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HomeMy WebLinkAboutMP23-054 4R tt�V,no J�v 19 VILLAGE OF RYE BROOK MAYOR 938 King Street, Rye Brook,N.Y. 10573 ADMINISTRATOR Jason A. Klein (914) 939-0668 Christopher J. Bradbury www.ryebrook.org TRUSTEES BUILDING& FIRE INSPECTOR Susan R. Epstein Steven E. Fews Stephanie J. Fischer David M. Heiser Salvatore W. Morlino CERTIFICATE OF COMPLIANCE June 5,2023 Michael Caso&Patricia Caso 5 Old Orchard Road Rye Brook,New York 10573 Re: 5 Old Orchard Road, Rye Brook,New York 10573 Parcel ID#: 135.34-1-29 This document certifies that the work done under Mechanical Permit #23-054 issued on 4/25/2023 for the installation of a new heat pump and ductless system has been satisfactorily completed. Sincerely, Steven E. Fews Building&Fire Inspector /to oe 4RCj' 1982 BUILDING DEPARTMENT UILDING INSPECTOR ASSISTANT BUILDING INSPECTOR VILLAGE OF RYE BROOK ❑CODE ENFORCEMENT OFFICER 938 KING STREET • RYE BROOK,NY 10573 (914) 939-0668 FAx (914)939-5801 www.ryebrook.org - - - - - - - - - - - - - - - - - - - - INSPECTION REPORT - - - - - - - - - - - - - - - - - - - - ADDRESS: 1 � 1-�I 1 DATE: CJ PERMITS \ i `( ! �Y ISSUED: SECT: BLOCK: _ I LOT: , LOCATION: (�L c '(n,SS I ` Y Ac A OCCUPANCY: ❑ VIOLATION NOTED THE WORK IS... ACCEPTED ElREJECTED/REINSPECTION ❑ SITE INSPECTION REQUIRED ❑ FOOTING wv ❑ FOOTING DRAINAGE ❑ FOUNDATION ❑ UNDERGROUND PLUMBING NOTES ON INSPECTION: ❑ ROUGH PLUMBING ❑ ROUGH FRAMING ❑ INSULATION ❑ NATURAL GAS p L.P. GAS ❑ FUEL TANK ❑ FIRE SPRINKLER ❑ FINAL PLUMBING [� CROSS CONNECTION FINAL ❑ OTHER r . _ = a ■ _ s � H y _ Ln w ■ �, � N d' b y N \ a7 o eq N is 'v � _ WWO : � vi Q v w ■ W a = 5 0-4 U °" Ldi �--7 r' z q y � 0 3 �, � •� W v ou O Cn as U U ~ v U V5 Ln ti o ' ,, O 0 0G1 0 y z a a OQ � ~ w W 2 � v o 00 y 7 I a j--i w rJ O � °w w a. � a O F1 E� 04z uZ � ao. ° _ w I v Q a �' M1 cn w '04 z �,, >, N ao Q tq _ H y #A oA z o w w \ACo AV = R+ xN.0 o W , 00 w � x pu oH a� Z 14 � a w A ° C7 Q z a va a E•I °- BUILDING DEPARTMENT ® �� � ��/� VIL AGE OF RYF. OOK V 938 KING TREET RYE BRO `,NY 10573 APR 2 0 2023 L� 939-0668 c3 k.ur VILLAGE OF RYE BROOK BUILDING DEPARTI IEIt T APPLICATION FOR PERMIT TO INSTALL AND/OR REMOVE HEATING, VENTILATION AND/OR AIR CONDITIONING EQUIPMENNT FOR OFFICE USE ONLY: PERMIT Approval Date: APR 2 Permit Fee: $ L-_—z Approval Signature: Other: Disapproved: (fees are non-refundable) REOIJIREMENTS FOR RELEASE OF PERMIT&CERTIFICATE OF COMPLIANCE: 1. Properly completed& Signed Application. 2. Site/Staging Plan if Required by the Building Inspector. 3. Copy of Licensed Contractor's Liability Insurance.(village of Rye Brook must be listed as certificate holder)& Workers Compensation Insurance on a NYS Board form(Form#C105.2 or Form#U26.3/or NY State Workers Compensation Waiver) 4. Payment of Fees/Unit: RESIDENTIAL=$100.00/unit• COMMERCIAL=$350.00/unit. 5. Inspection by the Building Department for removal and/or installation. (48 hour notice required 6. Electrical work requires a separate Electrical Permit& Electrical Inspection. 7. Plumbing/Gas work requires a separate Plumbing Permit& Plumbing Inspection. ation dated, i Q ;,'J—is hereby made to the Building Inspector of the Village of Rye Brook for a permit for the and or removal of the HVAC equipment as listed below.The applicant and property owner,by signing this document agrees that said equipment will be installed and/or removed in conformance with all applicable Local,County,State&Federal laws, codes,rules and regulations. I. Address:.5 o 1A n r t ka j o2oJ SBL: 13 S. — Zone: 2. Property Owner: �f r j({ke% ,(;yh C Address:F— Phone#: q 145S a'-S S S 1 Cell#: email: 3. Contractor: [1, C` y�4�11 �.ed1i Address: �� )I(��arry/�et,w�royr�(rlh�t�71a1F,5 1C Phone#: r tI v� Cell#: 9/ ( ? u� email: ley kin ITb,,LhC e5r1Vr/. 6,r\ 4. Scope of Work:NW OK)liation� •Replacement( )•Removal( )•Other 5. List Equipment: 1 In e I y+ A l� 6. Location ofEquipment: I 10 F' I`' 0f IN" l j <,. lh�L'7r L,31,1 1 014, QA !4: 111 7. Method of Installation/Removal(list all equipment needed to perform job): mJe 0or CA urw W L_, t,` �.� 4 1L_ .� r is, t.A) w151 if 3/3/2d23 STATE OF NEW YORK,COUNTY OF WESTCHESTER ) as: rmil, w n LdC+ ..0 r- ,being duly sworn,deposes and states that he/she is the applicant above named, (print name of in rvi al signing as the applicant) and further states that(s)he is the Heating,Ventilation and/or Air Conditioning Contractor for the legal owner and is duly authorized to make and file this application. That all statements contained herein are true to the best of his/her knowledge and belief,and that any work performed,or use conducted at the above captioned property will be in conformance with the details as set forth and contained in this application and in any accompanying approved plans and specifications,as well as in accordance with the New York State Uniform Fire Prevention&Building Code,the Code of the Village of Rye Brook and all other applicable laws,ordinances and regulations. Sworn to before me this �� Sworn to before me this day of - Irl 20 day of 20 Si ure of Property Owner Signature of Applicant M PATS 4C.IA L�� a r� � P I rint Name of Property Qwner Print Name of Applica No ublic R&MR#NotaryPublic,/ GREGORY M.R1VM �'mmina,stab of New Netary Public,State of New York of�11114"13" GREGORY M.F- No.01R16441398 Public,Slats, . Qumfkd In Westchester County MIptMe4 No.01RI6441 Co W""Ettplrss Saprtenrber 26,20, 2+ VlWd in Westches 9C Expires Septen, < This application must be properly completed in its entirety and must include the notarized signature(s) of the legal owner(s)of the subject property, and the applicant of record in the spaces provided. Any application not properly completed in its entirety and/or not properly signed shall be deemed null and void and will be returned to the applicant. 2 3/3/2023 o N N N N N \ CL WLn Ln 1, N z LL. C!; ■ �w W LLi CN cN w L. eq �M v a a L, N F, n -04 w00 z N W g ¢ V) ■, Ln : hurl �i U x ; a Q ~ N hT �, O � z Ln U �— �+ w z Nz �. ~ ■ O o Z W H a cn Z W z z W c� s Z s CN A z - it 0 Q w U w Q A < u w _ ►� °O aI w A 4 Ln f v > w 1 nce cI; • Q ° A N M- w 0.-0 A w w U 0.Q t �u w0 zz W Ln V H S ►w o w z < -" 9 z a o U Q �I z w = � yE, [3RClv�, p �M� BUIL v E : L MENT MAY - 1 2023 VIL (31 OK 938 KIN :T ,NY 10573 VILLAGE OF RYE BROOK BUILDING DEPARTMENT or ELECTRICAL PERMIT APPLICATION Westchester County Master Electricians License Required FOR OFFICE USE ONLY wi-*— EP#: Approval Date: 1023 Permit Fee: $ Approval Signature: X Other: Application dated, 4/27/23 is hereby made to the Building Inspector of the Village of Rye Brook NY,for the issuance of a Permit to install and/or remove electrical equipment,wiring, fixtures, or to perform other high or low voltage electrical work as per the detailed statement described below. By signing this document, the applicant & property owner agree that all electrical work performed will be in conformance with all applicable Federal,State,County and Local Codes. 1.Address: 5 Old Orchard Rd, Rye Brook NY 10573 SBL: 135`34-1-29 Zone:oe'/5 2.Property Owner: Patricia Caso Address: Phone#: 9145528381 Cell#: email: PEMM8287@email.com 3.Master Electrician: Angelo Zaccagnino Address: 81 Maple Ave, Rye NY 10580 Lic.#: 755 Phone#: 9149213244 Cell#: email: Office@zaccagnino.net Company Name: Zaccagnino Electric Address: 4.Proposed Electrical Work/Fixture Count: Wiring of HVAC mini split condenser 5.31 Party Electrical Inspection Agency: SWIS **********«,r******+r,r,e*,r**,r:*•****:**,r*:*******,r*+►***,rt***,e***********:t***t***:,t,r:***r,r,r,r*t#�rt•r,r*t�r�**,r,r STATE OF NEW YOM COUNTY OF WESTCHESTER ) as: Angelo Zaccagnino ,being duly swom,deposes and states that he/she is the applicant above named,and does further (print name of individual signing as the applicant) Electrician state that(s)he is the legal owner of the property to which this application pertains,or that(s)he is the for the legal owner and is duly authorized to make and file this application. (indicate architect,contractor,agent,attorney,etc.) The undersigned finther states 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 Rya Brook and aft other applicable laws,ordinances,and regulations. n Swom oLeme his Sworn to bef me this 2 /day o day o ,ao z �l Si of Property Ov er Si ature of ppllc 21G 1 Print NarriFrq aBR� t arrest h C3A N NOTARY ► Of NEW YORK Notary Pulpit 0 ' b100YJf3 No bk O,, 10 38 _ Qualified I W ichester Count Qualified in stc ester Count My Commission Ex ctober 11, II /✓�� My Commission zplr October 11, s O 6/23/2022 STATEWIDE • 1:1 Main Street, Fishkill, NY 12524 1 email:office@swisny.coni SWIS JOBAPPLICATION tel845.202.7224 • 1• • • Office Use Elect.Permit#r 1 1 DateLl 7/) Utility ID# Final Certificate# City/Village t Zip Township .i � � County vt: �Zivs4ei Address �"O�� `.- i � Cross Street Section '26 3q Block I Lot d 9 Owner Name/Address(If different than above) I�T d Contact Number q 1 ❑Basement ❑ 1st FI. ❑2nd A. ❑3rd Fl. ❑More Than 3 FI. ❑Garage ❑Attic ❑Outside Residential ❑commercial Receptacles Special Recept GFCI AFCI Switches Dimmers Smoke Alarms Carbon Monox Hood Trash Compact Amt Amps Range(s) Cooktop(s) Oven(s) Dishwashers Refrigerator Disposal Microwave Warm Draw Incandescent Fluorescent SERVICE Amperage Voltage 1P 3P #Meters #Disconnect ❑Underground ❑ New ❑Reconnect ❑Overhead ❑Change ❑Visual Re-Inspection ❑ Safety Re-Inspection ❑ Re-Inspection Additional Information R['AY - 1 2023 VILLAGE OF RYE BROOK BUILDING DEPARTMENT This application is valid for one(1)year from the date received by SWIS.This application is intended to cover the above listed items to be inspected,if at any time of inspection additional items have been installed,you are authorized to make the inspection and adjust the fee for the additional items inspected.The applicant declares that there is no open applications for the above address with arty ottw inspection comparry.The applicant.owner or authorized agent agrees to all the above tennis and conditions as set forth for the application. Inspector Date Finalized Inspector# Company Name , Date Ul Sign t Address �;t�� City/State Code G .. License# 15 S Phone# !( q) ) L Dv State Wide Inspection Services 1080 Main Street DD[MAY 1 5 2023 Fishkill, NY 12524 845 202-7224 Phone VILLAGE OF RYE BROOK 914-219-1062 Fax STATE WIDE INSPECTIONS'RVICES Email: office@swisny.com BUILDING DEPARTMENT Website: www.swisny.com Service With Integrity BY THIS CERTIFICATE OF COMPLIANCE STATE WIDE INSPECTION SERVICES CERTIFIES THAT: Upon the application of: Upon Premises Owned by: Zaccagnino Electric Michael David Caso& Patricia Caso Angelo P.Zaccagnino 5 Old Orchard Road 81 Maple Avenue Rye Brook, NY 10573 Rye, NY 10580 Located at: 5 Old Orchard Road, Rye Brook, NY 10573 Section: Block: Lot: Electrical Permit Number: EP23-105 135.34 29 Certificate Number: 2023-3487 Mechanical Permit Number: MP 23-054 A visual inspection of the electrical system was conducted at the Residential occupancy described below.The electrical system consisting of electrical devices and wiring is located in/on the premises at: 5 Old Orchard Road, Rye Brook, NY 10573 The Exterior was inspected in accordance with the NYS and NFPA 70-2017 and the detail of the installation, as set forth below,was found to be in compliance on the 15`h Day of May 2023. Name Quantity Rating Circuit Type HVAC System 01 Ak officer: Frank J. Farina This certificate may not be altered in any way and is validated only by the presence of a seal at the location indicated.This certificate is valid for work performed on the date of inspection only. co FUJITSU SUBMITTAL 18RLB a SingleInverter Driven Heat Pump 18K BTU Job Name Location Date Engineer _ — Approval Submitted To Construction Submitted By Unit No Reference Drawing No PRODUCT FEATURES Auto Changeover 24 Hour Timer Auto Louver:4 way -- - -- Minimum Heat Mode Quiet Mode Auto Restart Economy Mode Auto Fan ruf[Tw It ormation Indoor Unit ASU18RLB Outdoor Unit AOU18RLB System 18RLB EFFICIENCIES 7 Year Compressor,5 Year Parts out-of-the-box Warranty SEER 19.0 WARRANTY EER 12.5 HSPF 10.6 e COP kW/kW 4.11 Btu/hW 14.0 10 Year Compressor,10 Year Parts Warranty when registered within OUTDOOR OPERATION RANGE 30 days of installation in a residence Cooling F(.C) 14 to 115(-10 to 46) Heating 5 to 75(-15 to 24) CAPACITIES Cooling Rated 18,000 12 Year Compressor,12 Year Parts Warranty when registered within Min.-Wax. BTU/hW 3100-19000 30 days of installation in a residence,and installed by a Fujitsu Elite Heating Rated 18,000 contractor Min.—Max. 7000-20000 LINESET REQUIREMENTS Connection Method Flare Liquid in(mm) 0 1/4(0 6.35) Gas 0 112(0 12.70) ACCESSORIES Pre-Charge Length 49(15) UTY-TTRX 3rd Par tyThermostate Converter Minimum Length ft(m) 10(3) FJ-IR-WIFI-1 NA Intesis WiFI IR Modile Maximum Length 66(20) FJ-RC-WIFI-1 NA Intesis WiFI Wired Module Max.Height Diff. 49(15) UTY-TFNXZ2 WiFi Interface Module INDOOR DIMENSIONS UTY-RNNUM Wired Remote Net(H x W x D) in 320 x 998 x 228 UTY-RVNUM Wired Remote w/backlight mm 12-10/16 x 39-5/16-9 UTY-RSNUM Simple Remote Gross(H x W x D) in 319 x 1090 x 429 UTY-XWZX Dry Contact Wire Kit mm 12-9/16 x 42-15/16-16-14/16 Net Weight lb(kg) 31 (14) Gross Weight 40(18) IM O t t r DIMPUMENSIONS This system combination is Energy Star qualified Net(H x W x D) in 24-7/16 x 31-2/16•11-7/16 mm 620 x 790 x 290 Gross(H x W x D) in 28-1/16•37-3/16 x 15-9116 mm 713 x 945 x 395 Net Weight lb(kg) 86(39) Gross Weight 93(42) A- Indoor Unit ETL#:3170288 interrek Outdoor Unit ETL#:91987 Due to continuous product improvements,specifications are subject to change without notice. Please log in to the Fujitsu Portal for the most up-to-date Effective Date: 3/26/2019 Version 18RLB-2018A documentation https://portal.fujitsugeneral.com CO FUJITSU SUBMITTAL 18RLB �cyvn 18K BTU Single Zone Wall 18K BTU Single Zone Wall Mounted System 1• ELECTRICAL SPECIFICATIONS High 541 (920) Voltage/Frequency/Phase 208/230V- 60Hz Cooling Medium 435(740) Voltage Range 187-253V Low 365(620) Cooling Rated 6.4 Indoor Unit Airflow Quiet 306(520) Current Heating Rated 5.8 Rate High S41 (920) Cooling A 8.3 CFM(m3/h) Maximum Operating Current Heating Medium 435(740) Heating 11.8 Low 365(620) Starting Current 6.4 Quiet 318(540) MCA 14.6 Outdoor Unit Cooling 1,206(2,050) Maximum Circuit Breaker 15 Airflow Rate Heating 1,083(1,840)1 Rated 1.44 1 Cooling Min.—Max. 1.63 Input Power kW High 42 Rated 1.285 Cooling Medium 35 Heating Min.—Max. 2.06 Low 31 Power Factor Cooling % 98 Indoor Unit Quiet 26 Heating 96 High dB(A) 43 1 Heating Medium 36 Moisture Removal pints/h(L/h) 1.9(4) Low 33 Energy Star YES Quiet 28 Drain hose Material PVC Outdoor Unit Cooling 51 Size in(mm) 015/32(12) (I.D.), 5/8(16) Heating 50 Cooling °F('C) 64 to 90(18 to 32) Operation Range %RH 80 or less Type R410A Heating "F("C) 88(30)or less Charge lb oz 3lbs.1 oz kg 1 Oil Type POE(RB68) Data:Bracket L)nnlcenter OtArlrw of txw 35-0116(903) T 25r6(67) 13116(20) f` m v 1 1 � 1 I 1 1 1 1 � ———————————— m ^• 17-1/4(A3tl) 16-6m(397) b 0 3-1/0 80 ho plop Mdol 39-5116(998).Lh»t We 0 3-1/8(60)hoW The Fujitsu logo Is a worldwide trademark or Fujitsu General Limited.The Halcyon logo and name is a worldwide trademark Note:Specifications are based on the following conditions: of Fujitsu General Limited and is a registered trademark in japan,the USA and other countries or areas.Copyright 2018 Cooling:Indoor temperature of 807(26.7Y)DB/67'F(19.4'C)WB,and outdoor temperature of 95'F(35'C)011175'F Fujitsu General America,Inc.Fujitsu's products are subject to continuous improvements.Fujitsu reserves the right to modify (23.M WB.Heating:Indoor temperature or 70-F(21.1'C)081607(15.6'C)WB,and outdoor temperature of 47'F(8.3Y) product design,specifications and information in this brochure without notice and without Incurring any obligations. DB143•F(6.1*0 WB.Pipe length:251t.(7.5m),Height difference:Oft.(0m)(Outdoor unit-indoor unit). ', 5111110111VIIII14M , t t c:D u FUJITSU SUBMITTAL 18RL6 a/cyon� Single18K BTU fne Wall 18K BTU Single1 ( , System DIMENSIONS Units:In.(mm) Unit:in(mm) 39-5/16(9M) 0 N Cq N a 20-V2 620 23-1/4 590 1(75) 28-318 721 9(228) 3 2 1 �3 cl 20-1/2 520 Unit:in.(mm) Top view 35-7/18 MOO) ills nn �jj� 13(330) (12) a o A T Front view ,s314(400► n wir,(aco) Side view Au F w,. mn If 8 e s, Bottom view S17H8(147) 611/18(170) The Fujitsu logo is a worldwide trademark of Fujitsu General limited.The Halcyon logo and name is a worldwide trademark Note:Specifications are based on the following conditions: of Fujitsu General Limited and is a registered trademark in Japan,the USAand other countries or areas.Copyright 2018 Cooling:Indoor temperature of 807(26.7•C)DB167•F(19.4%)WB,and outdoor temperature of 957(35•C)DBf75•F Fujitsu General America,Inc.Fujitsu's products are subject to continuous Improvements.Fujitsu reserves the right to modify (23.9Y)W8.Heating:Indoor temperature of 70•F(21.M D131604(I5.6•C)Will,and outdoor temperature of 47•F(8.3•C) product design,specifications and Information in this brochure without notice and without Incurring any obligations. DB143•F 16.1*0 WB.Pipe length:25ft.(7.5m),Height difference:Oft.(Om)(Outdoor unit-indoor unit). DATE(MM/DD/YYYY) ACORO CERTIFICATE OF LIABILITY INSURANCE �i 4/20/2023 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: MiChaele M.Wilbert Miller& Miller Insurance Agency Inc PHONE FAX 720 Commerce Street A/C,No,EXtI:914-741-6400 (AIC,No1:914-741-6407 Thornwood NY 10594 n oRess: michaelew@miller-ins.com INSURERS)AFFORDING COVERAGE NAIC# INSURER A:Merchants Preferred Ins Co 12901 INSURED TECHN5 INSURER B: Technique Heating &Cooling Inc 333 Old Tarrytown Rd., I INSURERC: White Plains NY 10603 INSURERD: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:1421837263 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR - - - ADDL SUBR - POLICY EFF POLICY EXP LTR TYPE OF INSURANCE POLICY NUMBER MM/DDNYYYI (MWDDrfYYYI LIMITS A X COMMERCIAL GENERAL LIABILITY CTRI003364 1/1/2023 1/1/2024 EACH OCCURRENCE $1,000,000 CLAIMS-MADE X JOCCUR DAMAGE TO RENT D PREMISES Ea occurrence) $500,000 MED EXP(Any one person) $5,000 PERSONAL&ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 X POLICY JET LOC PRODUCTS-COMP/OP AGG $2,000,000 OTHER $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ _ Ea accident ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY(Per accident) $ HIRED L NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per accident $ UMBRELLA LIAO OCCUR EACH OCCURRENCE $ EXCESS LIAO CLAIMS-MADE AGGREGATE $ DED 1 1 RETENTION$ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANYPROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ OFFICER/MEMBEREXCLUDED7 NIA (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) 'Policies shown are subject to terms,conditions,exclusions,sublimits and deductibles not listed on this certificate.We recommend that requests for policy copies be directed to the Named Insured shown above.' CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Village of Rye Brook 938 King Street New York NY 10573 AUTHORIZED REP ESENTATIVE ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD NYSIF New York State Insurance Fund PO Box 66699.Albany, NY 12206 1 nysif.com CERTIFICATE OF WORKERS' COMPENSATION INSURANCE ^^^A A^ 274972432 1 TECHNIQUE HEATING&COOLING INC 333 OLD TARRYTOWN RD i WHITE PLAINS NY 10603 SCAN TO VALIDATE AND SUBSCRIBE POLICYHOLDER CERTIFICATE HOLDER TECHNIQUE HEATING&COOLING INC VILLAGE OF RYE BROOK 333 OLD TARRYTOWN RD 938 KING STREET WHITE PLAINS NY 10603 RYE BROOK NY 10573 POLICY NUMBER CERTIFICATE NUMBER POLICY PERIOD DATE W2292123-3 242845 08/10/2022 TO 08/10/2023 4/20/2023 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE NEW YORK STATE INSURANCE FUND UNDER POLICY NO. 2292123-3, COVERING THE ENTIRE OBLIGATION OF THIS POLICYHOLDER FOR WORKERS' COMPENSATION UNDER THE NEW YORK WORKERS' COMPENSATION LAW WITH RESPECT TO ALL OPERATIONS IN THE STATE OF NEW YORK, EXCEPT AS INDICATED BELOW, AND, WITH RESPECT TO OPERATIONS OUTSIDE OF NEW YORK. TO THE POLICYHOLDER'S REGULAR NEW YORK STATE EMPLOYEES ONLY. IF YOU WISH TO RECEIVE NOTIFICATIONS REGARDING SAID POLICY, INCLUDING ANY NOTIFICATION OF CANCELLATIONS, OR TO VALIDATE THIS CERTIFICATE,VISIT OUR WEBSITE AT HTTPS://WWW.NYSIF.COM/CERT/CERTVAL.ASP.THE NEW YORK STATE INSURANCE FUND IS NOT LIABLE IN THE EVENT OF FAILURE TO GIVE SUCH NOTIFICATIONS. THIS POLICY DOES NOT COVER CLAIMS OR SUITS THAT ARISE FROM BODILY INJURY SUFFERED BY THE OFFICERS OF THE INSURED CORPORATION. PRESIDENT DAVID J MERCADO TECHNIQUE HEATING&COOLING INC ONE OF ONE THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS NOR INSURANCE COVERAGE UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICY. NEW YORK STATE SUR NCE FUND /l�Y� �V DIRECTOR,INSURANCE FUND UNDERWRITING VALIDATION NUMBER: 734642624 U-26.3