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HomeMy WebLinkAboutRP24-019PERMIT # SECTION TYPE OF WORK JOB LOCATION T. COST vcO #.,CdcA TCO # DATE: 5 LOT FEE ATE FEE DATE FOOTING FOUNDATION FRAMING RGH FRAMING INSULATION PLUMBING O RGH PLUMBING GAS SPRINKLER ELECTRIC LOW -VOLT 0 ALARM E3 AS BUILT O � J FINAL C9iy)y3yL5759 3 /) a70-'i3N 9 OTHER APPROVALS ARB 80T PB ZBA OTHER DRY C Lt Chu�JJ V t w 19 Q 1�u4 Vuy VILLAGE OF RYE BROOK MAYOR 938 King Street,Rye Brook,N.Y. 10573 ADMINISTRATOR Jason A. Klein (914)939-0668 Christopher J.Bradbury www.iyebrookny.gov_ TRUSTEES BUILDING & FIRE INSPECTOR Susan R. Epstein Steven E. Fews Stephanie J.Fischer David M. Heiser Salvatore W.Morlino CERTIFICATE OF COMPLIANCE June 21,2024 Kamlesh Dungersingh Kothari& Charul Kothari 6 Heritage Court Rye Brook,New York 10573 Re: 6 Heritage Court,Rye Brook,New York 10573 Parcel ID#: 124.65-1-20 Roof Permit#24-019 issued on 5/1/2024 to Re-Roof Existing Building This certifies that the new roof,installed under the above captioned permit has been satisfactorily completed. Sincerely, Nv�'� ��, v. Freddy DiVitto Assistant Building&Fire Inspector /to ECE �WEB BUILD G DEPARTMENT For office use only: PERMIT# (7 —61 g JUN 14 2024 VIL OF RYE BROOK ISSUED: S— _4 I 8 KING STRE OF BROOK,NEW YORK 10573 DATE: VILLAGE OF RYE BROOK 9 -06 , C�� FEE: 1z� PAID BUILDING DEPARTMENT www >t r-o k)-or APPLICATION FOR CERTIFICATE OF OCCUPANCY9 CERTIFICATE OF COMPLIANCE., AND CERTIFICATION OF FINAL COSTS TO BE SUBMITTED ONLY UPON COMPLETION OF ALL WORK, AND PRIOR TO THE FINAL INSPECTION Address: (o 44 ( CY, �V f3ct-atC )_i�q I o S -7 '3 Occupancy/Use: 1—fate Parcel ID#: 1 c944 - (.0E — % —cl'O Zone: Y �` Owner: (1,Aj4 L,,e_SP4 Zr �'` �'`' K`' I Address: 6 K r< Gz I e CB e--Y Fa G y_c� t-k o P.E./R.A. or Contractor: A-T(,A-rvTC e1-PT Lr_S. Address: '( 3o Cr-"T_Ye4 I?Lu b, y:v tT-_b, Person in responsible charge: Address: N`� I(}3 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: K 1'A- L4,_ S-4 being duly sworn,deposes and says that he/she resides at 16 W—t T-A-&-(zr C.-L (Print Name of Applicant) (No.and Street) in �_u 1=b ie� ,in the County of W 8 S T C4-t in the State of 645, ,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:$ O-CYa for the construction or alteration of: Q— �zs0 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. �p Sworn to before me this y Sworn to before me this y V day of j U-V`Z , 20 a `{ day of _J�-�"-� , 20 a� Z4LA_���_ a P_�Sie of Property Owner Si ature of Applicant K,')yA t r y" k yT{A jP f A-M C"H, t o-1 R72 r Print Name of Property Owner int Name of Applicant icant '^l c Notary Public Notary Public MICMI1Et.A.NAPIMAW NotaA►INAlk lOft d NOW YO* MICHAM A.NAPOUTANO s%12r2021 Rep. No.ONA480M tIOMry Public,State of New York OualHied M eater County kpims March 16, 20, Qualified In County Commisslo�Expires Commission Expires March 16, 2n�2 QyE BRC�v� 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: (-) - -2 y L 'J1-I PERMIT# ISSUED: SECT: BLOCK: / LOT: 2- 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 ❑ L.P. GAS ❑ FUEL TANK ❑ FIRE SPRINKLER ❑ FINAL PLUMBING ❑ CROSS CONNECTION ❑ FINAL ❑ OTHER N O rJ 04 4 a � u I1 ■ Vi r G' v� r PLC � z A ° a ■ © z oAat - N4 A . O ►.� O O o v o W s Wbi 2 z A C~/3 rn v v W Q `"v' G� pq �' H a sa 0 ■ x Q a a co 06 N H F� w 0 w E V r O00 A a VP. ~ ■ �T� R. S °D 03 u 1zi v, s CN N O00 _ WCf q " a o z 2 W o o � oE zc °aa.dv !1-4 cn w O roe° u U MW V d V v z g °` � a F� G7 A z O w m a Z W Ey p BUIIrD D��'ARTMENT V E OF RYE BROOK 938 KING T ET RYE BR(K)K,NY 10573 EP -0668 V!LLr: r- OF RYF: BROOK FOR OFFICE USE ON Y: !J Approval Date: APR 2 9 Za2�Pcrn ' 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: /92XPermit Fees: C) DOF ROOF PERMIT APPLICATION Application dated: cs 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: (a CO'— SBL: lt)7 i&5"1 a0 Zone: '40ab Property Owner: t<AM C &' fA'91)L-k077_`Ad ess: 6 "99(T*&F CL Phone#: of 4 At-9 4 S7 f r'1 Cell#: 9 J L4 t13 t[S` 7 13'1 email: 2. Applicant: 1C&N C-f-9;4 K.a 1_'2 Address: Phone#: Cell#: email: 3. Roofing Contractor: /-71-MlT7C F;C rtkt0)tS Address:100 CAI&QUY/J 6t-4rb, > i2l+liiJ� Nth�(7 Phone#: 6 31.?7043 Q I Cell#: email:6&rV\aL' Q�- czr 4. Job Description,list all Methods&Materials: i t A-9 eA.1 Z_P Cie.,AJ 6-1-6_S S. Estimated Cost of Job:S J' 4 07"'P Z (NOTE:The estimated cost shall include all site improvements.labor,material,scaffoldiAf.fixed eyui mt,professional fees,and material and labor which may he donated gratis.) b. If comer property.indicate street front 7. Construction Type:_ t2 — kDo F NYS Construction Class: 8. Number of stories: Height: 9. is garage being re-roofed:No:( )•Yes:(v(Attached No:( )•Yes:(-yNumber of Cars: L 10. Is roof peaked,hip,mansard,flat,etc: 11. Estimated date of completion: "07 -t- 1a3a2o23 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: V_ -nd�y.�l-� k t-)E /y 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 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 ")3� Sworn to before me this P&- day of Aff;I 20 P� day of i f 20 gl__ Signature of Property er Sighature of Applicant Print Name of Property Owner Print Name of Applicant Notary 116f lic NotaryA6ublic ANGELINA LLOYD ANGELINA LLOYD NOTARY PUBLIC,STATE OF NEW YORK NOTARY PUBLIC,STATE OF NEW YORK Registration No.OILL0003053 Registration No. 01LL0003053 Qualified in Westchester County County Qualified in Westchester County County Commission Expires March 20,20 Commission Expires March 20, 20 2� HIY-d.!"..iJtlUlL04 fI(. nlue 1 nv.crl.. �--- e.Jk f—ar.e.R..III. ., VAPR6 2024 April 17, 2024 VILLAGE OF RYE BROOK BelleFair ARB BUILDING DEPARTMENT 24 Bellefair Blvd Rye Brook, New York 10573 Kamlesh Kothad 6 Heritage Court Rye Brook, New York 10573 Re: Roof Replacement on Home It Garage Dear Kamlesh, We write in response to your request to the ARB for approval of the installation of GAF Timberline HDZ Lifetime Roof Shingles in Slate on your home and garage situated at 6 Heritage Court, Rye Brook, New York. We are pleased to inform you that based on the details of your application, your application has been approved. Once this installation is complete contact our FirstService representatives, Rafael Reyes or Michael Napolitano so that a final inspection may take place. Please be advised that our approval will be expressly conditioned upon your continued compliance with Schedule D of the Declaration. Accordingly, if the aforementioned fails at any time to comply with the Regulations, the ARB reserves the right to direct modification or the removal of the improvements at your sole expense to ensure compliance. Please note that approvals are valid for one year as of the date of this letter. As a reminder, certain alterations wilt require the approval of the Village of Rye Brook's Building Inspector or Engineer. You shall be responsible for obtaining all required approvals and permits. The Village of Rye Brook will consider applications after BelleFair ARB approval is given. The Village of Rye Brook approval does not preclude the need for ARB approval, nor does ARB approval relieve you from any responsibility of obtaining Village of Rye Brook approval. If you have any questions, please do not hesitate to contact us. Very truly yours, The BelleFair Architectural Review Board Prepared For Kamlesh Kothari hall 6 Heritage Ct ATLANTIC EXTERIORS INC.ROOFING 8 SIDING Rye Brook, NY 10573 (914)434-5759 Atlantic Exteriors Inc Estimate # 8560 Date 02/29/2024 130 Carolyn Blvd Unit D Farmingdale, NY 11735 Business / Nassau H0808360000 Suffolk Phone: (631) 270-4349 Tax# 49369-H GAF Master Elite 45463 Email: atlanticexteriorsinc@gmail.com Web: atlanticexteriorsinc.com Description Total GAF LIFETIME ROOF SYSTEM WITH GOLDEN PLEDGE WORKMANSHIP WARRANTY $0.00 *Remove the existing layers of roof shingles down to the sheathing on all facets of the house roof. *Inspect roof deck for damaged and compromised areas of sheathing. *Replace up to (3)sheets of plywood,thereafter shall cost an additional $3.50 per sq.ft. *Install F-5 1/2"aluminum drip edge along the eaves and rakes of the roof to provide for proper runoff of water, directing water away from the fascia and into the gutter. *Install GAF Weather Watch Ice and Water Leak Barrier along the eaves, in valleys and around all roof penetrations.Soffit areas greater than 12"shall require a double course of GAF WeatherWatch Ice and Water Leak Barrier as per manufacturer's specifications.This leak barrier helps keep water, snow and ice out of the most vulnerable areas of your asphalt roof. *Install GAF WeatherBlocker Eave/Rake Starter Strip Shingles with factory-applied Dura Grip Adhesive.This product tightly locks down the roof edges at the eaves and rakes. *Install GAF FeltBuster Synthetic Underlayment to cover the roof deck.This product provides a critical layer of extra protection between your shingles and the roof deck as well as reducing inside moisture that can become trapped in the roofing system,which can cause mold, mildew, and extensive structural damage. *Replace existing waste pipe flashings for a proper seal around the plumbing vents. *If applicable: Install a Custom Copper Chimney Flashing with the counter flashing set into masonry on the chimney.Chimneys greater than 24"wide shall require the construction of a "Cricket"(small diverting roof)for preventing build up water behind a structure by redirecting it away. *Install GAF Timberline HDZ Lifetime Roof Shingles using six 1-1/2"galvanized nails per shingle. GAF HDZ's offer an architecturally stylish look using proprietary color blends and an enhanced shadow effect for a genuine wood-shake look.The LayerLock Technology mechanically fuses the common bond between overlapping shingle layers creating a stronger attachment. GAFFS legendary Page 1 of 8 Dura Grip sealant pairs with the smooth micro-granule surface of the StrikeZone nailing area for fast tack and superior adhesion.This new shingle technology offers a wind proven wind warranty with no maximum wind speed limitation.The 25 Year Limited Warranty StainGuard Plus Algae Protection helps ensure the beauty of your roof against unsightly blue-green algae. *Install GAF Cobra Ridge Ventilation System.This system allows heat and moisture to escape, and provide a significant 14.1 sq. inches per linear foot of net free ventilating area. *Install GAF Timbertex Premium Two Ply Hip & Ridge Cap Shingles.Timbertex offers excellent protection at high-stress areas of your roof by its extra-thick, double layered design all while providing a distinctive, bold appearance. *If applicable: Inspect existing skylights for compromised flashing once the roof shingles are removed. If the flashing is compromised then a replacement skylight with a warranty will be suggested. If the homeowner declines,they agree to not hold Atlantic Exteriors Inc responsible for any leaks to the said unit. *If applicable: Replacement of the existing skylights is highly suggested as skylights are good for generally 25 years. Upon agreement of replacement of the units, an additional charge will be applied to do the said work.Atlantic Exteriors Inc. is not responsible for any interior disturbances when working on existing units or replacing existing units with new. *Replacement of damaged fascia boards shall cost an additional $9.95 per linear foot. *Atlantic Exteriors Inc.will not be held responsible for any unforeseen, improperly located electrical or HVAC lines located below the roof deck. *Atlantic Exteriors Inc.will not be held responsible for any disturbances to the interior drywall on the ceilings or walls such as"popped fasteners" in which the nails or screws on the drywall can cause the joint compound to expose the fasteners.This rarely occurs and is caused by the weight of the existing roof shingles being removed as well as the fastening of new material being installed. *Atlantic Exteriors Inc.will not be held responsible for any debris that may enter the attic space which may occur during the replacement of the roof. It is suggested that the homeowner remove or cover any belongings. *Removal and proper disposal of debris from the job site.After the removal of debris,we shall walk the property with a high powered magnet to ensure a thorough cleanup of nails from the premises. *If applicable, all permits are to be submitted by the homeowner. *This roof system will be installed according to manufacturer's specifications. *This scope of work carries a Transferrable Non Pro-Rated GAF Lifetime Manufacturer's Warranty, an Unlimited Wind Warranty and an Exclusive GAF Golden Pledge Twenty Five Year Workmanship Warranty. These warranties can only be offered by a GAF Certified Master Elite Roofing Contractors. Subtotal $0.00 Total $0.00 Thank you! Page 2of8 ATLANTI C EXTERIORS INC . ROOFING & SIDING A + r Rating BBB. Page 3 of 8 y 4 r } 4yt t L. t MASTER ELITE o� G� O� G �O �O Page 4. 0 StainGuard'"' Algae Protection GAF STAINGUARD ALGAE sy'''�'! PROTECTION � � P 1 . lifetime Shingles 6 2. Cobra Attic Ventilation 3. Roof Deck Protection 2 4. Leak Barrier 4 0 5. Starter Strip Shingles 3 b. Ridge Cap Shingles a s .M� F v Page 6of8 AVERAGE GAF GAF GAF Comparing Roofing INDUSTRY tems SYA SILVER Golden System Warranties WARRANTY Plus PLEDGE Pk*e Manufacturing Defect Coverage Standard Standard Extended Extended •Overall coverage period 50%are Lifetime Lifetime Lifetime Lifetime • Up-front(100%)coverage period 30 Years 50 Years 50 Years 50 Years •Covers roofing system Partial Entire System Entire System! Entire System • Cost of installation labor included 30 Years Lifetime Lifetime Lifetime Workmanship Coverage • 100%Coverage period None 2 Years 10 Years 25 Years • Misapplication of certain fleshings None 2 Years 10 Years 25 Years •Tear-off costs included NO YES Yes YES • Disposal costs included NO NO Yes YES Peace Of Mind •Contractor factory certified NOT USUALLY YES Yes YES •Warranty transferable for free NO YES Yes YES •Good Housekeeping protection NO YES Yes YES 491 Pak � r 1 / Page 7of8 0• 4 n E30 4.• I y. ,g Uzi A O � ♦r V C. z m cc • L r..� pOf ection tom► z Q� O � w W J F- O > W m A ; o C� O U_ Z Z y ¢Lu 'O 0 O Z O CY e 00 � QNEW o r.r E Q LL O = Q U X w Z o � u u u "J Y L � ' V it �1 AC-"RO CERTIFICATE OF LIABILITY INSURANCE Cw-aiMMCO-•ry.- Ca *11:4 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RKOfTS UPON THE CERTIFICATE HOLDER THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE A"ORDED BY THE POLICItS BELOW. THIB CIATWICATE OF INSURANCE DOES NOT CONSTTTUTE A CONTRACT BETWEEN THE ISSUING NtSUREit(S),AUTMORtMD REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT If the c*fwkAfe holder man ADDITIONAL k6UK0.tTle pofic3r(iesl must Nave ADO Rio ons or be endorsed If SUBROGATION 18 WAIM,suboct to the terms and conditions of the policy.cmuln policies may reglAre an endortennrlt. A stat mernt on this certificate does nol condor rights to the certnccab hold"in lieu of such dndarssnkenlla. OAOOtlttaCGINITACTfUc7telk Boizma i MAW Aw�ptlenUC«t�on, wlotlt (0.1tn 4lOD (B31)g2Jgd IBC Grua-*A.h,l� 14 tea. Mr,I�ais1 A""wo o_cwvtAm NAIL I 3eevel. _ N'r tt`3i MON=A d•]nl wt McLIarlCe Company 246M ,es,rttc• *a~e Attanu ExIork <Irc Ole~C 1 lD CdrdYn at" st>KA�bt S Ltrw D — - mviwstt I Frmr�poale NY lit35 r COVERAG" M"FICATi NWAW: 24 25 Mmru Tress Ib TO CERTFY THAT t11E FOUCEB OF PISURAACE LttfTEO eEl WY W#4 BEEN INUED TO THE fit LRM NAWD ABdVE FOR THE POLICY PEWO INCITED NOTI 111)"IiTANDNC ANY REUL►/tCAtENT TERM OR CONDITION Of AM'CONTRACT Cq uII,*R DOCU W-MT*tTH RESPECT TO V*4CH TWO CERTIFICATE MAY W IBSLED OR MAY PERTAA THE ikauRMICE A/FQRDED BY THE POLIMS 0E*cr4BED HERFM N SI RI,ECT TO ALL THE TMIO' EXCLUSIONS AND CONDIR Cots OF SUCH POLICIES L/ZITS(HOWN#MY WWE BEEN REDWxD BY PAID CLAIM6 -hMTree tlP MfYJIA�rCN: �p, POLICY allot twlwlascw oo�wAl uAaaln I,Boom — cvr�c u+u PIN OCCIA I �OIIA00 WFD EIF-A• j 5.000 A r cwgCctan�tEr.e 01,31=4 0113tr7o?5 1,000000 P0404AL a uw IXhMf w0011E4A1!LMR OFR tllNI7RAl TE 2.1XI0,000 OT _ VCl ICY® T OF4000 To-CCWMP AGO 1 2 000,OW AUTOOOKi U#AL Rr 4LD 6f.IQ..t tM' I AW AVTO - GCM t 4AAY Or Paww) a A1JfOa 6w, t'D eiX1:�N l aY lfr 4 L Home M0101ovMec rscct a"v E A MG OPLr A4lros Oran t+.arsrart I IRIaIISLLA LAN iNCBLBLOA anslsa�At4 GA'F aatiaTp► _ --,-- AIO MtATlIt IMRsrrr r,a ST MPrPeIIP�E E10.CLaORD7 a.Tvf El)NIA b..�,'O�KXOQCYr oil" 1 - ops 4NOW k ne tl WAASK• 4FE'WILM era. attrr* I MSeRiPIlal1 OF OPOMTtCMe I Lo"TWIM I YOatiaa Nca0 I"-A/Mona awrana Brardrll.M sr Oawad a own,year w Mai" _ As teepalO IO 6s.lwsl Lrldlty If rpuihd b/.,wits,uxwrau tM ftdoti.tq ere tnclutds�ss aodfotWl Ins/fld per I+e Po"form CG2010 Whip of Ryr boo ce iR CMCKLLATM 5N0IA.D My OP"N"0"DUCRO D POLJCOS N GMCE.LBD WORK Tw•x►IRATION"TV 1tI tow,tionca ro"a Of<+IMRBD IN Vile"CO Rre Book ACCONOMWE WrTW TtM POLICY P1111MBIONS. 938 KirV Sir"I AUTHOOrM Irt►11101NvltfVe Rtie Brook NY Q 1lq•201 S ACORO CORPORATION Ail nyMs re"rv" ACORD 24(Me" The ACORD name and logo are n Isiftred marks of ACORD NYSIF NOW York State Insuemms F c. PO 902 M99.Albany,NY 12206 1 nysll.com CERTIFICATE OF WORKERS' COMPENSATION INSURANCE O ""A A A 113636606 LEVITT•FUIRST ASSOCIATES LTD S20 WHITE PLAINS ROAD, 2ND FL DI TARRYTOWN NY 10691 SCAN TO VALIDATE AND SUBSCRIBE POLICYHOLDER CERTIFICATE HOLDER ATLANTIC EXTERIORS, INC VILLAGE OF RYE BROOK 130 CAROLYN BLVD UNIT D 938 KING STREET FARMINGDALE NY 11735 RYE BROOK NY 10573 POLICY NUMBER CERTIFICATE NUMBER POLICY PERIOD DATE GCY NUMBER SM20 M2912023 TO O&2W2024 41712024 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WfTH THE NEW YORK STATE INSURANCE FUND UNDER POLICY NO. 2433 723-0 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 CANCEL.LAT*104, OR TO VALIDATE THIS CERTIFICATE,VISff OUR WESSR'E AT HTTPS:MWWW.NYSW.COIWCERTICERTVALASP,THE NEW YORK STATE INSURANCE FUND a NOT LIABLE IN THE EVENT OF FAILURE TO ONE SUCH NOTWXATION& THIS POLICY DOES NOT COVER CLAIMS OR SUITS THAT ARISE FROM BODILY INJURY SUFFERED BY THE OFFICERS OF THE INSURED CORPORATION. PRESIDENT ROSERT SODA OF ATLANTIC EXTERIORS INC (ONE PERSON CORP► THE POLICY INCLUDES A WAIVER OF SUBROGATION ENDORSEMENT UNDER WHICH NYSIF AGREES TO WANE ITS RIGHT OF SUBROGATION TO BRING AN ACTION AGANST THE CERTIFICATE HOLDER TO RECOVER AMOUNTS WE PAID IN WORKERS COMPENSATION A XOR 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 WANED. 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 SU CE FUND T,// � DIRECTOR INSURANCE tu%o uNOERWRfT*4G VALIDATION NUMBER:343344709 U-26.3