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HomeMy WebLinkAboutMP17-005 t'Cy V.du JJ V fit` a VILLAGE OF RYE BROOK MAYOR 938 King Street, Rye Brook,N.Y. 10573 ADMINISTRATOR Paul S. Rosenberg (914) 939-0668 Christopher J. Bradbury www.ryebrook.org TRUSTEES BUILDING& FIRE Susan R. Epstein INSPECTOR Stephanie J. Fischer Michael J. Izzo David M. Heiser Jason A. Klein CERTIFICATE OF COMPLIANCE October 25, 2021 Suzanne Elson&Marie Mazzone 111 Brush Hollow Lane Rye Brook,New York 10573 Re: 111 Brush Hollow Lane, Rye Brook,New York 10573 Parcel ID#: 129.76-1-149 This document certifies that the work done under Mechanical Permit #17-005 issued on 1/30/2017 for the installation of a new oil fired boiler has been satisfactorily completed. Sincerely, Michael J. Izzo Building&Fire Inspector /tg �E QRO N -' 1982 BUILDING DEPARTMENT UbUILDING INSPECTOR �RAsSISTANT BUILDING INSPECTOR VILLAGE OF RYE BROOK u CODE ENFORCEMENT OFFICER 938 KING STREET - RYE BROOK,NY 10573 (914) 939-0668 FAX (914) 939-5801 www Uebrook.org - - - - - - - - - - - - - - - -- - - - INSPECTION REPORT - - - - - - - - - - - - - - - - - - - - I ADDRESS : ]�J l_Lo L i lT _ DATE: t D Z Z PERMIT# coa! ISSUED: P3 D/I SECT:I 6 BLOCK: �; LOT: r LOCATION: � J7�r(. OCCUPANCY: ❑ VIOLATION NOTED THE WORK IS... > ACCEPTED ❑ REJECTED/REINSPECTION ❑ SITE INSPECTION REQUIRED ❑ FOOTING ❑ FOOTING DRAINAGE. ❑ FOUNDATION ❑ UNDERGROUND PLUMBING NOTES ON INSPECTION: ❑ ROUGH PLUMBING ❑ ROUGH FRAMING ❑ INSULATION ' ❑ NATURAL GAS f E` ❑ L.P. GAS ❑ FUEL TANK ❑ FIRE SPRINKLER ❑ FINAL PLUMBING ❑a CROSS CONNECTION FINAL ❑ OTHER Season after season , whatever the weather, cut up t 40% off hcosts '. el,,, If A00-Ift-I WOW -Ow� A Featuring . . ERGY STAR PARIWEB Fs cirs "' r ' r r rr- Your heat 1 hot water syster-k to learn why System 2000, the TWO WAYS HOMEOWNERS SAVED MONEY BY INSTALLING SYSTEM 2000: NEW CONSTRUCTION:HEAD WITH SYSTEM 2000 ANNUAL CONVENTIONAL TO HEAD COMPARISONS SHOW SAVINGS ■ HOW SYSTEM 2000 SAVED FUEL System 2000 was tested against t SAVED modern, conventional boilers in three 4 2 sets of brand new, identical homes. r The homes were all built by the same contractor, in similar geography, and 2,56o sq.ft. 2,560 sq.ft. are identical in every important specification: same size, same r+, �„ � � materials, same insulation. Only , the heating systems were different. '` '4 .s And, of course, the fuel consumption. Your home is no doubt your primary 2,560 sq. ft. 2,560 sq.ft. investment. Installing or replacing SAVED its heating system is an opportunity to improve your investment. Tale 31 % a few minutes here to learn why • ' - System 2000 is the right choice no matter what style of home you awn. 3,700 sq.ft. 3,700 sq. ft. AVERAGE ANNUAL SAVINGS WITH SYSTEM 2000:40% 2 UPGRADES SHOWN BELOW ARE FOUR EXAMPLES WHERE HOMEOWNERS UPGRADED TO SYSTEM 2000. . AVERAGE FUEL COST SAVINGS FOR THESE FOUR HOMES WAS$1000(=EXTRA MONEY THEY PUT IN THEIR POCKET). COMPARISONS ARE BASED R.W.,Bernordsvifle,NJ. E.W.,Middleton,CT. WY.,Cromwell,CT M.L.,Bennington,VT. ON AN ORIGINAL ANNUAL Replaced a boiler that had Replaced a boiler and oil Replaced a boiler and water Converted his system ENERGY BILL OF a 79%efficiency.Converted fired water heater,converted storage tank,converted from a boiler with a modern $2000 to 2 zones.Saved 50% to 2 zones.Saved 51% to 2 zones.Saved 5f3% burner,Saved 46% L lJ --------------/ ----, r----- - --- -----------/ - -; --- - ----f- -- -; ti�l HOUSE #1: i HOUSE #2: HOUSE #3: HOUSE #4: 50% SAVINGS : 51% SAVINGS 53% SAVINGS 46% SAVINGS by! SAVED SAVED SAVED SAVED 1020 1060 S920 J i000 - HOMEOWNERS PUT IT HOMEOWNERS PUT IT HOMEO�'"FRS Ps' HOMEOWNERS PUT IT IN THEIR POCKET IN THEIR POCKET IN" � IN THEIR POCKET P1 h�i f ANNU0.L FUEL COST PG1tADE I_� I���- i II Iilr II Now .r YSTEM ,1i' I, '11t � rift � . T _ q 1' r © �.YOUR CURRENT ZZbift SAVED UNT SAVED MOU SAVED NT SAVED COST OF FUEL COST OF FUEL FOR YEAR COST OF FUEL FOR YEAR COST OF FUEL FOR YEAR COST OF FUEL FOR YEAR ENDED SEPTEMBER 2014 ENDED SEPTEMBER 2014 ENDED SEPTEMBER 2014 ENDED SEPTEMBER 2014 is a lifetime investment. / take minute Lry hybrid heating system, right for you ! IMPORTANT INFORMATION ABOUT THE COST OF HOT WATER FOR HOME USE: How much hot water does your family use? Believe it or not, an average family uses 64 gallons of hot water every day for baths, laundry and kitchen, etc, and that's sometimes too much for a typical boiler to produce. But System ► 2000 makes as much as eight times ,n Hot tub or pool: can be hundreds of gallons more hot water than an electric water heater and 3 to 4 times more System 2000 provides abundant hot than a typical gas water heater.And, water at significant savings. since producing hot waterrepresents Because System 2000 is an integrated 113 of a typical home's total heating system,* with Hybrid Energy Recovery' cost, it's very important to make it can produce tremendous amounts of it as efficiently as possible. , hot water for far less cost than conven- Dirty laundry: 15 gallons per load tional boilers. In fact, System 2000 produces enough hot water to run the . =w �v dishwasher, the washing machine and several showers all at once. System 2000 does it by combining three high performance components: a high capacity hot water storage tank, a low mass high efficiency boiler that "> produces more hot water per hour, �► and a Hybrid Energy Recovery system to optimize performance and comfort. 'That means System 2000 does not have a separate water heater. Using Hybrid Energy Recovery technology, it produces all the heat needed to warm your living spaces,plus it simultaneously provides for all your The dishes: 10 gallons per load Taking a shower: 20 gallons per shower hot water requirements. That's efficiency. System 2000 fuel savings repay LOOK HOW MUCH YOU'LL SAVE JUST ON HOT WATER! THIS CHART SHOWS TYPICAL ANNUAL COSTS FOR HEATING DOMESTIC HOT WATER.` your investment, and then provide extra money that you'll have in your • - . . • . pocket year after year. . . after year. Depending on your area of the country, System _ costs $401 — 992 per year 2000 may be more costly to install than a conventional Gas boiler or heater. But the chart at left shows how the fuel savings you enjoy with System 2000 can easily pay for Conventional • • osts $498- 656 per year this increase in a short period of time.After that, those annual savings are a cash bonus you'll earn year after year for many years to come! costs $765- 936 per year At the same time, you'll enjoy System 2000 CALCULATIONS BASED 2014 RESIDENTfAL ENERGY PRICES comfort and convenience, and, in addition, features that are far superior to other home heating equipment. understandingA consumer's guide to In addition: yellow (energy guide) AFUE doesn't measure in any way how ratings efficiently your boi[er makes hot water for bath, laundry and faucets, which typically equals 20-30% of your heating costs!' Don't be misled by yellow Here are the severe energy losses Adding up all these common energy losses AFUE government "efficiency" that AFUE doesn't measure: (listed at left), plus the demands of making stickers. They don't accurately Jacket loss hot water, reveals the real efficiency rate indicate how in-efficient Poor insulation on the boiler, usually of typical boilers. These actual unbiased a boiler really is. only 3/4" of fiberglass (and that's only rates are shown in the blue boxes and the Most conventional boilers claim to be on the boiler jacket) allows heat to chart that you can find on these pages. "high efficiency" because their AFUE escape constantly. This loses a great (government) efficiency ratings, shown amount of heat to your garage or base- The logical conclusion is: on yellow labels are based only on limited ment. AFUE doesn't measure it. testing. However AFUE measures onlyDon't choose a home heating energy wasted from boiler heat that's Conventional boilers are hot at the end system based on its AFUE rating. lost up the chimney.With short heat of a heat call, and some even continue Instead, ask about a boiler's real efficiency rating, as shown transfer passages (some only 16"long, to run day and night to keep hot water or less) conventional boilers can't absorb available, even when no one is using hot in the blue boxes below and all the heat they create before it literally water. This is "idle loss," a terrible in the chart at right. blows up your chimney. AFUE does record waste of energy. On a typical hi-mass "There are no federally prescribed testing and rating standards this loss. However there are other more boiler, idle losses are the inevitable for combined ap:U.S.e5:•vein enhance the,make both neat and r hat watery.From:U.S.Government AFUE,ANSI/ASHRAE 124-199 f, costly inefficiencies that AFUE simply result of the need to heat the equiva- ignores completely. See the next column. lent of over 1000 pounds of iron, every ABOUT"DEMAND FIRED"OR time the system turns on. AFUE doesn't SO-CALLED GOLD START BOILERS Old fashioned draft measure this terrible waste of energy. While boilers with heavily insulated tanks regulators and draft y hoods lose a terrible Draft regulators, draft hoods may store plenty of hot water, they also amount of energy, but and room air loss waste significant energy. Here's why: yellow AFUE labels Draft regulators suck warm air out of A tremendous amount of energy is still don't measure that your home in order to control chimney needed to heat up the 6-10 gallons of loss. System 2000 draft for the boiler, but AFUE ratings water and massive amounts of cast iron does not use a in conventional boilers. Then, once your draft regulator. don't measure this loss. System 2000 hot water needs are met and the boiler uses outside air for combustion and shuts off, this heat is wasted. Typically, does not have a draft regulator this will account for about 15-20%of your annual fuel bill. Chart at right shows the THREE TYPICAL INEFFICIENT BOILERS: inefficiency this process causes. _ Conventional gas boiler Cast iron Typical high-mass and water heater. tankless coil boiler. boiler with indirect water heater. This gray box is the low efficiency boiler control. Many boilers are AFUE tested at a loweroperating tamp- erature than the actual temperature set on the i 3 box they install in your home. This loophole can artificially boost a boiler's AFUE rating. Compare the 2 boxes below) The US government mandates u better gray box controls by 2012,however,since AFUE y -e may still test at artificially low temperatures,.AFUE ratings will still not change! When test criteria are applied fairly across the widest select- - tion of boilers,System 2000 is _ shown to be the most efficient. (See the chart AFUE on thepages.l AFUE Real AFUE Real rating rating rating rating rating rating =80% 0 1 =86% . ' . =86% 0 Under contract with the United States _ Department of Energy, Brookhaven National Labs confirms: U.S. energy guide (AFUE) ratings miss significant areas of energy loss. ' REAL EFFICIENCIES VS AFUE:2 95% AFUE AFUE rating rating AFUE 90/o ° AFUE 93% =95% 91% rating s FUE 89.8% rating 87.5 85% — AFUE — rating — =aa% System 2000 � 8�% AFUE —— and our _. rating — 90+Resolute 81 _ have the Real 75% AFUE _ best real efficiencies AFUE ratings — — of an rating may systems rating 70/° mis- � � i t tested! � • represent U _ o7% • fuel _ 650% efficiency by as The REAL efficiency rating for System 2000 is 85%! 60 — mash Compare this to the other real ratings for conventional �pPo t — boilers, shown in the blue boxes and chart on these pages! 55% i best energy cost 50% _ �, savins heating• system,", System2000! 45% — 22yearold CASTMON tThis means some AFUE efficient TANKLESS With ratings under-estimate fuel y Low chimney loss COIL BOILER HOT OTANAKER consumption by more than 5fl�o. System 2000 minimizes chimney loss with a unique counterflow design that incorporates THE ELECTRIC HOT WATER ENERGY PIT: over ten feet of heat transfer passage. Almost no jacket loss With conventional gas and oil systems, it's possible to System 2000 has 2-4" of insulation all make general comparisons on efficiency. However, estimating around, and is raised 18" off the cold floor. the efficiency of electric hot water is more complicated because Near zero idle loss electric power is drastically more expensive than either gas or oil. System 2000 had the lowest idle loss of all For example, a typical electric water heater can legally systems tested in the important, independent display an energy guide sticker that states its efficiency rating Brookhaven National Labs study. is 93%. On the surface, this sounds impressive. However, that Plus, the System 2000 patented spiral boiler rating means only that once electricity is connected to the holds only 2.5 galtons of water and heats heater, 93% of the electricity is converted to heat. What is not up six times faster than the competition. represented in this energy guide rating is this staggering fact: Combined with our high performance hot electricity itself i5 3 to 5 times more expensive than either water system, System 2000's Hybrid EnergyRecovery®captures heat that other boilers oil or gas. That means electric hot water usually costs simply waste, and virtually eliminates idle loss 3 to 5 times more than System 2000 hot water! while meeting all your heat and hot water needs. AFUEL_", The real efficiency of makingNo draft regulator or draft hood loss rating hot water with electricity System 2000's advanced design =93% --- is an embarrassing 28%. does not require draft regulation and uses outside air for combustion. P Data and conclusions are drawn from the report"Performance of Integrated Hydronic Heating Systems."Paper and presentation by Brookhaven National Laboratory,Upton,New York,under contract No.DE-ACO2-98CH10986 with the Urited States Department of Energy by Dr.T Butcher;and"Chimney Related Energy Losses in nesidential Oil-Fired Heating Systems(1990)."Available on request. System 2000 is ranked the # 1 top--rated system by Brookhaven National Laboratory in a study under contract with the U.S. Department of Energy' The science behind quiet efficiency. With Hybrid Energy Recovery, System 2000 produces your home's heat plus almost endless hot water! And it runs so efficient and quiet! Here's why; High Performance Domestic Hot Water System Heavily insulated storage tank provides a ready supply of hot water • Advanced technology stainless steel heat exchanger captures full boiler output for domestic hot water - recognized worldwide for most effective and efficient heat transfer. • integrated design works seamlessly with the Digital Energy Manager to provide energy recovery and maximum efficiency Unique stratified storage for improved water quality High output provides 210 gallons per hour Optional tanks for unique water requirements 'Domestic hot water rating based on EK-i first hour draw with 70f rise and 40 gallon � storage tank. EK-2 model provides up to 350 gallons per hour. • D. . and conclusions drawn from the report"Performance of Integrated Hydronic Heating Systems."Paper and presentation by Brookhaven National Laboratory, Upton,NY,under contract No. DE-ACO2-98CH10886 with the United States Depa 6 Digital Energy Manager Automatic operation - no need to set or adjust complicated programs Comes standard on every System 2000-not an option like on typical boilers _ • Better efficiency and performance than"temperature reset"systems • Monitors and controls System 2000 for peak heat and hot water efficiency • Matches enemy usage to the exact requirements of your home • • Allows priority for hot water ►i Hybrid Energy Recovery' makes sure no heat is left wasted in the boiler r i and saves fuel dollars. This cycle, combined with the low mass spiral boiler design, means idle losses are virtually eliminated. Hot water plus 4 zones standard (10 and 15 zone options available) Unique, Patented Spiral Boiler Design 10 feet of energy absorbing flue passages Ultra low mass design contains only 2.5 gallons of water 1/3 the mass of typical systems for highest efficiency No pins or baffles to foul up and reduce efficiency _ Specially formulated steel boiler is a gasketless one-piece construction designed to last the life of your home 20 to 50 times the insulation used on conventional boilers Special silent burner enclosure makes System 2000 more quiet than a microwave oven - recognized as the quietest oilheat system; also available in ultra quiet gas heat Outside combustion air connection - doesn't steal heated air from your home and eliminates drafts Durable combustion chamber provides near perfect combustion .77 1 i 1, _ E•' ,. With System 2000's Hybrid no heat energy is left i HERE'S WHAT HAPPENS WHEN YOU NEED HOT WATER: As hot water is used, the tank thermostat signals the ' Digital Manager and the Digital Manager turns on the burner. Within 90 seconds the domestic -- circulator is passing water from the storage tank through the stainless steel heat exchanger. This charges the top of the tank with hot water. Combined with the boiler, it can provide 210 gallons of hot water per hour. When the tank is re-heated, the thermostat signals the aquastat which turns off the burner. The Digital Manager directs the domestic circulator to continue sending cooler water at the bottom of the tank through the heat exchanger. This unique process ' recovers the heat left in the boiler. This heat is then stored back in the r hot water tank, adding to your exist- ing hot water supply. As a result, it's longer before the tank calls on the I boiler for additional hot water - and that conserves your fuel dollars. $ . The result: no heat is -- left wasted in the boiler. Energy �' cRecove ° l cycle, Wasted in the boiler. erauro. G - ..t HERE'S WHAT HAPPENS r" WHEN YOU NEED HEAT. The Digital Manager senses your thermostat(s) require ments, and turns on the burner. Within 90 seconds the boiler sends heat through each zone valve, into your home. When your thermostat is -_I satisfied, the Digital Manager turns off the burner. =— The Digital Manager then starts the unique Hybrid Energy Recovery' which pumps any heat that is remaining in the boiler back into your home. This transfer takes — --- about 20 minutes and guarantees that it will be longer before your thermostat needs to call for more heat. When the Digital Manager senses another call, the sequence begins again. The result: no heat is left wasted in the boiler. 0 Energy Kinetics' attention to detail. Our systems offer sophisticated zoned comfort for year-round enjoyment of every room in your home. Our Digital Managers control multiple zones and provide near endless hot water. This flexibility means you can control the energy used to heat unoccupied rooms while living areas stay cozy and comfortable. Zones also can be expanded in the future - to accommodate changing life styles or home renovations. BONus MONEY SAVER! Energy Kinetics systems can be Precise, expandable control to maintain comfort y levels in all areas of your home. installed with or without a chimney. Many homeowners, planning to save money by upgrading ,,, " -•'r , or converting to another fuel, sometimes find themselves up against a brick wall. the high cost of re-lining or repairing an aging chimney! But Energy Kinetics' revolutionary designs run clean and Paw Wb t relatively cool. This allows for safe venting directly through the wall, much like your clothes dryer venting system. This can save thousands of dollars on costly chimney upgrades. Expandable up to 15 zones You can also vent our 90+ Resolute'boiler up through any existing chimney with a cost effective polypropylene chimney lining system - there's no need for an expensive stainless steel liner! Or _ MComooseon airimm s —11 4 ^-I or scWhionel chimney lien , 1:= Vent connecu., .,. ..,/+.a..a..••"' can he eek-le.der and More! Install with or without • EnergyKinetics is represented b onl the a chimney. lent easily p Y Y through the sidewall or best heating professionals in your area. in any existing chimneys POLYPROPYLENE VENTING • Our factory direct Pro-Train"programs for Side wall vents remain For 90+Resolute installations installers and technicians mean you'll benefit cool to the touch! from the industry's leading technology. • Tech support includes both telephone service and website assistance and backup at: www.Energy Kinetics.com. m V I I Energy Featuring System 2000, Accel CS and 90+Resolute rya There's a versatile Energy Kinetics z3 configuration that's just right for you. i• z Energy Kinetics manufactures systems that are perfect for homes fueled by oil, natural gas or propane. There are models specifically designed for the smallest condominium to the largest estate. In addition, ask your heating representative for details about stackable configurations for closets and tight spaces, plus Accel CS' swimming pool and spa heaters. 90+Resolute" Natural Gas and Propane Multi Fuel Qilheat and Gas Condensing boiler with Hybrid Energy Recovery with Hybrid Energy Recovery a M La r SYSTEM 20000 EK3 STACKABLES MULTI BOILER ARRAY SMART SOLAR ESTABLISHED 1979 TANKS Ll'FETIME LIM�TE©WARRANTY ENERGY KJNET1CS Energy Kinetics: committed to quality and the finest warranty in the industry: Energy Kinetics'selection of high-efficiency • Residential lifetime limited warranty on pressure vessels hot water storage tank sizes can handle • Residential lifetime limited warranty on Digital Energy Managers the largest hot water requirements. Durable • 12-Year warranty on standard tanks glass-lined models provide high • Built with industry standard and factory direct parts performance operation. (See warranties for specific details.) (&The color yellow for heating boilers is a registered trademark of Energy Kinetics. m "I HAND CRAFTED 1+5 n BY AMERICANS FOR ® AMERICAN HOMES Iw,..., . Authorized Energy Kinetics Dealer: Energy Kinetics is an ENERGY STAR*Partner f and a leading manufacturer i of ENERGY STAR heating r equipment.@The color yellow -. for heating boilers is a registered • trademark of Energy Kinetics. ENERGY (� KINETICS Better Heating.Bigger Savings. 51 Molasses Hill Road,Lebanon,NJ 08833•(800)323-2066•Fax 1800)735-2066.visit:EnergyKinetics.ccim E IMM(DDNYYY) CERTIFICATE OF LIABILITY INSURANCEDAT04/121016 oa/1212016 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. 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 endorsements . PRODUCER CONTACT FEDERATED MUTUAL INSURANCE COMPANY NAMEPHONE HOME OFFICE: P.O. BOX 328 AIc No Eat):888-333-4949 CLIENT CONTACT CENTER A C No:507-446-4664 OWATONNA, MN 55060 EDORIEss•C IENTCON CE R INS C INSURERS AFFORDING COVERAGE NAIC# INSURER A:FEDERATED MUTUAL INSURANCE COMPANY 13935 INSURED 330-130-6 INSURER IS: WESTMORE FUEL COMPANY INCORPORATED INSURER C: 86 NORTH WATER STREET GREENWICH,CT 06830-5886 INSURER D: INSURER E: INSURER R£R F.: COVERAGES CERTIFICATE NUMBER:35 REVISION NUMBER:0 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. INSR TYPE OF INSURANCE DL SUSR POLICY NUMBER POLICY EFF POLICY EXP LTR _Ma! 1 W MID 1 Y LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $1,000,000 CLAIMS-MADE I X1 OCCUR DAMAGE TO RENTED $100,000 rence MED EXP(Any one person) $5,000 A N N 9062815 06/01/2016 06/01/2017 PERSONAL&ADV INJURY $1,000,000 F-P 'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 OLICY El JECT O LOC PRODUCTS-COMPIOP AGO $2,000,000 THER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMITMe accidentl $1,000,000 X ANY AUTO BODILY INJURY(Per person{ ALL OWNED SCHEDULED A AUTOS AUTOS N N 9062815 06/01/2016 06/01/2017 BODILY INJURY(Per accident) HIRED AUTOS NON-OWNED AUTOS PROPERTY DAMAGE Per lscino X UMBRELLA LIAR X OCCUR EACH OCCURRENCE $5,000,000 A EXCESSLIAB CLAIMS-MADE N N 9062816 06/0112016 06/01/2017 AGGREGATE $5,000,000 DED RETENTION WORKERS COMPENSATION X PER STATUTE T - AND EMPLOYERS'LIABILITY Y 1 ANY PROPRIETORWARTNERIEXECUTIVE EL.EACH ACCIDENT $500.000 A OFFICER/MEMBER EXCLUDED? NIA N 9917566 06/01/2016 06/01/2017 (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $500,000 It yes,describe under DESCRIPTION OF OPERATIONS below E.L DISEASE-POLICY LIMIT $500,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,I1 more space is required) CERTIFICATE HOLDER CANCELLATION 330-130-6 35 0 VILLAGE OF RYE BROOK SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 938 KING ST THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN RYE BROOK, NY 10573-1226 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE © 1988-2014 ACORD CORPORATION.All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD STATE OF NEW YORK WORKERS' COMPENSATION BOARD CERTIFICATE OF NYS WORKERS' COMPENSATION INSURANCE COVERAGE 1a. Legal Name &Address of Insured (Use street address only) tb. Business Telephone Number of Insured WESTMOREFUELCOMPANY INCORPORATED 330-130-6 (203)531-5656 86 NORTH WATER STREET GREENWICH, CT 06830-5886 1c. NYS Unemployment Insurance Employer Registration Number of insured Work Location of Insured (Only required if coverage is specifically limited to certain locations in New York State,i.e., 1 d. Federal Employer Identification Number of a Wrap-Up Policy) Insured or Social Security Number 06-0739367 2, Name and Address of the Entity Requesting Proof of Coverage 3a. Name of Insurance Carrier (Entity Being Listed as the Certificate Holder) Federated Mutual Insurance Company Village Of Rye Brook 35 3b. Policy Number of entity listed in box "la" 938 King St Rye Brook,NY 10573-1226 9917566 3c. Policy effective period 06/01/2016 to 06101/2017 3d. The Proprietor,Partners or Executive Officers are: included. (Only check box it all partners/officers included) ©all excluded or certain partners/officers excluded. This certifies that the insurance carrier indicated above in box "3" insures the business referenced above in box "1a" for workers' compensation under the New York State Workers' Compensation Law. (To use this form, New York (NY) must be listed under Item 3A on the INFORMATION PAGE of the workers' compensation insurance policy). The Insurance Carrier or its licensed agent will send this Certificate of Insurance to the entity listed above as the certificate holder in box"2". The insurance Carrier will also notify the above certificate holder within 10 days IF a policy is canceled due to nonpayment of premiums or within 30 days IF there are reasons other then nonpayment of premiums that cancel the policy or eliminate the insured from the coverage indicated on this Certificate. (These notices may be sent by regular mail.) Otherwise, this Certificate is valid for one year after this form is approved by the insurance carrier or its licensed agent, or until the policy expiration date listed in box "3c", whichever Is earlier. Please Note: Upon the cancellation of the workers' compensation policy indicated on this form, if the business continues to be named on a permit,license or contract issued by a certificate holder, the business must provide that certificate holder with a new Certificate of Workers' Compensation Coverage or other authorized proof that the business Is complying with the mandatory coverage requirements of the New York State Workers'Compensation Law. Under penalty of perjury, I certify that I am an authorized representative or licensed agent of the insurance carrier referenced above and that the named insured has the coverage as depicted on this form. Approved by: Renea Carroll (Print name of authorized representative or licensed agent of Insurance carrier) f...a+n.�-P.�... 05-17-2016 Approved by. (Signature) (Date) Title: Authorized Representative Telephone Number of authorized representative or licensed agent of insurance carrier: (888) 333-4949 Please Note: Only insurance carriers and their licensed agents are authorized to issue Form C-105.2. Insurance brokers are NOT authorized to issue it. C-105.2 Ed.09-07 wwwmcb.state.ny.us