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HomeMy WebLinkAboutBP23-172PERMIT # til SECTION TYPE OF WORK JOB LOCATION EST. COST \/co #-C21 Tco # FOOTi NG FOUNDATION FRAMING RGH FRAMING INSULATION PLUMBING CJ RGH PLUMBING GAS SPRINKLER e% ELECTRIC LOW -VOLT Q ALARM AS BUILT C7 FINAL �3- 7") zokb LOT EE DATE 'r Ir f NSP _may HQrzt7i 4 l� OTHER APPROVALS VILLAGE :OF RYE BROOK wrsTcHEsTER cou , Nrw YOPK - No: -006 Certificate of ecrupancp his is to certify that Vi / /a-aie c r Bko6 k r of, j ,e 9)166 ,e having duly filed an application on 20 requesting a Certificate of Occupancy for the premises known as, i Rye Brook,NY,located in a��Zoning District and shown on the most current Tax Map as Section: /4// 43BIock: / Lot: , and having fully complied with the requirements of the Building Code and the Zoning Ordinance under Building Permit No. 74�, issued 20J Z3, such authority and permission is hereby granted to the property owner to lawfully occupy or use said premises or building or part thereof listed under the following New York State Classifications,Use: 4ew'51Z) �� Construction: , for the following purposes: 1/ �C1Y �� /A& Subject to all the privileges, requirements, limitations, and conditions prescribed by law, and subject also to the following: This certificate does not in any way relieve the owners or any person or persons in possession or control of the premises, building,or any part thereof from obtaining such other permits or licenses as may be prescribed by law for the uses or purposes for which the building or premises is designed or intended. Furthermore, it does not relieve such owners or persons from complying with any lawful order issued with the object of maintaining the premises rding in a safe and lawful condition. No changes or rearrangement in the structural parts of the building or in the a ac* es shall be made,and no enlargement, whether by extending on any side or by increasing in height shall be ma r I the building be moved from one location to another until a permit to accomplish such change h be n obta' d uilding Inspector. Building Inspector,Village of Rye Brook: Date: .I AN 2 3 2024 Ll -®Rro-oj-�� For office a-only J - j T BUILENT PERMIT# c�3-f'74 VILKRi JAN 172024 ' `"'' ISSUED:%�•—Sa3 938 KING SIREYORK 10573 DATE:VILLAGE OF R't'E i�R30C' FEE: PAID E3 BUILU' ' re 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 Address: 6 tssssssss*s*s*ss**+«+«wtttrsssrsrrsss*s*****s*+««//«tssssstssssss**ss*s«*rwwrtt+«r+sserrsrrsrrsrrssss*++««s*r*r***t+tst*:tsstt p� Q �/ Q/C4 / /O/Q(12 le— Occupancy/Use• ss _ '4 1 Parcel ID#: %'!j�%, 3 — l—3 5— Zone: F` Owner: ��Q 9 P D r��y e �-QOI k Address: 930 /i!y d� /C ye /X/-oo4 M / J' \/ P.E./R.A. or Contractor: V/•/)C o '6-o) ye/S Address: �yPS'f-,6" /-a,7e /"l a A di�QC, / )1 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: being duly swom,deposes and says that he/she resides at (Print Name of Applicant) (No.and Street) in ,in the County of in the State of '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:$ / O O v ' 2/ for the construction or alteration of: 7 O Vc2-le p w/e 0l c2 'k% 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 I g Sworn to before me this day of v` , 20 2¢ day of , 20 Signature of Prepedy.9wMr Signature of Applicant Print Name of Property Owner Print Name of Applicant Notary Public Notary Public BR°Uk Village of Rye Brook Public Works and Engineering Department 938 KING STREET•RYE BROOD,NY 10573 1982'� (914)939-0753 FAx(914)939-0242 INSPECTION REPORT Address: T�'v 4f i Date: Name: ,�(�/- C�/ lr� Location: . Permit#: Phone: Email: / Work being Inspected:/ Work Inspected is: d Rejected Re-Inspection Required Violation Noted Code Section Code Section: Action Taken Code Section: Action Taken 118 Erosion Sediment Pass Fail Violation 210 Storm Water Pass Fail Violation 135 Refuse Pass Fail Violation 215 Street Sidewalk Pass Fail Violation 213 Steep Slopes Pass Fail Violation 235 Trees Pass Fail Violation 216 Illicit Discharge Pass Fail Violation 245 Wetlands Pass Fail Violation Other: Pass Fail Violation Notes: l/�/, fl L NTS Diagram: Signature ' ■ . M v > +4 h+l s o a zoo wx CD 14 a A cz co ow 04 en Qr-) � V W Fit h+h w o `i) U 6 a z , ~—' a MCI a?j . V �i O r� d Q O � a p V o In ZZ .o 00 > U O4 ug � a � W. 0 'v v v � a w F Z 14 y I� ~ a N o C7 A O 0> x, •• V BUILDING DEPARTMENT D VILLAGE OF RYE BROOK ECEME 938 KING STREET RYE BROOK,NY 10573 (914)939-0668 SEP 2 2 2023 DD wwwxyebrook.em VILLAGE OF RYE BROOK BUILDING DEPARTMENT FOR OFFICE USE ONLY: Approval Date:,0 C T 03 �� t b�J—/lc�-- Application# Approval Signature: -- ARCHITECTURAL REVIEW BOARD: Disapproved: Date: BOT Approval Date: Case# Chairman: PB Approval Date: Case# Secretary: ZBA Approval Date: Case# Other: Application Fee: Permit Fees: EXTERIOR BUILDING PERMIT APPLICATION Application dated: 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. 1. JobAddress: ! j Place e' 8 /a573 2. Parcel ID#: L41 — " J 5 Zone: 3. Proposed Improvement(Describe in detail): 6_'/ HIS 4. Property Owner: Address: rm G Phone# r�w Cell# e-mail List All Other!Properties Owned in Rye Brook: Applicant: T f ,/'/ q Address: �� / Y /L�i'a `l ll �l�/ 3 Phone# — Cell# e-mail C Architect:-IMAI G 4or Address: Phone# Cell# e-mail Engineer: Address: Phone# Cell# e-mail General Contractor: V i l(/, �+ Address: Ir Phone :ell# e-mat (1) 6/1/2023 5. Occupancy;(1-Fam.,2-Fam.,Commercial.,et ...)Pre-construction: Post-co nstru tion: 6. Area of lot: Square feet:_ I. Acres: 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: I'fl: 2'fl: 31 fl: 10. Total Square Footage of the proposed new construction: 11. For additions,total square footage added:Basement: I `fl: 2°d fl: 31d fl: 12. Total Square Footage of the proposed renovation to the existing structure: 13. N.Y.State Construction Classification: N.Y.State Use Classification: 14. Number of stories: 1 Overall Height: �d Median Height: 15. Basement to be full,or partial: / yyL , finished or unfinished: G Nf ���7 16. What material is the exterior finish: G 17V C ire 17. Roof style;peaked,hip,mansard,shed,etc: Roofing material: 18. What system of heating: / 19, If private sewage disposal is necessary,approval by the Westchester County Health Department must be submitted with this application. 20. Will the proposed project require the installation of a new,or an extension/modification to an existing automatic fiJe suppression system?(Fire Sprinkler,ANSL System,FM-200 System,Type I Hood,etc...) Yes: No: (if yes,applicant must submit a separate Automatic Fire Suppression System Permit application&2 sets of detailed engineered plans) 21. 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:-LX—Area: 22. Will the proposed project require a Site Plan Review by the Village Planning Board as per§209 of Village Code? Yes: No: V (if yes,applicant must submit a Site Plan Application,&provide detailed drawings) 23. Will the proposed project require a Steep Slopes Permit as per§213 of Village Code Yes: No: (f yes,you must submit a Site Plan Application,&provide a detailed topographical survey) ` 24. Is the lot located within 100 ft.of a Wetland as per§245 of Village Code? Yes: No: 1'� (f yes,the area of wetland and the wetland buffer zone must be properly depicted on the survey&site plan) v 25. Is the lot or any portion thereof located in a Flood Plane as per the FIRM Map dated 9/28/07? Yes: No: Y (f yes,the area and elevations of the flood plane must be properly depicted on the survey&site plan) 26. Will the proposed project require a Tree Removal Permit as per§235 of Village Code? Yes: No: (if yes,applicant must submit a Tree Removal Permit Application) 27. Does the proposed project involve a Home-Occupation as per§250-38 of Village Code? Yes: No: y Indicate: TIER I: TIER II: TIER III: (if yes,a Home Occupation Permit Application is required) 28. List all zoning variances granted or denied for the subject property: 29. What is the total estimated cost of construction: $ 11/. 11 O. ' 9 .Note.The 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: (2) 6/1/2023 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. STATEOF NL YO CQQUNTY OF WESTCHESTER ) as: a14 dky ,being duly sworn,deposes and states that he/she is the applicant above named, (print name of in vidual signing as the plicant) and further states that (s)he is the legal owner of the property to which this application pertains, or that (s)he is the 0 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. Swom to before me this Sworn to before me this day of 6 G � , 20 day of 120 Signature oqProperty7�0�wnear Signature of Applicant Print Name of Property Owner Print Name of Applicant Notary Public Notary Public (8) 8/12/2021 a1 a' i. N N W a � O 64PLO F+ti sl O al U o z x00 c :, �.y V p 'r s pZ �'• �i 0 = F1 a O o W o N eq Cf) 00 co in z I C � ie Cf) O � 0.0 ' w � O c� Z Q Cl) z CO z W v Z it O cn G ,'fir O 1�1 U Oo CA z H a A ¢ V z a U U $ W w w x z H F" o ° R-+ ►� �, w z z � cn N z ° ° o z od .47 F a j E-7 BUILDING DEPARTMENT DD VILLAGE OF RYE BROOK DEC 13 2023 938 KING STREET RYE BROOK,NY 10573 (914)939-0668 VILLAGE OF RYE BROOK wwwjyebrook.org BUILDING DEPARTMENT ELECTRICAL PERMIT APPLICATION Westchester County Master ElectriciansLicense Required FOR OFFICE USE ONLY BP#: 0�3`- / EP#: �3-CD 5`� Approval Date: �.��'+ � l -Zb Permit Fee: $ Approval Signature: Other: DO NOT START WORK or CONSTRUCTION UNTIL A PERMIT HAS BEEN ISSUED BY THE BUILDING INSPECTOR THE ADMINISTRATIVE FEE FOR WORK PROGRESSED OR COMPLETED WITHOUT A PERMIT IS 12%OF THE TOTAL COST OF CONSTRUCTION WITH A MINIMUM FEE OF$750.00 Application dated, (:)—/3-c�3 is hereby made to the Building Inspector of the Village of Rye Brook NY, for the issuance of a Permit to install and/or remove electrical equipment,wiring, fixtures, or to perform other high or low voltage electrical work as per the detailed statement described below. By signing this document, the applicant & property owner agree that all electrical work performed will be in conformance witcrh,� all applicable Federal,State,County and Local Coo/des.J/2 1.Address: G t K�� (�r ►" 1 GIC' SBL:1 T1r 7 J Zone: gj� 2.Property Owner: iiJ/00 6~ Address: Phone#: Cell#: email: //� `� � 3.Master Electrician/Licensed Installer: � ` wtG� Address:- � &-00 Ks rGt"p P�p Lic.#:�� �_Phone#: T l(4 WN -1 1r22�Z Cell#: email: N el � n��4/-C �< <4.0 �/`� C.co'z Company Name: WAAe-C.�� C/�W 6 C_ Address: ,B�by fts'-�((- 10 4.Proposed Electrical Work/Fixture Count: l.c��`re_ }or'--,d 2 /f cr rs _'CL 1 a..._c� f 4 (( r` 14 cc C- ce 5.31 Party Electrical Inspection Agency: STATE OF NEW YORK,COUNTY OF WESTCHESTER ) as: ,being duly swom,deposes and states that he/she is the applicant above named,and does further (print name of individual signing as the applicant) state that(s)he is the for the legal owner and is duly authorized to make and file this application. (Master Electrician/Licensed Installer) The undersigned further states 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 20 day Signature of Property Owner S i"ghaturi 6 f X phcant Print Name of Property Owner P ' ame of Applicant a Notary Public Now Pub'GREGAY M.RNERA I;,4ary Public,State of New YOW30/2023 No.01 R16441398 'lualifled In Westchester County Commission Expires Seotember 26.20 STATE WIDE INSPECTION SERVICES, INC., cok) Scir-vice 11'ith lnlegi-il.v •:0 • • SWIS JOB APPLICATION0. • Office Use Elect. Permit# �� 5 1' Date Bldg Permit# 3_ / 174— sq Ft Plumbing Permit# Final Certificate# City/Village }� P ��C) Zip 'US 7-3Building Dept. County Address r`.f t_(I r• t,)(,, Cross Street Section Block Lot Owner Name/Address(If different than above) 1 1' ''� G -,C Contact Numb �i 3 �Y 7 3 ❑Basement ❑ 1st FI. ❑2nd FI. ❑3rd FI. ❑More Than 3 FI. ❑Garage ❑Attic ❑Outside ❑Residential ❑Commercial Receptacles Special Recept GFCI AFCI Switches Dimmers Smoke Alarms C/0 Detector Hood Trash Compact Amt Amps Range(s) Cooktop(s) Oven(s) Dishwashers Refrigerator Disposal Microwave Luminaires Generator Transfer Switch SERVICE Amperage #Panels 1P 3P # Meters # Disconnect ❑Underground ❑ New ❑ Reconnect ❑ Repair ❑Overhead ❑ Upgrade ❑ Disconnect Utility ID# ❑Con Ed ❑ NYSEG ❑Central Hudson ❑ Orange/Rockland PHOTOVOLTAIC SYSTEM PV Modules Inverters AC Disconnect Junction Box Combiner Box Load Center PV Monitor Energy Storage System DC Disconnect ❑Legalization ❑ Safety Inspection ❑Consultation �ep(4 DEC 13 2Q23 VILLAGE OF RYE BROOK BUILDING DEPARTMENT This application is valid for one(1)year from the date received by SWIS.This application is intended to cover the above listed items to be inspected,Hat any time of inspection additional items have been installed,you are authorized to make the inspection and adjust the fee for the additional items inspected.The applicant declares that there is no open applications for the above address with any other inspection company.The applicant, owner or authorized agent agrees to all the above terms and conditions as set forth for the application. Email Address /L" N /' t If C pZ* Name till License# '� Date /�•/3 •�3 Signatures Address /� , City/State:> (f Zip Code / `7� Company t �(P - C Phone# / v 1'5/— Iv _? �/ ED D E C E�� State Wide Inspection Services 1080 Main Street JAN 162024 Fishkill, NY 12524 To �a 845 202-7224 Phone VILLAGE OF RYE BROOK 914-219-1062 Fax STATE WIDE INSPECTION SERVICES BUILDING DEPARTMENT Email: office(ccbswisny.com Website: www.swisny.com Service With Integrity BY THIS CERTIFICATE OF COMPLIANCE STATE WIDE INSPECTION SERVICES CERTIFIES THAT: Upon the application of: Upon Premises Owned by: Marchi Electric Corp Village of Rye Brook Neil Marchi Anthony J. Posillipo Senior Center 20 Brookside Place 32 Garibaldi Place Pleasantville, NY 10570 Rye Brook,NY 10573 Located at: 32 Garibaldi Place, Rye Brook, NY 10573 Section: Block: Lot: Electrical Permit Number: EP 23-254 141.43 i 35 Certificate Number:2023-9244 Building Permit Number: BP 23-172 A visual inspection of the electrical system was conducted at the Commercial occupancy described below.The electrical system consisting of electrical devices and wiring is located in/on the premises at: 32 Garibaldi Place, Rye Brook,NY 10573 The Exterior was inspected in accordance with the NYS and NFPA 70-2017 and the detail of the installation, as set forth below,was found to be in compliance on the 22"d day of December 2023. Name Quantity Rating Circuit Type Luminaires 12 LED Surface Mounted Lights 04 r' Officer: Frank J. Farina This certificate may not be altered in any way and is validated only by the presence of a seal at the location indicated.This certificate is valid for work performed on the date of inspection only. C1 Buildin Pernut Check List&Zoning Analysis Address: SBL• ' Zone: -1 c Use: Const.Type: V Other. Submittal Date: \ ZZ` Revisions Submittal Dates: Applicant: Nature of Work. Reviews:ZBA: fl PB: BOT: Other. NEED OK ( ) ( ) FEES:Filing. _ 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. ( ) ( ) CfQ DE 753#: Dated. N/A; ( ) ( THIGH-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: REOLMED EXIMNG PROPOSED NOTFS Area: APPROVED Circle: Fie Front: Front. Sides R,ar Main Co Accs.Cov Fc H S S .HS • Tag: Ft.In' Par Hcight/Stories: notes: ACOR" CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 14.. � 8/23/2023 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(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 rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Feehan Insurance Agency NAMES Carol Burke FAX 2350 Route 6 WL ExtIo 845-278-7070 No:845-278-6498 Brewster NY 10509 ADDRESS: carolb@feehaninsurance.com INSURE S AFFORDING COVERAGE NAIL• License#:BR-1062080 INSURERA:Selective Insurance Co.of America 12572 INSURED VINCBUI-01 INSURER B: Vinco Builders LLC 5 Veschi Lane S INSURER C: Mahopac NY 10541 INSURER D: INSURER E: INSURER F COVERAGES CERTIFICATE NUMBER:363908031 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. INSRR TYPE OF INSURANCE DL POLICY NUMBER POLICY EFF POLICY EXP LIMBS A X COMMERCIAL GENERAL LIABILITY Y Y S 2377059 10/9/2022 10/9/2023 EACH OCCURRENCE s1,000,D00 CLAIMS-MADE �OCCUR AMA E T NT REED PREMISES Ea occurrence $500,000 MED EXP Any one person $15,000 PERSONAL&ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $3,000,000 POLICY JECOT LOC PRODUCTS-COMP/OP AGG $3,000,000 OTHER: $ A AUTOMOBILE LIABILITY Y Y S 2377059 10/9/2022 10/9/2023 COMBINED SINGLE LIMIT $1,000,000 Ea a.dent X ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY Per accident) $ AUTOS ONLY AUTOS ( X HIRED X NON-OWNED PROPERTY DAMAGE AUTOS ONLY AUTOS ONLY Par accident $ $ A X UMBRELLA LIAR X OCCUR Y Y S 2377059 10/9/2022 10/9/2023 EACH OCCURRENCE $10,000,000 EXCESS LIAR CLAIMS4AADE AGGREGATE $10,000,000 DIED I X I RETENTION$ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY YIN STATUTE ER ANYPROPRIETOR/PARTNER/EXECUTNE E.L.EACH ACCIDENT $ OFFICER/MEMBEREXCLUDED7 El N/A (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ Hyea deibe under DESCscrRIPTION 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 included as additional insured when required by written contract. 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 St AUTHORIZED REPRESENTATIVE Rye Brooke NY 10573 �- ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016103) 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 A A A A A A 270121260 e LOVELL SAFETY MGMT CO., LLC '} M 110 WILLIAM STREET 12TH FLR NEW YORK NY 10038 SCAN TO VALIDATE AND SUBSCRIBE POLICYHOLDER CERTIFICATE HOLDER VINCO BUILDERS LLC VILLAGE OF RYE BROOK 5 VESCHI LANE SOUTH 938 KING ST MAHOPAC NY 10541 RYE BROOK NY 10573 POLICY NUMBER CERTIFICATE NUMBER POLICY PERIOD DATE Z2325163-0 598908 04/01/2023 TO 04/01/2024 8/23/2023 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE NEW YORK STATE INSURANCE FUND UNDER POLICY NO. 2325163-0, 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 THE SOLE PROPRIETOR. PARTNERS AND/OR MEMBERS OF A LIMITED LIABILITY COMPANY. THE POLICY INCLUDES A WAIVER OF SUBROGATION ENDORSEMENT UNDER WHICH NYSIF AGREES TO WAIVE ITS RIGHT OF SUBROGATION TO BRING AN ACTION AGAINST THE CERTIFICATE HOLDER TO RECOVER AMOUNTS WE PAID IN WORKERS'COMPENSATION AND/OR MEDICAL BENEFITS TO OR ON BEHALF OF AN EMPLOYEE OF OUR INSURED IN THE EVENT THAT, PRIOR TO THE DATE OF THE ACCIDENT, THE CERTIFICATE HOLDER HAS ENTERED INTO A WRITTEN CONTRACT WITH OUR INSURED THAT REQUIRES THAT SUCH RIGHT OF SUBROGATION BE WAIVED 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. 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