Loading...
HomeMy WebLinkAboutMP14-157 �yE DR Eta duo�J V VILLAGE OF RYE BROOK MAYOR 938 King Street, Rye Brook,N.Y. 10573 ADMINISTRATOR Jason A. Klein (914) 939-0668 Christopher J.Bradbury www.!yebrookny.gov TRUSTEES BUILDING &FIRE INSPECTOR Susan R. Epstein Steven E. Fews Stephanie J. Fischer David M. Heiser Salvatore W. Morlino CERTIFICATE OF COMPLIANCE September 10,2024 Roberto Macias&Patricia Iorfino 34 Tamarack Road Rye Brook,New York 10573 Re: 34 Tamarack Road, Rye Brook,New York 10573 Parcel I D#: 135.60-1-1 This document certifies that the work done under Mechanical Permit#14-157 issued on 11/18/2014 for the installation of a new gas fired hot water heater has been satisfactorily completed. Sincerely, Steven E. Fews Building&Fire Inspector /to �yE BRC��. O� Z� cu � 1982 BUILDING DEPARTMENT ❑BUILDING INSPECTOR ASSISTANT BUILDING INSPECTOR VILLAGE OF RYE BROOK ❑CODE ENFORCEMENT OFFICER 938 KING STREET • RYE BROOK,NY 10573 (914) 939-0668 FAx (914) 939-5801 www.ryebrook.org - - - - - - - - - - - - - - - - - - - - INSPECTION REPORT - - - - - - - - - - - - - - - - - -- - ADDRESS : ! A &l A Q A C L P 1: H DATE: ? �c,oZ S/ PERMIT# m P 1 y- /S" 7 ISSUED: /L _- 1 ECT: 3 , BLOCK: LOT: / LOCATION: J 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 ❑ L.P. GAS ❑ FUEL TANK ❑ FIRE SPRINKLER ❑ FINAL PLUMBING ❑ CROSS CONNECTION ❑ FINAL ❑ OTHER Ln r, 00 = D � d, ai ,p ►. Ofl co 06, c ,o a a 00 R EC ENE VILLA46E OF RYIE BROOK .0 BUILDING DEPARTMENT NOV 17 20% 938 KING STREET YE It�K,NY 10573 VILLAGE OF RYE BROOK (914)939-0668 FA�L,(911 t32 - www.r ebrook.o BUILDING DEPARTMENT APPLICATION FOR PERMIT TO INSTALL AND/OR REMOVE HEATING, VENTILATION AND/OR AIR CONDITIONING EQUIPMENT Permit#: P I `4—1,51 Building Inspector: Fee Paid: l Date of Approval: NOV r9 1014 Parcel ID#: Bldg/Use Class: Res. (-4/, Comm. ( ); REQUIREMENTS FOR RELEASE OF PERMIT&CERTIFICATE OF COMPLIANCE: 1. Properly Completed& Signed Application. 2. Site/Staging Plan if required by the Building Inspector. 3. Copy of Licensed Contractor's Insurance including Liability&Workers Compensation naming the Village of Rye Brook--m-CeT to Holder. 4. Payment of Fees/Um esidential: $75.00, Co ercial: $250.00. (fees are non-refundable) 5. Inspection by Builds ig Department for removal and/or installation. (48 hour notice required) 6. Any electrical work requires a separate Electrical Permit and Electrical Inspection. 7. Any gas/plumbing work requires a separate Plumbing Permit and Plumbing Inspection. Application is hereby made to the Building Inspector of the Village of Rye Brook for the approval of a permit for the installation and or removal of the HVAC equipment as listed below. The applicant, by signing this document agrees that said equipment will be installed and/or removed in conformance with all applicable Local, County, State& Federal laws, codes,rules and regulations. ;1 1. Site Address: , V-1�t�1^ez4Clzj l b 2. Property Owner& Phone: �_JU/)V,G6EL — ('9/0 957 3. Applicant: 4. Contractor name, address, contact phone: &U&I/ CAWIP/S/ Iti'4 . ' /9 06F&401�) D,OJVF- /�)( 9V6 5. Scope of Work: New Installation( ); Replacement( ; Removal ( ); Other( ) 6. Type of Equipment: 46- 45 LZ_QA J 4/K)/Z ,67U 1&7— &,V1 TE_2 tZ_E 2 . 7. Location of Equipment: 1 8. Applicant Signature: V Date: t - ( U - �L4 6.1.12 BRADFORD WHITE W A T E R H E A T E R S Residential Atmospheric Vent Energy Saver Gas Water Heater The Atmospheric Vent FVIR Defender Safety System"Models Feature. L ■ Bradford White ICON System'"—Intelligent gas control with proven millivolt powered technology and built-in piezo igniter. A standard,off the shelf thermopile converts heat energy from the pilot flame into electrical energy to operate the gas valve and microprocessor. No need for external electricity. - Enhanced Performance—Proprietary algorithms provide enhanced First Hour Delivery ratings and tighter temperature differentials. -Advanced Temperature Control System—Microprocessor constantly a -'s monitors and controls burner operation to maintain consistent and accurate water temperature levels. -Intelligent Diagnostics—An exclusive green LED light prompts the installer during start-up and provides ten different diagnostic codes to assist in troubleshooting. - Pilot On Indication—Flashing green LED provides positive indication that pilot is on. -Separate Immersed Thermowell—High strength advanced polymer composite thermowell provides isolation between electric temperature sensor and surrounding water. No need to drain the tank when removing gas valve. ■ Advanced ScreenLok®Technology Flame Arrestor Design—Flame arrestor is designed to prevent ignition of flammable vapor outside of the water heater. ■ Resettable Thermal Switch—Proven and reliable bimetallic switch prevents burner and pilot operation in case of ongoing flammable vapor burn inside of the combustion chamber or restricted air flow. ■ Maintenance Free—No regular cleaning of air inlet openings or flame arrestor is required under normal conditions. ■ Sight Window—Offers a view into the combustion chamber to observe the a , operation of the pilot and burner. ■ Factory Installed Hydrojer Total Performance System—Cold water inlet I sediment reducing device helps prevent sediment build up in tank.Increases first hour delivery of hot water while minimizing temperature build up in tank. ■ VitraglasO Lining—Bradford White tanks are lined with an exclusively engineered enamel formula that provides superior tank protection from the highly e� corrosive effects of hot water.This formula(Vitraglas")is fused to the steel surface by firing at a temperature of over 1600oF(871°C). ■ 1" Non-CFC Foam Insulation—Covers the sides and top of tank, reducing the _. amount of heat loss. This results in less energy consumption,improved operation efficiencies and jacket rigidity. Photo is of ■ Pedestal Base. M-I-5036FBN ■ Water Connections-314" NPT factory installed true dielectric fittings. ■ Factory Installed Heat Traps. FEATURING::- ■ Protective Magnesium Anode Rod. ■ 3x4"Snap Lock" Draft Diverter—Allows either 3" or 4"vent connections with IcoN _ inputs of 40,000 BTU/Hr or less. Over 40,000 BTU/Hr. has the 4" "Snap Lock" Draft Diverter. ^^System " �! ■ T&P Relief Valve—Included. ��dr}� t*vpi'� 1<~ - ■ Low Restriction Brass Drain Valve—Durable tamper proof design. As RW, a� ji 6 or 10-Year Limited Tank Warranties/6 or 10-Year Limited Warranty on Component Parts. For more information on warranty,please visit www.bradfordwhite.com L For products installed in USA,Canada and Puerto Rico.Some states do not allow limitations on warranties.See complete copy of the warranty included with the lieater. MANUFACTURED UNDER ONE OR MORE OF THE FOLLOWING U.S.PATENTS:5,954,492:5,761,379:5.943,984.5.081,696,5,988,117:6.142,216:5,199.385:5.574,822;5.372,185:5,485,879;5,277,171, (81)5,341.770:5.660,165:5,596.952,5.682,666;4.904.428,5,023.031,,5.000,893.4,669,448;4.829,983:4,808,356;5,115,767:5,092.519;5.052,346:4,416,222;4,628.184;4,861,968:4,672.919;Re.34,534; 7,270,087 82.OTHER U.S.AND FOREIGN PATENT APPLICATIONS PENDING.CURRENT CANADIAN PATENTS:1272,914:1,280,043:1.289,832:2.045,862;2,112.515:2108,186:2.107,012:2.092,105:2.409.271. Defender Safety System•,Screent.01,Vitragias"and Hydrolet•are registered trademarks of Bradford White'Corporation. 101-B-0213-A Residential Atmospheric Vent Gas Water Heater Energy Saver Models Meet or exceed ASHRAE 90.1b(current standard)C.E.C.Listed NATURAL GAS AND LIQUID PROPANE GAS 79%Recovery Efficiency Capacity Recovery A B C D E F Approx. Model 90°F Rise Floor to Jacket Vent Floor to Floor to Floor to Shipping Number Flue Dia. Size T&P Gas Water Weight S. V. Nat. LP Nat. Nat. LP LPp Conn. Conn. Conn. Conn. Gal. Gal. Bi p/Hr. Bi p/1r GPH GPH- GP i GPH in. in. in. in. in. in. lbs. M-I-30T6FBN9 30 25 32,000 31,000 33 28 32 27 59A 16 3x4 49%/56x 1 13 57'r.". 104 M-I-30S6FBN 30 25 30,000 26.000 31 26 27 23 48% 18 3x4 38Y 13 46% 100 M-1-303T6FBN• 29 24 40,000 35,000 42 34 37 31 58 16 3x4 49Y/55Y 13 56Y 109 M-I.40T6FBN• 40 33 40,000 36.000 42 34 38 32 5914 18 3x4 50/56% 13 57Y 120 M-1.403S6FBN• 40 33 40,000 38,000 42 34 40 33 50 20 3x4 41147Y 13 48% 128 M-1-404T6FBN• 40 33 50,000 48.000 53 44 50 42 60'/4 18 4 51X/58 13 589 127 M-1-5036FBN• 50 42 40,000 36.000 42 34 38 32 59% 20 3x4 50/67 13 58 145 M-1-501-6FBN 48 40 40,000 38,000 42 34 40 33 49% 22 3x4 40'! 13 48% 153 M-1.504S6FBN• 50 42 50,000 48,000 53 44 50 42 58/ 20 4 50/55Y 13 57 150 M-1-60T6FBN 60 50 40,000 38,000 42 34 40 33 601: 1 22 3x4 50X� 1 13 1 58% 166 Capacity Recovery A B C 0 E F Approx. Model 50"C Rise' Floor to Jacket Vent Floor to Floor to Floor to Shipping Number Five 013. Size T&P Gas Water Weight Nat. LP Nat. LP Conn. Conn. Conn. Conn. kW kW Liters/ Liters/ Liters Input Input Hour Hour mm. mm. mm. mm. mm. mm. kg. M-1-30T6FBN• 114 9.4 91 125 121 1502 406 76002 1264/1432 1 330 1461 47 M-1-30S6F8N 114 8.8 7.7 117 102 1229 457 76xl02 9841 330 1187 45 M-1303T6FBN• 110 11.7 10.3 159 140 1473 406 76z102 1264/1403 330 1435 49 M-1.40T6FBN6 151 11.7 10.6 155 140 1508 457 76xl02 1270/1438 330 1467 54 M-1.403S6FBN• 151 11.7 11A 155 148 1270 508 76xl02 1041/1200 330 1232 58 M-1.404T6FBN• 151 14.7 14.1 201 189 1543 457 102 1308/1473 330 1486 58 M-1-5036FBN• 189 11.7 10.6 159 144 1514 508 76x102 1270/1445 330 1473 66 M-1-50L6FBN 182 11.7 11.1 159 151 1264 559 76xl02 1029 330 1226 69 M-1.504S6FBN• 189 14.7 14.1 201 189 1486 508 102 1270/1416 330 1448 68 M-1-60T6FBN 227 11.7 11.1 163 151 1543 609 76xl02 1282 330 1480 75 Propane models feature a Titanium Stainless Steel propane burner.For Propane(LP)models change suffix"BN"to"SX". YI For 10 year models,change suffix from"6"to"10". 'Based on manufacturers rated recovery efficiency. •Models feature optional top T&P location and must be specified when ordering. Note:M-I-30S.M-I-50L and M-1-60T do not have top T&P option. 14-7 a F D• A Optional Top T&P eOe Valve Location • 1 IE i Meets NAECA Requirements •"D"dimension listed as side/top. General All gas water heaters are certified at 300 PSI test pressure(2068 kPa)and 150 PSI working pressure(1034 kPa).All water connections are''/"NPT(19mm) on 8"(203mm)centers.All gas connections are%"(13mm). All models design certified by CSA International(formerly AGA/CGA),ANSI standard Z-21.10.1 and peak performance rated. Dimensions and specifications subject to change without notice in accordance with our policy of continuous product improvement. Suitable for Water(Potable)Heating and Space Heating. Toxic chemicals,such as those used for boiler treatment,shall NEVER be introduced into this system.This unit may NEVER be connected to any existing heating system or component(s)previously used with a non-potable water heating appliance. BR"ORD MITE' W A T E R H E A T E R S Ambler,PA For U.S.and Canada field service,contact your professional installer or local Bradford White sales representative. Sales 800-523-2931•Fax 215-641-1670/Technical Support 800-334-3393•Fax 269-795-1089•Warranty 800-531-2111 a Fax 269-795-1089 International:Telephone 215-641-9400•Telefax 215-641-9750/www.bradfordwhite.com BRADFORD*MITE-CA.NADA'INC. Sales/Technical Support 866-690-0961/905-238-0100•Fax 905-238-0105/www.bradfordwhite.com Built to be the BeStTM r02013,Bradford White Corporation.All rights reserved. 101-B-0213-A Printed in U.S.A. Westchester County Board of Plumbing Examiners Westchester County Clerk's Office Master Plumbing License 2014 Frank Campisi p. Height: 5'07 Weight: 175 Hair: Brown Eyes: Brown Company: �.. Bruni and Campisi Pig and Htg 199 Ridgewood Drive I Elmsford, NY 10523 License No.: 2 y Expires on: 12/31/2014 John Royce NEW YORK STATE Commisslondlf Motor Yahlolan DRIVER LICENSE, ID: 275 434 676 CLASS D v r- CAMPISI FRANK 38 COTSWOLD DR NORTH SALEM NY 10560 DOB: 03-03-48 SEX. M EYES BR HT 5-06 E NONE B SSUED 02-19-13 03 D3 21 113PFL3UADS Aco CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYYY) 02/12/2014 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 endorsement(s). PRODUCER 914-738-9297 CONTACT Meridian Risk ManagementPH _ Meridian Risk Management ONE.Extl: 914-738-9297 [,vcNOIL E-MAIL - PO Box 8419 INSURER(S)AFFORDING COVERAGE - - NAIC/ Pelham, NY 10803 _ INSURERA:Merchants Preferred Insurance Co INSURED INSURER B:Merchants Mutual Insurance Co Bruni &Campisi Plumbing & Heating Inc. INSURERC:_ _ 199 Ridgewood Drive INSURERD:__ Elmsford, NY 10523 INSURERE: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: 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 ADDL SUBR POLICY EFF , POLICY UP' LTR POLICY NUMBER MMIDDIYYYY MM/DDIYYYY LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1000000 A ___ 7 DAMAGE TO RENTEO CLAIMS-MADE ✓�OCCUR PREMISES Ea occurrence) $ 100,000 _ CMP9152330 02/16/2014 02/16/2015 MEDEXP(Any oneperson) s5000 PERSONAL&AOV INJURY S1,000.000 GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE s 2,000,000 POLICY PRO- JECT l� l [I LOC PRODUCTS-COMPIOPAGG s2,000,000 OTHER s BIN B AUTOMOBILE LIABILITY EO a�GdE�DISINGLE LIMIT 11,000,000 - ✓ ANY AUTO BODILY INJURY(Per person) $ ALL OWNED ✓ SCHEDULED AUTOS AUTOS CAP9267382 02/1612014 02/16/2015 BODILY INJURY(Per accident) $ ✓ HIRED AUTOS ✓ NON-OWNED PROPERTY DAMAGE $ AUTOS fPer accidentl_— _--- a ✓ UMBRELLA LIAR OCCUR EACH OCCURR_E_NC_E_ _ s 5,000,000 B ExcessuAe 02/16/2014 02l1612015 _ CLAIMS-MADE CUP9143430 AGGREGATE_ __ _ s 5,000,000 1111 L.-'--- DED___?✓ RETENTION$ 10,000 s WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY _YIN STATVrE -_ ER __ ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT s OFFICER/MEMBER EXCLUDED ❑ N I A I — --- (Mandatory In NH) E L DISEASE-EA EMPLOYEE$ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT I S DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Certificate Holder is listed as an Additional Insured. CERTIFICATE HOLDER CANCELLATION Village of Ryebrook 938 King Street SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Rye Brook, NY 10573 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Y ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Joseph Solimine ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD 14 STATE OF NEW YORK WORKERS' COMPENSATION BOARD CERTIFICATE OF NYS WORKERS' COMPENSATION INSURANCE COVERAGE I a 1-eaal Namc and:lddress of Insured(Use street address only lb Business Telephone Number of Insured Bruni and Campjsj Plumbing And Heating inc (914)946-5558 199 Ridgewood Drive Ic NYS Unemployment insurance F.niployer Registration Elmsford, NY 10523 Number of Insured 3 Work Location,of Insured(Onhy required if coverage is specrficalIi' i t d Federal Employer Identification Number of insured Limited to certain locations iu Neni )ork Srare. I e a 11"rap-tip Policy) 1 3-2 99964 6 2 Name and Address of the Entity Requesting Proof of 3a Name of Insurance Carrier Coverage(Entit) Being Listed as the Certificate Holder) State Fund 9455 VILLAGE OF RYF.BROOK 3b Policy Number of entity listed in box"la". 938 KING STREET 22331243 RYEBROOK,NY 10573 3c Policy effective period 511/2013 to 5/1/2015 3d 1'he Proprietor.Partners or Executive Officer are ❑ Included (Only check box it all partnersiofficers include) ❑X all excluded or c.rtain partners;,(beers excluded This certifies that the insurance carrier indicated above in box'3' insures the business referenced above in box"Id for workers' compensation under the New fork State Workers' Compensation Law (To use this form, Neu York (NY)must be listed under Item 3A oil 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"T' The hourance C'arner iivll also nottrj the above ceriificaie bolder within 10 dgrs IF a polio is canceled due to nonpcowient of piemmnrs or nvthin 30 dgrs IF Ihere are reasons other than nonpa)uient of preiruinns that cancel the polio or elunrrate the insured from t the coverage indicated on is Certificate (These notices mar be.sent Fi regrilar marl 1 Othen,Ise,this Certificate is valid jor a maxinium of are tear after this form is approved by the insurance carrier or its licensed agent,or until the policy e_spiratiou date listed in box"A.,",whichever is earlier. Please Note:Upon the cancellation of the workers'compensation polio}indicated on this form,if the business continues to be named on a permit,license or contract issued b) 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 mandator}coverage requirements of the New fork State Yorkers'Compensation Law. Under penalt) of perjur),I certify that I out 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 Keevily Spero Whitela%%.Inc (Print name of authori7ed representative or licensed agent of insurance carrier) Approved by "—,7--7 V:�- April 24, 2014 (Signature) (Date) Title: President Telephone Number of authorized representative or licensed agent of insurance carrier (9 Ed)381-55(i Please Note:Oil) Insurance arriers and their licensed agents are authorced to Issue Form C403. lnsurnnce brokers are AWT ourhorr-ed to use it C-105.'-f9-071 ResclSc New York State Insurance Fund Workers'Compensation& Disability Benefits Specialists Since 1914 199 CHURCH STREET,NEW YORK,N Y 10007-1100 Phone:(888)997-3863 CERTIFICATE OF WORKERS' COMPENSATION INSURANCE ^A A^A^ 132999646 KEEVILY,SPERO•WHITELAW INC. 500 MAMARONECK AVENUE HARRISON NY 10528 POLICYHOLDER CERTIFICATE HOLDER BRUNT AND CAMPISI PLUMBING AND VILLAGE OF RYEBROOK HEATING ,INC. 938 KING STREET 199 RIDGEWOOD DRIVE RYE BROOK NY 10573 ELMSFORD NY 10523 POLICY NUMBER CERTIFICATE NUMBER PERIOD COVERED BY THIS CERTIFICATE DATE G 2233 124-3 215820 09/15/2012 TO 05/01/2015 2/1012014 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE NEW YORK STATE INSURANCE FUND UNDER POLICY NO 2233124-3 UNTIL 05101/2015. COVERING THE ENTIRE OBLIGATION OF THIS POLICYHOLDER FOR WORKERS' COMPENSATION UNDER THE NEW YORK WORKERS' COMPENSATION LAW WITH RESPECT TO ALL OPERATIONS IN THE STATE OF NEW YORK, EXCEPT AS INDICATED BELOW. IF SAID POLICY IS CANCELLED,OR CHANGED PRIOR TO 05/01/2015 IN SUCH MANNER AS TO AFFECT THIS CERTIFICATE, 30 DAYS WRITTEN NOTICE OF SUCH CANCELLATION WILL BE GIVEN TO THE CERTIFICATE HOLDER ABOVE. NOTICE BY REGULAR MAIL SO ADDRESSED SHALL BE SUFFICIENT COMPLIANCE WITH THIS PROVISION THE NEW YORK STATE INSURANCE FUND DOES NOT ASSUME ANY LIABILITY IN THE EVENT OF FAILURE TO GIVE SUCH NOTICE. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS NOR INSURANCE COVERAGE UPON THE CERTIFICATE HOLDER THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICY NEW YORK STATE INSURANCE FUND DIRECTOR,INSURANCE FUND UNDERWRITING This certificate can be validated on our web site at htfps:/(www.nysif.com/certicerlval asp or by calling(888)875-5790 VALIDATION NUMBER 107529507 U-26 3 590/CD54670-20/1413