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HomeMy WebLinkAboutMP19-070 . 19 VILLAGE OF RYE BROOK MAYOR 938 King Street, Rye Brook,N.Y. 10573 ADMINISTRATOR Jason A.Klein (914) 939-0668 Christopher J. Bradbury x8-w-w ryebrook.org TRUSTEES BUILDING&FIRE INSPECTOR Susan R.Epstein Steven E. Fews Stephanie J. Fischer David M.Heiser Salvatore W.Morlino CERTIFICATE OF COMPLIANCE August 9,2023 Allen Marks,Louise Marks&Robert Marks 9 Maple Court Rye Brook,New York 10573 Re: 9 Maple Court, Rye Brook,New York 10573 Parcel ID#: 135.66-1-78 This document certifies that the work done under Mechanical Permit #19-070 issued on 5/10/2019 for the installation of a new ductless system has been satisfactorily completed. Sincerely, Steven E. Fews Building&Fire Inspector /to QyE BRC�k. BUILDING DEPARTMENT UILDING 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 : ` -`"t.J DATE. C� U PERMIT .,5�1 "'I I� . l l7D ISSUED. IECT. BLOCK: LOT. LOCATION: 1 � � o"f- �J "' ` ' OCCUPANCY: ❑ Violation Noted THE WORK IS... 2 PASSED ❑ FAILED REINSPECTION ❑ SITE INSPECTION (Z ��Q 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 a 4 a i s N M M � s a N sY OC k Gs7IV Not i r' N 12 l am _ z 04% co.a Z •.• _ 1••� Z �^ Q Z � � F > ^ OC I•r -� a rA 0.. U G Z rn � .. La z BUIL IN��E�A/T_R, ;MENT MAY 2 2 2019 VIL E OF RYE POK 938 KIN ET RYE B ,NY 10573 (914)9� 939-5801 VILLAGE OF RYE BROOK I ' or BUILDING DEPARTMENT v n c. ELECTRICAL PERMIT APPLICATION Westchester County Master Electricians License Required FOR OFFICE USE ONLY L EP#: jq— ,P< f f Approval Date: MAY 2 3 2 19 Permit Fee: $ ' Approval Signature: Other: Disapproved: (fees are non-refundable) Application dated, is hereby made to the Building Inspector of the Village of Rye Brook NY, for the issuance of a Permit to install and/or remove electrical equipment, wiring, fixtures,or to perform other high or low voltage electrical work as per the detailed statement described below. The applicant & property owner, by signing this document agree that all electrical work performed will be g in conformance with all applicable Federal, State,County and Local Codes. 1.Address: l 44 9 P C f_ c�u� i SBL: 13, J. 1o6-1 7S Zone:Bdlo 2.Property Owner: C"[2A C-E k S [� oAddress: Phone#: S 18 -\\'(6 9 - /Z Q v Cell#: HI 7� 71 4 email: 3.Master Electrician: 11 Q Address: G 7 L,.� �-0�.✓ /��. Lic.#:J Phone#: Cell#: 1 Iq-4 It 7 -5-7S1 email:T(L&. L t t)�?63 Company Name: H2 M pia ✓ ELg-'_ Address: SAa� 4.Proposed Electrical Work/Fixture Count: (N ( (L (STATE OF NEW //YORK, COUNTY OF WESTCHESTER ) as: Su u n S Z'n q ,being duly sworn,deposes and states that he/she is the applicant above named,and does further (print name of individual signing as the applicant) " � state that(s)he is the legal owner of the property to which this application pertains,or that(s)he is the L-i C T�c_ for the legal owner and is duly authorized to make and file this application. (indicate architect,contractor,agent,attorney,etc.) The undersigned further states that all statements contained herein are true to the best of his/her knowledge and belief,and that any work performed,or use conducted at the above captioned property will be in conformance with the details as set forth and contained in this application and in any accompanying approved plans and specifications,as well as in accordance with the New York State Uniform Fire Prevention&Building Code,the Code of the Village of Rye Brook and all other applicable laws,ordinances and regulations. Sworn to before me this Sworn to before me this- a day of 20 day of ,20 ' Signature of Property Owner S gnature of Applicant -A o J n O_NCr c °� Print Name of Property Owner ame of A licant Notary Public Notary Public SHARI MELILLO Notary Public,State of New York No.01 ME6160063 Oualified in Westchester County Commission Expires January 29.20�Z1i19 .Westchester Rockland Electrical Inspection Services, Inc Phone: 914-347-3595 DO NOT WRITE HERE-FOR OFFICE USE ONLY 43 North Lawn Avenue fL �N Fax: 914-347-3596 \, Elmsford, NY 10523 -q BUILDING PERMITtjQ,, TEMP# DATE t� CITY OR VILLAGE ZIP CODE TOWNSHIP Cp�}pr F STREET ID NO. RgA4� POLE NUMBER 7 �n fV'l. CNa r i BETWEEN WHAT TWO CROSS STREETS IS PREMISES LOCATED? �W�'_ _ BUCK - ) OCCUPIA T4rf NAME BUILDING OCCUPANCY OWNER'S NAME AND ADDRESS CURRENT SUPPLIED BY FROM THEIR OFFICE WORK TELEPHONE NUMBER LIST BELOW ALL EQUIPMENT WHICH YOU INSTALLED NUMBER OF OUTLETS NO.OF FIXTURES& MOTORS HEATERS OFFICE USE LOCATION LAMP RECEPTACLES ONLY RE FLUO NO. SIDEWALL SWITCH INa�. H.P.EACH NO. WATTS EACH INSPECTION OUTSIDE BASEMENT 1^FL ni I . ----] 2-FL. 31FL VILLAGE OF R EEBE4-BUILD NG DE RMENT REMARKS:LIST OTHER ELECTRICAL DEVICES NOT SET FORTH ABOVE: (ri / 12 L / Cu ti, f AJJ-� THIS APPLICATION IS INTENDED TO COVER THE ABOVE LISTED ITEMS TO BE INSPECTED.IF AT ANY TIME OF INSPECTION ADDITIONAL ITEMS HAVE BEEN INSTALLED,YOU ARE AUTHORIZED TO MAKE THE INSPECTION AND ADJUST THE FEE FOR THE ADDITIONAL ITEMS INSPECTED AS PROVIDED BY THE APPLICANT.THE APPLICANT DECLARES THAT THERE IS NO OPEN APPLICATIONS FOR THE ABOVE WITH ANY OTHER INSPECTION COMPANY.WREIS,INC.IS NOT LISTING,LABELING,UNDERWRITING OR CERTIFYING ANY EQUIPMENT, MATERIALS OR DEVICES WHICH ARE PERFORMED BY OTHER CERTIFIED TESTING AGENCIES OR INSPECTION COMPANIES.THE APPLICANT,OWNER,OR AUTHORIZED AGENT AGREES TO ALL THE ABOVE TERMS AND CONDITIONS AS SET FORTH FOR THE APPLICATION. SIZE OF SERVICE FEEDERS CHARACTER OF WORK NEW❑ ADDITIONAL❑ EXPOSED❑ CONCEALED❑ MUST ENTER APPLICANTS IDENTIFICATION NUMBER l SERVICE ENTERS BUILDING OVERHEAD❑ UNDERGROUND❑ L1 1 t `�{/ v AVOID DELAYS BY GIVING FULL AND ACCURATE INFORMATION.ALL SPACE MUST BE FILLED IN OR APPLICATION MAY BE RETURNED. NAME OF COMPANY DATE OF APPLICATION SIGNATURE OF APPLICANT X STREET ADDRESS TELEPHONE NO. CITY OR POST OFFICE ZIP CODE LICENSE NO.WHEN APPLICABLE WESTCHESTER ROCKLANO ELECTRICAL INSPECTION 4VREI SERVICES,INC. BY THIS CERTIFICATE OF COMPLIANCE THE Westchester Rockland Electrical Inspection Services 43 North Lawn Ave, Elmsford, NY 10523 914-347-3595 (Office) 1 914-347-3596 (Fax) CERTIFIES THAT Upon the application of: Upon premises owned by: Homeowners Electric Grace Marks 67 Lincoln Avenue Pelham NY 10803 Located at: 9 Maple Ct, Rye Brook, NY 10573 Certificate Number: 591598 Section: 135.66 Block: 1 Lot: 78 BDC: Permit Number: EP:19-121 BP:19-070 A visual inspection of the electrical system at this premise described as a Residential occupancy, wherein the premises electrical system consisting of electrical devices and wiring, described below, located in/on the premises at: 9 Maple Ct, Rye Brook, NY 10573 El Basement ❑1st Floor ❑2nd Floor ❑3rd Floor ❑Garage ❑Attic ❑X Outside Other: Inspection was conducted in accordance with the NYS and NFPA 70-2017 International Electrical Code and detail of the installation, as set forth below, was found to be in compliance therewith on 6/11/2019 Name Quantity Rating Circuit Type A/C Condenser 1 This Certificate has been approved by Westchester Rockland Electrical Inspection Services. This certificate may not be altered in any way. This certificate is valid for work performed before date of inspection onl . %.01-1 1kta-1c—yv-o- n *- HFIFU ITSU - "'ems.,_ Hybrid Flex Inverter Submittal1 . III BTU Wall MountF Inverter Driven Heat Pump Job Name: Diitc: Location: Approval: Engineer: Construction: Submitted to: Unit#: Submitted by: Drawing#: Reference: General Features *Refrigerant Type R410A. -Removable air filter -Wired and wireless remote controllers -Program timer -Auto changeover •5 years standard parts warranty -Weekly timer -Eligible for 10 year or 12 year parts -- -Removable open panel warranty.See warranty statement -Super quiet operation for details. Wel Information Temperature Setting Range tporator.........................................................................ASU24RLF Cooling..........................................................64°F-90OF(18°C—32°C) idenser compatibility...AOU24RLXFW,AOU24RLXFW I,AOU24RLXFWH Heating..........................................................60DF-88°F(16°C-30°C) AOU36RLXFZ,AOU36RLXFZI,AOU36RLXFZH Enclosure AOU45RLXFZ,AOU48RLXFZ,AOU48RLXFZI Material...............................................................Galvanized Steel Sheet ectrical .........................................................208/230V AC Iph-60Hz Sound Pressure Level tilable Voltage Range...................................................208/230+/-10%Cooling iimum Circuit Ampacity..............................................................0.71 A High/Medium/Low/Quiet...............49 dB(A)/42 dB(A)/37 dB(A)/33 dB(A) I Load Amps........................................................................0.57 A Heating ut Power...............................................................................69 W High/Mediun3/Low/Quiet.............48 dB(A)/42 dB(A)/37 dB(A)/33 dB(A) fining Current.......................................................................0.53 A Dimensions aCl HxWxD urinal Cooling.................................................................24,000 Btu/h in.(mm).............................................................12-5/8 x 39-1/4 x 9(320098x228) In Motor Connection Pipe )e:DC.......................................................................Cross flow xl Liquid........................................................................ 1/4"in.(6.35 min) forOutput.............................................................................42 W Gas...........................................................................5/8"in.(9.52 mm) 1 Motor Protection.......................................off:302+27°F(150+150C) Method(Liquid/Gas).........................................................................Flare rflow Rate on:248+27°F(120+15°C)Drain hose )ling(High/Medium/Low/Quiet) Material..........................................................................PP+LLDPE 9 CFM(1,120 m3/h)/530 CFM(900 m3/h)/436 CFM(740 m3/h)/365 CFM(620 m3/h) Size............................................01/2(I.D.),05/8[012(I.D.),016 O.D.)] sting(High/Medium/Low/Quiet) Weight 47 CFM(1,00 m3/h)/530 CFM(900 m3/h)/436 CFM(740 m3/h)/365 CFM(620 m3/h) Net...............................................................................31 lbs.(14 kg) at Exchanger Gross..............................................................................40 lbs.(18 kg) pensions Accessories x W x D)in.(nun)........................15-7/8 x 33-3/4 x 1-1/16(378032x26.6) Wired Remote Controller...................................................UTY-RNNUM Pitch...........................................................Main 21 FPI/Sub 18 FPI Backlit Display..................................................................UTY-RVNUM ,vs x Stages.......................................................Main 2 x18/Sub 1 x4 Simple Remote Controller......................................................UTY-RSNUM e Type(Material)....................................................................Copper Dry Contact Wire Kit.......................................................UTY-XWZXZ5 )e(Material)............................................................................Aluminum Interface Kit..................................................................UTY-XCBXZ2 IntertekeETL Number ASU24RLF...................................................................91986 Fujigsa G 1 America.Inc. 353 Ran'46 West �a 9IV Favfiela NJ 07006 1r,a6.n,.,�e.,'e,m u.wumnag umlWl. ��1 Toll Fret: fickl.NJ 07004 a IN�.r lmgcanue ofW'F(_6.7')DR67`F(14N^(')M-R.0 �uu ua ,n of OT115<')DR7<T12191)M'R Fax:(971)83""7 g:Indv lmanalwe of lU`r 1'_I.11 r-)DR 39'F 115 r')WR,aM.u16wr 1mlpnamee of�l•f'1g tf'<')UR�f'F 16.1 I K'I N'H I Of 2 nph..+a��¢1]Sml.Ilnalu 4iBna�rcc:aa.iom)1(lmdv unil-1Mmr um1) rtuln Talc %.0v FUJITSU kA a/cyon *-HF1 Hybrrd Flex Inverter Dimensions: [Unit:in.(tnrn)] 39-5/16 (998) 0 N M 00 tj N i M 20-1/2 520 23-1/4 590 9 1(25) 28-3/8 721 (228) 3 2 � N M O NI _ m O 20-1/2 520 1-7/16 37) 13/16(20) 17-5116(439)\. Unit center 15-3/4(400) 5/8 16) 15-1/4(387) \ 9-9/16(243) 4-7/16(113) 11/16 x 7/16(18 x 11)hole 1 x 7/16(26 x 11)hole 1 x 7116 26 x 11)hole 11/16 x 7/16(18 x 11)hole 2-15/16(75) 6-11/16(170 5-1/8(130 2-15/16 75) 13/16 x 3/16 21 x 5):14holes 3/16 x 11116(5 x 18):14holes 13/1 (122) -3/4(172) \ 1/4(133 4-15 6 ) out I i ne of UNI T N N 1-3/4(44) N T .N I _ O O^i N j N I v w N c? cp I � N ( I --—————————— — J 1-3/16(30) p o3-1/8(80)hole 17-1/4(438) 15-5/8(397) e3-1/8(80)hole Piing inlet 39-3/8(1000).Unit size Piping nlet 3/16 x 1-15/16(5 x 50):3holes o3/16(5):55holes for tapping screw 1/2 x 3/16 13 x 5):4holes CO FUJITSU Fujitsu General America.Inc. Fujitsu logo is a registered trademark of Fujitsu Limited. 353 Route 46 West Halcyon logo and name is a trademark of Fujitsu General America.Inc.Copyright 2016 Fairfield,N107004 tsu General America,Inc. Toll Free: 1-888-888-3424 tsu's products are subject to continuous improvements. Fujitsu reserves the right to Fax:(973)836-0447 lify product design,specifications and information in this brochure without notice and 2 of 2 www.fu1itsuizeneral.com tout incurring any obligations. Aqueduct Services 115 Wall Street Date December 12, 2018 Valhalla NY 10595 914-666-9199 FAX:914-997-9800 PfOpOSaI# 216347-01 Customer ID 108196 Fujitsu 24K Single Zone Heat Pump & 36k Multi Zone 12/13/18 Billing Information Service at Louise (Daughter) Marks Louise (Daughter) Marks 9 Maple Ct 9 Maple Ct Port Chester NY 10573 Port Chester NY 10573 518-784-3047 518-784-3047 OptionA� liFujitsu Ductless • down to 5 degrees) -ASU24RLB 24,000 BTU wall mounted indoor unit installed in the bonus room above the garage ✓ -Necessary copper line set run on the exterior of the house -Vinyl Drainage Tubing -14/3 Outdoor wire from the heat pump to the indoor units -Ultra Lite Heat Pump Pad to set the heat pump on and protect the unit from the elements -White Line set covers on the exterior of the house Fujitsu 10 Year Compressor Warranty Fujitsu 5 Year Parts Warranty Aqueduct 1 Year Labor Warranty *An electrician is required to bring a 230 volt service to the heat pump on the exterior of the house $91 Monthly for 60 Months Total $4,759.00 Option B ,Fujitsu Ductless • down to-5 degrees) -ASU24RLF1 24,000 BTU wall mounted indoor unit installed in the bonus room above the garage ✓ -Necessary copper line set run on the exterior of the house -Vinyl Drainage Tubing -14/3 Outdoor wire from the heat pump to the indoor units -Ultra Lite Heat Pump Pad to set the heat pump on and protect the unit from the elements -White Line set covers on the exterior of the house Fujitsu 10 Year Compressor Warranty Fujitsu 5 Year Parts Warranty Aqueduct 1 Year Labor Warranty *An electrician is required to bring a 230 volt service to the heat pump on the exterior of the house $106 Monthly for 60 Months Total $ 5,531.00 Page 1 of 4 Aqueduct Services 115 Wall Street Valhalla NY 10595 Date December 12, 2018 914-666-9199 FAX:914-997-9800 Proposal# 216347-01 Customer ID 108196 Option C 'Fujitsu Ductless AOU24RLXFWH 19.5 SEER Heat Pump(Works down to -15 degrees) -ASU24RLF 24,000 BTU wall mounted indoor unit installed in the bonus room above the garage ✓ -Necessary copper line set run on the exterior of the house -Vinyl Drainage Tubing -14/3 Outdoor wire from the heat pump to the indoor units -Ultra Lite Heat Pump Pad to set the heat pump on and protect the unit from the elements -White Line set covers on the exterior of the house Fujitsu 10 Year Compressor Warranty Fujitsu 5 Year Parts Warranty Aqueduct 1 Year Labor Warranty *An electrician is required to bring a 230 volt service to the heat pump on the exterior of the house S110 Monthly for 60 Months Total $ 5,740.00 Option D �Fujitsu Ductless • . . degrees) -ASU24RLF1 24,000 BTU wall mounted indoor unit installed in the kitchen above the window ✓ -ASU7RLF1 7,000 BTU wall mounted indoor unit installed in the 2nd floor bedroom toward the rear of the home -ASU7RLF1 7,000 BTU wall mounted indoor unit installed in the 2nd floor bedroom toward the front of the home -Necessary copper line set and R-410A refrigerant run on the exterior of the house and through the basement -Vinyl Drainage Tubing -14/3 Outdoor wire from the heat pump to the indoor units -Ultra Lite Heat Pump Pad to set the heat pump on and protect the unit from the elements -White Line set covers on the exterior of the house Fujitsu 10 Year Compressor Warranty Fujitsu 5 Year Parts Warranty Aqueduct 1 Year Labor Warranty 'An electrician is required to bring a 230 volt service to the heat pump on the exterior of the house S240 Monthly for 60 Months Total $ 12,474.00 Page 2 of n Aqueduct Services 115 Wall Street Date December 12, 2018 Valhalla NY 10595 914-666-9199 FAX:914-997-9800 Proposal# 216347-01 Customer ID 108196 Option E Fujitsu Ductless AOU36RLXFZH Heat Purn p(Works down to -15 degrees) -AS024RLF1 24,000 BTU wall mounted indoor unit installed in the kitchen above the window ✓ -ASU7RLF1 7,000 BTU wall mounted indoor unit installed in the 2nd floor bedroom toward the rear of the home -ASU7RLF1 7,000 BTU wall mounted indoor unit installed in the 2nd floor bedroom toward the front of the home -Necessary copper line set and R-410A refrigerant run on the exterior of the house and through the basement -Vinyl Drainage Tubing -14/3 Outdoor wire from the heat pump to the indoor units -Ultra Lite Heat Pump Pad to set the heat pump on and protect the unit from the elements -White Line set covers on the exterior of the house Fujitsu 10 Year Compressor Warranty Fujitsu 5 Year Parts Warranty Aqueduct 1 Year Labor Warranty `An electrician is required to bring a 230 volt service to the heat pump on the exterior of the house S260 Monthly for 60 Months Total $ 13,563.00 Scheduling And Completion Of The Job Below is a list of items that may concern the timing and/or outcome of your job. Permits: We will submit an application for a permit to your municipality but we must wait to receive the permit before commencing work. In many cases the municipality will act quickly in the event of an emergency but this is entirely out of our hands. Some applications have to be notarized by the owner; we cannot file the application without this. Incomplete applications are not accepted. Inspections: Inspections must be completed by the municipality. The utility also requires inspections if natural gas is involved. The municipality and the utilities will schedule inspections so in many cases we cannot move on to the next phase of a job until the inspection has been completed. Con Edison or other utilities: If natural gas is involved a Request for Service must be filed by Aqueduct Services, we shall complete this. After the request is filed there is a series of forms that we have to submit. These forms are submitted as the job progresses. In some cases we cannot submit these forms until inspections by the building department are completed.After we complete all the paperwork required by the utility there is a series of steps and/or inspections that they must complete before the gas is turned on. It can be a matter of a few days to months especially if you require a new gas service or other equipment. Their scheduling is completely out of our hands. We will stay in contact with them to try and move things along. Delays: On any job, delays can happen. We try to avoid them but sometimes the wrong part is delivered, people call in sick, a truck can break down, etc. The municipality or the utility can also cause delays with their scheduling. Electricians: Many municipalities require a licensed electrician in order to issue a permit if the job requires one such as boilers, furnaces, air conditioning, etc. There is no provision in this proposal for the electrician fees and permits. We can put you in touch with one that we use or you can use your own electrician. We will coordinate timing with them so the job is not delayed (we have no control over their schedules). Excavation: If your job requires excavation there is no provision in this proposal for the excavator fees and permits. We can recommend one that we use or you can use your own excavator. We will coordinate timing with them so the job is not delayed (we have no control over their schedules). Please note that excavators may run into obstructions that may cause additional fees (large rocks, tree stumps, bury holes, underground utilities) so it is your responsibility to resolve this with your excavator. Our staff will do everything they can in order to keep your job running smoothly and in a timely manner. We will stay in touch with the building departments, utilities, and other contractors involved on your project. It is our desire that your project run smoothly and turns out to be a first-rate job Page 3 of 4 Aqueduct Services 115 Wall Street Date December 12, 2018 Valhalla NY 10595 914-666-9199 FAX: 914-997-9800 'Proposal# 216347-01 Customer ID 108196 Contract Terms The owner or agent for the owner is responsible for filling out all manufactures warranties, it is recommended that you complete this within 30 days of installation. If rebates are available the owner or agent for the owner is responsible for filing for all rebates whether it be manufacturers or third party such as a utility company. Any alteration or deviation from the above specifications involving extra costs, will be executed only on written orders, and will become an extra charge over and above the estimate. The owner is responsible for having fire and other necessary insurance upon the commencement of the above work. Workman's Compensation and Public Liability shall be taken out by Aqueduct Plumbing and Heating All material, fixtures, equipment, etc. supplied under this contract shall remain the property of Aqueduct Plumbing and Heating until full payment has been made. This proposal may be withdrawn by us if not accepted within 30 days. You the owner/general contractor have the right to cancel this transaction at any time prior to midnight of the third business day after the acceptance date below. Initial Payment Terms 1. Customer will be billed after indicating acceptance of proposal 2. Payment will be due as follows: -60% Upon Acceptance of Proposal -30%When Equipment is in place -10% Completion of Job 3. First payment shall be considered a legal and binding acceptance of this proposal and the above terms and conditions regardless if there is a signature below. 4. Any sums not paid when due shall accrue an interest rate of one and one half percent(1 '/z%) per month, eighteen percent per annum (18%) until paid. In the event it shall become necessary for this contractor to employ an attorney for the collection of sums due under this contract,the owner will be responsible for this contractor's reasonable attorney fees, court fees, and expenses incurred with the collection of the sums due under this contract. The undersigned submits themselves or itself(company, business, corporation, partnership, etc.)to the jurisdictions of thq courts of the State of New York, including the Westchester Supreme Court, Putnam County Supreme Court and to the local courts having jurisdiction over the location of the property on which the work described in this proposal took place. Trial by jury in any collection proceeding is waived. Please confirm your acceptance of this proposal by signing below and returning an executed copy to our office via e-mail or mail. If you have any questions or concerns please feel free to contact us. Thank You For Your Business! Accepted Option: Acceptance (Customer) Date Approval (Company) Date Page 4 of 4 A� CERTIFICATE OF LIABILITY INSURANCE �T04/ o4rzsrzo,s THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsements. PRODUCER CONTACT NAME: CLIENT CONTACT CENTER FEDERATED MUTUAL INSURANCE COMPANY PHOE HOME OFFICE: P.O. BOX 328 A CNNo Ext:888-333-4949 A/c No):507-4464664 OWATONNA, MN 55060 E-MAIL ADDRESS:CLIENTCONTACTCENTER FEDINS.COM INSURER(S)AFFORDING COVERAGE NAIC# INSURER A: FEDERATED MUTUAL INSURANCE COMPANY 13935 INSURED P78-487-4 INSURER B: AQUEDUCT PLUMBING AND HEATING OF PUTNAM INC INSURERC: 115 WALL ST VALHALLA, NY 10595-1456 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:80 REVISION NUMBER:0 TFIIS 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 SUER POLICY NUMBER POLICY EFF POLICY EXP LIMITS T INSR WVD MM/DDIYYYY MMIDDIYYYV X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $1,000,000 CLAIMS-MADE X❑OCCUR DAMAGE TO RENTED $100,000 PREMISES Ea occurrence MED EXP(Any one person) EXCLUDED A Y N 6065330 03/31/2019 03/31/2020 PERSONAL&ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 �.,OTHER: POLICY PRO- LOCPRODUCTS-COMPIOP AGG $2,000,000 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT accident $1,000,000 X ANY AUTO BODILY INJURY(Per person) A OWNED AUTOS ONLY AUT SOLED N N 6065330 03/31/2019 03/31/2020 BODILY INJURY(Per accident) HIRED AUTOS ONLY NON-OWNED PROPERTY DAMAGE AUTOS ONLY Per acciden X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $2,000,000 A I EXCESS LIAR CLAIMS-MADE N N 6065331 03/31/2019 03/31/2020 1 AGGREGATE $2,000,000 DED X RETENTION$10,000 WORKERS COMPENSATION PER STATUTE OTH- AND EMPLOYERS'LIABILITY Y N ER ANY PROPRIETOR/PARTNERIEXECUTIVE E.L.EACH ACCIDENT OFFICERIMEMBER EXCLUDED? N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE I!f yes.describe und^r DESCRIPTION OF OPERATIONS below E.L DISEASE-POLICY LIMIT I I p DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) THE CERTIFICATE HOLDER IS AN ADDITIONAL INSURED SUBJECT TO THE CONDITIONS OF THE ADDITIONAL INSURED - OWNERS, LESSEES �OR CONTRACTORS '- AUTOMATIC STATUS WHEN REQUIRED IN CONSTRUCTION AGREEMENT WITH YOU ENDORSEMENT FOR GENERAL LIABILITY. CERTIFICATE HOLDER CANCELLATION 278-487-4 80 0 VILJaGE 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 RYF BROOK, NY 10573-1226 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE © 1988-2015 ACORD CORPORATION.All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD YORK'I Workers' CERTIFICATE OF STATE Compensation ( Board NYS WORKERS' COMPENSATION INSURANCE COVERAGE 1a.Legal Name&Address of Insured(use street address only) 1 b.Business Telephone Number of Insured ADP TotalSource FL XVI, Inc. 914/666-9199 10200 Sunset Drive Miami,FL 33173 UC/F 1c.NYS Unemployment Insurance Employer Registration Number of Aqueduct Plumbing and Heating Of Putnam Inc. DBA Aqueduct Services Insured 115 Wall St 47353002 Valhalla,NY 10595 1d. Federal Employer Identification Number of Insured or Social Security Work Location of Insured(Only required if coverage is specifically limited to Number certain locations in New York State,i.e., a Wrap-Up Policy) 562324496 2.Name and Address of Entity Requesting Proof of Coverage 3a. Name of Insurance Carrier (Entity Being Listed as the Certificate Holder) New Hampshire Ins Cc Village of Rye Brook 3b.Policy Number of Entity Listed in Box"la" 938 King Street WC 047028133 Rye Brook,NY 10573 3c.Policy effective period 07/01/2018 to 07/01/2019 3d.The Preprietor,Partners or Executive Officers are ®included.(Only check box if all partners/officers included) ❑ all excluded or certain partners/officers excluded. This certifies that the insurance carrier indicated above in box"Y'insures the business referenced above in box"la"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"T'. The insurance carrier must notify the above certificate holder and the Workers'Compensation Board within 10 days IF a policy is canceled due to nonpayment of premiums or within 30 days IF there are reasons other than 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. This certificate is issued as a matter of information only and confers no rights upon the certificate holder.This certificate does not amend,extend or alter the coverage afforded by the policy listed,nor does it confer any rights or responsibilities beyond those contained in the referenced policy. This certificate may be used as evidence of a Workers'Compensation contract of insurance only while the underlying policy is in effect. Please Note: Upon 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 it 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 OF lieensed agent of the insurnnee earrier referenced above and that the named insured has the coverage as depicted on this form. Approved by: Adriana Sanchez (Print name of authorized repr tative or licensed a of insurance carrier) Approved by: _ 4/25/2019 (Signature) (Date) Title: Account Specialist II Telephone Number of authorized representative 800-743-8130 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(9-17) www.wcb.ny.gov