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HomeMy WebLinkAboutRP24-083PERMIT # .I SECTION TYPE OF WORK JOB LOCATION OWNER CONTRACTI EST. ✓CO # Tro # L": 3 "7i IQAI BLOCK 3 FEE DATE INSPECTION RECORD I DATE I NSP FOOTING -- FOUNDATION FRAMING RGH FRAMING INSULATION PLUMBING Cl RGH PLUMBING GAS C3 - SPRINKLER ELECTRIC C� LOW -VOLT O ALARM C� AS BUILT 0 �psSE FINAL ll- I- 2o2y I 3 OTHER APPROVALS 60T Ps ZBA OTHER �yE 4Rp p Cz� ti ��j to 198 �•��p 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.Qov TRUSTEES BUILDING & FIRE INSPECTOR Susan R. Epstein Steven E. Fews Stephanie J. Fischer David M. Heiser Salvatore W. Morlino CERTIFICATE OF COMPLIANCE November 7,2024 Renee Boyd 125 Brush Hollow Crescent Rye Brook,New York 10573 Re: 125 Brush Hollow Crescent, Rye Brook,New York 10573 Parcel ID#: 129.76-1-135 Roof Permit#24-083 issued on 7/1/2024 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 QyE BRC�k. 1982 BUILDING DEPARTMENT ❑,00ILDING 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 - - - - - - - - - - - - - - - - - - - - INSPECTIONREPORT - - - - - - - - - - - - - - - - - - - - ADDRESS : L - --e5 • DATE: Z I PERMIT# ISSUED: -/-Z y SECT: lZ q. 7(o BLOCK: LOT: , 1 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 1 ❑ NATURAL GAS , j ❑ L.P. GAS ❑ FUEL TANK ❑ FIRE SPRINKLER ❑ FINAL PLUMBING ❑ CROSS CONNECTION FINAL ❑ OTHER EI � V� R it For office use only: BUILDINGn EPARTMENT PERMIT ,-003 OCT 2 8 2024 VILLAGE OF RYE BROOK ISSUED: 1-7-1-Dq 938 KING STREET,RYE BROOK,NEw YORK 10573 DATE: /0 --Q� VILLAGE OF RYE BROOK (914)9 2.-0668 FEE: e f U— PAIDAU BUILDING DEPARTMENT www Ii o 1 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 rssrsrsssrssssttsrrssrrrsrsra♦ssarsaaaasssssrsrasttsrtstrtrstrtarwrsssrrraaaassaasaaaaaas►arias■assaasaastastsrrssrtsrtssrrr Address: 12 J f-V-S N O OM/ Lf U,() � Occupancy/Use: P M t arce #: �(J� »9� 7�0 -��— 13S Zone: Owner: Address: 16fa-5k NoNI ,/ (,r6s nt P.E./R.A. or Contractor: ?ur f H V Cx f'o fl e- , LL(. Address: St, Q je'(LSe"n V k N' 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: L 1 P&f f 4 V VIC fie, being duly sworn,deposes and says that he/she resides at 2 g�t�Sr\ \\OI I O W CMS L ► r (Print Name of Applicant) ( '• (No.and Street) � v in �L b f DD k ,in the County of Q S�(,y� }� in the State of 1 ,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:$ S, 500. w for the construction or alteration o£ f O 0:� f e.YVIG✓4 f e.'Q'd-- V l U')t - 10 S 1 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. ' I Sworn to before me this Sworn to befo e me this �`1 day of L160 y ,20N da of , 20 \\�ttttiillriiii Sigfiture of w� ��i�i ` t t 1 i r r r Si nature of A icant r STATEOkK i ATE t of Pro �& r LIC OF Nr of A licant PORK OIPA634750jC^�Y 1 f = 1 NO_ TAR UBL OIP.A6}g7 'C /O 1711C 'i� S ��� \\ �� \ SION EXP1O5\��`\ 6/l/2024 111111t e ■ z a a z, a en N Q z 00 z eq a� x cn 0-4 ■ Z a o Cl) ■ -1 LO v ■ z �, � W U �' � � a v � � ■ a Ln W a ►� _ w � N � o .� v Cz. W ■ z � ■ ■ cn 0 z cc U O _ F+� w L F z z 1 OWL A U O O p a a `.J � a hpi a.i ccCA ■ W CJ Y ° Y ZID _ O � Cc r..+ W 0 .. O !N z OlLnLn Z c a U 00 cy O Z W Ln o o o CA OD O O p4 v a fl W W a � a w°J av > x a BUI0. 0V ENT JUN 2 8 20Z4 VIOK 938 KINGNY 10573 VILLAGE OF RYE BROOK BUILDING DEPARTMENT FOR OFFICE USE ONLY: , a Approval Date: \� m P")L 00 ,4 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: 40 00-Pb Permit Fees: ROOF PERMIT APPLICATION Application dated: 6/27/24 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: 125 Brush Hollow Crescent SBLA ,'76 I4 Zone: L Property owner: Renee Boyd Address: 125 Brush Hollow Crescent Phone#: (914) 255-2324 Cell#: email: Rhboyd41 @gmail.com 2. Applicant: Perry Verrone Address: 12 Center St, Pleasantville Phone#: 914-747-7663 Cell#: email: info@perryverroneroofing.com 3. Roofing contractor: Perry Verrone, LLC _Address: 12 Center St, Pleasantville Phone#: 914-747-7663 Cell#: email: info@perryverroneroofing.eom 4. Job Description,list all Methods&Materials: Roof removal and replacement - see scope of work attached 5. Estimated Cost of Job:s 8,500.00 (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 corner property,indicate street frontage: 7. Construction Type: Residential NYS Construction Class: 8. Number of stories: Height: 9. Is garage being re-roofed:No:00•Yes:( )Attached No:( )•Yes: ( )Number of Cars: 10. Is roof peaked,hip,mansard,flat,etc: 11. Estimated date of completion: 7/5/2024 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: 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. Sworn to before me this Sworn to before me this day of J{,(J1Q, , 20 a q day of J u '-t , 20 a y Signature of Property Ow r Signature of Applicant jlttIttt?If Renee Bge yL,k PA ',,,, Perry Verrone Print Nam"f Prareft Print Nam of Applicant STATE NE-W YE?RK�� _ I Op NEµr YC `1 tkRY PUBLIC ��aR t *tary4PAI Otary\ 01 PACU7c0' / �'` �\ 01PA63d73 R z ^'I r. 0 yx -2- 6/112024 'Hie Arbors I lomeowners' Association 173 Ivy I I I I I Crescent Rye Brook, NY 10573 D CLOUD JUL 17 2024 July 12, 2024 VILLAGE OF RYE BROOK BUILDING DEPARTMENT Rene Boyd 125 Brush Hollow Crescent Rye Brook, NY 10573 Re: Entire Roof Replacement — 125 Brush Hollow Crescent Dear Renee, This letter serves as confirmation that the Architecture & Grounds (A&G) Committee has reviewed and accepted your application for the above-named work. This approval is valid for six (6) months from today's date. If any changes need to be made to the original plans submitted to A&G either before or during construction, the Committee must be notified in writing and your application must be amended. Work must stop and cannot proceed until you receive written approval for those changes. A permit from the Village of Rye Brook must be presented to the property manager before work begins. You are also required to inform the Property Manager when work begins. When the project is complete, the Property Manager must again be notified so that an inspection may take place. Please include a photograph of the work as well. Failure to comply with these procedures will result in fines and/or work stoppage. If you have any questions, contact me at: Property Manager. Nicholas Salzarulo Property Manager Perry Verrone, LLC 12 Center Street Pleasantville, NY 10570 info@per!yverroneroofing.com Office: (914)747-7663 Fax: (914)747-7665 License WC 21701 H09 6.27.2024 Prepared by Perry Renee Boyd 125 Brush Hollow Crescent Rye Brook, NY 10573 (914) 255-2324 Rhboyd4lPgmail.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: HICKORY) • 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 • Brown aluminum drip edge flashing installed around entire perimeter of roof • GAF Weather Blocker starters installed on all perimeter edges • Copper chimney flashing fabricated and installed Page 1 of 5 Initial& Date: • Copper apron flashing fabricated and installed on front side - INCLUDED • GAF Lifetime Material Warranty included • Perry's Roofing"10 Year Workmanship Warranty"included • Rye Brook Building Permit-additional cost TBD The price for the aforementioned work,which includes labor and material (excluding any additional plywood),totals to the sum of. $8,500.00 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 ❑ Aluminum Seamless Gutters and Leaders fabricated and installed o 6-inch gutters and 3x4 leaders (brown) with gutter screens for an additional $1,400.00 ❑ 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 ❑ Building Permit for an additional cost TBD (if needed) 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: 125 Brush Hollow Crescent, Rye Brook, NY 10573 (1) QuickMeasure June 25, 2024 Roof Reports in Under an Hour Prepared For: Perry's Roofing A N Contents Measurements Overview 1 Roof Area 958 sq ft Top View 2 Roof Facets 4 Side Views 3 Predominant Pitch 8 / 12 Lengths 4 Ridges/Hips 19 ft Pitches 5 Valleys 2 ft Areas 6 Rakes 82 ft Summary 7 Eaves 56 ft Materials 8 1 • 00 2024-06-14 IL a � p .I K ' • `�... s North East • 441 r � South West i r Alm � :fl. QuickMeasure Lengfhs Roof Reports in Under an Hour AFlash Step Drip N y M Eave 0 Rake M Ridge M Valley 56 82 19 2 Lengths in feet Prepared For: Perry's Roofing 125 Brush Hollow Crescent, Rye Brook. NY 10573 (1) QuickMeasure Pitches Roof Reports in Under an Hour A N 3 6 Pitches in inches per foot Prepared For: Perry's Roofing © 125 Brush Hollow Crescent, Rye Brook, NY 10573 (1) QuickMeasure Areas Roof Reports in Under an Hour A N a� 32 Areas in square feet Prepared For: Perry's Roofing 125 Brush Hollow Crescent, Rye Brook, NY 10573 (1) QuickMeasure Summary Roof Reports in Under an Hour Pitch 6 8 Area 32 926 Percent 3% 97% Suggested Waste 0% 1% 4% 6% 8% 11% 16% Area 958 968 997 1,016 1,035 1,064 1,112 Squares 10 10 10 11 11 11 12 Roof Area 958 sq ft ARoof Facets 4 N Pitch 8 / 12 Eaves 56 ft Rakes 82ft Ridges 19 ft Valleys 2 ft Flash 19 ft Step 33 ft Drip Edge 138 ft Leak Barrier 192 ft Ridge Cap 19 ft Starter 138 ft Notes.1)Measurements are rounded to the nearest whole number.2)Rakes are defined as sloped roof 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)Drip 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 125 Brush Hollow Crescent, Rye Brook, NY 10573 (1) QuickMeasure Roofing Materials Roof Reports in Under an Hour Suggested Waste 0% 1% 6% 1 1% Shingle Products HDZ, UHDZ, Natural Shadow, ASII, bundle 30 30 31 33 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 2 2 2 2 Pro-Start bundle 2 2 2 2 Quick-Start roll 5 5 5 5 Roof Deck Protection Deck-Armor, Tiger Paw, FeltBuster 10 sq roll 1 1 2 2 Shingle-Mate roll 3 3 3 3 VersaShield roll 3 3 3 4 Leak Barrier StormGuard, WeatherWatch 2 sq roll 3 3 4 4 WeatherWatch 1.5 sq roll 4 4 5 5 Ridge Cap Seal-A-Ridge, Seal-A-Ridge AS bundle 1 1 1 1 TimberTex bundle 1 1 2 2 Z-Ridge bundle 1 1 1 1 TimberCrest box 1 1 2 2 Nails Cap Nails box 1 1 1 1 Coil Nails 1.25 in box 1 1 1 1 Step Flashing Step Flashing 10 ft piece 4 4 4 4 Step Flashing 8 ft piece 5 5 5 5 Drip Edge Drip Edge 10 ff piece 14 14 15 16 Drip Edge 8 ft piece 18 18 19 20 Notes.1)These approximate quantities are based on estimated measurements and are for guidance purposes only you should always confirm quantities 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. S)Ridge cap=hips+ridges.6)Low-slope products applied to Ill2 pitch areas 7)Timberline products applied to 2/12 pdch 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 got.com/liberty. Prepared For: Perry's Roofing U 125 Brush Hollow Crescent, Rye Brook, NY 10573 (1) QuickMeasure Attic Vents Roof Reports in Under an Hour Static Quantity Units Cobra@ Rigid Vent 31m, SnowCountry@& SnowCountry F Advanced 13 ft Cobra@ Exhaust Vent Roll-Nail Gunnable 17 ft Cobra@ Exhaust Vent Roll-Hand Nailable 14 ft Cobra@ RidgeRunner@ 19 ft Cobra@ Hip Vent 26 ft Master Flow@ SSB960 Metal Super Slant-Back Roof Vents 4 vent Master Flow@ RV50/R50 Square-Top Roof Vents 5 vent Master Flow@ IR65 Plastic Slant-Back Roof Vents 4 vent Master Flow@ High-Capacity Dome Vents 2 vent Master Flow@ 10' Aluminum Ridge Vent 11 ft Cobra IntakePro@ Rooftop Intake Vent 26 ff Master Flow@ Undereave Intake Vents- 16" x 8" 5 vent Powered - Roof Mount Exhaust Cobra Master Flow 16x8 (vent) IntakePro (ft) Intake (vent) Master Flow@ ERV4 Power Attic Vents 1 54 10 Master Flow@ ERV5 Power& Wi-Fi Attic Vents 1 67 12 Master Flow@ ERV6 Power Attic Vents 1 80 15 Master Flow EZ CoolTY Plug-in Power Attic Vents 1 56 11 Master Flow@ GreenMachineTM Solar/Dual-Powered Vents 2 56 11 Master Flow@ GreenMachineTm High-Power Solar/Dual-Powered Vents 1 40 8 Master Flow@ 12" Wind Turbines 2 53 10 Master Flow@ 14"Wind Turbines 1 38 7 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 ridge must never exceed the amount of intake ventilation at or near the soffit. See gat.com/ventcalculator for details. Prepared For: Perry's Roofing 125 Brush Hollow Crescent, Rye Brook, NY 10573 (1) gz, -� %r -•O '_�.R?` iA dQ :,., \11rr�Y lr.,Ff • f -Q: �I�.;�^ tQ.h -+J- '� rl,�fi; �0'• ;::Z Ot Q': ti $'Q: a • v •�7�A W//h'4,. v � rFdY a: v, �"t,'lhh-v,G�y-;^(�r9f �r ''''0��� 4 -v .N ti�..ti�. v :.dl'• ��� • rr. I �._ ------ Ln .!z j, Jg O 0 O � R y o 1� IU Q Lu •. U w z_ w y o •° o�action (n w -40 �ica.i V O w 3 Fir Q •- ;, �., LLI c� Q N �s ^ Q w C w o 4j�1 p 813 1low CL ., O Z >;. C w y 4- (V ±. 1 V t N y ��)> - �t"•-_ �.a'-1'!f Ih�- '+a >'���y11�j1 .,,aat��j'j sue._YI) r 1 <,:-.ze - -�P 1.+"-• � y�1/1 � �j 1 .► iL •a�l� rw t ),11� •:.i•I^ Y'j .- A PERRVER-01 CDOLCE ACORO CERTIFICATE OF LIABILITY INSURANCE DATE(M s127/202 YYY) 2o2a 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 Levitt-Fuirst Associates, LTD PHONE FAX 520 White Plains Road (A/C,No.Exq:(914)457-4200 (vc,No>:(914)457 4200 2nd Floor E-MAIL info@levittfuirst.com Tarrytown,NY 10591 ADORE s: 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 SUBRD POLICY NUMBER POLICY EFF POLICY EXP LIMITS LTR N WVD MMIOD/YYYY MM/DD/YYYY A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE �X OCCUR CA000045827-03 7/1/2024 7/1/2025 PRMMGES( a occu ence) $ 300,000 MED EXP(Any oneperson) $ 5,000 PERSONAL&ADV INJURY S 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER. GENE RAIL AGGREGATE S 2,000,000 POLICY JECT LOC PRODUCTS-COMP/OP AGG S 2,000,000 OTHER: S AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ ANY AUTO BODILY INJURY Perperson) S OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY Per accident S HIRED NON-(WNED PROPERTY DAMAGE AUTOS ONLY AUTOS ONLY Per acciden0 $ B UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 5,000,000 X EXCESS LIAB CLAIMS-MADE GXL000147003 7/1/2024 7/1/2025 AGGREGATE $ 5,000,000 DED I X I RETENTION$ 10rOF0 S WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y/N TAT TE I I ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT S OFFICER/MEMBER EXCLUDED? NIA (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT S C NYS Disability DBL358637 5/10/2022 5/10/2025 Limit-Statutory DESCRIPTION OF OPERATIONS/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 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) XQ 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 agent of insurance carrier) Approved by: 5td414_ T�4�zk"rcall 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