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Home My WebLink AboutMP21-148 DRn t4w�JJV CCvC t �°up vuY . 19(3 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 January 5,2024 Win Ridge Realty LLC c/o Alena Hakanjin 24 Rye Ridge Plaza Rye Brook,New York 10573 Re: 126 South Ridge Street, Rye Brook,New York 10573 Parcel ID#: 141.27-1-6 This document certifies that the work done under Mechanical Permit#21-148 issued on 10/18/2021 for the installation of a new rooftop HVAC unit has been satisfactorily completed. Sincerely, Steven E. Fews Building& Fire Inspector /to Sound Path 63 Hz 125 Hz 250 Hz 500 Hz 1 kHz 2 kHz 4 kHz 8 kHz Mi ted Discharge 88 dB 85 dB 79 dB 82 dB 75 dB 72 dB 72 dB 67 dB Ducled Inlet 86 dB 82 dB 74 dB 72 dB 67 dB 62 dB 62 d8 56 dB Outdoor Noise 102 d8 89 dB 93 dB 94 dB 92 dB 87 dB 83 dB 75 dB �yE BR y 0 Zm w � 1932'��OT 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: /2 L S e y In Rid DATE: 0 L 1 PERMIT# Y`rl r Z((� - ISSUED::/U-1(9-ZI SECT: /y/.17 BLOCK: / LOT: LOCATION: 1�On i J=42 .14 yn c l �) �/ // T OCCUPANCY: ❑ Violation Noted THE WORK IS... PASSED ❑ 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 ��. t O�� ❑ FIRE SPRINKLER ❑ FINAL PLUMBING �- ❑ CROSS CONNECTION B-FINAL ❑ OTHER ' t7 '.: rN `IYAMA �i e �i LAI �• �� SUM S�� ' - � _. All IA 4 q t f m f.� F N.•riNi • •.. cNN•I.10 Vlb• r)i „ Voyager Gas/Electric Packaged Rooftop Application Unit Size Supply Fan External Dimensions(in,) Operating Weight EER IEER/SEER Elevation Extemal Airflow Static Height Width Length Mminurrn Maximum Gas/Electric 20 Ton Pressure 11.0 EER 12.40 8000 cfm 0.500in 5 5.)11 102 ft 10.14 It 2257.0 lb 2824.0 lb Fresh Air Selection Econ-Dry Bulb 0-100%w/bar ref I Voltage/phase/hertz 2.06-2WA 013 MCA 98.00 A MOP 125 00 A Unit Controls P01,110 coolinjo Entering Dry Bulb 80.00 F Capacity Entering Wet Bulb 67.00 F Gross Total 248,45 MBh Ambient Temp 95.00 F Gross Sensible 195A0 MBh Leaving Coil Dry Bulb 57A2 F Not Total 234 64 MBh Leaving Coil Wet Bulb 56.95 F Not Sensible 18129 MBh Leaving Unit Dry Bulb 59.39 F Fan Motor Heat 13.81 MBh Leaving Unit Wet Bulb 57-71 F Refrig Charge-clrcult 1 15 5lb .� Refrigeration System Options Refrig Charge-circuit 2 15 lb Leaving Dow Point 56 66 F Heating Section ti Heat Type Gas Heating Stages 2 Output Ileating Capacity 320 00 MBh Heating EAT 70.00 F Heating LAT 106.87 F Healing Temp Rise 36.87 F Indoor Fan Data Outdoor Fan Data Type FC Centnfugai Type Propeller Drive Type 13e4 Fan Quantity:' Evap Fan FLA iG 70 A Drive Type Direct Indoor Fan Performance Outdoor Fan Performance Airflow ri000 rnn Outdoor Motor Power 1 73 kW Design ESP 0.500 in 1120 Condenser Fan FLA 4 80 A Component SP 0,320 in H2O Total SP 0 820 in H2O Supply Motor Horsepower 5 000 hp Indoor Motor Operating Power 4 38 hip Indoor Motor Power 3 27 kW Indoor RPM 720 rpm CompresscirMT Power 1727 kW Roof curb yes Caicult 1 RLA 41.00 A Ckcult 2 RLA 19M A 09/150021 12:51:35 -- >�tYcMISiiN�11�It� NOTES t GAS CONN ECt ION PIPE SIZE 3/4' 2 THRU-THE-BASE GAS AND ELECTRICAL IS NOT STANDARD ONALL UNITS (SELECTED OPTION:SEE ACCESSORY SHEET) 3 VERIFY WEIGHT,CONNECTIONS,AND ALL DIMENSIONS WITH INSTALLER DOCUMENTS BEFORE INSTALLATION 1-DOWNFLOWCONDENSATE y. L GAS CONNECTION(SEE NOTE 1) <,r 61 11/16• ) 1t 1118' Y 61 51W - 118'DIA HOLE (UNR CONTROL WIRE) 3• 22 1116' - 3'DIA HOLE 121 II MO* (UNIT POWER WIRE) 53 I/18- PACKAGED GASIELECTRIC-DOWNFLOW 84 3a- ISOMETRIC DRAWINO - 1 - --� 1 I 4 ta"-- I I I I 11\ I I I RLIUR(t I FAIIN'I Y 1 IB 51 1 66 I1118• 16• I 1 I I 1 L__ _J 1 1 I 1 PACKAGED GASIELECTRIC•DOWNFL OW PLAN VIEW DRAWNG 09/15/2021 12:51:35 Pape 3 d 11 r4�c�ica�S7b�d ELECTRICAL/GENERAL DATA GENERAL PERFORMANCE Standard Motor (111a1 M0601(Ton) YHD240G(20.0) Mimmum CircuilAmpacity 980580 Unit Operating Volage Range 187-253 Maximum Fuse Size 125011250 Unit Prmary Voltage 200 Maximum(HACR)Circuit Breaker. 125011250 Unit Secondary Vote go 230 Lint Hertz: 60 SIB rut a nd Oversized Motor 0)(4I Accessory Oversized Motor 11I NI Unit Phase. 3 Minimum CircutAmpaciy Minimum Circuil Ampacily: Maximum Fuse Size Maximum Fuse Sue EER R) 11 0 Maxmum(HACR)Circus Breaker Maximum(HACR)Ckcue Breaker GAS HEATING COMPRESSOR Healing Models High Cucail(s) Healing and l Stage Input(Blu)h) 400000/300000 Number 2 Heeling end I Stage Output(Bllilh): 320000/2 40001) Horsepower. 11 7/89 Min(Max Gas Input- Phase. 3 Pressure Natural or LP(in w c). 2 5114 0 Rated Lead Amps: 41 01198 Gas Connection Pipe Size 3/4' Locked Rolor Amps: 304 011 36 0 INDOOR MOTOR Slandaid Motor Standard Oversized Motor (4) Accessory Oversized Motor (4) Number (3) 1 Number. Number. Horsepower. 5 3 Horsepower Horsepower Motor Speed(RPM)'. 3.450 Motor Speed(RPM) Mdor Speed(RPM). Phase 3 Phase Phase F oil Load Amps 18.7 Full Load Amps Full Load Am ps. Locked RotorAmps. 109a Locked RotorAmps Locked Rotor Amps OUTDOOR MOTOR POWER EXHAUST COMBUSTION BLOWER (Flay Installed Power Exhaust) MOTOR Number 2 Horsepower N/A (Gas�Fired Healing only) Horsepower. 1 0 Motor Speed(RPM): NIA 01 M Dior 8peeci(R PM) 1,125 Phase. N/A Horsepower. 35 Phase. 3 Full Load Amps N/A dolor Speed(RPM) 35002800 Locked RotorAmps: NIA Phase 1 Full Load Amps_ 4 8 Full Load Amps 0 8 Locked ROIo,Amps 20 0 Locked Rotor Amps 2 00 RLTER REFRIGERANT a) Circus a1/2 Type. Throwaway Type. R-4 Furnished. Yes Factory Charge Number 814 Circuit al 12 15 51b1 L51b Recommended See. 203r20 XT 120'x 16'x2' NOTES. 1 Maximum(HACR)Circuit Breaker sizing is for nslellallens in the United Stakes only 2. Refrigerant charge is an approxmele value For a more precise value,see unit nameplate and sa-ce Instructions 3 Value,nclude Standard Moor 4 Value include Oversized Motor 5 EER is rated atAHRI conditions end in accordance with DOE test procedures 09/152021 12:51.36 Page 4 of i t hhlaLH,S,134� CLEARANCE 68' ! (1727 2mm) 1 f CLEARANCE 36' CLEARANCE FROM THE (914 4mm) TOP OF UNIT 72' (18288mm) i h . , " v, CLEARANCE 6LT , CLEARANCE 4er (1219 2M) L1 ,� DOWNFLOW-PACKAGED GASIELECTRlC CLEARANCE UNIT OUTLINE—.• ROCFOFEW":G - \> 781J2' er DOWNFLOW-PACKAGED GASIELECTRIC ROOF OPENING CLEARANCE 0911&2021 12:51:36 Pape 5 of 11 177 a h"illd"I Job Name:RYE RIDGE Poap:acd By:COASTAL MECHANICAL wr,i.., . ,r• .o.oniu vr•c Unit Tag Y4V n OaMy1 Base Unit and Corner Weights Only Base unit weigerls Caner Weights Center ut Gieviy • I SHIPPING I NE1 lJ E F r �+ _2700010 I 2257 01b 719 01b 591 0 to 1 430 0lb 517 0 1b 1 Allweghtsare approximate 2 The aduat weight are ssled on the unit nameplate 3 Refer to me nem eplalo and installed ion gu Ida for wegh!s before s hrld ulmg Ira nspondl ion p / The in weight slow of unlit 1 The weight shown represents the typical unit ape rating we,ghl to the cadgurahon l so ecded Eshmaled at+F 10 %ofthe nameplate weight 5 Veny weighl,conxisi,and all dmensnn wib installer documents before nrstatuuon 6 Cner weghis ere gwen for nforinadon only 7 NeorUShrpping weight of optional accessories should he added to unit*eight when ordermg factory or field nsiallod accessories Installed Options Net Weight Data 1i IA) Accessory Weight Economizer,Manuel and Moloreed Outside Air Damper 60 0 to CORNER WEIGHT —- Parer Exhaust _ Root Curb — — 2750111 Oversized Mol« HeN Guard 51 0e H nged Access Doors Power Cony.0 rafet Through Ore Base Electlicd CkarN Breaker Disowned Smoke Detector - Nwar ._. Zone Semeor HighfEow Slebc Drive Kil _ _ _ 20lb EP Gas Conversion Slalnless Sled Hed Exchanger Stainless Steal Dram Pan _ VFD High ElhaercylAdor - — 1.Weights for options are approximate 2 Weights for oplans Ihal are not Int refer to Installation guide p_Y i PACKAGED GASI ELECTRIC RIGGING AND CENTER OF GRAVITY O9115=1 12*61:96 Page of 11 Joe Name:RYE RIDGE Prepared By,COASTAL MECHANICAL UrdtMaAT.Ya a ♦la COMSITIe Y{Y OU C Tap:Ianllly: END PAN I— ` / 1 a v ACCESSFIANLI -- t!� rr j 1'CONOYRffRHOOD— - tl tlY ECONOMIZER HOOD PI PW VFW DRAWING OW1642021 12:51:95 Pepe 7 of I I r�lt+rc�i41 S�u41r;(rt�t7� , , I — 116 7/8" 221/4" —23 1/4" 28 1 13I18" 69 1/2" 8U 5/8" 7r RETURN SUVPLY 1 13l18 ACCESSORY-ROOF CURB 10 5I15" 73 lilt, ` raw" 2511ne' �.: 1 :ill1`PI Y I 1 ' 1 7 Mr 141110 m am r ACCESSORY-DOWNFLOW DUCT CONNECTIONS 09/15/2021 12:51:35 Pps 5 0l 11 ,4w,wrtw•SAP** d. • I4i • •1• LOV VI110YMw General -60 Hz Downflow Unit The units shall be dedicated downflow airflow. The operating range shall be between 1151 and 0°F in cooling as standard from the factory for all units. Cooling performance shall be rated in accord;.mce with ARI testing procedures. All units shall be factory assembled, internally wired, fully charged with R- 410A, and 100 percent run tested to check cooling operation, fan and blower rotation and control sequence, before leaving the factory. Wiring internal to the unit shall be colored and numbered for simplified identification. 60 I-1z units shall be UL listed and labeled, classified in accordance to UL 1995/C 22.2. 236-05 3rd Edition. Packaged Rooftop units cooling, heating capacities, and efficiencies are AHRI certified within scope of AHRI Standard 340/360 (I-P) and ANSIZ21.47 and 10 CFR Part 431 pertaining to Commercial Warm Air Furnaces (gas heating units). Casing - Downflow Unit casing shall be constructed of zinc coaled, heavy gauge, galvanized steel. Exterior surfaces shall be cleaned, phosphalized, and finished with a weather-resistant baked enamel finish. Unit's surface shall be tested 672 hours in a salt spray test in compliance with ASTM B117. Cabinet construction shall allow for all maintenance on one side of the unit. In order to ensure a water and air tight seal, sexvic;�Fia is shalUiaueJifiiny handles, and nnmoraAhan_three scre.ws-tQ_Lenlove. All exposed vertical panels and top covers in the indoor air section shall be insulated with a 1/2 inch, 1 pound density foil-faced, fire-resistant, permanent, odorless, glass fiber material. The base of the downflow unit shall be insulated with 1/2 inch, 1 pound density foil-faced, closed-cell material. The downflow unit's base pan shall have no penetrations within the perimeter of the curb other than the raised 11/8 inch high supply/return openings to provide an added water integrity precaution, if the condensate drain backs up. The base of the unit shall have provisions for forklift and crane lifting. Unit Top The top cover shall be one piece, or where seams exist, double hemmed and gasket sealed to prevent water leakage. Filters Two inch standard filters shall be factory supplied on all units Compressors All units shall have direct-drive, hermetic, scroll type compressors with centrifugal type oil pumps. Motor shall be suction gas-cooled and shall have a voltage utilization range of plus or minus 10 percent of nameplate voltage. Internal overloads shall be provided with the scroll compressors. All models shall have crankcase heaters, phase monitors and low and high pressure control as standard. Dual compressors are available on all standard efficiency models and 12.5 to 20 tons high efficiency models and allow for efficient cooling utilizing 3 stages of compressor operation (high efficiency models only). 25 tons high efficiency units have 3 compressors for up to 4 stages of compressor operation. Crankcase Heaters These band heaters provide improved compressor reliability by warming the oil to prevent migration during off-cycles or low ambient conditions. Refrigerant Circuits Each refrigerant circuit shall have service pressure ports, and refrigerant line filter driers factory installed as standard. An area shall be provided for replacement suction line driers. Evaporator and Condenser Coils Evaporator Coils (only on T/YS'150, 180, 210, 240, 30OG models)- Microchannel evaporator coils will be burst tested by the manufacturer. Internally finned, 5/16"copper tubes mechanically bonded to a configured aluminum plate fin shall be standard for evaporator coils. Coils shall be leak tested to ensure the pressure integrity. The evaporator coil shall be leak tested to 225 psig and pressure tested to 450 psig. Condenser Coils (available on T/Y"'150, 180, 210, 240, 30OG models) - Microchannel condenser coils shall be standard on all units. Coils shall be leak tested to ensure the pressure integrity. The condenser coil shall be leak tested to 225 psig and pressure tested to 450 psig. Gas Heating Section 09/15/2021 12.51:35 Pape 9 of 11 �kN'ICAN S'�AflAlt�. The heating section shall have a drum and tube heat exchanger design using corrosion resistant steel components. A forced combustion blower shall supply premixed fuel to a single burner ignited by a pilotless hot surface ignition system. In order to provide reliable operation, a negative pressure gas valve shall be used on standard furnaces and a pressure switch on furnaces with modulating heat that requires blower operation to initiate gas flow. On an initial call for heat, the combustion blower shall purge the heat exchanger 45 seconds before ignition. After three unsuccessful ignition attempts, the entire heating system shall be locked out until manually reset at the thermostat. Units shall be suitable for use with natural gas shall also comply with California requirements for low NOx emissions. Condenser Coil The microchannel type condenser coil is standard for the standard efficiency models. Due to flat streamlined tubes with small ports, and metallurgical tube-tofin bond, microchannel coil has better heat transfer performance. Microchannel condenser coil can reduce system refrigerant charge by up to 50% because of smaller intemal volume. which leads to better compressor reliability. Compact-ail-aiu+ninufn rnicroGhafinel Goils also 1vdJp4,G 4,aduGe_U:te_u uLweight.All-alumina n construction improves re-cyclability. Galvanic corrosion is also minimized due to all aluminum construction. Strong aluminum brazed structure provides better fin protection. In addition, flat streamlined tubes also make microchannel coils more dust resistant and easier to clean. Coils shall be leak tested at the factory to ensure the pressure integrity. The evaporator coil and condenser coil shall be leak tested to 600 psig. The assembled unit shall be leak tested to 465 psig. Outdoor Fans The outdoor fan shall be direct-drive, statically and dynamically balanced, draw-through in the vertical discharge position. The fan rnotor(s) shall be permanently lubricated and shall have built-in thermal overload protection. Indoor Fan Units above shall have belt driven, FC centrifugal fans with adjustable motor sheaves. Units with standard motors shall have an adjustable idler-arm assembly for quick-adjustment of fan belts and motor sheaves. All motors shall be thermally protected. All indoor fan motors meet the U.S. Energy Policy Act of 1992 (EPACT). Controls Unit shall be completely factory wired with necessary controls and contactor pressure lugs or terminal block for power wiring. Unit shall provide an external location for mounting a fused disconnect device. ReliaTel controls shall be provided for all 24 volt control functions. The resident control algorithms shall make all heating, cooling, and/or ventilating decisions in response to electronic signals from sensors measuring indoor and outdoor temperatures. The control algorithm maintains accurate temperature control, rninirnizes drift from set point, and provides better building comfort. A centralized control shall provide anti-short cycle timing and time delay between compressors to provide a higher level of machine protection. High Pressure Cutout This option is offered for units that do not have High Pressure cutout as standard. Discharge Line Thermostat A bi-metal elernent discharge line thermostat is installed as a standard option on the discharge line of each system. This standard option provides extra protection to the compressors against high discharge temperatures in case of loss of charge, extremely high ambient and other conditions which could drive the discharge temperature higher. Discharge line thermostat is wired in series with high pressure control. When the discharge temperature rises above the protection limit, the bi-metal disc in the thermostat switches to the off position, opening the 24 VAC circuit. When the temperature on the discharge line cools down, the bi-metal disc closes the contactor circuit, providing power to the compressor. When the thermostat opens the fourth time, the ReliaTel control must be manually reset to resume operation on that stage. Tool-less Hail Guards Tool-less, hail protection quality coil guards are available for condenser coil protection. 09152021 12:51.35 Page 10 of 11 Accessory - Roof Curb - Downf low The roof curb shall be designc:cl to mate with the downflow unit and provide support and a water tight installation when installed properly. The roof curb design shall allow field-fabricated rectangular Supply/return ductwork to be connected directly to the curb. Curb design shall comply with NRCA requirements. Curb shall be shipped knocked down for field assembly and shall include wood nailer strips. Accessory - High Static Drive The high static drive option shall allow the standard motor on the 121/2 and 20 ton units to operate with improved external static; capabilities. Sequence of Operation (if applied in a SINGLE-ZONE CONSTANT-VOLUME SYSTEM or a CHANGEOVER BYPASS SYSTEM) B. SINGLE-ZONE CONSTANT-VOLUME SYSTEM 1. OCCUPIED HEAT/COOL: The RTU shall operate the supply fan continuously and modulate (or cycle) compressors, modulate (or staff)-heat, and/or enable airside economizing to maintain zone temperature at setpoinL lle-QA damper shall open to bring in the required amount of ventilation. 2. MORNING WARM-UP/PRE-COOL: The RTU shall operate the supply fan and modulate (or cycle) compressors or modulate (or stage) heat to raise/lower zone temperature to its occupied setpoint. The OA damper shall remain closed, unless economizing. D. CHANGEOVER BYPASS SYSTEM 1. OCCUPIED HEAT/COOL: Each VAV terminal shall use pressure-independent control, with airflow measurement, to vary primary airflow to maintain zone temperature at its occupied setpoint. The RTU shall modulate the bypass damper to maintain duct static pressure at setpoint and modulate (or cycle) compressors, modulate (or stage) heat, and/or enable airside economizing based on current zone cooling/heating demands. The OA damper shall open to bring in the required amount of ventilation. 2. MORNING WARM-UP/PRE-COOL: Each VAV terminal unit shall vary primary airflow to raise/lower zone temperature to its occupied setpoint. The RTU shall modulate the bypass damper to maintain duct static pressure at setpoint and modulate (or cycle) compressors or modulate (or stage) heat based on current zone cooling/heating demands. The OA damper shall remain closed, unless economizing. 3. COOLING/HEATING CHANGEOVER LOGIC: The System Controller shall determine the overall system cooling/heating mode based on "voting" from each zone. When the majority of zones require cooling, the RTU shall operate in cooling mode and any zone that requires heating shall reduce primary airflow to minimum. When the majority of zones require heating, the RTU shall operate in heating mode and any zone that requires cooling shall reduce primary airflow to minimum. 09115I2021 12:51:35 Pa,,e 1+of 11 -� COASMEC-02 PSUzIQ '4�oRo CERTIFICATE OF LIABILITY INSURANCE DA�o�s/2o2 YY) 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 Ileu of such o_nd_orsement(s). _ PRODUCER NAMFACT Paul A.Suzio AssuredPartners New England,Inc. PHONE Esn:(203)514 7863 FAX Nal:(203)514-7863 100 Beard Saw Mill Road Shelton,CT 06484 I J'%ss Paul.SuzioJr@AssuredPartners.com ___...- - SURERIS)AFFORDING COVERAGE NAIL _W INSURER A:American Fire&Casualty Co. 124066 INSURED INSURER 8:Ohio Security Insurance Company _i24082 Coastal Mechanical Services,Inc. INSURER C:Ohio Casualty Ins.CO. __ 24074 40 Hathaway Dr. INSURER D: Stratford,CT 06615 INSURER E _ INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION 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 ADOL 9UBR —— ----- POLJCY EFF POLICY EXP TYPE OF INSURANCE POLICY NUMBER (�Qryyyyl LIMITS A X COMMERCIAL GENERALLIABSJTY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE I X]OCCUR X BKA58336167 12/17=2 12/17/2021 P TO RENTED s 300,000 _ MED E%P(Any ons perw) (E 15,No _ PERSONAL 6 ADV INJURY S 1,000.000 GENL AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE S 2,000'000 X Mi.ICY! 1 LOC PRODUCTS-COMPIOP AGG S 2,000,000 B AUTOMOBILE LIABILITY COI I EIEDD SINGLE LIMIT S 1,000,000 tEsX ANY AUTO pp BASS8336167 12/17/2020 12117/2021 BODILY INJURY(Per person) S _ AURTEO�S ONLY (WNED A�UUT�OSSyUyN��Dp VB��ODDIILEY INJURYAPPr sociden S _ X A MS ONLY X AUTOS(7NLY �L - S C UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 2,000,066 X EXCESS LIIAB CLNMS-MADE USOGS336167 12/1712020 12117/2021 AGGREGATE S - 2'000,000 DED X RETENTIONS 10,000 C WORKERS COMPENSATION X I STATUTE I I Zr AND EMPLOYERS'LIAINLITY XWO58336167 1211/2020 12/1/2021 500,000 ANY PROPR IET gO ER R/PARTNER/EXECUTIVE IY I NI ( E L_EACH ACCIDENT S IMan�tory In NH(EXCLUDED? NIA I 6t10,000 E L DISEASE-EA EMPLOY S It yes,describe under 500,000 DESCRIPTION OF OPERATIONS below E.L DISEASE-POLICY LIMIT DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101.Additional Remarks Schedule,may be attached If more space is requlredl Village of Rye Brook is additional Insured. CERTIFIC TF HOLDER_ CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Village of Rye Brook THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 9 ACCORDANCE WITH THE POLICY PROVISIONS. 938 King Street Rye Brook,NY 10573 - - AUTHORIZED REPRESENTATIVE ..KAEs.�ass ACORD 25(2016/03) 01988-2015 ACORD CORPORATION. All rights roserved. The ACORD name and logo are registered marks of ACORD YORK Workers' CERTIFICATE OF TATE Compensation Board NYS WORKERS' COMPENSATION INSURANCE COVERAGE 1a Legal Name&Address of Insured(use street address only) 1b. Business Telephone Number of Insured Coastal Mechanical Services, Inc. (203)953-3732 0 Hathaway Dr. 1c. NYS Unemployment Insurance Employer Registration Number of Insured Stratford ,CT 06615 Work Location of Insured(Only required if coverage is specifically limited to 1 d Federal Employer Identification Number of Insured or Social Security certain locations in New York State,i.e,a Wrap-Up Policy) Number 06.1450112 2 Name and Address of Entity Requesting Proof of 3a Name of Insurance Carrier Coverage(Entity Being Listed as the Certificate Holder) Ohio Casualty Ins.Co. VIIInge uh Rye IIrook 3b Policy Number of Entity Listed in Box"I a" WDS8336167 Rvc Brook,NY 10573 3c Policy effective period 1211/2020 to 12/1/2021 3d. The Proprietor,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"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 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 7'. 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 a certificate holder,the business must provide that certificate holder with a new Certificate of Workers'Compensation Coverage or other authorized proof that the business is complying with the mandatory coverage requirements of the New York State Workers'Compensation Law. Under penalty of perjury,I certify that I am an authorized representative or licensed agent of the insurance carrier referenced above and that the named insured has the coverage as depicted on this form. Approved by: Paul A. Suzio (Print name of authorized representative or licensed agent of insurance carrier) Approved by: loa- z 101512021 (Sig t e) (Date) Title: Account Executive Telephone Number of authorized representative or licensed agent of insurance carrier: (203)514-7863 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.