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HomeMy WebLinkAboutAbandoned Roof Application �yE BRC�k. /�• 19b2•� BUILDING DEPARTMENT ❑BUILDING INSPECTOR 9AsSISTANT BUILDING INSPECTOR VILLAGE OF RYE BROOK ❑CODE ENFORCEMENT OFFICER 938 King Street . Rye Brook,NY 10573 (914) 939-0668 FAx (914) 939-5801 www ryebrook.org - - - - - - - - - - - - - - - - - - - - INSPECTION REPORT - - - - - - - - - - - - - - - - - - - - ADDRESS : -! 1 ' 'AY y ooC..: A y r DATE: /- Z ZGIe 7 PERMIT# ISSUED: SECT: /��,.i }J BLOCK: ( LOT• Z LOCATION: �cr1 OCCUPANCY: ❑,/violation Noted THE WORK IS... [I PASSED El FAILED REINSPECTION LN SITE INSPECTION REQUIRED ❑ FOOTING ❑ FOOTING DRAINAGE ❑ FOUNDATION ❑ UNDERGROUND PLUMBING NOTES ON INSPECTION: ❑ ROUGH PLUMBING ❑ ROUGH FRAMING ❑ INSULATION ❑ Natural Gas \y J U_, k , ICQ I } vW A C as e ❑ FUEL GTANK ❑ FIRE SPRINKLER ❑ FINAL PLUMBING ❑ CROSS CONNECTION 1� l A V V)0, ' ` 0�lj c/ ❑ FINAL i / V ❑ OTHER ' h2 iw /t ou Laura Petersen From: Laura Petersen Sent: Wednesday, October 26, 2022 9:22 AM To: ctinstalls@powerhrg.com Cc: bayer316@gmail.com Subject: Roof Permit Application - 9 Maywood Avenue Good morning, The Building Department has not yet received the Westchester County Home Improvement license for Power Home Remodeling Group. In order to process the roof permit, a valid license is required. Thank you ¢ Lauras� Laura Petersen � Office Assistant Village of Rye Brook �Q 938 King StreetjL Rye Brook, New York 10573 Phone(914)939-0668 1 Igetersenervebrook.or4 WC...S � - � z - zY Laura Petersen From: Laura Petersen Sent: Tuesday, September 13, 2022 12:35 PM To: ctinstalls@powerhrg.com Cc: bayer316@gmail.com Subject: Roof Permit Application - 9 Maywood Avenue Attachments: Signature Page for 9 Maywood Avenue.pdf Good afternoon, The Building Department has received the roof permit application for 9 Maywood Avenue. Please provide a valid Westchester County Home Improvement license as well as the Signature page with the property owners notarized signature (please see attached). Thank you Laura Laura(Petersen Office Assistant Village of Rye Brook `�/ \ 938 King Street I© C3 7 �� Rye Brook, New York 10573 Phone(914)939-0668 1 Ipeterseneryebrook.org �'he Czl ice . BuILDIN(.' DE-PA "I'ME T SEP 1 2 2922 VILLAGE of RYE 0K VILLAGE OF RY'C: BROOK 116x MMPUTT RYF HPs. K,%,Y 1€573 BUILDING DEPA?l-Mlr NT 114 . k «aaasiii s.+ki#+.ia.is4aiai-ia # as iia is is-iaa#i ilia i-•ie.ici aiiM ai#aia4-i a+Firaiii444i4i iaiii.aiii+� A,pprotal9alc Q rf ARCH U WkL REVI 1Ar' ii(_ARD: I(Yr AppruN ZBA =1rprr,,,11 b ti€ �3tt�t r: «,wa a:«rxa«ss aas as a.a.i«a as ial,ia as♦•as aw«...a.tfisr ai«a n««:aa ssaaasidi rasa.ax ai iia4 iii�i:s►r 4a4e444#sapc4a�:�i aasi.4 r.�+-. ROOF PERNII`I" APPLICATION 9/7/2022 ApplizatwirdAud ,`.Ia zt^, s :az9.. ., `•So;ils.'alit, !i1wl,:-•a�an' -(ftr HIAA V tf P.%Ill ITr"'a" .,Nly.fr"d"ft tmit lit of ik Permit rah, u�-�!`'a�I�b F�t�liti ,+t eau .,i.s.. <i.n..,i r a:a,r ,a,..�-ui•rd ...au 9 Maywood Avenue 135.75-1-24 1. TE:,tt z a3zi� s T9 Zmw: Dawn Bayer 9 Maywood Avenue Ptt�+rrt+. �i•n srri 'x, lrrE-> (914) 879-3251 1 „ 1 bayer316@gmail.com Applicz rAnthony Costello ,,.I1 2501 Seaport Dr Chester PA 19013 (610)874-5000X6662 (203)400-0707 ctinstalls@powerhrg.com pliand:o Lraaarl Power Home Remodeling Group 2501 Seaport Dr Chester PA 19013 6108745000 x6662 2034000707 ctinstalls@powerhrg.com 4. Job M-'wrirtim. fast all M«~ft,iar & ?'.ihlc-ntt(:5 Remove and replace 14.5 sq roof with 50 year GAF shingle, ice and water to code, deck armor and taped seams. No structural changes 16124 b. VB VB .aitairxi�iiaal t lo;,, 2 9, IN uatdsc bvirty I, �,^ I 1 X a a,E; : a._.; X .a ',E,.•f „r i u� 1 ,.. Peaked W. Il rw+ f perk Peakedk, ,hip. „ r,-. �.i °L If. 1 xttmj1cJ datL ivfvwnpl or. 10/1/2022 tttLI iNG D.FP TN E: T VILLAGE qAy1�,RR0,0K '€fur:Code ofVilla e ot"Rye Brook re4uifes p+.-1rsuty tur Ahy rc-rVuft L4 PT J._ . Apvlkanti se kiarg ts,r f are exis,.tr � tmnkting with rtm like matrw-rialto rnisxt obtwo pvoT.appnival from the ViHie i.a ierr 8 li is�az lDnaxrsl t A tl3 t i' c c contact the Building l3cpaitn r,t for further inforrraation regarding nor-like r�,, 1 its,rrnwzials. DO NOT START CONSTRUCTION UNTIL A PERMIT IT HAS KEN ISSUE} BY T'HIE BU140ING INSPECTOR APFILtCAN I'`^a Y 110t1!'S10`ti I tt I I I F- t4LII.I)t vie Mill kR l VIEN l NIL'IST IM Lt=DE; 1. A properly rcomplctcd api,h�',iijon ',,.'th rtotanied signatures Where indicated Application filing fee: Rcsid,,-wi:,l .. fig ' 0 Commercial - 50, fAIVli-.:atioit Nes Are tioi�-ftfiir dab M 3. Your cuntractnr's valid Wr stchcstcT C minty Home li,Wprovemcnt I wcnsc. 4: Your wntr ttor's valid tafof Itabilily inSUrQ1rt 1V. 0`o Lip,ofRye Limit r ani by ht.-irJa%cvniC'i"itf hoimit 5. (Your contracts valid p f cat`workers c�:�mperisa.ti n it urance. qt"um z(IOC w So t'imn a Uz. .:3 i Of NY kdaJV Wllfk r; fa. Permit fie; '-1. 1 .tl0 1 $1,000,00 of Con tnwt:icirt Cost with it ininitr uin fee.of S100 00 C'ommercial = 25 00 f$1,OW,00 afConstructiomCost with a minimum fec cif$275.00. Itc)JIRS F`(U ()Pk RAT QN t4F't [y� �t'`I I{'` t:01;1 11N*-N I' Weekdays: 8:00ain to 6:00pm or dusk, whichever is earlier `un�.4 1;1 PERAIJON fl1°` '() 'S f ?1"+ a 14 ' 1 fit,t ' ,' ,T t1: ,.. 1 `i'' ' i7 Ilk,lc.Tayfs Include: Nuns.Year Day,January l Pres ent's.Day.3"'r Monday its l" ry; hicn_. t t last Nlonda 4 in tadenLe Day,July 4''i Labor trap, I"4lcaricl y in Supicirthtt,Thanksgiving IL CIanarnas Ds ,,, December 211";when the hAdays sit f xth fall on a Sunday,the holiday is cep*caved clan:iseat da,. §15X-4,C odc of the Village of Rye I*K4 aNX. State Building Codes fGr Re-Roofing 2 Family lfin : §*411099-1I._1, WhCn ACWhMg IN arrr ovvi or r lac t during re nu f ng expostng tbi roof cavity and the Tuwl'imvM is omitl car"insulation.the roo,f cav-iiy shall.tae ins last i such that the flicamai envelope of the ceitin c rtpb s with t rrgmr mcntr,of the Into matromt Errcrgy Code fm new tri :tr n f -491 i 05,1.2. Ice barrier shall be Whed to the sheathing r itch that it extends froin the lawvst edges ofall reef surfaces to a drat measured 24"pffprndtcUJAT trom the insidr of the exterior wail of t e Nl ild ng" Please keeg these instruction sheets throughout the gurafion of the job for reference. Please note that this application must include the notarized signatures) 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, ♦rAt1R+x♦-�♦,R tit#Fit eR�rt*svr♦►4f ta1 r4R+t-r tsar-+.,*..**r•rs lw 1rr•r•�+-t+elxss4r+.Rrs,...-++xrt4+ease s4:w��-�r�R�'.r+r+rRwAa A�g�ngrCI&&YOOIIK COUNTY Or,W17,5TOIFSTI7 It being duly swurn deposcs and states that hetshe is tic applicant abkwc tined, (­w w7,4 ,,t it fiViA4a paiva"r I"the appketm I arts] fur€h states that Whe is the legal u� net of the prupcity to whLch this applsc:ition pellrins. M d1at (s)}ye is tlx GOntrer actor for t,rc lcg;il i twnct'uit�Li rs tluly arutltonz !tq make artvj file thtr appbcarion V$10diC *ri' tt`t.aZ:rt9r8a'1cY. ;pMlt,irwpr }.trx�!__ 'Mio all f4aletwnts contained herein.arc"c to the thest of htt:,'hcr kn(y,*lmilpc arvd tvaucf,and that any wo6 rforn-v 1.or use cconducted at the aboNc captimied prope tv will tic in cc nfiwmance w ah the deUiLs as-wt forth and contained in this applWation wW in any accompanying approved plam and speci ticalions,as well as in accordancr.with,the New Y(wk Sale 1 niform Fire Prevention,&Building Code.the Codc of the Village of Stye Br rk and all other gplic~abIi laws,otdinan es and regulatioiss. Swom to litfc nic aea� _..- _.. ._. _., Swumi to lukn t rnrc this 7th ,h,Y kit 20 September `it�n�t.ur of Pro t} t)�ttrr ti,yr,,�t-tt�� ,t :1:rpii•.�:nt fD A hony Costello alA�� y I' ntN tarPnperty(Wrier No,p!EZA ecticut ,; , ; rt ;;t th,.,,-,,,,; MY12023 sMARI MEULLO Notary No. York OiMEU60063 Qualified In Westchester 29 2Y02'1 commission Expires January i*aempWVp 2,st--ru td un+.r-} Ytad ud In.2aw'E ru8q ata;�e�:�!•t .^,A;e,,<t ��asrt�u.�e..,�:.w�^�4t4 • la.ir (K ' }n Axp %!qt aw aaaiarl srt tr.m,ns — —stir,,aw u..ijaq r.o tuat y 'MkX)Jkl O,Of)O 3*910A"!,P o .V i)1-Or Zk lad vo JQt:radwt 7crlpiin pl ayt.dy pan�x!.�it�p ua�y a.tirg Ilrr{+.mvtjdtuoLj tt.air?t{lua, w k-xmdsraa()ju steaiIgjza)t J!tun aunI1fuI.%.w asu�:r tv'(!urd jo Cl�ist�:vr`per,�mir�ssr lr .stm�`pa�tmp patwa'patra.ta•�U'r�•i.l;raaagt;sruf su srasetua�d�u Rrrsr}rnr{.i.rre�u aecn arty irur�as: . ,; �;��a±nci ,� ,,; rint�ts,acilar'i�atHr�sl>�rrrrtaaJaF!unJat�tJP�)3txtur�da(1 uu�aanJ)5SN}.��ttclsrrsr�l�ulwaur�s.n+la�lga!,,;,arl,�:, i.• ...,. ,.,sxar:., ra ;1aruvgtnr Ajlarval u-%.N;1.%rq;ugJaragt suxariruT'a sx M)!xs uk) ,xa criaJatp sluawpux m dui puar s.uerd patir;.I. : ,z gijko:t r:patalr rua 3 to tau agsrq�u� , ,ant�rtalc `I 11 rlUti s_,rl Sill t a+l.1111011n!;I rim'1112n t4'a azr.,�: .�- to atuxj!ua.)x qai"tsry(it ixuwjja uraiaq €sss,asn,ru,ayx Ju av!v{d i,;-w dr:a4{{jsjulwwxa stltf alp," tegt ruauc d-XI lbr w�rr tatlr.Al rt,rttaur7 uv c{t u�{ S.sr.n s!t'A patrrsrrp uaay ar.rq :Caren yalyxt IOLM'Pde SPU*gtw Ku"10;Xipt.e km;)t situ ayt)turprq.wt put`spa I ruolss*uud uumildi bo paxy`Aurplo)4els-slerj:;'tf<w Jogtl +t ►ta+� d sit nws lit►Ruipol:wr't1jom 391 i.)►r+"rrkat Eenve at{r trig p+ae u010a0i alp IV 1pe W.a11-1 per-,J:NdnN SQy ar jS,a4 irill In 71aas Mp ui l n,;arm.,-)at{)us W ;�:'<�+r«�z a�x.ag,�t s.(rs lri�e s.�r�:iap'rzursss hl�Amy H.11S IJISAM AC? :,%JN 10:3.1.t IS Ail till vt at�tr�urxx�art�txnJu�u►ucaJ;aq unrtt�t,tl�;°ucsnxitJisu��-;+Jtu�nats.yt Ju;�atJetlaf<ue����*�tQ�lnra e). :C,cr�dn��_?��,aye�t;ttJ:r.,� I,,her a:aurms! aaill Iral MoOJ}f 3.C2f.lu a*lltA aql Jet 10134idsul 11utplInfl N1 (il paiilwgns putt iprw hey st uogv.:Iq&JV :s1,vppv III !uotaatl .Czcirppt N 11, :1,41 : Sajp!pV A.M.W4 Jar — --_- - a < urdrr„ aZ #C7] ! - d7: () .......................................................................................................<...<<................ t(J>j.Dads �L IMI.J 3l,',1 01 3ta1?�%T C:ltty ilti)m 'i V err JLr1K3 a3,LLrJMS 3a 01 sl5o�) "1vm: j ,ICJ as,% ''3jNv1 1dfti0j Ao 31v:31dl.Lin `aJVYd(1J7 30 3.Jv4'A-4111111-i j HOJ S.M.0,;J1 lddV i lip c6 ft. Ot a,"(),AtiN' el.t:t,til "lEd'r)!()Odf[ IAH:It):i!""I :�Cnu�rn aa>,�cr aw,l x Nrationn i le;adcau arte*r n r 2501 Seaport{ tt1 3,Chester,r. HA 1190 i 888-736-6335 WWW-POWEAHR&CON1 CUSTOM REMODELING AND IMPROVEMENT AGREEMENT Buyer(!;)'Information and Description of the Property: Projml Number 36-06436 August 22,2022 ©awn Bayer (9t4) 9 Maywood Avenun t379 3251 ft).7tvn's{srNr tsayor316+ gmAil.c.nm Port CheasteY,NY, 14573 County:Wc%tchc;ter Township: Buyer(s) listed alcove hereby jointly and severally agrees to purchase the goods and/or services of Power Home Remodeling Group arid its vendors ("Contractor")in accordance with the prices and terms described in ttais 5 page document and the Product Specifications, which are incorporated as part of the Agreement(collectively, this'Agreement'). This Agreement represents a cash sale of goods and services. Buyer(s) agrees to pay the cost of the goods ,and services purchased as described herein, regardless of timing or approval of any financing Buyer(s) may seek tot their purcha f;o Purchar;e Price St6.124.54 Pre installation Inspection Dates: Gown Payment: SO.00 Estimated Project Start: 3 to 4 weeks Balance Due on S 16.t 24.54 Estimated Project Completion: 1 to 2 days Substantial Completion: ,,,rs.$k �nt�cxtKrtrd�r'�c� ;g-nao Nfri'1�0a€u+[t?15t�u.r7 (}r,i,y.:,. . Method of Payment: Othor Contractor`,control nisi inctc tt m ceicu,utingf turm tra rims. Saga Dolay'Un)(no vn r.I,)netitirais F3uyeu(s) linwhy recknrI0dgPs recolpt of a ropy of Iho partthhlt'll. "rho I.€sad-Safer Codified Guido it) Ronov,ain Hitliii" !nkirming Buyor(s) of the potential risk of leafs hazard exposure from renovation activity to be perfotmed In or at Buyer(s)`Property, at the address written above. Buyer(s) received this pamphlet on the date of this Agreement, before commencement of work. �._._Buyer(5)' Initials.. This Agreement constitutes the entire agreement and understanding between the parties, and this Agreement replaces any sand all prior negotiations, representations, or agreements, either written or oral. No amendment, modification or waiver of this Agreement shall be valid or eftective unless in writing and signets by both parties. Buyer(s) hereby acknowledges that Buyer(s) t) has read the entire Agieement and has received a completed, signed, and (Irtict(f cctpy of this Agreement, including the two accompanying Notice of Cancellation forms, on the date first written above, 2) was orally informed of his/her right to cancel this transaction. 3) has received a copy of New York's Consumer Bill of Rights no C°ontrartinq for Homer Improvement, ants 4) has received a Certificate of Workers` Compensation Insurance before worse has begun on the Property. Buypr(s) also agrees and understands that if Buyar(s)finances the work with a third-party, the term-, of that financing will be contained on separate documents, including any finance charge. Future promotions not applicable, I have read and received each page of this 5 page agreement. Power Home Remodeling Group Buyer(s) �1Q8/2 f22 � ...... . Via'' '"_ _/08/22{22 Signature of Remodeling Consultant Signature Donald Pierro Dawn Bayer YOU.THE BUYER(S). MAY CANCEL THIS TRANSACTION AT ANY TIME PRIOR TO MIDNIGHT OF THE THIRD BUSINESS DAY AFTER THE DATE OF THIS TRANSACTION, SEE THE ATTACHED NOTICE OF CANCELLATION FORM FOR AN EXPLANATION OF THIS RIGHT. August 22, 2022 20:25 Pace 1 of 5 National Ileadquarters Dawn Bayer 2501 Seaport(hive,Chester.FA 1 190 13 36 06436 888-736-6335 August 22, 2022 WWW.PCYWERHRG.COM taavira-llGA ••• -- PRODUCT SPECIFICATIONS '5.e7 Buyer(-,)'Information and Description of the Property �'rr l ;a N.;!' nor 36- 416 August 22,2022 Dawn Bayer notekitA Yvan, y 191+1) f�79 3251 ff�aevnns fs€�ayi S)M."nod Avnnup t-4my r3I54gmail rnm Port Chester,NY, 10573 E MJ11 A-.,: County:Wenlchrstrr Township: Buyer(s) listed above hereby jointly aril severally agrees to purchase the quids andtot services Ilftted on the accompanying specification sheets,in accordance with the price.9 and terms d"cribed in the Cusinm Remodeling and Improvement and the. Product SpecificAlionS (collectively,this Agreement'). Pro Installation Inspection Date: Your pro install)alton inspectwn i; tontalive ly schottulod for TBD Roofing-GAF Inclusions: For steep slope roofs, the application includes Fortitude Lifetime Shingles with 50 year non prorated labor warranty. Also includes removal of existing shingles, inkiallation of F-style drip edge,Weather Watch ice and water shie:kf, Deck Atmor breathable root deck protection, Pro Starter starter *.trip,Snow Country ridge vent exhaust, Timbertex premium ridge cap shinnies, PowerVent intake ventilation, all flashing and chimney crickets where neodod and 6 nails per full shingle.All applications used only whore applicable. Clean up and haul away of all job related debris. Any wood replacement needed will be done at a cost to the homeowner of S3.94 per square foot. For Example:After the shingles have been removed, if we find there is a need to replace 96 square feet of wood, it is the responsibility of the homeowner to pay for the cost of the 96 square feet of replacement at$3.94 per square toot, which in this ex;tmpte is$378 24 For low slope roofs,which are roofs with a pitch below 2/12. Rio r=lhcation includes a 16 year non prorated labor and material warranty, removal of all existing roofing materials, new decking. base and cap sheet, drip edge and flashing,where applicable. Roofs with cedar shingle removal will include all new decking as part of the installation. :lean up and haul away of all job related debris. It is sargrood trod understood by and bir1wourl the parties that tho Product Specifications, along wills tho Curjiom Romcx4oling and Improvement Agretmant,constitutes the entire understanding between the parties, and replace any And I!'prior nogotiationf. representations, or agreements, either written or oral- The Product Specifications may not be changed, modified, of varied in any way unless such changes are in writing and signed by both Buyer(s)and Contractor. Buyers)hereby acknowledge that Buyer(s)has read they Product Specifications. I have read and received each page of this 2 page agreement. Power Home Remodeling Group Buyer(s) - V---N /08/22/22 .i ee..n._['_e , ,n f�R122/22 Sign the cif Remodeling Consultant �-W Signature Donald Plerro Dawn Bayer YOU,THE BUYER(S), MAY CANCEL THIS TRANSACTION AT ANY TIME PRIOR TO MIDNIGHT OF THE THIRD BUSINESS DAY AFTER THE DATE OF THIS TRANSACTION, SEE THE ATTACHED NOTICE OF CANCELLATION FORM FOR AN EXPLANATION OF THIS RIGHT. A"qi.ist22, 202220:25 111111111111111111111111111illllllillllllllllilN National I 4radquartm Dawn Bayvi 2501 beaport Drive, Ghester,PA 19013 36064,36 888-736-6335 Augus122,2022 # WWW.POWEAHRG.COM 14 40 1"�5-L�A Project Specifications WC'.S'W7 flooring, R00FIN(7j: Model GAF Stytr Fortitude Type Nnnr. Config Nam OPTIONS, Color(Vaphite I HemovAl Star and Shinq:a I Drip Edge Color WhOo I Inatal/Atkan Details None W: "F MAITRWS CORPO"TION Graoite HOOFING: Medal GAF Styfo Replace Wood I Ve Sheathing Cmt)g None 0%:)tion None I Install ll"on Oplads NonA m 6- m" "F MATMALS CORPORATION 0 14 1000* VA August 22, 2022 20:25 71RAI, !1#. s � w— pp, sm e r`v Al- PQ " it FF i„ � ,oil - 'Jor.........4 .. E �,,OF�, ::�- - M rn rn Al f f tti & t WX t�",�' -� of * �i x IN y AC fh DATE(MM o(YYYY) CERTIFICATE OF LIABILITY INSURANCE F3r9i2022 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 SUBRO13ATION 15 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), PRO00GER CONTACT Lacher&Associates Insurance Agency r TIME I acher Insurance Group nI!,,rgi. 215 7734371t1 632 East Bread Street ADonrsr Cettlt? er lacherinsurence com Souderton PA 18964 j INsuncn(,sl At rvnalNG CovenAae NAIC• ..._ _.._ _ ____....._._.....--- _ WtUntnA.Pennsylvania M:Inufalurerx'A tiarialkm Insurance 12262_ NsuRED iNSIJRFR R Marne}American Ins(;O Power Mr)rnr. F2ttmtxlr^Iirxl Group, LLC th%urttn c Endurance American S clslt 41718 2501 Seaport Drive,4th door ___.�__.... E1__. .Y.. ___.._. C;hesttar PA 14013 IN;unrnn INSURER E INSURER F COVERAGES CERTIFICATE NUMBER:1481041286 REVISION NUMBER: THIS IS 10 GLHIIFY THAT THE POLICIES Of- INSUHANt E LISIED BELOW I1AVL LI LN ISSUED TO IHL INSUHLD NAMED AHOVL ILOH 1HL P0LI(,;'r FLHIUD INr)1(7.ATFn NCITW(THSTANDING ANY REQUIREMENT, TFRM ()n CONtiITION OF ANY C30NTRACT OR OTHER DO UI,AFNT WITH nF5('F(.;T TO WHICH THIS CLRrif-ICAI'L MAY 13E ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY IIIL POLICIES DESCRIBED HERLIN IS SUBJECT 10 ALL TIIL KHMB LXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SiK)WN MAY HAVE BEEN RLDUCE&BY PAID CLAIM; INBR -! aA POLICY EFF POLICY EXP TYPE 11i�iRttRANCE T.�G1r.X1....illlbM`Bik.TY..TXI. lelsn wvn I PaLMV NUMpER --� _ t IMITA _ x_J COMMERCIAL GENERAL LIABILITY 302271,fife 70%7 4,1 2;>2;^ 4;1,2023 - t At:H(X:C011111 td(:t S2,000,000 I irAlRA;,E r014ENTE't5_.._ . ._+ C:A?2&MAOF i X (1CCI➢R ------- `i ; i MEO EXP(Any ww Purusn) 110000 — I touk1AI AAnv Ir4nu1 ; a2r60000 d _._ __. _ ._.._._.. 3EN1 A©43REGATE L WT APPLIES PER. � t LCIEN ltL Agq!f!4 ATE 1 14 U{II},UUU X POLICY �,It�t;t I LOC � ! I PRODUCTS COMSPIOP Asap 3 d UUU UUU ,�rTI4Ep .. _ � 152275 AUTOMnnll r I IAnil ITY 66 20 96 7A 1111022 111/2023 .L.t t t l 31( (ji(l1.It) X ANY At i t t j aC(d}iLY INJURY(Put r i ' 4 OWNED $CHEOUlEO I R(INI Y"ItitlY(11wt AUTO$ONLY AQ1TO8 X 1111111) X WN•nwr4 1) tsaiih iilniA�NAt:r AVIUSUNLY AUILYSUNLYAKtAMY�, _ t...___............_.__. ......................-._-. _. ;t UMHHLLLALIAM X OCCUR j ; i MKLM7E.UL100494 ....._._ 411t2022 4ii'202.1 i EA{;H(X;(:iJltriErN(E $3:000,000 X rxcr ;tlAn E CsAIM MAnE Aa6RFfArE S 3()00,000 A WORKERSCOMPEN,3ATION j 20?�Tri ra 24�S ',7 1`1f202� 1t1:,. i'? I+ PER V AMC CMPLOYCRS'LIAA(LITY ANYPROPRIETORlPARTNEWEXEGUTIVE IY r N orrK,r.swmarntXCtiA7 v7 NIA N 0xl(nC (WrC~lory Its NMI __._ D*EA$E EA EWPL4YEEi 41 OIC W ,,tk*SCrikr,ttrxkv OiSEAest I t,LteY Ls+,T }I�ODD�(jgq� _.�.. rxr.EavllAnttlYl F.rr3t7tXIt}R34204 1 4,1 il;; rAcwrxalRr:ra,:r 3,000,000 OvrQ 1101ICy N 4[:.jtr't:Arr 5.000.000 MKLM7EUL100494 or rc nt P I ION Or OPt"A I ION!;'LOCAI IONS 1 VEHIC LCS (AC 0110 101.Addt mi—1 RMnurh•5ct—du'+.mxy bo mnar hwd In ntputrwd) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE Ti1E'_REOf. NOTICE WILL 011 DLLIVERED IN Village of Rye Brook ACCORDANCE WITH THE POLICY PROVISIONS. 938 King St Ua Brook NY 10573 AU I HO ItIZ L V It It PIT CSCN I AI IV A C-1988-2016 ACORD CORPORATION. All rights reserved. ACORD 25(2016!03) The ACORO name and logo are registered marks of ACORD NIrW f YORK workers' CERTIFICATE OF ------ STATE OfT1�7t'CflSclill?11 -} Board ornp NYS WORKERS' COMPENSATION INSURANCE COVERAGE to t egil N.vnt!n Address of Insured(vst streal addret5,:ttty) Ib Husiness Ieiephrme Niimtxir of In-,erred Ilowtrr I lomc: R modding Croup, LLC'' 6'0-574-5000 2 5U.I Seaporl Drive, 4 th Floor I c NY5 Unemployment in.iirnnce FrTw4over Registralion Number of Che,det, PA 19013 inrlired j I Work I.ncatiori(if Inmired I't-Wily regt1ired it o0verage hi Spec kaj� y knlrted to j 1 d.Fiaderal Ernploycr Identificatitx+Number of lwi uied o,Socia!Security I c.t?rtain tvcsvona In New York State.l.e. a wrap-op i-cw Y? trurllbet 2.3 3030708 _ _-_._--_ 2.Name and Address of Entity RequestiN Proof of Coverage Set. Name of In'suurrance Garner (Entity BeI09 Li91ed as the Certificate Holder) j q a',�rt Ref t ty:'fi�,i Y. A.;�e:fllEr�rr Village of Rye Brook 13b. Paticy Number of Entity Llstea;n Hox t i' 938 King St Rye t rt)tik NY 1()573 'k eolrcy ettec,13ye period 01,01/2022 01/01/2023 tU jin foci Propnttrnr,A:utnem or Ewculiver Offkot.-~ are included ionsy(jwA rok";u >,vt�arafntte�r�rrs�aoaaj I✓ ,all excluded to certain partnarshrlficara excluded. Thi?;r ot'tiiie>;that thce tnallrance corner indicated above in box"3'insures the tausittcss re;forotice-d above rn wx -la' for workers compensation under the New York 5tatu Workers' G:e)rrtponRation Liw (To use this form, New York(NY) must be list"under Ilem 3A on the INFORMATION PAGE of the workers' compensation Insurance policy). The Insurance Gairivr or it lir.r:.n;tt:i anion?will ,rand this Certificate of Insurance to the entity listed above its(fie cvrti!ic itt.,heftier in Mix'2'. The insurance carrier must notify the above certificate holder and tire Workers'Cornponlcation Board within 10 days IF a policy is canceled duo to nonpayment of pronliums or within 30 days iF there are reasons other titan nonpayment of promiurns that crinr:Pt the policy or eliminate the insured fr0rT1 the coverage indir;;_tled Vrl t!'ti:Ct�rnficale. (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 cortilk-all"is issued its a mattor of information only and confers no rights upon the corlificato holder This cc nificatc d003 not amond, extend or alter the coverage afforded by the policy listed, nor does it confer any rights or responsibilities beyond those c milainwl in the referenced policy. This certificate may be used as uv+cloticv Qf a Workerf, Ooinpensation contract of insurance only while tire undurlyiftg GKAIcY 11 in oftect. Please Note: Upon cancellation of the workers' compontsatian 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 Now York State Workers' Compensation Law. Under penalty of perjury, I certify that I am an authorized representative or licensed agent of the insurances carrier referenced above and that the named insured has the coverage as depicted on this form. Approved by; Ashley Madorrno (Print nar-c CSi J:itf�xiYcU rVGtS=SE��t"�t'1..:��i�rnf3Ew': 001 t'!j11PA,rAr"C4111.A nw,u"n•d hy. Approvud by' � (�(J4l�f Y kA 10/1(1 OP i j 2:')/:04 PM EDT Title Urine>rwritetr ielephone Number of authorized representative or liuvritioW.,tVret(,)I r,f;,r,;nt to cgrrler, 484 530,8392 Please Note: Only Insurance carriers and their licensed agents are authorized to issue corm C-105.2. Insurance brokers are NOT authorized to issue It, C-105.2 (9.17) www.wct),Ily.gov