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HomeMy WebLinkAboutRP24-067llm PERMIT # � - V� ? DATE,* C� o�`o Wp; SECTION LOCK LOT J TYPE OF WORK /S n JOR LOCATi N r) Ile. '/ OWNER 1C � Q///S � Q/O O//%S 6QZ� 9e455 70 CONTRACTOR �f/l ✓)E/ PLC - /I /Ch Q To _tCO # FEE DATE TCO # FEEIIIIIIIIIIIAIIIIIIIIIIII� I DATE iN¢oE TIG ON REDOR i DATE INSP FOOTING FOUNDATION FRAMING RGH FRAMING INSULATION PLUMBING C� RGH PLUMBING GAS I] SPRINKLER ELECTRIC LOW -VOLT CJ ALARM AS BUILT 0 I I_ ,7, ASSQ FINAL OTHER APPROVALS �yE DR L Q Ja4f.'VyV 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 ww,%v.ryebrookny.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 Michael Morris & Carol Morris-Fox 29 Longledge Drive Rye Brook,New York 10573 Re: 29 Longledge Drive, Rye Brook,New York 10573 Parcel ID#: 135.67-1-15 Roof Permit#24-067 issued on 6/26/2024 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 MI BUILDMG.IIE TMIENTFor office=---�— PERMIT# VILI� OF RYE b� OK ISSUED:� 2024 �� 938 KING STRE ! YE BRoolz, by YORK 10573 DATE: 9 -06 FEE: PAID RYE BROOK `` ov EPARTMENT 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 rttbMbbbbbbbMMMbbbbbrtbMbbbbbrtbMbbMbrtbMbMbbbrtrtrtMbrtbMMbMrtbMbttttrtrtrtttrtrtttMtrtttrtrtrtrtt#rtrt++tt4rt4rttMtMrtttrttrtttrtMMbrt+rt MMMbbrtrtrtMMtMrtMrt Address: 29 Longledge Dr Rye Brook NY 10573 Occupancy/Use: ) Parcel ID#: � lUT — � Zone: R-12 Owner: Stephan Fox&Carol orris-Fox Address: 29 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 at 29 Longledge Dr (Print Name of Applicant) (No.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: $ 32,107.00 for the construction or alteration of: Roof Replacement, Asphalt Roof Deponent further states that he/she has examined the approved plans of the structuretwork 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§250-10A.of the Code of the Village of Rye Brook. Sworn to before me this 64'( / ' Sworn to before me this rat of ��C �Q�' ,20 0-4 day of �( e � 20 SiTmttjrc of Property Owner ���P0Y Zq A,������ Signature of Applicant Carol Moms-Fox Q - •�A Andrew Prchal Print Name of Property Owner _ ; �Q�/4 R y N,� = Print Name of Applicant 'gip AUBL�G �: tary Public .?!� �• � ry Pub is C EXp• �yE BRC��. 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 : ? 1 DATE: // 7 Z v Z ,�l PERMIT# � Z �"� " ISSUED: SECT: BLOCK: LOT: S LOCATION: > '� OCCUPANCY: ❑ VIOLATION NOTED THE WORK IS... 0 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 : cu m : CV N irnh� fxa-c, 10, W = u a � 'I., rx O [-+ a v h o s _ fW U A � A 0 � � of W W as � w � v � _ : p, o o o W to Zto a `Owooa ° Oo O F--1 W ° y O W s Z ap 3 'r b x in W O ai o en W w UL v v UGo VO0 z � s=Ln = W c G1 O 00 OEM( a 00 :V W 'a Gas A V W CN A '� v v GL Fil ~ G j 1-4 en c� z - W O O p g n a g� lCj V . = z x c7 A z O N z od : w z x ob = : � ajb BUIL MENT VIL E OF R OK R JUN 2 5 2024 938 KING 'ET RYE BR R NY 10573 0§¢ _: VILLAGE OF RYE BROOK BUILDING DEPARTMENT *tttr*rrr**ttt*t***t*****t****t+tr*+t*ttt**tt**t+tttttt**++**+++*s++t*++++ttt**++tttt+++*+**+**++++t+t+**tt FOR OFFICE USE ONLY: / J Approval Date: ,SUN 2 �nz� 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. 6— Permit Fees: ROOF PERMIT APPLICATION Application dated: 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 helow. I. Job Address: 29 Longledge Dr Rye Brook, NY SBL: 135.67-1-15 Zone: R-12 Property Owner: Carol Morris-Fox Address: 29 Longledge Dr Rye Brook, NY Phone#: (203) 984-5570 cell#: email: cmfoxlaw@gmail.com 2. Applicant: Andrew Prchal Address: 194 S Water St Greenwich CT 06830 Phone#: 203 388 5555 Cell#: email: kauanny.zanetti@gunnerroofing.com 3. Roofing Contractor: Gunner LLC Address: 194 S Water St Greenwich CT 06830 Phone#: 203 388 5555 Ceti#: 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, underlayment, asphalt shingles, and proper ventilation. Install new white aluminum 6"K-Style Gutters using hidden fasteners elbows and downspouts.Remove&replace existing 4 fixed Skylights. S. Estimated Cost of Job:$ 32,107.00 (NOTE".;The estimated cost sha[]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: interior property 7. Construction Type: Roof Replacement , Gutters, Skylights YP _ NYS Construction Class: 8. Number of stories: 2 stories Height: 9. Is garage being re-roofed:No:( )•Yes:(%/1'Attached No:( )•Yes:VNumber of Cars: 10. Is roof peaked,hip,mansard, Flat,etc: Pitched and flat roof 11. Estimated date of completion: July/August 2024 -I- 10130/2023 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 WESTCI IESTER ) as: Andrew Prchal ,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 hef�me this Sworn to before me this tF� day of U UI 1(_J 20 day of �0 , 20 t Signature of Property Owner Signature of Applicant C1 rf�dYtO� V2lSk Andrew Prchal AtameofPrmopertygone Print Name ofApplicantblic otary Publi •`•••�p�t r r u r r,p�'�I, . 1► ;� AVBL'►G ^;t� z 10 UBLXG�'� N - 1GJ••. 10/30/2023 DocuSign Envelope ID:CB4828E7-A848-4114-9C2A-A4DCC7EF33FE 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-WC32180H19 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-1-18342-21-00015 www.gunnerroofing.com PROPOSAL/CONTRACT 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 Stephan Fox (hereinafter the "Owner" or "Customer") whose address is 29 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$32107(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 the week of July 8, 2024 and the estimated completion date is one to three working days after work has begun;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:CB4828E7-A848-4114-9C2A-A4DCC7EF33FE 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 "Si ned accepted. Contractor is authorized to do the work as Home Energy Repair LLC d /a�un�ler`Ooofing LLC specified. By signing below, Customer acknowledges that �bD�tln� 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. DocuSi9ned by: Fsfcf" F60 ' Its: Customer Signature: ��— Date: 6/17/2024 Date: 6/17/2024 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:CB4828E7-A848-4114-9C2A-A4DCC7EF33FE 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 HICKORY(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 Skylight Install: • Remove existing skylights • Install new skylights • Install Ice and Water membrane around skylight • Dispose of job-related debris • Protect siding and shrubbery • Provide materials • 4 fixed skylights, removed, installed,and flashed DS DS GIS S .�•'"�,P^'1�'q/�'��.<.!�,.�"��►�;'r�"1►'•r"�ji�'�r�x'.<� w '�•``` � _ ) � �.�; i ��� � 1� • �'`� � � tom. i �', •�C 111 5�5;^! IYH+�li� .;tis �1t+fttii ,5;.� 11+`fN1'i 4�t6ss� � �e it0,1/ll�r 5;�f„s;�' �11+'�� �,,r'r �N+`fltA ,t�' 'i' 111' ;�, :�LL1•�N .q'�'�g1 . i ao» ���ai try -rsrter { Lias►i George Latimeri{ ,. j • Jame+Maisano � Jr F+tr� WaleAesterCounty Executive " `•u�jn Director.Consumer Protection L' c�)� Department of Consumer Protection L j Home Improvement License " GUNNER LLC I 194 SOUTH WATER STREET GREENWICH,CT-06830 This license is issued in accordance with Article XVI of the Westchester County Consumer Protection Code and is valid only upon gr required for issuance of this license. '► 4 presence of the official department seal.Proof of citizenship or immigration status is not NOT FOR FEDERAL PURPOSES s 1: `ot Cons(j,�e ` V. �� I �eo �.o l:_ ! _ License Number °� Date of Expiration L �_ d v WC-35879-H22 0 11/01/2024 li .1 Ito) ester Coy r 88 ,' ,/r fj5 �/Ql7. 1;�r ,��l+f 1�7 .ti i. rl • �r,l,�,� fit, u1`f,� r i ` ',5..lT.•�' ,, ; .--�rqr—+f l5;?fi'�-'s,?:1j S'S- ';`to�1)� L t4.J� e� y U ff• `�;, ,V, �+(f 1N wy kf.1 .. i �l �N/.1 �NI .� �•Y���lf�tlT irwCbu$w Client#: 1952221 HOMEEN ACORD.,, CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 06/12/2024 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 any rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Jennie Foster USI Insurance Services LLC NAMEP4"�°NN :855 8740123 FAX A/C No 203 6345701 530 Preston Avenue EMAIL usictcertificates@usi.com Meriden,CT 06450 ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# 855 8740123 INSURER A:Admiral Insurance Company 24856 INSURED INSURER B:Liberty Mutual Insurance Company 23043 Gunner LLC Selective Insurance Company 194 S Water St INSURERC: p y of America 12572 Greenwich, CT 06830 INSURER D: 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_ ADDL SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER FOLIC YYYY POLICY YYY LIMITS A X COMMERCIAL GENERAL LIABILITY CA00004513602 4/21/2024 M11/2025 DEAA E EACH OCCURRENCE $1,000,000 CLAIMS-MADE ❑X OCCUR PREMI�ES EBENTE ence $50,000 MED EXP(Any one rson) $5 000 PERSONAL&ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER,PRO- GENERAL AGGREGATE $2,000,000 POLICY X JECT LOC PRODUCTS-COMP/OP AGG $1,000,000 OTHER: C AUTOMOBILE LIABILITY S2579842 9/27/2023 09/27/202 Ea ECINErDitSINGLE LIMIT 1,000,000 IX ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED ALTOS ONLY AUTOS BODILY INJURY(Per accident) $ HIRED NON-OWNED PROPERTY DAMAGE AUTOS ONLY X AUTOS ONLY Per alx:Ident $ _ S UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS-MADE AGGREGATE $ O LIED RETENTION$ $ B A , MPSCOMPENSATION WC533S381014053 1/19/2024 01/19/202 X PER OTH- AND EMPLOYERS'LIABILITY OFFICER/MEMBEER EXCLUDED?ECUTIVE N/A E.L.EACH ACCIDENT $1 000 000 (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $1,000,000 It yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1 000,000 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 included as an Additional Insured under the General Liability policy,for ongoing and completed operations,when required in a written agreement in accordance with policy terms,conditions,and exclusions regarding services provided by the Named Insured. CERTIFICATE HOLDER CANCELLATION Village of Rye Brook SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 938 King Street ACCORDANCE WITH THE POLICY PROVISIONS. Rye Brook, NY 10573 AUTHORIZED REPRESENTATIVE r ©1988-2015 ACORD CORPORATION.All rights reserved. ACORD 25(2016/03) 1 of 1 The ACORD name and logo are registered marks of ACORD #S43188187/M42873328 SZBZP NYSIF New York State Insurance Fund PO Box 66699,Albany,NY 12206 1 nysif.com CERTIFICATE OF WORKERS' COMPENSATION INSURANCE 0 "^^^^^ 832024199 = GUNNER LLC 194 S WATER ST GREENWICH,CT 06830 0 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 TCERTIFICATE NUMBER POLICY PERIOD DATE W2485 011-7 889799 09/12/2023 TO 09/12/2024 6/12/2024 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: 925072824 U-26.3