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HomeMy WebLinkAboutRP23-041PERMITT #` Cf 7 SECTION 13 TYPE OF WORK Ae'067 JOB LOCATION /' Ike moon OWNER WIMI e14A69el 3a>i c� - 3S % Q CONTRACTOR : .LL-� - /�C sT. COST �% oi. % Y - FEE �/ CO #t li C I . C FEE &h 0— P,6 DATE TCO #t FEE DATE FOOTING FOUNDATION FRAMING RGH FRAMING INSULATION PLUMBING O RGH PLUMBING GAS - SPRINKLER - - ELECTRIC C7 LOW -VOLT CI ALARM C7 AS BUILT CD FINAL20��� 3� 36� 5555 OTHER APPROVALS ARB `�yE dR�v�A VILLAGE OF RYE BROOK MAYOR 938 King Street, Rye Brook,N.Y. 10573 ADMINISTRATOR Jason A. Klein (914) 939-0668 Christopher J. Bradbury www.tyebrookny.gov TRUSTEES BUILDING & FIRE INSPECTOR Susan R. Epstein Steven E. Fews Stephanie J. Fischer David M. Heiser Salvatore W. Morlino CERTIFICATE OF COMPLIANCE August 14,2024 Himi Kittner 9 Longledge Drive Rye Brook,New York 10573 Re: 9 Longledge Drive, Rye Brook,New York 10573 Parcel ID#: 135.67-1-26 Roof Permit#23-041 issued on 9/21/2023 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 Building&Fire Inspector /to ID BUILDING DEPARTMENT PERMIT#koO 3- AUG 12 2024 VILLAGE OF RYE BROOK ISSUED: — /- 938 KING STREET,RYE BROOK,NEW YORK 10573 DATE: VILLAGE OF RYE BROOK (914)939-0668 FEE:,4 /5O— PAIDb BUILDING DEPARTMENT www.ryebrookny.P-ov APPLICATION FOR CERTIFICATE OF OCCUPANCY,CERTIFICATE OF COMPLIANCE, AND CERTIFICATION OF FINAL COSTS tfffttttttttttititf♦ft►fttftttttttitftitifit►ffftftftttttttftittttitftfiftflttf•fttfttftttiifififffftffffttttttttitttftftfftf Address: Lvl !�ILJ -C'e— co/e s c'9-0 O J Occupancy/Use: //efff Parcel ID#: '' — Zone: (�J"/ / Owner: ) w1 1 I�� fi`^e� 1 Address: 9 ` f CLt (Q �C P 1C &'02 G r1`/ P.E./R.A.or Contractor: L-LC,t✓ Address: /'� W rl I e 4 �" &f(<�„W I c`-C j 73 Person in responsible charge: fi'%n rl�✓ 2G1+ Address: I y y W A-Tcf- S� G'CceH�✓I�M PW 30 T Application is hereby made and submitted to the Building Inspector of the Village of Rye Brook for the issuance of a Q b 13 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: I I VV't I y 1•-1-V%e I?— being duly swom,deposes and says that he/she resides at � L1,1(Lt �1'� �f'• (Print Name of Applicant) tgo and S etl in �� S J coo I<- in the County of��C S T cLt c,-re in the State of—AU—,that 1cavrrown;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:S 15 , 3 1 1i► I c( , for the construction or alteration of. p p 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 l-C� Sworn to before me this day of '� , 20 day of ,20 Signature of Property Owner /J Signature of Applicant PI yv► I L— 'nt erne of Property Owner Print Name of Applicant Notary blic Notary Public SHARI MELILLO Notary Public,State of New Yor:. No.01ME6160063 Qualified In Westchester County Commission Expires January 29,20 QyE BRC�v�_ 1982 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: L JL` 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 4 f ❑ L.P. GAS / ❑ FUEL TANK r ❑ FIRE SPRINKLER ❑ FINAL PLUMBING ❑ CROSS CONNECTION ❑ FINAL ❑ OTHER a ■ M N �° � ■ 1 N W f-it cn p� n c 4-4 le-1 w z cl o� a y � w � W � x Q'� .v v � • Ra a a a v • �--� �O a � cn v sa � � � W ■ � z Ga o '� ° � �" aj ■ v a m 4Ci � O � ■ r ; ' -ia nCO •� a A1 W W in Ln o O 0 v � V ■ in � A q U � u � � � � Q � b a Z tZ 0 o 00 M Cz+ z z b °� u V� r.T� h■y j G� Q F+1 M M M t^ W c? v� o o A �a i F- �a � Q ■ M a O w o w 0en CD S Ca W ■ ■ H Z ��O// O A Qw �0 g � T � U V ■ � W Q ,.., M V a w h V h�l cn .N (j yO `/ Qy/ U cn U wAell" � � � � U b � o 0 I., j•V►j � �. � � V[f f° v U � Z Q V ull � y � � x a C7 A z 0 w , I a cn > 'v p z9) 0 H BUIL DEPARTMENT Q 1/ VILLAGE OF RYE BROOK SEP 19 2023 � 938 KING STREET RYE BROOK,NY 10573 21IS-1 0 VILLAGE OF RYE BROOK BUILDING DEPARTMENT FOR OFFICE USE ONLY: _^� Approval Date: --b\2 'Pe # C7�� Application# Approval Signature: ARCHITECTURAL REVIEW BOARD: Disapproved: Date: BOT Approval Date: Case# : Chairman: PB Approval Date: Case# Secretary: ZBA Approval Date: Case# Other: /� ,[ Application FeeA C046 Permit Fees: ROOF PERMIT APPLICATION Application dated: 9/18J23 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: 9 Longledge Dr Rye Brook NY 10573 SBL: 135.67-1-26 zone: R-10 Property owner: Himi Kittner Address: 9 Longledge Dr Rye Brook NY 10573 Phone#: (732) 239-3570 Cell#: email: hkittner@yahoo.com z. Applicant: Andrew Prchal Address: 194 S Water St Greenwich CT 06830 Phone#: 203 388 5555 Cell#: email: kauanny.zanetti@gunnerroofing.com 3. Roofing Contractor: Gunner LLC Address: 194 S Water St Greenwich CT 06830 Phone#: 203 388 5555 Cell#: email: kauanny.zanetti@gunnerroofing.eom 4. Job Description,list all Methods&Materials: Remove 8 replace existing roof. Inspect roof deck to verify that all all sheathing is suitable. Install seam tape per CT Code. Install water and Ice barrier, underlayment, asphalt asphalt shingles, and proper ventilation. 5. Estimated Cost of Job: $ 18,312.79 (NOTE:The estimated cost shall include all site improvements,labor,material,scaffolding,fixed equipment,professional fees,and material and labor which may be donated gratis.) 6. If corner property,indicate street frontage: Interior Property 7. Construction Type: Roof Replacement NYS Construction Class: 8. Number of stories: 2 Stories Height: 9. Is garage being re-roofed:No:( )•Yes:O Attached No:( }•Yes: O Number of Cars: 10. Is roof peaked,hip,mansard,flat,etc: Peaked 11. Estimated date of completion: September 30th 2023 4- 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. STAT OF NEW YORl�COUNTY OF WESTCHESTER ) as: { 6(C&W 1'C&Yi I ,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 Grunile C (.L(— 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 Ci c , 0 day of e)O {g-, 20 -el—) 3 L�__ "�_, lwtt. — Signature of Property O ner Signature of Applicant rint Name of Property caner Print Name of Applicant "* blic puhl' ,�p�111111Mip�h• NNYL''••• Y vP '•-�'N •�� r'ri � i ,��rr e�. 0 ,p tv. 3 o . %;0VN�CS� -2- 6/1/2023 i HOME ENERGY REPAIR LLC d/b/a GUNNER ROOFING LLC 194 South Water Street,Greenwich,CT 06830 Phone: 203-347-3368 License No.: CT-0653672 NY-WC3218OH19 Yonkers,NY License No.- 7592 Rockland County,NY License No. 20118 NJ HIC- 13VH10245900 RI HIC-GC-44886 Federal EIN No. 83-2024199. RRP License-R-1-18342-21-00015 www.gunnerroofing.com PROPOSAL/ CONTRACT This construction agree me a (the "Agre a me f1') is made and a sere d into by and betwe e n Home Energy Repair LLC d/b6 Gunner Roofing LLC(here ina$er re fare d to as "Gunner Roofing" or"Contractor") and_Hirai Kittner (hereinafter the "Owner" or "Customer")whose address is_9 Longledge Dr,Rye Brook,NY 10573 (the"Project"). Contractor and Owner hereby agree as follows: Contract Documents: The contract documents consist of this Agreement, and any exhibits attached hereto, Terms and Conditions, Notice of Cancellation, Statutory Warnings, and limited workmanship warranty(if any) and all modifications and change orders issued after execution of the Agreement(the"Contract Documents").Owner represents that it has read,reviewed,analyzed and become familiar with all of the Contract Documents and has identified and included costs in the Contract Price(as defined below)as could be expected, associated with any errors,inconsistencies,omissions,or discrepancies.These contract documents represent the entire agreement of both parties and supersede any prior oral or written agreement. Scone of Work:The scope of work is contained and limited to the work contained on Exhibit"A"—Scope of Work.The scope of work does not include any engineering or design professional work.All work shall be performed by Contractor in a workmanlike manner and shall meet or exceed all state and local building codes. Contractor shall obtain all permits necessary for the work to be completed. Contractor shall remove all construction debris and leave the project in a broom clean condition.(In Rockland County,New York:Work other than that described in Exhibit"A"—Scope of Work_is is not required to be performed in order for the scope of work to comply with all laws, ordinances, local laws, resolutions, or building codes governing home improvement work or requiring permits therefor or any requirement contained in the rules and regulations of the Home Improvement Licensing Board and any revisions thereof.) Contract Price:The materials required for this job will be furnished by Gunner Roofing,including necessary equipment,and the services performed for a total of$ 18,312.79 (the "Contract Price"). Owner shall pay Contractor the Contract Price in accordance with Exhibit "B"- Schedule of Progress Payments. Customer shall remit payment to Contractor within thirty (30) days of receipt of Contractor's invoice. (In Rockland County,New York: any deposit charged hereunder shall be the lesser of$1,000.00 or 15% of the Contract Price.Upon satisfactory payment being made for any portion of the work performed,the contractor shall,prior to any further payment being made,furnish to the person contracting for the work a full and unconditional release from any claim of a mechanic's lien by the contractor or by a person entitled to enforce a mechanic's lien for that portion of the work for which payment has been made.) Estimated Date of Commencement/Comoledon: The estimated start date of the Work is _9/26/23 and the estimated completion date is_9/30/23 ,these dates are subject to change due to delays caused by weather,shortage of materials or labor,Acts of God, riots, revolutions, strikes, pandemics, medical emergencies that have resulted in a local, state, or federal state of emergency, COVID-19 or viruses/illnesses requiring quarantine,or other causes or factors beyond Gunner Roofing's reasonable control.Time is not of the essence for all purposes of this Agreement unless expressly provided to the contrary. Unless otherwise specified, there is no specific completion date for Contractor's work.Contractor shall complete all work in a reasonable amount of time. Change Orders: All changes to the plans, specifications or selection of finished materials which may be requested in writing by Owner("Change Orders"), shall be submitted to Contractor using Exhibit "C" — Change Order and are subject to Contractor's approval.A Change Order is any change in work from the original,permit set,plans and specifications.Each Change Order shall only be incorporated into the Agreement if signed by both Owner and Contractor prior to the commencement of any work covered by said Change Order.In the absence of an express lump sum agreement with respect to any Change Order,changed work shall be billed to the Owner at the direct cost to the Contractor plus twenty percent(20%). Additional time needed to complete change orders shall increase the time needed for Project completion. Warranty and Legal Requirements: Contractor shall guarantee the quality of all workmanship for a period of ten(10)years from the date of completion. _ Contractor shall obtain any necessary permits and provide to Customer a certificate of occupancy, if required by the home improvement. OR _ Customer shall obtain any necessary permits and certificate of occupancy, if required by the home improvement. I HAVE READ AND UNDERSTAND THIS CONTRACT, THE TERMS AND CONDITIONS, AND ALL APPLICABLE CONTRACT DOCUMENTS AND AGREE TO BE BOUND BY THEIR TERMS. ACCEPTANCE OF CONTRACT: The above prices, specifications and conditions are satisfactory and are Home Energy Repair LLC d/b/a Gunner Roofing LLC hereby accepted. Contractor is authorized to do the work as specified. By signing below, Customer Authorized Signature: acknowledges that Customer is the owner (or authorized agent of the owner) of the property where the work is to be performed. Contractor will provide By: Customer with a copy of this Contract after it is signed Its: by both parties. Customer Signature: Date: Date: CONSUMER'S RIGHT TO CANCELLATION.CUSTOMER MAY CANCEL THIS CONTRACT WITHOUT ANY PENALTY OR FURTHER OBLIGATION WITHIN THREE(3)DAYS FROM THE DATE OF THIS TRANSACTION. SEE THE ATTACHED NOTICE OF CANCELLATION FORM FOR AN EXPLANATION OF THIS RIGHT. EXHIBIT A—SCOPE OF WORK DESCRIPTION OF THE WORK TO BE PERFORMED: Roofing: • Tear off existing Shingles • Inspect plywood and replace damaged Plywood as needed (3 sheets included, additional sheets $110 per sheet) • Install GAF Timberline HDZ TBD (Weathered Wood) • Use Roofing Coil Nails - 1 1/4" (7200 Cnt) • Install Elastomeric/ Caulk (Clear) (10.3 oz) • Install GAF Weather Watch Ice and Water Shield - Unboxed (2 SQ) along eaves, valleys, and rake edges. • Install GAF Tiger Paw Underlayment • Dynamoic Caulk (Limestone) • Use T50 Staples - 3/8" (5000 Cnt) • Install GAF Weather Blocker WeatherBlocker • Install GAF Timbertex Hip & Ridge Install GAF Cobra Snow Country Advanced • Install Standard Aluminum Drip Edge— F5 1/2 - 1.0" (10')—White • Install Aluminum Pipe Flashing Combo 1"-4" (Over all pipe vents) • Inspect chimney for any damage • Install Copper Flat Sheet Metal around Chimney and install cricket if needed • Clean up all job-related debris and materials • Provide Dumpster and place plywood underneath to prevent any damage • Provide GAF Golden Pledge Warranty (50 Years on materials and 25 years on labor) • Our Crews are licensed and insured. • Crews will maintain safety requirement at all times during the construction process • Provide owner with all manufacture warranties • Gunner will null permit for owner(and subsequently close) and save receipt for reimbursement from customer(if needed) • Gunner will protect siding and shrubbery and will replace if any damage is done • Roof will be covered during any inclement weather EXHIBIT B—SCHEDULE OF PROGRESS PAYMENTS Work or Services Performed and Materials Amount Due Upon Completion: to be Supplied: Deposit_00%) $_1,831.29 Start(60%) $_10,987.67 Completion (30%) $_5,493.83 1 � /�_ �.' .•at1 5S t.._;;._ ,:SS ii Qfl' .':a. .�+:. S4'. f.L-_ug_5�i1;i._ _ _���'. _..1.5t � _riL_� �tit��/ {I 5�t /'. On &¢mot=+.. ---- -----------_ _— G iL �• Ceorge Latimer „ x►til�s�• James Maisano Tor Westchester Westchester County F.)eccutice X I I Director,Consumer Protection c Department of Consumer Protection 4� Home Improvement License GUNNER LLC s Q �a 194 SOUTH WATER STREET � `+ �� � GREENWICH,CT-06830 a ys�� .I This license is issued in accordance with Article XVI of the Westchester County Consumer Protection Code and is valid only upon r a presence of the official department seal.Proof of citizenship or immigration status is not required for issuance of this license. NOT FOR FEDERAL PURPOSES e `otGonsu , o License Number t Date of Expiration R¢ � °, WC-35879-H22 11/01/2024 a �chester C0 (a<is)i .:: 11/ � .,11' ;, �11„ .�, �"`f ,�1f ��._.!{fi' ;." /ri �� •�.— air ��, , i/oH� '1#/ili` „t �##)i61 e;�; 'bf .iii' :�:� "#it iN�'�r:'. . fir it' �#�,y�ya ,rN,�11'; •� � ';Y D i'�� 1rti Q�., �� a.� �, K'�l�, +a♦��r� a,.���F �•5.5 a: �. � aft � � 4r.. ,;���;. ��1r, a ��if ,,!��*raw,w*rrr>/,�•`�'+1`'�r'rditr>�" '�"�r`�.i/�' �� vi' �'�' .,1''I." ���'`��.'af�/r�-`v`►'`'` '`�°'� Client#1:1952221 HOMEEN ACORD. CERTIFICATE OF LIABILITY INSURANCE DATE(MMUDO(YYYY) 09/18/2023 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 pollcy(les)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 N ME.,CT _ _Carmel McCabe USI Insurance Services LLC PH IJE Eft:SW 874-0123 IFAX A No Aro No):203 634-5701 530 Preston Avenue E-mIIL , usictcertMcates@usic.com Meriden,CT 06450 ppgINSURERS AFFORDING COVERAGE NAICI 855 874-0123 INSURER A:Admiral Insurance Company 24856 INSURED - Gunner LLC INSURER B:Arbella Protection Insurance Company 41360 194 South Water Street INSURER C: Liberty Mutual Insurance Corporation 33600 Greenwich 06830 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. INSR TR TYPE OF INSURANCE INSR VWD POLICY NUMBER M Y EFF POLIC EXP LIMn's A X COMMERCIAL GENERAL LIABILITY X X CA00004513601 4/21/2023 M1=24 DEAAqCC�HpG�OE�CTCURRENCE s1 OOO OOO ENTED CLAIMS-MADE a OCCUR PREMISES oocurrenoe s5O OOO X 5,000 ded BI,Phy MED EXP one s5 OOO Dam,Per Adj PERSONAL 6 ADV INJURY $1 00O 000 GENL AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE s2 OOO 000 X POLICY JET El LOC , PRODUCTS-COMP/OP AGO $1 00O OOO OTHER $ B AUTOMOBILE LIABILITY 1020117559 1/2023 M1/ZO2 CO acci�EnntSINGLE LIMIT 1,000 000 X ANY AUTO BODILY INJURY(Per person) $ AAUTOS ONLYkAUTOS AUTOS BODILY BODILY INJURY(Per accident) s X AUTOS ONLY ONLY PROPERTY DAMAGE s Per accident s A UMBRELLA UABCUR X X CiAOOOO4513601 1/2023 MI/20 EACH OCCURRENCE S 5 000,000 X EXCESS LIARAIMS-MADE AGGREGATE $5,000,000 DED X I RETENTION $ C WORKERS COMPENSATION X WC5-33S-381014-019 1/19/2023 O1/19/2024 X PER OTH- AND EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N E.L.EACH ACCIDENT S 500 O00 OFFICER/MEMBER EXCLUDED4 N/A (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 500,000 M yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT s 500,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additlonal Remarks Schedule,may be attached it more space Is required) Village of Rye Brook 938 King Street Rye Brook, NY 10573 is an additional insured on aprimary and non- contributory basis on the general liability 30-day notice of cancellation affordedto certificate holder,10 days for non-payment ofpremium. 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 938 King Street ACCORDANCE WITH THE POLICY PROVISIONS. Rye Brook, NY 10573 AUTHORIZED REPRESENTATIVE ©1988-2015 ACORD CORPORATION.All rights reserved. ACORD 25(2016/03) 1 of 2 The ACORD name and logo are registered marks of ACORD #S35749643/M35749611 RXTCH NYSIF New York State Insurance Fund PO Box 66699,Albany,NY 12206 1 nysif.com CERTIFICATE OF WORKERS' COMPENSATION INSURANCE 10. "m .0 ^^^^^A 832024199 Gunner LLC 194 S Water St Greenwich,CT 06830 SCAN TO VALIDATE AND SUBSCRIBE POLICYHOLDER CERTIFICATE HOLDER Gunner LLC 194 S Water St VILLAGE OF RYE BROOK Greenwich, CT 06830 RYE KING STREET RYE BROOK NY 10573 POLICY NUMBER CERTIFICATE NUMBER POLICY PERIOD DATE W2485 011-7 381847 09/12/2023 TO 09/12/2024 9/18/2023 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE NEW YORK STATE INSURANCE FUND UNDER POLICY NO. 2485 011-7, 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:/NVWW.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 �V DIRECTOR,INSURANCE FUND UNDERWRITING VALIDATION NUMBER:630619715 U-26.3