Loading...
HomeMy WebLinkAboutRP24-104PERMIT # /t`/'� _._.L f' DATE: 7/4-3 cZ Q!(p; SECTION i d� BLOCK OT QQ- TYPE OF WORK e - UO / of / //% ion OWNERS.7_I CONTRACTORi EIST. COST 0 #.III,� TCO # q v P2 7- C1 e/i Co / � elc7� uic' /7 (Y/yj 931- 8/ 70 l�i o�S =lam (2 ol ZcliriQ� � � S6 c) & 9 7 t, / FEE GATE -' INSPEOTION RECORD I DATE INSP FOOTING - FOUNDATION FRAMING - RGH FRAMING INSULATION PLUMBING RGH PLUMBING GAS L� - SPRINKLER ELECTRIC E3 LOW -VOLT C� ALARM C� AS BUILT 0 --r—�— FINAL 10' 2 y' LO Z ` RSSeo rL OTHER APPROVALS iBOT Ps ZBA OTHER Qy� BR19 p ct� y t VILLAGE OF RYE BROOK MAYOR 938 King Street, Rye Brook,N.Y. 10573 ADMINISTRATOR Jason A. Klein (914) 939-0668 Christopher J. Bradbury w-vvw.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 25,2024 St. Paul's Evangelical Lutheran Church 761 King Street Rye Brook,New York 10573 Re: 761 King Street,Rye Brook,New York 10573 Parcel ID#: 136.21-1-22 Roof Permit#24-104 issued on 9/23/2024 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 (� �/J BUILQYEBRO0K,(.O ` ENT For office use only: D L� � V PERMIT# r?,S-Z 4 VILK ISSUED: Z � LOCT 2 ��2]4 DD938 KING STREPORK10573 DATE: qFEE: PAV VILLAGE OF RYE BROOK BUILDING T R 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 tittitiii►i►Hitt►►iitiiii►i►t►iit4■tC#t►►#►##►i##iL# ►#■i►##n####it#•tt#ttt###kikkikkiiiiiiiiiiti►#it#►tti►4►####i###i#itt4it Address: �� �t•' S /l.0 T IC t� �y 1 d�7 Occupancy/Use: ty*m Parcel ID#: 131/� 1- a Zone: Owner:Yfa,-(s 45-b r A w aS Address: S4— 1" y e 0 T 73 P.E./R.A.or Contractor: Address: p Person in responsible charge: &V.3*_ S A�� 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: being duly sworn,deposes and says that he/she resides at , (Print Name of plicant) (No.and Street) in �� -,in the County ofi.�,1 2C�tL2ftjL in the State of ,that ( ity/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:$ - , for the construction or alteration of: ' 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. Sworn to before me this Sworn to before me this day o V � , 20_ day of , 20 —A—M-14 Signature rope Owner Signature of Applicant i ame of Property Owner Print Name of Applicant Notary Public Notary Public SHARI MELILLO Notary Public,State of New York No.01ME6160063 Qualified In Westchester County Commission Expires January 29,202� QyE BRC�v� o`` tim w � • 1982 BUILDING DEPARTMENT WILDING 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 : to I K I '.1 �'n -.7(L 1 DATE: 1 0 - �- 7 Z C7 Z y PERMIT# ?,? 2 L'1" ISSUED: 'Z ` SECT: BLOCK:/LOT: _ LOCATION: l ni- OCCUPANCY: ❑ VIOLATION NOTED THE WORK IS... El ACCEPTED ❑ REJECTED/ REINSPECTION ❑ SITE INSPECTION REQUIRED ❑ FOOTING ❑ FOOTING DRAINAGE ❑ FOUNDATION ❑ UNDERGROUND PLUMBING NOTES ON INSPECTION: ❑ ROUGH PLUMBING ❑ ROUGH FRAMING ❑ INSULATION I I ❑ NATURAL GAS I Cl ❑ L.P. GAS ❑ FUEL TANK J ❑ FIRE SPRINKLER ❑ FINAL PLUMBING ❑ CROSS CONNECTION ❑ FINAL OTHER .. x x s N N N c e CP o, y z W � x H a s oj W W v x F� 0 'v0 cc 'b d b,0 d w * e 5 W r1 `° a o 0 a to A .04 x 00 w W w 1--1 paQ Ln w Mo© 0 o � ,o V H `� W V A O Q � w au � W Fi v Z -1 o. o cn in W o env 14 oo � a w Nov - 0.4 M' [-4 °iLn v B o F H v = Cn N 14 'g u - ao 1�i O � v - I p w �'' Cn� lu CA U IS bdb W o F �U = W z Q Q O eu «: •y 41 BUILDING-DEPARTIVIENT VILLAGE OF RYE BROOK SEP 2 O 2024 DD 938 KING STRI:f:T RYE BROOK,NY 10573 (914)939-06b8 VILLAGE OF RYE BROOK www.ryebroQkny.gov BUILDING DEPARTMENT FOR OFFICE USE ONLY: d cc �f A Approval DateSEP 2 3 2024 Permit 4 Application # Approval Signature: : ARCHITECTURAL REVIEW BOARM Disapproved: Date: BOT Approval Date: Case# Chairman: PB Approval Date: Case# Secretary: ZBA Approval Date: Case# Other: Application Fee:"pK]� (:�- Permit Fees: Q ROOF PERMIT APPLICATION Application dated: 7—01O c)y 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 statements described below. 1. Job Address: 6 l ; /v:"VL: /361 4/—lr 4,4 Zone:�e—/J Property Owner: t Address: (U Phone#:eld -�3�t/7p {Cell#: IL,-?�1 7 email: 6/o h K�- • ,5'��5� �1�e c�•co 2. Applicant: e�4j"" 01 Address: 7� ( &Z� Si Lee` ' (26 Al y Phone#: ll Cell#: 1/T f D"3 37 7c f email:rJo t tee•�ate. • s' �.c.,'Q g � 4 � Address: e r -66,r S 3. Roofing Contractor; �� { _�'�^ Phone#: ,A 3 t3j 73n Y Cell#: oqD3 9./t%;& 1? email: trX� ��a n�L M Q,����t�ra-��� . 4. Job Description,list all (Methods&Materials: � L4_ A;'-F k_,d G[�,�,. —(�,4 -�i v�� «(�•� r�aS^• V S c Q S'4��-► f C55 ���G( 41�,,�S IZ.vDr-- �,�.• ��'�-" c..�S C� t za it't ci f 5. Estimated Cost of Job:S YY "aD (NOTE The estimated cost shall include all site improvements,labor,material,s�'fofding,fixed equipment.professional Ices•and material and labor which may be donated gratis.) 6. If corner property,indicate street frontage: 7. Construction Type: NYS Construction Class: 8. Number of stories: ,3 Height: 9. Is garage being re-roofed:No:V4•Yes:{ )Attached No:{ }•Yes:( )Number of Cars: 10. Is roof peaked,hip,mansard,flat,etc: �����e-� _ l 1. Estimated date of completion: (of xyl "2V g�f 6/112024 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, (print name of individual signing as the applicant) and further states that (s)he is the legal owner of the property to which this application pertains, or that (s)he is the for the legal owner and is duly authorized to make and file this application. (indicate architect,contractor,agent,attorney,etc.) That all statements contained herein are true to the best of his/her knowledge and belief,and that any work performed,or use conducted at the above captioned property will be in conformance with the details as set forth and contained in this application and in any accompanying approved plans and specifications,as well as in accordance with the New York State Uniform Fire Prevention&Building Code,the Code of the Village of Rye Brook and all other applicable laws,ordinances and regulations. Sworn to before me this Sworn to before me this 19 c1lday of 520 day of 4 w , 20 Signature of Property Owner Sig lure ofjica#n 00k)&S&hJ - Print Name of Property Owner Print Name of A plicant Ajg�ly-ulm Notary Public Notary eu6lic GREGORY M.RIVERA Notary Public,State of New York No.01 R16441398 ; Qualified M Westchester County Commission Expires September 26,201 stv2o2a LANDMARK EXTERIORS �.�:. V 761 King Street-24-212EJ new asphalt roof.docx LANDMARK EXTERIORS 1 PROPOSAL Date: 6/5/2024 No: 24-212E1 Client Information: St.Paul's Lutheran Church (John Tormondsen) 761 King Street Rye Brook,NY 10573 (914)939-8170 Donna Smith spelch@msn.com Project Description: New Asphalt roof over main part of church • Establish property protection • Remove existing asphalt roof down to sheathing • Remove existing aluminum drip edge • Chimney flashings to remain • Install new ice and water shield(6 feet at eaves) • Install new aluminum drip edge • Install new GAF Timberline architectural asphalt shingles (color to be determined) • Dumpster will be on site • Remove all debris Note:Any rotted wood found will be repaired on a time and material basis with approval. Labor&Materials: $44,228.00 1 18 Sheehan Avenue,Norwalk,CT 06854•Main:203-838-3838•Fax:203-838-3834•www.1andntarkexteriors.com Connecticut NHC.0002905/HIC.0553981 *Westchester WC-17240-HO5*New Jersey HIC.13VHI 1769200 761 King Street- 24-212EJ new asphalt roof.docx ACCEPTANCE OF PROPOSAL We propose hereby to furnish material and labor in complete accordance with the specifications presented in the proposal,for the sum of$ 44,228.00 Payments are due as follows: 50%due at signing of contract-30%midway-Balance upon completion Estimated Start Date: Estimated Completion Date: Authorized Signature (Client) Date Scott Teed,Principal,Landmark Exteriors,Inc. (Contractor) Date ACKNOWLEDGMENT OF RECEIPT OF DOCUMENTS BY SIGNING THIS AGREEMENT YOU ARE AGREEING AND ACKNOWLEDGING RECEIPT OF THE FOLLOWING DOCUMENTS THAT HAVE BEEN PROVIDED TO YOU AND COMPLY WITH THE APPLICABLE CONNECTICUT GENERAL STATUTES 1. A COPY OF THE SIGNED AND DATED CONTRACT 2. TWO (2) COPIES OF THE NOTICE OF CANCELLATION, ONE TO KEEP FOR YOUR RECORDS AND ONE TO SUBMIT THE THE CONTRACTOR (IF APPLICABLE 3. A COPY OF THIS SIGNED AND DATED ACKNOWLEDGEMENT I HAVE RECEIVED THE ABOVE-MENTIONED DOCUMENTS AND UNDERSTAND THEM IN THEIR ENTIRETY. I UNDERSTAND THAT IF I HAVE ANY QUESTIONS REGARDING THE ABOVE DOCUMENTS, I HAVE DISCUSSED THEM WITH THE CONTRACTOR PRIOR TO SIGNING THIS ACKNOWLEDGEMENT (Client Signature) TERMS AND CONDITIONS: 2 18 Sheehan Avenue,Norwalk,CT 06854•Main:203-838-3838•Fax:203-838-3834•www.landmarkexteriors.co n Connecticut NHC.0002905/HIC.0553981 *Westchester WC-17240-HO5*New Jersey HIC.13VH11769200 761 King Street- 24-212EJ new asphalt roof.docx - Start and End Dates: The Client understands and agrees that,due to changes in circumstances, the Estimated Start Date and Estimated Completion dated noted above are subject to change with or without notice to the Client. - Change Orders: Any alterations or deviation from the specifications in this proposal will be considered a change order and will be executed only upon approved written orders, signed by both the Client and a duly authorized representative of the Contractor with any additional costs/credits due in accordance with the payment terms noted above. Client agrees that any delay in signing a change order may result in the suspension of work and an extension of the anticipated completion date.Should such a suspension of work occur,the Client agrees to hold the Contractor harmless for any damages that might be incurred as a result of such suspension. If such a change order affects the scope of this agreement,the Client agrees that the Contractor is entitled to retain the appropriate amount of monies for supervision, overhead and lost profit as, in the Contractor's sole discretion, may have been received had no such change order been made, Nonrefundable Deposit: The Client agrees that a deposit will be required to be paid at acceptance of this agreement to reserve the necessary materials. The Client agrees and acknowledges that any deposit monies received by the Contractor pursuant to this agreement are nonrefundable. Late Payments: Client agrees that interest will accrue at 1% per month on any late payment. Clients' failure to make payment when due may result in the suspension of work and an extension of the anticipated completion date. Latent Rot: Client agrees that any rot found by the Contractor must be repaired and will be billed to the Client on a time and material basis. Faulty Flashing: Client agrees that any flashing found, in the Contractor's sole discretion, to be faulty but not listed for replacement, will be replaced and will be billed on a time and material basis. - Additional Repairs:Any repairs needed due to penetrations in the roof after the roof is installed (including solar panels, satellite dishes,waste pipes,dryer vents,stove exhausts,attic vents, weathervanes, etc.) will be done on a time and material basis with written consent. Roof Penetration: Client agrees that Contractor will not be responsible for the removal, re- positioning, or re-installation of any satellite system,attached solar panels, or any other roof- penetrating materials. - Property Features: Buildings, plants and property will be protected during work and all debris cleaned up and removed by the Contractor at the completion of the agreed-upon project. Notwithstanding the foregoing sentence, the Client agrees that the Contractor shall not be liable for damage to buildings, plants and property of the Client except for where such damage is a result of the gross negligence of the Contractor. Insurance: Employees of the Contractor are covered by General Liability and Workers Compensation Insurance; certificates of insurance are available upon request. 3 18 Sheehan Avenue,Norwalk,CT 06854•Main:203-838-3838•Fax:203-838-3834•www.landmarkcxteriors.cont Connecticut NHC.0002905/HIC.0553981*Westchester WC-17240-HO5*New Jersey HIC.13VHI 1769200 761 King Street-24-212EJ new asphalt roof.docx - Force Majeure:All agreements contingent upon strikes, weather conditions, accidents or delays beyond our reasonable control. Manufacturer's Guarantee: The manufacturers guarantee all materials used. Specific information can be provided to the customer upon request. Liability Limitation: The Client agrees that the Contractor will have no obligation to remedy any defect existing at the Client's property, other than as provided in this agreement, including but not limited to any pre-existing conditions, personal property of the Client or unknown third parties, removal of debris or repair of damage, deferred maintenance or any other condition outside the scope of the services provided for in this agreement. The Client expressly waives any claims against the Contractor or its affiliates, deriving from or in any way relating to the Client's property or the services provided under this agreement,unless and except where the Contractor has specifically provided a separate warranty to the Client. The Client agrees to defend and indemnify the Contractor and its affiliates from any claims deriving from or in any way relating to the Client's property or the services provided under this agreement. Miscellaneous: The Contractor agrees to obtain any and all necessary permits at the request of the Client, and the cost incurred for said permits will be additional charges to the Total Contract Price as defined above. It is understood by all parties that the Contractor reserves the right to lien the Property if invoices are not paid in full according to the payment schedule provided herein.The Client agrees to pay the Contractor all costs incurred by the Contractor to enforce this Agreement, including but not limited to attorney's fees and court costs.The Client agrees that Payment will be due to the Contractor whether or not the Services are effective in remediating leaks or other issues bring rise to the Client's need for the Services. - Corporate Disclosure: The owners of the Contractor also maintain an interest in Sheetmetal Services, LLC d/b/a Cedar-Life, a Connecticut-licensed home improvement contractor. Entire Agreement: This agreement contains all of the covenants and agreements between the parties, and may not be modified except in writing,signed by both parties. Proposal Expiration: Proposal is valid for 10 days; due to fluctuating material pricing. Warranty: Contractor warrants that all services, deliverables, and/or work product under this Contract shall be completed in a workmanlike manner consistent with standards in the Contractor's trade, profession, or industry; shall conform to or exceed the specifications set forth in the Contract; and shall be fit for ordinary use, of good quality,with no material defects for a period of ten (10) years from the date of completion of the Contractor's work contemplated in this Agreement. NOTICE OF CANCELLATION (Date of Transaction) 4 18 Sheehan Avenue,Norwalk.CT 06854•Main:203-838-3838•Fax:203-838-3834•www.1andmarkexteriors.com Connecticut NHC.0002905/HIC.0553981 *Westchester WC-17240-HO5*New Jersey HIC.13VHI 1769200 761 King Street- 24-212EJ new asphalt roof.docx YOU MAY CANCEL THIS TRANSACTION,WITHOUT ANY PENALTY OR OBLIGATION, WITHIN THREE BUSINESS DAYS FROM THE ABOVE DATE. IF YOU CANCEL, ANY PROPERTY TRADED IN,ANY PAYMENTS MADE BY YOU UNDER THE CONTRACT OR SALE,AND ANY NEGOTIABLE INSTRUMENT EXECUTED BY YOU WILL BE RETURNED WITHIN TEN BUSINESS DAYS FOLLOWING RECEIPT BY THE SELLER OF YOUR CANCELLATION NOTICE,AND ANY SECURITY INTEREST ARISING OUT OF THE TRANSACTION WILL BE CANCELLED. IF YOU CANCEL, YOU MUST MAKE AVAILABLE TO THE SELLER AT YOUR RESIDENCE, IN SUBSTANTIALLY AS GOOD CONDITION AS WHEN RECEIVED,ANY GOODS DELIVERED TO YOU UNDER THIS CONTRACT OR SALE;OR YOU MAY, IF YOU WISH, COMPLY WITH THE INSTRUCTIONS OF THE SELLER REGARDING THE RETURN SHIPMENT OF THE GOODS AT THE SELLER'S EXPENSE AND RISK. IF YOU DO MAKE THE GOODS AVAILABLE TO THE SELLER AND THE SELLER DOES NOT PICK THEM UP WITHIN TWENTY DAYS OF THE DATE OF CANCELLATION,YOU MAY RETAIN OR DISPOSE OF THE GOODS WITHOUT ANY FURTHER OBLIGATION. IF YOU FAIL TO MAKE THE GOODS AVAILABLE TO THE SELLER, OR IF YOU AGREE TO RETURN THE GOODS TO THE SELLER AND FAIL TO DO SO,THEN YOU REMAIN LIABLE FOR PERFORMANCE OF ALL OBLIGATIONS UNDER THE CONTRACT. TO CANCEL THIS TRANSACTION, MAIL OR DELIVER A SIGNED AND DATED COPY OF THIS CANCELLATION NOTICE OR ANY OTHER WRITTEN NOTICE, OR SEND A TELEGRAM TO LANDMARK EXTERIORS INC. 18 SHEEHAN AVE NORWALK, CT 06854 NOT LATER THAN MIDNIGHT OF .... (Date) I HEREBY CANCEL THIS TRANSACTION. (Date) (Client's Signature) 5 18 Sheehan Avenue,Norwalk,CT 06854•Main:203-838-3838•Fax:203-838-3834•www.1andmarkexteriors.com Connecticut NHC.0002905/HIC.0553981*Westchester WC-17240-HO5*New Jersey HIC.I3VH 11769200 wA� K �I1 o�� ;'#• � i :;�lil�h�i'��f � .'il)hii' af,::;.Iil�hti'�J. �'il�h�il�:r.-:_.._. ' ` Ilil�l�ili�`� e t.�lillhtil��� > ' �I�I����il��•:.,- - � 3� . N CA OLLI Zi- t 1- •� z C w -• 0 teCtlOq >� � C 4 ,err,. �s �. J �•• w o o 'c`s tp .`t = J = J u L LULli I❑, ,1 ' Rico» ✓ C Y W O O pack r. Ln O a: -% o z - (<c.�s»a � 1«O)>°, � rirl �:- _:- 1.� s. '-,"�R�•.-orc�,- ...�;,� 1 f.,.\.-.�;^...,��ii I s.i,s tl.,l ..', 'ss� .� SiI 1 i's:� I IN I `.. k `G111111 aF R! qd1/N �tINN f D! yt11��11111 :f E( r 11�(�(111. # 'II1��((111� x� L !II��1((111 �;1 3; �.t41 , .. �.,.; ;,�i.t« ,,fi�.`ril r 4,1.•, {1�.t�11 �.� ..�f.�l 19 1tllp.�4t; 'FOR � �'. :�� "''N�K v4.• .{if r�+-� �•:.v:;�b',GSs/.�✓``�''.�•-�•�.•¢5;,�w�"�•.•��r•'-'?!! �►� CERTIFICATE OF LIABILITY INSURANCE °9/1 /20'4 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 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 NAME: The Roberts Agency, Inc. PHONE (860)242-7726 Fvc Ne: (a60)242-5505 31 Tunxis Avenue E-MAIL ADDRESS:dag atan@robertsins.com Bloomfield, CT 06002 INSURER 5 AFFORDING COVERAGE NAIL# INSURERA:EMC Companies 25186 INSURED INSURERS:The Hartford 70815 Landmark Exteriors, Inc. INSURERC: 18 Sheehan Avenue INSURER D: Norwalk, CT 06854-4612 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:CL2431509644 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. INSRPOLICY EFF POLICY EXP LTR TYPE OF INSURANCE ADDL BURR POLICY NUMBER MM/DDIYYYY) (MM/DDfYYYYI LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO CLAIMS-MADE �X OCCUR PREMISES Ea occuDence $ 500,000 5D27358 03/26/2024 03/26/2025 MED EXP(Any one person) $ 10,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'LAGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY PRO JECT 7 LOC PRODUCTS-COMP/OPAGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 Ea accident A x ANYAUTO BODILY INJURY(Per person) $ ALL OWNED X SCHEDULED 5E27358 03/26/2024 03/26/2025 BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE X HIRED AUTOS x AUTOS Per accident $ X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 5,000,000 A EXCESS LIAB CLAIMS-MADE SJ27358 03/26/2024 03/26/2025 AGGREGATE $ 5,000,000 DED I X I RETENTION$ 10,000 $ WORKERS COMPENSATION SH27358 03/26/2024 03/26/2025 X PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE NIA E.L.EACH ACCIDENT $ 500,000 OFFICER/MEMBER EXCLUDED? N❑ A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 500,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 A Leased & Rented Equipment 5A27358 03/26/2024 03/26/2025 $25.000 omit $500 Ded. B NY Disability LNY614670 01/01/2024 12/31/2024 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Property address: St. Paul's Lutheran Church - 761 King Street Rye Brook, NY. 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 938 King Street ACCORDANCE WITH THE POLICY PROVISIONS. Rye Brook, NY 10573 AUTHORIZED REPRESENTATIVE J Semple & Laura Lang '"' ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD INS025(201401) NYSIF New York State Insurance Fund PO Box 66699,Albany,NY 12206 I nysff.com CERTIFICATE OF WORKERS' COMPENSATION INSURANCE 0. W .Li +,c ^^^^A A 061450777 ROBERTS AGENCY INC 31 TUNXIS AVENUE ■ BLOOMFIELD CT 06002 SCAN TO VALIDATE AND SUBSCRIBE POLICYHOLDER CERTIFICATE HOLDER ST PAULS LUTH CHURCH LANDMARK EXTERIORS, INC. (CT CORP) VILLAGE OF RYE BROOK 18 SHEEHAN AVE 938 KING STREET NORWALK CT 06854 RYE BROOK NY 10573 POLICY NUMBER CERTIFICATE NUMBER POLICY PERIOD DATE 12409 087-0 124608 03/26/2024 TO 03/26/2025 9/12/2024 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE NEW YORK STATE INSURANCE FUND UNDER POLICY NO. 2409 087-0, COVERING THE ENTIRE OBLIGATION OF THIS POLICYHOLDER FOR WORKERS' COMPENSATION UNDER THE NEW YORK WORKERS' COMPENSATION LAW WITH RESPECT TO ALL OPERATIONS IN THE STATE OF NEW YORK, EXCEPT AS INDICATED BELOW, 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. THE POLICY INCLUDES A WAIVER OF SUBROGATION ENDORSEMENT UNDER WHICH NYSIF AGREES TO WAIVE ITS RIGHT OF SUBROGATION TO BRING AN ACTION AGAINST THE CERTIFICATE HOLDER TO RECOVER AMOUNTS WE PAID IN WORKERS'COMPENSATION AND/OR MEDICAL BENEFITS TO OR ON BEHALF OF AN EMPLOYEE OF OUR INSURED IN THE EVENT THAT, PRIOR TO THE DATE OF THE ACCIDENT, THE CERTIFICATE HOLDER HAS ENTERED INTO A WRITTEN CONTRACT WITH OUR INSURED THAT REQUIRES THAT SUCH RIGHT OF SUBROGATION BE WAIVED. 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 S7NCE FUND / DIRECTOR,INSURANCE FUND UNDERWRITING VALIDATION NUMBER:497958769 U-26.3