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HomeMy WebLinkAboutRP22-046PERMIT #t�..0 SECTION � � TYPE OF WORK ZOB LOCATIO OWNER CONTRACTOR T. �1C0 # �cP:,.L;,L.,%ls�.� T �� � lacy �k��s�%�gS�y��yhf ►�- -- �° J "VIVO # FEE DATE INSPECTION RECORD I DATE INSP FOOTING FOUNDATION FRAMING RGH FRAMING INSULATION PLUMBING C� RGH PLUMBING GA5 SPRINKLER ELECTRIC 0 LOW -VOLT L ALARM C7 AS BUILT O FINAL =�o�ua C°Qs��av� L�o3�`�- 3y3� OTHER APPROVALS ARB .� :� • L� +vJ� e A"� 1� / annivmaW 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 Michael J. Izzo Stephanie J. Fischer David M. Heiser Salvatore W. Morlino CERTIFICATE OF COMPLIANCE December 8,2022 Richard Curtis 103 Brush Hollow Close Rye Brook,New York 10573 Re: 103 Brush Follow Close, Rye Brook,New York 10573 Parcel ID#: 129.84-2-92 Roof Permit#22-046 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 D E C IE � V BUILD r TMENT For office us only: JDING AR PERMIT# -0�10 NOV 15 2022 VILLAGE OF RYE BROOK ISSUED: / 1-7-2)a 938 KING STREET,RYE BROOK,NEw YORK 10573 DATE: l/—Y 5-- VILLAGE OF RYE BROOK (914)939-0668 FEE: ,fir PAMI S BUILDING DEPARTMENT wwwxygbrook.ort= 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 iRR►t1ltll�►►►�►►►ttj�t►►►t►t►■►tt►tltRt!!!!l►►►►►i►►Rt►►►►►t/!�/►1►t►�ti-,►�t►►lt!l►►l►►tl►►►►t►►►►►tttlt►►t/RtttltRll►t►t►►tt►►►►►► Address:-43 A V -(�/`✓� Occupancy/Use: � Parcel ID#: /39, 8 7 c'� 9 a Zone: Owner: Address: ��3 Oaag_% �j/l (,[J L�L,Q �' n_Vh 1�iE. lr'_ .C,'S, N/AZ& 5r P.E./R.A. or Contractor: �ddress• Person in responsible charge; Cy 54Al2A Address: J�/�IMI T r 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: TATE OF NEW YORK,COUNTY OF WESTCHESTER as: J� t being duly swop,deposes and says that he/she resides at_�' of �1- t N e Applicant _ (No.and Street) in ,in the County of �� 1 ;n the State of ,that �—�ity/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:$_T/), //0 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 me this 15 Sworn to before me this day ofmlir ,20 day of , 20 Si tur of Property owner Signature of Applicant RI cutm-��/TjS Print Name of Property Owner dacma�&-Upw— Notary Print Name of Applicant Pub' Notary Public GREGORY M.RIVERA Notary Public,State of New York 8/12/2021 No.01 RIS441398 Qualified In Westchester County Commission Expires September 26,2 QyE aRnuk - BUILDING DEPARTMENT ❑BUILDING INSPECTOR ASSISTANT BUILDING INSPECTOR VILLAGE OF RYE BROOK ❑CODE ENFORCEMENT OFFICER 938 KING STREET . RYE BROOK,NY 10573 (914) 939-0668 FAx (914) 939-5801 www.ryebrook.org - - - - - - - - - - - - - - - - - - - - INSPECTION REPORT - - - - - - - - - - - - - - -- - - - - ADbRESS: 0 ✓ (�S-U S 0 1 �V l Q� j(J-) DATE: a 16(20 oR PERMIT# 1�-i�1 ISSUED: 1 SECT: 1� h BLOCK: LOT: LOCATION: (.��� (a �" t ' VV OCCUPANCY: ❑ 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 tea. M y a En WEn 0-4 N Wyy 0. No v �j G1 htr V] Aa as yj as oo Cn Ncq a b L • o o a AenOno 0 W Q M yg z Uo Z O o (� • O w00Qull � o v FBI ~j O N C7 ,n M Q6 W W Z -y Q C�J/j7 I�""1 11 {rj G1 Q M n •-1 O w o to u " en eq 0 � � � MM G1 F, cn z Z U all -00 11 C7 A Z o o Q A W o � �--1 o _ a BUIL MENT l Vl E of RY OK 938 KING ET RYE BR NY 10573 OCT 2022 -0 1 VILLAGE OF RYE BROOK BUILDING DEPARTMENT FOR OFFICE USF,,tOQall.�;: ? g0 q2 f� Approval Date: [ [ P mit# / C;+1 'C)z —Oq(j Application 4 Approval.Signature: Z ARCHITECTURAL REVIEW BOAJ L. Disapproved: _ Date: BOT Approval Date: Case# : Chairman: PB Approval Date: Case# Secretary: ZBA Approval Date: Case# Other: ,,++�� Application Fee�1 75 ' b Permit Fees: O� ` 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 statement Idescriibed below. ` ,r� D 1. Job Address:!C� J + LUAS� �tO I AII/ � 050 SBL: f ann9• a �—3— 9- ) Zone: Property Owner: r' lC& Address: o-S Grysk 8,2 1l oyl CIO Phone#: l I't" '137— D, —Cell#: Y v411 / email: !MA 2. Applicant: Ga5Gy1" 2eWZfiC(y�l r✓y� Address: q/6q 1'NGI0 Phone#: (I 65 3 q35 //Cell#: r_ r / erm�rail: n?S /I QOVQI I�'"Cli) � 3. Roofing Contractor: L// /0�fi1 Ilv( f1�0�1fdJ LL CAddress: ` 6_f I'VI G I o J5t T&rr Vi-,`le 67 Phone#: —515 —3H3S Cell#: -email: 4. Job.Description,list all Methods&Materials: 0 NA vol ho f 1� 5. Estimated Cost of Job: $ 000 (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:f 7. Construction Type: I t�i d' l U ce lvtoo 6/0� NYrS Construction Class: E. Number of stories: 2 Height: Y v 9. Is garage being re-roofed:No: Yes:( }Attached No: (`}•Yes: ( )Number of Cars: 10. Is roof peaked,hip,mansard,flat,etc: In& It. Estimated date of completion: C C+ 17 2 022' 8112(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: �/(�f Gm n -�/ IZ��� 641-;5 W 3 P-✓0h Ad]4,v _zot?ltNu C,FSUv" ,being duly sworn,deposes andsfates that he/she is the applicant above named,Clow (print name of individual signing as the applicant) and futtber states that (s)he is the legal owner of the property to which this application pertains, or that (s)he is the 1M G C for the legal owner and is duly authorized to make and file this application. (indicate architect,contractor,agent,attorney, .) 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 day of , 20 Signature of Property Owner gnature of Applicant U �Aa �05 Print Name of Property Owner P ' Name of Applicant Notary Public Notary Public ^� o - 3©-Zo -2- 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 WES"TCHESTER ) as: KOff," C-iAA" ,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. Sworn to before me this Z Sworn to before me this Z day of c 0),r , 20 2 i- day of 0 C�- , 20 Z Z Tijnafurc of Property Owner Signature of Wphcant e ` t Name of Prop rty Owner Print Namc of Applican Notary Public Notary Public CHRISTOPHER J.BRADBURY CHRISTOPHER J.BRADBURY Notary Public,State of New York Notary Public,State of New York No.01 BR6159985 No.01 BR6159985 Oualified in Westchester CountY2� Qualified in Westchester County Commission Expires January 29,20 Commission Expires January 29,20�21 -2- g11212021 �Ovl Casanova Remodeling, LLC Windows . Roofing • Siding PrON SAA1 fY' Magic Brush *�. Painting (Indoor/Outdoor) Licensed& Insured ©�j 655 Main Street, Plymouth, CT 06782 Powerwashing CT HIC 95 17692 MAHIC 176929 V Toll Free: 877-283-8158 We work magic RI HIC 37486 Toll Free: 877-488-7737 Westchester County WC-2723 4 PROPOSAL SUBMITTED TO: DATE: NAME: r JOB NAME: STREET: STREET: CITY: CITY.. M STATE: HOME BUSINESS PHONE: PHONE: We hereby submit specifications and estimates for: rK ulood1 %'12416 i a>" n� 1 Y-.- (e c I t t d� 5end' PRICE: S rt Date: _ �, CT. SALES TAX: Atel Completion Date. TOTAL: We hereby purpose to f ni bor and materials, omplete, in actor nce with the above specifications,for the sum of: o i X ,Z(„tA - dollars($ (0,-QOO ). Payments to be made as follows: udNuaii U(S 3,00�o to be recaived with order,balance of$ 3,dO� to paid in ful!on complet en Check tc ^-given to job forman. BUYERS RIGHT TO CANCEL �17q_Q300 _1 763-0�q9 YOU,THE BUYER, MAY CANCEL THIS TRANSACTION AT ANY TIME PRIOR TO MIDNIGHT OF THE THIRD BUSINESS DAY AFTER THE DATE OF THIS TRANSACTION. 0 J;VV 3 3�j 7 All material is guaranteed to be as specified.All work to be completed in a workmanlike manner according to ftandard 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 cant'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 I due immediately upon completion or work by the contractor. Authorized Signature /,, Date�124 Q- NOTE:This proposal may be withdrawn by us if not accept within days. This proposal is subject to approval by the management. Acceptwtcz of Propos h S-gnatur Date__ Signature— — _ — Page 1 of 173'/z Ivy Hill Crescent Rye Brook, NY 10573 914-939-2440 October 19, 2022 OCT 2 4 2022 Lorraine & Richard Curtis VILLAGE OF RYE BROOK BUILDING DEPARTMENT 103 Brush Hollow Close - Rye Brook, NY 10573 Re: Roof Replacement Dear Lorraine & Richard Curtis, 1 he 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 .,:Hveyebrookfp02/users/lpetersen/Documents/My%2oPictures/hoa.jpg 10/24/20: 173'h Ivy Hill Crescent 4 Rye Brook, NY 10573 914-939-2440 October 19. 2022 ' oc�2 s Zozz VILLAGE OF RYE BROOK Lorraine & Richard Curtis BUILDING DEPARTMENT 103 Brush Hollow Close Rye Brook, NY 10573 Re: Skylight Replacement Dear Lorraine & Richard Curtis, 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 Laura Petersen From: Laura Petersen Sent: Tuesday, October 25, 2022 11:25 AM To: casanovajjc@gmail.com Subject: Roof Permit Applications for 102 and 103�Brush Hollow Close Good morning, Please send the following items required to issue the roof permits for 102 and 103 Brush Hollow Close; v/1. Copy of general contractor's valid Westchester County Home Improvement License. /2. General contractor's valid liability insurance (the Village Of Rye Brook must be the v certificate holder) V3. General contractor's valid workers compensation on a NY State Board form (C105-2 or U26.3) Thank you Laura Laura Petersen Office Assistant Village of Rye Brook 938 King Street Rye Brook, New York 10573 Phone(914)939-0668 1 Ioetersen(Q)ryebrook.org 1 )Z/9Z/01 Odf•tsto/sainiaidOZ%XW/sluawnaoQ/uas.zaiadl/szasn/ZOdj3iooiga/tzn//:�- Aq + 9( RIO t(ts)►� Zol 40 f 1 • •L„ �, fir, � - d r(�))� L il�•-it .� , .► 1ds.�,11�) d���,l� } ,lid f,dl l _..�.,� ;-� "'i Le rJ W • , ' "'j+ .r � �'s�'i�•:�1,'.°r-� � ����;aj+�•�1�►, 11 r,,f l�'►�ji'�l�A'0113f� ,�1i�,��r�1► �1�r+ ���� Al fir - r QUA, ., �tJ.. �•; f. 711E .y�l ��,, � .c✓y 4 !A� �1• ,.�C��►A� t • (�j1�(1! t3��� � ..r :: I•'t!.• r.. Y� ��JN L r\r•�` !" v P i: .,,��' r ; � �/ l�1tj t �• r � J��J�JIpjj,;�j�' ^ r��•,,�j�J���Jj ,�s t /•��'l Yr.�V _ rA,��h+ �r� ri '' 9+V' •.,�rl�v 1 ���41r15.' :�r.•,VH y��'�/4J%"yti:. O "'y+.�'.YJ.'(q!I��,� A DATE(MM/DD/YYYY) ACORN® CERTIFICATE OF LIABILITY INSURANCE 10/26/2022 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 The Guion Agency Inc NAME: Dianne RipleyPHONE FAX 23 Tompkins Ave WC.No. : (914)769-0501 (914)769-9221 Pleasantville, NY 10570 E-MAIL ADDRESS: dianner@guion.com License#: PC-668085 INSURERS AFFORDING COVERAGE NAIL# INSURERA: Evanston Insurance Company INSURED INSURER 8: 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. ILTR TYPE OF INSURANCE IN 9UBR POLICY NUMBER PItO DD EFF POLICY VDDYFJ(P LIMITS A X COMMERCIAL GENERAL LIABILITY Y 3FF1391 05/01/2022 05/01/2023 EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE I OCCUR PREMI ES13E To RENTED a occurrence) $ 100,000 MED EXP(Any one person) $ 5 000 PERSONAL 8 ADV INJURY 9 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 )( POLICY❑JECT LOC PRODUCTS-COMP/OP AGG t 2,000,000 OTHER: $ AUTOMOBILE LLABIL17Y COMBINED SINGLE LIMIT : Ea acddent ANY AUTO BODILY INJURY(Per person) f OWNED SCHEDULED Peracddent AUTOS ONLY AUTOS BODILY INJURY( ) i HIRED NON-OWNED PROPERTY DAMAGE : AUTOS ONLY AUTOS ONLY Per acddent $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LAB CLAIMS-MADE AGGREGATE f DIED RETENTION $ WORKERS COMPENSATION I ST TUTE OR AND EMPLOYERS'LIABILITY YIN ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT f OFFICERIMEMBER EXCLUDED9 ❑ N/A (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE i If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT f DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be 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 g 5 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:/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 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 4/ DIRECTOR,INSURANCE FUND UNDERWRITING VALIDATION NUMBER: 516653987 U-26.3