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HomeMy WebLinkAboutBP22-112PERMIT # �,I_LjDATE: 3 J XP: EGP 30 3 SECTION i BLOCK _ LOT L TYPE OF WORK Off X �/ o� �ya� e QC��'le✓I JOB LOCATI N O � S O/JQk� �-`" OWNEROe/ 35I-�/gab/4/JC4 EST. COST �-'��f J FE itsis CO # FEE �`//O DATE TCO # FEE DATE mill INSPECTION RECORQ I DATE INSP FOOTING FOUNDATION FRAMING RGH FRAMING INSULATION PLUMBING RGH PLUMBING GAS SPRINKLER ELECTRIC LOW -VOLT C7 ALARM AS BUILT FINAL OTHER APPROVALS ARB � BOT PB ZBA jOTHER v bV4I / U 1�?. -Y . 19 4t" annitlP1oomj VILLAGE OF RYE BROOK MAYOR 938 King Street, Rve Brook,N.Y. 10573 ADMINISTRATOR Jason A. Klein (914) 939-0668 Christopher J. Bradbury www.ry ebrook.org TRUSTEES BUILDING& FIRE INSPECTOR Susan R. Epstein T,v ichael J. Izzo Stephanie J. Fischer David M. Heiser Salvatore W. Morlino CERTIFICATE OF COMPLIANCE August 16,2022 Keith Kivel&Denise Cronin 108 Brush Hollow Close Rye Brook,New York 10573 Re: 108 Brush Hollow Close,Rye Brook,New York 10573 Parcel ID#: 129.76-1-152 Building Permit#22-112 issued on 6/30/2022 to Replace Front Exterior Door This certifies that the new front exterior door,installed under the above captioned permit has been satisfactorily completed. Sincerely, 2, Steven E. Fews Assistant Building& Fire Inspector /to D ������ D ��3� For office u e nl BUILDII'�f7E �'MENT PERMIT# AUG 10 2022 VIL&ItYE OF RYE$ROOK ISSUED: — 0-a_a 938 KING STRE BROOK,NEW YORK 10573 DATE: -/c�-a�► VILLAGE OF RYE BROOK (914)939-0668, FEE: O- -PAID iW BUILDING DEPARTMENTv.reo .erg APPLICATION FOR CERTIFICATE OF OCCUPANCY,CERTIFICATE OF COMPLL4,NCE9 AND CERTIFICATION OF FINAL COSTS TO BE SUBMITTED ONLY UPON COMPLETION OF ALL WORK, AND PRIOR TO THE FINAL INSPECTION tttitttttt►►►►►►►►►itiiittttitttt►►■tt►ti■ttttt►►►►►t►t►iitttttttttt►ttt►ittttttttt/►t►f►►itttttttt►►►■i►►►ittitttt►tt►tti►ti Address: IV .// Occupancy/Use: / Parcel ID#:�la7Y 2/ - — /�� Zone: � �U��i /OL1� Owner: �'? Address: P.E./R.A.or Contractor-A&, X, &AW,6 /00� Address: Person in responsible charget"7 QfD B/A/I/L'l� Address: L(/��✓� D/L7�8 'C . Application is hereby made and submitted to the Building Inspector of the Village of Rye Brook for the issuance of a Certificate of Occupancy/Certificate of Compliance for the structure/construction/alteration herein mentioned in accordance with law: STATE /OF_NEW �YORK,COUNTY OF WESTCHESTER as: `` `l /LC T11 /61/� being duly sworn,deposes and says that he/she resides at�0"P Ly eTIJ h�'zl&J�? (Print Name of Applicant) (No.and Street) in /f,/iF & , ,in the County of in the State of that (City/Town/Village) he/she has supervised the work at the location indicated above,and that the actual total cost of the work,including all site 2provemets, labor,materials,scaffolding,fixed equipment,professional fees,and including the monetary value of any materials and labor which may have been donated gratis was:$ 2V76, 06 for the construction or alteration of rTEd/YY Deponent further states that he/she has examined the approved plans of the structure/work herein referred to for which a Certificate of Occupancy/Compliance is sought,and that to the best of his/her knowledge and belief,the structure/work has been erected/completed in accordance with the approved plans and any amendments thereto except in so far as variations therefore have been legally authorized,and as erected/completed complies with the laws governing building construction.Deponent further understands that it shall be unlawful for an owner to use or permit the use of any building or premises or part thereof hereafter created,erected,changed,converted or enlarged,wholly or partly,in its use or structure until a Certificate of Occupancy or Certificate of Compliance shall have been duly issued by the Building Inspector as per§250-10.A.of the Code of the Village of Rye Brook. Sworn to before me this i V Sworn to before me this day of ,20a�a_ day of , 20 Signa e P pe Owner Signature of Applicant Prial Name of Property Owner Print Name of Applicant L�\ Notary Public Notary Public SHARI MELILLO Notary Public,State of New York 8/12/2021 No.01ME6160063 Qualified in westchester County Commission Expires January 22,20� 0E Majj . 1982 BUILDING DEPARTMENT ❑BUILDING INSPECTOR 4,,,ASSISTANTB 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 - - - - - - - - - - - - - - - - - - - - y rr \ `J �ADDRESS : VS`\ �\ 1 _sy (yyDATE: K PERMIT# / 1 ISSUED: 6I'3� SECT: I LOCK: LOT: LOCATION: -� \ )� `\ ` ` OCCUPANCY: ❑ VIOLATION NOTED THE WORK IS... YJ 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 3' FINAL ❑ OTHER Iry cNv o ■ M � a QI \ \ `�' d W � 10, u w a Ln a A. 1� N � y N w r Ocs O w r ao ° U ice-. u en o cn Z- oo w mz � a tn 001 00 A U - Vz ,�d a V P-4 _ W �I G1 A c,7 � 04 00 `- U 4 N Q m w CIA v en A r�i d U :" W i 1-4 U U U o A o z � W a v� a"� �.:.) z � z o , A4 F wd " v G .c av a" BUILD TMENT D) ECMWED VIL OF R \ OOK 11 JUN 1 1 2022 938 KING ET RYE BROc NY 10573 (914)9 , 68 www.rvook.org VILLAGE OF RYE BROOK BUILDtl4G DEPARTMENT ADMINISTRATIVE EXTERIO DING PERMIT APPLICATION FOR EXTERIOR WORK WHICH DOES NOT REQUIRE VILLAGE ARCHITECTURAL REVIEW BOARD APPROVAL_ FOR OFFICE USE ONLY: JUN28 Approval Date: Permit # : / � '/ / d-� Application Fee: 75t'f Approval Signature: Permit Fees: 6co_ H.O.A. Approval: � Date: Disapproved: Other: Application dated: is hereby made to the Building Inspector of the Village of Rye Brook,NY,for the issuance of Permit for the construction of buildings,structures,additions,alterations or for a change in use,as per detailed statement described below. 1. JobAddress: 108 Brush olllow Close 2. Parcel ID#: d /s / — Zone: az1 6 3. Proposed Improvement(Describe in detail): Replacement of existing Front Exterior Door and Sidelite with same dwmensions as existing Front Exterior Front Door. 4. Property Owner: Keith J. Kivel Address: 108 Brush Hollow Close Phone#914-351-8183 Cell# e-mail keithkivel(asmail.com List All Other Properties Owned in Rye Brook: N/A Applicant: Keith J Kivel Address: 108 Brush Hollow Close Phone#914-351-8183 Cell# e-mail keithkivel@g_mail.com Architect: Address: Phone# Cell# e-mail Engineer: Address: Phone# I (Cell# e-mail General Contractor: Double R 41� �-~/or�Ee gym,©/aVe�►P � Address: 439 Wiliet Ave Port Chester NY 10573 Phone#914-937-4279 Cell# e-mail (1) 8/12/2021 5. Occupancy; (1-Fam.,2-Fam.,Commercial.,etc...)Pre-construction: Post-construction: 6. Area of lot: Square feet; Acres: 7. Dimensions from proposed building or structure to lot lines: front yard: rear yard: right side yard: left side yard: other: 8. If building is located on a corner lot,which street does it front on: 9. Area of proposed building in square feet: Basement: 11 fl: 2"d fl: 3"d ft: 10. Total Square Footage of the proposed new construction: 11. For additions,total square footage added:Basement: 1 n fl: 2nd fl: 31d fl: 12. Total Square Footage of the proposed renovation to the existing structure: 13. N.Y.State Construction Classification: N.Y. State Use Classification: 14. Construction Type&Location:()Typical Western Lumber Frame;()Timber Frame[TC];()Wood Truss[TT]; ()Pre-engineered wood[PW];Located;O Floor Framing[F];O Roof Framing[R];()Floor&Roof Framing[FR];Other: 15. Number of stories: Overall Height: Median Height: 16. Basement to be full,or partial: finished or unfinished: 17. What material is the exterior finish: 18. Roof style;peaked,hip,mansard,shed,etc: Roofing material: 19. What system of heating: 20. If private sewage disposal is necessary,approval by the Westchester County Health Department must be submitted with this application. 21. Will the proposed project require the installation of a new,or an extension/modification to an existing automatic fire suppression system?(Fire Sprinkler,ANSL System,FM-200 System,Type I Hood,etc...)Yes: No:_ (if yes,applicant must submita separate Automatic Fire Suppression System Permit application &2 sets of-detailed engineered plans) 22. Will the proposed project disturb 400 sq.ft.or more of land,or create 400 sq.ft. or more of impervious coverage requiring a Stormwater Management Control Permit as per§217 of Village Code? Yes: _No: Area: 23. Will the proposed project require a Site Plan Review by the Village Planning Board as per§209 of Village Code? Yes: No: (if yes,applicant must submit a Site Plan Application,&provide detailed drawings) 24. Will the proposed project require a Steep Slopes Permit as per§213 of Village Code Yes: No: (if yes,you must submit a Site Plan Application,&provide a detailed topographical survey) 25. Is the lot located within 100 ft.of a Wetland as per§245 of Village Code? Yes: No: (if yes,the area of wetland and the wetland buffer zone must be properly depicted on the survey&site plan) 26. Is the lot or any portion thereof located in a Flood Plane as per the FIRM Map dated 9/28/07? Yes: No: (if yes,the area and elevations of the flood plane must be properly depicted on the survey&site plan) 27. Will the proposed project require a Tree Removal Permit as per§235 of Village Code?Yes: No: (if yes,applicant must submit a Tree Removal Permit Application) 28. Does the proposed project involve a Home-Occupation as per§250-38 of Village Code? Yes: No: Indicate:TIER 1: TIER 1I: TIER III: (if yes,a Home Occupation Permit Application is required) 29. What is the total estimated cost of construction: $ a 10 <=�o Note:estimated cost shall include all site improvements,labor, material, scaffolding, fixed equipment,professional fees,including any material and labor which may be donated gratis. If the final cost exceeds the estimated cost,an additional fee will be required prior to issuance of the CIO. 30. Estimated date of completion: (2) 8/12/2021 BUILDING DEPARTMENT VtLLAGF,OF RYE BROOK 938 KING STIMET RYE Bttoox,NY 10573 (914)939-0668 wr w.—Ty. e-A&I www**,r,rwwwwwwww,rwwwwwwwww**,rww****,t*,t,tww*www*wet*w**www*w**ww*wwwww*w,rwwwwwww**,c+*w*www+rw�rwwwwww*,rwwwww* AFFIDAVIT OF COMPLIANCE. VILLAGE CODE §216 • STORM SEWERS AND SANITARY SEWERS THIS AFFIDAVIT MUST BEAR THE NOTARIZED SIGNATURE OF THE LEGAL PROPERTY OWNER AND BE SUBMITTED ALONG WITH ANY BUILDING OR PLUMBING PERMIT APPLICATION. ANY BUILDING OR PLUMBING PERMIT APPLICATION SUBMITTED WITHOUT THIS COMPLETED AND NOTARIZED FORM WILL BE RETURNED TO THE APPLICANT. STATE OF NEW YORK, COUNTY OF WESTCHESTER ) as: 1, lc tr77H kl lf6 Z — ,residing at, _ Al ,US lY /7a 14 aj (Print name) (Address where you live) being duly sworn, deposes and states that(s)he is the applicant above named, and further states that(s)he is the legal owner of the property to which this Affidavit of Compliance pertains at; lei? .&zs_-& �C/ � , Rye Brook,NY. (Job Address) Further that all statements contained herein are true, and that to the best of his/her knowledge and belief,that there are no known illegal cross-connections concerning either the storm sewer or sanitary sewer,and further that there are no roof drains, sump pumps, or other prohibited stormwater or groundwater connections or sources of inflow or infiltration of any kind into the sanitary sewer from the subject property in accordance with all State, County and Village Codes. hl- - (Signature of Prope wner(s)V. (Print Name of Property Owner(s)) Sworn to before me this day of Vv�,� , 20 al-a (Notary Public) SHARI MELILLO Notary public,State of New York No.01ME6160063 Qualified In Westchester County (3) Commission Expires January 29.2 � en zi2021 This application must be properly completed in its entirety by a N.Y. State Registered Architect or N.Y. State Licensed Professional Engineer& signed by those professionals where indicated. It must also include the notarized signature(s) of the legal owner(s) of the subject property, and the applicant of record in the spaces provided. Any application not properly completed in its entirety and/or not properly signed shall be deemed null and void, and will be returned to the applicant. Please note that application fees are non-refundable. STATE Ofr NEW YORK,COUNTY UNTY OF WESTCHESTER ) as: 7 d i 1y, ,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 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. By signing this application, the property owner further declares that he/she has inspected the subject property, and that to the best of his/her knowledge there are no roof drains, sump pumps or other prohibited stormwater or groundwater connections or sources of infiltration into the sanitary sewer system on or from the subject property. Sworn to before me this r '\ Sworn to before me this day of 1 , 20 day of 120 _/Avo Signature of KoYerty Owner Signature of Applicant jTf-�K!VrZ— Print Name of Property Owner Print Name of Applicant Notary Public Notary Public SHARI MELILLO Notary Public,State of New York No.01ME6160063 Qualified In Westchester County Commission Expires January 29,20 3 (4) 8/12r2021 173'/2 Ivy Hill Crescent Rye Brook, NY 10573 914-939-2440 June 21 , 2022 Keith Kivel 108 Brush Hollow Close Rye Brook, NY 10573 Re: Front Door Dear Keith Kivel, This letter serves as confirmation that the Architecture & Grounds (A&G) Committee has reviewed and accepted your application for the above named work. This approval is valid for six (6) months from today's date. If any changes need to be made to the original plans submitted to A&G either before or during construction, the Committee must be notified in writing and your application must be amended. Work must stop and cannot proceed until you receive written approval for those changes. You are required to inform the Property Manager when work begins. When the project is complete, the Property Manager must again be notified so that an inspection may take place. Please include a photograph of the work as well. Failure to comply with these procedures will result in fines and/or work stoppage. If you have any questions, contact me at: Property Manager. Ashlee Pasquale Property Manager LICENSE NUMBER � "THE OORiGIMAL'� DOUBLE Westchester WC-8561-H97 Family Owned And Connecticut 00556256 Operated Since 1960 All Home Improvements EST. 1960 439 Willett Ave. Port Chester,N.Y.10573 Tel#(914)937-4279 Fax(914)937-4172 http://www.DoubleRwindows.com Keith Kivel May-26-2022 108 Brush Hollow Crescent. Rye Brook,N.Y. 10573 (914)351-8183 email keithkivel@gmail.com Insurance: All work involved within the followmL,proposal is cox erect b1N Workmen's compensation.Public I tabilrty.and Completed Operations Insurance Therma tru entry door contract. Supply Labor & Material for the following A- Double'R'to replace the front door&side lite with a new Therma tru smooth star fiberglass entry door system. B- The doors is fiberglass and comes with a primed finish,the jamb is a white vinyl lifetime jamb and comes with a double bore prepped for hardware that the homeowner will supply. C- The door style is a model#S4816 flush style door with 6 panes above with granite glass and the side lite is a 12" model# S2000 flush glazed side lite with full glass in a granite type glass for privacy. D- Install all new pvc trim on the exterior and new primed trim on the interior. E- We will cart away all job related debris. F- This is a special order door,once order has been placed it cannot be cancelled. Terms: Painting,and windows cleaning to be done by others Bidden rotten wood not included Standard industry cash term,one half rtirth the order,balance due upon completion Terms may be modified to meet special conditions Past due balances are subject to a monthly service charge of 1 1R%(18%per annum). If the account becomes delinquent,we agree to pa}any legal or collection fees expended by Double-k"arising from collection of the account Permit&Application fees not included. Double"R"is not responsible for reconnecting existing alarm systems on windows and doors. You the owner may cancel this transactional anytime 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 community improvements,or in writing postmarked prior to the fourth business day.We accept VISA or Mastercard with a 3%convenience surcharge on total amount being charged. Acceptance: The above prices,specifications and conditions are satisfactory and are accepted. Double"R"is authorized to do the work as specified Contractor Performance Warranty: Double"R"proposes to furnish and install labor and material in accordance with above specifications in order that the above qualifies for the Manufacturer's Long-Term Warranty In addition,all labor provided by Double"R-is unconditionally warranted for a period of Ten years from the date of installation. Approximate Start Date:6 to 8 weeks Approximate Completion Date: I day Customer: $3,970.00 (Amount) Date: 0% (Sales Tax) Double"R": Carlo Labianca $3,970.00 (Total Amount) Date: May-26-2022 $1,800.00 (Deposit) $2,170.00 (Balance Due Upon Completion) Return original contract to Double"R", retain a copy for your records. Visit Our Showroom Located At 439 Willett Avenue Port Chester, N.Y. 10573 5/26/22,7:20 AM image001.png 2022 Energy Star; Qualification Chart n THERMAIM' Fiber-Classic.&Smooth-Stara Fiberglass Doors and Sidelites ® DOORS featuring EnLiten.Flush-Glazed Designs GYM Designs Was Sar(Nehes) 27xM 25x64 2lxG4 20x64 14x64 25x46 21 x46 22x35 23x16 71M kA M6 Decorative .231.09 2WA6 .23/.09 Nv aq 6 Texheed Glass .311.27 .31127 11127 .31/.27 27/20 23/.09 2W.06 .23/.o9 Was Between GNP .34126 .31I28 -W26 .341.26 .291.20 251.15 2W.06 .WO$ Low-E Giles Between Glass .M.15 .281.15 26/15 261.15 25r.10 .22/3)6 .18.04 .16/.04 Gea .32/.30 .311.30 MJ0 25/.17 .32120 M23 .251.17 .M.15 .261.1s .M.09 WAS 5 21/.O9 2w.15 23/.12 .2L1H 2&.os .i6.a5 .22J06 Mnibki& 26125 .36125 Low-E Mnbinds .31121 .31/21 Glass Sae(Inches) 25M 21xes 14xM 25M 20x64 23x16 7xM M6 Decoranve .M09 24115 IWA Pri eq Uatred Glass .31127 .31127 M2M&I .31/27 23/.D9 24115 .231.09 G1ies Between GYM .34/26 .34126 .34126 Low-E GrOn Between GNas M.15 .26r.15 .26/.15 Close .32/.30 .32/.30 .3?J.30 .321.30 .32/.30 Low-E Glass .261.15 261.15 1&.15 .261.15 -M.15 221.06 2M .221A Mmbinds .36125 .W25 _ Low E Mn,binos 21121 .31/21 hftps://mail.google.com/mail/u/0/?tab=rm&ogbl#inbox/FMfcgzGpGBFFktXzHBkCmgVpLSzKtFTg?projector-1 1/1 5/26/22,4:41 PM 67528997644_A1AE9A96-073C-4B5D-B584-12D6E7E0488F.jpg , i https://mai1.google.com/mail/u/O/?tab=rm&ogbI#inbox?projector-1 1/1 5/26/22,4:41 PM 67528995501_28CB8310-3C1E-4DCF-905E-59347CD78960.jpg `r.. r. I f' i:. i" y f 1 �:", a https://mai1.google.com/mail/u/O/?tab=rm&ogbl#inbox?projector=l 5/26/22,4:25 PM Design Your Door-Share DYD Project I Therma-Tru Doors THERMAITRV DOORS Where Home Begins. S4816-SDLF1 Smooth-Star® Included in Your Entryway Project https://www.thermatru.com/explore-products/design-your-door/step3/ 1/3 ;ZOZ/1 Z/9 iidf-az)il/saanloidOZ%XN/sluauznooCl/uas ialadj/siz)sn/ZOdj�iooagaXJn//:aj .#1i •Gr T1 � ♦ I N 0-0 = CV 04 to s y y O it G. .LL i V U) • y C a • O 0Cie Z y '' y L W W es >O p c ct Z ? Y LLI ection a. > Z obi,a `Q '�. LU > W W E a a a w O > a 0 w —_ - "s LLJ x z co = — z Q - 2„ �' l N ,. C) GtjU z- r it u [3o j 32led AC RO O® CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) '1 05/27/2022 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 Gerard Seward NAME: Borrelli Partners Insurance Agency PHONE (914)939-7900 FAX Bowman Avenue E-MAIL (914)407-5088 A/C No Ext: A/C No ADDRESS: Suite 406 INSURER(S)AFFORDING COVERAGE NAIC X Purchase NY 10577 INSURER A: Evanston Insurance Company 35378 INSURED INSURER B: ARC Home Improvements Corp. INSURER C: 439 WillettAVe INSURER D: INSURER E Port Chester NY 10573 INSURER F: COVERAGES CERTIFICATE NUMBER: 22-23 MSTR 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 CONTRACTOR 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. IN R P LICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER MWDD/YYY MM/DD/YYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE OCCUR PREMISES Ea occurrence $ 100,000 MED EXP(Any one person) $ 5,000 A 3AA550197 04/01/2022 04/01/2023 PERSONAL&ADV INJURY $ 1,000,000 GEN'LAGGREGATE LIMITAPPLIES PER: GENERAL AGGREGATE g 2,000,000 X POLICY ❑ PRO- ❑ JECT LOC 2,000,000 1PRODUCTS-COMP/OPAGG $ OTHER, $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ANYAUTO Ea accident OWNED SCHEDULED BODILY INJURY(Per person) $ AUTOS ONLY AUTOS BODILY INJURY(Per accident) $ HIRED NON-OWNED PROPERTY DAMAGE AUTOS ONLY AUTOS ONLY Per accident $ $ UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESS LIAB HCLAIMS-MADE AGGREGATE $ DEDI RETENTION$ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY YIN N STATUTE ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? N I A (Mandatory In NH) If yes,describe under E.L.DISEASE-EA EMPLOYEE $ DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/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. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN Village of Rye Brook ACCORDANCE WITH THE POLICY PROVISIONS. 938 King Street AUTHORIZED REPRESENTATIVE Port Chester NY 10573 } ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD NYSIF New York State Insurance Fund PO Box 66699.Albany,NY 12206 1 nysif.com CERTIFICATE OF WORKERS' COMPENSATION INSURANCE ^^^^^^ 133940830 MARENCO INSURANCE AGENCY INC 2525 PALMER AVE SUITE 1 a , NEW ROCHELLE NY 10801 SCAN TO VALIDATE AND SUBSCRIBE POLICYHOLDER CERTIFICATE HOLDER ARC HOME IMPROVEMENTS CORP VILLAGE OF RYE BROOK DBA DOUBLE R ALL HOME IMPROVEMENTS 938 KING STREET 439 WILLETT AVE RYE BROOK NY 10573 PORT CHESTER NY 10573 POLICY NUMBER CERTIFICATE NUMBER POLICY PERIOD DATE W2358 628-2 876874 04/16/2022 TO 04/16/2023 5/5/2022 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE NEW YORK STATE INSURANCE FUND UNDER POLICY NO. 2358 628-2, COVERING THE ENTIRE OBLIGATION OF THIS POLICYHOLDER FOR WORKERS' COMPENSATION UNDER THE NEW YORK WORKERS' COMPENSATION LAW WITH RESPECT TO ALL OPERATIONS IN THE STATE OF NEW YORK, EXCEPT AS INDICATED BELOW, AND, WITH RESPECT TO OPERATIONS OUTSIDE OF NEW YORK, TO THE POLICYHOLDER'S REGULAR NEW YORK STATE EMPLOYEES ONLY. IF YOU WISH TO RECEIVE NOTIFICATIONS REGARDING SAID POLICY, INCLUDING ANY NOTIFICATION OF CANCELLATIONS, OR TO VALIDATE THIS CERTIFICATE,VISIT OUR WEBSITE AT HTTPS:/IWWW.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 CLAIMS OR SUITS THAT ARISE FROM BODILY INJURY SUFFERED BY THE OFFICERS OF THE INSURED CORPORATION. PRESIDENT FRANK J VERRASTRO TREASURER RALPH CACCOMO ARC HOME IMPROVEMENTS CORP TWO PERSON CORPORATION THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS NOR INSURANCE COVERAGE UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICY. NEW YORK STAT SU NCE FUND /Yr DIRECTOR,INSURANCE FUND UNDERWRITING VALIDATION NUMBER 864645330 U-26 3