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HomeMy WebLinkAboutRP24-130 Qy� DR �- J v l�4`Vu�j 190 VILLAGE OF RYE BROOK MAYOR 938 King Street, Rye Brook,N.Y. 10573 ADMINISTRATOR Jason A.Klein (914) 939-0668 Christopher J.Bradbury www.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 September 22,2025 Kate Mejia 26 Reunion Road Rye Brook,New York 10573 Re: 26 Reunion Road, Rye Brook,New York 10573 Parcel ID#: 124.73-1-5 Roof Permit#24-130 issued 11/26/2024 to Re-Roof Existing Building This certifies that the new roof,installed under the above captioned permit has been satisfactorily completed. Sincerely-, Steven E. Fews Building&Fire Inspector /to For office a onl,,/ BUILD R ENT PERMIT# r� AUG 1 1 2025 VIL OF RYE� OK ISSUED: 938 KING STRE IVE BROOK, YoRK 10573 DATE: -ate UI 1 9 -06 FEE: ,� c PAID W 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 ##4tf####t###4#####fti#Riit#####kittttFtF#f#ftf R#♦ffff####}}#k#ik#4#4#44ifi4#iti##iii#f#f#fR#t##f14t#lift#ttFi#ii##RRt Rt Rtiik Address: 26 & 28 Reunion Occupancy/Use: Residental Parcel ID#: 124.73-1-5/ 124.73-1-4 Zone: R3 Owner: Bellefair Homeowners Association Address: 24 Bellefair Blvd P.E./R.A.or Contractor: Franzoso Contracting LLC Address: 33 Croton Point Avenue Croton on Hudson NY 10520 Person in responsible charge: Mark Franzoso 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 a Certificate of Occupancy/Certificate of Compliance for the structure/construction/alteration herein mentioned in accordance with law: STATE OF NEW YORK,COUNTY OF WESTC14ESTER as: Mark Franzoso being duly swom,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 (City/Town/Village) he/she has supervised the work at the location indicated above,and that the actual total cost of the work,including all site improvements, labor,materials,scaffolding,fixed equipment,professional fees,and including the monetary value of any materials and labor which may have been donated gratis was:$ $36,6000.00 for the construction or alteration of: Roof Replacement 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 A Sworn to before me this day of L"� ,20 day of 10 1 o pe _ Own Signature of Ap i n ,710 Mark Franzoso Print Name of Pop rty O% Print Name of Applicant RotaryPublicV Notary Public Michael Babit Notary Public,State of New York .A/2,2 t DAM E.LEVINE No.01 BA6331102 WtWy Public,StMe of NowllbfE Qualified In Westchester County Registration No.02LE6004399 Commission Expires September 28,2027 0dalCormti�som Ems"�; F,11ko,),�_ O T w � BUILDING DEPARTMENT ❑BUILDING INF111(;roR ,ICJ AsSUSTAN•1•BUILDING INSPIi/:T(1N VILLAGE OF RY)N BROOK ❑Coin:IiNPORCEMENT OFFICER 938 King Street • Rye Brook, NY 10573 (914) 939-0668 FAX (914) 939-5801 www.rychroo.k.org INSPECTION REPORT - - - - - _ - - - _ - _ _ - ADURI:ss : Z(v -IC.e- u N /p 1`T Z y— 13 v Issul•:1): Au—I/1SIi<:'1: �•�y�3 lit.c�<:1.: I,c)1' LOCATION: D Violation Noted FAILED / REINSPECTION ❑ SI'IT INS111- TION REQUIRED ❑ FOOTING ❑ TOOTING DRAINAGP. ❑ FOUNDATION ❑ UNDERGROUND PLUMBING NO TUN ON INSPECTION: ❑ ROUGH PLUMBING ❑ ROUGH FRAMING ❑ INSULATION D Natural Gas D L.P. Gas D FUE1.TANK ' ❑ TIRE SPRINKLER ❑ FINAL PLUMBING ❑ CROSS CONNECTION — XFINAL O c Moo w � 4. '9N" BUILDING .DEPARTMENT ❑BUILDINGINhl+l t.'IY►K SsI8•1•ANT RVII.DING INSI►EC OR VILLAGE OF RY1; BROOK ❑CODI.IiNrnul:r•.nlrN r(h r•Icr.K 938 King;Street . Rye Brook, NY 10573 (914) 939-0668 FAX (914) 939-5801 www.rychruuk.org INSPECTION REPORT - - - - - - - - - - - - - - - - ADDRESS : ✓ Qe L4 ti /O J DATI- 111?ItMl'1'# 1� a y — 1,3C) ISSU1:1):1��LIp-z/,'1 : 12 y 23 131.00K: I,OCATI ON: �� OCCUPANCY: ❑ Violation Noted T111" WORK IS... PASSED ❑ FAILED REINSPECTION ❑ SITE, INSPECTION REQUIRED 0 FOOTING ❑ FOOTING DRAINAGE ❑ FOUNDATION ❑ UNDI:RGR(>UND PLUMBING NOTFS ON INSI►FICTION: ❑ ROUGH PLUMBING ❑ ROUGII FRAMING r 0 INSULATION ❑ Natural Gas ✓�IK,1 ❑ L.R Guff ❑ FUEL TANK , ❑ FIRE SPRINKLER ❑ FINAL PLUMBING - -- ❑ CROSS CONNECTION - -j!r-FINAL -- �O'1'Illat �J _ N w M N N a _ a a rl W s� 0-4 z isi M P v v u c Ocu C w w W � a c. V V ZLr) p W a 0 w c ob 4 y WTI o W 'Cr u a' = W � � 00 r W U b4 Ali W 0 00 ^ 1� z C7 ri+ O O b avii 1-4 a M�`i 0 � � � \ � H N � � a _ 14 o © 00GN cn U C 0 � m � ►r v 'n 0-4 en W U z o a v r U � y � w cn cn N O V V °' o � x z H W W � C7 F w d u q a -E o N = R [ECE V E BUIL - _ MENT NOV 2 1 2024 V E OF RYE OK 938 KING ET RYE BR NY 10573 VILLAGE OF RYE BROOK (914)939 39-5801 BUILDING DEPARTMENT FOR OFFICE USE ONLY: Approval Date: NOV 2 4 P rmit 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: Permit Fees: )q ROOF PERMIT APPLICATION Application dated: II 1 ��t' 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 Budding,as per etailed statement described below. 1. Job Address: 26 & 28 Reunion Road SBL:124.73-1-5 124.73-1-4 Zone: .N 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#: NIA email: sales@franzoso.com 3. Roofing contractor: Franzoso Contracting, Inc. Address: 33 Croton Point Avenue,Croton on Hudson,NY 10520 Phone#: (914) 271-4572 Cell#: NSA email: sales@franzoso.com 4. Job Description,list all Methods&Materials: Roof Removal/Replacement at conjoned 26 &28 Reunion Rd (61 squares) 5. Estimated Cost of Job: S 36,600.00 (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 comer property,indicate street frontage: N/A 7. Construction Type: protected non-combustible NYS Construction Class: 1 A 8. Number of stories: 1 story Height: 18 feet 9. Is garage being re-roofed:No: V-Yes:( )Attached No:( ) •Yes: VNumber of Cars: 10. Is roof peaked,hip,mansard,flat,etc: Roof peaked 11. Estimated date of completion:TBD -t- 61112020 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: Mark Fr nz SO ,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 wit]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 rlations. Sworn to before me this Sworn to before this ZY day of �`) � W� 920 day ofI/a1/ee�( ?< 20 f opert Own lr �} Signature of ant � j Mark Franzo Print Name of Property Owner not Name of A pecan Notary Public iv Notary Public Npdf 0411ftem Now York MICHAELat�eNelnrO 0188605 Notary Public,Sat Mr Cou t Reg. No. t}21VM1888895 � YOdt �1d� r .+� Qualified in Westchester COUnt�► COS c orrmmission Explres Match 169 zv sn/2020 Work Scope JOB: PRJ #58552:Bellefair: Roof Replacements ADDRESS: Meeting House Lane, Rye Brook, NY 10573 CONTACT: Mr. Rafael Reyes, 24 Bellefair Boulevard, Rye Brook, NY 10580 PHONE#'S: (914)690-1371 (845)323-0178 ext.John Bladel (914)690-1371 ext.Rafael Roof Replacements: • Roof Area in Scope of Work: COMPLETE ROOFS 26, 28, 19, 21, 22, 24,18, 20, 23, 25 • 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. • 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. • 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(lashings/counter-flashings. • Install all new perimeter drip edge. Color: White. • 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. • *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 Printed 10/02/2024 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 damaged will be replaced at no charge. • Contactor will inspect each unit owner's screens for damage at the start of the job. Document with pictures and notify homeowner. Any screen damaged by us will be rescreened at no charge. • Proper disposal of debris; complete job site restoration. All areas damaged will be raked and cleaned. Any areas that need to be seeded will be. Printed 10/02/2024 S (�w � Ilk S �. � y � Z .. •�„ � , .� l4 _ _ rt ��' ,..n. `t..�,v � •T� ` '1 �� ''�, - r7h .r+���' -+ � - f'' - - The GAF Lifetime Roofing System Ridge Cap Shingles The finishing touch that ' — — — — — — — — — — — — — — helps defend against leaks 6 at the hips and ridges f t" ^ Cobras Attic Ventilation Helps reduce attic moisture and heat ` Lifetime Shingles Beautify and protect ?' for years to come Starter Strip Shingles /%% Helps guard against shingle blow-offs — — — — S Roof Deck Protection .,r Helps shield the roof deck from moisture infiltration ,. Leak Barrier Helps prevent leaks � caused by wind-driven L_J 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 LIFETIME rED and et a Lifetime'limited warrant our GAF factory-certified contractor' unnrTY g y y y ANTY TERM on your qualifying GAF products plus about enhanced GAF warranties. 7*v 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. Color Availability M TimberlineHDT High Definiffon'Litet me Shir,g es Nationally Available Colors Weathered Wood Harvest Blend Colors Nantucket Morning Appalachian Sky Regionally Available Colors (See next page for details.) now- a ' Biscayne Blue Copper Canyon Fox Hollow Gray Williamsburg Slate For more details vis, gaf.com/TimberlineHDZ Note:It is difficult to reproduce the color clarity and actual color blends of these products.Before selecting your color.please ask to see several full-size shingles. slonpotd 6wA4pDnb puo'suolpulsar puo a6waroo ale ldwoo tol NuajoM PalIw17 Arossaa0y 9 916u143 iy9 aaS-0601 optonE)u!DIS a4l BuuDeq sa6Dlood w plos spnpad uo Aluo slonpwd iy9 BuLkplDnb wl SdW=loO usy,/Ou=M papwrl AwssaxV y 07 algopow S!U04D1010OSIP ODBID UOOI"nlq tswD6o NuwroM paPw!1 u01100totd ao6ry„P)DngujolS tDaA.pt, a&41S M a4t aas'NUD.UOM Pallwrl walsAS BU400d M ayl wl algl6118 IOU-!IDpDtSw wi'SU04OUISOJ AluouoM PaPw7 AwssaDoy 9 a16w4g iy9 Puo a6aaw0 alapuw0 wl NuouoM Pdl!w!1 waISAS 6uyOO8 M 4aOS seuoss800y m 6u4,lonb E IsDal ayl aas'Nua�oM pa11w!7 walsA$6uyooy�yg a41 toy algi6!a ou suoyo4olsw ws ID puo 816u14S-.gal!l Nq Auo ID asn ayl salmba,sauOmOOD puo salbu!4s uo abDi wo awllap slonpoid 1 i Pod iVe BwN4onb 4yq NL4,jonb iol SdIA—W6 ps!stw4014s8t puo a6wawo atapwoO wI NUDUDM P911WIl UDssaxV w{SdywaO{o611s!SU0140ulsaJ puo 05DtaAM eleldwoo tol NuouoM pauw7 walsAg ouyooy lye aaS f at6wyS M ayl wS-Nuo salbu!4S aw!lakl M!o asn ayl sannbar salbu!4s uo a6aawD aw4ap.1 uo4DINUOA D4ly w JOWDB 4D81 Duo sal6w4S doo atpib'uO4oalwd 1000 Pod'sdulS JOVDIS iyJ 10 am lonb aql sarmbai Abolou4oal�poliaAol UPM sal6wgS lye Uo NUaJDM pUIM Pagw4„uawidpwM joaA-St: apD011ddDojd iou a suv[()jauawilapmo uooasairil0 ap16i1 ]ta4lo wi�pallotsu!a t sl0npod�BwAaumo ayl atayM Ayadow ayl suMo 1(s)xuMo puooas ap!Bila w]aouapisat pa40olap Nwohalbu!5 o p(s)�auMD -MtlWlsar Puo aBaawo ataldwoo wl Nua OM Pagwrl Aw 8XV g al6u!4S M OOS. lonpwpui lDuibuO aql so b wl so suoaw Duo paPywd 46aawo NUDIIOM p 416ua1 aLp 01 slapi aw48111, • ========== '� eu6iejeAOS IDAoH elBu14S gDI-E t ® �m Sb eDlonbeS puDj� c. II SV eeullJegw11 uolloelloc)SOIBu14S al Pe111Pow SGS ========== 4 eeulla}DIS eII e}olewDO ePuDIPooM ®DlonbeS puDJg ®uoAuoo puDJf) u011381100 SOIBu14S .ew11OI!l JauBlsaa ® ® ® / 4\ So eeu!laegw!1 !L-I Li ET] AL \ SN aullJaquJll 0 ® ® JaHn eeWNegwu ��� � z© a eZ(3H aullsaguaij u014001100 seIBu14S,AW11e111 Yeulljegwll uoi;onJ;suoZ) elBul4S A601ou4081 A4Ut)JJDM e1Bul4S suoilooLlpedS eIBU14S 4 D, NO, i Approximate Codes Special 4 Physical Attributes Fire Wind National Regional Features e b _ g $ $ LL yyy s r J Q p r Y1 C E+ IsJ31 qi y -E 'ao g °JWS z IE i 0E c a a a —`ki g 5%" 13'/I"x 39 V 7 8 64 3 256 (143 mm) (337 x 1,000 mm) • • • • • • • • • • • • 5%" 13'/."x39V 7 64 3 256 (143 mm) (337 x 1,000 mm) • • • • • • • • • • • 5%" 13'/I"x 39 V 7 64 3 256 (143 mm) (337 x 1,000 mm) • • • • • • • • • • • 5%" 13'/a"x 39%" 7 64 3 256 (143 mm) (337 x 1,000 mm) • • • • • • • • • • • • 72 6 360 5" 17"x 40" n * s s e • a • (127 mm) (432 x 1,016 mm) 70 5 360 1 (127 mm) (432x 1 01 "6mm) • r • » • o • e • • • 56 4 280 1 (165 mm) (432x 1 01 "6mm) • e ° + , • • ° • • 56 4 280 7'h" 17"x 34'/2" p G a n • a e • (191 mm) (432 x 876 mm) 48 3 288 7 V 17"x 40" 3 a s a s t► e • • • (191 mm) (432 x 1,016 mm) • 64 3 256 5%" 1314"x 39%" • • • • • • • • • • • • (143 mm) (337 x 1,000 mm) 72 4 360 (127 mm) (4321x 1 016"mm) 0 • r • • • e • e • English English English English 5" 12"x 36" • 79 3 316 (127 mm) (305 x 914 mm) • • • • � • •7 • • � • •7 Metric Metric Metric Metric 64 256 5% 13'/4"x 39%" (143 mm) (337 x 1,000 mm) , '25-year StainGuard Plus`Algae Protection Limited Warranty against blue-green olgoe discoloration is available only 13G-year StainGuard Plus PRO'Algae Protection limited Warranty against due-green algae discolorafion on products sold in packages bearing the SlainGuard Plus`logo.See GAF Shingle&Accessory Limited Warranty for is available only on products sold in packages bearing the StainGuard Plus PRO`logo.See GAF Shingle& complete coverage and restrictions,and qualifying products. Accessory limited Woaontyfor complete ooveMe and restrictions. 'Steeper slopes and maximum wind warranties may require more nails. Periodically tested by independent and internal labs to ensure compliance with ASTM D3462 at time of manufacture 'Applies to some plans(that make referenced product). "Applies to White only. 21 y.0 • Roofing Accessories Install any GAF Lifetime' Shingle and at least 3 qualifying GAF Accessories and M you'll get a Lifetime' limited warranty on your qualifying GAF products. Visit gaf.com/LRS for a list of qualifying products Leak Barriers Help prevent leaks caused by wind-driven rain and ice dams Roof Deck Protection i^; © Helps shield the roof deck i 21 2 from moisture infiltration Starter Strip Shingles 1 Help guard against shingle 3 blow-offs at the eaves and rakes og 2� Cobra Attic ^ Helps reduce attic moisture and heat Ventilation Also available, Master Flow'-Ventilation Products, pg 26 5 see page 28 � Ridge Cap ^� � I Shingles �/`; The finishing touch that helps defend against leaks at the hips and ridges pg 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 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 Visilgot.com/LRStor 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 G4F Roofing System Limited Warranty for complete coverage and restrictions.For installations not eligible for the GAF Roofing System Limited Wononly.seethe GAFShingle&Accessory Limited Worronty.Vat gat com/LRS for qualifying GAF products 15-year WindProven'limited wind warranty on GAF Shingles with Loyed.ock Technology requires the use of GAF Starter Stnps,Roof Deck Protection.Ridge Cap Shingles,and Leak Barrier or Attic Ventilation.See GAF . Rooing System Limited Warranty for compete coverage and restrictions.Visit gat cornARS for qualifying GAF products For installations nor eligible for the GAF Roofing System Limited Wanonry see the GAF Shingle& Accessory Landed Wanonry. LIFETIME' LIMITED RRA""EPM • For the full collection visit gaf.com/System /u^ 22 TiT 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 StormGuard° ■Self-seals fasteners and helps protect vulnerable areas of the roof ■250'F high-temperature design.Meets or exceeds the performance O criteria of ASTM D1970. ■2 Sq.(200 ft2[18.58 m2])roll size—excludes laps h ■Mineral-surfaced peel and stick underlayment for asphalt shingles ■Self-seals fasteners and helps protect vulnerable areas of the roof WeatherWatch® ■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— 0 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 3.Valleys&dormers warmer zones 6.Ridges 2.Warmer zone 4.Flashings&transitions t rl For the full collection visit gaf.com/LeakBarriers Always check local building codes for requirements in your area. 'To qualify for this coverage,must be installed with GAF Lifetime'Shingles ono of least 3 quolitpng GAF Accessories.See GAF.com/LRS for qualifying products and see G4F Roofing System Limited Warranty for complete coverage and restrictions. 23 Roof Deck Protection ! Helps shield the roof deck from moisture infiltration, LIFETIME = uMrreo �WAaf AfJT/iC�M ■Premium breathable synthetic underlayment for asphalt shingles and other roof systems Deck-Armor"' ■Nom.16 perms,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 ■Premium synthetic underlayment for asphalt shingles and other roof systems W Tiger Pa 'M ■High-traction surface,tear-resistant construction,and deck side 44 coating provides moisture control ■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 FeltBusterO ■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 fiat 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° (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— fbb\h excludes laps For the full collection visit gaf.com/PoofDeckProtection 'To qualify for this coverage.must be installed wOh GAF Lifetime'Shingies ono at ieust 3 quautying GAF Accessories.See GAF.com/LRS for qualifying products and see GAF Roofing System Limited Warranty 24 for complete coverage and restrictions. i 3 Starter Strip Shingles Help guard against shingle blow-offs at the eaves and rakes. LIFETIME' UMITED V"PANTYTEM.1 ■Premium starter strip shingles for all asphalt shingles ■Extra-wide format,pre-perforated design,and factory-applied WeatherBloekerTM Dura 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 81/2"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-StarV1 •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 61/2"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 QuiekStartG ■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 StarterMatcW StarterMatch'Starter Strip Shingles from unsightly stains.' •Used in conjunction with WeatherBlocker" ' •Full sheets measure 13 1/4"x 40"(337 mm x 1,016 mm)and cover 60 lin.ft.(18.3 Im)per bundle • 1 For the full collection visit gaf.com/StarterStrip To quality for this coverage,must be installed with GAF Ldetime'Sningies ano of least 3 quafitying GAF Accessories,See GAF.com/LRS for qualifying products and see GAF Roofing System Limited Warranty • for complete coverage and restrictions. '25-year StoinGuard 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 LimitedWanantyfor complete coveroge and restrictions,and qualifying products. 25 r CobraO Attic Ventilation Helps reduce attic moisture and heat.' 3 i ETIME Ridge & Hip Exhaust Ventilation ■Mesh roll ridge vent for all climates ■101/2'(267 mm),8"(203 mm),and 11 3/4"(298 mm)widths;20'(6.1 m) Cobra- and 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); #r Nail Gunnable—14.1 sq.in./lin.ft,(29,845 mm2 per lineal meter) ■Premium plastic ridge vent for colder climates Cobra`s ■Includes 3"(76 mm)ring shank nails,Snow Guard"Filter&3"(76 mm) SnowCountry® EasyTearO Sizing •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' ■Includes Snow Guard'Filter&3"(76 mm)EasyTear•Sizing SnowCountry® •11 1/2"(292 mm)width;4'(1.2 m)length,40 lin.ft.(12.21m)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)EasyTears Sizing '"" ■11 1/2"(292 mm)and 9"(229 mm)widths;4'(1.2 m)length, Rigid Vent 3 40 lin.ft.(12.21m)per box ■NFA: 18 sq.in./lin.ft.(38,100 mm2 per lineal meter) • ■Plastic roll ridge vent for all climates Cobra® ■Includes 1 3/4(44 mm)coil nails,Weather Fighter'filter&12"(305 mm) EasyTear®Sizing RidgeRunner's' ■11 Yz'(292 mm)width;20'(6.1 m)length ■NFA:12.5 sq.in./tin.ft.(26,458 mm2 per lineal meter) ■Plastic hip vent for all climates Cobra' ■Includes 1 3/4"(44 mm)coil nails and Dual Weather FighterO Filter Hip Vent ■11 1/2"(292 mm)width;4'(1.2 m)length,40 lin.ft.(12.2(m)per box ■NFA:9 sq.in./lin.ft.(19,050 mm2 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 • IntakePro® ■11"(279 mm)width;20'(6.1 m)length ■NFA:9 sq.in./lin.ft.(19,050 mm2 per lineal meter) • 1.See photo for product placement For more details visl gaf.com/Cobra 'To quality for this coverage.must be in Nnh GAF lifetime'Shingles and at least 3 qualitying GAF Accessories.See GAF comARS for qualifying products and see G4F Roofing System(im fed Warranty for complete coverage and restrictions 26 'NM:Always have a balanced attic ventilation system.In no case should the amount of exhaust ventilation at or near the ridge exceed the amount of intake ventilation at or near the soffit. Visit gat.coMrenbdcubbr for more details. 6 Ridge Cap Shingles The finishing touch that helps defend against leaks at the hips and ridges. J f ■Premium double-layer ridge cap shingles for use with Timberline HDr,Timberline®NS,UHDr,and GAF Designer 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 HDZs,TimberlineO NS,UHDZ'",and CS Shingles ■Pre-perforated design&factory-applied Dura Grip'Adhesive Seal-A-Ridge® ■12"(305 min)width,6 2/a(169 min)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 HDr,Timberline®NS,UHDr,RS/RS+,CS,and GAF Designer Lifetimet Shingles TimberCresP ■Pre-folded/flexed design&factory-applied Dura Grip-Adhesive ■10"(254 mm)width,8"(203 mm)exposure,covers 20 lin.ft. (6.1 Im)per box ■Available in the West area 1� ■High-profile SBS-modified ridge cap shingles for use with Timberline HDZ8,Timberline"NS,RS/RS+,and UHDZ'Shingles ® ■Pre-folded design&factory-applied Dural Grip-Adhesive ' Ridglass ■10"(254 mm)width,8"(203 mm)exposure,covers 31 lin.ft. (9.4 Im)per box • ■Available in the West area ■Wood shake-look ridge cap shingles for use with "011 Timberline HDZB,Timberline"NS,and UHDZ'Shingles Midge ■Pre-perforated design with unique Z-fold design ■10"(254 mm)width,5 5/e"(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 Dura Grip'Adhesive " ■For use with GAF ArmorShields Series Shingles AS C7 ■12"(305 mm)width,5"(127 mm)exposure, 1 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 Lifetimet Shingles and at least 3 qualifying GAF Accessories.See GAF.com/LRS for qualifying products and see GAF Roofing System Limded Warranty for complete coverage and restrictions. NOTE:These products are not avoiloble in oil areas.Visit gal.cwtlrldgecapavaibDllity,lot more information 27 Timberline HMO" Availability Color Availability p Chart Most Popular Colors: Barkwood Charcoal `"^ Hickory Hunter Green Mission Brown Pewter Gray n Shakewood n Slate n Weathered Wood n Hlarvest Blend Colors: Nantucket Morning Appalachian Sky Golden Harvest n n Cedar Falls n iReVonal Collars: Birchwood n Biscayne Blue Copper Canyon' - Driftwood Fox Hollow Gray - Golden Amber' . - Oyster Gray Q Patriot Red - Sunset Brick White' Rated by the Cool Roof Rating Council(CRRC);can be used Williamsburg Slate to comply with 2019Title 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.):131/<'x 39 V • 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 Engineered Asphalt ' StainGuard Plus-Algae Protection ■ Meets ASTM D3O18,Type 1 g p Limited Warranty ■ Meets ASTM D34622 Ceramic-Coated • Hip/Ridge:TimberTex0l;TimberCrest44; ■ Miami-Dade County Product ` Granules Seal-A-Ridge**'l■Ridge;Ridglass® Control approved ■ Starter:Pro-Start®;6luickStart-; ■ ICC-ES Evaluation Reports —Engineered Asphalt WeatherBlccker" ESR-1475 and ESR-3267 ■ Meets Texas Department of Insurance Fiberglass Core 1 3'/4"x 39%"(337 x 1.000 mm) Requirements Fiberglass Core q ° ° ° ■ Rated by the CRRC;Can be used to Engineered Asphalt comply with 2019 Title 24 Part 6 Cool F1 7 F1 Roof Requirements of the California Adhesive Dura ive ^ 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 StoinGuard 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 Tim1berTex1 and Seal-A-Ridge''. Rti tit f� y • tf - r7' \EP n to :n�ti RRYa4 , ...,vt�W.t' la '^ h• >„t•t ...A ��i' 3iht � vr�`ul" ,11u'..R :A +••w,�•.`�'\1?�yh A N!':\' � � ,firt.. �'. n � !�5 tin- . • � ,��I.. \O + Rf4�1 \a .0'f'`�\ 1�'h1 - �Dc •T�'�`'U7�S��•'t;. \O •{�5�,th } `� 1'�Nv 17Of •'�.�1�{' tn. �O' age, " f: �jp.,"t iir?��fifA-fi,.•�1./Y•R/•/� .i�J1.��v�b f iIti tu(�✓1:/7•�/•:1�'�4#in,n.�1�4v���tcr.li�f�il'.`Rl•/•1..'�.iq Jr vv. ;4i`''}�Sf"W'141 1Y,''i•`t.;',�.. s�s rs��1"1t i•Affil y ,,1;i �,vrs �?R,tiy ` ,Y,y>It�': lje;tl\#`�.,� Vk_Xt Mot ;A\'•,�. fN/•111'., � !f<Nc7�)�`11/ <��".'oc E z i.11�11.. � ot.}.t 11/1{ � '.A. ..111/1� - 8 e .:Illill. +..c ti+i�..ll) 11:•�iv'� �r'lllll/lll A � H ,.,/.1' amain •Y OLO CN CN CO O OO it E v CL Lei N` p L: N ° a0 PEI D U V • > Z W N O «o»' '4'� F- > Z c c ate: U Q Z o '� totectioq +-� y Q F- O u ,a. �Q -(y °.yam_• Z (n '- L7 U �► _ L / Li. O O zea z pl FBI Q co O 0 0 i Fq i.l 'r. •�S •U _ a a�i o o .��• �� AS • . w •'• /7� ' ! t� 1//// Id�il ' a ' -�;Iddill�l'Iat u�,I ,111/1/•1,11 ( +' `.° ♦p ' ��(i[A :,�{ • 'tA�' �� ••♦ ��w���, ♦• , .��/��`wB��r.�,Lt•.•� �11��w�)s'!,�,{��I,��•,• [1��.� ���,•�� l-.\V :r:.. oyy.. IkO ,f/.•_ ! v0 _-k ' O .- �:il'WO� 1`•�'f }h 'WIf YV�" :O'f•� HJ, 1 '2 '•,��,o _. .+yY�lr9 ;... ��v�/,.� ....... ey.��r,`Y, I - �..�:�vx.:�-. �r:�.l��vv� .. ...�1 O,\r� __._�. ��� ts•/• . DATE(MM/DD/YYYY) ACOR" 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 NAME: Certificate Team ROBERT T.KIRKWOOD,INC. PHGNE (914)769-9070 (914)769-4706 , No Eat): A/C,No 91 Washington Avenue E-MAIL certificates@kirkwoodinsurance.com ADDRESS: INSURERS)AFFORDING COVERAGE NAIC If Pleasantville NY 10570 INSURERA: Selective Way Insurance Company 26301 INSURED INSURER 8: Merchants Mutual 23329 Fran ZOSO 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 FfAVE"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. LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER MMLDD/YYYY MM DD/YYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE FX—I OCCUR PREMISES Ea occurrenceI $ 500,000 MED EXP(Any one person) $ 15,000 A S2332054 04/01/2024 04/01/2025 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER. GENERAL AGGREGATE $ 2,000,000 X POLICYPRo JECT LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 Ea accident X ANYAUTO 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 LIAR X OCCUR EACH OCCURRENCE $ 4,000,000 B EXCESS LAB CLAIMS-MADE CUP0000898 04/01/2024 04/01/2025 AGGREGATE $ 4,000,000 DIED I X RETENTION$ 10,000 $ WORKERS COMPENSATION �/ PER OTH- Y/N AND EMPLOYERS'LIABILITY X STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE 1,000,000 C OFFICER/MEMBER EXCLUDED? NIA WC9082S56 04/O1/2024 04/O1/2025 E.L.EACH ACCIDENT $ (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 11 yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT I $ 1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/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 COMPLEX18-26&28 REUNION ROAD 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 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD Workers' STATE Compensation CERTIFICATE OF Board NYS WORKERS COMPENSATION INSURANCE COVERAGE 1 a.Legal Name 1£Address of Insured(use street address only) 1 b.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 Z 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"T'insures the business referenced above in box 1a"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 contained in the referenced policy. This certificate may be used as evidence of a Workers'Compensation contract of insurance only while the underlying policy is in effect. Please Note: Upon cancellation of the workers'compensation policy indicated on this form, if the business continues to be named on a permit, license or contract issued by a certificate holder,the business must provide that certificate holder with a new Certificate of Workers'Compensation Coverage or other authorized proof that the business is complying with the mandatory coverage requirements of the New York State Workers'Compensation Law. Under penalty of perjury, I certify that I am an authorized representative or licensed agent of the insurance carrier referenced above and that the named insured has the coverage as depicted on this form. Approved by: Robert Kirkwood (Print name of authorized representative or licensed agent of insurance carrier) Approved by: A t,--&;/� 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