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BP22-251
PERMIT #&/lio DATE: /� a LXP: a� �3 SECTION L J, TYPE OF WORK 10B LOCAT,AON CONTRACTOF ` ST. COST 'd co #—yam. TCO # c3 BLOCK / LOT � QC C /�7ca✓oGcJ $11?J4eX) A ins %.0009 /�}sa.� 7019 % FEES c %Q-- P� l� INSPECTION RECORD DATE FOOTI N G FOUNDATION FRAMING RGH FRAMING INSULATION PLUMBING L7 RGH PLUMBING GAS O SPRINKLER ELECTRIC 0 LOW -VOLT C7 ALARM 0 AS BUILT C] FINAL INSP faTHER APPROVALS %FRB i BdT ' PB zBa _ OTHER cL Wa b.Jd<t VILLAGE OF RYE BROOK MAYOR 938 King Street,Rye Brook,N.Y. 10573 ADMINISTRATOR Jason A.Klein (914)939-0668 Christopherj. Bradbury wwry.rvebrook.org TRUSTEES ACTING BUILDING&FIRE INSPECTOR Susan R. Epstein Steven E. Fews Stephanie J. Fischer David M. Heiser Salvatore W. Morlino CERTIFICATE OF COMPLIANCE February 1,2023 Paul Feinstein&Joan Feinstein 6 Robins Roost Rye Brook,New York 10573 Re: 6 Robins Roost,Rye Brook,New York 10573 Parcel ID#: 135.27-1-31 Building Permit#22-251 issued on 12/21/2022 for 7 New Replacement Windows This certifies that the seven new windows,installed under the above captioned permit have been satisfactorily completed. Sincerely, Steven E. Fews Acting Building&Fire Inspector /to D E C E� " E For office use onl : BUILDING DEPARTMENT PERMIT#j -a5) JAN 2 7 2023 D VILLAGE OF RYE BROOK ISSUED:� -p?/-'�r'� 38 KING STREET,RYE BROOK,NEW YORK 10573 DATE: Z7'a3 VILLAGE OF RYE BROOK (914)939-0668 FEE: / PAID BUILDING DEPARTMENT www.ryebrook.orz 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 t#ittittitt#t##ititt##titi#fk#i#ii#i#i##iti#ittttt4tti4iiiif4ttffii4#if ii4f it#i4#f#i#t4t4t4f ittt#ittititititf ff tti#iiitifiiff Address: 6 Robins Roost, Rye Brook NY 10573 Occupancy/Use: I-Fam Parcel ID#: Zone: ..— L Owner: Joan Feinstein Address: 6 Robins Roost,Rye Brook NY 10573 P.E./R.A. or Contractor: FairChester Custom Windows Address: 2041 West Main Street Stamford CT 06902 Person in responsible charge: Kat Wood Address: 2041 West Main Street Stamford CT 06902 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: Joan Feinstein being duly swom,deposes and says that he/she resides at 6 Robins Roost (Print Name of Applicant) (No.and Street) in ,Rye Brook in the County of Westchester in the State of NY ,that (Cityrrown/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:$ 16,091 for the construction or alteration of: Installation of(7)Replacement windows into Existing Openings,No Structural Alterations 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. dd rl Sworn to re me this `'� 'J Sworn to before me this 3 day of l , 2023 day of ,20 a3 C2 Sign a of Piroperry Owner 5ignature of Applicant G 4— (—� dex( Print Name of Property Owner Print Name of Applicant Notary Pu Notary Franklin Barahona Notary Public - State of Connecticut My Commission Expires 12/27/2027 oc Q) 1982 BUILDING DEPARTMENT UILDINGINSPECTOR 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 - - - - - - - - - - - - - - - - - - - - ADDRESS: a I �C DATE: L V C.- PERMIT# - 2 _ ISSUED: ":---[)J2�21LOCK: LOT: LOCATION: K3 \C\ 6 bo,�A v OCCUPANCY: M ❑ VIOLATION NOTED THE WORK IS... C� ACCEPTED ❑ REJECTED/REINSPECTION ❑ SITE INSPECTION REQUIRED ❑ FOOTING ❑ FOOTING DRAINAGE ❑ MUNDATION ❑ UNDERGROUND PLUMBING NOTES ON INSPECTION: ❑ ROUGH PLUMBING ❑ ROUGH FRAMING ❑ INSULATION ❑ NATURAL GAS ❑ L.P. GAS ❑ FUEL TANK ❑ FIRE SPRINKLER ❑ FINAL PLUMBING ❑ CROSS CONNECTION EY FINAL OTHER a x a s P'S s w O ►. W � 1�1 U yam'� o '� � _y 1�l ■ Cl) C4 pla� cn n a O Lei z L \ � A O Q © C Lc) F a . U00 co ~ W 00 Lo NIn Wo ° � � ~ � � C x � J u 0 � 3 c�j. 1� ■ rT� a ■ � w Z o ` oo � V O w00 z E z A Q �a � v ^ Q H o 1 v 04 �.. a r"� OI r�T1 �..� \ W oo P� w zi rs (> WG1 w 4" O C� 00 w A b vv i. H A Ix PLO o _ w z ° Z � 0 3 z � �,� vd U A z o IL 0 w w " o � ° w Z x ° 9 � � a POI w _ � -o BUILDING DEPARTMENT E C E D V E VILLAGE OF RYE BROOK R I DEC 19 20Z2 938 DING STREET RYE BROOK,NY 10573 (914)939-0668 VILLAGE OF RYE BROOK -*vww.rYebrook.orl BUILDING DEPARTMENT ADMINISTRATIVE EXTERIOR BUILDING PERMIT APPLICATION FOR EXTERIOR WORK WmCH DOES NOT REQUIRE Vii.i_1(;F.ARCHITECTURAL.REVIEw BOARD APPROVAL. FOR OFFICE USE ONLY: � L� APPROVAL DATE: DEC2 RMIT#%�J APPLICATION FEE: APPROVAL SIGNATURE: PERMIT FEES: H.O.A. APPROVAL: DATE: DISAPPROVED: OTHER: Application dated:f%_>-/9—._,)a- is hereby made to the Building Inspector of the Village of Rye Brook,NY,for the issuance of a Permit for the construction of buildings,structures,additions,alterations or for a change in use,as per detailed statement described below. I. JobAddress: S FOCISk fo 4 13 2. Parcel ID#: 4 __21 S. 2 Zone: 1 Proposed Improvement(Describe in detail): ty)S - -1©!2� 6T S P ve ) �a ff Q kn ck ffY p� -f k,pi MC`} i ski(lam o Yl i t'1CA S Yl C) 5}C 0 C_+u C1cti� 0_�+e-"-0A� O YES . 4. Property Owner: Joao -� Address: (o Rtp�p. &Os* Phone# q 14--S/f2 019 Cell# q I L4- 3j -3(02 ( e-mail 5K I Y-"+s n n,_J �Gtol.coon List All Other Properties Owned in Rye Brook:L Applicant:1 Q� -k t_ ()() to r IFa't r the s+e_F rr' 5+bf'fl W,r\cio ,0S Address:QO H � VI Main S�r�ee_ .c`G rrr�ora J� non G D a Phone# �p 3 L40!( L�5y 5 Cell# 03 LIF2 2 3181 e-mail > . woodC�f bat.�s+c k,r�s-ter'. cOr�, Architect: Address: Phone# Cell# e-mail Engineer: Address: Phone# Cell# e-mail General Contractor: a /FGl,t (bn64-eT CtpS-iorn iKA rYov-0 Address: L904L W MaQktl S4 I Stot.Mpor A C T 0 Co Q0 d Phone# .26� (o Cell# 3 a 31 1 e-mail K& W 0CA pvv\ (I) 8112rzo21 5. Occupancy;(1-Fam.,2-Fam.,Commercial.,eta...)Pre-construction: l= FG.rn Post-construction: I 6. Area of lot: Square feet: Acres:--a o (0-1 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 comer lot,which street does it front on: 9. Area of proposed building in square feet: Basement: _ 1 u fl: N R 2°d fl: N 3'fl: N 10. Total Square Footage of the proposed new construction: N I A 11. For additions,total square footage added: Basement: N 1 R 1'`fl: NJ Q 2 d fl: N A 3rd fl: �l M 12. Total Square Footage of the proposed renovation to the existing structure: 13. N.Y. State Construction Classification: NY. State Use Classification: 14. Construction Type&Location:()Typical Western Lumber Frame;()Timber Frame[TC];()Wood Truss[TT]; ()Pre-engineered wood[PW];Located;()Floor Framing[F];O Roof Framing[R];O Floor&Roof Framing[FR];Other: 15. Number of stories: m?, Overall Height: Median Height: 16. Basement to be full,or partial: N /Ll finished or in" ed: -e x;5+;11C 17. What material is the exterior finish: N.-� 00 C- ct�r^ 18. Roof style;peaked,hip,mansard,shed,etc: Roofing material: 19. What system of heating: For L e-d Gil f- 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: P( (if yes,applicant must submit a 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: X Area: 23. Will the proposed r ject 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: �4- (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: (ifyes,the area and elevations of the food 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: (f yes,applicant must submit a Tree Removal Permil Application) 28. Does the proposed project involve a Home-Occupation as per§250-38 of Village Code? Yes: No: �yl Indicate:TIER 1: TIER It. TIER III: (if yes,a Home Occupation Permit Application is required) 29. What is the total estimated cost of construction: $ [R 5 1 (P 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 C/O. 30. Estimated date of completion: '�c�n 0 Gx,f 3'd 2 Da 3 (2) 8/12/2021 ED BUILDINOb6ARTMENT E IE M VILLAGE OF RYEA OOK DEC 19 2022 938 KING STREET RYE BR ,NY 10573 (914) � VILLAGE OF RYE BROOKwww.r w�ww.r 8 BUILDING DEPARTMENT 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: 3J, �C,az" �(l� �_c�'1 >residing at,_ co i r1S jQs+ (Print uaitic) %� c you 11� 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; n S 'Q LP) �-,+ , Rye Brook,NY. (Jul}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. (Si!�11001 of Property owner(,}) (Print Name of Prop.ity Ownerys)) Sworn to before me this c2 s day ofNL 20 07 Notary Public) (3) sn 21202 i 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 OF NEW YORK,C UNTY OF WESTCHESTER ) as: K D -V \,)n n ,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 o 4-�( _ ��( 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 Sworn to before me this day of , 204:; d— day of M&eA re , 20 Sigpdture o Property Owner Signature of Applicant d ti Z Print Name of Property Owner Print Name of Applicant *,t.,.,Public Notary Public (4) 8/12/2021 DBA:RENEWAL BY ANDERSEN OF WESTCHESTER AND FAIRFIELD COUNTY Joan A Paul Feinstein Legal Name: Fairchester Custom Windows LLC 6 Robins Roost CT HIC#.0667292 Rye Brook,NY 10573 2041 West Main Street I Stamford,CT 06902 H:(914)937-3626 RE N E WA L Phone:203-406-0545 1 Fax:203-406-0828 1 sales@rbawestchester.com byANDERSEN Thank you for your order Please find, enclosed for your convenience, the contents of your agreement with Fairchester Custom Windows LLC d/b/a Renewal By Andersen of Westchester and Fairfield County Table of Contents Agreement Document and Payment Terms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2 Itemized Order Receipt . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .3 Notice of Cancellation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 RbA2021 Warranty . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6 Terms and Conditions of Sale . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .8 Whatto Expect . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 Lead-Safe Form . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .14 Instant Product Rewards Program (IPRP) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .15 Price Presentation Discounts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16 ReleaseAgreement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17 Supply Chain Communication . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .19 10/24/22 Page 1/ 19 � Agreement Document and Payment Terms VFAF7A DBA:RENEWAL BY ANDERSEN OF WESTCHESTER AND FAIRFIELD COUNTY Joan&Paul Feinstein Legal Name:Fairchester Custom Windows LLC 6 Robins Roost RENEWAL CT HIC#.0667292 Rye Brook,NY 10573 byANDERSEN 2041 West Main Street I Stamford,CT 06902 H:(914)937-3626 Phone:203-406-0545 1 Fax:203-406-0828 1 sales@rbawestchester.com Joan & Paul Feinstein 10/24/22 BUYER(S)NAME CONTRACT DATE 6 Robins Roost , Rye Brook, NY 10573 (914)937-3626 BUYER(S)STREET ADDRESS PRIMARY NUMBER SECONDARY NUMBER skimtsnow@aol.com PRIMARY EMAIL SECONDARY EMAIL NOTES: Buyer(s)hereby jointly and severally agrees to purchase the products and/or services of Fairchester Custom Windows LLC d/b/a Renewal By Andersen of Westchester and Fairfield County("Contractor"),in accordance with the terms and conditions described in this Agreement Document and Payment Terms, any documents listed in the Table of Contents,and any other document attached to this Agreement Document,the terms of which are all agreed to by the parties and incorporated herein by reference(collectively,this "Agreement"). Buyer(s)hereby agrees to sign a completion certificate after Contractor has completed all work under this Agreement. TOTAL JOB AMOUNT: $16,091 By signing this Agreement,you acknowledge that the Balance Due,and the Amount Financed must be made by personal check,bank check,credit card,or cash. DEPOSIT RECEIVED: $0 BALANCE DUE: $16,091 We schedule installations based on the date of the signed contract and secondarily on the date in which we complete the technical measurements.The installation date that we are providing at AMOUNT FINANCED: $16,091 this time is only an estimate.We will communicate an official date and time at a later date. Rain and extreme weather are the most common causes for delay. METHOD OF PAYMENT: Financing NOTES: 20 year labor and installation warranty Buyer(s)agrees and understands that this Agreement constitutes the entire understandings between the parties and that there are no verbal understandings changing or modifying any of the terms of this Agreement. No alterations to or deviations from this Agreement will be valid without the signed,written consent of both the Buyer(s)and Contractor. Buyer(s)hereby acknowledges that Buyer(s)1)has read this Agreement,understands the terms of this Agreement,and has received a completed,signed,and dated copy of this Agreement,including the two attached Notices of Cancellation,on the date first written above and 2)was orally informed of Buyer's right to cancel this Agreement. NOTICE TO BUYER: Do not sign this contract if blank.You are entitled to a copy of the contract at the time you sign. YOU, THE BUYER, MAY CANCEL THIS TRANSACTION AT ANY TIME NOT LATER THAN MIDNIGHT OF 10/27/2022 OR THE THIRD BUSINESS DAY AFTER THE DATE OF THIS TRANSACTION, , WHICHEVER DATE IS LATER. SEE THE ATTACHED NOTICE OF CANCELLATION FORM FOR AN EXPLANATION OF THIS RIGHT. SIGNATURE OF SALES PERSON SIGNATURE SIGNATURE Joseph Patyi Joan Feinstein Paul Feinstein PRINT NAME OF SALES PERSON PRINT NAME PRINT NAME 10/24/22 Page 2/ 19 �� Itemized Order Receipt DBA:RENEWAL BY ANDERSEN OF WESTCHESTER AND FAIRFIELD COUNTY Joan R Paul Feinstein Legal Name:Fairchester Custom Windows LLC 6 Robins Roost RENEWAL CT HIC#.0667292 Rye Brook,NY 10573 byANDERSEN 2041 West Main Street I Stamford,CT 06902 H:(914)937-3626 wtum,.mow i a w..r+ Phone:203-406-0545 Fax:203-406-0828 1 sales@rbawestchester.com • • DETAILS: ow Misc, Misc, Miscellaneous Item, Lead Safe Work Practices 6 0 H to 10 Windows 001 laundry 24 W Window, Double-Hung (DG), 1:1, Slope Sill, Insert Frame, 37 H Traditional Checkrail, Exterior White, Interior White, Performance Calculator, PG Rating: 40 1 DP Rating: + 40 / 40, Glass, All Sash: High Performance SmartSun Glass, No Pattern, Hardware, White, Standard Color Recessed Hand Lift, Screen, Fiberglass, Full Screen, Grille Style, No Grille, Misc, None 101 living 22 W Window, Casement, Single, Left, Base Frame, Exterior White, 57 H Interior White, Performance Calculator, PG Rating: 40 1 DP Rating: + 40 / - 40, Glass, All Sash: High Performance SmartSun Glass, No Pattern, Hardware, White, Screen, Fiberglass, Full Screen, Grille Style, No Grille, Misc, None 102 living rm 58 W Window, Picture, Insert Frame, Exterior White, Interior White, 57 H Performance Calculator, PG Rating: 35 1 DP Rating: + 35 / - 35, Glass, All Sash: High Performance SmartSun Glass, No Pattern, Grille Style, No Grille, Misc, Aluminum Casing, Wrap exterior with aluminum coil. 103 living 22 W Window, Casement, Single, Right, Base Frame, Exterior 57 H White, Interior White, Performance Calculator, PG Rating: 40 1 DP Rating: + 40 / - 40, Glass, All Sash: High Performance SmartSun Glass, No Pattern, Hardware, White, Screen, Fiberglass, Full Screen, Grille Style, No Grille, Misc, None 10/24/22 Page 3/ 19 Itemized Order Receipt DBA:RENEWAL BY ANDERSEN OF WESTCHESTER AND FAIRFIELD COUNTY Joan 8 Paul Feinstein Legal Name: Fairchester Custom Windows LLC 6 Robins Roost RENEWAL CT HIC#.0667292 Rye Brook,NY 10573 by AN DER S E N 2041 West Main Street i Stamford,CT 06902 H:(914)937-3626 Phone:203-406-0545 Fax:203.406-0828 1 sales@rbawestchester.com ROOM: SIZE: DETAILS: PRICE: 104 primary 36 W Window, Double-Hung (DG), 1:1, Slope Sill, Insert Frame, 49 H Traditional Checkrail, Exterior White, Interior White, Performance Calculator, PG Rating: 40 1 DP Rating: + 40 / 40, Glass, All Sash: High Performance SmartSun Glass, No Pattern, Hardware, White, Standard Color Recessed Hand Lift, Screen, Fiberglass, Full Screen, Grille Style, No Grille, Misc, Aluminum Casing, Wrap exterior with aluminum coil. 105 primary 36 W Window, Double-Hung (DG), 1:1, Slope Sill, Insert Frame, 49 H Traditional Checkrail, Exterior White, Interior White, Performance Calculator, PG Rating: 40 1 DP Rating: + 40 / 40, Glass, All Sash: High Performance SmartSun Glass, No Pattern. Hardware, White, Standard Color Recessed Hand Lift, Screen, Fiberglass, Full Screen, Grille Style, No Grille, Misc, None 106 primary 36 W Window, Double-Hung (DG), 1:1, Slope Sill, Insert Frame, 49 H Traditional Checkrail, Exterior White, Interior White, Performance Calculator, PG Rating: 40 1 DP Rating: + 40 / 40, Glass, All Sash: High Performance SmartSun Glass, No Pattern, Hardware, White, Standard Color Recessed Hand Lift, Screen, Fiberglass, Full Screen, Grille Style, No Grille, Misc, Aluminum Casing, Wrap exterior with aluminum coil. WINDOWS: 7 PATIO DOORS: 0 ENTRY DOORS:0 SPECIALTY: 0 MISC: 1 TOTAL $16,091 Renewal by Andersen is committed to our cwtomers'safrty by WMM-71111 complying with the rules and lead-safe work practices specified by the F.PA. 10/24/22 Page 4/ 19 it Notice of Cancellation MPWDBA:RENEWAL BY ANDERSEN OF WESTCHESTER AND FAIRFIELD COUNTY Joan J1 Paul Feinstein Legal Name:Fairchester Custom Windows LLC 6 Robins Roost RENEWAL CT HIC#.0667292 Rye Brook,NY 10573 brANDERSEN 2041 West Main Street I Stamford,CT 06902 H:(914)937-3626 ra.vrni ws�v xv ewr� Phone:203-406-0545 1 Fax:203-406-0828 1 sales@rbawestchester.com You, the buyer(s) may cancel this transaction at any time prior to midnight on 10/27/2022 NOTICE OF CANCELLATION NOTICE OF CANCELLATION Date of Transaction: 10/24/22.You may cancel this Date of Transaction: 10/24/22.You may cancel this transaction,without any penalty or obligation,before midnight transaction,without any penalty or obligation,before midnight on 10/27/2022 or the third business day after the date of this on 10/27/2022 or the third business day after the date of this transaction,whichever date is later. If you cancel,any property transaction,whichever date is later. If you cancel,any property traded in,any payments made by you under the Contract or traded in,any payments made by you under the Contract or Sale,and any negotiable instrument executed by you will be Sale,and any negotiable instrument executed by you will be returned within 10 business days following receipt by the Seller returned within 10 business days following receipt by the Seller of your cancellation notice,and any security interest arising out of your cancellation notice,and any security interest arising out of the transaction will be canceled. If you cancel,you must of the transaction will be canceled. If you cancel,you must make available to the Seller at your residence,in substantially make available to the Seller at your residence,in substantially as good condition as when received,any goods delivered to as good condition as when received,any goods delivered to you under this Contract or Sale;or you may,if you wish,comply you under this Contract or Sale; or you may,if you wish,comply with the instructions of the Seller regarding the return with the instructions of the Seller regarding the return shipment of the goods at the Sellers expense and risk. If you shipment of the goods at the Sellers expense and risk. If you do make the goods available to the Seller and the Seller does do make the goods available to the Seller and the Seller does not pick them up within 20 days of the date of your Notice of not pick them up within 20 days of the date of your Notice of Cancellation,you may retain or dispose of the goods without Cancellation,you may retain or dispose of the goods without any further obligation. If you fail to make the goods available to any further obligation. If you fail to make the goods available to the Seller,or if you agree to return the goods to the Seller and the Seller,or if you agree to return the goods to the Seller and fail to do so,then you remain liable for performance of all fail to do so,then you remain liable for performance of all obligations under the Contract.To cancel this transaction,mail obligations under the Contract.To cancel this transaction,mail or deliver a signed and dated copy of this cancellation notice or deliver a signed and dated copy of this cancellation notice or any other written notice,or send a telegram,to: or any other written notice,or send a telegram,to: dba: Renewal By Andersen of Westchester and dba: Renewal By Andersen of Westchester and Fairfield County Fairfield County Legal Name: Fairchester Custom Windows LLC Legal Name: Fairchester Custom Windows LLC 2041 West Main Street 2041 West Main Street Stamford,CT 06902 Stamford,CT 06902 Phone: 203-406-0545 Phone: 203-406-0545 Fax: 203-406-0828 Fax: 203-406-0828 Email: sales@rbawestchester.com Email: sales@rbawestchester.com NOT LATER THAN MIDNIGHT OF 10/27/2022 NOT LATER THAN MIDNIGHT OF 10/27/2022 OR THE THIRD BUSINESS DAY AFTER THE DATE OR THE THIRD BUSINESS DAY AFTER THE DATE OF THIS TRANSACTION,WHICHEVER DATE IS LATER. OF THIS TRANSACTION,WHICHEVER DATE IS LATER. I HEREBY CANCEL THIS TRANSACTION I HEREBY CANCEL THIS TRANSACTION BUYER SIGNATURE DATE BUYER SIGNATURE DATE 10/24/22 Page 5/ 19 RENEWAL Products and Installation byANDERSEN Transferable Limited Warranty WINDOW&DOOR REPLACEMENT Units Installed After January 1,2022 Renewal by Andersen® Limited Warranty and Dispute Resolution Process IMPORTANT:Please carefully read the Dispute Resolution Process that appears In this document after the Limited Warranty.The Dispute Resolution Process includes class-action and jury trial waivers that affect your legal rights.To opt out of these waivers,you must visit our website at www.renewalbyandersen.com/optout and complete the opt-out form within one year from the original Installation date of your Renewal by Andersen'products.The opt-out only applies to the terms of the Dispute Resolution Process. Transferable Limited Warranty on Glass Transferable Limited Warranty on Installation The glass in Renewal by Andersen®factory glazed windows including High-Performance Installation of your Renewal by Andersen®windows Low-E4'glass,High-Performance Low-E4®Sun glass,High-Performance Low-E4®SmartSun"" or other Andersen®window and/or door products by glass,High-Performance HeatLock®glass,High-Performance Low-E4 PassiveSuno glass Renewal by Andersen installed after January 1,2022 r patterned glass(including obscure,fern,reed,and cascade designs),Finelight m grilles, is warranted for a period of two(2)years from the date divided light grilles,and tempered versions of these glass options,is warranted to be free from of original installation.During this period,should your ANT Y defects in manufacturing,materials,and workmanship for a period of twenty(20)years from Renewal by Andersen window or door fail to perform ■u p R R the original installation date.It is also warranted not to develop,under normal conditions,any according to our specifications due to improper Ifs . material obstruction of vision or broken glass resulting from manufacturing defects or as a original installation,we will bring the workmanship result of premature failure of the glass or organic seal for a period of twenty(20)years from up to our professional standards,at no cost to you. the original installation date.This limited warranty on glass does not apply to special order See the Andersen product warranties for additional glazings,discontinued glass,art glass,insulated art glass,impact-resistant glass,or glass warranty details. that is not factory installed by Renewal by Andersen. This limited warranty on installation does not extend to labor/services performed by anyone In the event a glass failure occurs as a result of a defect in manufacturing,materials,or other than the original Renewal by Andersen installer or other contractor authorized by workmanship within the limited warranty period,Renewal by Andersen,at its option,will: Renewal by Andersen nor to the installation or repair of any finishing or other materials (1)provide and install the appropriate replacement glass product or(2)provide a factory- that have been applied to or adjacent to the product after the initial installation. authorized repair to the existing glass.Such replacement or repair is warranted for the remainder of the original limited warranty period. Non Renewal by Andersen Products For products that are not specifically branded Renewal by Andersen,see the specific product Transferable Limited Warranty on Fibrex® Material Components warranties for those Andersen products available at andersenwindows.com. The Fibrex®material components of your Renewal by Andersen windows(including frame, sash,and exterior grilles)are warranted not to flake,rust,blister,peel,crack,pit,or corrode No Other Warranties or Representations and to be free from defects in manufacturing,materials,and workmanship for a period of twenty(20)years from the original installation date. THIS LIMITED WARRANTY IS IN LIEU OF ALL OTHER WARRANTIES,EXPRESS OR IMPLIED, In the event a Fibrex material component fails as a result of a defect in manufacturing, INCLUDING,BUT NOT LIMITED TO,ANY IMPLIED WARRANTIES OF MERCHANTABILITY OR materials or workmanship within the limited warranty period,Renewal by Andersen,at its FITNESS FOR A PARTICULAR PURPOSE.ALL WARRANTIES ARE LIMITED TO THE APPLICABLE option,will:(1)provide and install the appropriate replacement components or(2)provide a STATUTE OF LIMITATIONS,BUT IN NO CASE WILL EXTEND BEYOND THE LIMITED WARRANTY factory-authorized repair to the existing product.Such replacement or repair is warranted for PERIODS SPECIFIED ABOVE.RENEWAL BY ANDERSEN EXCLUDES AND WILL NOT BE the remainder of the original limited warranty period. LIABLE FOR ANY INCIDENTAL OR CONSEQUENTIAL DAMAGES,WHETHER ARISING OUT OF CONTRACT,TORT,OR OTHERWISE.THE REMEDY OF REPAIR OR REPLACEMENT OF THE PRODUCT PROVIDED BY THIS LIMITED WARRANTY IS THE EXCLUSIVE REMEDY WITH RESPECT Transferable Limited Warranty on Components TO ANY AND ALL LOSS OR DAMAGE. Other Than Glass and Fibrex® Material The non-glass components of your Renewal by Andersen windows,including non-electric Applicable Law operators,locks,lifts,balance systems,hinges,handles,insect screens,weatherstripping, This Limited Warranty is only applicable in the U.S.A.(i.e.,the fifty states and the District of sash,and frame members,are warranted to be free from defects in manufacturing,materials, Columbia)and Canada.This Limited Warranty gives you specific legal rights,and you may and workmanship for a period of ten(10)years from the original installation date. have other rights which vary from state to state or province.Some states do not allow the In the event a component other than glass or Fibrex material fails as a result of a defect in exclusion or limitation of incidental or consequential damages or limitation of the duration manufacturing,materials,or workmanship within the limited warranty period,Renewal by of an implied warranty,so the above limitations or exclusions may not apply to you.If any Andersen,at its option,will:(1)provide and install the appropriate replacement parts or(2) specific term of this Limited Warranty is prohibited by any applicable law,it shall be null provide a factory-authorized repair to the existing product.Such replacement or repair is and void,but the remainder of this Limited Warranty shall remain in full force and effect. warranted for the remainder of the original limited warranty period. Non-Warranty Repair or Replacement Transferable Limited Warranty On Exterior Color Finish You will be responsible for all costs related to any repair or replacement that is not covered The color finish on Fibrex®material exterior components(frame,sash,window sills,and by this Limited Warranty or which is outside of the limited warranty period.When warranty grilles)on Renewal by Andersen windows is warranted to be free from manufacturing defects coverage is unclear,Renewal by Andersen may charge an inspection fee for any on-site resulting in color fade greater than 5 delta-EA(Hunter)when measured in accordance with product inspection.If the service provider determines the Renewal by Andersen product has ASTM D2244-16el,for a period of ten(10)years from the original installation date. a defect covered by this Limited Warranty,the inspection fee will be waived. Weatherstripping,accessories,and hardware,including insect screen frames,handles, trim sets,and lock components,exterior trim profiles,and exterior aluminum coil stock are not covered by this exterior color finish warranty. In the event there is a defect covered by this limited warranty for exterior color finish within the limited warranty period,Renewal by Andersen,at its option,will:(1)refinish the product -labor is included(the finish will be applied with standard commercial refinishing techniques and may not be the same finish as originally applied to the product)or(2)repair or replace the affected product or component.Such replacement parts,refinishing,or repairs are warranted for the remainder of the original limited warranty period. What Is Not Covered by This Limited Warranty Dispute Resolution Process Specific Additional Exclusions In addition to any otter limitations or exclusions in this Limited Warranty,Renewal by Andersen General shall hoe no obligation for product failure,damage,or costs due to or related If you are dissatisfied with the remedy provided to you under the Limited Warranty set forth to the following: above or have any other claim against Renewal by Andersen related to your Renewal by Product modifications or glass shading devices(e.g.,glass tinting,security systems, Andersen'products,you and Renewal by Andersen agree to resolve the claim using the painting or staining,insulated coverings,etc.) following process("Dispute Resolution Process").This Dispute Resolution Process will apply Failure due to the application of non Renewal by Andersen hardware(e.g.,locksets, to claims of any nature relating to your Renewal by Andersen product("Dispute(s)").Disputes trim sets,hinges,panic hardware,closers,etc.) include,but are not limited to:claims for breach of contract or breach of warranty;claims for Water infiltration other than as a result of a defect in manufacturing,materials,or violation of state or federal laws or regulations;claims based in tort,negligence,or product workmanship liability;claims based in fraud or fraud in the inducement,marketing,or advertising claims; and claims related to the enforceability or effect of any term of the Limited Warranty or the Failure as a result of settling or structural failure of the structure in which the products Dispute Resolution Process,including,but not limited to,the waivers of class action and jury are installed trials. Condensation Improper maintenance,such as use of brick wash,razor blades,sealants,sanding,or Notice Required improper washing Failure to properly seal and maintain the exposed wood portions and veneer of a product in To assert a Dispute,you must first provide Renewal by Andersen with written notice. accordance with Renewal by Andersen painting or staining guidelines A Notice of Dispute form is available for your use on Renewal by Andersen's website •Obtaining safe and reasonable access to the product for service at www.renewalbyandersen.com/noticeofdispute. Fading of furniture,flooring,window coverings,or other surrounding materials Chemicals or airbome pollutants,such as salt or acid rain Renewal by Andersen Response Accidents Renewal by Andersen will have 60 days from receipt of your Notice of Dispute to respond to you in writing.In that response or at any later time,Andersen may make one or more written Acts of God offers to you to resolve your Dispute. Normal wear and tear No Class-Action or Jury Trials Additional Items Excluded from This Limited Warranty: YOU AGREE THAT YOU MAY ASSERT DISPUTES AGAINST RENEWAL BYANDERSEN Products not manufactured by Renewal by Andersen ONLY ON AN INDIVIDUAL BASIS AND NOT AS A PLAINTIFF OR CLASS MEMBER IN Products not purchased through Renewal by Andersen and installed by an authorized ANY CLASS OR REPRESENTATIVE ACTION OR PROCEEDING.AS PART OF THIS DISPUTE Renewal by Andersen installer RESOLUTION PROCESS,YOU AND ANDERSEN ALSO AGREE TO WAIVE ANY RIGHT Installation services other than by authorized Renewal by Andersen installers TO A JURY AND AGREE TO HAVE ALL DISPUTES HEARD AND DECIDED SOLELY BY THE FEDERAL OR STATE COURT JUDGE. Removal of Renewal by Andersen windows from the structure in which it was originally installed by anyone other than an authorized Renewal by Andersen installer Labor,service,and materials to paint or stain any repaired or replaced product,component, Opt-Out Procedure trim,finish,or other materials applied to or adjacent to products or other carpentry work You may opt out of this Dispute Resolution Process by completing and submitting that may be required a written Opt-Out Notice.The Opt-Out Notice is located on Renewal by Andersen's website •The performance of the low-maintenance exterior glass coating on products with High- at www.renewalbyandersen.com/optout.Whether or not you opt out of the Dispute Resolution Performance Low-E49 glass(performance will vary depending on environmental conditions) Process,all terms of the Limited Warranty set forth above remain in force and effect. Slight glass curvature,minor scratches,or other imperfections in the glass that do not impair structural integrity or significantly obscure normal vision Applicable Law and Severability Rattling of grille bars within an air space This Dispute Resolution Process,including,but not limited to,issues related to its Insects passing through or around the insect screen enforceability and effect,will be governed by the laws of the State of Minnesota without Tarnish or corrosion to hardware finishes regard to conflict of law principles.If any term of this Dispute Resolution Process is found Special glazings-contact us concerning the limited warranty on special glazings to be invalid or unenforceable in any particular jurisdiction,that term will not apply to that issue in that jurisdiction.Instead,that term will be severed with the remaining terms Broken glass continuing in full force and effect. Art glass and decorative insulated art glass,impact-resistant glass Fading of furniture,flooring,window coverings,or other surrounding materials Questions Other product series:Some products,product options,and accessories have their own If you have questions about the Dispute Resolution Process or Opt-Out Procedure, limited warranties and are not covered by this Limited Warranty.For information on contact us at 1-800-441-1109. warranty coverage,please refer to the specific limited warranties for these products available at andersenwindows.com Warranty Claim Procedure To make a claim under this Limited Warranty,contact the nearest Renewal by Andersen location,our Warranty Service Line at 800-441-1109,or visit our website at renewalbyandersen.com.We will contact you to investigate your claim within approximately two weeks after notification and arrange for appropriate action.Warranty services may be provided by Renewal by Andersen and/or an authorized Renewal by Andersen service provider. You can help us serve you faster by providing the following important information: The serial number of the affected product(located on a label affixed to the top or side of the window frame) Description of the product concerns 1 R E N E WA L Documentation of the purchase date,if available -Your name,address(with zip code)where product is installed,and telephone numbers by A N D E R S E N ULL•SERKE WINDOW 8 DOOR REPLACEMENT F• Terms and Conditions of Sale Jr DBA:RENEWAL BY ANDERSEN OF WESTCHESTER AND FAIRFIELD COUNTY Joan&Paul Feinstein RENEWAL SF�� Legal Name: Fairchester Custom Windows LLC 6 Robins Roost CT HIC#.0667292 Rye Brook,NY 10573 byANDERSEN 2041 West Main Street I Stamford,CT 06902 H:(914)937-3626 N:fM..•�1)l.QM1411 Phone:203-406-0545 1 Fax:203-406-0828 1 sales@rbawestchester.com Fairchester Custom Windows LLC d/b/a Renewal by Andersen of Westchester and Fairfield County is an authorized and independent dealer of Renewal by Andersen. You are entering into a contract with Fairchester Custom Windows LLC d/b/a Renewal by Andersen of Westchester and Fairfield County. Quoted Prices: This proposal will expire six (6) months from the date signed by an RBA of Westchester/Fairfield representative. Payment Terms: Unless otherwise specified, a down payment of one-third (1/3) of the total price of this Agreement is required prior to ordering windows and doors for contracts up to $30,000. Remaining two-thirds (2/3) balance is due on day of completion. For proposals exceeding $30,000, a down payment of one-third (1/3) is required at time of order, and a second payment of one-third (1/3) is required at time of technical measurement of windows and doors. Remaining one-third (1/3) balance is due on day of completion. Acceptance: All proposals are subject to final approval by RBA of Westchester management. If Contractor determines work can not be performed according to normal professional standards, Contractor has the right to cancel this Agreement by notifying buyer in writing and returning deposit money. Some of the things that could cause Contractor to cancel this Agreement would be unforeseen structural defects to home, unknown pre-existing conditions to home, or incorrect pricing. Entire Agreement: This proposal constitutes the entire Agreement of the parties and may not be modified or amended except by written agreement or change order signed by both parties. This proposal supersedes all prior agreements and understandings. SIGNATURE OF SALES PERSON SIGNATURE SIGNATURE Joseph Patyi Joan Feinstein Paul Feinstein PRINT NAME OF SALES PERSON PRINT NAME PRINT NAME 10/24/22 Page 8/ 19 Xg r Terms and Conditions of Sale DBA:RENEWAL BY ANDERSEN OF WESTCHESTER AND FAIRFIELD COUNTY Joan&Paul Feinstein Legal Name: Fairchester Custom Windows LLC 6 Robins Roost RENEWAL CT HIC#.0667292 Rye Brook,NY 10573 by AEN RENEWAL Nip. ]QIf4Y1 N 2041 West Main Street I Stamford,CT 06902 H:(914)937-3626 Phone:203-406-0545 1 Fax:203-406-0828 1 sales@rbawestchester.com Late Cancellation: You have three (3) business days to cancel this Agreement, as described on the front page of this Agreement. I understand that if I want to cancel this Agreement after those three business days, Contractor does not have to allow that. I understand that if Contractor does allow me to cancel, however, I will have to pay Contractor a late cancellation fee of between 25% and 50% of the purchase price on the original Agreement to cover Contractor's labor, administrative, and material costs. The exact amount of the cancellation fee will be determined by the Contractor based on the size of the job and progress in manufacturing of the windows and doors. Additional Work: Unless specified in this proposal, this Agreement does not include any plumbing, electrical, plastering, carpentry or painting. Any additional work performed at your request will be charged for as an extra. Unforeseen Conditions: Any additional work uncovered during the course of installation that is unforeseen but deemed necessary for the satisfactory completion of the job (such as carpentry to repair rotted wood or re-frame and opening) is the responsibility of the homeowner and is not included in this Agreeement unless specifically noted. If additional work is uncovered, Contractor will notify homeowner immediately of the problem and postpone further work to allow homeowner time to obtain reasonable pricing to address required carpentry repair work. If homeowner elects to have Renewal by Andersen perform the additional work, homeowner shall sign a change order agreeing to scope of work and additional cost. Renewal by Andersen will not be obligated to make any repairs for unforeseen work until written change order is executed. Interior Damage: Renewal by Andersen shall not be liable for any interior damage to the walls, plaster, tile or woodwork that might occur during the performance of this contract as a result of normal installation procedures. It is understood that the use of hammers, drills and saw blades may cause minor damage to interior finish of walls and trim. Contractor is not responsible for such damage. Delays: Installation dates are estimates only and are not guaranteed, performance being made on a best efforts, as available basis. Contractor will make every reasonable effort to meet any performance dates quoted in this proposal, but Contractor will not be liable for its failure to meet such dates. �Adv .� SIGNATURE OF SALES PERSON SIGNATURE SIGNATURE Joseph Patyi Joan Feinstein Paul Feinstein PRINT NAME OF SALES PERSON PRINT NAME PRINT NAME 10/24/22 Page 9/ 19 Xir Terms and Conditions of Sale DBA:RENEWAL BY ANDERSEN OF WESTCHESTER AND FAIRFIELD COUNTY Joan i Paul Feinstein Legal Name: Fairchester Custom Windows LLC 6 Robins Roost RENEWAL RE CT HIC#.0667292 Rye Brook,NY 10573 bYAN RENEWAL Nwn.snERSEN 2041 West Main Street I Stamford,CT 06902 H:(914)937-3626 Phone:203-406-0545 1 Fax:203-406-0828 1 sales@rbawestchester.com Access: As the owner of the premises which is the subject of this Proposal, you agree to grant Renewal by Andersen reasonable access to your premises during normal business hours for purposes of installing the products and performing the services contemplated by this proposal. If necessary, you agree to obtain consent to enter upon all adjoining neighbor's property in order to enable Renewal by Andersen employees to complete the work specified under the terms of this contract. Arbitration: Unless Contractor and homeowner mutually agree otherwise in writing, all claims and disputes arising in connection with this Proposal or the performance of the parties hereunder shall be resolved by arbitration in accordance with the Commercial Arbitration Rules of the American Arbitration Association in effect on the date of this Proposal by a single arbitrator appointed in accordance with such rules. Judgment may be entered upon any award rendered by an arbitrator hereunder in any court having proper jurisdiction in the States of Connecticut or New York. p �,46— Vwr SIGNATURE OF SALES PERSON SIGNATURE SIGNATURE Joseph Patyi Joan Feinstein Paul Feinstein PRINT NAME OF SALES PERSON PRINT NAME PRINT NAME 10/24/22 Page 10/ 19 �N What to Expect DBA:RENEWAL BY ANDERSEN OF WESTCHESTER AND FAIRFIELD COUNTY Joan&Paul Feinstein Legal Name: Fairchester Custom Windows LLC 6 Robins Roost RENEWAL CT HIC#.0667292 Rye Brook,NY 10573 byEN D � EN 2041 West Main Street I Stamford,CT 06902 H:(914)937-3626 Phone:203-406-0545 1 Fax:203-406-0828 1 sales@rbawestchester.com TECHNICAL MEASURE Opening Your Home You are required to be present during your technical measure in order to open your home and review your contract specifications with our technician. Tentatively Scheduling Your Installation Our technician will measure the opening for each purchased unit and determine the amount of time required for your installation. He will then provide you a tentative installation date. PRE-INSTALLATION Installation Date Confirmation Once your units have a scheduled arrival date, our office will confirm the tentative installation date with you. Please keep in mind that this installation date may need to change. Disruptions to our supply chain related to the pandemic may cause extended lead times or back orders on certain products. In addition, variables such as rain and extreme weather may also require a change in the installation date. We appreciate your understanding and flexibility in advance. We will confirm your installation date two days prior to install. INSTALLATION Furniture and Decorations We ask that you remove any furniture that may block access to the windows or door openings. We ask that you remove pictures from any walls being worked on and any decorations that are in the work area before work begins. This will greatly reduce the likelihood of any accidental damage to personal property. SIGNATURE OF SALES PERSON SIGNATURE SIGNATURE Joseph Patyi Joan Feinstein Paul Feinstein PRINT NAME OF SALES PERSON PRINT NAME PRINT NAME 10/24/22 Page 11/ 19 V What to Expect DBA:RENEWAL BY ANDERSEN OF WESTCHESTER AND FAIRFIELD COUNTY Joan i Paul Feinstein RENEWAL Legal Name:Fairchester Custom Windows LLC 6 Robins Roost CT HIC#.0667292 Rye Brook,NY 10573 byANDERSEN 2041 West Main Street I Stamford,CT 06902 H:(914)937-3626 HfVMr.I.YO ibl. RYIFK Phone:203-406-0545 1 Fax:203-406-0828 1 sales@rbawestchester.com INSTALLATION (CONTINUED). Window Coverings Please remove all blinds, shades or shutters from window openings before we arrive. Should you need assistance removing and reinstalling your existing blinds, shades or shutters, please bring this to the attention of your Installation Manager at the time of your Technical Measure appointment and we will assist you in any way possible at the time of installation. In the event a Renewal by Andersen installer reinstalls a window shade or blind, homeowner understands that the installer may be required to adjust the location or position of the shade or blind hardware and window covering to accommodate the new window installation and the shade or blind therefore may not fit in exactly the same position as prior to the installation. In the event a Renewal by Andersen installer does remove or re-install a shade or blind homeowner understands that Renewal by Andersen assumes no responsibility for accidental damage to the window treatments. Renewal by Andersen will not remove or reinstall MOTORIZED shades or blinds. All MOTORIZED shade and blind devices must be removed and reinstalled by a third party authorized technician. Air Conditioners If you have an air conditioner, we ask that you remove the air conditioning unit prior to installation. Should you need assistance removing and reinstalling your existing air conditioner, please bring this to the attention of your Installation Manager at the time of Technical Measure and we will assist you if possible at the time of the installation. In certain instances, existing air conditioners will not be able to be reinstalled in the existing opening after the new window is installed due to the reduction in the clear opening width and height as compared to the original window. Security System We ask that you contact your security alarm company and arrange in advance to disconnect your security system and any window contacts or hardware prior to the installation and reconnect after the installation is completed. SIGNATURE OF SALES PERSON SIGNATURE SIGNATURE Joseph Patyi Joan Feinstein Paul Feinstein PRINT NAME OF SALES PERSON PRINT NAME PRINT NAME 10/24/22 Page 12 / 19 �� What to Expect DBA:RENEWAL BY ANDERSEN OF WESTCHESTER AND FAIRFIELD COUNTY Joan&Paul Feinstein Legal Name:Fairchester Custom Windows LLC 6 Robins Roost RENEWAL CT HIC#.0667292 Rye Brook,NY 10573 byANDERSEN 2041 West Main Street I Stamford,CT 06902 H:(914)937-3626 ruum.wnna an`ira Phone:203-406-0545 1 Fax:203-406-0828 1 sales@rbawestchester.com Pets Because not all pets react favorably to the excitement of the construction process, we ask that you keep all of your pets confined during the time we are working on your home. This should keep them from becoming stressed, accidentally escaping or possible injury. Final Payment The final payment is due at the completion of the installation. The check is made payable to Renewal by Andersen of Westchester or Renewal by Andersen of Fairfield County. You may hand the check to the installer who will then bring the check into the office. If you have financed your project, the instructions provided by the finance institution will be followed. - �10 e �Afy/--- SIGNATURE OF SALES PERSON SIGNATURE SIGNATURE Joseph Patyi Joan Feinstein Paul Feinstein PRINT NAME OF SALES PERSON PRINT NAME PRINT NAME 10/24/22 Page 13/ 19 J:. Lead-Safe Form DBA:RENEWAL BY ANDERSEN OF WESTCHESTER AND FAIRFIELD COUNTY Joan&Paul Feinstein Legal Name:Fairchester Custom Windows LLC 6 Robins Roost RENEWAL R E CT HIC#.0667292 Rye Brook,NY 10573 16YAN RENEWAL SEN 2041 West Main Street I Stamford,CT 06902 H:(914)937-3626 Phone:203-406-0545 1 Fax:203-406-0828 1 sales@rbawestchester.com Lead Safe Work Pamphlet Receipt and Lead Testing Permission Form Pamphlet Receipt I have received a copy of the lead hazard information pamphlet informing me of the potential risk of the lead hazard exposure from renovation activity to be performed in my dwelling. I received this pamphlet before the work began. Permission to Test I confirm and understand that if my house was before 1977, 1 give my permission to have my house tested for Lead Paint, I understand that the if the test does show the presence of lead paint, that the firm performing the renovation will be required to use the lead-safe work practices required by EPA's Lead-Based Paint Renovation, Repair, and Painting Rule. By signing below, I hereby agree to the terms and conditions above. (,p a�_) �AdA_ SIGNATURE OF SALES PERSON SIGNATURE SIGNATURE Joseph Patyi Joan Feinstein Paul Feinstein PRINT NAME OF SALES PERSON PRINT NAME PRINT NAME 10/24/22 Page 14/ 19 ME Ci Instant Product Rewards Program (IPRP) DBA:RENEWAL BY ANDERSEN OF WESTCHESTER AND FAIRFIELD COUNTY Joan&Paul Feinstein RENEWAL Legal Name:Fairchester Custom Windows LLC 6 Robins Roost CT HIC#.0667292 Rye Brook,NY 10573 bYANDERSEN 2041 West Main Street I Stamford,CT 06902 H:(914)937-3626 N,YM HMO\lllV RJIr� Phone:203-406-0545 1 Fax:203-406-0828 1 sales@rbawestchester.com To: All Design Consultants Date: September 1, 2022 From: Joe Fleming, General Manager, Renewal by Andersen of Westchester and Fairfield County Re: Instant Product Rewards Program (IPRP) As our material and delivery costs have increased this year, we must find ways to economize and control prices—without compromising quality. We can not—and will not—cut back on the quality of our products, installation or customer service. At the same time, we must ensure we keep our prices competitive. To that end, we have found a way to reduce our marketing costs and pass that savings on to our customers ( in addition to the currently advertised Andersen factory promotions). Since our Design Consultants can estimate up to three new projects per day, it costs us more money(per customer) to visit a customer for a second or third time. When we make multiple visits to the same house to price a job, we lose an opportunity on the weekly schedule to estimate a new project. While we are happy to visit our customers as many times as it takes to earn their business, we do save time and money every time a customer makes a buying decision on the first visit. We have therefore decided to offer an additional discount to customers who place an order on the day we deliver the quote. For a limited time, you are authorized to offer an additional 5% off across the board on all window and door prices given to any customer who places an order on the initial visit. This additional discount must be offered to all homeowners at the time you present the price—and either accepted or rejected. If it is not accepted, we will of course honor the current advertised promotional discount. Best Regards, Joe Fleming- General Manager Renewal by Andersen i (),l �,df-- 1 SIGNATURE OF SALES PERSON SIGNATURE SIGNATURE Joseph Patyi Joan Feinstein Paul Feinstein PRINT NAME OF SALES PERSON PRINT NAME PRINT NAME 10/24/22 Page 15/ 19 Price Presentation Discounts DBA:RENEWAL BY ANDERSEN OF WESTCHESTER AND FAIRFIELD COUNTY Joan$Paul Feinstein RENEWAL Legal Name:Fairchester Custom Windows LLC 6 Robins Roost CT HIC#.0667292 Rye Brook,NY 10573 byANDERSEN 2041 West Main Street I Stamford,CT 06902 H:(914)937-3626 'rwm.+aw�ai+u�.aera Phone:203-406-0545 1 Fax:203-406-0828 sales@rbawestchester.com PROJECT • DISCOUNTS INDIVIDUAL SAVINGS BASED ON 7 UNITS % Off the Project Savings: 20% Off Project $4,234 Instant Product Rewards Plan (5%) Savings: $846 $5,,080 TOTAL PRICE: $16,091 SAVINGS 10/24/22 Page 16/ 19 Release Agreement DBA:RENEWAL BY ANDERSEN OF WESTCHESTER AND FAIRFIELD COUNTY Joan&Paul Feinstein RE NVEWAL Legal Name: Fairchester Custom Windows LLC 6 Robins Roost R ENDE L CT HIC#.0667292 Rye Brook,NY 10573 bYAN 2041 West Main Street I Stamford,CT 06902 H:(914)937-3626 Phone:203-406-0545 1 Fax:203-406-0828 1 sales@rbawestchester.com UNDERSTAND that my name, my company name, voice, picture, likeness, biographical material , photo images of my home and/or person, and statements and/or opinions made by me, in whole or in part, edited or unedited, in any and all media (hereinafter "Information"), without limitation for any and all purposes (including but not limited to incorporating the material into commercials, advertisements, promotions, coupons, in- store displays, on-line programs, free standing inserts and/or publicity or other materials of Renewal by Andersen's products or services). I agree that Renewal by Andersen LLC will have the right to attribute this Information to me and that the Information is accurate to the best of my knowledge. No benefit has been given or promised to me in consideration of expressing my beliefs about Renewal by Andersen° products. I hereby consent to the use of the Information to Renewal by Andersen LLC, their successors and assigns, for use without restriction as to frequency, scope or duration of usage. In connection herewith, I hereby release and agree to hold harmless Renewal by Andersen LLC, its successors and assigns, each of them from any and all claims of any kind which I, my heirs, executors or assigns, may have on account of such use including what might be deemed to be misrepresentations of me, my character or my person due to distortion, optical illusion or faulty reproduction which may occur in the finished product. BUYER(S) WITNESS SIGNATURE SIGNATURE SIGNATURE Joan Feinstein Paul Feinstein Joseph Patyi PRINT NAME PRINT NAME PRINT NAME 6 Robins Roost 6 Robins Roost 10/24/22 ADDRESS ADDRESS DATE Rye Brook, NY 10573 Rye Brook, NY 10573 CITY/STATE/ZIP CITY/STATE/ZIP 10/24/22 Page 17 / 19 "t Release Agreement Jw !� DBA: RENEWAL BY ANDERSEN OF WESTCHESTER AND FAIRFIELD COUNTY Joan&Paul Feinstein Legal Name:Fairchester Custom Windows LLC 6 Robins Roost RENEWAL CT HIC#.0667292 Rye Brook,NY 10573 by A N D E R S E N 2041 West Main Street I Stamford,CT 06902 H:(914)937-3626 Phone:203-406-0545 1 Fax:203-406-0828 1 sales@rbawestchester.com I hereby agree to waive any compensation rights and/or benefits other than the publicity my business will receive from this advertisement for my participation in this project. Renewal by Andersen LLC, its successors and assigns, shall be the absolute owner of any and all advertising materials (and all rights therein, including the copyright) produced pursuant to this Agreement. No promise or representation which is not expressed herein has been made to me, and I have read this release, understand it and am signing it voluntarily. BUYER(S) WITNESS SIGNATURE SIGNATURE SIGNATURE Joan Feinstein Paul Feinstein Joseph Patyi PRINT NAME PRINT NAME PRINT NAME 6 Robins Roost 6 Robins Roost 10/24/22 ADDRESS ADDRESS DATE Rye Brook, NY 10573 Rye Brook, NY 10573 CITY/STATE/ZIP CITY/STATE/ZIP 10/24/22 Page 18/ 19 Supply Chain Communication DBA:RENEWAL BY ANDERSEN OF WESTCHESTER AND FAIRFIELD COUNTY Joan&Paul Feinstein RENEWAL Legal Name:Fairchester Custom Windows LLC 6 Robins Roost CT HIC#.0667292 Rye Brook,NY 10573 brANDERSEN 2041 West Main Street I Stamford,CT 06902 H:(914)937-3626 Phone:203-406-0545 1 Fax:203-406-0828 1 sales@rbawestchester.com To Our Valued Customers, Thank you for choosing Renewal by Andersen and for trusting our company for your home improvement project. Since the start of the pandemic, our homes have become even more central to our lives, which has resulted in a greatly increased demand for building and home improvement products. Unfortunately, the pandemic has also placed extreme pressure on our entire supply chain with the result that our material suppliers are struggling to keep up with this demand. Ultimately, these challenges have resulted in extended lead times for manufacturing windows and doors as well as shipping and delivery to our Stamford location. Most impacted at this time by extended lead times are the patio door, casement window, Terratone window and Provia entry door product manufacturing lines. In some cases, we are receiving shipment of partial orders, with the remainder of the order placed on back order for shipment at a later date. (In these instances, customers will be given the option to install the job in two stages, or postpone the entire installation until the back ordered products have been received.) We apologize for any delay and want you to be assured that we are doing everything possible to reduce lead times back to normal levels. Once again, we appreciate your flexibility and understanding as we are doing all we can to deliver on our commitment to provide the highest quality products with exceptional customer service. Sincerely, Joe Fleming - General Manager Renewal by Andersen of Westchester and Fairfield County -- p I-------- (I'Adt- - --- — SIGNATURE OF SALES PERSON SIGNATURE SIGNATURE Joseph Patyi Joan Feinstein Paul Feinstein PRINT NAME OF SALES PERSON PRINT NAME PRINT NAME 10/24/22 Page 19/ 19 Building Permit Check List&Zoning Analysis Address: ry � —=.7c�c SBL: Zone: iZ -Z Use: Const.Type: Other. Submittal Date: 2 Revisions Submittal Dates: Applicant: fix" Nature of Work: yJ iu-r--t�, Ouo S Reviews:zBA- DEC 2 0 2022 P& BOT• Other. OK ( ( ) FEES:Filing:. BP: C O: Flood Plane: Legalization: ( ) ( ) APP: Dated. / Notarized. ✓ SBL: Truss I.D. Cross Connection H.O.A.: ( ) ( ) Scenic Roads: Steep Slopes: Wetlands: Storm Water Review: Street Opening: ( ) ( ) ENVIRO:Long. Short: Fees: N/A: ( ) ( ) SITE PLAN:Topo: Site Protection: S/W Mgmt.: Tree Plan Other. ( ) ( ) SURVEY:Dated: Current:. Archival• Sealed: Unacceptable: ( ) ( ) PLANS:Date Stamped: Sealed. Copies: Electronic. Other. ( ) (�License: ✓ Workers Comp: Liability Comp.Waiver. Other. ( ) ( ) CODE 7S3#: Dated: N/A: ( ) ( ) HIGH-VOLTAGE ELECTRICAL:Plans: Permit N/A: Other. ( ) ( ) LOW-VOLTAGE ELECTRICAL:Plans: Permit N/A Other. ( ) ( ) FIRE ALARM/SMOKE DETECTORS:Plans: Permit: H W.I.C.:_Battery:_Other. ( ) ( ) PLUMBING Plans: Permit: Nat. Gas: LP Gas: N/A/: Other. ( ) ( ) FIRE SUPPRESSION:Plans: Permit: N/A: Other. ( ) ( ) H.V.A.C.: Plans: Permit: N/A Other. ( ) ( ) FUEL TANK:Plans: Permit: Fuel Type: Other. ( ) (� 2020 NY State ECCC: N/A: Other. ( ) ( ) Final Survey Final Topo: RA/PE Sign-off Letter. As-Built Plans: Other. ( ) ( ) BP DENIAL LETTER: C/O DENIAL LETTER: Other. ( ) ( ) Other. ( )ARB mtg.date: approval: notes: ( )ZBA mtg.date: approval;- notes: ( )PB mtg.date: approval• notes: REQUIRED EXISITNG PROPOSED NOTES APPROVED Arm [late• DEC 2 0 2022 cir Fr n Front: Front sue: �: Main Co Accs.Cov Ft.H Sb: S .H Sb: CE& Tot,imp: F bn : Pkine Hight/Stories: notes: Residential Building Permit Fee Work Sheet Permit#: Date Issued: SBL: Zone: Address: Property Owner&Contact Info: Job Description: For all new dwellings and for additions measuring 800 sq. ft. or more made to existing dwellings, the following fee schedule shall apply: (plus any alteration fees) Total Sq. Ft. (excluding basements)x $300.00 x $I5.00/$I,000.00 Basement Sq. Ft. x $65.00 x $I5.00/$1,000.00 -------------------------------------------------------------------------------------------------------------------- New Construction Sq.Ft. • New Construction Cost • Building Permit Fee Basement= sq. ft.x$65.00 = $ x$I5.00/$I,000.00= $ Attached Garage= sq. ft.x$300.00= $ x$I5.00/$I,000.00= $ I"Fl. = sq.ft.x$300.00= $ x$I5.00/$1,000.00= $ 2"'Fl. = sq. ft.x$300.00 =$ x$I5.00/$I,000.00 = $ 3`1 Fl. = sq. ft.x $300.00= $ x$I5.00/$I,000.00= $ 4d,Fl.= sq. ft.x$300.00= $ x$I5.00/$I,000.00= $ Total Sk.Ft. = sq. ft. Total Cost= $ Total B.P.Fee= $ .i Total Amount Paid = $ Total Amount Due= $ Date: Signed: f f 1 ••••� '(1 1YJ t�!t r•.• ; �'E 1 r;°.`s► JA\r t"►' "fl \�Nt1�1•�It,�!li/'_'t:.4.1,_. !!l:i:_',,�'}j:11t�lil��l':.(�H t�l�:_�iN��t1y.L1<ti��l�_�.__.r i�t� 111R =i;.'N./,1 ��.iit 1 � EL 04 96 tto►I .I• 7s.l�, 5�'' aCa d v u N c c `0 ca a� v1 N U R CD (D 3 0 section tti vJ _ ~ C Lr_ LL _v / O y41 N M LO ,*z Vp (<(o)► ` .'i'�•It�i' i'$t11Q'i'.� ,�. .'i�ttlt'i'r. �ON- .*�11� �t0.0'++'�'1}�liit�1), `',.�.❖.1 �Plti1�� �u/•b� Plr.ilt t�;b1., ,Plr+.�lt tt1.1•�.,, R(1f.�11 '�t1•�•1.t� ,IP�/./�1�k "�d.1.4tt ,!(Il.'t11< f�(�Yf$���✓��}T 1�{�.�1J '1' L!. � L!J t✓•. r A W, 5/.b r yg, .. '+f..�L�P'j` •O r`!1�/�r�''r � 1�'r r � 77 .. :Q,. � �hN � 'irQ I ' O 'fY�I��V,h�� � x�Y�., ., rl.Y� tiCy. vr• .;Y :' .Y\ N r Y 11 4 /v�.. gr\1' )y,�'.: ,\ ^ .+ •. .J y p,�.�c��°' � x,ol.,i' s{K r�n � .+ rNr Y... •.s� ,c;iW4r Y,� slp 71r1 v s FAIRCUS-01 TBRAND ACORN CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) 9/26/2022 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 Theresa Brandon NAME: MBI Company Group LLC. PHONE FAX 280 State Street (A/C,No,Ext):(203)288-3401 (A/C,No): North Haven,CT 06473 A oRE :theresa.brandon@mbi-ins.com 'I INSURERS AFFORDING COVERAGE NAIC M INSURER A:Selective Insurance Company of America 12572 F INSURED INSURER B: Fairchester Custom Windows LLC dba: Renewal by Andersen INSURER C: Fairchester 2041 West Main Street INSURER D: Stamford,CT 06902 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 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. INSR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFY MMLICY EXPLTIR IDDIYYYYI LIMBS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE F_X]OCCUR X '$ 2516791 8/12/2022 8/12/2023 DAMAGE TO RISESEaENTED occurrence) $ 500,000 MED EXP(Any oneperson) $ 15,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 3,000,000 JE� LOC PRODUCTS-COMP/OP AGG $ 3,000,000 POLICY a OTHER: $ A AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 ANY AUTO S 2516791 8/12/2022 8/12/2023 BODILY INJURY Perperson) $ OWNED SCHEDULED AUTOS ONLY X AUTOS Ep BODILY INJURY Per accident $ X AUTOS ONLY X AUUT S ONIV PRBOaE enl AMAGE $ F $ A X UMBRELLA LIAR X OCCUR EACH OCCURRENCE $ 4,000,000 EXCESS LlAB CLAIMS-MADE X S 2516791 8/12/2022 8/12/2023 AGGREGATE $ 4,000,000 DED I X I RETENTION$ 0 A WORKERS COMPENSATION X PER X OTH- AND EMPLOYERS'LIABILITY Y/N C 9099063 8/12/2022 8/12/2023 ISTATUTE ER 500,000 ANY PROPRIETORIPARTNER/EXECUTIVE ❑ N/A E.L.EACH ACCIDENT �FFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 500,000 If yes,describe under 500,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Village of Rye Brook is Additional Insured as required by written contract per the endorsements included with this certificate. 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 9 Y ACCORDANCE WITH THE POLICY PROVISIONS. 938 King Street Rye Brook,NY 10573 AUTHORIZED REPRESENTATIVE ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD YORK Workers' CERTIFICATE OF STATE Compensation Board NYS WORKERS' COMPENSATION INSURANCE COVERAGE 1a.Legal Name&Address of Insured(use street address only) 1b.Business Telephone Number of Insured Fairchester Custom Windows LLC. 203-406-0545 Renewal by Andersen Fairchester 2041 West Main Street 1c.NYS Unemployment Insurance Employer Registration Number of 204 Stamford,CT 06902 Insured Work Location of Insured(Only required if coverage Is specifically limited to 1 d.Federal Employer Identification Number of Insured or Social Security certain locations in New York State,i.e.,a Wrap-Up Policy) Number 88-2855660 2.Name and Address of Entity Requesting Proof of Coverage 3a.Name of Insurance Carrier (Entity Being Listed as the Certificate Holder) Selective Insurance Company Village of Rye Brook 3b.Policy Number of Entity Listed in Box"1 a" 938 King Street Rye Brook,NY 10573 WC9099063 3c.Policy effective period 0 8/1 212 0 2 2 to 08/12/2023 3d.The Proprietor,Partners or Executive Officers are �X included.(Only check box if all partners/officers included) all excluded or certain partners/officers excluded. This certifies that the insurance carrier indicated above in box"3"insures the business referenced above in box"1a"for workers' compensation under the New York State Workers'Compensation Law.(To use this form,New York(NY)must be listed under�tp 3A on the INFORMATION PAGE of the workers' compensation Insurance policy). The Insurance Carrier or its licensed agent will send this Certificate of Insurance to the entity listed above as the certificate holder in box"2". The insurance earner must notify the above certificate holder and the Workers'Compensation Board within 10 days IF a policy is canceled due to nonpayment of premiums or within 30 days IF there are reasons other than nonpayment of premiums that cancel the policy or eliminate the insured from the coverage indicated on this Certificate. (These notices may be sent by regular mail.)Otherwise,this Certificate is valid for one year after this form is approved by the insurance carrier or Its licensed agent,or until the policy expiration date listed in box"3c",whichever is earlier. This certificate is issued as a matter of information only and confers no rights upon the certificate holder.This certificate does not amend, extend or alter the coverage afforded by the policy listed, nor does it confer any rights or responsibilities beyond those contained in the referenced policy. This certificate may be used as evidence of a Workers'Compensation contract of insurance only while the underlying policy is in effect. Please Note: Upon cancellation of the workers'compensation policy Indicated on this form,if the business continues to be named on a permit,license or contract Issued by a certificate holder,the business must provide that certificate holder with a new Certificate of Workers'Compensation Coverage or other authorized proof that the business is complying with the mandatory coverage requirements of the New York State Workers'Compensation Law. Under penalty of perjury,I certify that I am an authorized representative or licensed agent of the insurance carrier referenced above and that the named insured has the coverage as depicted on this form. Approved by: Theresa Brandon (Print name of authorized representative or licensed agent of insurance carder) Approved a 0 (Signature) ate) Title: Agent Telephone Number of authorized representative or licensed agent of insurance carrier: 203-288-3401 Please Note:Only insurance carriers and their licensed agents are authorized to issue Form C-105.2.Insurance brokers are NOT authorized to Issue It. C-105.2 (9-17) www.wcb.ny.gov