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HomeMy WebLinkAboutRP24-002PERMIT # �c� 7 — OO<; DATE:--"/ // a e B(P, a �S SECTION c3�i J BLOCK77K ` L07 TYPE OF WORK JOB LOCATI N p/) ' e Q 7/ v OWNER V/ (: / 3 = CONTRACTOR 61,/ /»e/ u) i'c a o) . COST Ao) FEE — 6 VCO # FE DAM TCO # FEE DATE DATE INSP FOOTING FOUNDATION FRAMING RGH FRAMING INSULATION PLUMBING LD RGH PLUMBING GAS SPRINKLER ELECTRIC 0 LOW4OLT O ALARM AS BUILT Z p Z`i FINAL OTHER APPROVALS C'4R. 19 W iipGwojJju G t V G J J O VILLAGE OF RYE BROOK MAYOR 938 King Street, Rye Brook,N.Y. 10573 ADMINISTRATOR Jason A. Klein (914) 939-0668 Christopher J. Bradbury -.vw-,v.rye b ro o kn y.gov TRUSTEES BUILDING& FIRE INSPECTOR Susan R. Epstein Steven E. Fews Stephanie J. Fischer David M. Heiser Salvatore W. Morlino CERTIFICATE OF COMPLIANCE November 8, 2024 David Bolen 2 Longledge Drive Rye Brook,New York 10573 Re: 2 Longledge Drive, Rye Brook,New York 10573 Parcel ID#: 135.65-1-33 Roof Permit#24-002 issued on 1/12/2024 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 S C E �,W E BUILDING DEPARTMENT For offic e VILLAGE OF RYE BROOK PERMITRRN0V - 1 2024 ISSUED:938 KING STREET,RYE BROOK,NFw YORK 10573 DATE: 7 VILLAGE OF RYF BROOK (914)9 -0668 FEE: PAm BUILDING DEPARTMENT wwW.ry rookny.P-ov 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 rt♦rt#♦irtirt#rt#W#irtWirtrtiiiirtrt##Wii}i##irt}rt►#WW#}}WWW}}rtrt#rtrtrtWrtiWWWrtWrtrtWiirti444rtWi}ii4i}}##4####4#WWWWrtrtW#Wirtrtirt4###i}rtiii44#i4Frt Address: 2 Longledge Dr Ryeq Broo NY 10573Occupancy/Use: 1-P m1 Parcel ID#: 135. (D5 - 1 - . Zone: R-12 Owner: David Bolen Address: 2 Longledge Dr Rye Brook NY 10573 P.E./R.A.or Contractor: Gunner LLC Address: 194 S Water St Greenwich CT 06830 Person in responsible charge: Andrew Prchal Address: 194 S Water St Greenwich CT 06830 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: Andrew Prchal being duly sworn,deposes and says that he/she resides at2 Longledge Dr (Print Name of;Npplicant) t Ao.and Street) in Rye Brook in the County of Westchester in the state of NY that (City Town 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:$ 27,565.66 for the construction or alteration of: Roof Replacement, Asphalt Roof 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 orpremises 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§250-10A.of the Code of the Village of Rye Brook. Sworn to before me this 16? Sworn to before me this day of O g,(- 20--2'4 day of()(�� ' m,"M Si o operty Owner Signature of Applicant David Bolen „aeeeeeeeee,, Andrew Prchal t.1 t Name of Property Owner ,' N Y Z /`/��., Print Name of Applicant �pTA/� co, otarc I u1 1 y N" = ota Public 0. = eY C\ ' , p�AUBL\G\�, �yE BRC��. • �9�2 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.or� - - - - - - - - - - - - - - - - - - - - INSPECTION REPORT - - - - - - - - - - - - - - - - - - - - ADDRESS : X � �Q AAA( �e 1�I': DATE: PERMIT# P Z q - QQ L ISSUED: 2'L SECT: /3S I�BLOCK:_L 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 �� J ❑ L.P. GAS _ ❑ FUEL TANK ~ ❑ FIRE SPRINKLER ❑ FINAL PLUMBING ❑ CROSS CONNECTION FINAL ❑ OTHER p�� ■ _ s a ■ 0 a q N \ W y N 1-1 � z W s W z a a. � Cl) s Lei to V en a �Le) 44 S q v w (A `y a � �i O W � a �, y Q w° o400b W W � clll*� . a I � isco = A r• ] �"'� FBI �'J j °� .'y^ c"'� sue+ '� ." / _ E+ 00 1�1 C/� W =ri Ln ►r� O w o v o v © w r`_I �..� z M A V (> _ o ~ ; J O all pip, oob z � z � v � K 00 ow en z N �/ O a.a [ Cj ■ 0.0 z o5ba, OLei � �Ln � p z W U L W W w 0" oS� a � � o Cl) 0 W o � w u cu BUILDING DEPARTMENT D u V ACE OF RYE BROOK J A N 1 1 2024 938 KING OFET RYE BROOK,NY 105 3 #1 -068 VILLAGE OF RYE BROOK v�W9v z BUILDING DEPARTMENT FOR OFFI( , [ISE ONLI : Approval Date: ermit 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: ROOF PERMIT APPLICATION Application dated: 01/1 1/24 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: 2 Longledge Dr SBL: 135.65-1-33 Zone; R,12 Property Owner: David Bolen Address:.2 Longledge Dr Rye Brook, NY 10573 Phone#: (914) 935-0979 Cell#: email; db3l-email@gmaii.com 2. Applicant: Andrew Prchal Address: 194 S Water St Greenwich CT 06830 Phone#: 203 388 5555 Cell#: email: kauanny.zanetti@gunnerroofing.com 3. Rooting Contractor: Gunner LLC Address: 194 S Water St Greenwich CT 06830 Phone* 203 388 5555 Cell#: email: kauanny.zanetti@gunnerroofing.com 4. Job Description,list all Methods&Materials: Remove&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, undedayment,asphalt shingles, and proper ventilation. Install new white aluminum 6"K-Style Gutters using hidden fasteners elbows and downspouts 5. Estimated Cost of Job: S $27,565.66 (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 comerproperty,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:(0-Yes:( )Attached No: ( )•Yes:( )Number of Cars: 10. Is roof peaked,hip,mansard,flat,etc: 1 pitch 11. Estimated date of completion: Feb 5th 2024 t- 6/1/2023 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 YORK,COUNTY OF WESTCHESTER ) as: Andrew Prchai ,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 contractor 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 fore me this Sworn to before me this ` I day of , 20 day of �(�Cl( �' 120 C�Z Signature of Property Owner Signature of Applicant Print Name of Property Owger Print Name of Applicant vo�,�f �� r 10,14 ry Pu o Public JPNNY Z,%�.,so Of ,,' o UB00 IZ I. - = ;0 A G ANC Ug 4� exp C; 41 •,,�''pNN��,G�\`V,• ''0HNECTIG� -2- 6/1/2023 DocuSign Envelope ID:CC627D7C-7C54-44CF-A6F5-50BE5952EED7 HOME ENERGY REPAIR LLC d/b/a GUNNER ROOFING LLC 78 Halloween Blvd., Stamford, CT 06902 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-1-1 8342-21-0001 5 www.gunnerroofing.com PROPOSAUCONTRACT This construction agreement (the "Agreement") is made and entered into by and between Home Energy Repair LLC d/b/a Gunner Roofing LLC (hereinafter referred to as "Gunner Roofing" or "Contractor") and David Bolen (hereinafter the "Owner" or "Customer") whose address is 2 Longledge Drive 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. Scope 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 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 $18272.66 (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/Completion: The estimated start date of the Work is February 1, 2024 and the estimated completion date is February 5, 2024;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 (20) percent. 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. DocuSign,Envelope ID:CC627D7C-7C54-44CF-A6F5-50BE5952EED7 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 hereby D uSi ned accepted. Contractor is authorized to do the work as Home Energy Repair LLC /a didr er oofing LLC specified. By signing below, Customer acknowledges that 6 r660" Customer is the owner (or authorized agent of the owner) of Authorized Signature: the property where the work is to be performed. Contractor will provide Customer with a copy of this Contract after it is By:Edward Prchal signed by both parties. ro �Docu Signed by: j b6 t ln, Its: Customer Signature: Date: 12/27/2023 Date: 12/27/2023 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. DocuSign Envelope ID:CC627D7C-7C54-44CF-A6F5-50BE5952EED7 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 Shingles in WEATHERED WOOD (color) • Use Roofing Coil Nails- 1 1/4"(7200 Cnt) • Install Elastomeric/Caulk(Clear)(10.3 oz) • Install GAF WeatherWatch 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 WeatherBlocker(100 LF)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" • Install Copper Flat Sheet Metal around Chimney and install cricket • Clean up all job-related debris and materials • Provide dumpster • Provide GAF Golden Pledge Warranty(50 years on materials and 25 years on labor and 30-year Stainguard Warranty • Our crews are licensed and insured • Crews will maintain safety requirement at all times during the construction process • Provide owner with all manufacturer warranties • Detached structures included: No • Gunner will pull permit for owner(and subsequently close)and save receipt for reimbursement from customer(if needed Gutters: • Install K-Style 6"Gutters/Downspouts • Install Seamless.032 Aluminum Gutter • Install new aluminum elbows and downspouts DocuSign Envelope ID:CC627D7C-7C54-44CF-A6F5-50BE5952EED7 EXHIBIT B - SCHEDULE OF PROGRESS PAYMENTS Work or Services Performed and Materials to be Supplied: Amount Due Upon Completion: La� DS Deposit $1827.27 At Start of Job $10963.59 Completion $5481.8 ^w^�,�"'�,`sw�4'.//�+�'�e��,./ �,r�4j•""�i'.n,�.e•-+,�,r.1�, '1,n�,i.� 000 .s� I � � , • � a•n ''•la ,rl+•nA •v +t+ ' ►A .. u•nA •; N! ;�•;� ► !+ ;qn•.nA ,tN. v gip,,. I 15• 1 1 . 1 1�h �.11' 1! 1• 11 I► �5•�'1 ���, �1 !«O/� 5111.5�1� y i_....5� t,SL'� ..tt4 _u.il�'��•�.�__f/b..J111..���-7 --�S all_51 George Latimer . ` XxS James Maisano Flr �a Westchester County *Executive Director,Consumer Protection ,11 i -� Department of Consumer p Protection j Nome Improvement License ` GUNNER LLC 194 SOUTH WATER STREETa`. ?. GREENWICH.CT-06830 R 5co»� ;F-4 This license is issued in accordance 15 ith Article XVI of the Westchester County Consumer Protection Code and is valid onh,upon presence of the official department seal.Proof of citizenship or immigration status is not required for issuance of this license. �.- NO'f FOR FFDFRAL PURPOSES �l�a ; �o�ConsunP `.�con� k1ZJ y�f"- i License Number rF °� Date of Expiration r' j WC-35879-H22 0 tkico» "• 1110112024 Item) %� + ester CO32 ��! �, -�ts•�-err -�c� �,:-1 ,s, - cr. � 1 �,=�� -M' '1, 1: c .i,ttl/- tt. l 1 :; ut t �5-x.a '�9f` .;, ;5--�-c_ ?�-.-►-•'_. 'r�.', «ol.� �► Ifs • .,I.Ilt�r. ft! 1�1��'.1 1 t�i/iti d, � i11itS ��il lttr', q I�11�,5 !w` fit. lw .\1 „'',� ►TA�Y. ti54W�w�f.�W �tilwNx� ie. �. <t. -S%�. �Nlw� t..�yy�N(�►�w�11�,,���� �f/wr{���.'i��:_ Y Vomit ���Y•' � �,�..:. �4.V��� 1 '+}j�°� � �4Z:,Y_�'�r p. �cry,�j,1�� � �d' "�,.� �.�,,'ti•i"P�'�J�'�y.�y�''�i1�'4�"���.#�.. ..,;X`..Z.�yJ. '•�a� �•y FI�\`ice .�•� �Y1� Client#: 1952221 HOMEEN DATE(MM/DD/YYYY) ACORD. CERTIFICATE OF LIABILITY INSURANCE 01/0a12023 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 CONTACT NAME: Carmel McCabe USI Insurance Services LLC PNHcN� Ext_855 874,0123 F A/C No: 203 634-5701 530 Preston Avenue E-MRESS:JUL usictcertificatesC�Dusic.com Meriden,CT 06450 ADD 855 874-0123 INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Admiral Insurance Company 24856 INSURED Gunner LLC INSURERS:Arbella Protection Insurance Company 41360 194 South Water Street INSURER c: Liberty Mutual Insurance Corporation 33600 Greenwich 06830 INSURERD: 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 ADOLSUBR POLLEI Y EFF pp�I Y XP LTR TYPE OF INSURANCE _ INSR WVD POLICY NUMBER (MWO MID LIMITS A X COMMERCIAL GENERAL LIABILITY X X ICA00004513601 4/21/2023 M11/2024 pEAACCHppOECTCURgREENCE $1 000000 CLAIMS-MADE 1 OCCUR PRE %J Ee p�rD. $50 000 X 5,000 ded BI,Phy MED EXP(Any,one person) S5 000 Dam,Par Ad] PERSONAL a ADV INJURY $1 OOO 000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE S2 00O OOO X POLICY ECT LOC PRODUCTS-COMP/OP AGG $1 000 000 OTHER: $ B AUTOMOBILE LIABILITY 1020117559 1/7023 M11/2024 COMBINED SINGLE LIMIT Ea a««+dant 1,000,000 X ANY AUTO BODILY INJURY(Per person) $ AUTOS ONLY ED SCHEDULED AUTOS BODILY INJURY(Per accident) $ HIRED NON-OWNED PROPERTY DAMAGE X AUTOS ONLY Ix AUTOS ONLY Per accldent $ _ $ A UMBRELLA LIAR X OCCUR X X CA000W13601 O4/21/2023 MIPA24 EACH OCCURRENCE $5,000,000 X EXCESS LIAR CLAIMS-MADE AGGREGATE $5,000,000 DED X I RETENTION S $ C WORKERS COMPENSATION X WCS-33S-381014-019 1/19/2023 01/19/2024 X PER oTH- AND EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N E.L.EACH ACCIDENT S 500,000 OFFICER/MEMBER EXCLUDED? a N/A (Mandatory In NH) E.L.DISEASE-EA EMPLOYEES 500,000 "yes,describe under 500,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT S DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional 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 generalliability 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 iri, ^^^^^A 832024199 Gunner LLC 7 r 194 S Water St ■ Greenwich, CT 06830 SCAN TO VALIDATE AND SUBSCRIBE POLICYHOLDER CERTIFICATE HOLDER Gunner LLC VILLAGE OF RYE BROOK 194 S Water St 938 KING STREET Greenwich, CT 06830 RYE BROOK NY 10573 POLICY NUMBER CERTIFICATE NUMBER POLICY PERIOD DATE W2485 011-7 381847 09/12/2023 TO 09/12/2024 01/08/2023 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://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 �V DIRECTOR,INSURANCE FUND UNDERWRITING VALIDATION NUMBER: 630619715 U-26.3