HomeMy WebLinkAboutRP24-118 QyE BRn
�
VILLAGE OF RYE BROOK
MAYOR 938 King Street, Rye Brook,N.Y. 10573 ADMINISTRATOR
Jason A. Klein (914) 939-0668 Christopher J. Bradbury
%vw%v.ryebrookny.gov
TRUSTEES BUILDING& FIRE INSPECTOR
Susan R. Epstein Steven E. Fews
David M. Heiser
Donald T. Krom,Jr.
Salvatore W. Morlino
CERTIFICATE OF COMPLIANCE
April 15,2025
Lin Poo Wang&Yuan Yuan Wang
9 Meeting House Lane
Rye Brook,New York 10573
Re: 9 Meeting House Lane, Rye Brook,New York 10573
Parcel ID#: 124.73-2-47
Roof Permit#24-118 issued on 10/9/2024 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
7
I D,
BUILDING DEPARTMENT For office u onl
DEC 19 2024 VILLAGE OF RYE BROOK PERMIT# of —//�ISSUED:/0-9-a 5/
VILLAGE OF RYE BROOK 938 KING STREET,RYE BROOK,NEW YORK 10573 DATE: /a-'/9—j y
BUILDING f7lEPARTMENT (914)939-0668-FAx(914)939-5801 FEE: .9 S O PAIDJO
wwwaebrook.org
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
!k!t!k!!k!!kt!!t4lttilk►►4k►lik►►t!/i■iktkittk4!►itt■►ktitl►►ikt►k►i►ktitiktt►itl►lti!!k►lk►■!k4!l4►4►!!!tklrtrtlrtrtilrtirtrtrtrtrtrtrtrt
Address: 9 Meeting House Lane
Occupancy/Use:t Family Residential Parcel ID#: 124.73-2-47 Zone:
Owner: Bellefair Homeowners Association Address: 24 Bellefair Road
P.E./R.A.or Contractor: Franzoso Contracting, INC Address: 33 Croton Point Avenue Croton on Hudson NY 10520
Person in responsible charge: Peter Klatt/Franzoso Contracting Address: 33 Croton Point Avenue Croton on Hudson NY 10520
Application is hereby made and submitted to the Building Inspector of the Village of Rye Brook for the issuance of 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:
Mark Franzoso being duly sworn,deposes and says that he/she resides at 33 Croton Point Avenue
(Print Name of Applicant) (No.and Street)
in Croton on Hudson in the County of Westchester in the State of NY that
(Cityrrown/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:$ 14,400.00
for the construction or alteration of: Roof Removal/Replacement
Deponent Ru-ther 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. Q�
Sworn to before me this q 1 ` Sworn to before me s ll
day of N 'M Xc , 209-t day of 60C , 20 2�
lz=-
9rgn—a—tu-ryfP rty Own Signature of Applicant
=11 geLC�w Ik,) . S�m,(,-.y Mark Franzoso
Print Name of ro rty r / Print Name of Applicant
Notary Publie Notary Public
DAViI?E.i.�Li+tt.ile Michael BaNt
1G State of �rr1!* Notary Public,State of New York
WC n,> No.01 BA6331102 -
(n c ESOZQDO Qualified in Westchester County
Commission Expires September 28,2027
�yE BRC�k.
BUILDING DEPARTMENT
UILDINGINSPECTOR
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 : m pp l 1.1 C_ A j\l'\D L v F'_ DATE: Z O
PERMIT# �1 L U ISSUED:./0-57'1 Y SECT: :"," BLOCK: L LOT:�Z
LOCATION: "U 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
❑ NATURAL GAS /-✓E hJ (� t
❑ L.P. GAS -4o
❑ FUEL TANK
❑ FIRE SPRINKLER
❑ FINAL PLUMBING
❑ CROSS CONNECTION
] FINAL
❑ OTHER
_
■ a
■
■
�i � cn a � a � ", � ■
M P4 a"i It
¢} :l
w H •
w CDHS � o � o�2
� �
14
° N [ w
►n O a a O v V
00 z O U A q U ,� C U
0 '0
bO Q ee
O It V
►"� W A p3 /z� O a a o as I v (M�
= W Q x CDwo °' 0v0E-
y "
41
■ H W O N V z a 0 cry v =
21
wovv „ !w =
a �~ �� � � �
W o o U 01,
J. ■
V V
A z O
W 0.f W x id .cu b =
a
s
■
ti
BUILET
'MENT
VE OK �� - 8 ZOZ4
938 KINR NY 10573 VILLAGE OF RYE BROOK
(914) 9 39-5801 BUILDING DEPARTMENT
o .
FOR OFFICE USE ONLY:
OCT 0 9 2024 -J/
Approval Date: e r # _ Application#
Approval Signature: ARCHITECTURAL REVIEW BOARD:
Disapproved: Date:
BOT Approval Date: Case# Chairman:
PB Approval Date: Case# Secretary:
ZBA Approval Date: Case#
Other:Application Fee: .$�� CX?- 37c)b Permit Fees: —/o
d
ROOF PERMIT APPLICATION
Application dated: 10/7/2024 is hereby made to the Building Inspector of the Village of Rye Brook,NY,for the issuance of a Permit to
Re-Roof an Existing Building,as per detailed statement described below.
1. Job Address: 9 Meeting House Lane SBL:124.73-2-47 zone: pu b
Property Owner: Bellefair Homeowners Association Address: 24 Bellefair Blvd
Phone#: Cell#: 914-690-1371 email: manager@bellefair.org
2. Applicant: Mark Franzoso @ Franzoso Contracting, Inc. Address: 33 Croton Point Avenue Croton on Hudson NY 10520
Phone#: (914) 271-4572 Cell#: N/A email: sales@franzoso.eom
3. Roofing Contractor: Franzoso Contracting, Inc. Address: 33 Croton Point Avenue,Croton on Hudson,NY 10520
Phone#: (914)271-4572 Cell#: N/A email: sales@franzoso.com
4. Job Description,list all Methods&Materials: Roof Removal/Replacement (24 squares)
5. Estimated Cost of Job: $ 14,400.00 (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: N/A
7. Construction Type: Protected non-combustible NYS Construction Class: 1A
8. Number of stories: 1 story Height: 18 feet
9. Is garage being re-roofed:No: V-Yes:{ }Attached No:( )•Yes:(Number of Cars:
10, Is roof peaked,hip,mansard,flat,etc: Roof peaked
11. Estimated date of completion:TBD
W/2020
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.
*x t**x*��:r*xt:x*xx*;tx,t*x*,rx*x, �*:u�*: •x-x•x,rx***,:•xx�*x:rx**,t�,t,rxx*:r*xx� tx,txx��,r*:r�: *:t*,k,'x+��:w-r x:rxrx�� :r�xr�•
STATE OF NEW YORK,COUNTY OF WESTCHESTER ) as:
Mark Franzoso ,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
Franzoso Contracting, Inc. 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 mg this Sworn to before me this
day of �' '— — ,20� day of DC fO�e f , 20 2Y
Si roperty wner Signature of Applicant
>' S s� �
A I Mark Franzoso
'nt Name of Pr e O er Print Name of Applicant
Notary Public Notary Public
MICHAEL A. NAPOLITANO Michael Babit
Notary Public,State of New York Notary Public,State of New York
Reg. No. 02NA4888695 No.01 BA6331102
oualited in Westchester County r Qualified in Westchester County
commission Expires March 16, 20 Commission Expires September 28,2027
611020
OCT 0 9 2024
p GCENE
Work Scope ocT o 9 2024
JOB: PRJ #58552:Bellefair: Roof Replacements
GE OF RyE BROOK
ADDRESS: Meeting House Lane, Rye Brook, NY 10573
BUILDING DEPARTMENT
Roof Replacements:
• Roof Area in Scope of Work: COMPLETE ROOFS 15,11, 9, 7, 5, 3, 1, 10&12, 6&8, 2&4
MEETING HOUSE LANE
• Install permanent OSHA approved stainless steel single D-Ring fall protection anchor to
each building.
• Remove existing gutters, as necessary to proficiently install the leak barrier membrane over
fascia boards.
• To prevent wash out, landscape damage and possible interior water damage, gutters will be
removed carefully and put to the side for reinstallation, after leak barrier and custom drip
cover is installed. Gutters will be hand washed and immediately connected to leader drains.
• Remove existing roofing material down to roof deck.
• Inspect, remove and replace any damaged or rotten plywood with new comparable
thickness CDX plywood sheathing @$90.00 per 4'x8'x 1/2"; @$120.00 per 4'x8'x 5/8";
@$135.00 per 4'x8'x 3/4" sheet installed; only as necessary.
• Contractor to include (1) sheet of Plywood at no charge for each individual home, plywood
at no charge for each individual home or 88 sheets for the home portion of the project. In
addition, 12 sheets will be provided for the 3 Community Buildings.
• Install GAF Weather Watch leak barrier protection across remaining portions"Ice and
Water Shield" impervious membrane behind gutters on to the fascia board continuing up
onto the roof decking 6 feet and lining the valleys.
• In addition, Franzoso Contracting will wrap the weather watch leak barrier 3" over the fascia
board for extra protection against ice dam back up. We will install a custom fabricated drip
covering on site for optimum coverage. Please see attached diagram.
• Roof to Wall Flashing:
• Remove siding (vinyl)from all sidewalls -wrap and stow away for re-installation.
• Install (1) layer of GAF Weather Watch leak barrier protection, divided in half with one half
adhered to side walls.
• Install new jumbo aluminum step and kick out flashing at roof meets wall locations.
• Install new chimney flash ings/counter-flashings.
• Install all new perimeter drip edge. Color: White.
• All satellite dishes, removed and placed on com-deck roof platform.
• Apply GAF Breathable Deck-Armor roof deck protection across remaining portions of
exposed sheathing, fastened with button type nails.
• Install GAF Pro-Start starter shingles to roof area.
• Install GAFO Timberline HDZ with LayerLock technology shingles, Lifetime manufacturer
warranted architectural shingles to roof area according to manufacturer's specifications.
Color: TBD.
Printed 10/02/2024
• *Includes a GAF "Golden Pledge" warranty which can only be provided by a factory certified
Master Elite Contractor. Materials covered 100% during full protection period against any
defect. GAF "Golden Pledge" warranty covers contractor workmanship for 25 years on
installation of lifetime shingles; includes tear-off and disposal. Franzoso Roofing, Inc.
provides 25-year installation warranty.
• Install new Lifetime Vent Pipe Flashing: The Ultimate Pipe Flashing features premium
silicone & UV stabilized molded PVC compression collar with Kynar PVDF coated 24 ga.
galvanized sheet metal perimeter flashing.
• Install new Broan Nu-Tone attic hood vent. Color: Black.
• Install GAF Snow Country ridge vent to existing ridge vent opening.
• Install GAF Timbertex ridge hips to peaks.
• Hand wash vinyl siding before re-installation.
• Hand clean, rehang and re-pitch existing gutters and leaders. Any gutter or leader dented or
• Proper
Printed 10/02/2024
The GAF Lifetime Roofing System
Ridge Cap Shingles
���� The finishing touch that
helps defend against leaks
at the hips and ridges
^ Cobra" Attic Ventilation
—
- - — — — _ — — — — Helps reduce attic
moisture and heat
5
Lifetime' Shingles
Beautify and protect
4 for years to come
I.
�% •
• Starter Strip Shingles
/jam Helps guard against
'' shingle blow-offs
LJ
`' �:_. — ' — ' •► Roof Deck Protection
^� Helps shield the roof
2 deck from moisture
infiltration
Leak Barrier
/jam Helps prevent leaks
caused by wind-driven
rain and ice dams
Install any GAF Lifetime'Shingle and non-prorated coverage for the first 10
at least 3 qualifying GAF Accessories years. For even stronger coverage, ask 'WFETI
and get a Lifetime'limited warranty your GAF factory-certified contractor' urnrrEoT
on your qualifying GAF products plus about enhanced GAF warranties.
Lifetime refers to the length of warranty coverage provided and means as long as the original individual owner(s)of a
single-family detached residence[or eligible second owner(s)]owns the property where the qualifying GAF products are
installed.For other owners/structures.Lifetime coverage is not applicable.Lifetime coverage on shingles requires the use of
GAF Lifetime Shingles only.See the GAF Shingle&Accessory Limited Warranty for complete coverage and restrictions.Visit
gat.com/LRS for qualifying GAF products.Lifetime coverage on shingles and accessories requires the use of any GAF Lifetime
Shingle and at least 3 qualifying GAF Accessories.See the GAF Roofing System Limited Warranty for complete coverage
and restrictions.For installations not eligible for the GAF Roofing System limited Warranty see the GAF Shingle&Accessory
Limited Warranty Visit gaf.com/LRS for qualifying GAF products.
Contractors enrolled in GAF certification programs are not employees or agents of GAF,and GAF does not control or otherwise
supervise these independent businesses.Contractors may receive benefits,such as loyalty rewards points and discounts on
marketing tools from GAF for participating in the program and offering GAF enhanced warranties.which require the use of a
minimum amount of GAF products
Definition'Color Availability Timberline HDZ'
High
Nationally AvailableColors
Weothered Wood Charcoal Pewlor Gray 6cvh..oud Shakewood
Hickory Slatc• Misvon 6iuwn Hurler Goren
Harvesti • Colors
�t
Regionally Available Colors (See nextpage for details,)
NanTucket Morning Appalachian Sky Golden Harvest Cedar Failti
Birchwood Biscayne Blue Copper Canyoiti � Fox Hollow Gray
Golden Amber OEM-=- RedFor more details Visit 9af.CoM/Timber1ineHDZ
Sum,et Back lV
Williamsburg Slate
Note:It is difficult to reproduce the coior clarity and actual color blends of these products.Before selecting your color,please ask to see several full-size shingles.
slonpad Bui aw Nilonb puo sUMPIsal puo a6wawo alaldw00 A NuouoM
Pallw.n A/oss4xv F alkogS fto aaS 0601 ap,onE)u!ojS BuPoaQ saB ���� 6
opod ul plos sgnpoid uo Aluo udplonb al Stllwo0tOB I5A'N u0u
oM PaJwfl,AasaxV 9 �Z
alQollono sl u0u0wl00slp ao610 ueajNnlQ lsulo60 NuouoM Pallwl7 uoQoalwd ao61y apionE)u!olS IoaA-pl, albQIYS M aw aas NuouoM Pallw walsAS 6ugood M aw Iol apl6lle Iou-!pllolsul mj s u.ow%j
'NUwla iwl Aassaao a Bu! Puo aft)WO alaldwoo pt NuouoM pallw7 W4AS Buyoob M 8Q1 aaS'rauoesaoaq M 6uplplonb E Isoal
M Pal. 1 le 8 I 4S m to puo alBuIQS aw6apl M Auo p am aW sannbei sapossa000 puo sal6ulys uo aBwawo owgapl slonpwd
aw aas'NuouoM paUw 7 w97sAS Buyoog JY`J a4l J0I aIQ!66e pu suollopolsul p j s40npod 1VE)Bu.N!lonb jVo 6w4.lonb Iol SyjAuw l!l Ipin suollolysal puo o6wawo alapwoo ioj NuouoM palwq Nomxy
pl SdVwa0 lab PS!A suoyoulsaJ puo aBwanoo aloldwoo Iol NuouoM Po w!1 wams 6uyood mg eaS V a/kiyS M aw aaS Aluo sel6wQS aw6aP1 M Io am aw sannbal ml6u!Qs uo ebwawo awuayl
MIDIQuaA 00)O lawog>Ioal puo'sal6wQS do0 a6Pld'�40alwd A�100d WULIS iapolS dV9Io am
aw sannbal A6opuQoal dlool aAol wlM sal6ulyS jY�J u0 NuouoM pwM papw!I.ua^okpu IoaA-Sl, apao lddo lou 5 aBwanoo awuapl samlxwsyauMo awo mJ Pallolsul wo sionpo d M Budylonb
ow a*qm Apadwd aw sumo[(s)laum0 puooas ap llila b]awapisai payoolap ApwolalBuls o IO(s)JOUM0
su0.40ulrai Puo 96o>awo alapuroo bl 4u0ueM Papwrl A--V 9 a#J.IgS M On, l0npwpul loul6uo aw so Buol m suoaw Duo papPoid a6wawo NUwlom lo w6ual aw 01 sialai awuapl, •
========== ®u6leJenoS lDJtoa
e115ul4S qoi-£ '
® S Sy ®DlonbeS puoig
I Li Li LI II SV ®eullJagwll
u0113e1100 seI6uI4S tJt PelllPoW Ses
®eulle4DlS
II (9401ewDo
e ®puDlpooM
Se ®DlonbeS puDJg
e �
®UOAUDO pUDJG
uol;oelloo sGIBu[4S .awiteill JeuBtsea
® a a So ®eUllJegwll
L-I LI [T]
- — SN ®eUllJegwll
E 1
® � JdHA oeulljegwll
a Z 1
Cl
u0110e1103 se[Bul4S -ew11e111 y9ul[Jegwjj
uoijonJ;suoo e[6ui4S A60101J43ei AIUDJJDM OIBUI14S
suoilompoedS elBuiuS
v
Approximate Codes Special 4
Physical Attributes Fire Wind National Regional Features
4, g 8
o
U U i3 g r&
,o ig
d p n "No
C? °V C
VE m w wa
i 5 $ $
5%" 13Y4"x39V 7 8
64 3 256 (143 ram) (337 x 1,000 mm) • • • • • • • • • • • •
5 s/e" 13'/<"x 39% 7
64 3 256 (143 mm) (337 x 1,000 mm) • • • • • • • • • • •
5V 131/4"x39V 7
64 3 256 (143 mm) (337 x 1,000 mm) • • • • • • • • • • •
5 s/e 13'/4"x 39'/e' 7
64 3 256 (143 mm) (337 x 1,000 ram) • • • • • • • • • • • •
72 6 360 5" 17"x 40" • • • • s • • • • • s
(127 mm) (432 x 1,016 mm)
70 5 360 5" 17"x 40' • •
(127 mm) (432 x 1,016 mm)
56 4 280 (165 mm) (4321x 1 016"ram) • • • • • • • • ,
56 4 280 7 ih' 17"x 34'h" v • • s y s ♦ • • s
(191 ram) (432 x 876 mm)
48 3 288 7'h" 17"x 40" • • • • a ♦ •
(191 ram) (432 x 1,016 mm) •
64 3 256 5 W 131/4"x 39 5/e" • • • • • • • • • • • •
(143 ram) (337 x 1,000 mm)
72 4 360 1 " i •
(127 ram) (432x 1 016mm) • • • s • • o • • >.
English English English English
5' 12"x 36" •
79 3 316 (127 mm) (305 x 914 ram) • • • • • • • � • •7
Metric Metric Metric Metric
64 256 5 s/e' 13 14"x 39'/e"
(143 mm) (337 x 1,000 mm) ,
425-year StainGuard Plus`Algae Protection Limited Warranty against blue-green algae discoloration is available only 130-year SainGuard Plus PRO'Algae Protection limited Warranty against blue-green algae disWorafion •
on products sold in packages bearing the StainGuard Plus"logo.See GAF Shingle&Accessory Limited Womanly for is available ortiy on products sold in packages bearing the StainGuard Plus PRO'logo.See GAFSMigle&
complete coverage and restrictions,and qualifying products. Accessory limited Warranty for compete coverage and restrictions.
'Steeper slopes and maximum wind warranties may require more nails.
°Pedodicolfy tested by independent and internal labs to ensure compliance with ASTM D3462 at time of manufacture.
'Applies to some pants(that make referenced product).
'Applies to White only,.
27
Roofing Accessories
Install any GAF Lifetimet Shingle and at
least 3 qualifying GAF Accessories and
you'll get a Lifetimet limited warranty on �x
your qualifying GAF products.
Visit gaf.com/LRS for a list of qualifying products.
A
Leak Barriers /0 zs" Help prevent leaks caused
P9 23
by wind-driven rain and ice dams
� 1���
Roof Deck
Protection ^; Helps shield the roof deck
2 from moisture infiltration
pc; 24
Starter Strip
Shingles Help guard against shingle
p9 5 3
blow-offs at the eaves and rakes
�
Cobra A Attic ^ ' Helps reduce attic moisture and heat
Ventilation y/��`� Also available, Master Flow' Ventilation Products.
pg 26
5 see page 28
Ridge Cap %^ ,
Shingles i/ `; The finishing touch that helps defend against
leaks at the hips and ridges
P9 27 6
' 'Lifetime refers to the length of warranty coverage provided and means as long as the original individual owner(s)of a single-family detached reside%e ica eligible second owner(s)]owns the property
where the qualifying GAF products ore installed For other owners/structures.lifetime coverage is not applicable.Lifetime coverage on shingles requires the use of GAF Lifetime Shingles only.See the
OAF Shingle&Accessory Limited Warranty for complete coverage and restrictions.Visit gof.com/LRS for qualifying GAF products Lifetime coverage on shingles and accessories requires the use of any
GAF Lifetime Shingle and of least 3 qualifying GAF Accessories.Seethe GAF Roofing System Limited Warranty for complete coverage and restrictions.For installations not eligible for the GAF Roofing
System Limited Warranty,seethe GAF Shingle&Accessory Limited Warranty Visit got com/LRS for qualifying GAF products
15-yeor WindProren"limited wind warranty on GAF Shingles with layedack Technology requires the use of GAF Starter Strips,Roof Deck Protection.Ridge Cap Shingles,and Leak Bomer Or Adic Ventilation.See GAF
. Roofing System Limited Wmrdnryfor complete coverage and restrictions.Visit got comARS for qualifying GAF products.For installations not eligible for the GAF Roofing System Limited Warranty see the GAF Shingle&
Accessory limited Watrontk.
•
LIFETIM
LIMITED
• WARRANTY TERM
• For the full collection visit gaf.com/System
22
ILF
Leak Barriers
Help prevent leaks caused
by wind-driven rain and ice dams.
■Patterned synthetic film-surfaced peel and stick underlayment for
asphalt shingles and metal roofing
■Self-seals fasteners and helps protect vulnerable areas of the roof
StormGuard m ■2501 high-temperature design.Meets or exceeds the performance
Cl criteria of ASTM D1970.
■2 Sq. (200 ft2(18.58 m2))roll size—excludes laps
ICA ■Mineral-surfaced peel and stick underlayment for asphalt shingles
■Self-seals fasteners and helps protect vulnerable areas of the roof
WeatherWatchc ■Meets or exceeds the performance criteria of ASTM D1970
■2 Sq. (200 ft2(18.58 m2])& 1.5 Sq.(150 ft2 (13.94 m2)roll sizes—
excludes laps
Leak Barrier Application Recommendations:
Strongly recommended around Optional around Required by code at' Region'
1.Penetrations
S.Hips&rake edges 7. Eaves in colder zones 1.Colder zone
2.Skylights Recommended in
wormer zones
3.Valleys&dormers
-- -- - - b.Ridges 2.Warmer zone
4.Flashings&transitions
For the full collection visit gaf.com/LeakBarriers
'Always check local building codes for requirements in your area. /
To quality for this coverage,must be installed with GAF Lifetime'Shingles and at least 3 qualifying GAF Accessories.See GAFcom/LRS for qualifying products and see GAF Roofing System limited Warranty
for complete coverage and restrictions 23
i
Roof Deck Protection
Helps shield the roof deck
from moisture infiltration.
■Premium breathable synthetic underlayment for asphalt shingles
and other roof systems
Deck-ArmorTM ■Nom.16 perms,high-traction surface,and tear-resistant construction
■48"x 250'0.22 m x 76.2 m); 10 Sq.(1,000 ft2[92.9 m2])roll size—
excludes laps
■Premium synthetic underlayment for asphalt shingles and other
roof systems
Tiger PawtM ■High-traction surface,tear-resistant construction,and deck side
z-� coating provides moisture control
S ■48"x 250'0.22 m x 76.2 m); 10 Sq. (1,000 ft2[92.9 m2])roll size—
excludes laps
■High-traction synthetic underlayment for asphalt shingles
FeltBuster® r ■Value-priced, high-traction surface,and tear-resistant construction
__ ■48"x 250'(1.22 m x 76.2 m); 10 Sq.(1,000 ft2[92.9 m2])roll size—
excludes laps
■Fiberglass-reinforced underlayment for asphalt shingles
■Fiberglass reinforcement lays flat and helps prevent
Shingle-Mate'M telegraphing through shingles
• ■36"x 144'(.914 m x 43.89 m);4 Sq.(432 ft2[40.13 m2])roll size—
excludes laps
Specialty Underlayment
' ■Fiberglass-reinforced fire-resistant underlayment for asphalt shingles,
metal,wood,and other roof systems
• ■Helps upgrade the UL Fire Rating of many roofing systems
VersaShield'3R (always see the UL Certification Directory)and helps resist
. dangerous flame spread
■42"x 100'(1.07 m x 30.48 m);3.5 Sq.(350 ft2[32.5 m2])roll size—
excludes laps
1
For the full collection vibi gaf.com/Roof Dec kProtection
'To quality for this coverage.must be installed with GAF Lifetime'Shingles and at least 3 qualifying GAF Accessories See GAF.com/LRS for qualifying products and see GAF Roofing System Limited Worronty
24 for complete coverage and restrictions.
� 3
Starter Strip Shingles
Help guard against shingle blow-offs
at the eaves and rakes.
■Premium starter strip shingles for all asphalt shingles
■Extra-wide format,pre-perforated design,and factory-applied
WeatherBlocker'M Dural Grip"Adhesive
■Full sheets measure 17"x 40"(432 mm x 1,016 mm)and cover
50 lin.ft.(15 Im)per bundle.Half sheets measure 8 t/s"x 40"
(216 mm x 1,016 mm)and cover 100 lin.ft.(30 Im)per bundle.
■Starter strip shingles for most standard English and metric-sized
asphalt shingles
Pro-Starfl •Pre-perforated design with factory-applied Dura Grip"Adhesive
■Full sheets measure 13"x 38"(330 mm x 965 mm)and are split
into half sheets measuring 6 t/z"x 38"(165 x 965 mm)to cover
120.33 lin.ft. (36.69 Im)per bundle
■Peel and stick starter strip roll for most standard English and metric-
sized asphalt shingles
QuickStart° ■Mineral surfacing with factory-applied Dura Grip'Adhesive
■9"x 33'(228 mm x 10 m)roll size
■Complementary-color starter strip shingles for Grand Sequoia
and Grand Canyon"Shingles
■25-year StainGuard Plus"Algae Protection"Limited Warranty protects
StarterMatch° StarterMatch Starter Strip Shingles from unsightly stains.'
•Used in conjunction with WeatherBlocker- '
■Full sheets measure 13 t/4"x 40"(337 mm x 1,016 mm)and cover
60 lin.ft.(18.3 Im)per bundle •
For the full collection visit gaf.com/StarterStrip
To quality for this coverage,must be installed with GAF Litenme'Snngles and at least 3 qual tying GAF Accessories.See GAF.com/LRS for qualifying products and see GAF Roofing System Limited Warranty •
for complete coverage and restrictions.
25-yeor StainGuard Plus'Algae Protection Limited Warranty against blue-green algae discoloration is available only on products sold in packages bearing the StainGuard Plus"logo.See GAFShingle&
Accessory Limited Warrantyfor complete coverage and restrictions,and qualifying products. 25
i
5
Cobra° Attic Ventilation
Helps reduce attic moisture and heat.'
LIF
T
Ridge & Hip Exhaust Ventilation
■Mesh roll ridge vent for all climates
ti ■101/2"(267 mm),8"(203 mm),and 11 3/4"(298 mm)widths;20'(6.1 m)
Cobra-' Ind 50'(15.24 m)lengths
Exhaust Vent •Includes 21/2"(64 mm)Smart Nails'(Hand Nailable)or 1 3/4"(44 mm)Coil
Nails(Nail Gunnable)
■NFA:Hand Nailable—16.9 sq.in./lin.ft.(35,772 mm2 per lineal meter);
Nail Gunnable—14.1 sq.in./lin.ff.(29,845 mm'per lineal meter)
■Premium plastic ridge vent for colder climates
Cobra'J In Includes 3" (76 mm)ring shank nails,Snow Guard-Filter&3"(76 mm)
EasyTear'Sizing
SnowCountry ■11 1/2"(292 mm)and 9"(229 mm)widths;4'(1.2 m)length,
Advanced 40 lin.ft. (12.2 Im)per box
■NFA: 18 sq.in./lin.ft.(38,100 mm2 per lineal meter)
•Plastic ridge vent for colder climates
Cobra 6' ■Includes Snow Guard'Filter&3" (76 mm)EasyTear'Sizing
SnowCountry�' •11 1/2"(292 mm)width;4'(1.2 m)length,40 lin.ft.(12.2 Im)per box
■NFA:18 sq.in./lin.ft.(38,100 mm2 per lineal meter)
■Premium plastic ridge vent for warmer climates
Cobra--" •Includes 3"(76 mm)ring shank nails&3"(76 mm)EasyTearl Sizing
RI id Vent 3TM ■11 1/2"(292 mm)and 9"(229 mm)widths;4'(1.2 m)length,
g 40 lin.ft.(12.2 Im)per box
' ■NFA: 18 sq.in./lin.ft.(38,100 mm2 per lineal meter)
• ■Plastic roll ridge vent for all climates
Cobra`R' ■Includes 1 3/4(44 mm)coil nails,Weather Fighter" Filter&12"(305 mm)
EasyTear"Sizing
RidgeRunner® ■11 1/2"(292 mm)width;20'(6.1 m)length
' ■NFA: 12.5 sq.in./lin.ft.(26,458 mm'per lineal meter)
■Plastic hip vent for all climates
Cobra ■Includes 1 3/4"(44 mm)coil nails and Dual Weather Fighter'Filter
Hip Vent •11 1/2"(292 mm)width;4'(1.2 m)length,40 lin.ft.(12.2 Im per box
■NFA:9 sq.in./lin.ft.(19,050 mm'per lineal meter)
Intake Ventilation
■Tapered roll intake vent for all climates
Cobra •Includes 1 3/4" (44 mm)coil nails and end cap fabric
■11"(279 mm)width;20'(6.1 m)length
IntakeN6 ■NFA:9 sq.in./lin.ft.(19,050 mm2 per lineal meter)
• 1.See photo for product placement
For more details visit gaf.com/Cobra
To qualify for this coverage.must be installed with GAF Lifetime'S, ,. r!east 3 qualifying GAF Accessories.See GAF.com/LRS for qualifying products and see GAF Roofing System limited Warranty
for complete coverage and restrictions.
26 'NOTE:Always have a balanced attic ventilation system.In no case should the amount of exhaust ventilation of or near the ridge exceed the amount of intake ventilation at or near the soffit.
Visit gatcom/ventcalculalor for more details.
6
Ridge Cap Shingles
The finishing touch that helps defend
against leaks at the hips and ridges.
I Z
�- ■Premium double-layer ridge cap shingles for use with
Timberline HDZ",Timberline"NS,UHDZ',and GAF Designer
f Lifetimet Shingles
TimberTex _ ■Pre-perforated design&factory-applied Dura Grip-Adhesive
■12"(305 mm)width,8"(203 mm)exposure,covers 20 lin.ft.
(6.1 Im)per bundle
■Available in all areas(except West area)
■Traditional look ridge cap shingles for use with
Timberline HDZ°,Timberline'NS, UHDT",and CS Shingles
■Pre-perforated design&factory-applied Dura Grip"Adhesive
Seal-A-Ridge ■12"(305 mm)width,6 2/3(169 mm)exposure,
covers 25 lin.ft. (7.6 Im)per bundle
■Available in all areas
■Premium SBS-modified bullnose ridge cap shingles for use
with Timberline HDZ",Timberline'NS,UHDZ-,RS/RS+,CS,and
GAF Designer Lifetimet Shingles
TimberCrest ■Pre-folded/flexed design&factory-applied
Dural Grip"Adhesive
■10"(254 mm)width,8"(203 mm)exposure,covers 20 lin.ft.
(6.1 Im)per box
■Available in the West area
■High-profile SBS-modified ridge cap shingles for use with
- Timberline HDZ',Timberline'NS, RS/PS+,and UHDT"Shingles
Rid lasso _ .'""C=`'R ■Pre-folded design&factory-applied Dura Grip"Adhesive '
g ■10"(254 mm)width,8"(203 mm)exposure,covers 31 lin.ff.
.,� ( )per box •
-.. ■Available in the West area
■Wood shake-look ridge cap shingles for use with
= -
_ Timberline HDZ',Timberline'NS,and UHDZ"Shingles
Z"Ridge ■Pre-perforated design with unique Z-fold design
■10"(254 mm)width,5 5/s"(143 mm)exposure,
-�. covers 33.3 lin.ft. (10.1 Im)per bundle •
■Available in the Southwest and West areas
■UL Class 4 impact resistance,pre-perforated
Seal-A-Ridge' -� design&factory-applied Dural Grip"Adhesive
■For use with GAF ArmorShield'Series Shingles
AS ■12"(305 mm)width,5"(127 mm)exposure, '
covers 25 lin.ft.(7.6 Im)per bundle •
For more details vis gaf.com/RidgeCaps
'To quality for this coverage.must be installed with GAF Lifetime'Shingles and at least 3 qualifying GAF Accessories.See GAF com/LRS for qualifying products and see GAF Roofing System Limited Warranty
for complete coverage and restrictions.
NOTE:These products are not available in all areas.Visit gaf.aomindgecapavailabillly for more information. 27
Timberline HDZ° Availability
Color Availability p
Chart
Most Popular Colors: A
o Charc
Charcoaall
Hickory a
Hunter Green n
Mission Brown
Pewter Gray n
Shakewood
Slate -
Weathered Wood
Harvest Blend Colors:
Nantucket Morning
Appalachian Sky
Golden Harvest n a
Cedar Falls
Regional Colors:
Birchwood
Biscayne Blue -
Copper Canyon'
Driftwood
Fox Hollow Gray
Golden Amber'
Oyster Gray
Patriot Red
Sunset Brick
White'
Rated by the Cool Roof Rating Council(CRRC):can be used
Williamsburg Slate to comply with 2019 Title 24 Part 6 Cool Roof Requirements of
the California Code of Regulations.
The protective layers of a Timberline HDZ° Shingle
Product/System Specifics Applicable Standards&Protocols:
Ceramic-Coated ■ Fiberglass asphalt construction ■ UL Listed to ANSI/UL 790 Class A
Granules ■ Dimensions(approx.):13'/V x 39'/e' ■ State of Florida approved
Engineered Asphalt (337 mm x 1,000 mm) ■ Classified by UL in accordance
■ Exposure:5%"(143 mm) with ICC-ES AC438
High-Strength ■ Bundles/Square:3 ■ Meets ASTM D7158,Class H
Fiberglass Core ■ Pieces/Square:64 ■ Meets ASTM D3161,Class F
■ StoinGuard Plus'Algae Protection ■ Meets ASTM D3018,Type 1
Engineered Asphalt Limited Warranty' ■ Meets ASTM D34622
Ceramic-Coated ■ Hip/Ridge:TimberTex":TimberCrest"; ■ Miami-Dade County Product
Granules Seal-A-Ridge";l"Ridge;Ridglass" Control approved
• Starter:Pro-Start";62uickStart"; ■ [CC-ES Evaluation Reports
- Engineered Asphalt WeatherBlocker' ESR-1475 and ESR-3267
■ Meets Texas Department of Insurance
High-Strength 1 3'/4"x 39%"(337 x 1,000 mm) Requirements
Fiberglass Core ■ C q
■ Rated by the CRRC:Can be used to
Engineered Asphalt comply with 2019 Title 24 Part 6 Cool
Roof Requirements of the California
Dura Grip'"^Adhesive Code of Regulations.
25-year StainGuard Plus"Algae Protection Limited Warranty against blue-green algae discoloration is available only on products sold in packages bearing the
StainGuard Plus"'logo.See GAF Shingle&Accessory Limited Warranty for complete coverage and restrictions and qualifying products.
Periodically tested by independent and internal labs to ensure compliance with ASTM D3462 at time of manufacture.
'Harvest Blend colors are only available on TimberTex"and Seal-A-Ridge''.
w+r
_.. .. -_. . - �_�.. �".`o`". �.Zi, •�r�i.'�"e„3:. .. - _.._ter- �'���
aw R,
i
ti
-k� Y
�l'
J
_ d _»:.
•a
Ao�,. �y A�• �
- _....
/�
�;
.:,.�._�
N-1 �.iSf` IA�(i Jikt "��pAr -_. .ry - ail' A fie}- __ :iAil(� r•�. r Ar Y�l t. y ..tiv�
�'if••:��J�lj :COY i(�+�SY' f �O� 5�� y '.�0� ! t ;r '�O� ,,,�R � .• Irk
4� w qfi ir 0l1 tvS� nl �r 1 r4/h k Y t q11�h{{SSt r �l A�S• 1 y Of �r
'� ir, v 4 h s)). v tU,!7 i Jtt. v fl•.Y.! n'': v "I:N. v �1.. v. :d
it + dd'� I�IIi/11i�{�;tY1�- 1�Olt�►IQ►IIp`1�1} _d+lt! I�/D/Mild i��� d��l 4j1►1011i��`�'/1f'
<eo>►y a 1111{..ta..+ e s r.11111 � a�riFi Illlll.f ,�a , Eft 11►1i1{ (.t�:. .tss..11ll/llll�►i t. ._1111�111;11�,. sy —gt i�11/11111=1+ff aJJyy:}}
-150
rx ea cn
c
rZ
O
LLI
00
`
o
U N
h
v: `Y 1'♦ ILI U Z W 0 C CO)Plm Zvi
t D O a W �♦
Lu
4—d �0'/^� U
O
v Lu
L
' 0 FO O
CQ O Z
ON v HO o '~ "�edap V,e ��♦ r'
0 j w 0
LL
cd
15.
ci
�I s
♦ tz 00
6 ♦
L- ♦�� V CI N N
CL
-f�-' ,� -E ..I,/111►,1. :llll/11►111, _ �-�11/111111h t = 'lli/lllhl - =- �`{1+/1114, = :`IIIIN, __ ;,I/l/y w.. «O)►
^SO ,OV.Vk �l E'g 111N, lrtp3 L 63 i I//lljl )Qg s �; 111111 pp Yg(( 111/1111Alp y�{' 1►11111► - ~�
)�NAi fty%, i� �) Y• 'h •1� f�N`SIAS�� ����• 111 � j�!( i4P 1 i7 ��H� t�
h$ r •'•31 A, Fn t7 (. ty. A Ir �� t A fc cw •♦ • s i:. \
rj9;' gr r,44,n.: �. (In
- � : � Ydjrr i Srn'VAr' / �rJf' S� .^ R�/7r V ti'�i+� c.tVr �i+t�Y f1&,t'GI'nvr,
.� +a
7�0� ir�0� -r (fO�i JN� /O a1"r�, /O� r/.�kti, io, ,1Akti"�• / s `ti'!lrr4�'��
,�•._.v�v '�BT -•�� .: �'� d+ �,.:7 f�,� •o'r �,tii..-•�%r,� �✓ �ern."�!� /�' _. "fin"��O,v�•'.�n � -.��0?) ny� l�
A��8 DATE(MM/DD/YYYY)
CERTIFICATE OF LIABILITY INSURANCE 10/07/2024
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 rights to the certificate holder in lieu of such endorsement(s).
PRODUCER CONTACT Certificate Team
NAME:
ROBERT T.KIRKWOOD,INC. PHONE (914)769-9070 FAX (914)769-4706
A/C No Ext: AIC,No
91 Washington Avenue E-MAIL certificates@kirkwoodinsurance com
ADDRESS:
INSURER(S)AFFORDING COVERAGE NAIC N
Pleasantville NY 10570 INSURERA: Selective Way Insurance Company 26301
INSURED INSURER B: Merchants Mutual 23329
FranZOSo Contracting Inc. INSURER C: Selective Insurance Company of America 12572
33 Croton Point Ave INSURER D:
INSURER E:
Croton On Hudson NY 10520 INSURER F
COVERAGES CERTIFICATE NUMBER: 24-25FRANZOSO REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW T-fAVE BEEN-SSUED 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 rypE OF INSURANCE POLICY EFF POLICY EXP
LTR INSD WVD POLICY NUMBER MM/DD/YYYY MM/DD/YYYY LIMITS
X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000
CLAIMS-MADE Fx-] OCCU RE cc
R PMISES Ea ourrence $ 500,000
MED EXP(Any one person) $ 15,000
A S2332054 04/01/2024 04/01/2025 -PERSONAL BADVINJURY $ 1,000,000
GEN'L AGGREGATE LIMIT APPLIES PER. GENERAL AGGREGATE $ 2,000,000
X POLICY ❑PRO ❑ LOC PRODUCTS-COMP/OP AGG $ 2,000,000
JECT
OTHER I 1 1 $
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000
Ea accident
X ANY AUTO BODILY INJURY(Per person) $
A OWNED SCHEDULED S2332054 04/01/2024 04/01/2025 BODILY INJURY(Per accident) $
AUTOS ONLY AUTOS
HIRED NON-OWNED PROPERTY DAMAGE $
AUTOS ONLY AUTOS ONLY Per accident
X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 4,000,000
B EXCESSUAB CLAIMS-MADE CUP0000898 04/01/2024 04/01/2025 AGGREGATE $ 4,000,000
DED I X RETENTION$ 10,000 $
WORKERS COMPENSATION X PER OTH-
AND EMPLOYERS'LIABILITY Y/N STATUTE ER
ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 1,000,000
C OFFICER/MEMBER EXCLUDED? NIA WC9082556 04/01/2024 04/01/2025
(Mandatory in NH) E.L DISEASE-EA EMPLOYEE $ 1,000,000
If yes,describe under 1,000,000
DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required)
VILLAGE OF RYE BROOK IS ADDITIONAL INSURED UNDER GENERAL LIABILITY PER BLANKET ENDORSEMENT AS RESPECTS WORK
PERFORMED BY THE INSURED AT BELLEFAIR COMPLEX 1-15 MEETING HOUSE LANE RYE BROOK,NY 10573.
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 10573
O 1988-2015 ACORD CORPORATION. All rights reserved.
ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD
PORK Workers' CERTIFICATE OF
STATE Compensation NYS WORKERS' COMPENSATION INSURANCE COVERAGE
Board
la.Legal Name&Address of Insured(use street address only) 1b.Business Telephone Number of Insured
Work Location of Insured(Only required if coverage is specifically limited to (914)271-4572
certain locations in New York State,i.e.,a Wrap-Up Policy)
1c.NYS Unemployment Insurance Employer Registration Number of
Franzoso Contracting, Inc. Insured
3 Croton Point Avenue
Croton on Hudson,NY 10520
1d.Federal Employer Identification Number of Insured or Social Security
Number
471320112
2.Name and Address of Entity Requesting Proof of Coverage 3a.Name of Insurance Carrier
(Entity Being Listed as the Certificate Holder) Selective Insurance Company of America
Village of Rye Brook 3b.Policy Number of Entity Listed in Box"la"
938 King Street wc9082556
Rye Brook, NY 10573 3c.Policy effective period
04/01/2024 to 04/01/2025
3d.The Proprietor,Partners or Executive Officers are
S 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"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 conlained 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: Robert Kirkwood
(Print name of authorized representative or licensed agent of insurance carrier)
Approved by: A &�'/(
10/7/2024
(Signature) (Date)
Title: Principal
Telephone Number of authorized representative or licensed agent of insurance carrier: 914-769-9070
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