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Home My WebLink AboutRP21-072PERMIT # (z) O DATE: IXP: of c�m c�c� SECTION 7 - BLOCK I LOT �9 TYPE OF WORK — L(: JOB LOCATIQN OWNER CONTRACTOR LC 131 ES�O�ST W # TCO n INSPECTION RECORD DATE FOOTING FOUNDATION FRAMING RGH FRAMING INSULATION PLUMBING F1 RGH PLUMBING GAS C� SPRINKLER ELECTRIC d LOW -VOLT L7 ALARM C7 AS BUILT C� FINAL INSP ucholw) ' ,-,o s/q c� re (9/J)g39-77/0 DA DATE CJTHER APPROVALS �ARB BOT rB j �BA I ;ETHER L� VILLAGE OF RYE BROOK MAYOR 938 King Street, Rve Brook, N.Y. 10573 ADMINISTRATOR Paul S.Rosenberg (914) 939-0668 Christopher J.Bradbury n!ww.ryebrook.or TRUSTEES BUILDING& FIRE Susan R. Epstein INSPECTOR Stephanie J. Fischer Michael J. Izzo David M. Heiser Jason A. Klein CERTIFICATE OF COMPLIANCE January 24,2022 Amelia Irizarry 6 Lincoln Avenue Rye Brook, New York 10573 Re: 6 Lincoln Avenue, Rye Brook, New York 10573 Parcel I D#. 135.73-1-29 Roof Permit#21-072 issued on 12/22/2021 to Re-Roof Existing Building This certifies that the new roof,installed under the above captioned pemnit has been satisfactorily completed. Sincerely, Michael J. Izzo Building&Fire Inspector Ag Firefox about:blank p [ECIEdWE ID For offic•use onl JQN 2 2022 BUiLlliNG DEPARTMENT PFAMrr,4 - _ 7a VILLAGE OF RYE BROOK ISSUED: 938 KIiNG STREET,RYE BROOK,NEw'YORK 10573 DATE' VILLAGE OF RYE BROOK (9I4)9"-0668 FEE: PAM BUILDING DEPARTMENT ww ,ryetirook.or� APPLICATION FOR CERTIFICATE OF OCCUPANCY,CERTIFICATE OF COMPLIANCE, AND CERTIFICATION OF FINAL COSTS TO BE SUBMITTED ONLY UPON CokPLETION OF ALL WORK, AND PRIOR TO THE FINAL INSPECTION rrrrrrarrrrrrrr•rr!!r!!!rlrrirrr►larralaar+aalaaara+lrrrararlaa arrrr+rrrrrrrWrrrrrrrrrrrrr rrrrrrr•rrrrrrrlrrrral rrrrrrrrrirrr Address: tom, L�nc�ln Are Occupancy/Use: i22e 5 Parcel[U 4:_ 3S *0__:1k 00(0a 9 0W0G )o _-zone: � Owner: �CLIC6+'LUX)t71 CLVO Addrr5s: G�t,+ Lifxo1r, PvG, eu-r BrrJ(_ P.E./R.A.or Contractor: (Z (} (Crn�, t 0 _ _-Address: 1 941 .1 r� Person in responsible charge: Mai tc c ohm Address: � �1f°0111Y1. i2iae Bm]kr 1`ry 1�3 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 NF.W YORK,COUNTY OF WESTCHESTER as: N1(I OL j A f`e._ being duly swom,deposes and says that he she resides at ' t Tcan crarw i 4'•:n,'7 e;nr,\l+r9icmi9i !�. ��$Crccai in Ry,B r octK. -_,in the County of in the State of T`✓� ,that it,ly 1-kn!vi0jocl he/she has supervised the work at the location indicated above,and that the actual total cast of the work,including all site improvernentc, IaboT,materials,scaffolding,fixed equipment,professional I'm,and including the monetary value of any materials and labor which may o0 have been donated gratis was:S a I?5'C) for the construction or alteration of: iV f W ( O4- -1" !)L--)k v s Dcptment 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 structurehvork has been erected/completed in accordance with die approved plans and any amendments thereto ezcept in so fir as variations therefore have hccn leg,lly 113thori7ed,and as crceted/completed complies with the taws 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 orpart thereof hereafter created,erected,changrd,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 theCode of the Village of Rye Brook. Sworn to before me this ` Sworn to before me this y f 20 0— day of ,20 -9- 2�, SitPetltro or prGptaty Owner Sitpis a of Applic lu }'rim N�/�rry tTwner ;_`y '.�l�e of'Atapli�:rnt .Notary Pabl b is 111ahard C,Lt U No public,State of N.Y. lo.01LAW03242 CAROLYN MARiE CANNISTRARO Quaft In Westclxl rC NotaryPublic-StalBDf New York CnM,rj"," c..nirCs Feb.23. No,01CA6177080 Qualined in Westchester County My Commission Expires Nov.5,2023 1 of 1 1/10/2022, 11:46 AM �E BR(�j�. w � • �9�2 BUILDING DEPARTMENT ❑BUILDING INSPECTOR ASSISTANT BUILDING INSPECTOR VILLAGE OF RYE BROOK f❑CODE ENFORCEMENT OFFICER 938 KING STREET • RYE BROOK,NY 10573 (914) 939-0668 FAX (914) 939-5801 www.ryebrook.org - - - - - - - - - - - - - - - - - - - - INSPECTION REPORT - - - - - -- - - - - -- - - -- - - - b '� �y ADDRESS : L , 0 ( o �� '-- DATE: PERMIT` ISSUED: �ECT: BLOCK: LOT: LOCATION: — �C ( 1 Vl 0� OCCUPANCY: ❑ VIOLATION NOTED THE WORK IS... ACCEPTED ❑ REJECTED/REINSPECTION ❑ SITE INSPECTION REQUIRED ❑ FOOTING p FOOTING DRAINAGE ❑ FOUNDATION ❑ UNDERGROUND PLUMBING NOTES ON INSPECTION: ❑ ROUGH PLUMBING ❑ ROUGH FRAMING ❑ INSULATION ❑ NATURAL GAS p L.P. GAS ❑ FUEL TANK ❑ FIRE SPRINKLER ❑ FINAL PLUMBING ❑jCROSS CONNECTION [� FINAL f❑ OTHER r E Cq C` s O rr N E N C cz ■ !'� N > C-4 w o ° ° E w N ►' � � �00 O lk " v O MCI I---1 W M 6�0 ?• p a F s z 1o0e 10 0 ■ ICI >.I w 9U0 - a 3 w �w s lT M,A Rr co - 00 0-4 l%CfsZ is 7 v v v C V Or V E f' Z Rr C > O E R. m �-+ V z .� 3 o 601) \O a w E•• �, Q c z c� flaw > s' 1 D DEC BUILD 1 t MENT V "E OF RY VkQOK DEC 15 2021 938 KING ET RYF BROOi,INY 10573 ` VILLAGE OF RYE BROOK -0668 BUILDING DEPARTMENT FOR OFFICE USE t) N i A : DEC 2 1 2021 �._G �, Approval Date: # Application# Approval Signature: ` : ARCHITECTURAL REVIE OARD: J � )v f_ Disapproved: Date: BOT Approval Date: Chairman: PB Approval Date: Case_ Secretary: ZBA Approval Date: Case# Other: Application Fee: 5 AN Permit Fees: ROOF PERMIT APPLICATION Application dated:/a—j,5 4/ is hereby made to the Building Inspector of the Village of Rye Brook,NY,for the issuance of a Permit to Re-Roof an Existing Building,as per deuriled statement described below. 1. Job Address: Co L, ncoin Pue, SBL::/3S 73—"f�—,,e,)?,r�Zone:�wf Property Owpner: 'gv�xl a �r!ZQFr�' Address: (o Lincoln r�vim, . IZUc LB'C1 Phone#: 1 1'1-CUPQ 5 33y Cell``#'':'' ,,,, email: $Q (2 ►lam - - t •Cd'r1 2. Applicant: r`Q )l,r+.X�� Address: ��Gr'1 LQf Q_ .10U Ny Phone#; �� -] O Cell#: f� email: OlUH er o bsf-e C401. (all3. Roofing Contractor: -Doable R A Cm A, "P F" Address: q 1 Tron(QM - 12U2 E3Cnok_P4 Phone#: 1� w ��Cell#: email:,� nAh1e f noS f(- QD . d�► 4. Job Description,list all Methods&Materials: SCtpcj2oFr %rskrll laydQ�b, fipwnw�t Amp ed ac . lnsl-etll r1et,J shte�a�s�r�r�h�v+en{. Cui•I�fc •firaa.►i-r bacY__r�-� .ins-l-w� Soffifs �1Fr+surtzy �ul•�-rr Irad.W. Insi-all ax i. an rattrr 1-v 6vad oy+(Ajccrat1xQ-r Llad to K ,4-alummv+rt 5. Estimated Cost of Job:$ D 44 a$y .oo (NOTE:The estimated cost shall include all site improvements,labor,material,scattolding,fixed equipment,professional fees,and material and labor which may be donated gratis.) 6. If corner property,indicate street frontage: 1 13 .$q oR 5. `l1 5-7, -3 SS 7. Construction Type: NYS Construction Class: 8. Number of stories: Height: 9. Is garage being re-roofed:No: ( •Yes:( Attached No: { )•Yes: O Number of Cars: 10. Is roof peaked,hip,mansard,flat,etc: �ea-ucl 11. Estimated date of completion: G 8)1212021 auuut.utdtin ire fox Please note that this application must include the notarized signature(s) of the legal owner(s) of the above-mentioned property, in the space provided below. Any application not bearing the legal property owner's notarized signature(s) shall be deemed null and void, and will be returned to the applicant. STATE OF NEW YORK.COUNTY OE WES`VIIESTER ) as: t(,IL c f e— ,being duly sworn,deposes and states that hc/shc is the applicant above named, (print name of individual signing as the applicant) and further states that (s)he is the legal owner of the Property to which this application pertains, or that (s)he is the C G YlA-5 CA C t Cvr for the legal owner and is duly authorized to make and rile this application. ,Indicate architem contraaor,agent.attorney,cic-) 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 wel I as in accordance with the New York State Uni form Fire Prevention&Building Code,the Code of the Village orRyc Brook and all other applicable laws,ordinances andregulations. Swum to before me this t I Sworn to before me this \ day of Q(;t , 20 day of 20 Oawrc of Pr y Owner Sig ture of Applicant Fnln[Name o opetty Owner t Namr of Applicant L Notary Public Notary Public RIOWG.Lit= SHARI MELILLO Y. of Asoo3xa2 O Notary Public,State of New York 73 Qual�d In Westchester Coun No. 01 t:�'t 6 tl%B3 Corrtrr t^^F ''£, Q'-� Q°ialified in Westch_,ster County, Commission Expires Janttary 29.20 M212D2i 1 of 1 12/8/2021,U9 AN r 5*STAR BBB ati w.a. LICENSE NUMBERS PAGE 1 OF 5 WESTCHESTER: WC-15450-1104 YONKERS: 4017 CONNECTICUT: 578736 PUTNA ' PC-2892-A NEW YORK CITY: 1230531 � O B L E A CONSTRIC ON CORP. (914)....7.. Fax:(914)93"991 9 Jean Lane•Rye Brook,NY 10573 NAME: JASON & LINDA BRAVO ADDRESS: 6 LINCOLN AVENUE CITY: RYE BROOK STATE/ZIP:-NY 10.573 DATE: NOVEMBER 11,2021 INSURANCE: All work involved within the following proposal is covered by Worker's Compensation and Public Liability. A. STRIPPING: Yes_X Remove existing, roof down to sheathing and install underlayment._ROOF RUNNER PLYWOOD: CDX, Exterior grade for entire roof_X No Any rotted plywood $145.00/per sheet additional for 4' x 8' 1/2" CDX Plywood All plywood is installed with 1/8" space for contraction and expansion PIPE FLASHING: Install new pipe flashing with neoprene gaskets—ULTIMATE On g PERIMETER EDGE FLASHING: Drip edge provides efficient water shedding at the perimeter edges and protects the underlying wood from rotting. Fabricate and install Aluminum Roof Flashing to all rake edges where required. Color:_WHITE Customer Initials Date PAGE 2 OF 5 STARTER SHINGLES-. CertainTeed Starter Shingles-YES UP RAKES FOR 130 MPH WIND WARRANTY HIP & RIDGE SHINGLES: CertainTeed Hip & Ridge Shingles-YES PERPENDICULAR ROOFING WALL FLASHING: New metal step flashings where necessary. YES C®1/Mt ul AM �. SLOPE ROOF VENTILATION SYSTEMS: To prevent super heating of trapped air during the summer and harmful condensation during the winter air must circulate freely under the roof deck. The Roofing Industry and F.H.A. Minimum Property Standards requirements are 1 sq. foot of total net free ventilation for each 150 sq. foot of ceiling area. _APPROX. 36 FT NOTE: DURING RIDGE VENT INSTALLATION, SAW DUST WILL BE INTRODUCED TO ATTIC SPACE; HOMEOWNER SHOULD TAKE PRECAUTIONS TO PROTECT ITEMS STORED IN ATTIC SPACE =...ram„_.... jail FREEZE BACK FLASHING: A common roof leak problem in this geographic area is freezing ice in the gutters and along the eave edge. Under certain conditions the ice may expand up and under the roof shingles where it may melt when exposed to attic warmth resulting in leaks. For double protection along the eave edge it is recommended to install 6' Freeze Back Flashing (AKA Winterguard); which is designed to stop any expanding ice under the roof shingles from penetrating the roof deck and flap fascia. YES PICTURES ARE FOR INFORMATION PURPOSES ONLY. MANUFACTURER: CERTAINTEED BRAND: LANDMARK COLOR: Customer Initials Date PAGE 3 of 5 _X—This roofing system meets the standards of the CertainTeed Integrity Roofing System and will be installed by Double R A Construction Corp, a 5 Star Contractor with CertainTeed. The Sure Start Warranty by CertainTeed is a lifetime warranty which gives you 100% coverage for any defect in materials non-prorated for 50 years and contractor application for the first 25 years of the product. GUTTERS & LEADERS: Remove existing gutters. Inspect, remove and replace any rotten or damaged fascia with new primed pine fascia ($12.00/per foot installed for 1 x 6 fascia). Install .032 gauge aluminum 5" K-Style seamless gutters using heavy duty concealed brackets and galvanized screws spaced every twenty four inches. Leaders .019 gauge aluminum 2" x 3" in 10 ft. lengths. WHITE color. ROOF: CUT BACK ROOF ON FRONT & BACK. INSTALL SOFFITS IN WHITE WAINSCOTTING AND FASCIA BOARDS (INCLUDED) OPTION: INSTALL 2 X 6'S ON RAKES TO BUILD OUT AND CLAD WITH WHITE ALUMINUM. $ 2,880.00 "ALL PLANS AND PERMITS TO BE OBTAINED BY HOMEOWNER" NOT RESPONSIBLE FOR CRACKING SHEETROCK OR POPPING NAILS ON VAULTED OR CATHEDRAL CEILINGS DOUBLE "R" TO CART AWAY ALL JOB RELATED DEBRIS. All hidden rotted wood will be priced accordingly. Please note: When a dumpster is removed there may be some wood and a small amount of debris remaining. Please use caution in this area. Double "R" A Construction Corp shall guarantee workmanship to be free of defects for the natural life of the products installed by our certified installers and will furnish all necessary materials, labor and equipment. During installation, HOMEOWNER should take necessary precautions as required to protect items stored on walls and/or shelves. Double"R" shall not be responsible for any damaged items that were not protected during installation. Double"R" shall take all necessary precautions to protect the property of our customers, although, some damage may occur. A job sign will be placed on property near road at start of job and shall remain on property for two(2) weeks upon completion of job. To accomplish our goals, Double "R", uses photographs of homes and aspects of homes in many types of media (newspapers, radio, television and the internet) and uses photos in our own publications. It is the right of the individual whether or not to consent to the use of his/her photograph for the above publicity purposes. By signing a contract with Double"R", you will hereby authorize us to use any photographs taken of your home before, during or after the project for marketing purposes. Written documentation of disapproval is required by Double"R" if you wish to exercise your right not to allow us to use such materials. You, the owner, may cancel this transaction at any time prior to midnight of the third business day. After the date of this transaction, such cancellation must be made in person, at the offices of Double"R" 9 Jean Lane, Rye Brook, NY, or in writing, postmarked prior to the fourth (4)business day. If you cancel this agreement at any time subsequent to midnight of the third business day after the date of the contract and prior to the start of the work, you agree to pay us the difference of the cost of material and labor and the amount of the total sale (our lost profit). We reserve the right to cancel this contract at anytime within fifteen (15) days of this contract. If we cancel, you will be promptly notified in writing by an authorized officer of Double"R" A Construction Corp. If we cancel, we will promptly return any down payment(s) you have made. You agree to pay cash according to the terms show below, or, if your credit is approved, to sign a note provided by us for payment of the amount due. You also agree to sign a completion certificate upon completion of work. If you fail to pay according to the below terms and have not signed our note, the entire unpaid amount becomes immediately due and you must pay a collection cost equal to our actual costs of collection, up to 15% of the total amount you owe, plus attorney's fees and court costs. Material overages are not subject to reimbursements. The installation will begin on or about and will substantially be completed It is understood by you that the following contingencies could materially change the estimate completion date stated above: customer's inability to obtain or qualify for financing, inclement weather, strikes or other labor disruptions; non-availability of materials; acts of God, or any other. Due to rapidly escalating prices and extreme volatility in the pricing of petroleum based construction products, the price set forth in this proposal/contract applies only to orders that are ordered and paid for within 10 days of the date of this proposal/contract. All other orders shall be subject to change based upon changes in the price material charged to Double"R". The buyer and the seller understand that with reference to the aforementioned completion date, time is not of the essence. CONTRACTOR PERFORMANCE WARRANTY: Double"R" proposes to furnish and install labor and material. All work will continue on job without stopping until completion barring any circumstances beyond contractor's control. Any changes to the job after signing of the contract are subject to an additional cost, and shall be handled in writing on a change order. Customer Initials Date PAGE 5 OF 5 ACCEPTANCE: The below prices, specifications and conditions are satisfactory and are accepted. You are authorized to do the work as specified. Payment will be made as follows: 19,200.00 ROOF 2,200.00 GUTTERILEADER 2,880.00 RAKE BUILD OUT TOTAL: $ SALES TAX: $ PERMIT FEES (IF APPLICABLE): $ TOTAL SALES: $ PAID WITH ORDER $ Cash Check# $ BALANCE DUE: $ Terms: Cash to be paid as follows $ (2"d deposit of 1/3'd is due) Half completion Financing balance (3''d deposit of 1/3"d is due)Day of completion CUSTOMER SIGNATURE: DATE: DOUBLE "R" A CONSTRUCTION AUTHORIZED SIGNATURE • ' � , a I I t�. Y t Y 1x t �` k ��:, ,� ". � �. ;.. �.. ti �. �,� • <� �a. � ,� ,.w . .4� g. ��i . � .��, :c ' t.;•� i • - � ,� a ? a T 1,f I I 1f ..�. ' �L f �. +A I, , �� P {' //i . �� Y qc, f .e y r 7 `. • ,A 1 � � s +� � � 5 r. P� t f � i - Il Ili �� ■ �. �e 1 ' r � a 1 . i. r f. i 3 _T m v ice! 11, .,h1. h v �k as C c►. M ` a _ I ' AWy V .00 U Z 0 CIO , � � r. O H LO J W o ' ;ectiaa `. �J O Z v CD tNriq► .n m �Z X w 'Z , 1 + go 41 c y t O ci .cc gla _ €k€kLo (( „ L L z v In Ln cj CL ,I � �. F i ice► \ . _ 1, - DATE(MWDDIYYYYI ACOR" CERTIFICATE OF LIABILITY INSURANCE 116 � 1 11/24/2021 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 endorse ment(s). PRODUCER CONTACT NAME; Charles Eatman Dur-America Brokerage Inc I mONE ziz 3Dz-zs7z FAX, No): 718 956-9731 214 W 39th Street, Suite 207 E-MAIL ADDRESS: certificates@duramerica.com New York, NY 10018 INSURER(S)AFFORDING COVERAGE NAICiI CASUALTY INSURANCE CO46 INSURED INSURER B Double R A(Construction Corp NSURERC: 9 Jean Lane NSURERD: Rye Brook, NY 10573 NSURERE: INSURER F: COVERAGES CERTIFICATE NUMBER: 00003019-1454864 REVISION NUMBER: 140 THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. (VTR TYPE OF INSURANCE ADD POLICY NUMBER MM OD/YEY MMLODY EXP LIMITS A X COMMERCIAL GENERAL LIABILITY y L302000882-0 10115/2021 1011512U22 EACH OCCURRENCE $ 1 000 000 ENTED CLAIMS-MADE �OCCUR PREMISES DA AGE ToEa occurrence $ 100 000 _ MED EXP(Any one rear) $ rj 000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY jEa �LOC PRODUCTS-COMPIpPAGG $ 1,000,000 OTHER $ AUTOMOBILE LIABILITY COMBINED LE L $ Ea accede rt ANY AUTO BODILY INJURY Per ( person) $ OWNED SCHEDULED P BODILY INJURY erecddent AUTOS ONLY AUTOS ( ) $ HIRED NON-0WNED PROPERTY DAMAGE AUTOS ONLY AUTOS ONLY Per ecci yr[ $ S UMBRELLA LIAB OCCUR EACH OCCURRENCE S EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED I RETENTION$ $ WORKERS COMPENSATION - PER OTH- AND EMPLOYERS'LIABILITY YIN STAT TE I ER ANY PROPRIETORIPARTNER/EXECUTNE E.L,EACH ACCIDENT S OFFICERIMEMBER EXCLUDED? ❑ NIA' (Mandatory In NH) E.L.DISEASE-EA EMPLOYE S If yes,descdbe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ iJ_ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Village of Rye Brook is included as additional insured CERTIFICATE 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 Building Department ACCORDANCE WITH THE POLICY PROVISIONS, 938 King Street AUTHORVFO REPRESENTATIVE Rye Brook, NY 10573 11i (F P) G 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD Printed by F_P on 11/24/2021 at 11:22AM 4 NYSIF New York State Insurance Fund PO BOX 66699,Albany,NY 12206 nysif.com CERTIFICATE OF WORKERS' COMPENSATION INSURANCE (RENEWED) ^^^^^" 061605879 DURAMERICA BROKERAGE INC 214 W 39TH ST STE 207 NEW YORK NY 1001$ ME%P� SCAN TO VALIDATE AND SUBSCRIBE POLICYHOLDER CERTIFICATE HOLDER DOUBLE RA CONSTRUCTION CORP VILLAGE OF RYE BROOK 9 JEAN LANE BUILDING DEPARTMENT RYE BROOK NY 10573 938 KING STREET RYE BROOK NY 10573 POLICY NUMBER CERTIFICATE NUMBER POLICY PERIOD DATE W2336 816-0 671905 06/13/2021 TO 06/13/2022 11/2412021 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE NEW YORK STATE INSURANCE FUND UNDER POLICY NO. 2336 816-0, 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.COM/CERT/CERTVAL.ASP.THE NEW YORK STATE INSURANCE FUND IS NOT LIABLE IN THE EVENT OF FAILURE TO GIVE SUCH NOTIFICATIONS. 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 STAT SU NCE FUND v I I/ DIRECTOR,INSURANCE FUND UNDERWRITING VALIDATION NUMBER: 516054019 U•26.3