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HomeMy WebLinkAboutMP23-099 Qy J do�JV°Ji c C�c J J �vy�y VILLAGE OF RYE BROOK MAYOR 938 King Street,Rye Brook,N.Y. 10573 ADMINISTRATOR Jason A. Klein (914)939-0668 Christopher J. Bradbury www.ryebrooUy.gov TRUSTEES BUILDING & FIRE INSPECTOR Susan R. Epstein Steven E. Fews Stephanie J. Fischer David M. Heiser Salvatore W.Morlino CERTIFICATE OF COMPLIANCE December 16,2024 Paula Pagano 61 Valley Terrace Rye Brook,New York 10573 Re: 61 Valley Terrace, Rye Brook,New York 10573 Parcel ID#: 135.59-1-51 This document certifies that the work done under Mechanical Permit #23-099 issued on 7/7/2023 for the removal of an above-ground oil tank has been satisfactorily completed. Sincerely, Steven E. Fews Building&Fire Inspector /to Q�E BRcb, 1932 BUILDING DEPARTMENT ❑BUILDING INSPECTOR El 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: 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 •, ' 1 ❑ L.P. GASH ❑ FUEL TANK ❑ FIRE SPRINKLER ❑ FINAL PLUMBING ❑ CROSS CONNECTION Z 7 ❑ FINAL ,� 1 LLB L ' j L 07 ❑ OTHER BR • �9a2 BUILDING DEPARTMENT [BUILDING INSPECTOR A❑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 : JCJ �4p � ( DATE: � 1 Z PERMIT# / ` Y ISSUED: \4 SECT: I BLOCK: 1 LOT,- LOCATION: U � �*:\o ► ' ; `�1� V� OCCUPANCY: G t r ❑ Violation Noted THE WORK IS... ❑ ASSED ❑ FAILED REINSPECTION ❑ SITE INSPECTION \k REQUIRED ❑ FOOTING ❑ FOOTING DRAINAGE ❑ FOUNDATION ❑ UNDERGROUND PLUMBING NOTES ON INSPECTION: ❑ ROUGH PLUMBING ❑ ROUGH FRAMING ❑ INSULATION ❑ Natural Gas >r' '1 ''1C�VC_(c _.. � �j`n� - ,1 ( ( �vl k4 ❑ L.P. Gas ' ��S ` (�- ❑ FUEL TANK �'G`�X �� /^(� ��� \ l(�' ❑ FIRE SPRINKLER ❑ FINAL PLUMBING ❑ CROSS CONNECTION ❑ FINAL ❑ OTHER , • , Q1 `� • N N � a� � � a d V a C y G� � • • � O � a w W 44 4-4 oj tw rA , Z AP PCi Vr 7. CCZ ti 4. co 00 O W U o v a o +� C V) *� H r � � �t z '�' I b oA °" • pq aw x w 4) lu t W wou W C U U V � C7 A Z A Z i BUILDING�IIEPARTMENT VILL'&CE OF RVE1-ROOK JUL - 5 2023 JD 938]KING TREET RYE BRo i ,NY 10573 ( �4)939 066$ VILLAGE OF RYE BROOK wwwxyebxook.,orgy L BUILDING DEPARTMENT Application for Permit to Remove Abandon and/or Install Fuel Stora a Tank (*Storage Tanks in excess of 1,100 gallons require registration with the County of Westchester)) FOR OFFICE USE ONLY: ERMIT#: /—© -3- o 7 Approval Date: JUL 1 0 2 Permit Fee: $ /���'/ Approval Signature: Other: Disapproved: (fees are non-refundable) ******#,t,t**,�*,t*,t***,t*t******,tt*,t*,r**,t***:r**,r,�*�,��:*,t*,t****,r**,t,tt;�*********,t,�*,tom****t*****�•,�,t t**,�****ar** REQUIREMENTS FOR RELEASE OF PERMIT&CERTIFICATE OF COMPLIANCE: 1. Application Completed by Bonded, Licensed Contractor. 2. Your contractor's valid proof of liability insurance. (Village of Rye Brook must be listed as certificate holder) 3. Your contractor's valid proof of workers compensation insurance. (Form#C 105.2 or Form#U26.3 /or NY State Workers Compensation Waiver) 4. Fee per Tank: Removal,Abandonment, or Installation: $185.00 per Tank. 5. Dig Safely New York#(dial 811): 6. Inspection by Building Department for removal/abandonment and/or installation. 7. Submit all Manifests&Reports(after work has been completed). 8. Certificate of Compliance will be provided when all requirements are fulfilled. Application dated, S c;k, ,is hereby made to the Building Inspector of the Village of Rye Brook for a permit to remove,abandon,and/or install a Fuel Tank as herein described.The applicant and property owner,by signing this document agree that the subject fuel tank(s)will be removed,abandoned and/or installed in conformance with all applicable Village,County,State& Federal laws,codes,rules and regulations. Indicate Permit Type: Installation ( )•Removal V) -Abandonment( )/Above Ground �, •Buried in Ground( ) I. Address: {li / (/ SBL: 135-IS9--I-5-1 Zone: 2. Property Owner&Address: L)dU C j9 A,0611 ND Phone#: (p b 9 --30 b- 400 6 Cell#: email: 3. Contractor&Address: -Bbkf1&IC C11Nr.CtiCT/n!(r LLC, Phone#: Cell#:Q1q-7100- L�49D email: GLA JAI i Ca /ER, Pyr� 4. Applicant: ba�)AylyE -TE-FFEYS Phone#: Cell#: 9/11-71oD- 19096 email: 5. Indicate Fuel Type:Fuel Oil( •L.P. Gas( )•Gasoline( )•Other( ): 6. Number and Capacity of each Tank: 0 75 7. Exact Location(s)of each Tank: % Cr1h r "ez JIf 1�1 /Y /4 e"et( J 1 8/12/2021 STATE OF NEW YORK,COUNTY OF WESTCHESTER ) as: _WAYIVG -TEFI%E1L ,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 C-E 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 �--� Sworn to before me this day of z�20 Z� day of L- 20 Signature of Property Ovner Signature of A lean ?oLI Cc, Pma►)(D cF Ens Print Name of Prope Owner Print e of ica n 45 SCOTT W.CRAIG otary Pub tc Nohmy public of 11ew York REGNO. 91CR6390567 Notary Public EL m, LANbtri Sk COl1IItNlSSION F�CpIR�S p411512027 Y R1< NOTARY pllBLtCrSTATE OF N NR. OILA6205175 ns { Wesichester This application must be properly completed in its entirety and must inclR�� ��S May o4, 2 __ signature(s) of the legal owner(s) of the subject property, and the applicdll�t%?T-ecor2 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- 2 3/12/2021 �a� � w�� ��,� Piz Barrier Contracting, LLC. P.O. Box 385 Tarrytown, New York 10591 December 11, 2024 Village of Rye Brook 938 King Street Rye Brook NY 10573 Re: 61 Valley Terrace Rye Brook NY Barrier removed a 275 gallon above ground heating oil tank from 61 Valley Terrace. Barrier cut open the tank, and removed tank bottom sludge to a 55 gallon containment drum to be removed to Allstate Orc. The tank was removed and inspected by Barrier and the Rye Brook Fire Department Inspector. There was no evidence of spills or staining. The tank was recycled to Brookfield Resource Management, Inc., a copy of which receipt is attached. Sincerely, Wayne Jeffers, Jr. President Phone 914-760-2090 D 1EQEUV[E DEC 12 2024 VILLAGE OF RYE B BUILDING DEPARTMENT i T"r!-��i:,• Y' ri �^�i"tt1-W'!W^ �14.i1-.Y��i^7i^�4�1�W.^fl�Y!1 r�'I�l'!: .. _ _ R' _ _ .. _ !1 •••�■.�W"rl�a„'tMk'u1�^�IY'V•Y7•� t� VILLAGE OF RYE BROOK - ' PERMIT#:MP 23-099 C" BUILDING DEPARTMENT IssuED: 7/7/2023 14 J38 KING STRFF,,r, RYF. BROOK,NY 10573 Expms: 7/7/2024 (914) 939-0668 xv-tm.r�,chntok.Or� MECHANICAL INSTALLATION PERMIT "? RI-' iQVT�, ABOVF. GROUND OIL TANK AT: 61 VALLEY TERRACE BUILDING CLASSIFICATION&PARCEL Ill#:R-3/ONE FAMILY RESIDENTIAL/.13559-1-51 PROPERTY OwNE PAULA PAGANO(609)306-4000 l s ffi L1CI NSiiD CON,rRAcroR:BARRIER CONTRACTING LLC(�14)760-2090 - -`j fro LOCATION OF WORK:BASEMEN!' PEE PAID:S185.00 • Q$ ^' CONTRACTOR h1vsT;BKY tRSUN"I'ON-T-HEJOBS1Tl: FoR Aix IN7; IONS HOURS OF OPERATION OFCONSTRI�CTIOV EQUIPMENT/VILLAGE CODE$158-4:WEEKDAYS.-8:09AM'ru 6.-WPN OR W.SK,U't/ICItL•VER 1S EARLIER; �"•" SATURDAYS-9:00AMTo4i00PAt; - SIiVDAYS&i101.TDAY�-WO CO IWcIn AtflVtn't�ti.vaF.0 ets This permit is valid for a peno4,if I exceed Melve A 2)muntlts from the date ofissuance,and covets 4)nh that work li�trd aliovr.tieparstc permits are required for e0 irk anv electrical,plumbing,fire sup*ssion,ltrelsntukcicarbun monoxide dctactors/rdarms,nr im ithcr a nrk nut owercd undeT tht,pernut.1'he approved plans must 0 be kept on the job she&be made:iValtablC tur rct ice be dw 11caldittg Dep.utment upon tit nand .%m amcudmt w: or dwrtg,s to the approved plans must be m? designed by your architect/engineer anJ sulnuutcd to the Uuildptg Depattntcot for revicu:md ajyto%a prior to I—Itic hint;thr,wnnk. �. .,ft A Certificate of(1ccutpAncv or Ccriiricate ul Compliantt Lcquired m(,rder In clnsc.,ut thi"permit. � Y lift Steven E.Fews Building&Fire Inspector THIS PERMIT MUST BE CONSPICUOUSLY POSTED AT THE JOB SITE r^r.a�r • _ n r , r • i r•r^r• _ ray +rt-.«» DEC 12 2024 VILLAGE OF RYE BROOK BUILDING DEPARTMENT i O Copyright 2007 J.J.KELLER 8 ASSOCIATE'S,INC..Neenah,WI•USA•(800)327-6666•%no w.jiieller.com•Punted in the United States -STRAIGHT BILL OF LADING-ORIGINAL-NOT NEGOTIABLE Shipper's No. Carrier Allstate ORC SCAC Carrier's No. NJD986588630 FEURIEn.rejewo ind:wrArily tleleonined rate:or caltra=lbat have been aimed upon to-uini beirmen the corner and ahppel.it OW-V e,othere6Be to IM tares•c!3sb:5c34orC and ru:ea:hot nave been Wab%hca by the carder and arc at'aiahlc to mo srrp r,on r;q and at apellcabi d letlefal re;u:elro:u; aI (O� 1/ 1 / �2/1PF Qt/rs I�XIM� date from RarriPr(°pa1tCSCtt11�he Pop:uy tleacnbxtl be:C:r. nt GccJ chdtu,eucp rnlad(cents sae ce•ukiW contra:aCacU2.rnW—).nnited,.--khed,and domed a:i 2aied 71la)::vAt;Jt°9d ccmpatr/(the rm-j ahcpart•tefn7 enEersSetf N:o;halt e.;cmtran a:rrl2aTn7 Uly Peron er ee. al.7n ift p^..1=1h of an prwAny under the CYdtact)a;ce:tot."to ea'N°y at f.7r°°00inal,an,it cn it:mute.er eetcn:te to deWer to a-utsw caaler on the teute to:a:j ce.unxi°i it 1: uwa:/dsreed a:to each Cairn:el e]ch a.'n•d:aid Prppany°:Cr ae er a';"ejon cf said rose to dCeratien oral as b[tsh Cat'al any 4nte iale.•cc'ed la ae or any oI a'J PM°ny Itul etYry sen'le le t0 pentrmetl f1efC111dC:soil bo suC;etl to aC Ile can'_'I;hrn tKl prorhtcd by low,ttnolhof:itivJ u' n.ten,r:erekt s:nt:cxd,P._:fi)Iho�n3Sern en the Eck harech.trlrich oro herxlry arecdbby lt:D shiprar and oee�lad foh nin1:c11ama hL-e::;ana. Consigned to Allstate ORC Destination State County Zip Delivery CMEG - 917 Industi�al Road Waterboro SC 29480 Address Route Delivering Allstate ORC vehicle Carrier Number Number of l Weight Class Subject to Section 7 of condition:,It ihls Packages Description of Articles g I Oipraent 1°t°be 400—d 1° he ceharbnoe (sub.to correction) or Rate ".thou[fccoune ty the coe 9pnm.the cohmnor shalt Yin tIC fe:?alni ftetcfmllL Tn0 stun not make eotvory of fhb I drum -petroleum contaminated liquids I 300 I lbs 9�W��,9'cooler'"" "'° °ty"""J 0°'he' Non-hazardous - may contain solids (Stinaitce at Ccitugh r) FREIGHT CHARGES: :::--E I Prepaid ❑ j Collect ❑ 000) AMT: I TOTAL CHARGES: Collect On Delivery j and remit to COD FEE: Prepaid[) II S Collect ❑ NOTE:Where the rate is dependent on value, shippers are required to state specifically in writing the agreed or declared value of the property.The agreed or declared value of the property is hereby specifically stated by the shipper to be not exceeding$ per NOTE:Liability Limitation for loss or damage in this shipment may be applicable.See 49 U.S.C.14706(c)(1)(A)and(B) Shipper. Allstate ORC Carrier: Allstate ORC Per: �r._!/... .: .l '. Date:_ Per: Date: -- 1 BLS 10(Rev.1/07) e LI I E OW IE DD DEC 12 2024 VILLAGE OF RYE BROOK BUILDING DEPARTMENT I '�'l''r'UI 4 p;l Cl. F3al AF wvi . iJYID Ill' ii VJeigl In _5;:u_ I1 i 1 Q7 HM r. 1a ANI _ .. Tare ..ity u os_ — . - - Tir,b MIS Tickets.' tZ A < Aa l Ott Rou i An,;' _of 0 .� �wie,�t Inii inJj�IIOU15 aril i vilro:n�duiu�heck US+�ul ;oin B,uuklivlri:.. F uok gtwehuysG,.tP DEC 12 2024 VILLAGE OF RYE BROOK BUILDING DEPARTMENT Alfredo DiVitto From: Alfredo DiVitto Sent: Tuesday, December 10, 2024 8:43 AM To: waynejr@barrier.com Subject: 61 valley terrace Attachments: M P23-099.pdf Good morning regarding conversation we had this morning on the removal of the 275 AST can you please email the closure report with recycle ticket so we can close this permit thanks. 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R=.(�V`t.-}�o'�hb0•'t� " t �. 9".'• lh �:((ov ..� `y +i���F. lA.4Sk` �rs�- +'.F•ha.ti'" D Lrl.�lskX + S tr �nt ;'•h�: �: »��5��•4;�''}:z A �k -'. \• y`•y ._''4..a� {�v1�7��,•'�`��3`=+�C {�(,•``•` •}-ruy .fi.,nat ♦u7[:;`� >� .')),,��.� pry' 1"y�Oy�.•./ �a+�v...?� �eL/l v.W.i,�- � ��6 �'. .?. -- ` �� •�+aX' -��' i'�'d1 .c�� x �`\'�Fia`�. ...r\ "�'� �' ^ •0 ��: ySC •� V S ti �` ti Client#: 216815 BARRCON1 ACORD , CERTIFICATE OF LIABILITY INSURANCE DATEDD/YVYY) 6/20/220/2023 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 any rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Karissa white NAME: Edgewood Partners Ins. Center PHONE _ ac,No,Ext: A/C,No): 73 Troy Road ADDRESS. ssa.w ADDRESS: Karihite@EP Icbrokers.cm A East Greenbush, NY 12061 INSURER(S)AFFORDING COVERAGE NAICIf INSURER A:Great Divide Insurance Company 25224 INSURED INSURER B:Selective Insurance Company of SC 19259 Barrier Contracting, LLC INSURER C PO Box 385 Tarrytown, NY 10591 INSURER D 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. VTR TYPE OF INSURANCE INSR W D POLICY NUMBER POLICY EFF POLICY EXP LIMITS INSR WVD ___ ___ (MMiDD A X COMMERCIAL GENERAL LIABILITY ECP200397121 10/14/2022 10/1412023 EACH OCCURRENCE $1000000 CLAIMS-MADE OCCUR PREMISES Eaoxurrr nce $100,000 _ MED EXP(Any one person) $5 000 PERSONAL&ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE s 2,000,000 POLICY ECOT- LOC PRODUCTS-COMP/OP AGG $2,000,000 OTHER: $ B AUTOMOBILE LIABILITY S2439819 2/20/2022 12/20/202CO MBIa�NEDISINGLE LIMIT 1,000,000 X ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per accident UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS-MADE AGGREGATE $ DIED RETENTION$ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y/N R ANY PROPRIETORIPARTNER/EXECUTIVE E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? N/A (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ A Professional Liab ECP200397121 10/14/2022 10/14/202 LIMIT-$1,000,000 A CONTRACTORS POLL ECP200397121 10/14/2022 10/14/202 Limitl,000,000 DED5,000 B Physical Damage S2439819 12/20/2022 12/20/202 Comp &Coll Ded. 500 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION Village of Rye Brook SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE g y THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 938 King Street ACCORDANCE WITH THE POLICY PROVISIONS. Port Chester, NY 10573 AUTHORIZED REPRESENTATIVE ©1988-2015 ACORD CORPORATION.All rights reserved. ACORD 25(2016/03) 1 of 1 The ACORD name and logo are registered marks of ACORD #S5670439/M5074682 JW105 NYSE F New York State Insurance Fund PO Box 66699,Albany,NY 12206 1 nysif.com CERTIFICATE OF WORKERS' COMPENSATION INSURANCE (RENEWED) a. •.rrr • l AAAAAA 452562229 BARRIER CONTRACTING LLC PO BOX 385 TARRYTOWN NY 10591 i SCAN TO VALIDATE AND SUBSCRIBE POLICYHOLDER CERTIFICATE HOLDER BARRIER CONTRACTING LLC VILLAGE OF RYE BROOK PO BOX 385 938 KING STREET TARRYTOWN NY 10591 RYE BROOK NY 10573 POLICY NUMBER CERTIFICATE NUMBER POLICY PERIOD DATE W2161632-1 418266 09/15/2022 TO 09/15/2023 10/25/2022 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE NEW YORK STATE INSURANCE FUND UNDER POLICY NO. 2161632-1, COVERING THE ENTIRE OBLIGATION OF THIS POLICYHOLDER FOR WORKERS' COMPENSATION UNDER THE NEW YORK WORKERS' COMPENSATION LAW WITH RESPECT TO ALL OPERATIONS IN THE STATE OF NEW YORK, EXCEPT AS INDICATED BELOW, AND, WITH RESPECT TO OPERATIONS OUTSIDE OF NEW YORK, TO THE POLICYHOLDER'S REGULAR NEW YORK STATE EMPLOYEES ONLY. IF YOU WISH TO RECEIVE NOTIFICATIONS REGARDING SAID POLICY,INCLUDING ANY NOTIFICATION OF CANCELLATIONS, OR TO VALIDATE THIS CERTIFICATE,VISIT OUR WEBSITE AT HTTPS://WWW.NYSIF.COM/CERT/CERTVAL.ASP.THE NEW YORK STATE INSURANCE FUND IS NOT LIABLE IN THE EVENT OF FAILURE TO GIVE SUCH NOTIFICATIONS. THIS POLICY DOES NOT COVER THE SOLE PROPRIETOR,PARTNERS AND/OR MEMBERS OF A LIMITED LIABILITY COMPANY. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS NOR INSURANCE COVERAGE UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICY. NEW YORK STAT SUR NCE FUND T DIRECTOR,INSURANCE FUND UNDERWRITING VALIDATION NUMBER:557754064 U-26.3