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HomeMy WebLinkAboutBP21-048PERMIT # a_ l -o`Z U DATE: 311 a� IXP• 3 J� SECTION 3 BLOC LV 1 TYPE OF WORK a /i a s JOB LOCATION 17e e Pr OWNER �l P/• .$ L<l /a0I !- �l/�� D EST. COST � FEE e FEE t D DATE �CO # C� # FEE DATE - TCO DATE FOOTING FOUNDATION FRAMING RGH FRAMING INSULATION PLUMBING RGH PLUMBING GAS SPRINKLER 0 ELECTRIC LOW -VOLT ALARM � LT J INALI INSP �aecoMoC9/4J) 93 7' `V c 9 OTHER APPROVALS ARB BOT PB ZBA OTHER DR t� . 19 VILLAGE OF RYE BROOK MAYOR 938 King Street, Rye Brook,N.Y. 10573 ADMINISTRATOR Jason A. Klein (914) 939-0668 Christopher J. Bradbury www.ryebrook.org TRUSTEES BUILDING& FIRE INSPECTOR Susan R. Epstein Steven E. Fews Stephanie J. Fischer David M. Heiser Salvatore W. Morlino CERTIFICATE OF COMPLIANCE November 3,2023 Ray Vollmer&Laura Bandler-Vollmer 7 Pine Ridge Road Rye Brook,New York 10573 Re: 7 Pine Ridge Road, Rye Brook,New York 10573 Parcel ID#: 135.41-1-54 Building Permit#21-048 issued on 3/15/2021 for Replacement Windows This certifies that the thirteen new windows,installed under the above captioned permit has been satisfactorily completed. Sincerely, Steven E. Fews Building&Fire Inspector /to D (� 1/7 - Dcc� �, For office use nl : n BUILDING iIE�A�tTMENT PER # -D�c� SEP ' 5 2023 VILLAGE OF RYE BROOK ISSUED: 3—/ —3/ 38 KING STREET,RYE BROOK,NEw YORK 10573 DATE: VILLAGE OF RYE BROOK (914)939-0668 FEE: 0 //n_ PAm-N BUILDING DEPARTMENT wwpv, reo>taere APPLICATION FOR CERTIFICATE OF OCCUPANCY,CERTIFICATE OF COMPLIANCE, AND CERTIFICATION OF FINAL COSTS TO BE SUBMITTED ONLY UPON COMPLETION OF ALL WORK, AND PRIOR TO THE FINAL INSPECTION i►\►►tttttttttttttt►I►►►►•►■■tt\•tttttittt►•►tttttttit►►ttt\\/tt►1►\\\\►tt\•\\ttttttttt►•ttt►tttt►ttt•t►tttttittttttttittt►t\ Address: Occupanc /Use: / � P c �el ID#: ���� /"—�—S Zone: Owner: Address: P.E./R.A. =ontractor:Gn)De— Address: 7 /t° ct Person in responsible charge: axr-7 Address: Application is hereby made and submitted to the Building Inspector of the Village of Rye Brook for the issuance of a Certificate of Occupancy/Certificate of Compliance for the structure/construction/alteration herein mentioned in accordance with law: STATE OF NEW YORK,COUNTY OF WESTCHESTER as: A',- e/ being duly sworn,deposes and says that he/she resides at 66i AL Tint Name of Appl'cant) l/ (No.and 0 in ,in the County of Abe C/e7- in the State of� that (City/Town/Village) he/she has supervised the work at the location indicated above,and that the actual total cost of the work,including all site improvements, labor,materials,scaffolding,fixed equipment,professional fees,and including the monetary value of any materials and labor which may have been donated gratis was:$ for the construction or alteration of Deponent further states that he/she has examined the approved plans of the structure/work herein referred to for which a Certificate of Occupancy/Compliance is sought,and that to the best of his/her knowledge and belief,the structure/work has been erected/completed in accordance with the approved plans and any amendments thereto except in so far as variations therefore have been legally authorized,and as erected/completed complies with the laws governing building construction.Deponent further understands that it shall be unlawful for an owner to use or permit the use of any building or premises or part thereof hereafter created,erected,changed,converted or enlarged,wholly or partly,in its use or structure until a Certificate of Occupancy or Certificate of Compliance shall have been duly issued by the Building Inspector as per§250-10.A.of the Code of the Village of Rye Brook. Sworn to before me this Sworn to before me this day of , 20 day of , 20 i Signature o erty Owner Signature of Applicant Print me of Property Owner / �nr Print Name of Applicant Notary Pub' Notary Public GREGORY K RIVERA Notary Public,State of New York 8/12/2021 No.01 RINN 396 QuaBfkd In Westchester County Con�nt'kslon Expires September 26,20� �E BR(�k, 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 : I DATE: _� 4-? PERMIT# �� � L_ 1 l �q � ISSUED:^ ,J1' SECT: BLOCK: LOT LOCATION: z,::R—� OCCUPANCY: 7 1 ❑ Violation Noted THE WORK IS... JLI PASSED El FAILED 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 100West 7th Street•Bayonne NJ 07002 ACKNOWLEDGEMENT Proof/NO BM Phi 800.631.3400 • 201.437A300 I E=800.758.7528 • 201.437.4533 455303 ,. www.Idw1w1ndowrcm IDEAL WINDOW Our name sags it allf AWVW us an ' "? Page 1 of 2 Customer Service Hours: Mon - Fri 8:30AM - 4:30PM SHIP TO DOUBLE R ALL HOME IMPROVEMENT DOUBLE R ALL HOME IMPROVEMEN 439 WILLETT AVENUE 439 W!LLETT AVENUE PORT CHEST ER NY 10573 PORT CHESTER NY 10573 Phone 914-937-4279 FAX 914-937-4172 Sism Gone Acctk Customer?.'0 t-r Est. Ship Date TERMS INVOik�. 4 UB 134672 VOLMER 02/04/2021 NET 30 45530v Line# Ouant. Description Price T.. I ' I 5 Linen, DH, MAJESTIC ��/ 215.95 W-27.750 x H-49.500 Finish W-27.750 x H49.500 Oper:D, H Scr, ESM Pkg, Foam, Dbl.Low/E [MAX],,Arg, S Ang &H Exp, DS Glass, D Lock, Linen Regular Limit Latch, Shd Grv, S St!Sper 2 Linen, DH, MAJESTIC 215.95 W-27.750 x H-37.500 Finish W-27.750 x H-37.500 Oper:D, H Scr, ESM Pkg, Foam, Dbl.Low/E [MAX],Arg, S Ang & H Exp, DS Glass, D Lock, Linen Regular Limit Latch, Shd Grv,S St!Sper l , ! 2 Linen,DH, MAJESTIC / 234.45 W-27.750 x H-61.500 Finish W-27.750 x H-61.500 V Oper:D, H Scr, ESM Pkg, Foam., Dbl.Low/E[MAX],Arg, S Any &H Exp, DS Glass,D Lock, Linen Regular Limit Latch, Shd Grv,S Stl Sper Linen, DH, MAJESTIC � 207.22 W-23.750 x H-37.500 Finish W-23.750 x H-37.503 Oper:D, H Scr, E Elite Pkg, Foam,Low/E+Obscure Lower,Arg, S Ang &H Exp, DS Glass,S Lock Linen, Regular Limit Latch,Shd Grv, S Sti Sper 3 Linen, DW 112 Lt,Slider 125.78 W-30.750 x H-18.000 TTT W-30.750 x H-18.000 Oper:LR, H Scr, Low/E,Arg; H Exp, S Ana S Lock 3 FRAMES(s) D (� � �� V 6 INSERTS �C, `"/ 3D ' MAR 12 2021 Please Check Revised Dehvery Date_ VILLAGE OF RYE BROOK BUILDING DEPA4�1EN /2 20 Customer 100 West 7th Street • Bayonne NJ 07002 INVOICE Ph: 800.631.3400 • 201.437.4300 Fax:800.758.7528 • 201.437.4833 455303 .. www.idealwindow.com 1111111111111111111 IUI,c�1[(1ntWINDIOW follow uson 1312 Page 1 of 2 CHECK EST. SHIP DATE IT MAY BE UPDATED FROM ORIGINAL DATE DOUBLE R ALL HOME IMPROVEMENT SHIP TO DOUBLE R ALL HOME IMPROVEMEN 439 WILLETT AVENUE 439 WILLETT AVENUE PORT CHESTER NY 10573 PORT CHESTER NY 10573 Phone 914-937-4279 FAX 914-937-4172 sip,„ 1,011z AcctN Customer P/O# Est. Ship Date TERMS INVOICE# 4 UB 134672 VOLMER 03/04/2021 NET 30 455303 .. L s- " -- - - -- - - - - 0 5 Linen. DH. MAJESTIC W-27.750 x H-49.500 Finish W-27.750 x H-49.500 Or)er:D, H Scr, ESM Pkq. Foam. Dbl.Low/E [MAXI. Ara. S Ana & H Exp. DS Glass, D Lock. Linen Regular Limit Latch, Shd Grv, S Stl Sper IIIIII IIIIII IIIIII 1111 0 2 Linen, DH, MAJESTIC W-27.750 x H-37.500 Finish W-27.750 x H-37.500 Oper:D, H Scr, ESM Pkq, Foam, Dbl.Low/E [MAXI. Ara, S Ana & H Exp, DS Glass, D Lock, Linen Reqular Limit Latch, Shd Grv, S Stl Sper 111111111111 I I II III 111 0 2 Linen, DH, MAJESTIC W-27.750 x H-61.500 Finish W-27.750 x H-61.500 Oper:D, H Scr, ESM Pkq, Foam, Dbl.Low/E [MAXI. Ara, S Ana & H Exp, DS Glass, D Lock, Linen Regular Limit Latch, Shd Grv, S Stl Sper 1111111111111111111111 0 1 Linen. DH, MAJESTIC W-23.750 x H-37.500 Finish W-23.750 x H-37.500 Oper:D. H Scr, E Elite Pkq, Foam, Low/E+ Obscure Lower. Ara, S Ana & H Exp. DS Glass, S Lock Linen, Reqular Limit Latch, Shd Grv, S Stl Sper 111111111111 II II III 111 3 Linen, DW II 2 Lt. Slider W-30.750 x H-18.000 TTT W-30.750 x H-18.000 Oper:LR, H Scr, Low/E, Ara, H Exp, S Ana S Lock 3 FRAMES(s) 6 INSERTS IIIIII IIII I I I I I I III III -Customer Copy Belinda 11/20/20 **" U R G E N T *** EST.SHIP DATE REVISED "** 100 West 7th Street • Bayonne NJ 07002 INVOICE Ph: 800.631.3400 • 201.437.4300 Fax:800.758.7528 • 201.437.4833 455303 --- www.idealwindow.com IDEAL WINDOW -Our nante says it all' follow us on Page 1 of 2 CHECK EST. SHIP DATE IT MAY BE UPDATED FROM ORIGINAL DATE DOUBLE R ALL HOME IMPROVEMENT SHIP TO DOUBLE R ALL HOME IMPROVEMEN 439 WILLETT AVENUE 439 WILLETT AVENUE PORT CHESTER NY 10573 PORT CHESTER NY 10573 Phone 914-937-4279 FAX 914-937-4172 r Zone at:Ct# Customer P/O# Est. Ship Date TERMS INVOICE# 4 UB 134672 VOLMER 03/04/2021 NET 30 455303 ne# �t:a�t ) r►ir1t�1!iL. .# v ^� —�a-��� - c �.:.� � ,sue ® 5 Linen, DH, MAJESTIC 215.95 1,079.7 W-27.750 x H-49.500 Finish W-27.750 x H-49.500 Oper:D. H Scr. ESM Pka. Foam. Dbl.Low/E rMAXl. Ara, S Ana & H Exp, DS Glass, D Lock. Linen Reqular Limit Latch, Shd Grv, S Stl Sper 111111 IIlI I I i ll ll l 1111 — — 0 2 Linen, DH, MAJESTIC 215.95 431.9 W-27.750 x H-37.500 Finish W-27.750 x H-37.500 Oper:D, H Scr, ESM Pkq, Foam, Dbl.Low/E [MAXI. Ara, S Ana & H Exp, DS Glass, D Lock, Linen Reqular Limit Latch, Shd Grv, S Stl Sper 1111111111111111 III 111 --- 2 Linen, DH, MAJESTIC 234.45 468.9 W-27.750 x H-61.500 Finish W-27.750 x H-61.500 Ooer:D. H Scr, ESM Pka. Foam. Dbl.Low/E rMAXl. Ara, S Ana & H Exp, DS Glass. D Lock. Linen Reqular Limit Latch. Shd Grv. S Stl Sper 11111111111111111111111 — 0 1 Linen. DH. MAJESTIC 207.22 207.2 W-23.750 x H-37.500 Finish W-23.750 x H-37.500 Oper:D. H Scr, E Elite Pka. Foam. Low/E+ Obscure Lower. Ara, S Ana & H Exp. DS Glass, S Lock Linen, Reqular Limit Latch, Sha Grv, S Stl Sper 111111111111 1111 I II 111 — -- 3 Linen. DW II 2 Lt. Slider 125.78 377.3• W-30.750 x H-18.000 TTT W-30.750 x H-18.000 Oper:LR, H Scr, Low/E, Ara, H Exp, S Ana S Lock 3 FRAMES(s) 6 INSERTS II 11111111 I I I I I 1111111 — -- ORIGINAL INVOICE Belinda 11/20/20 �'* URGENT - EST.SHIP DATE REVISED xx * r � 100 West 7th Street • Bayonne NJ 07002 INVOICE Ph: 800.631.3400 2G1.437.4300 Fax:800.758.7528 • 201.437.4833 455303 • www.idealwindow.com IDEAL. WINDOW - Our name says it all follow us on ® Elm Page I of 2 CHECK EST. SHIP DATE IT MAYBE UPDATED FROM ORIGINAL DATE SHIP TO DOUBLE R ALL HOME IMPROVEMENT DOUBLE R ALL HOME IMPROVEMEN 439 WILLETT AVENUE 439 WILLETT AVENUE PORT CHESTER NY 10573 PORT CHESTER NY 10573 Phone 914-937-4279 FAX 914-937-4172 Skin zone AWF Customer P/O# Est. Ship Date TERMS INVOICE* 4 UB 134672 VOLMER 03/04/2021 NET 30 455303 SC 0 5 Linen, DH, MAJESTIC W-27.750 x H-49.500 Finish W-27.750 x H-49.500 Oper:D. H Scr, ESM Pkq, Foam, Dbl.Low/E MMAXI. Ara, S Ana & H Exp, DS Glass. D Lock, Linen Reqular Limit Latch, Shd Grv, S Stl Sper II 1111 IIIIII I II II 11111 2 Linen. DH, MAJESTIC W-27.750 x H-37.500 Finish W-27.750 x H-37.500 Oper:D, H Scr, ESM Pkq, Foam, Dbl.Low/E [MAXI, Ara, S Ana & H Exp, DS Glass, D Lock, Linen Reqular Limit Latch, Shd Grv, S Stl Sper IIIIII IIIIII 1111 Al ill 0 2 Linen, DH, MAJESTIC W-27.750 x H-61.500 Finish W-27.750 x H-61.500 Oper:D. H Scr, ESM Pkq. Foam, Dbl.Low/E [MAX]. Ara, S Ana & H Exp. DS Glass, D Lock, Linen Reqular Limit Latch, Shd Grv, S Stl Socr IIIIII I111I11111II I NI — 1 Linen, DH, MAJESTIC W-23.750 x H-37.500 Finish W-23.750 x H-37.500 Oper:D. H Scr. E Elite Pkq. Foam. Low/E+ Obscure Lower, Ara, S Ana & H Exp. DS Glass, S Lock Linen, Reqular Limit Latch, Shd Grv, S Stl Sper 111111 111111 I I I I III 111 0 3 Linen. DW II 2 Lt. Slider W-30.750 x H-18.000 TTT W-30.750 x H-18.000 Oper:LR, H Scr, Low/E, Ara. H Exp, S Ana S Lock 3 FRAMES(s) 6 INSERTS IIIIII IIIIII I I I I III III -Customer Copy Belinda 11/20/20 K** U R G E N T*** EST.SI-11P DATE REVISED "`� c v h I v b - m 3 0 � � c >, 3 h \ ► �_ mm Q� I^I 1 • ,a � U ,-. .• 1 ice, � C v Zr ;7 Casa° °�' v � lzIR r r A �� IIIIIIIIIIII � `\1 IIIIIIIIIIII a - ilt s ? I C � raj ryS r cr -1' O .S� C s V z j m w I a m O OAi oa zz J ^ y yb['j C — ccrO�� � c�. O � � •�'. cam.. � •n pL 1 C •-•• � � � :�, i Old at C � - •C '� "� C v � `� :. v O e'er y � .v 4, � G 4 0 � z w � � = � 0 o c w I 1 O f — 1 3 �a `. r. 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W w a m W V w �_ N z 4 a O 4011 8 W � 0 0 0 w oL G4 d G 0 U � o � U o r ^ b V 1 � •� h 3 h 3 ®r �111�y Lul i� Building Permit Check List&Zoning Analysis Address: (N rz- —0 E ­2_--t, SBL l _S?, Zone:_-1 Z Use: 2 t o Const.Type:-:� Other. Submittal Date: 3— ( Revisions Submittal Dates: Applicant: y 3 L L_VA G__ C Nature of Work: �: �7t-L E—w"F N- \^1 2 1 27-1 N (T L. Reviews:ZBA: PB: BOT: Other. ITOK ( ) FEES:Filing ? BP: Q0 - C/O: Legalization ( ) (-Y APP: Dated: ✓ Notarized. ✓ SBL: gnus I.D. Cross Connection: H.O.A.: ( ) ( ) Scenic Roads: Steep Slopes: Wetlands: Stone Water Review: Street Opening: ( ) ( ) ENVIRO:Long. Shore Fees: N/A: ( ) ( ) SITE PLAN:Topo: Site Protection S/W Mgmt.: Tree Plan: Other. ( ) ( ) SURVEY:Dated: Current: Archival:- Sealed: Unacceptable: ( ) ( ) PLANS:Date Stamped: Sealed: Copies: Electronic: Other. ( ) ( License: ✓ Workers Comp: ''- Liability: Comp.Waiver. Other. ( ) ( ) CODE 7S3#: Dated: N/A: ( ) ( ) HIGH-VOLTAGE ELECTRICAL:Plans: Permit: N/A Other. ( ) ( ) LOW-VOLTAGE ELECTRICAL:Plans: Permit: N/A: Other. ( ) ( ) FIRE ALARM/SMOKE DETECTORS:Plans: Permit: H.W.I.C.:_Battery:_Other. ( ) ( ) PLUMBING:Plans: Permit: Nat.Gas: LP Gas: N/A/: Other. ( ) ( ) FIRE SUPPRESSION:Plans: Permit: N/A: Other. ( ) ( ) H.V.A.C.: Plans: Permit N/A: Other. ( ) ( ) FUEL TANK:Plans: Permit: Fuel Type: Other. ( ) ( ) 2020 NY State ECCC: N/A: Other. ( ) ( ) Final Survey: Final Topo: RA/PE Sign-off Letter. As-Built Plans: Other. ( ) ( ) BP DENIAL LETTER: C/O DENIAL LETTER: Other. ( ) ( ) Other. ( )ARB mtg.date: approval:- notes: ( )ZBA mtg.date: approval• notes: ( )PB mtg.date: approval• notes: REQUIRED EXISnNG PROPOSED NOTES 1 2 2021 A Dee: Cir Fmntag� Front: Front: Ste: Rear. Main Cow. Accs.Cov Ft.H Sb: S .H Sb: Tot,ImP Fc I Par Height/Stories: not tA- 0 F W> r /"✓ .� a 4r ;�::?` vN � .;f. ", _ C \ w ..' cts N CL CL N x o .-rA CL 4 (U caLIJ CL •� O c•,) s T. Y 1 •1- • � C ui Jn > w W G o 01 e= vl QLLJ G W rr ll G = _ _ •3 � 6d e5� a, p �ljedaa J U b tt } U m r it Q O -v •� Rl A a ; Y. N y G V v ci is f i A`COROB GATE IMM/DDNVVVI CERTIFICATE OF LIABILITY INSURANCE 1y410,o.o 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 endorsemerlt(s). rACT PRODUCER NAME Laura Rodincfh '.larenco Insurance Agency Inc ArC,Na Est (914)235-3144 (MC.No): (914)235.15'11 1h Church Street ADDRESS: Lauua :narencomsurance com INSURER(S)AFFORDING COVERAGE NAIC• New Rochelle NY I Oh01 INSURER A Utica First Insurance Company 15326 INSURED I INSURER B ARC Home Improvements Corp DBA Double R ALL Home Improvem INSURER C. 439 Willett Ave INSURER D: INSURER E Port Chester NY 10573 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-HE POLICY PERIOD INDICATED NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRAC,OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN.THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HERE'N IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER NYYY) YYY LIMITS x COMMERCIAL GENERAL JABILrTY I EACH OCCURRENCE $ 1,000.000 CLANS-MADE �7k OCCUR I PREMISES IEa ocvr!rc ce; S 500,000 MED EXP;Any one Person) $ 5.000 Y ARTS128737 05'06,2020 05,0&2021 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE S 2,000,000 POLICY F7 PEOT 0LOC PRODUCTS COMPrOPAGG $ 2,000,000 OTHER S AUTOMOBILE LIABILITY (Ea accident) $ ANY AUTO BODILY INJURY(Per tenon) S OWNED SCHEDULED BODILY INJURY(Per awdent) S AUTOS ONLY AUTOS HIRED NON-OWNED PROPER,Y t S AUTOS ONLY AUTOSONLY (Pwaccdenr S UMBRELLA LIAR OCCUR EACH OCCURRENCE SADE EXCESS LIAB CLAIMS-M AGGREGATE S !DEC) RETENTION$ S ORKERS COMPENSATION STATUTE I I ER ND EMPLOYERS'LIABILITY Y I N V PROPRI ETC W-ARTNERICXECUTIVE❑ E.L.EACH ACCIDENT S N I A FFtCERIMEMBER EXCLUDED? Mw daWy in NMI JEL DISEASE-EA EMPLOYEE S yyeps OeacrlW under ESCRIPTION OF OPERATIONS Chow E.L.DISEASE-POLICY LIMIT S DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Addrtronal Remarks Schedule.may be MUchad it more slasm is required) VI)lagc of Rye Brook arc named as additional insured with respects to General Liabllitc CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN Village of Rye Brook ACCORDANCE WITH THE POLICY PROVISIONS. 938 King Street AUTHORIZED REPRESENTATIVE R",Im ra A PAm#— Rye Brook NY 10573 C 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD NYSIF WESTCHESTER ONE,44 SOUTH BROADWAY,10TH FLOOR,WHITE PLAINS,NY 1 060 1-441 1 1 nysif.com CERTIFICATE OF WORKERS' COMPENSATION INSURANCE (RENEWED) 4• ^^^^^^ 13394083C MARENCO INSURANCE AGENCY INC 36 CHURCH ST �If NEW ROCHELLE NY 10801 SCAN TO VALIDATE AND SUBSCRIBE POLICYHOLDER CERTIFICATE HOLDER ARC HOME IMPROVEMENTS CORP VILLAGE OF RYE BROOK DBA DOUBLE R ALL HOME IMPROVEMENTS 938 KING STREET 439 WILLETT AVE RYE BROOK NY 10573 PORT CHESTER NY 10573 POLICY NUMBER CERTIFICATE NUMBER POLICY PERIOD DATE W2358 628-2 175479 04/16/2020 TO 04/16/2021 4/30/2020 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE NEW YORK STATE INSURANCE FUND UNDER POLICY NO. 2358 628-2, 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, AND, WITH RESPECT TO OPERATIONS OUTSIDE OF NEW YORK, TO THE POLICYHOLDER'S REGULAR NEW YORK STATE EMPLOYEES ONLY. IF YOU WISH TO RECEIVE NOTIFICATIONS REGARDING SAID POLICY,INCLUDING ANY NOTIFICATION OF CANCELLATIONS, OR TO VALIDATE THIS CERTIFICATE,VISIT OUR WEBSITE AT HTTPS://WWW.NYSIF.COMiCERTICERTVAL.ASP.THE NEW YORK STATE INSURANCE FUND IS NOT LIABLE IN THE EVENT OF FAILURE TO GIVE SUCH NOTIFICATIONS. THIS POLICY DOES NOT COVER CLAIMS OR SUITS THAT ARISE FROM BODILY INJURY SUFFERED BY THE OFFICERS OF THE INSURED CORPORATION. PRESIDENT FRANK J VERRASTRO TREASURER RALPH CACCOMO ARC HOME IMPROVEMENTS CORP TWO PERSON CORPORATION 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 ►NSURANCE FUN DIRECTOR,INSURANCE FUND UNDERWRITING VALIDATION NUMBER 720054833 U-26.3