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HomeMy WebLinkAboutRP24-085PERMIT ## �( SECTION TYPE OF WORK JOS LOCATION CONTRALTO EST. COST ti \/ C/O #_� TCO # FOOTING FOUNDATION FRAMING RGH FRAMING INSULATION PLUMBING 0 RGH PLUMBING GAS ED SPRINKLER ELECTRIC F1 LOW -VOLT 0 ALARM M AS BUILT 0 FINAL �5 DATE: / 7 Ecp. 71 BLOCK I,QT Jai ;Pmm �12 ramie ilaeir9 C /77o5/--0// 7 �71�e J.LC C91 7� 7- ?6 6 4 FEE `& _ FEE 150 /ob DATE _ FEE DATE INSPECTION RECORD DATE INSP 1>- OTHER APPROVALS ARB BOT Ps — ZBA _ OTHER �yE BRnv� {.L11`lyt,J.l V (Co VILLAGE OF RYE BROOK MAYOR 938 King Street,Rye Brook,N.Y. 10573 ADMINISTRATOR Jason A. Klein (914)939-0668 Christopher J.Bradbury www.ryebrookny.gov TRUSTEES BUILDING & FIRE INSPECTOR Susan R. Epstein Steven E. Fews Stephanie J. Fischer David M.Heiser Salvatore W.Morlino CERTIFICATE OF COMPLIANCE March 17,2025 Todd Kaplan&Barrie Suskin 11 Birch Lane Rye Brook,New York 10573 Re: 11 Birch Lane, Rye Brook,New York 10573 Parcel ID#: 135.43-1-5.23 Roof Permit#24-085 issued on 7/17/2024 to Re-Roof Existing Building This certifies that the new roof,installed under the above captioned permit has been satisfactorily completed. Sincerely, %0­ 4 Steven E. Fews Building&Fire Inspector /to D BUILDING DEPARTMENT DD For office use on1 JAN 3 1 2025 VILLAGE OF RYE BROOK ISSUED:PERNUT#7—/ 7—�y 8S VILLAGE OF RYE BROOK 938 KING STREET,RYE BROOK,NEw YORK 10573 DATE: /-__3 BUILDING DEPARTMENT (914)939-0668 FEE: j,/' s(; PAMX w-vyw-rvebrookny.Lvov APPLICATION FOR CERTIFICATE OF OCCUPANCY, CERTIFICATE OF COMPLIANCE, AND CERTLFICATION OF FINAL COSTS TO BE SUBMITTED ONLY UPON COMPLETION OF ALL WORK, AND PRIOR TO THE FINAL INSPECTION +p Hrr+rrrrr+riH rrgrrrrrr rrrrr+gtr►♦Nrrrrr rrarrrrrrrrrr♦rrrrN rrr♦♦rr+rrrrrrrrrri rirra tr rrrY rrrrrrr rrrrr rsararrrsrr roar Address: 11 Birch Lane Single family Parcel 113 , ��� — 6-f c3� Zone:�� Occupancy/Use: RPsiriantial p l ID# s Owner: Todd Kaplan Address: 11 Birch Lane P.E./R.A. or Contractor: Perry Verrone, LLC Address: 12 Center St, Pleasantville, NY 10570 Person in responsible charge: Perry Verrone Address: 12 Center St, Pleasantville, NY 10570 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/a Iteration herein mentioned in accordance with law: STATE OF NEW YORK, COUNTY OF WESTCHESTER as: Perry Verrone being duly sworn,deposes and says that he/she resides at 12 Center Street (Print Name of Applicant) (No and Street) in Pleasantville _,in the County of Westchester in the State of NY that (Gty,'Teen Villages 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 17,900.00 for the construction or alteration of: Roof removal and replacement 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 crected/complctcd 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 thenr Code of the Village of Rye Brook. Swam to before me this �) y' Swam to before me this C) f ,20 day f _i ,20 �1 and v-1) igna a of Pr city Owner Signature of Applicant Todd Kaplan ___ ►� Perry Verrone Print Name of Prope Owner l - ' ����� P ' t Name of Applic yt � Notary Public 0,`, Notary Public I1 1 �yE BR1. C��. 1932 BUILDING DEPARTMENT ❑����BV' ILDING INSPECTOR b"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 :- 1 , 1 2 C� DATE: 3 - IV y� PERMIT# \\ T 1 0 ISSUED: SECT: BLOCK:LOT: S 2 LOCATION: j` co� OCCUPANCY: Z / -" ❑ 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 � a s a a. h a in N00 _ C N a 'a q a N R+ _ \ n v ro ti ci ZLO O I—I O o e� Q C aO I - _ L J^ rr 0 w g w I u gov V o W R" I� G� I „V� ►� W r/� � y � .v �t oc i k 0-4 '-7 V W ° Z O V O z ate ' a' a o .11 �' rT0 . 1—� N 4 'd a r BUI5D, ENT DP � v VIOK , 5 ���� 010 938 KINGY 10573 VILLAGE OF RYE BROOK BUILDING DEPARTMENT *.*.*rts***�s*s�ss�*s•�*«**�***►***�*M***see**��**t+r�*s*w****�.+��**�*******�***s*****�**********s.**:«:*�.* FOR OFFICE USE O LY: -� ► -tee-( Approval Date: ` r 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: 100 Permit Fees: ****�«+****�**********�****�*a****«��********+**•a+*****�*�*r�*�*�***�**�*�**��*:wr*�«*s*�r*�r*sir■*s*s�r*: ROOF PERMIT APPLICATION Application dated: 7/12/2024 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. I. Job Address: 11 Birch Lane SBL:13.S. 41/13 —A IS f 43Zone:e IS Property Owner: Todd Kaplan Address: 11 Birch Lane Phone#: 914-774-0117 Cell#: email: scelf@icioud.com 2. Applicant: Perry Verrone Address: 12 Center St, Pleasantville Phone#: 914-747-7663 Cell#: email:-maria@perryverro eroofing.com 3. Roofing Contractor: Perry Verrone, LLC Address: 12 Center St. Pleasantville Phone#: 914-747-7663 Cell#: email: maria@perryverroneroofing.eom 4. Job Description,list all Methods&Materials: Roof removal and replacement 29 sq - see scope of Work attached 5. Estimated Cost of Job: $ 17,900.00 (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 comer property,indicate street frontage: 7. Construction Type: Residential - single famiy_ NYS Construction Class: 8. Number of stories: Height: 9. Is garage being re-roofed:No:dQ•Yes:( )Attached No:( )•Yes: ( )Number of Cars: 10. Is roof peaked,hip,mansard,flat,etc: peaked 11. Estimated date of completion: 61112024 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: Perry Verrone ,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. Swom to before me this �[J Swom to before me this i day �U1 201,4A dW of 20 �y Signature of Property Owne�C" 1'ql '�� Signature of Applicant +t I,,, srAr` �'�f P. Todd Kaplan = '°F NEW yp �x Perry Verrone Print Name of Pr tty� tie rAR�fjf i.� ~r��ll,l Print Name of A 1' { i N�T,gA, o RK� _ t1w,,r, �� —_ - y o,FAc«M , �"047.102 v F�LI I - �� O �y Notary Public '�.,501, io--- Notary Public /i3O,vrxY1REs 111111100 -2- 61112024 Perry Verrone, LLC 12 Center Street Pleasantville, NY 10570 info@perryverroneroofing.com Office: (914)747-7663 Fax: (914)747-7665 License WC 21701 H09 7/10/24 Prepared by Perry Chris Scelfo (Todd Kaplan) 11 Birch Ln Port Chester NY 10573 Homeowner: Todd Kaplan Chris: 914-774-0117 scelf@icloud.com PROPOSAL ROOF REMOVAL AND REPLACEMENT • All existing asphalt roofing removed and carted from job site • All rotted plywood replaced at$90.00 per sheet • GAF Weather Watch Ice and Snow barrier installed on all gutter edges,valleys and around skylights (6 feet up) • GAF TIGER PAW paper installed on the entire field of roof • GAF LIFETIME Timberline Architectural HDZ shingles installed on entire field of roof(SHINGLE COLOR: ) • GAF Cobra Ridge vent installed on all ridges of roof for attic ventilation • GAF TimberTex hip and ridge shingles installed on all ridges • Aluminum vent pipe boots installed over all vent pipes • WHITE Aluminum drip edge flashing installed around entire perimeter of roof • GAF Weather Blocker starters installed on all perimeter edges • New aluminum apron flashing on front side dormers included Page 1 of 5 Initial&Date: • Rye Brook Building Permit for an additional cost TBD • GAF Lifetime Material Warranty included • Perry's Roofing"10 Year Workmanship Warranty"included The price for the aforementioned work,which includes labor and material (excluding any additional plywood),totals to the sum of: $17,900.00 PRICE EXPIRES 90 DAYS AFTER ESTIMATE DATE ADDITIONAL WORK OPTIONS Please check appropriate box for desired extra work ❑ Carpentry/handyman work calculated on a time and material basis,said work performed at$120.00 per man hour plus material ❑ Liberty membrane installed over front roof entrance for an additional $900.00 ❑ Copper chimney flashing fabricated and installed for an additional $675.00, if needed El Step flashing fabricated and installed to meet current building code standards (aluminum or copper) for an additional cost TBD,if needed ❑ Perry's Roofing is a GAF Master Elite Installer which allows us to offer you top of the line warranties directly from GAF for a minor additional cost,please contact our office for details and pricing Payment schedule is as follows: 50% 3 Days Prior to Start 50% Due the day of substantial completion 5% Retention may be held for resolution of unresolved issues Payment is accepted via personal checks and certified bank checks (made payable to Perry Verrone LLC or Perry's Roofing), MasterCard,Visa,American Express,and Discover credit and debit cards.All card transactions over$2,000.00 are subject to a 3%service fee. Payments of$4,000.00 or more are accepted via ACH/wire transfer upon request. Any monies not paid as specified above will be subject to accrue interest at a rate of 1.5% monthly,and 18% per annum. Page 2 of 5 Initial&Date: QuickMeasure 11 Birch Ln, Rye Brook, NY 10573 (1) July 8, 2024 Roof Reports in Under an Hour Prepared For: Perry's Roofing A N ID Z/N- Z/[\- El Contents Measurements Overview 1 Roof Area 2,891 sq ft Top View 2 Roof Facets 21 Side Views 3 Predominant Pitch 7 / 12 Lengths 4 Ridges/Hips 125 ft Pitches 5 Valleys 59 ft Areas 6 Rakes 166 ft Summary 7 Eaves 241 ft Materials 8 QuickMeasure Top View Roof Reports in Under an Hour IF 4-VIA, kL j 1 -- E s Prepared For: Perry's Roofing © 11 Birch Ln, Rye Brook, NY 10573 (1) QuickMeasure Side Views Roof Reports in Under an Hour • e ■ ■ as • a 1�1 / + South + 1 .eJ -y�'� - •iK Jr Prepared For: Perry's Roofing © 11 Birch Ln, Rye Brook, NY 10573 (1) QuickMeasure Lengths Roof Reports in Under an Hour AFlash Step Drip N 56 108 407 -- -- - 64 1 11 11 20 /D 19 11 1 1 —1A— �T Eave Hip Rake Ridge Valley 241 7 166 118 59 Lengths in feet Prepared For: Perry's Roofing U 11 Birch Ln, Rye Brook, NY 10573 (1) QuickMeasure Pitches Roof Reports in Under an Hour A N c a o ( 7 1C a Pitches in inches per foot Prepared For: Perry's Roofing © 11 Birch Ln, Rye Brook, NY 10573 (1) • QuickMeasure Areas Roof Reports in Under an Hour A N 9 2 2 2 3 Areas in square feet Prepared For: Perry's Roofing 11 Birch Ln, Rye Brook, NY 10573 (1) QuickMeasure Summary Roof Reports in Under an Hour Pitch 0 7 8 10 Area 38 2,308 21 523 Percent 1% 80% 1% 18% Suggested Waste 0% 10% 13% 15% 17% 20% 25% Area 2,891 3,180 3,267 3,325 3,383 3,469 3,614 Squares 29 32 33 34 34 35 37 Roof Area 2,891 sq ft ARoof Facets 21 Pitch 7 / 12 Eaves 241ft Hips 7 ft Rakes 166ft Ridges 118 ft Valleys 59 ft Flash 56 ft Step 108 ft Drip Edge 407 ft Leak Barrier 611 ft Ridge Cap 125 ft Starter 390 ft Penetrations 3 Pen. Area 101 sq ft Pen. Perimeter 89 ft Notes 1)Measurements are rounded to the nearest whole number 2)Rakes are defined as sloped root edges 3)Eaves are defined as level roof edges.4)Flashing pertains to level roof edges and excludes valleys.5)Step flashing pertains to sloped roof edges and excludes areas around penetrations.6)Dnp edge=eaves.rakes.7)Waste table excludes additional materials needed for ridges,hips.valleys,etc.8)Suggested waste factor is based on the roof complexity and is provided for guidance purposes only, you should confirm the appropriate waste factor prior to ordering. Prepared For: Perry's Roofing 11 Birch Ln, Rye Brook, NY 10573 (1) • QuickMeasure Roofing Materials Roof Reports in Under an Hour Suggested Waste 0% 10% 15% 201,% Shingle Products HDZ, UHDZ, Natural Shadow, ASII, bundle 87 96 101 105 Reflector, Royal Sovereign, Cool Series Low-Slope Roofing System Liberty Base/Ply Sheet roll 0 0 0 0 Liberty Cap Sheet roll 0 0 0 0 Liberty Asphalt Primer gallon 0 0 0 0 Liberty Flashing Cement gallon 0 0 0 0 Starter WeatherBlocker bundle 4 5 5 5 Pro-Start bundle 4 4 4 4 Quick-Start roll 12 13 14 15 Roof Deck Protection Deck-Armor, Tiger Paw, FeltBuster 10 sq roll 3 4 4 4 Shingle-Mate roll 8 8 9 9 VersoShield roll 9 9 10 10 Leak Barrier StormGuard, WeatherWatch 2 sq roll 10 11 11 11 WeatherWatch 1.5 scl roll 13 14 15 15 Ridge Cap Seal-A-Ridge, Seal-A-Ridge AS bundle 6 6 6 7 TimberTex bundle 7 7 8 8 Z-Ridge bundle 4 5 5 5 TimberCrest box 7 7 8 8 Nails Cap Nails box 2 2 2 2 Coil Nails 1.25 in box 2 2 2 2 Step Flashing Step Flashing 1Off piece 11 12 13 14 Step Flashing 8 ff piece 14 15 16 17 Drip Edge Drip Edge 10 ft piece 41 45 47 49 Drip Edge 8 ft piece 51 56 59 62 Notes:1)These approximate quantities are based on estimated measurements and are for guidance purposes only you should always confirm quantifies prior to ordering and ensure you are following local building code requirements.2)For Timberline.3 bundles=0.984 squares.3)Starter=eaves+rakes.4)Leak barrier=bends+eaves+flashing+hips+rakes+step+valleys 5)Ridge cap=hips+ridges.6)Low-slope products applied to 1/12 pitch areas.7)Timberline products applied to 2/12 pitch areas and above 8)Installed coverage will be less and depend on quantity and width of side and end laps.9)Liberty low slope roofing system should be installed as a system.For more information,see gat.com/liberty. Prepared For: Perry's Roofing U 11 Birch Ln, Rye Brook, NY 10573 (1) QuickMeasure Attic Vents Roof Reports in Under an Hour Static Quantity Units Cobrae Rigid Vent 31m, SnowCountry f & SnowCountrym Advanced 39 ft Cobra@ Exhaust Vent Roll -Nail Gunnable 49 ff Cobra@ Exhaust Vent Roll -Hand Nailable 41 ff Cobra@ RidgeRunner i, 55 ft Cobra@ Hip Vent 77 ft Master Flow@ SSB960 Metal Super Slant-Back Roof Vents 12 vent Master Flow®R RV50/R50 Square-Top Roof Vents 14 vent Master Flow@ IR65 Plastic Slant-Back Roof Vents 11 vent Master Flow@ High-Capacity Dome Vents 5 vent Master Flow@ 10' Aluminum Ridge Vent 32 ft Cobra IntakePro l Rooftop Intake Vent 77 ft Master Flow Undereave Intake Vents- 16" x 8" 14 vent Powered - Roof Mount Exhaust Cobra Master Flow 16x8 (vent) IntakePro (ft) Intake (vent) Master Flow l+ ERV4 Power Attic Vents 2 107 20 Master FlowrJ ERV5 Power& Wi-Fi Attic Vents 2 134 24 Master Flow@ ERV6 Power Attic Vents 2 160 29 Master Flow EZ Coollm Plug-in Power Attic Vents 2 1 1 2 21 Master Flow@ GreenMachinelm Solar/Dual-Powered Vents 4 112 21 Master Flow@ GreenMachineTm High-Power Solar/Dual-Powered Vents 3 120 22 Master Flow@ 12"Wind Turbines 5 132 24 Master Flow@ 14"Wind Turbines 3 112 21 Note.The estimated quantity of attic ventilation products in this report is based solely on the total exterior square footage of all roof planes and is meant for estimating purposes only. It is the responsibility of the installer to verity the correct quantity and type of attic ventilation products prior to commencement of work Installer must always review job-specific attic ventilation needs such as local code requirements,attic floor square footage.roof design,and conditioned spaces under the roof. GAF recommends a minimum of 1 square foot of attic ventilation(evenly split between intake and exhaust)for every 300 square feet of attic floor space.The amount of exhaust ventilation at or near the edge must never exceed the amount of intake ventilation at or near the soffit See gat corn/ventcalculator for details Prepared For: Perry's Roofing 11 Birch Ln, Rye Brook, NY 10573 (1) - y { y1 k •'� -e, -:3>=*NO O II. :1 LO .:s". .. Ia. C14 C L b u w O a ll7 R in d <CO))l � U U Ca :w� .•y. �� C off • V r- o U W o W } \.ectionFL wn LLI O 7 Z ~ a n.CaW � �` COwho i sir"+' • V O �' W Q 3 c w ..o W c,4 Q .�1e =- 'i •:� : " O �r" W C W o �1 e 8Q l CL > �« FO r X ° cu Ci •�: d cC etl a� O �� i w E dL" y b 14E 0 :. _ ti � \\ is N --__—_ ___----_____—______—_ — —_.__ •.=s'__—_—•' __—_ --__ _.,—`"a _ `iii�l`'.^.•£�a� 4 <c0)> / 1 • �css)�`- ..�. . .,. _��•. " f,:='p �y`�' �#=d� by �,_ ` t�►� � d .•f h� � -7i "''Z _� . ... ,:vv4: �'•vim � : ..l,_,,v :... 'Q..y PERRVER-01 CDOLCE ACORO F�;61271'2 TE(MMDDIYYYY) �� CERTIFICATE OF LIABILITY INSURANCE o24 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Kevin Kelley NAME: Levitt-Fuirst Associates,LTD PHONE 520 White Plains Road (A/C,No,Ext):(914)457-4200 (A/C,No):(914)457-4200 2nd Floor nooRlE :info@levittfuirst.com Tarrytown,NY 10591 INSURERS AFFORDING COVERAGE NAIC# INSURER A:Admiral Insurance Company 24856 INSURED INSURER B:Accident Fund Insurance Company of America 10166 Perry Verrone LLC INSURER C:ShelterPoint 81434 12 Center Street INSURER D Pleasantville,NY 10570 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 CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS. EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUER POLICY NUMBER POLICY EFF POLICY EXP LIMITS LTR IN SD WVD MM/DDIYYYY MM/DD/YYYY A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S 1,000,000 CLAIMS-MADE a OCCUR CA000045827-03 7/1/2024 7/1/2025 DAMAGE TO RENTED 3i)0 O00 REMISES a occurrence $ MED EXP(Any oneperson) $ 5,000 PERSONAL SADVINJURY S 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY 7 PRO- LOC PRODUCTS-COMP/OPAGG S 2,000,000 OTHER s AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT a accident) $ ANY AUTO BODILY INJURY Perperson) S OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY Per accident $ HIRED NONJWNED PROPERTY DAMAGE AUTOS ONLY AUTO ONLY Per accident S S B UMBRELLA LIAB X OCCUR EACH OCCURRENCE S 5,000,000 X EXCESS LIAB CLAIMS-MADE GXL000147003 7/1/2024 7/1/2025 AGGREGATE $ 5,000,000 DED I X I RETENTIONS 10,000 S WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY TAT T YIN I ER ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ E.L.EACH ACCIDENT S OFFICER/MEMBER EXCLUDED) N I A (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE S If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT S C NYS Disability DBL358637 5/10/2022 5/10/2026 Limit-Statutory DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Village of Rye Brook-is included as Additional Insured for covered operations of the named insured 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 9 Y ACCORDANCE WITH THE POLICY PROVISIONS. 938 King St Rye Brook,NY 10573 AUTHORIZED REPRESENTATIVE ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD PORK Workers' CERTIFICATE OF STATE Compensation NYS WORKERS' COMPENSATION INSURANCE COVERAGE Board 1a.Legal Name&Address of Insured(use street address only) 1b.Business Telephone Number of Insured 914-867-1747 Perry Verrone LLC DBA Perry's Roofing 1 c.NYS Unemployment Insurance Employer Registration Number of 12 Center Street Insured Pleasantville,NY 10570 Work Location of Insured(Only required if coverage is specifically limited to 1d.Federal Employer Identification Number of Insured or Social Security certain locations in New York State.i e.. a Wrap-Up Policy) Number 26-2754386 2.Name and Address of Entity Requesting Proof of Coverage 3a. Name of Insurance Carrier (Entity Being Listed as the Certificate Holder) Continental Indemnity Village of Rye Brook 3b.Policy Number of Entity Listed in Box"1 a" 938 King Street 46-8841910120 Rye Brook.NY 10573 3c. Policy effective period 03/01/2024 to 03/01/2025 3d.The Proprietor, Partners or Executive Officers are ❑ included.(Only check box if all partners/officers included) �X all excluded or certain partners/officers excluded. This certifies that the insurance carrier indicated above in box 3" insures the business referenced above in box '1 a"for workers' compensation under the New York State Workers' Compensation Law. (To use this form, New York(NY)must be listed under Item 3A on the INFORMATION PAGE of the workers'compensation insurance policy). The Insurance Carrier or its licensed agent will send this Certificate of Insurance to the entity listed above as the certificate holder in box"2". The insurance carrier must notify the above certificate holder and the Workers' Compensation Board within 10 days IF a policy is canceled due to nonpayment of premiums or within 30 days IF there are reasons other than nonpayment of premiums that cancel the policy or eliminate the insured from the coverage indicated on this Certificate. (These notices may be sent by regular mail.)Otherwise,this Certificate is valid for one year after this form is approved by the insurance carrier or its licensed agent, or until the policy expiration date listed in box"3c",whichever is earlier. This certificate is issued as a matter of information only and confers no rights upon the certificate holder. This certificate does not amend, extend or alter the coverage afforded by the policy listed, nor does it confer any rights or responsibilities beyond those contained in the referenced policy. This certificate may be used as evidence of a Workers' Compensation contract of insurance only while the underlying policy is in effect. Please Note: Upon cancellation of the workers'compensation policy indicated on this form, if the business continues to be named on a permit, license or contract issued by a certificate holder,the business must provide that certificate holder with a new Certificate of Workers'Compensation Coverage or other authorized proof that the business is complying with the mandatory coverage requirements of the New York State Workers' Compensation Law. Under penalty of perjury, I certify that I am an authorized representative or licensed agent of the insurance carrier referenced above and that the named insured has the coverage as depicted on this form. Approved by: Steven Diamond(President) (Print name of authorized representative or licensed aqent of insurance carrier) Approved by: 5' 41,2, 02/26/2024 (Signature) (Date) Title: Licensed Insurance Broker Telephone Number of authorized representative or licensed agent of insurance carrier: 516-488-3040 Please Note: Only insurance carriers and their licensed agents are authorized to issue Form C-105.2. Insurance brokers are NOT authorized to issue it. C-105.2 (9-17) www.wcb.ny.gov