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HomeMy WebLinkAboutRP22-054PERMIT # DATE: ycXP:3 SECTION Q c� BLOCK � L T TYPE OF WORK %S JOB LOCATION O O � � OWNER t �7�/ l�Ze/ / 937 ��y7 CONTRACTOR n/Q Cq/y) a7/ EST. COST 3 FEE'g'4ML?4 ' /job V CO # C FEE DATE TCO # FEE DATE INSPECTION RECORD DATE INSP FOOTI N G FOUNDATION FRAMING RGH FRAMING INSULATION PLUMBING 0 RGH PLUMBING GAS SPRINKLER ELECTRIC C7 LOW -VOLT O ALARM 0 AS BUILT FINAL OTHER APPROVALS ARB BOT PS zBA OTHER yE D . 19 VILLAGE OF RYE BROOK MAYOR 938 King Street, Rye Brook,N.Y. 10573 ADMINISTRATOR Jason A. Klein (914) 939-0668 Christopher J. Bradbury www.ryebrook.org TRUSTEES ACTING BUILDING& FIRE INSPECTOR Susan R. Epstein Steven E. Fews Stephanie J. Fischer David M. Heiser Salvatore W. Morlino CERTIFICATE OF COMPLIANCE March 30,2023 Charles Strauzer&Alison Strauzer 5 Country Ridge Close Rye Brook,New York 10573 Re: 5 Country Ridge Close, Rye Brook,New York 10573 Parcel ID#: 129.82-1-22 Roof Permit#22-054 issued on 12/9/2022 to Re-Roof Existing Building This certifies that the new roof,installed under the above captioned permit has been satisfactorily completed. Sincerely, Steven E. Fews Acting Building&Fire Inspector /to D ECEMIE D) For office use only: MAR - 6 2023 BUILDING DEPARTMENT PERMrr#, �a-0 sy f VILLAGE OF RYE BROOK ISSUED:/Q-9—c of VILLAGE OF RYE BROO1: 938 KING STREET,RYE BROOK,NEW YORK 10573 DATE: 3-7—a3 BUILDING DEPARTMENT- (914)939-0668-Fax(914)939-5801 FEE: //U— _PAIDJIF www.ryebrook.ore 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 sss►ser•rsrsssrssssrss►r►s►►s►►s♦►s►ss♦ssss►sss►sss►ssrssssssss►sssss►►sr►s►ssrsrrsrsesa»rrsrsrssrs►sssssss►s►sss►ss►srs►srs♦ Address: 5 Country Ridge Close Rye Brook, NY 10573 Occupancy/Use:one family residential Parcel ID#: 129.82-1-22 Zone: R`/J`— Owner: Charles &Alison Strauzer Address: 5 Country Ridge Close P.E./R.A.or Contractor: Franzoso Roofing INC Address: 33 Croton Point Avenue Croton on Hudson NY 10520 Person in responsible charge: Peter Klatt/Franzoso Contracting Address: 33 Croton Point Avenue Croton on Hudson NY 10520 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 YOM COUNTY OF WESTCHESTER as: Peter Klatt being duly swom,deposes and says that he/she resides at 33 Croton Point Avenue (Print Name of Applicant) (No.and Street) in Croton on Hudson in the County of Westchester in the State of NY that (City/rows/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: $ 3,380.00 for the construction or alteration of. Re-roof existing building 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-I O.A.of the Code of the Village of Rye Brook. w� Swom to before me this a Sworn to before me this 7 of /XOA c__k , 2002 .3 day of ( ' , 202_�_ Signature of Property Owner Signatu' re of Applicant �rag-r'a � , kK(_- KI ff Print Name of Property Owner Print Name of Applicant Notary Public JUDY A. BULLITT Notary Public NOTARY PUBLIC,STATE OF NEW YORK Michael Babit Registration No.01 BU5078632 Notary Public,State of New York Qualified in Westchester County No.01 BA6331102 Commission Expires May 27,2023 oualified in Westchester County Commission Expires September 28,2023 QyE BR�k, 1932 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 - - - - - - - - - - - - - - - - - - - - ADDRESS . DATE: PERMIT# ISSUED: SECT: BLOCK: LOT: LOCATION: \ t' `� 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 a a a a N N Q 2 a ' a 4 W N W 3 M a. o r '' a 00 ~ O ti b ao G j a © Cd Lr) o 72 � x 010 TO it Az x rl N V Q co Nob H a a O x a O L vy�i q O o u J C ' v tLga z W� w '� �° v � v z 0�4 M ►� O � °' cnvv3oc� H . 00 W G U 0 „ lu 0 r✓) z ►�' a K, p � p � U .� o = U U W z z oe . G Ga .. 0 1a $UIL MENT DEC - 8 2022 Vl E OF RYE)- OK 938 KING ET RYE BR NY 10573 VILLAGE OF RYE BROOK (914)9 39-5801 BUILDING DEPARTMENT 0R. FOR OFFICE USE ONLY: Approval Date:DED — 9 20ylernm�it#A�_05 � : Application# Approval Signature: ARCHITECTURAL REVIEW BOARD: Disapproved: Date: BOT Approval Date: ase# Chairman: PB Approval Date: Case# Secretary: ZBA Approval Date: Case# Other:Application Fee: '*N Permit Fees.• idOd—/)b ROOF PERMIT APPLICATION Application dated: 12/02/2022 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 described below. 1. Job Address: 5 Country Ridge Close, Rye Brook, NY 10573 SBL: 129.82-1-22 zone: —� Property Owner: Charlie Strauzer Address; 5 Country Ridge Close, Rye Brook, NY 10573 Phone#: (914) 937-0147 Cell#: (914) 907-1546 email: NSA 2. Applicant: Peter Klatt @ Franzoso Roofing, Inc. Address: 33 Croton Point Avenue,Croton on Hudson,NY 10520 Phone#: (914) 271-4572 Cell#: N/A email; sales@franzoso.com 3. Roofing Contractor: Franzoso Roofing, Inc. Address: 33 Croton Point Avenue,Croton on Hudson,NY 10520 Phone#: (914)271-4572 Cell#: NIA email: sales@franzoso.com 4. Job Description,list all Methods&Materials: Low Sloped Roof Replacement(5 squares) 5. Estimated Cost of Job: $ 3,380.00 (NOTE:The estimated cost shall include all site improvements,labor,material,scaffolding,fixed equipment,professional fees,and material and labor which may be donated gratis.) 6. If comer property,indicate street frontage: NIA 7. Construction Type: Protected non-combustible NYS Construction Class: 1 A 8. Number of stories: 1 story Height: 18 feet 9. Is garage being re-roofed:No:V•Yes: ( )Attached No:( )•Yes:( )Number of Cars: 10. Is roof peaked,hip,mansard,flat,etc: Roof peaked 11. Estimated date of completion:TBD -t- 6I112020 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 YOM COUNTY OF WESTCHESTER ) as: Peter Klatt ,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 Franzoso Roofing, Inc. 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 DZ Sworn to before me this QZ day of " ,20 2 Z day of IXczm , 20 2 2. SignaNeofoperty Owner SignatuVe of 'pplican Ak r�lk. 'Ar(IiAZCr Peter Klatt Print Name of Property O�wne�r" � Print Name of Applicant Notary Public Notary Public Michael Bablt Michael Bablt Notary Public,State of New York Notary Public,State of New York No.01 BA63311.02 No.01 BA6331102 Qualified in Westchester County Oualified in Westchester County Commission Expires September 28,2023 commission Expires September 28,2023 -2- 6/1/2020 Work Scope JOB: PRJ #51263:Strauzer, Charlie: Low Sloped Roof Replacement ADDRESS: 5 Country Ridge Close, Rye Brook, NY 10573 CONTACT: Mr. Charlie Strauzer, 5 Country Ridge Close, Rye Brook, NY 10573 USA PHONE#'S: (914)907-1546 (914)937-0147 Low Sloped Roof Replacement : • Roof Area in Scope of Work: LOW SLOPED ROOF REAR OF HOME. • Install permanent OSHA approved stainless steel single D-Ring fall protection anchor. • Remove existing roofing down to the wood deck on the flat roof area. • Broom Clean existing flat roof to remove any debris. • Inspect, remove, and replace any damaged or rotten plywood with new comparable thickness CDX plywood sheathing @$120.00 per 4'x8'x 1/2"; @$130.00 per 4'x8'x 5/8"; @$140.00 per 4'x8'x 3/4" sheet installed; only as necessary. • Install: Owens Corning DeckSeal. • 2-Ply Roofing System: • Install Self Adhering Base Sheet, mechanically fastening, as needed, to roof deck using button nails. • Install Granulated Top Sheet over applied Base Sheet. • "2-Ply System includes 12-year material warranty over approved substrates. • Choice of Color: Onyx Black. • Install new Drip Edge. Color: White. • Inspect, remove and replace any rotten or damaged fascia with new 1 x6 primed pine fascia @$7.00, 1x8 @$9.00, 1x10 @$10.00 or 1x12 @$12.00 per foot installed, only as necessary. • Repitch, rehang or tighten existing gutters. • Proper disposal of debris; complete site restoration. • "NOTE: Please Be Advised: This installation cannot be warrantied. The sloped roof that ties into the existing flat roof is not in good enough condition to sustain a repair. Depending on how bad the shingles on the sloped roof will determine if merging the old shingles with the new flat roof will be possible. Price is preliminary and subject to change during installation. Printed 10/25/2022 Franzoso Contracting, Inc. 33 Croton Point Ave Croton On Hudson, NY 10520 Phone: (914) 271-4572 FRANZOSO Fax: (914) 271-8644 www.franzoso.com l;. H 9 _. Lag/ --. r'Y. ��, Franzoso Contracting, Inc. 33 Croton Point Ave Croton On Hudson, NY 10520 Phone: (914) 271-4572 FRANZOSO Fax: (914) 271-8644 www.franzoso.com ,r �iI Franzoso Contracting, Inc. 33 Croton Point Ave Croton On Hudson, NY 10520 Phone: (914) 271-4572 FRANZOSO Fax: (914) 271-8644 www.franzoso.com F J OWENS CORNING • • - • • ••• Six Attractive, Popular Colors .'f �4 t i_�'�y `rE �":.�r pr` w �Y 1l x-Y'4 �,� w. • ?'�__ f'-h� 'i„'�P.l o+� ♦...• v1Y'"y-ti i.-. ,: ,� • 'Y.�r.' •_ �'�': ��r'tiyy.N.(�.+"4r`frx e��}�,�'�' `,. +�-'�"'•�s .�L-.n a1; <�'• r�i[*�1i a*�7H.S1w^i.«` 'AP -q r,R, j -. %i: jM,b�•` VLZ:�'��t�;r'� 12. .. .s`P� :::' -a-Y:.a �•i�:r '+" �y.;.•�f9��'rz.' � t'/`�_ :^���`6{ " � �•' w?�";�!�y.�. �+'��. -,.;�. -��l'•�}•`,,ci;���-w; c- ° .a..�fit:`�;4 „��.�+ .• j . '� �� �+ A !:.• +��+,,�� ;•- .mot ♦ ems`�" . :A•�i�Yf ti Y� !�' :�i � � �,' `:.�'�- �!�:' '��:�r:�j� "r~�+'viG��.i^ �r'S S. d�x" '� I'-1'.�s� •��.'fi l�.` •eo.� .�• ro, .,i?' �` ' �'.a{� i.1�4 '1.�Y ',.-t`• �•=�^'ys n'•. 55 1,r • Why DeckSeal is the Preferred Choice Product Attributes Features Benefits Warranty Length" Limited warranty—against material defects for up to 15 years • A Dual Compound Formula Excellent adhesion, to meet the performance handling, and long term The versatile DeckSeal Roofing System can be applied as either a needs of different layers: performance 2 or 3 ply system providing excellent protection to meet a range of ` Top coat compound customer needs. provides excellent Excellent wind uplift granule adhesion characteristics • Back coat compound DeckSeal SA: DeckSeal SA provides aggressive SBS Cap SBS Cap adhesion to the substrate DeckSeal SA DeckSeal SA I DeckSeal SA DeckSeal SA SBS Cap SBS Cap Base/Ply Base/Ply • Granule-free adhesive Fast tack and reliable selvedge on both the side seam adhesion DeckSeal MA DeckSeal SA ! DeckSeal MA DeckSeal SA and end laps NailBase Base/Ply NailBase Base/Ply • Attractive colors Color coordinated roof that complement elements to provide a Product Specifications popular shingle offerings "finished" look for the roof DeckSeal SA SBS Capt(self-adhered) • Most trusted brand' in Peace of mind that residential roofing Owens Corning offers Roll Dimension 32' 10"x 39 3/8" (10M x 1 M) warranties"on shingles Roll Thickness 130 mills (3.3 MM) and low slope roofing Roll weight 87 lbs. (39.5 kg) components Roll Size(Nominal) 100 sq.ft. Example of 3 Ply System DeckSeal SA Base/Ply#(self-adhered) Roll Dimension 65'8"x 39 3/8" (20M x 1 M) Roll Thickness 80 mils (2.0 MM) Roll weight 95 lbs. (43.1 kg.) Roll Size(Nominal) 200 sq.ft. DeckSeal MA NailBase# Roll Dimension 65'8"x 39 3/8" (20M x 1 M) • _. Roll Thickness 80 mils (2.0 MM) Roll weight 96 lbs. (43.5 kg.) Roll Size(Nominal) 200 sq.ft. Applicable Standards and Codes UL Classifed for use in Class A, B or C roofs as listed in the UL Roof Materials And Systems Directory" TDI Listed for Usage in Texas Coastal Regions DeckSeal DeckSeal DeckSeal 0 SA SBS Cap SA Base/Ply MA NailBase O 0 0 2016 Roofing Homeowner Brand Awareness Survey by Owens Corning Roofing and Asphalt,LLC. See actual warranty for complete details,limitations and requirements. OWENS CORNING ROOFING AND ASPHALT,LLC t Actual colors and granule blends may vary from the ONE OWENS CORNING PARKWAY photo.We suggest that you view actual product on the TOLEDO,OHIO,USA 43659 roof to get a better idea of the finished color.Color • availability subject to change without notice. .•, 1-800-GET-PINK" www.owenscorning.com/roofing ft DeckSeal self-adhered roofing system components are designed to be installed on roof slopes between 1/4:12 to 2:12. Pub.No.10020136-A.Printed in U.S.A.June 2016.THE PINK PANTHER-& ©1964-2016 Metro-Goldwyn-Mayer Studios Inc.All Rights Reserved.The #Available in fire-resistant(FR)versions.Visit www.owenscornig.com color PINK is a registered trademark of Owens Corning.©2016 Owens Corning. for product specification data sheets applicable to these products. All Rights Reserved. (Compton,Portland,Denver,Kearny,Medina,Minneapolis,Summit,Brookville) Fes♦ a� f ,^v•h , •.w ^'�`.1 .'✓M ,: ''t' y ro a'-1Z �cc +++. : .!.' `. ,?A aMa ow'' Qq .;'�.��}�`F �Q Mel �_�ia a ( �j f {i1 its n1� L ti V f�t� l� •• !v t f�" v v x C. i i / L ♦1 �f{� f1f .j i {-.�A��• ' _- _ �"'x�'=�:-.-�.�'J.� _,.�r� e„ a George Latimer ILIx"ster James Maisano 5- Westchester County Executive )`•,(,OlT� Director,Consumer Protection I� :• ,. Department of Consumer Protection :RRrars Home Improvement License ' �. FRANZOSO ROOFING INC 33 CROTON POINT AVENUE \ CROTON ON HUDSON,NY-10520 ! � g This license is issued in accordance with At XVI of the Westchester County Consumer Protection Code and is valid only upon . \` presence of the official department seal.Proof of citizenship or immigration status is not required for issuance of this license. . NOT FOR FEDERAL PURPOSES t(O» - r �: License Number roc °� Date of Expiration 1 WC-35225-1-122 04/20/2024 f' i chPsterCo�°`� �. fr ` �j'"nYXI., @tom Vi _ ♦ +f.'w\r �f�if� v( pt."�fif/f�'� H,' � �i���`,� , Y .i��.OWUYA A ® DATE / Y) CERTIFICATE OF LIABILITY INSURANCE 1z/01/o1/2022zozz 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 Certificate Team NAME' ROBERT T.KIRKWOOD,INC. A CONNo Ext: (914)769-9070 NC No): (914)769-4706 91 Washington Avenue E-MAIL s: certificates@kirkwoodinsurance.com ADDRE INSURER(S)AFFORDING COVERAGE NAIC# Pleasantville NY 10570 INSURERA: Sutton Specialty Insurance Co. 16848 INSURED INSURER B Franzoso Roofing Inc. INSURER C 33 Croton Point Avenue INSURER D: INSURER E Croton On Hudson NY 10520 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 CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE POLICY EFF POLICY EXP LIMITS LTR INSD WVD POLICY NUMBER MM/DD/YYYY MM/DD/YYYY X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S 1,000,000 CLAIMS-MADE Fx_]OCCUR PREMISES Ea occurrence S 300,000 MED EXP(Any one person) S 10,000 A ISC01000000009-00 12/21/2021 12/21/2022 PERSONAL BADVINJURY S 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER. GENERAL AGGREGATE S 2,000,000 POLICY F PRO 2,000,000 JECT LOC PRODUCTS-COMP/OP AGG S OTHER: $ AUTOMOBILE LIABILITY C EaMBINED SINGLE LIMIT O accident S ANY AUTO BODILY INJURY(Per person) S OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPER-ZDAMAGE S AUTOS ONLY AUTOS ONLY Per accidJ I ent S UMBRELLA LIAB OCCUR EACH OCCURRENCE S EXCESS LIAB HCLAIMS-MADE AGGREGATE S DED I RETENTIONS S WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY STAT YIN UTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE El /A E.L.EACH ACCIDENT S OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE S If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT S DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Village of Rye Brook is additional insurance under general liability per blanket endorsement as respects work performed at 5 Country Ridge Close,Rye Brook,NY 10573, CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN Village of Rye Brook ACCORDANCE WITH THE POLICY PROVISIONS. 938 King Street AUTHORIZED REPRESENTATIVE Rye Brook NY 10573 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD NYSIF New York State Insurance Fund PO Box 66699,Albany, NY 12206 1 nysif.com CERTIFICATE OF WORKERS' COMPENSATION INSURANCE Elie" Tr E ^^^^^^ 200742207 LOVELL SAFETY MGMT CO., LLC qh 110 WILLIAM STREET 12FLR NEW YORK NY 10038 SCAN TO VALIDATE AND SUBSCRIBE POLICYHOLDER CERTIFICATE HOLDER FRANZOSO ROOFING, INC. VILLAGE OF RYE BROOK 33 CROTON POINT AVENUE 938 KING STREET CROTON ON HUDSON NY 10520 RYE BROOK NY 10573 POLICY NUMBER CERTIFICATE NUMBER POLICY PERIOD DATE Z2435 833-5 189067 01/01/2022 TO 01/01/2023 12/1/2022 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE NEW YORK STATE INSURANCE FUND UNDER POLICY NO. 2435 833-5, 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. IF YOU WISH TO RECEIVE NOTIFICATIONS REGARDING SAID POLICY, INCLUDING ANY NOTIFICATION OF CANCELLATIONS, OR TO VALIDATE THIS CERTIFICATE,VISIT OUR WEBSITE AT HTTPS://WWW.NYSIF.COM/CERT/CERTVAL.ASP.THE NEW YORK STATE INSURANCE FUND IS NOT LIABLE IN THE EVENT OF FAILURE TO GIVE SUCH NOTIFICATIONS. THIS POLICY DOES NOT COVER CLAIMS OR SUITS THAT ARISE FROM BODILY INJURY SUFFERED BY THE OFFICERS OF THE INSURED CORPORATION. PRESIDENT MARK FRANZOSO FRANZOSO ROOFING, INC. 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 S7NCE FUND / DIRECTOR,INSURANCE FUND UNDERWRITING VALIDATION NUMBER: 760501262 U-26.3