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Home My WebLink AboutMP21-079 �yE D t��4uU�J V 4 l.0 UU VV`�,i v�JC+4v4 y./ 19 Am annivvoaW VILLAGE OF RYE BROOK MAYOR 938 King Street, Rye Brook,N.Y. 10573 ADMINISTRATOR Jason A. Klein (914) 939-0668 Christopher J. Bradbury www.tyebrook.org TRUSTEES BUILDING& FIRE INSPECTOR Susan R- Epstein Michael J. Izzo Stephanie J. Fischer David M. Heiser Salvatore W. Morlino CERTIFICATE OF COMPLIANCE May 11,2022 Joshua Balik Klein&Tracey Levi 69 Winding Wood Road Rye Brook,New York 10573 Re: 69 Winding Wood Road, Rye Brook,New York 10573 Parcel ID#: 135.34-1-37 This document certifies that the work done under Mechanical Permit #21-079 issued on 5/18/2021 for the installation of a new condenser has been satisfactorily completed. Sincerely, r'• _" l Michael J. Izzo Building&Fire Inspector /to se- 4R�k, o`` tim 04 1932 BUILDING DEPARTMENT BUILDING INSPECTOR I ❑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 : v ( �J� l/L�� DATE: PERMIT# I C l ISSUED:-� SECT: BLOCK: LOT: S % LOCATION: nrfiw �G �O/�� (�S '— 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 i r ;rxw•eu.r ouLJLt vvl t••...-...y...�..:::.'.:�'..`:M•::.::�"..;..:.::-. VUM.+w~rp.r rr.. Nr CAI:@X,U ♦ N/f N@LLbe •"^^-""'- ��tf 1•f Sew NO 00 r� .«.+..rr.w,...rw'-tee«'w:«•r ram.. L�Mrt• --�•�i�_— •ALL--- Y'r.' �' ti�♦yrKy • r! VV � Jw 8 .�.�.. 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Of eYt wesrcmasrte cDuvrY NEW yxr- fcALe•'•ro"_ ' 5/17/2021 Trane XR14 Series Central Air Conditioner-4TTR40361-1000A Abt Scheduled Delivery to Bronxville learn more Home>Appliances>Heating,Cooling&Air Quality>Air Conditioners>Central Air Conditioning Units>Trane 4TTR40361-1000A Trane XR14 Series 34,000 BTUH Central Air Conditioner - 4TTR4036L1000A 4 Questions,4 Answers or Be the first to write a review "Z C 7 T r ! r ,ht Model:4TTR4036L Trane XR14 Series 34,000 BTUH Central Air Conditioner - 4TTR40361-1000A https://www.abt.com[Trane-XR14-Series-34-000-BTU H-Central-Air-Conditioner-4TTR4036L1000A/p/109687.html 1/2 5/17/2021 Trane XR14 Series Central Air Conditioner-4TTR40361_1000A -Efficiency and reliability.The XR14 central A/C unit offers up to a 16.00 SEER rating. Features: • Efficient performance The XR14 A/C system has a SEER rating of up to 16.00,making it an excellent choice for home comfort and for earning energy-efficiency tax credits. • Economical Operation The increased energy efficiency of this air conditioning system may substantially lower your home cooling costs. • Durable construction Materials for all components in this central A/C unit are tested again and again for long-lasting performance and reliability. • Cleaner, healthier indoor air Add Trane CleanEffectsTM to your air conditioning system for advanced air filtration that removes more dust, pollen and other irritants from conditioned air for a cleaner, healthier, more comfortable home. Specifications: • Cooling Capacity BTUH: 34,000 • Nominal Tons: 3 • Power Conns.—V/PH/Hz:208/230/1/60 • Min. BRCH. CIR.AMPACITY: 18 Be the first to review this item WRITE A REVILV, C�Copyright 1997-2021,Abt Electronics Inc.1200 N.Milwaukee,Glenview,IL 60025 A https://www.abt.comrrrane-XR14-Series-34-000-BTUH-Central-Air-Conditioner-4TTR4036L1000A/p/109687.htmi 2/2 0 TRWE' Product Specifications Model No.(a) 4TTR4018L1000A 4TTR4024L1000B/ 4TTR4030L1000A/ 4TTR4036L1000A/ 4TTR40251-1000B 4TTR40311_1000A 47TR40371_1000A POWER CON NS.—V/PH/HZ(b) 208/230/1/60 208/230/1/60 208/230/1/60 208/230/1/60 MIN.BRCH.CIR.AMPACITY 12 14 17 18 BR.CIR.PROT.RTG.—MAX. 20 20 25 30 (AMPS) COMPRESSOR CLIMATUFFS- CLIMATUFF@- CLIMATUFF®- CLIMATAUFF®- SCROLL SCROLL SCROLL SCROLL RL AMPS—LR AMPS 9—63 10.1—52 12.8—68 14.1—72 Outdoor Fan FL AMPS 0.60 0.90 0.77/.64 0.77/.64 Fan HP 1/15 1/8 1/8 1/8 Fan Dia(inches) 18.2 18.2 23.0 23.0 Coil SPINE FIN'^ SPINE FINT" SPINE FIN"" SPINE FIN— Refrigerant R-410A 4 LBS.,8 OZ 4 LBS.,11 OZ 5 LBS.,4 OZ 6 LBS.,1 OZ LINE SIZE—IN.O.D.GAS W 3/4 3/4 3/4 3/4 LINE SIZE—IN.O.D.LIQ.(c) 3/8 3/8 3/8 3/8 Charge Spec.Subcooling 10°F 10OF 10*F 10°F/(8°F on 037) Dimensions H x W X D Crated 30.1 x 26.7 x 30 30.1 x 26.7 x 30 34 x 30.1 x 33 38 x 30.1 x 33 (IN.) Weight—Shipping(lbs.) 153 153 183 183 Weight—Net(lbs.) 133 133 156 156 Optional Accessories: Anti-short Cycle Timer TAYASCT501A TAYASCT501A TAYASCT501A TAYASCT501A Evaporator Defrost Control AY28XO79 AY28XO79 AY28XO79 AY28XO79 Rubber Isolator Kit BAYISLT101 BAYISLT101 BAYISLT101 BAYISLT101 Extreme Condition Mount Kit BAYECMT023 BAYECMT023 BAYECMT023 BAYECMT023 Start Kit BAYKSKT263 — BAYKSKT263 BAYKSKT263 Crankcase Heater Kit BAYCCHT302 BAYCCHT302 BAYCCHT302 BAYCCHT302 Seacoast Kit BAYSEAC001 BAYSEAC001 BAYSEAC001 BAYSEAC001 Low Ambient Kit BAYLOAM103 BAYLOAM103 BAYLOAM103 BAYLOAM103 Refrigerant Lineset(e) TAYREFLN950 TAYREFLN950 TAYREFLN7* TAYREFLN7* Service Valve Panel Cover AAYSVPANL0022AA AAYSVPANL0022AA AAYSVPANL0032AA AAYSVPANL3343AA W Certified in accordance with the Unitary Air-conditioner equipment certification program which is based on AHRI standard 210/240. (b) Calculated in accordance with N.E.C.Only use HACR circuit breakers or fuses. a) Standard line lengths—60',Standard lift—60'Suction and Liquid line.For Greater lengths and lifts refer to refrigerant piping software Pub*32-3312-0*(*denotes latest revision).. (n) *=15,20,25,30,40 and 50 foot lineset available. 2 22-1904-1 H-EN MANE' Product Specifications A-Weighted MODEL Sound Power Full Octave Sound Power(dB) Level[dB(A)] 63 125 250 500 1000 2000 4000 8000 Hz* Hz Hz Hz Hz Hz Hz Hz 4TTR4018L1 71 74 71 65 68 67 63 56 50 4TTR40241_1 71 74 71 65 68 67 63 56 50 4TTR4025L1 4TFR403OL1 71 73 73 72 69 68 60 52 45 4TTR4031L1 4TTR4036L1 71 73 73 72 69 68 60 52 45 4TTR4037L1 477R40421_1 71 81 72 69 69 66 60 57 54 4TTR40431_1 4TFR4048L1 71 81 72 69 69 66 60 57 54 4TFR4060L1 71 81 72 69 69 66 60 57 54 Note: Rated in accordance with AHRI Standard 270-2008*For Reference Only 4 22-1904-1 H-EN MANE Outline Drawing B C SERVICE PANEL ELECTRICAL AND REFRIGERANT COMPONENT CLEARANCES PER PREVAILING CODES. TOP DISCHARGE AREA SHOULD BE UNRESTRICTED FOR AT LEAST 1524 15 FEET) ABOVE UNIT. UNIT SHOULD BE PLACED$0 ROOF RUN-011 RATER DOES NOT POUR DIRECTLY ON UNIT, AND SHOULD BE AT LEAST IDS(12') FROM GALL AND ALL SURROUNDING SHRUBBEIT ON TOO SIDES. OTHER 710 SIDES UNRESTRICTED. T— ELECTRICAL SERVICE PANEL K 25 11) A 22.2(1/8)DIA. HOLE LOO VOLTAGE 28.6 (1.118)DIA, K.0. OITM. 22.2 11/8) DU. HOLE IN CONTROL BOA BOTTOM FOR ELECTRICAL POOER SUPPLE H F ,O. FOR ALTERNATE O ELECTRICAL ROUTING UOUID LINE SERVICE VALVE, 'C' I.D. fCMALE BRAZE CONNECIIOU OIIM"'I SAC 4A5 LIEF I//TURN BALL SERVICE VALVE.Y[. '0' FLARE PRESSURE TAP FITTINGS, I.D. FEMALE BRAZED CONNECTION OIIM I/1'SAE FLARE PRESSURE TAP FITTING. Model Base A B C D E F G H J K 4TTR4018L 2 730 724 651 3/4 3/8 127 57 194 38 457 (28-3/4) (28-1/2) (25-5/8) (5) (2-1/4) (7-5/8) (1-1/2) (18) 4TTR4024L 730 724 651 127 57 194 38 457 4TTR4025L 2 (28-3/4) (28-1/2) (25-5/8) 3/4 3/8 (5) (2-1/4) (7-5/8) (1-1/2) (18) 4TFR4030L 730 829 756 127 76 197 60 508 4TTR4031L 3 (28-3/4) (32-5/8) (29-3/4) 3/4 3/8 (5) (3) (7-3/4) (2-3/8) (20) 4TTR4036L 832 829 756 127 76 197 60 508 4TTR4037L 3 (32-3/4) (32-5/8) (29-3/4) 3/4 3/8 (5) (3) (7-3/4) (2-3/8) (20) 4TTR4042L 4 741 946 870 7/8 3/8 143 83 206 70 508 4TTR4043L (29-1/8) (37-1/4) (34-1/4) (5-5/8) (3-1-4) (8-1/8) (2-3/4) (20) 4TTR4048L 4 741 946 870 7/8 3/8 143 83 206 70 508 (29-1/8) (37-1/4) (34-1/4) (5-5/8) (3-1-4) (8-1/8) (2-3/4) (20) 4TTR4060L 4 943 946 870 7/8 3/8 152 98 219 86 508 (37-1/8) (37-1/4) (34-1/4) (6) (3-7/8) (8-5/8) (3-3/8) (20) 8 22-1904-1 H-EN .ys✓!fin • �,.. 1 • tto s� � to ppa.9 V y N ca N 46 a. O cr COO G� 04 Q.i •., W o Q0Ln jection •:{ �! cr- N Z LLJM Cl) v E ¢UJ � � s c V 06 •: _ � � H CL o = o N o e U- : L Lr L•I � > c z � <c � Eo w Y ' o < 04 I: CID E `? ! CL �1 ft txx l(0)> �v�Ka,". +iC. V "�f :��V�•.' tTR'V�C .r/�� .:1�?��fY",�..��-.,...'�"'"Va :+ ,�\ G..A► •• r v .�•//`tS. ' ./L1�j\ •s'{ 7/t• `I r�+•.�''� • J`rjlr 5 10/06/2013 20:46 9142201440 KEEP INS AGENCY PAGE 01/08 ABSOCOM-03 GCOHAN �llh�R'�e CERTIFICATE OF LIABILITY INSURANCE DA51(MMMON1YYI 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 INSVRER(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 nights to the Certificate holder In lieu of such endorsement(s). -- PRODUCER V^ CONTACT Gerry Cohan Cohan Associates,Inc. NPHHHOON �1 (914)422-0500 we No:(914)220-1440 27 Cleveland Street Valhalla,NY 10596 %N65,CohanA99oclates(ROptonline.n9t _ INSURER(81 AFFORDING COVERAGE NAR%M INSURER A:MET P a C_ _ INSURED INsuRER B National Orange Mutual Ins.Co. 29939 Absolute Comfort&Temperature Control,Inc. INSURER C w:— I _ PO Box 325 INSURER D: White Plains,NY 10603 wsuRER e INSURER F COVERAGES CERTIFICATE NUMBER- REVISION NUMBER: THIS IS -0 CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED NOTWITHGTANOING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCVMENT 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, N/9R TVpe OF INSURANCE ADOL EUB DN POLICY NUMBERLTIR POLICY EFF i pOUCY ExP I UMI7E A X COMMERCIAL GENERAL UABIUTY EACH OCCURRENCE 1,000,000 CLAIMSMAOE OCCUP, X 1 BP044104P2019 6l13/2020 611312021 DAMAGE TO RENTED PREMISES(Ea opw79mg) 3 50,000 ME o crson S,000 PERSONAL d ADV INJURY 1,000,000 LAOORE TEUMITAPPLIESPER GENERAL AGGREGATE S 2,000,000 ,QAX POLICY � �{ a LOC lPR D CTS•COMPIOPAGG S_ 2,000,000 OTHER: B AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000,000 I I _._.. S ANY AUTO CACU6745Z 5/15/2020 1 5/15/2021 0oult.Y rr/JDRY Po. •non __ OWNED ��SCHEDULED AA�UgT�O�S ONLY ^ I�A�UUTNOSyy�.��D BODILY 94JLIRY Perecc S X AUTOS ONLY X AU70 ONLY Per aoEcaaM AMAGE. S UMAkELLA LIAR OCCUR EACH OCCURRENCE $ ExCESE LIAR CLA11MS4AADE gpQRF ATE DED RETENTIONS 1 WORNE as COMPENSATION PER,IN j I ERH- AND EMPlOYER8'LLABILJTY 'r--� ANY CPERRO RIETORR/P�LNER/EUIDED7 ECUTIVE IY� N f A E.L.EACH ACCIDENT IMendSt07'n NH) E.L.DISEASE-EA EMPLOYE S If yp* deecnce undir E RIPTI N OF OPEPATION$bob. L W6EASE-POLICY LIMIT S DESCRIPTION OF OPERAn DNS I LOCAnONS1 VEHICLES IACORD tot,AddIII—1 Remarks Schedule.mar be stlached II mom*Pies Is required) Additional Insured: Village of Rye Brook CERTIFICATE HOLDER CANCELLATION SHOULO ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Villa Of Rye Brook THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 90 Y ACCORDANCE WITH THE POLICY PROVISIONS. 936 King Street Rye Brook,NY 10573 - AUTHORIZED REP RESENTATIVE ACORD 25(2016103) a 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD 10/06/2013 20:46 9142201440 KEEP INS AGENCY PAGE 02/08 ARSOCOM-03 GI10HAN ACORO° CERTIFICATE OF LIABILITY INSURANCE DAT 5/12/2021 ��- 12I2021 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 pellcy(les)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 certlflcate holder in lieu of such endorsements). PRODUCER NTACT Gerry Cohan Cohan Associates,Inc. A1e0NH E tI;�814)422-0500 _ iac,Nol.(914)220-1440 27 Cleveland Street (Valhalla,NY 10595 aDREas:COhanAssociatesgROptonllne.net INSURHRIS)AFFORDING COVERAGE INaURERA Utica First Insurance Com an 15326 msuRED INSURER e:Merchants and Business Mens 11486 Absolute Comfort&Temperature Control,Inc. INSURER C_ PO Box 326 INSURE D White Plains,NY 10603 vR IN9V RER E- w_ 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 RDOUCED BY PAID CLAIMS. I R TYPE OF INSURANCE I wasp 1W12 POLICY NUMBER POLICY EFF POLICY EAP LIMFT9 A X �COMMERCIALGE�JPRAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE l X OCCUR X pRT2019291 6I13/7021 t3N3/2022 PpEM�'SE70 DENTED f 50,000 l MCC)FXP(Ay one M S 6,000 iPERSONAL&ADV INJURY f 1,000,000 GENT AGGREGATE LIMIT APPLIES PER: I GENERAL AGGREGATE S2,000,000 X POLICY a JECT a LOC PRODUCT - MP/ PAGG 2,000,000 ' OTHER: II ED SINGLE LIMIT $S 1,000,000 B AUTOMOBILE UABILJTY Ida ANY AUTO CAP1021921 5/15/2021 1116/1022 BODILY INJURY Per emon b AOWNEDGNIV X q) N�p$yU�L�EEPp BgDOILY{INJURY{Pw pcddemll$ AUTELID8 ONIY A0TOS ONLY �Pe�acEc demDAMAGE f f UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCL99 LIAB I CLAIN"ADE 1{AyGR FyGAYf f DED RETENTIONS WORKERS COMPENSAT10N AND EMPLOYERS'LIABILITY YIN -- - —ANY PROPRIEnORIPARTNERIEXECUTIVE I EL.EACH ACCIDENT f- XFICEMEMBER EXCLUO0 an W dalory IIn NH) NIA E.L.DIBEA6E-EA EMPLgYEEi� _ If -.dasc rya—do' DE SCRIP-ION OF OPERATIONS Debw E.L.DISEASE.POLICY LIMIT S i DESCRIPTION OF OPERATIONS I LACATIONS I VEHICLES IACORO 101,Additions Rwnef*s Schadula,may be aeaohsd N more soete to reaw ed) Addltlonal Ineured: Village of Rye Brook CERTIFICATE CEITTIFICATE HOLDEft CANCEL TION 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. 936 King Street Rye Brook,NY 105T3 AUTHORIZED REPRESENTATIVE` L� ACORD 25(2016103) 01968-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are regiswred marks of ACORD 10/06/2013 20:46 9142201440 KEEP INS AGENCY PAGE 03/08 few Workers' CERTIFICATE OF YTAT� Compensation �� Board NYS WORKERS' COMPENSATION INSURANCE COVERAGE a.Legal Name S Address of Insured(use street address only) 1b.Business Telephone Number of Insured Absolute Comfort & Temperature, Inc. 914-761-0529 PO Box 325 1c.NYS Unemployment Insurance Employer Registration Number of White Plains, NY 10603 Insured Work Locatlon of Insured(Only required if coverage is specifically Ilmlred to 1 d.Federal Employer Identification Number of Insured or Social Security certein locations in New York State,i e.,a Wrap-Up Policy) Number 13-3247458 2.Name and Address of Entity Requesting Proof of Coverage 3a.Name of Insurance Carrier (Ertity Be,ng Listed as the GertiftCato Holder) The Hartford Accident & Indemnity Insurance Co. Village of Rye Brook 3b.Policy Number of Entity Listed In Box"I a" 938 King Street 16WEC AD3VER Rye Brook, NY 10573 3c.Policy effective penod 06/20/2020 to 06/202021 3d.The Proprietor,Partners or Executive Officers are Included.(only check box if all partner5/OffiCtr3 Included) Q 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"1 a"for workers' compensation under the New York State Workers'Compensation Law. (To use this form, New York(NY)must be listed under l e 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 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 cancer the pol;cy or eliminate the insured from the coverage indicated on this Certificate.(Tirese notices may be sent by regular mail.)Otherwiso,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 certlflcate holder. This certificate does not amend, extend or after 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 affect 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 a certificate holder,the business must provide that certificate holder with a new Certfffcate 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 Gerald B Cohan (Print name of autho, ed repreeentative or Iloensed agent of insurance carner) Approved by: 5/1 2/202 (Date) TIUe: Telephone Number of authorized representative or licensed agent of insurance carrier- 9 1 4-422-0500 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 10/06/2013 20:46 9142201440 KEEP INS AGENCY PAGE 05/08 NEW I Workers' CERTIFICATE OF Board srt►r>< Compensation NYS WORKERS' COMPENSATION INSURANCE COVERAGE 'a.Legal Name&Add-ass of Insured(use street address only) 1b,Business Telephone Number of Insured Absolute Comfort & Temperature, Inc. 914-761-0529 PO Box 325 1c.NYS Unemployment Insurance Employer Registration Number of White Plains, NY 10603 Insured Work Location of Insured(Only required if coverage is specifically limited to 1d Federal Employer Identification Number a!Insured or Social Security certain locations in New York State,i.e.,a Wrre¢UP Policy) Number 13-3247458 2.Name and Addreas of Entity Requesting Proof of Coverage 3a.Name of Insurance Carrier (Entity Being Lieled as the Certificate Holder) The Hartford Accident & Indemnity Insurance Co. Village of Rye Brook 3b.Policy Number of Entity Listed in Box ''I a" 938 King Street 16WEC AD3VER Rye Brook, NY 10573 3c.Policy effective penod 06/20/2021 to 06/20/2022 3d.The Proprietor,Partners or Execullve Officers are O Included.;Only check box if all parineralof icers Included) Z all excluded or certain partners/officers a,rcluded. his certifies that the Insurance carrier indicated above in box"3"insures the business referenced above in box"a"for workers' compensation under the New York State Workers'Compensation Law.(To use this form,New York(NY)must be listed under Item�B 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 must notify the above certificate holder and the workers'Compensation Board within 10 days IF a policy is cance'ed due to nonpayment of premiums or within 3D days IF there are reasons othe•than nonpayment of premiums that cancel the policy or slim nate the insured from the coverage Indicated or III 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 llcensed 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 cett fficate 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. -his 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 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,1 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: Gerald B Cohan (Prix i name of authouzed representarve or Ilceneed agent of insurance carrier) Approved by. 5/1 2/2021 (Signature) (Date) Title: Telephone Number of authorized representative or licensed agent of insurance carrier: 9 1 4-422-0500 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) �YAw wcb.ny gov