond Scott 46 Lindstram Court, Manchester, NH 03103 CFO: Jason Kahan 53 Ash Avenue #1, Somerville, MA 02145 LLC Principals: Frederick Roy 99 Goshen Drive, Loudon, NH 03307
NAME OF GENERAL EMPLOYEES ENTITY WITH WHOM ENTITY PROVIDING OSHA-10 NAME & ADDRESS CONTRACTOR, EXPECTED TO WORK SUBCONTRACTOR OR WORKERS COMPENSATION CERTIFICAT OF INSURANCE SUBCONTRACTOR, OR ON THE JOBSITE INDEPENDENT IS COVERAGE E ON FILE CARRIER INDEPENDENT CONTRACTED (Y/N) Covenant Fire Protection, Inc. -- n/a Covenant Fire Protection, Inc. -- Desanctis Insurance 100 Unicorn Park Drive Woburn, MA 01801
Clark Insurance 80 Canal Street Manchester, NH 03101 Raymond Scott Covenant Fire Protection, Inc. Covenant Fire Protection, Inc. Yes -- Michael Joanis Covenant Fire Protection, Inc. Covenant Fire Protection, Inc. Yes -- Employee Name -- GC or Subcontractor/Indep name -- Employee Name -- GC or Subcontractor/Indep name -- Employee Name -- GC or Subcontractor/Indep name -- Employee Name -- GC or Subcontractor/Indep name -- Page 2 of 3
Employee Name -- GC or Subcontractor/Indep name -- Subcontractor/Independent -- GC or Subcontractor/Indep GC or Subcontractor/Indep name -- Name & Address Address name Employee Name -- GC or Subcontractor/Indep name -- Employee Name -- GC or Subcontractor/Indep name -- Subcontractor/Independent -- GC or Subcontractor/Indep GC or Subcontractor/Indep name -- Name & Address Address name Employee Name -- GC or Subcontractor/Indep name -- Employee Name -- GC or Subcontractor/Indep name -- Subcontractor/Independent -- GC or Subcontractor/Indep GC or Subcontractor/Indep name -- Name & Address Address name Employee Name -- GC or Subcontractor/Indep name -- Employee Name -- GC or Subcontractor/Indep name -- Employee Name -- GC or Subcontractor/Indep name -- Subcontractor/Independent -- GC or Subcontractor/Indep GC or Subcontractor/Indep name -- Name & Address Address name Employee Name -- GC or Subcontractor/Indep name -- Employee Name -- GC or Subcontractor/Indep name -- Employee Name -- GC or Subcontractor/Indep name -- Subcontractor/Independent -- GC or Subcontractor/Indep GC or Subcontractor/Indep name -- Name & Address Address name Employee Name -- GC or Subcontractor/Indep name -- Employee Name -- GC or Subcontractor/Indep name -- Employee Name -- GC or Subcontractor/Indep name -- Subcontractor/Independent -- GC or Subcontractor/Indep GC or Subcontractor/Indep name -- Name & Address Address name Employee Name -- GC or Subcontractor/Indep name -- Employee Name -- GC or Subcontractor/Indep name -- Employee Name -- GC or Subcontractor/Indep name -- Subcontractor/Independent -- GC or Subcontractor/Indep GC or Subcontractor/Indep name -- Name & Address Address name Employee Name -- GC or Subcontractor/Indep name -- Page 3 of 3
Employee Name -- GC or Subcontractor/Indep name -- Employee Name -- GC or Subcontractor/Indep name --