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HomeMy WebLinkAboutRP23-036PERMIT # A ' SECTION /3C TYPE OF WORK _ JOB LOCATION y 93501� /035 L1�vcl y�%a�al �ao3�9`13-58y9 • Ills f P a I IIIM ~4EA ro . • i 51 o W2 m u �� I► • •�: (•ice FOOTING FOUNDATION FRAMING RGH FRAMING INSULATION PLUMBING 0 RGH PLUMBING GAS SPRINKLER 0 ELECTRIC LOW -VOLT O ALARM 0 AS BUILT FINAL OTHER APPROVALS ARB I B07 ZBA OTHER �y6 4R •�- VILLAGE OF RYE BROOK MAYOR 938 King Street, Rye Brook,N.Y. 10573 ADMINISTRATOR Jason A. Klein (914) 939-0668 Christopher J. Bradbury www.ryebrook.org TRUSTEES BUILDING& FIRE INSPECTOR Susan R. Epstein Steven E. Fews Stephanie J. Fischer David M. Heiser Salvatore W. Morlino CERTIFICATE OF COMPLIANCE October 3,2023 Scott Pohlman&Michelle Pohlman 3 Winding Wood Road Rye Brook,New York 10573 Re: 3 Winding Wood Road, Rye Brook,New York 10573 Parcel ID#: 129.82-1-10 Roof Permit#23-036 issued on 8/3/2023 to Re-Roof Existing Building This certifies that the new roof,installed under the above captioned permit have been satisfactorily completed. Sincerely, Steven E. Fews Building&Fire Inspector /to 3Rn` For office use onl : BUILD EPARTMENT PERMIT# ' ,�)5-03(u VILLAGE OF RYE BROOK ISSUED: '2) 938 KING STREifT RYE BROOK,NEW YORK 10573 DATE: - 3 (924)9 -0668, FEE: PAID .r www Y o Lor 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 rrrrrrrrr►rrrsrrrrt+rrrrrtrrsrsr►rrrrrrrtsss►►rr►r►rrrrr►rrrr/►srsr*rrrrsrt►rrrrrrrr►rsrrrrrrrrrrrt►rtrr►s►►rrr►r►rrsrs►►rrrrr►rrrrr• Address: 3 w itio u 6 dour Al Occupancy/Use: ' / arcel ID#: �— l (� Zone: Owner: ' iv J Address: NCO P.E./R.A. or Contractor: 0V"o A-jo Address: Person in responsible charge: Address: 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: ��Co rT SON L"�,_) being duly swom,deposes and says that he/she resides at 3 W',,_g1-j6 c_,oqp /eD (Print Na f Applicant) '' (No.and Street) in ,in the County of //WL(IzAe,j'27 1, in the State of /y Y ,that (City/Town/Village) T 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:S (p Xo , for the construction or alteration of: Deponent further states that he/she has examined the approved plans of the structure/work herein referred to for which a Certificate of Occupancy/Compliance is sought,and that to the best of his/her knowledge and belief,the structure/work has been erected/completed in accordance with the approved plans and any amendments thereto except in so far as variations therefore have been legally authorized,and as erected/completed complies with the laws governing building construction.Deponent further understands that it shall be unlawful for an owner to use or permit the use of any building or premises or part thereof hereafter created,erected,changed,converted or enlarged,wholly or partly,in its use or structure until a Certificate of Occupancy or Certificate of Compliance shall have been duly issued by the Building Inspector as per§250-10.A.of the Code of the Village of Rye Brook. Sworn to before me this Sworn to fore me this da / , 20 day of �i:_A 113(5A__ , 20 7,3 Sign ure of erty Owner \ S atu a of Appli �t �COI1 t'oNc Ml�� 9-0 J 70NLM/J1j 3 Print N of Property Owner Print Name of Applicant No lic Not Pub'c JUDI L.PAGE-MELAGRANO JUDI L.PAGE-M GRANO Notary Public,State of New York Notary Public, State of New York No.01 PA5053772 No.01 PA5053772 s/12%2021 Qualified in Westchester County Qualified in Westchester County Commission Expires 0 t/a-1I a-& Commission Expires D// -7/a O Zm BR IDI 1. LL 1932 BUILDING DEPARTMENT ]iUILDING INSPECTOR 6, ❑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 : S Wl` Yl � k mJ`JO & DATE: 1 �� PERMIT# � SSUED- SECT: BLOCK: LOT:0,,2 -2 LOCATION: Z�. W Q OCCUPANCY: L -7) ❑ Violation Noted THE WORK IS... 'KSSED ❑ FAILED 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 CFASS CONNECTION INAL ❑ OTHER ■ ■ ■ _ ■ � M N �. � a ■ 0 C N W a ■ 00 y `° 0.4 `n a N 11 a > ` Lu O O ~ •� o c) wo a p k ooch � o � � � O en �1�,, � W (� � � � W O � o � � �( (j • a I� IT, O 1 H C� W © ob en z �0 0 o (� c� x U z 0,00 Itr w � � � " � O en 00 Sq A x CD zz � A p a go � U. 5O � � V 4 tx U � [ a y W � � o 0 U 0 ° y 0 y ■ A z o � o x H A o w W ] �2 � �. � BUiL MENT V E OF R OK AUG - 3 2023 1-DI 938 KING 'TREET RYE BR NY 10573 (914 -0 VILLAGE OF RYE BROOK www. BUILDING DEPARTMENT FOR OFFICE USE ONLY: Approval Date: AU V nn 3 Pe mit# Application# Approval Signature: ARCHITECTURAL REVIEW BOARD: Disapproved: Date: BOT Approval Date: Case# Chairman: PB Approval Date: Case# Secretary: ZBA Approval Date: Case# Other: 1� Application FeeiVC ,Pj6 Permit Fees:,d Q ROOF PERMIT APPLICATION Application dated: 7 .t? 0 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 B it ' g,as per detailed statement described below. 1. Job Address: © F- AJ SB2L: /�9 r�c�—���0� lZone:p_ _ �/ Property Owner: J�fT vH�R r-j Address: 3 oayolly6wco/) D ,/y _he&i V- N/ Phone#: 1 I Y JOSS' Cell#: 6% 3 3 t .3 Z email: f OHL M-2-) �, 6NJ,P1Z..ax 2. Applicant: Address: IND1wlGta,mn PC) Phone#:7/cl '73( /0 3 r Cell#: (516 3 3 9 1,Tq Z email: aLM./'ONLMntj JG� 3. Roofing Contractor: 4VID ,,A) /Wom,11) +ddress: ZrZlr,; WIL-10 ) C Phone#: 10C,1'L Cell#: 703 9 q3—rSH 9 email: A/}y/� E✓JRCriFiE�1 _� CJC .C4'^ 4. Job Description,list all Methods&Materials: /C pp mcx.,E, /1fPAW tT k VF_IA , ,ru1n,6LL J ar 1-'OttP r,— L11pr-L CNF GRF V-ecr _Rjrj '+, GRF j MmCRU+a �Dz 40orl-ic Tol NGt z P 5. Estimated Cost of Job:$ 16 , 00 y (NOTE:The estimated cost shall include all site improvements,labor,material,ff ding,fixed equipment,professional fees,and material and labor which may be donated gratis.) 6. If corner property,indicate street frontage: 7. Construction Type: NYS Construction Class: S. Number of stories: Height: 9. Is garage being re-roofed: No:O •Yes:06 Attached No: �j •Yes: O Number of Cars: 10. is roof peaked,hip,mansard,flat, etc: 'Pen I<jF,4) 11. Estimated date of completion: t / 1 0 /20 7 3 -3- 6/112023 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 NFW YORK, COUNTY OF WESTCHESTER ) as: �7T oAIc.maht , being duly sworn, deposes and states that he/she is the applicant above named, (print name of individual signing as the applicant) and further states that (s)he is the legal owner of the property to which this application pertains, or that (s)he is the for the legal owner and is duly authorized to make and file this application. (indicate architect,contractor,agent,attorney,etc.) That all statements contained herein are true to the best of his/her knowledge and belief,and that any work performed,or use conducted at the above captioned property will be in conformance with the details as set forth and contained in this application and in any accompanying approved plans and specifications,as well as in accordance with the New York State Uniform Fire Prevention&Building Code,the Code of the Village of Rye Brook and all other applicable laws,ordinances and regulations. 3 jot) n Sworn to before me this Sworn to before me this S t day of 46 $ , 202,.3 day of lei✓ 20 ✓� j Si ature Property Owner Sibbture of plicant O/lI.N11� J� 60L 140 Print Name of Property Owner Print Name of Applicant No Public otary Public ROSE PAULA PATAFEO NOTARY PUBLIC, STATE OF NEW YORK Registration No, 01 PA0004902 Qualified in Westchester County My Commission Expires April 3, 2021 -2- 611/2023 10AMAdvanced Roofing Inc. July 18, 2023 Mr. Scott Pohlman 3 Winding Wood Road Rye Brook, NY 10573 646-334-1342 Scott.Pohlman@gmail.com Roofing: Main House/Garage Demolition: Remove asphalt roofing shingles, roof paper, drip edge, vent pipe boots, flat roof membrane with any insulation, rotted plywood adjacent to skylight, edge metal Wood Roof Deck: Once roof shingle and accessories are removed, we will thoroughly inspect roof deck for its integrity. 4'x 8' Plywood %" replacement sheets will cost an additional, $100.00 (if necessary). Vent Pipe Boot Flashings: Install new aluminum vent pipe boot flashings Chimney Flashings: To remain, has been updated. Will seal where flashing tucks into mortar Existing wall flashings: All the existing step flashings hidden beneath siding at roof to wall intersects will be neatly inspected and neatly separated from the existing roof shingle and re- used with new roofing system. GAF Ice and Water Shield: Install GAF Weather-watch ice and water shield membrane extending 6' up from roof edge. All valleys, rake edges, roof penetrations will also require ice and water shield. GAF Synthetic Roof Paper Underlayment: Will apply GAF Felt Buster (or equivalent) synthetic roof underlayment will be applied to cover the balance of the wood roof deck Drip Edge: Install aluminum white baked enamel drip edge at rakes and eaves GAF Timberline HDZ Asphalt Roofing: Install GAF Timberline HDZ Architectural Roofing Shingles as new roofing system Fasteners: 1-1/4" large head roofing nails shall be used as fasteners GAF Ridge Ventilation: Install GAF Quarrix ridge vent at all peaks GAF Timbertex Hips and Ridges: New shingle work will be capped off using GAF "Timbertex" heavy duty double laminated hip and ridge cap shingle Detached Garage Low Slope Roof: Remove skylight Add framing to raise curb height Install new plywood to rotted area at skylight Reinstall existing skylight Install %" poly-iso insulation board over the entire low slope roof Iso Boards will be mechanically fastened using 2-1/2 "steel plates along with pan head screws Install a single ply rubber roof system by Elevate/Firestone Fabricate and install perimeter coping metal and edgings Interior Protection: It is recommended that attic contents be covered by homeowner where accessible to help protect from dust/debris accumulation Exterior Protection: Large tarps will be draped down the sidewalls of your home and onto the ground covering windows, plantings, and deck as protection against falling debris Debris Carting: Advanced Roofing Co. Inc. will haul debris from jobsite associated with our work Completion and Final Clean up: Premises will be inspected and blown free of any debris caused by our work Base Bid: $16,000.00 - Please note pricing is valid for ten days Additional work: Any additional work found necessary except for roof deck replacement priced above will be priced separately as additional work Payment Schedule: $10,000.00 due at job start/material delivery $3,000.00 due at mid-point Remaining balance due in full on day of completion Warranty GAF Shingle and Accessory ten-year manufacturer warranty will be activated with final payment. We are not responsible for any unforeseen damage that may occur while using standard installation practices. The homeowner shall protect interior/exterior fragile items from possible damage due to roof vibration. Nail pops or cracking to sheetrock, (not likely) may occur during roofing process and is the responsibility of the homeowner. Satellite Dish (if any) will be removed and replaced by our crew; owner may need to contact provider to re-boot system. Existing gutter mesh (if any) will not be replaced. Any building permits necessary are the responsibility of the homeowner to obtain, close and fund. We will assist with initial paperwork if requested. Please sign as your acceptance to this proposal, signature and deposit will indicate job acceptance. The above prices, specifications and conditions are satisfactory and accepted. 7/28/2023 Signature of Acceptance Date Scott Pohlman printed name You, the buyer may cancel this transaction at any time prior to midnight of the third business day after the date of this transaction. (Saturday is a legal business day in Connecticut.) Submitted by: David J. Hand, President 6 Salem Road, Wilton, CT 06897 203-762-1002— office 203-943-5849— cell/text www.AdvancedRoofingCompany.com CT License #554261 Westchester #17671-H06 NOTICE OF CANCELLATION Date of Transaction: YOU MAY CANCEL THIS TRANSACTION, WITHOUT ANY PENALTY OR OBLIGATION WITHIN THREE (3) BUSINESS DAYS FROM THE ABOVE DATE.IF YOU CANCEL, ANY PROPERTY TRADED IN, ANY PAYMENTS MADE BY YOU UNDER THE CONTRACT OR SALE, AND ANY NEGOTIABLE INSTRUMENT EXECUTED BY YOU WILL BE RETURNED WITHIN TEN (10) BUSINESS DAYS FOLLOWING RECEIPT BY THE SELLER OR YOUR CANCELLATION NOTICE, AND ANY SECURITY INTEREST ARISING OUT OF THE TRANSACTION WILL BE CANCELED.IF YOU CANCEL, YOU MUST MAKE AVAILABLE TO THE SELLER AT YOUR RESIDENCE, IN SUBSTANTIALLY AS GOOD CONDITION AS WHEN RECEIVED, ANY GOODS DELIVERED TO YOU UNDER THIS CONTRACT FOR SALE; OR YOU MAY, IF YOU WISH, COMPLY WITH THE INSTRUCTIONS OF THE SELLER REGARDING THE RETURN SHIPMENT OF THE GOODS AT THE SELLER'S EXPENSE AND RISK.IF YOU DO MAKE THE GOODS AVAILABLE TO THE SELLER AND THE SELLER DOES NOT PICK THEM UP WITHIN TWENTY (20) DAYS OF THE DATE OF CANCELLATION, YOU MAY RETAIN OR DISPOSE OF THE GOODS WITHOUT 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 FAIL TO DO SO,THEN YOU REMAIN LIABLE FOR PERFORMANCE OF ALL OBLIGATIONS UNDER THE CONTRACT.TO CANCEL THIS TRANSITION, MAIL OR DELIVER A SIGNED AND DATED COPY OF THIS CANCELLATION NOTICE OR ANY OTHER WRITTEN NOTICE, OR SEND A TELEGRAM TO: ADVANCED ROOFING COMPANY INC., 6 SALEM ROAD, WILTON, CT 06897, NO LATER THAN MIDNIGHT OF THE ABOVE DATE. I HEREBY CANCEL THIS TRANSACTION. (Buyer's Signature) Date now- 17-6 �%"'� l000 11�. v r�•/h�1�� 4 rr��)���i�, a��- .. - ri•)�•lir 1 r�(�/�•,, rg� •♦ r lair yq��s,� h4 rr�� N �r 1�1�11 4s .,rh ��i�;.f e r�•PO ��( v :-2 ; -S _ PSIE o W p , 5 ❑ o d •• ram,.•'` C i� � � �� ';' �� %f� �.,'I � w: •� �:�Z•sue' � O" i�itot rr � '+ .• r Qr •�•r Z0 � w ,.. Q U S rn ` O)►� : O CO O 'a gy m.i �- C'i a(o)3k. Y ^ Z U y W Z oo �. w a v I J O O Q C y :' n1) `` O _ •== ; � O Q C.0 ;Ga Y .s W 0 :t ��e eQ � � : •• Z X o O )) _ O �1 ^ns s E a _- 40 CIS U r Q ?! UEn ej \ � ,1 s)s v 4( +��ft�j'�'',,,1,111'�;�5 ` pol f'I,�/��,,�L art _ �� -� �... 'r�,,,,, • '3 f"�,'',,,1/,,,+1 (�f'�,�'' ^.,. ' DATE(MMIDD/YYYY) ACOR" CERTIFICATE OF LIABILITY INSURANCE 1 8/3/2023 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 rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: Sarah G IdOda John M. Glover Agency PHONE FAX, - P.O. Box 700 Arc • 203-956-2458 A/CNo):203-857-7848 Norwalk CT 06852 nDORess: sgjidodaj@jmg.com INSUREII AFFORDING COVERAGE NAIL It INSURER A:NGM Insurance Company 14788 INSURED ADVAROO-01 INSURERB:Century Surety Company 36951 Advanced Roofing Company, Inc. #6 Salem Road INSURER C:Mesa Underwriters Specialty Ins.Co. 36838 Wilton CT 06897 INSURER D:Travelers Casualty Insurance Company of America 19046 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:1299979836 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 I TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS ILTR POLICY NUMBER MM/DD MWDD C X COMMERCIAL GENERAL LI IABILITY MP0012014004322 11/8/2022 11/8/2023 EACH OCCURRENCE $1,000,000 DAMAGE TO REN 0 CLAIMS-MADE X 1 OCCUR PREMISES(Ea occu enoe) $100,000 MED EXP(Any one person) $5,000 PERSONAL a ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 POLICY1:1 PRO ❑ LOC PRODUCTS-COMPIOP AGG $2,000,000 X JECT OTHER. $ A AUTOMOBILE LIABILITY 81 P4670H 7/11/2023 7/11/2024 COMBINED SINGLE LIMIT $1,000,000 Ea accident ANY AUTO BODILY INJURY(Per penton) $ OWNED X SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS X HIRED X NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per accident B UMBRELLALL&B X OCCUR CCP1093045 11/8/2022 11/8/2023 EACH OCCURRENCE $1,000,000 X EXCESS LIAB CLAIMS-MADE AGGREGATE $1,000,000 DED I RETENTION$ $ D WORKERS COMPENSATION 6JUB-6R38676-8-23 7/11/2023 7/11/2024 X STATUTE ER CTonl AND EMPLOYERS'LIABILITY Y I N ANYPROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $500,000 OFFICERIMEMBEREXCLUDED? El NIA - (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $500,000 If yes,desenbe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $500,000 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (ACORD 101.Additional Remarks Schedule,may be attached If more space Is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Village of Rye Brook 938 King Street Rye Brook, NY 10573 AUTHORIZED REPRESENTATIVE ©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 ^^^^^ 061292605 ffi'-f N JOHN T OSTHEIMER AGENCY INC i}# +�'"� ■ C/O JOHM M GLOVER AGENCY PO BOX 700 NORWALK CT 06852 SCAN TO VALIDATE AND SUBSCRIBE POLICYHOLDER CERTIFICATE HOLDER ADVANCED ROOFING COMPANY INC VILLAGE OF RYE BROOK 6 SALEM ROAD 938 KING STREET WILTON CT 06897 RYE BROOK NY 10573 POLICY NUMBER CERTIFICATE NUMBER POLICY PERIOD DATE W2571120-1 540355 05/24/2023 TO 05/24/2024 8/3/2023 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE NEW YORK STATE INSURANCE FUND UNDER POLICY NO. 2571120-1, 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 CLAIMS OR SUITS THAT ARISE FROM BODILY INJURY SUFFERED BY THE OFFICERS OF THE INSURED CORPORATION. PRESIDENT DAVID J HAND VICE PRESIDENT CATHERINE B HAND OFFICERS/SHAREHOLDERS OF ADVANCED ROOFING COMPANY INC-2 OF 2 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 STATE SUR NCE FUND T �V DIRECTOR,INSURANCE FUND UNDERWRITING VALIDATION NUMBER: 169270762