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HomeMy WebLinkAboutRP22-047PER M17 # ��L � " � DATE: � � �(p; 7 SECTION BLOCK LOT / __ �� ,, (' / TYPE OF WORK �' O � %tS '�1 �// /. � Q�IJACP �X�J7i� `�-��y��,�/1� jog LOCAT[oN _1C�� ,B�crs ®l%cc� ��_ OWNER Q - iQ I � /7 � ��,3 % ��y� CONTRACTOR %/' p/yI �-�'—���Q �'q�Q�pvq � ���-� �35 EST. COSTn� � 5Oa— FEE_1 �CO # G C �LTT� FEE � � DATE ,Q�oZ TCO # FEE DATE �N�pFCT10N RECORD [ DATE INSP FOOTING FOUNDATION FRAMING RGH FRAMING fNSULATION PLUMBING CI RGH PLUMBING GAS C� SPRINKLER ELECTRIC Cl LOW -VOLT C� ALARM CI AS BUILT O FINAL OTHER APPROVALS ARB BOT PS ZBA OTHER l�c.y�uYs . 19 40A anaivmaW 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 Michael J. Izzo Stephanie J. Fischer David M. Heiser Salvatore W. Morlino CERTIFICATE OF COMPLIANCE December 8,2022 Frank Morabito&Anne Morabito 102 Brush Hollow Close Rye Brook,New York 10573 Re: 102 Brush Hollow Close, Rye Brook,New York 10573 Parcel ID#: 129.84-2-91 Roof Permit#22-047 issued on 11/7/2022 to Re-Roof Existing Building& Replace Skylight This certifies that the new roof and skylight,installed under the above captioned permit has been satisfactorily completed. Sincerely, Michael J. Izzo Building&Fire Inspector /to p EC ENErijN1 For office use only: 11 BUiLDiN+G-DEPARTMENT PERMIT# 7 EDEC 2022 VILLAGE OF RYE BI LOOK ISSUED: 938 KING STRECtji�t BROOK,NtW YORK 10573 DATE: VILLAGE OF RYE BROOK �9 4�9 FEE: A //(7 PAID1B MENT BUILDING DEPART ww Y l 6r 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 asssssssassssss•ssssaassssssssassssssss•ssssasesss►sasasasssssssssssssssssssssssssssasss►ssasasssaass•ssssssssassssssssssssss Address: j ()j jjRI.I,,S�N/ 1JOLLOW CLQSC, RYE DKOOK U1 f0573 Occupancy/Use: /��!'`7 Parcel ID#: / �, — — q/ Zone: /Oa6 Owner: A WJE FJ A(Q k M0 RA B 1 10 Address: S At1L A-5 A-&0V E P.E./R.A. or Contractor: CASAN'0VA RC-MOWEL/IJ�Address: Jr j NA/It/ Person in responsible charge: ,T7-,5ku A ('A;sA m(,/ c Address: S pc 1--t L 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 &A A 13 ) 1 (7 being duly swom,deposes and says that he/she resides at 109 8 R U 511 k o LL (Print Name of Applicant) (No.and Street) in EYE a f�D G K in the County of \J, G S 1 C'_k t C,S TC{L in the State of44,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 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:$ :ZY7 b0 O a for the construction or alteration of D D I^ L)Q Sl 11\j A I l b (N co i E P Ltd C l_. )= X LST 1 f�6i S l L 14FF►5 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 1 Sworn to before me this day of^��C{ ,,\N� ,20 a day of , 20 dx,n,,2_ 2�mAL�� Signature of Property 04er Signature of Applicant Akj,jc MoAhisim �%ame of Property Owner Print Name of Applicant I Notary Public Notary Public SHARI MEULLO Notary Public,State of New Yore I' i No.OIME6160063 Qualified In Westchester Count% Commission Expires January 29, ?: � QyE DRC��. Q�i� ��O•c 19,32 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 Uebrook.org - - - - - - - - - - - - - - - - - - - - INSPECTION REPORT - - - - - - - - - - - - - - - - - - - - ADDRESS: y� 1 U 1 I �1�Q DATE: PERMIT#_a -2:2 - O" ISSUED: SECT: �� ' 1 BLOCK: LOT: LOCATION: _� � V�J i'" OCCUPANCY: lZ ❑ VIOLATION NOTED THE WORK IS... ,� ACCEPTED ❑ REJECTED/REINSPECTION ❑ SITE INSPECTION REQUIRED ❑ FOOTING ❑ FOOTING DRAINAGE ❑ FOUNDATION ❑ UNDERGROUND PLUMBING NOTES ON INSPECTION: ❑ ROUGH PLUMBING ❑ ROUGH FRAMING ❑ INSULATION ❑ NATURAL GAS ❑ L.P. GAS ❑ FUEL TANK ❑ FIRE SPRINKLER ❑ FINAL PLUMBING CROSS CONNECTION FINAL ❑ OTHER 6 = ■ 6 6 h n C v W F A a ►.4 x 4-4 cs. a P O w v W r � U Or It. ~ � = a ~ V N00 y 0 3 w W 2 toen u o u = 7 � �-`I enpQop � � a A s r��r+��+ F+i a � W 6 O '« G O '1. , O 1,4 —I `n O v oo v (/} tn OD 0. h y td O A F+ . � Z � �z'� �•. W 0 M r0+ o w N a0i G (� A O V b ° a W �••� c% M Q M W w N w vWi � }�. o � �Q � � , w o o a r I-=1 A o W z a o e � `' rQ / l W 0 pQ o�j g a w A � 1 0 � aj Cl) o x ) O o Zo z W W O }' 1-4 .. u b W 4 a dil W 0 14 W x � -Cb BUIL MENT V E OF Rv OK OCT 2 4 2022 jD 938 KING ET RYE BR o NY 10573 -0 VILLAGE OF RYE BROOK BUILDING DEPARTMENT FOR OFFICE USE ONLY: OCT 2 7 1022 Approval Date: A Permit# 7 Application# Approval Signature: ARCHITECTURAL REVIEW BOARD: VTDisapproved: Date: BOT Approval Date: Case# Chairman: PB Approval Date: Case# Secretary: ZBA Approval Date: Case# Other: Application Fee:-4 Permit Fees: - . ROOF PERMIT APPLICATION Application dated: 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 detailed statements described below. 1. Job Address: 1 U Z &vs 6 Po l l t w G l ew SBL:/ t)9j�`'f—1z-)--pL 1/ Zone: /`"/� �� Property Owner: F rG6 Pt I' o rg b N) ,� Address: I(V B Ir(�S jn f+O 11 ('' C I� Phone#: q U Cell#: q j q' S �5 — ftp j email: 2. Applicant: Co 5'n6y', OM O W Il n &L G Address: U q (fin O M -rin yl/Jy-'N Phone#: 2 0/ ,— 525 -343S Cell#: email: 3. Roofing Contractor: 5Gv%.0 If 0.5 Q 66V& Address: Phone#: Cell#: ''nn �"_ LL� email: 4. Job Description,list all Methods&Materials: C C.0 4 t.t�ITY� a Q4M CGS, 5. Estimated Cost of Job:$ 0 (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.) 6. If corner property,indicate street frontage: 7. Construction Type:_Re P� ' f—&t;� NY,nS/Construction Class: 8. Number of stories: 2. Height: YV/A 9. Is garage being re-roofed: No: Yes:( )Attached No:( •Yes: ( )Number of Cars: 10. Is roof peaked,hip,mansard,flat,etc: nU 11. Estimated date of completion: Oa -1- 811212021 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: kd,�lv,MI 102 6N S L, F h Pv ���Q�r J 616,5e 25"00 �5016yyy ,being duly sworn,deposes and tates 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 C05 CV1 ��� ih �L!� for the legal owner and is duly authorized to make and file this application. (indicate architect,contractor,a t.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 Z day of C'� , 20 Q,9 day of 01D. , 20 Signature of Property Owner Signature of Applicant gEint Name of Property Owner Print Name of Applicant 'A, v\,� �i 711_kCkJ l Notary Public Notary Public SHARI MEULLO pfQ -30 l 2c `-� Notary Public,State of New York No.01ME6160063 Qualified In Westchester County Commission Expires January 29.202--s -2- 8f 12/2021 173'/2 Ivy Hill Crescent Rye Brook, NY 10573 914-939-2440 RIECIEWIF 3D NOV - 4 2022 November 2, 2022 VILLAGE OF RYE BROOK Anne Morabito BUILDING DEPARTMENT 102 Brush Hollow Close Rye Brook, NY 10573 Re: Roof Replacement Dear Anne Morabito, The Architecture and Grounds Committee (A&G) has reviewed and approved your application for the above named work. This project requires a permit from The Village of Rye Brook. You are directed to submit this letter to the Village along with your permit application. Once the permit is obtained, a copy must be provided to A&G. Work on the project may not begin until you receive written notice of receipt of your permit from A&G. If any changes are made to the original plans submitted to A&G, due to input from the Village or arising during construction, the Committee must be notified in writing. Work cannot proceed until you receive written approval for those changes. Failure to comply with these procedures will result in fines and/or work stoppage. If you have any questions, please contact me at: Property Manager. Ashlee Pasquale Property Manager 173'/2 Ivy Hill Crescent Rye Brook, NY 10573 914-939-2440 PRti �::42:022] November 2, 2022 OV Anne Morabito VILLAGE OF RYE BROOK BUILDING DEPARTMENT 102 Brush Hollow Close Rye Brook, NY 10573 Re: Skylight Replacement Dear Anne Morabito, The Architecture and Grounds Committee (A&G) has reviewed and approved your application for the above named work. This project requires a permit from The Village of Rye Brook. You are directed to submit this letter to the Village along with your permit application. Once the permit is obtained, a copy must be provided to A&G. Work on the project may not begin until you receive written notice of receipt of your permit from A&G. If any changes are made to the original plans submitted to A&G, due to input from the Village or arising during construction, the Committee must be notified in writing. Work cannot proceed until you receive written approval for those changes. Failure to comply with these procedures will result in fines and/or work stoppage. If you have any questions, please contact me at: Property Manager. Ashlee Pasquale Property Manager 1 � L C C asanova Remodeling, LLC Windo\vs - Roohn�� • siclin2 pro SAS Magic BrushMl'o Painting (1nCI0011n1.itdo )r) Licensed& Insured 655 Main Street, Plymouth, CT 06782 1'c�w�rw�tsllillg. CT HIC 0635095 MAHIC 176929 Toll Free: 877-283-8158 We work magic��itlt our bntshcsi RI HIC 37486 � Toll Free: 877-488-7737 Westchester County WC-2723 PROPOSAL SUBMITTED TO: DATE: nc NAME: ----- JOB NAME: _ D mo� kbaa STREET: STREET: CITY: CITY: STATE: HOME BUSINESS G PHONE: _ PHONE: We hereby submit specifications Id estimates for: h 7 v 1 ✓ r' 'Yf 1 T �_ f r vJ Y PRICE: CT. SALES TAX: tart Date: TOTAL: Completion Date: We hereby pw�ose to furni or and materia1l cpmplete, in ac rice with the above specifications.for the sum of: vC �1ryty�S�,,nG� �,rr_JL1enQK�L/_dollars($ �Ijv ). Payments to be made as follows: Deposit of$ tp be received with order, balance of$ f to be paid in full on completion. Check to be given to job foreman. '�/ f;6 BUYERS RIGHT TO CANCEL �O4U,THE UY R, MAY ANCEL THIS TRANSACTION AT ANY TIME PRIOR TO NFtDNIGH OF THE THIRD BUSINESS DAY AFTER THE DATE OF THIS TRANSACTION. ao``'' All material is guaranteed to be as specified.All work to be completed in a workmanlike m nngr according to standard practices.A late charge will be assessed at the rate of one and one half percent(1 _%) per month,Annual Percentage Rate of 18%, on the entire account if not paid when due as specified above. All costs, disbursements and attorneys' fees made or incurred in collecting payment of this account,shall be included and paid as part of the debt due hereunder.Any alteration or deviation from above specifications involv- ing extra costs,will be executed only upon written orders,and will become an extra charge over and above the estimate.All agreements contingent upon strikes,accidents or delay beyond our control.Owners to carry fire,tornado and other necessary insurance.Our work- ers are fully covered by Workman's Compensation insurance.The contractor herein does not and will not extend any credit to the owner or builder. All transactions are cash transactions and payment is due Imme ately upon completion or work by the contractor. Authorized Signature r —.Date n a NOTE:This proposal may be withdrawn by us if not accepted within_ days. This proposal is subject to approval by the management. AGGPl"aitc2 of PropoSad, I understand GutterTopper is an ice neutral product.. It will not prevent or cause ice dams at eaves of the roof. Also,if conditions are right icicles may occur in the front of the gutter The above prices,specifications,and conditions are satisfactory and hereby accepted. You are authorized to do the work as specified. Payment will be made as outlined above. Signature _ Laura Petersen From: Laura Petersen Sent: Friday, November 4, 2022 10:57 AM To: Anne Morabito Subject: RE:Approval Letters for 102 Brush Hollow Close Good morning and thank you for the email. Please note the permit has NOT been issued yet, therefore work cannot begin until then. We are still waiting on the workers comp from the contractor. I cannot do the permit until the workers comp is received. \�rece i vecl 1114J� Thank you Laura Laura Petersen Office Assistant Village of Rye Brook 938 King Street Rye Brook, New York 10573 Phone(914)939-0668 1 IaetersenOrvebrook.org From:Anne Morabito<anya512@aol.com> Sent: Friday, November 4, 2022 10:44 AM To: Laura Petersen<LPetersen@ryebrook.org> Subject: Fwd: Approval Letters for 102 Brush Hollow Close Laura, Attached are the Arbors A&G approval letters required for obtaining the necessary permits for the roof&skylight replacement at 102 Brush Hollow Close, which is scheduled for next week. Also would you please email me a copy of those permits so that I may submit them to A&G as they require? Thank you for your help, Anne Morabito 102 Brush Hollow Close (H) 914.937.4440 -----Original Message----- From: Arbors Property Manager<managera-arbors-rvebrook.com> To: Anne Morabito<ANYA512a-aol.com> Sent: Wed, Nov 2, 2022 4:21 pm Subject: Letters Good Afternoon, Please see the attached letters. Kind Regards, Ashlee Pasquale 1 )Z/9Z/O I 7dPL'sua/samlatdOZ%AyiMuaumaoQ/uasialadl,,saasn/Zpdjlooiga,Cin//:-- All a �r fs / c e+. IA Iv •' ��CCCtitifffiYYYTTT"'r. �'��� low A 1.� RRt 11 ' fy 37j:f�jl1l��,(())!•a �_ ... �lj 1 ��IJ► r� � 1 44 �111. ' ► . i V�1t»?1: y N��►.��r 0 ll a?ud ��® DATE(MM/DDIYYYY) A C" CERTIFICATE OF LIABILITY INSURANCE 10/26i2022 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 The Guion Agency Inc PHONE Dianne Ripley FAx 23 Tompkins Ave (At (914)769-0501 iA/c,Net;(914)769-9221 Pleasantville, NY 10570 ADDRESS: dianner@gulon.com License#: PC-668085 INSURERS AFFORDING COVERAGE NAIC0 INSURER A: Evanston Insurance Company INSURED INSURER B Casanova Remodeling Company LLC INSURERC: 269 Main St. INSURERD: _ Terryville, CT 06786 INSURERE: INSURER F: COVERAGES CERTIFICATE NUMBER: 00007901-305657 REVISION NUMBER: 80 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. INSR LTR TYPE OF INSURANCE ADDL SUBR WVD POLICY NUMBER MM/DDY EFF MOM/LDICDY EXP uMRs A X COMMERCIAL GENERAL LIABILITY Y 3FF1391 05/01/2022 05/01/2023 EACH OCCURRENCE t 11000,000 DAMAGE TO REN CLAIMS-MADE a 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: GENERAL AGGREGATE $ 2,000,000 �( POLICY❑JECT LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: _ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT : Ea accident ANY AUTO BODILY INJURY(Per person) f OWNED SCHEDULED BODILY INJURY(Per accident) t AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE AUTOS ONLY AUTOS ONLY Per a.Zt : i UMBRELLA LIAO OCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS-MADE AGGREGATE f DIED I I RETENTION $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY YIN STA TE ER ANY PROPRIETOR/PARTNERIEXECUTNE E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? ❑ N/A (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,maybe attached If more space Is required) Village of Rye Brook as an Additional Insured-municipality. 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 Rye Brook, NY 10573 AUTHORIZED REPRESENTATIVE DJR ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD Printed by DJR on 10/26/2022 at 02:15PM NYSIF New York State Insurance Fund PO Box 66699,Albany,NY 12206 1 nysif.com CERTIFICATE OF WORKERS' COMPENSATION INSURANCE ^^^^^^ 352458089 GUION AGENCY INC 23 TOMPKINS AVENUE PO BOX 263 PLEASANTVILLE NY 10570 SCAN TO VALIDATE AND SUBSCRIBE POLICYHOLDER CERTIFICATE HOLDER CASANOVA REMODELING COMPANY LLC VILLAGE OF RYE BROOK 269 MAIN ST BUILDING DEPT. TERRYVILLE CT 06786 938 KING ST. RYE BROOK NY 10573 POLICY NUMBER CERTIFICATE NUMBER POLICY PERIOD DATE W2402 298-0 432363 10/29/2022 TO 10/29/2023 11/1/2022 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE NEW YORK STATE INSURANCE FUND UNDER POLICY NO. 2402 298-0, 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 POLICY DOES NOT COVER THE SOLE PROPRIETOR, PARTNERS AND/OR MEMBERS OF A LIMITED LIABILITY COMPANY, 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 T �/ DIRECTOR,INSURANCE FUND UNDERWRITING VALIDATION NUMBER: 516653987 U-26.3