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HomeMy WebLinkAboutRP22-012OTHER APPROVALS PERMIT*/-Q aDATE: `a� D(P: '� �%3 ARB SECTION 5 BLOCK / LOT �1 DOT TYPEOFWORK E / f7 L// /n PB --' ZBA JOB LOCATION Pn fiVP Q� �^ y\ OTHER OWNE ene 6/ os us e _ /_die ne6/ossl�J �Usf �I/ J CONTRACTOR O/.Sss 3 P.S /+�I70n - -EEJ$$T. COST df FEE `� b lLl�'y101-%ii8a VO # FEE _ __ DATE 7 TOO # FEE DATE INSPECTION RECORD DATE INSP FOOTING FOUNDATION FRAMING RGH FRAMING INSULATION PLUMBING O RGH PLUMBING GAS Eml SPRINKLER ---^ ELECTRIC 0 LOW -VOLT O - --- ALARM AS BUILT 0 ZS' IOLy �'T7p FINAL DR. �w c c4 vu1°, 190 J'� 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 Steven E. Fews Stephanie J. Fischer David M. Heiser Salvatore W. Morlino CERTIFICATE OF COMPLIANCE April 29,2024 The Irene Glassberg Trust Irene Glassberg,Trustee 7 Hidden Pond Drive Rye Brook,New York 10573 Re: 7 Hidden Pond Drive, Rye Brook,New York 10573 Parcel ID#: 135.75-1-11 Roof Permit#22-012 issued on 4/8/2022 to Re-Roof Existing Building This certifies that the new roof,installed under the above captioned permit has been satisfactorily completed. Sincerely, Steven E. Fews Building&Fire Inspector /to D CCE0WE BUILD R NT For office u�se(�only: � �'R 19 2024 PERMIT VIL OF RYE OK — " ISSUED: VILLAGE OF RYA_ BROOK 938 KING STRE YE BROOK, YORK 10573 DATE: — oe BUILDING DEPARTMENT 9 -06 OY FEE: PAID 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 ittttitt�#tk]tk#tttu##itik #ittti####k#kkitt##it###ikkt########i#tt######i#ittt####kk#tittt#kkt##tttt####ktitt#####ittit#t###k Address: T f T rn rl l Occupancy/Use: �lC�f� Parcel JID#: 1,36 , 7S Zone: Owner: �—t? I-)Q ' 0.C S b P ('U Address: B eq IF I ` P.E./R.A.or Contractor:�te u t J �C�gl�-i nil Address:(Ioy K f1U S 1TC r I u Oj �{, Person in responsible charge: (/i ca� S fie! 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: 1.) _U, Y Q I.S A being duly sworn,deposes and says that he/she resides at Ll 60k/ 3 (Print Name of Applicant) (No and Street) in C,YIkA_-b D C(z I Ltq ,in the County of W e S )rJ, �_e J in the State of—/Aj ,that (Ci own/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:$ S O (1. O a 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 1me this Sworn to before me this l r6 day of ` 20 �� day of 1�:(Jr t ' , 20�� Signatur,of Property Owner Signature of Applicant /� EQualified Y ARANGO / !RC` ,:��jrState of New York / uV` `/n ,^ fV \TL J 71xR6356114 U/ K-Ct Print Name of Property Owner stchester County print Name of Applicant xpires Mar 20, 2025 pp C*Y Notary Public Notary Public 3/12/2021 QyE BRC��. BUILDING DEPARTMENT ❑l BUILDING INSPECTOR e A SSISTANT 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 : DATE: /- Z 2aZ PERMIT# R 1 ,Z-- ISSUED: /�0�lz SECT: 5 ��J BLOCK: LOT: LOCATION: t OCCUPANCY: ❑ Violation Noted THE WORK IS... 2/PASSED ❑ FAILED REINSPECTION ❑ SITE INSPECTION REQUIRED ❑ FOOTING ❑ FOOTING DRAINAGE ❑ FOUNDATION ❑ UNDERGROUND PLUMBING NOTES ON INSPECTION: ❑ ROUGH PLUMBING ❑ ROUGH FRAMING ❑ INSULATION ❑ Natural Gas e. - �� / ❑ L.P. Gas ❑ FUEL TANK ❑ FIRE SPRINKLER ❑ FINAL PLUMBING ❑ CROSS CONNECTION Er FINAL OTHER N 00 ` ro ° , "T b uON ? W Ca a'i C OR, .: v • = w CA W C1 �O v O` ■ A wo �� r FN T'1 P9 v yq ,� 14 � W a v ] N w M l Cn O p. 72 p F-1 o w E b u p WOCD � � = CJ) �rTT CV Cl' w w o z O '++0o ` ° ° 0 �+ p I l ■ © 00 w I--i C) W r, U z °' ° o W0. cn lu oo ON a v 5 a � �' � oa '0 d A d `, O H • A � W E� p � z � �q �,� Q c�1� �a � > = A w z O � � x � � a BUILDING DEPARTMENT R VI AGE OF RYE BROOK APR - 6 2022 938 KING�TREET RYE BROOD,NY 10573 (9 -0 VILLAGE OF RYE BROOK BUILDING DEPARTMENT FOR OFFICE USE ONLY: Approval Date: APR 8 202 rmit Application# Approval Signature: ARCHITECTURAL REVIEW ARD: Disapproved: _ : Date: BOT Approval Date: Case# Chairman: PB Approval Date: Case# Secretary: zBA Approval Date: Case# Other: Application Fee* Pb Permit Fees: ROOF PERMIT APPLICATION Application dated: 03/25/22 is hereby made to the Building Inspector of the Village of Rye Brook,NY,for the issuance o I'a Permit to Re-Roof an Existing Building,as per detailed statement described below. 1. Job Address: 7 Hidden Pond Drive SBL:13s ,?S—f—1/ zo.e: Property owner: Irene Glassberg Address: 7 Hidden Pond Drive Phone#: 914-934-1029 Cell#: email:. 2. Applicant: David's Roofring & Restoration Address: 400 King Street Suite 2, Chappaqua , NY 10E Phone#: 914-494-9094 Cell#: 914-461-7888 email: info@davidsroof.com 3. Roofing contractor: Davids Roofing & Restorations Address: 400 King Street Suite 2, Chappaqua , NY 105 Phone#: 914-494-9094 Cell#: 914-461-7888 email: info@davidsroof.com 4. Job Description,list all Methods&Materials: Full Roof removal and replacement see proposal 5. Estimated Cost of Job:$ 17,500.00 (NOTE:The estimated cost shall include all site improvements,labor,material,scaffolding,fixed equipment,professional fees,and material and labor which may be donated gratis.) G. If corner property,indicate street frontage: 7. Construction Type: NYS Construction Class: $. Number of stories: Height: 9, Is garage being re-roofed:No:V•Yes:( )Attached No:( )•Yes:( )Number of Cars: 10. Is roof peaked,hip,mansard,flat,etc: 11. Estimated date of completion:should only take one day -t- 8/12/2021 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 OF WESTCHESTER ) as: Irene Glassberg , being duly sworn,deposes and states that he/she 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 David Reisner for the legal owner and is duly authorized to make and file this application. (indicate architect,contractor,agent,attorney,etc.) That all statements contained herein are true to the best of his/her knowledge and belief,and that any work performed,or use conducted at the above captioned property will be in conformance with the details as set forth and contained in this application and in any accompanying approved plans and specifications,as well as in accordance with the New York State Uniform Fire Prevention&Building Code,the Code of the Village of Rye Brook and all other applicable laws,ordinances and regulations. Sworn to before me this Sworn to before me this day of , 20 a4 day of MCAIEC� , 20 ZZ— Sign ture of Proper Owner S4gnature of Applicant Irene Glassberg David Reisner Print Name of Property Owner Prin Name of Applicant _ kA.,k"M1\___ Notary Public N ary ublic ..•'iA MCA `p STATF �;•'OF NEtiM YORK,� NOTARY PUBLIC c C{') Qualified in ;N p+ Suffolk County AlCA63&tI %cb '•,,'limos.•... �_.,.•ca,'4.s �''•s�aN EX?\4�;.��` 111.1.41000. -2- 8/12/2021 David 's Roofing & Restorations LLC — 400 King Street, Suite 2 Chappaqua,NY 10514 info(&davidsroof.com 914-494-9094 LIC: WC-32748-H2O Irene Glassberg 03/04/22 7 Hidden Pond Drive Rye Brook, NY 10573 914-934-1029 Iglassberg7@gmail.com PROPOSAL ROOF REMOVAL AND REPLACEMENT • All existing asphalt roofing removed and carted from job site • All rotted plywood replaced at an additional $110.00 per sheet • GAF Weather Watch Ice and Snow barrier installed on all gutter edges,valleys and around skylights (6 feet up) • GAF Tiger Paw paper installed on entire field of roof • GAF Weather Blocker starter shingles installed on all perimeter edges • GAF LIFETIME Timberline Architectural HDZ shingles installed on entire field of roof 1 • GAF Cobra Ridge vent installed on all ridges of roof for attic ventilation • GAF TimberTex hip and ridge shingles installed on all ridges • Aluminum vent pipe boots installed over all vent pipes • Aluminum drip edge flashing installed around entire perimeter of roof • Cart away all debris from job site The price for the aforementioned work, which includes labor and material for the sum of. $17, 500.00 (permit fee not included if applicable)Winter price valid for 6 weeks. Regular price: 18,500.00 PAYMENT SCHEDULE IS AS FOLLOWS 50% 3 Days Prior to Start 95% Due the day of substantial completion 5% Retention may be held for resolution of unresolved issues Any monies not paid as specified above will be subject to accrue interest at a rate of 1.5% monthly, and 18%per annum. All material is guaranteed to be as specified above. All work to be completed in a workmanlike manner according to the standard practices. Any alteration or deviation from the above specification involving extra costs will be executed upon a written change order and will become an extra charge over and above the proposal. All agreements are contingent upon strikes accidents or delays beyond our control.Notices to Owner Right to stop work: If any payment under this agreement is not made when due, David's Roofing and Restorations, LLC may suspend work on the job until such time as all payments due have been made. 2 I'he rruposed sum above is valid for thirty(30) days and is based on prices of materials and ,quip,nent in effect as of the date of this proposal. The proposed sum is subject to increase because of tariffs, epidemics, import duties,trade policies,or market conditions. ° Notice of Lien: The contractor or subcontractor who performs on the contract and is not paid may have a claim against the owner which may be enforced against the property in accordance with the applicable Lien Laws. Cancellation: The owner has an unconditional right to cancel the contract without penalty until midnight of the third business day after he/she signs the contract. Cancellation must be done by giving David's Roofing and Restorations, LLC. a written notice indicating the owner's intention not to be bound. Upon cancellation,any property traded in,or payments made under this contract will be returned within 10 business days following the receipt of the cancellation notice by David's Roofing and Restorations, LLC. Acceptance of Proposal: I have read the introductory packet along with this document and accept the specified conditions as stated,and the prices associated with such. I understand that upon signing this proposal, all documents presented becomes a binding contract.You are authorized to do the work as outlined. Payment will be made as indicated above. 1 ignature 3 f 7 ,,, 02, Date 3 7 Hidden Pond Dr, Rye Brook, NY 10573 QuickMeasure February 28, 2022 Roof Reports in Under an Hour Prepared For: David's Roofing and Restorations LLC A N Contents Measurements Overview 1 Roof Area 3,146 sq ft Top View 2 Roof Facets 26 Side Views 3 Predominant Pitch 12 / 12 Lengths 4 Ridges/Hips 282 ft Pitches 5 Valleys 121 ft Areas 6 Rakes 67 ft Summary 7 Eaves 272 ft Materials 8 Bends 0 ft A QuickMeasure Top view Roof Reports in Under an Hour ' 1 n `� P,�I� r w A '4 A -O*S I;'VOV .J Y # c r S ' Prepared For: David's Roofing and Restorations LLC © 7 Hidden Pond Dr, Rye Brook, NY 10573 QuickMeasure Pitches Roof Reports in Under an Hour A N 1 12 8 9 12 9 7 7 I 7 7 12 12 I 7 7 12 7 12 7 7 12 Pitches in inches per foot Prepared For: David's Roofing and Restorations LLC © 7 Hidden Pond Dr, Rye Brook, NY 10573 QuickMeasure Areas Roof Reports in Under an Hour A N 101 83 19 31 19 108 111 68 66 81 534 131 Il 255 212 349 7 636 104 30 35 30 Areas in square feet Prepared For: David's Roofing and Restorations LLC 7 Hidden Pond Dr, Rye Brook, NY 10573 QuickMeasure Summary Roof Reports in Under an Hour Pitch 7 8 9 12 Area 1,153 83 53 1,857 Percent 37% 3% 2% 59% Suggested Waste 0% 19% 22% 24% 26% 29% 34% Area 3,146 3,744 3,838 3,901 3,964 4,058 4,216 Squares 32 38 39 40 40 41 43 Roof Area 3,146 sq ft ARoof Facets 26 N Predominant Pitch 12 / 12 Bends 0 ft Eaves 272 ft Hips 221 ft Rakes 67ft Ridges 61 ft Valleys 121 ft Flash 47 ft Step 54 ft Drip Edge 339 ft Leak Barrier 782 ff Ridge Cap 282 ft Starter 339 ft Parapets 0 ff Notes:1)Measurements are rounded to the nearest whole number.2)Rakes are defined as sloped roof edges.3)Eaves are defined as level roof edges.4)Flashing pertains to level roof edges and excludes valleys.5)Step flashing pertains to sloped roof edges and excludes areas around penetrations.6)Drip edge=eaves+rakes.7)Waste table excludes additional materials needed for ridges,hips,valleys,etc.8)Suggested waste factor is based on the roof complexity and is provided for guidance purposes only. You should confirm the appropriate waste factor prior to ordering. Prepared For: David's Roofing and Restorations LLC 7 Hidden Pond Dr, Rye Brook, NY 10573 QuickMeasure Roofing Materials Roof Reports in Under an Hour Suggested Waste 0% 19% 24% 29% Timberline Products HDZ, HD, Natural Shadow, American bundle 96 115 119 124 Harvest, Reflector, Royal Sovereign, and Cool Series Starter WeatherBlocker bundle 4 5 5 5 Pro-Start bundle 3 4 4 4 Quick-Start roll 11 13 13 14 Roof Deck Protection Deck-Armor, Tiger Paw, FeltBuster 10 sq roll 4 4 4 5 Shingle-Mate roll 8 10 10 11 VersaShield roll 9 11 12 12 Leak Barrier StormGuard, WeatherWatch 2 scl roll 12 14 15 16 WeatherWatch 1.5 sq roll 16 19 20 21 Ridge Cap Seal-A-Ridge bundle 12 14 14 15 TimberTex bundle 15 17 18 19 Z-Ridge bundle 9 11 11 12 TimberCrest box 15 17 18 19 Attic Ventilation Cobra 4' Plastic Ridge Vents foot 42 Master Flow SSB960 Metal Slant-Black vent 13 Master Flow High-Capacity Dome Vent vent 6 Cobra IntakePro Rooftop Intake foot 84 Notes.1)These approximate quantities are based on estimated measurements and are for guidance purposes only. you should always confirm quantities prior to ordering and ensure you are following local building code requirements. 2)For Timberline.3 bundles=0.984 squares. 3)Starter=eaves+rakes. 4)Leak barrier=bends+eaves+flashing+hips+rakes+step+ valleys. 5)Ridge cap=hips+ridges.b)Estimated quantity of attic ventilation products based solely on exterior roof area and intended for estimating purposes only. Installer must verify attic floor square footage,roof design,local code requirements,quantity/type of vent products,and conditioned space under the root. Always have a balanced attic ventilation system. In no case should the amount of exhaust ventilation exceed the amount of intake ventilation.For more info,visit gof.com/ventcalculotor. 'Installed coverage will be less and depend on quantity and width of side and end laps. Prepared For: David's Roofing and Restorations LLC 7 Hidden Pond Dr, Rye Brook, NY 10573 1 GAF l O e "F Timf HDZ Sell in the home or virtually with ' row I a streamlined digital sales tool - Ad � 5 c-AF 1 - Rewa rd s Y ��...: � Earn up to = � 2.5% back in GAF Rewards Points on your qualifying purchases. urchases. a a Terms and conditions apply '�- Learn more We protect gaf.com/Rewards what mattersmost- of G.r..■glnbp.YseK�aM7<.ylrsbREWYM/amme'aaa�eq!�mpnl.W USonk:a�.M.OaMaV"a4Oa1e0 vmxi[cadtp neriN remi[4ms n9mb,w 011cbRt O]IRl rri W1�•�]G6 mruer.ClaObfOwR..Y nw Vtwmur.Oa o•r U1n Wa[M>I:JS im gP.-.arJS�.a Ja'u:amp W YAM Yi ttaY�bn geOpi aTaa vd yci�ta�t R!OCR -•• -• • D. 0 •. 0 0 • 0 • 0 9 •.- '• • •• I QuickMeasure Side Views Roof Reports in Under an Hour i, 1 -;i; r w •4wr y�� �ps� Y ` k ' , • 4 11.DaG 1i 4 Prepared For: David's Roofing and Restorations LLC © 7 Hidden Pond Dr, Rye Brook, NY 10573 QuickMeasure Lengths Roof Reports in Under an Hour A Flash Step Drip N 6 22 1 14 / 14 �f \- 8 8 5� 9 \ 9 5 25 16 1 25 28 4 28 4 8 8 ■ Eave Hip ■ Rake ■ Ridge ■ Valley 272 221 67 61 121 Lengths in feet Prepared For: David's Roofing and Restorations LLC m 7 Hidden Pond Dr, Rye Brook, NY 10573 Laura Petersen From: Mike Izzo Sent: Tuesday, April 5, 2022 1:18 PM To: David's Roofing Cc: Tara Gerardi; Laura Petersen Subject: Re: Roofing Permit - 7 Hidden Pond Drive, Rye Brook Dear Ms. Margarita, Please proceed to submit the roofing applicant with whatever notarized signatures you have. Thank you. Sent from my Whone On Apr 5, 2022, at 10:15 AM, David's Roofing<info@davidsroof.com>wrote: Good morning Michael, I stopped by the building department yesterday to submit an application for a roof replacement building permit. I explained to the secretary that our client is elderly and unable to get her signature notarized. The secretary told me to contact you, in order that you would be able to waive this—and I can come back to submit the application today. Thank You Best Regards, Margarita David's Roofing & Restorations 400 King Street, Suite 2 Chappaqua, NY 10514 (o) 914-494-9094 info(@davidsroof.com i A t MIS Ig9�i,'1 4� Z. i{i '�•��'� C C V C / . ? d o \ 0. N o � y y U . CN <(0)>> V/ U C ram( • ). v 1 a W r� � y C 6. O N } 6. 1>0 ,< C1 o p o CL J i ti ~ lY o X Z Ln co � a U h• 4,. r v � y U f ,1111+, t .�1,1/1, ,l, N, h.4s. . 1 1 1 SSS ■ss€gq z+1i��41+�'LL tt e�+i'��c '���c+}I 1pcc�cyl ,l,. \.� iYAtl �1•�Y 1 A ♦.� ( A�t ♦• '�•fAi9la{ 1,�.• A ' 1� �A �..� • A! �.♦ A 1 9 �.. � �a1d �3+u .► }#i\�aa.✓ i� ,� �� i ^ iy i A ..� � ^ 'q1�{�' a5t .� .�'f'jI�• ,,�� � r. o� -,7 f1LyAd O$ O "i�?�'"� t r O. }�ti4��,1��e�"ilttb'� :.�, •:s� +fVU t _ WFV�t _ •'�V\v •��v� •�-`�' i: V�{ Si%:_.— :V&ll�V '4:. .� V �V�. .. �:,�,b .� �'ir.L�JV � � S. ..,.1�� 'lilti; . •� .l.l ��'.' r �.. ;�1��.,, y \.vJVtj�i,+ - .. , l r ATE(MMIDDIYYYY) ACOR" CERTIFICATE OF LIABILITY INSURANCE `� 3/30/2022 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 endorsement(s). PRODUCER CONTACT NAME: Erich Courant&Company PHONE FAx 25 East Spring Valley Ave Suite 270 •201-226-1200 Arc No:201-226-1201 Maywood NJ 07607 ADDRESS: INSURERS AFFORDING COVERAGE NAIC# Licensek BR525310 INSURER A:Abacus INSURED DAVIROO-01 INSURER B: David's Roofing & Restorations LLC 96 Campfire Road INSURERC: Chappaqua NY 10514 INSURERD: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:1048510003 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 REDUCED BY PAID CLAIMS. INS LTR TYPE OF INSURANCE ADDL SUER POLICY NUMBER MM/DDY/YYYY MMIDD/YYYY LIMITS A X COMMERCIALGENERALLIABILITY WS461792 3/30/2022 3/30/2023 EACH OCCURRENCE $1,000,000 F_�� DAMAGE TO RENTE15- CLAIMS-MADE OCCUR PREMISES Ea occurrence $100,000 MED EXP(Any one person) $5,000 PERSONAL&ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER I GENERAL AGGREGATE $2,000,000 POLICY PRO JECT LOC PRODUCTS-COMP/OP AGG $2.000,000 OTHER. Deductible $2.500 AUTOMOBILE LIABILITY EBODILY INGLE LIMIT $ ANY AUTC RY(Per person) $ OWNED SCHEDULED RY(Per accident) $ AUTOS ONLY AUTOSHIRED NON-OWNED DAMAGE $ AUTOS ONLY AUTOS ONLY 0 S UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB HCLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANYPROPRIETOR/PARTNER/EXECUTIVE ❑ N r A E.L.EACH ACCIDENT S OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E L DISEASE-POLICY LIMIT S DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space Is required) Certificate holder is included as additional insured when required by written contract. The insurance afforded by the policies described herein is subject to all the terms,exclusions and conditions of such policies.This form does not constitute a contract between the issuing insurer(s),authorized representative or producer,and the certificate holder. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF. NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Village of Rye Brook 938 King Street AUTHORIZED REPRESENTATIVE Rye Brook, NY 10573 VJ ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD /vmi�N NYSIF New York State Insurance Fund PO Box 66699,Albany,NY 12206 1 nysif.com CERTIFICATE OF WORKERS' COMPENSATION INSURANCE ^^^^^^ 850531987 ERICH COURANT&CO INC 25 EAST SPRING VALLEY AVE a f SUITE 270 MAYWOOD NJ 07607 SCAN TO VALIDATE AND SUBSCRIBE POLICYHOLDER CERTIFICATE HOLDER DAVID'S ROOFING AND VILLAGE OF RYE BROOK RESTORATIONS, LLC 938 KING STREET 96 CAMPFIRE ROAD RYE BROOK NY 10573 CHAPPAQUA NY 10514 POLICY NUMBER CERTIFICATE NUMBER POLICY PERIOD DATE W2514 987-3 33344 05/29/2021 TO 05/29/2022 3/28/2022 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE NEW YORK STATE INSURANCE FUND UNDER POLICY NO. 2514 987-3, 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 POLICY DOES NOT COVER THE SOLE PROPRIETOR, PARTNERS AND/OR MEMBERS OF A LIMITED LIABILITY COMPANY. THE POLICY INCLUDES A WAIVER OF SUBROGATION ENDORSEMENT UNDER WHICH NYSIF AGREES TO WAIVE ITS RIGHT OF SUBROGATION TO BRING AN ACTION AGAINST THE CERTIFICATE HOLDER TO RECOVER AMOUNTS WE PAID IN WORKERS'COMPENSATION AND/OR MEDICAL BENEFITS TO OR ON BEHALF OF AN EMPLOYEE OF OUR INSURED IN THE EVENT THAT, PRIOR TO THE DATE OF THE ACCIDENT, THE CERTIFICATE HOLDER HAS ENTERED INTO A WRITTEN CONTRACT WITH OUR INSURED THAT REQUIRES THAT SUCH RIGHT OF SUBROGATION BE WAIVED. 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 SUR NCE FUND FF �/ DIRECTOR,INSURANCE FUND UNDERWRITING VALIDATION NUMBER: 101924428 U-26.3