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HomeMy WebLinkAboutRP24-099PERMIT;# %-09 9 DATE; 9 3 ay ixp;�9 a Q5 SECTION BLOC LOT TYPE OF WORK k - CO O % /I L(// / JOB LOCATION O//0 Q q4e VC OWNER ice/ t24rks 00, 913- 38� CONTRACTOR 4// / cq�'Q/� 1��p/7;e - / XZ C (f O� EST. COST S- FEE 730, -/alb �CO FEES afS b DATE O� TCO FEE DATE _ wsrFr.T10N RECORD I DATE INSP FOOTING FOUNDATION FRAMING RGH FRAMING INSULATION PLUMBING RGH PLUMBING GAS 0 SPRINKLER ELECTRIC O LOW -VOLT C� ALARM CI AS BUILT 0 FINAL :Nano(, 1)1/d3-13y/ OTHER APPROVALS ARB BOT PB ZBA OTHER �QyE BRCS 19 C rtiC(t,. v. G VILLAGE OF RYE BROOK MAYOR 938 King Street, Rye Brook,N.Y. 10573 ADMINISTRATOR Jason A. Klein (914) 939-0668 Christopher J. Bradbury -,vww.ryebrookny.gov TRUSTEES BUILDING& FIRE INSPECTOR Susan R. Epstein Steven E. Fews Stephanie J. Fischer David M. Heiser Salvatore W. Morlino CERTIFICATE OF COMPLIANCE October 17,2024 Judith Ritter Marks 3 Longledge Drive Rye Brook,New York 10573 Re: 3 Longledge Drive, Rye Brook,New York 10573 Parcel ID#: 135.75-1-10 Roof Permit#24-099 issued on 9/3/2024 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 D SEP 2 0 2024 DD BUILDING DEPARTMENT For office,us pill VILLAGE OF RYE BROOK PERMIT# 1/-(�c`r VILLAGE OF RYE BROOK �38 KING STREET ISSUED: -3 -� BUILDING DEPARTMENT ,RYEBROOK,NEWYORK10573 DATE: (914)939-0668 FIE S- PA[D jp www.rvebroofc orQ APPLICATION FOR CERTIFICATE OF OCCUPANCY,CERTIFICATE OF COMPLIANCE, AND CERTIFICATION OF FINAL COSTS TO BE SU$MITTED ONLY UPON C014PLETION or ALL WORK AND PRIOR TO THE FINAL INSPECTION as•aa►.••♦••••••.•a•••.a.•••••••♦••••.•••••••••••••••••♦•••••••••.•s••••.•••.•a••s•••s•a•s►•s•sss•a•ss•ss•a•+•+•ss•saa•aas•a Address: 3ltanvtc(�G Qt,t u 4 2`i'� C32GU�c lV 105 I3 Occupancy/Use: Z Parcel ID#: /35, 7 T o O,�.t f+I q2t�5 Zone; -1 Owner: MS l� _Address: i c"C- fAc P.E./R.A.or Contractor: PA W' 3'i�aL +- S Person in responsible charge: C Address: 4-1 N• Qc iW CUN&fy�_s Ny i0� :20 Mt�Rc_ Co _ 9� N . 2, �Address- `tW (_oNG-r"s's N\\ 1 Lj i aU 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:�-- "ARC. SOArr"O ' (Print Nmnc of A war ws ppIkma) ses being duly sworn,� depo and says that he/she resides at 'VI N, 2r `j w > in Cfl OCiLI{12> (No.and Street) _. ,in the County of kc.-:ken"q in the State of N (Cuyfr--I viNagc) 'that 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 •34 8 a5 ' for the construction or alteration of: Rc c>s AfPLAX-!eAA f U I op `-- rLf%-1- tN6 la+V Q i w�'� Ft h3iYtfVC�rj C {'t rrnnlc- Deponent further states that fie/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 structuru/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 Of partly,in its use or structure until a Certificate of Occupancy or Certificate of Compliance shall have been duty issued by the Building Inspector as per§250-IO.A.of the Code of the Village of Rye Brook. Sworn to before me this is l Sworn to before me this day of 1 t t , ,20_�� day of t4 I t �20 Si re of Property Owner Signature ofAppticant - Print Name of Property O t I��� �G5►(41(3i�}() Mal Name of Applicant C X NlNary ablic — Nd Publie MiCHAEL S SCHNEIDER Notary Public-State of New York MICHAEL S SCHNEIDER L t ).t NO.OISC6434593 Notary Public-State of New York Qualified in Rockland County N0.OISC6434593 My Commission Expires Jun 6, 2026 Qualified in Rockland County My Commission Expires Jun 6, 2026 �yE BR(��• 1962 BUILDING DEPARTMENT ❑B,UILDING 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: l Cale. e vc DATE: 2 1 PERMIT# 1`� `7'�D 1 1 ISSUED: "j�L SECT: BLOCK: LOT: LOCATION: �a3 OCCUPANCY: ❑ VIOLATION NOTED THE WORK IS... E ACCEPTED ❑ REJECTED/ REINSPECTION ❑ SITE INSPECTION REQUIRED ❑ FOOTING ❑ FOOTING DRAINAGE ❑ FOUNDATION ❑ UNDERGROUND PLUMBING NOTES ON INSPECTION: ❑ ROUGH PLUMBING ❑ ROUGH FRAMING ❑ INSULATION ❑ NATURAL GAS p L.P. GAS ❑ FUEL TANK ❑ FIRE SPRINKLER ❑ FINAL PLUMBING ❑ CROSS CONNECTION E FINAL p OTHER a M 4+ fA Lin O Q N O Pr+ 4-4O N W v z N 4O /N eel ON cin cn � � Q � a� �°''" •o � w V J a CA ch �T� x q 04 0 3 Q x Ln \,/ m 'C .. L M M C) J u Q_ a w a � o W wo V Ln � "It � O v/ 00 ►�1 G� M E-i UO G 0 -v a o a rT� _ ZCA W CW7 cn 8 b Q _ � O�„ 0 00 o � O U M E-� 0. a v v o c F cy o. a ^ V o WAM � F+y C.) Lri O a00 N a� ■ W z w t�y M 0 0a o H � Ha v w o tiW o v °u zS W a u $ So � W = O = p V V U z w , o ►� O 029 .EE. U : D C W IE DD BUILDIv6*kRTMENT AUG 3 0 2024 VIIXAkOFRY'`$ROOK VILLAGE OF RYE BROOK 938 KiNC,T ET RYE BRO.'*-'I 10573 BUILDING DEPARTMENT (914)939.0668';' www:ry-6hook ova. FOR OFFICE USE ONLY: Approval Date: Pcrt# N C, Application# Approval Signature: xEyllEvy BOARD: Disapproved: Date: BOT Approval Data: Cue# Chairman: PB Approval Labe: Casc# : Secretary: ZBA Approval Date: Case# Other: AppBeaftit Fee, Permit Fees: ROOF PERMIT APPLICATION Application dated: 09-1 S'DA2H is hereby made to the Building Inspector of the Vill age of Rye Amok,NY,for the Issuance of a Perrott toRe-Roof an Existing Building,as per detailed stataraent described below. 1. Job Address: 3 Lowtrt.fwt �2 RYsr., NY SBL:1 i 7j —I—/D zone: /C) Prop"Owner Ms '7uW-M 1"m-y-s Address: -3 t�Lt'rt: L RYr- ve- N`(' 105-1 Phone#: tlQ� 9 i'3 8 3 b I Cell#: email: 4NE'l:A ot..C.OM 2. ApplIcant: Ht%(tr- Cos►tAftNe> Address: 91 N. Rr `;W Cpypra-s NY log 20 Phone#: Callm q'4 40% 134 1 email:SMr ES @TucE-,.coM 3. Rooting Contractor. iu:EK+ Sar6 iNG Addmia: 9JL (4, Qr JInl Cat' ( aeg---s N 4 I6Iab Phone#- %'AS 2Gb 51-70 Cclltl: qi`l `l03 13y 1 ' email: 5 Cr"1Ljct:-kC,c.oM 4. lob Description,list all Methodic 1ft Materials: Rae Aspyrtt.i Srilwcxzs ftA- RA6b4)NCFS ipt► n,frsw,NC- mr4a (�£�t.><c��- 1NtTl4 Nfv�i MYi f�iL�rect-'S /1ri\i l�fenl GiJ�1'�i/L S. Eatlmatad Cost of Job:S 84 8 5•°� (N(YrC:Tim estimated cost shin Include all site improvements,labor,material,sca(Pokling,fixed equipmGri,professional tees,and awtcriat and labor which may be donated gratis.) b. ifcomer property,Indicate area frontage: 9. Conshuation Type: (UP NY3 Construction Class: 8. Numbs•of stories: ( -'IL Height: 9. Is garage being re-roofed:No:( )•Yes:.n Attached No:( )•Yes• lumber of Cars: D 10. Is roofpeaited,hip,mansard,flat,etc: F�J'�1ta tt'S 11. Estimated date of completion: On a 1 ar-25" -t- OVA23 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; being duly sworn,deposes and states that he/she is the applicant above named, {Prktt name of iodividaal sighing as the applicant) and further states that (s a is the legal owner of the property to which this application pertains, or that (s)he is m ect,co tt 'CM, for the Legal owner and is duly authorized to make and file this application (indicate architect.contractor,agcttt,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 ffiig �� . Sworn to before me this day of 20 27� ==--1 day of f 1 20__Q ature of Property Owner _ Signature of Applicant Print Name of Property Owner ` 'M2 Print Name of Applicant ���i otary Public Public MICHAEL S SCHNEIDER MiCN#EL S SCHNE10ER Notary Public-State of New York Notary ICHAE- NO.OfSC6434593 State of Mew York Qualified in Rockland County NO. OISC6434593 My Commission Expires Jun 6, 202ii Qualified in Rocklantl County My Commission Expires Jun 6, 2026 -2- efWI= . . 4 y - A law •1� �� . trwa �.P�7lr w Y�11% / !� 1 - 4wgat y F r3S ': J FRANK j. TUCEK & SONS, INC. Since 1914 ROOFING SIDING REPAIRS RESIDENTIAL COMMERCIAL Main Office and Warehouse: 92 North Route 9W Congers, New York 10920 Fax#(845)288-0593 Connecticut Bergen Westchester Rockland!Orange(845)288-5170 (914)997-8180 (203)822-8280 (201)307-9272 Contractor License No.'s Rockland:H-02737 Westchester.WC-2248-H89 Yonkers:532 Connecticut:00541051 Contract August 15,2024 A. Frank J.Tucek&Son, Inc. (hereinafter, the Contractor)proposes to furnish to Ms. Judith Marks £e Mr.Aldred Netter of,3 Lon led�e)rive, Rye Brook, NY 10573 203- 913-8381 (hereinafter,the Customer)materials and or services as described in job Specifications,at the premises owned by the Customer and located at Same FOR THE PRICE AND CONDITIONS HEREAFTER EXPRESSED. B. The Customer agrees to pay the Contractor in consideration of the foregoing the Total Price of $34,825.00 plus any additional wood if/as needed and Building Permit Fee of$1,005.00 C. The Contractor employs skilled workmen fully covered by Workman's Compensation Insurance. The Customer's satisfaction with our workmanship is our goal and our best advertisement. D. The Contractor agrees to perform the described services in a workmanlike manner according to standards of the craft.All material furnished by the Contractor carry such warranties as are provided by their respective manufacturers.THE CONTRACTOR MAKES NO FURTHER WARRANTIES RESPECTING SAID MATERIAL INCLUDING IMPLIED WARRANTIES OF MERCHANTABILITY,FITNESS FOR A PARTICULAR PURPOSE OR WARRANTIES WHETHER EXPRESSED OR IMPLIED BY LAW except those pertaining to workmanship as expressly stated herein. E. F. In the event that the Contractor is performing work an a limited part of the structure,the Contractor assumes no responsibility for damages caused by defects in areas of the structure where no work was performed,regardless of proximity. G. The Contractor assumes no liability for changes in material specifications occasioned by the manufacturers thereof,but will endeavor to perform with materials specified so long as their availability continues. 1 R The Customer understands that roofing,siding,gutters,and related installation services involves manual hammering which sets up inherent and unavoidable vibrations in the structure serviced.In these cases,interior wall board and ceiling nails may be caused to pop or work loose.In the event that work is performed over"cathedral" ceilings this condition is more likely to occur than not.Similarly,objects nlac� oedr's control and assumes no liability fo pon interior walls may fall or ur anye damaged.This condition is beyond th consequential damages caused thereby. I. Shingle removal will cause dust and small particles of debris to enter the area immediately below the roof deck. It is the Customer's responsibility to protect items stored in attic space. J. The Contractor shall not be responsible for puncturing any conduits,freon lines,electrical lines,plumbing pipes,or the like that have been improperly installed within nailing proximity of the roof deck. According to building codes,and work standards;these lines should not be installed unshielded in areas where they could possibly be punctured,therefore we assume no responsibility for damage caused by fasteners puncturing these lines. K. Any changes from the above specification involving extra costs will be executed only upon written authorization by the Customer and will be at the latter's additional expense. accidents,inclement weather or L. All work is Conti control,includingfbut not/ delays beyond the Contractor's limited to the foregoing illustrative examples. Scheduled commencement dates are approximate. M. Any controversy or claim arising out of or relating to this contract or breach thereof shall be settled by arbitration in accordance with the rules of the American Arbitration Association and judgment upon the award rendered by the arbitrator may be entered in any court having jurisdiction thereof. N. This contract expresses the entire understanding of the parties and,when accepted by the Customer,shall be deemed the entire contract.No other terms,provisions,conditions, specifications,or representations are intended to bind the parties hereto unless reduced to writing and respectively signed by them or their authorized representatives. The Customer represents that he/she has read shall be construedbin accorndance/her withsth�wse below accepts o the States of it as agreeable.This instrument New York,New Jersey,or Connecticut;wherever the work is performed. O. If the payment schedule contained in the contract provides for a down payment,such down payment shall not exceed$1,000.00 or 15% of the contract price,excluding finance charges, whichever is the lesser. P. The Customer may cancel the contract until midnight of the third business day after the day on which the owner has signed an agreement or offer to purchase relating to such contract. If owner would like to waive this clause in order to start work immediately,please initial in the following space. Q. Approximate date of work to start is the week of_August 26th 20M,weather permitting. Customer understands that these dates are approximate and may deviate due to weather conditions. 2 Job description and specifications: Rip&Replace Existing Asphalt Shin a Roo£ 5ystem New Wall Flashings Reuse Skyli New Copper Chimnev plashing- New Gutters&Leaders 1. Contractor to set up all safety equipment needed to perform work. ,All work is to be performed in accordance with the requirements of the Occupational Safety&Health Administration(OSHA). 2. Contractor to carefully cut out,remove and discard the necessary existing clapboard siding from abutting walls to allow access to the existing wall flashings. 3. Contractor to remove the chimney flashing,wall flashings, (3)vent pipe(lashings and discard. 4. Contractor to remove(1)layer of existing shingles down to the wood deck and discard. 5. Contractor to carefully remove the existing gutters and leaders and discard. 6. Contractor to inspect the wood sheathing.If any sheets of decking are needed there will be an additional cost of$100.00 per sheet of lb" CDX above contract price or$120.00 per sheet of 3/4" CDX or$11.00 per foot for T&G. 2 Contractor to cut back decking on both sides of(3) main ridge beams by 1 &5/$" in preparation of new ridge vent installation. $. Contractor to inspect the rakes at an additional cost off$8replace any /00 per foot rotted wood with new primed WHITE installed or primed fascia board wrapped in new WHITE aluminum cladding at an additional cost of$12.00 per foot. 9. Contractor to install new GAP Ice &Water Shield at newly exposed eaves,folding down onto fascia 3"and extending up slope of roof 69". Install over top edge of fascia,a 3" X 3"WHITE aluminum right angle flashing. 10. Contractor to install at all abutting walls,a 3' width of new GAP Ice &Water Shield membrane extending up abutting walls by min of(r 11. Contractor to install at all valleys,a 6' width of new GAF Ice&Water Shield membrane extending up each side of the transition by appx 36". 3 12. Contractor to install new GAF Ice&Water Shield perimeter of all roof penetrations. (Chimney,Vent Pipes&Skylights) 13. Contractor to use GAF DECK ARMOUR synthetic breathable underlayment to the remainder of wood deck,secure with S/16" staples. 14. Contractor to install new GAF PRO START shingles at all eave and rake areas. 15. Contractor to install new closed face WHITE aluminum drip edge to all rake edges.Secure with roof nails of sufficient length 16. Contractor to install new open face WHITE aluminum drip edge to all eaves where no gutters exist.Secure with roof nails of sufficient length. 17. Contractor to replace(3)existing vent pipe flashing with(3) new 3" OATEY aluminum vent pipe flashings,complete with neoprene gaskets. Exposed nails in flange and gasket to be sealed with a Black GEOCEL caulk. 18. Contractor to seal base of(1)smokestack using KARNAK flashing grade roof cement and paint stack with GAF SHINGLEMATCH accessory paint to blend in with chosen shingle color of WEATHERED WOOD. 19. Contractor to install new GAF HDZ asphalt lifetime architectural style shingles,complete with matching color TR%4BERTEX Hip& Ridge cap. Color to be WEATHERED WOOD. 20. Contractor to install GAF SNOW COUNTRY ridge vent to(3) prepared ridges secured with provided 3" ring shank nails. 21. New shingles to be installed with(6) galvanized 1.25"collated roof nails per shingle to penetrate roof deck. 22. Contractor to install new 5" x 5" x 8" aluminum step flashings secured with 1.5" roof nails. 23. Contractor to install new WHITE aluminum apron flashing in conjunction of new shingle installation Secure with fabricated. WHITE aluminum clips. 4 24. Contractor to fabricate and install(1)new 16-oz.bright finish copper chimney flashing,complete with base and counter flashing. Corners of base flashings are to be soldered for watertight integrity. 25. Contractor to install new primed WHITE 1"x 6" lumber and newly fabricated WHITE aluminum drip cap where cedar siding was cut out previously. Contractor to secure new 1" x 6" with 3" deck screws and aluminum drip cap with 1.5" roof nails. 26. Contractor to install new 6"WHITE seamless"K" style aluminum gutters secured with hidden hangars and screws of sufficient length. 27. Contractor to install new 3" x 4" WHITE aluminum corrugated leaders secured with WHITE aluminum zip screws. 28. All underground drain adapters are included in the proposal pricing. 29. Contractor to be responsible for the removal of all job-related debris from jobsite. Our proposal includes all dumping fees for the removal of said debris. (Contractor does not utilize commercial containers for the disposal of debris. We will remove debris with our small dump trucks and/or trailers.) Provide GAF Silver Pledge"lifetime" limited warranty,which provides non-prorated coverage for the first 50 years for labor&materials,for all installation costs,including tear-offs,for any defects that arise out of manufacturer's product. This roofing system is backed up by the Good Housekeeping seal of protection,and is transferable to a new homeowner. GAF Inc. is to provide a full-service warranty for workmanship on new installations for a period of 10 years,from date of completion. This warranty is limited to problems arising out of improper workmanship during original installation. Contractor shall be notified in the event of any new work that may disturb roofing work area or this warranty may be void. 5 Total Labor &Materials: $W25'00 + Additional wood replacement if needed Deposit Required at Contract Signing: $ 1,000.00 At Job Start Payment: $16,915.00 Due upon Completion of Work: $16,910.00 + Any additional billable items(wood) &(permit) Frank J.Tucek&Sons,Inc ACCEPTED BY: Marc Cosimano 08-15-2024 g, Contractor-Date Customer--Date Sincerely, Marc Cosimano Tucek&Sons Inc 914-403-1341 Marc.Cosimano2018@gmail.com 6 t� New York State Department of Taxation and Finance ST 124 New York State and Local Sales and Use Tax (2112) Certificate of Capital improvement kfter this certificate is completed and signed by both the customer and the contractor.performing the capital improvement, t must be kept by the contractor. Bead this form completely before making any entries. Vhis certificate may not be used to purchase building materials exempt from tax. Name of customer(print or type) Name of contractor(print or"4 a-V Frank J.Tucek&Son, Inc. Address(number and streets Address(number and street) 3 r v 92 North Rt. 9W City State ZIP code city State ZIP code 1451,E Congers NY 1D920 Sales tax Cettifrcate of Authority number(it arty) Sales tax Certificate of Authority number(It any) 13-3300128 To be completed by the customer Describe capital improvement to be performed: CONi i 2 CLc 2EP E ('S'11�t S ticC1,E `.._ ..•... ..__ yyn . 5tiINC. 1t� nt Et,n t�tl��iG ftN C G NT a,V� Project Hama - � E� State ZIP code Street address(where the work is 10 be performed) city (same as above) t certify that: • I am the (merit me) 0 owner ❑ tenant of the real property identified on this form;and • the work described above will result in a capital improvement to the real property the sale of any within i hin thoerguidelines al property�t when,and installed,does not pers • this contract ap permanent one) ❑ Includes �es not for example,a free-standing microwave or washing machine). become a permariertt part of the real property( P I understand that. • I will be responsible for any sales tax,Interest,and penalty due on the oontractor's total charge for tangible personal property and for labor if it is determined that this work does not qualify as a capital improvamant;and • I will be required to pay the contractor the appropriate sales tax on tangible personal property(and any associated services) transferred to me pursuant to this contract when the property installed by the contractor does not become a permanent part of the real property;and I win be subject to civil or criminal penalties(or both)under the Tax Law If I issue a false or fraudulent certificate. Signature of cvsl Title Date$ Owner /S To be completed by the contractor 1,the contractor,certify that I have entered Into a contract to perform the work described by the customer named above,and that I accept this form In good faith.(A copy of the written contract,if any, is attached.) I understand that my failure to collect tax as a result of accepting an improperly completed certifleate will make me personally liable for the tax otherwise due,plus penalties and Interest. S fora of contract��r officer , Y Title Date President pfi ..IiiA —1l cc alt -ntrles are completed. Tfflz ............. r al 04 om gjfil.� MIROMir k", bm (0 cn k 1 ct > 41 14 CD zz G) C)UJ C-6 5L ImW 0-, lip ci ct ri a) ri Co co- CD ci �MPW IV f M,v 70 URI (I ANS I NMI. RISE' AM DATE(MM/DDIYYYY) 'ACC)IIR L® CERTIFICATE OF LIABILITY INSURANCE OB/14I2024 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 Aaron Epstein NAME: Westrock Insurance Agency PHONE (gq5)638-2300 FAX (845)638-6222 AIC No E. : AIC,No 151 N Main St E-MAIL Aaron@westrockinsurance.com ADDRESS: Suite 405 INSURER(S)AFFORDING COVERAGE NAIC R New City NY 10956 INSURER A: Falls Lake National Insurance Company 31925 INSURED INSURER B: Selective Insurance Company of SE 39926 Frank J.Tucek&Son Inc. INSURER C: Century Surety Company 36951 92 North Route 9W INSURER D INSURER E: Congers NY 10920 INSURER F: COVERAGES CERTIFICATE NUMBER: 2024-2025 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 POLICY EFF POLICY EXP LTR INSD WVD POLICY NUMBER MMIDDIYYYY MMIDD/YYYY LIMITS X COMMERCIAL GENERAL LIABILITY CURRENCE $ 1.000,000 EACH OC CLAIMS-MADE I-XI OCCUR PREMISES Ea occurrence S 100,000 X Blanket-AI-PNC-WOS MED EXP(Any one person) = 5,000 A X CG2033;CG2001;CG2404;CG2012 Y CPP120496915 08/15/2024 08/15/2025 PERSONAL&AOV INJURY $ 1,000,000 GENT AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X JECT ❑LC PRODUCTS-COMP/OPAGG $POLICY ❑PRO 2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 Ea accident X ANY AUTO BODILY INJURY(Per person) S B OWNED SCHEDULED Y S 2260389 11/30/2023 11/30/2024 BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS X HIRED 1xx NON-OWNED PROPERTY DAMAGE S AUTOS ONLY AUTOS ONLY PeraccidentXComp Coll State surcharge 1 f X UMBRELLA LIAR X OCCUR EACH OCCURRENCE $ 2,000,000 C EXCESS LIAB CLAIMS-MADE Y CCP1171353 08/15/2024 08/15/2025 AGGREGATE $ 2.000,000 DED X RETENTION$ 10,000 $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY YIN STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ NIA E.L.EACH ACCIDENT $ OFFICERIMEMBER EXCLUDED? (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE S If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space is required) Additional Insured:Village of Rye Brook CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN Village of Rye Brook ACCORDANCE WITH THE POLICY PROVISIONS. 938 King Street AUTHORIZED REPRESENTATIVE Rye Brook NY 10513 //' Ii1:,: ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD NEW Workers' YORK sTaTE Compensation CERTIFICATE OF Board NYS WORKERS'COMPENSATION INSURANCE COVERAGE Ia.Legal Name&Address of Insured(use street address only) 1 b.Business Telephone Number of Insured (845)268-5170 Frank J.Tucek&Son,Inc. 92 N Route 9W lc.NYS Unemployment Insurance Employer Registration Congers,NY 10920-1730 Number of Insured Work Location of Insured(Only required if coverage is specifically Id.Federal Employer Identification Number of Insured or limited to certain locations in New York State,i.e.a Wrap-Up Policy) Social Security Number 133300128 2.Name and Address of Entity Requesting Proof of Coverage(Entity 3a.Name of Insurance Carrier Being Listed as the Certificate Holder) Continental Indemnity Co. Village of Rye Brook 3b.Policy Number of Entity Listed in Box"la" 938 King Street Rye Brook,NY 10513 46-867891-01-12 3c.Policy effective period 04/01/24 to 04/01/25 3d.The Proprietor,Partners or Executive Officers are IXJ included.(only check box if all partners/officers included) ❑ 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"la"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"30,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: Todd Brown (Print name of imthorized representative or licenced agent of insurance carrier) Approved by: �� 04/30/2024 (Signature) (Date) Title: Authorized Representative Telephone Number of authorized representative or licensed agent of insurance carrier: (877)234-4424 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