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HomeMy WebLinkAboutRP20-0128/lmar� (o�-7os-(any spa ICV N FEE_ _ DATE INSPECTION RECORD DATE INSP FOOTING FOUNDATION FP.AMING RGU FRAMING :NSU�,:ON PLOMPING RG}i PLUMBING GAS _ SORT ULER ELECTEIC 0 LOW-W" T ALA^VI AS awLF L3 FINAL 4-I-tOLJ L-O 1�1� OTHER APPROVALS ARB BOT PB ZBA OTHER BR(� tc 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. Morko CERTIFICATE OF COMPLIANCE April 3,2024 Alvaro Ignacio Alfonzo-Larrain& Elina Bilman 43 Talcott Road Rye Brook,New York 10573 Re: 43 Talcott Road, Rye Brook,New York 10573 Parcel ID#: 135.58-1-31 Roof Permit#20-012 issued on 6/16/2020 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 3 ' For office use onl BUILDING DEPARTMENT PERMIT# p? /a JAN 19 2021 VIL OF RYE BROOK ISSUED: a- 0ad 938 KING STREE YE BROOK, NEW YORK 10573 DATE: _ — l (914)9 6&- Ax(914)939-5801 FEE: ,tip — PAID S " rook.or APPLICATION FOR CERTIFICATE OF OCCUPANCY9 CERTIFICATE OF COMPLIANCE., AND CERTIFICATION OF FINAL COSTS TO BE SUBMITTED ONLY UPON COMPLETION OF ALL WORK, AND PRIOR TO THE FINAL INSPECTION Address: 113�aIC011 _Qoaj Rye Brook, NY 10573 Occupancy/Use: )—F01"dV Parcel ID#: 135.58-1-31 Zone: owner: Aivaro Larrain Address: 43 Talcott Avenue Rye Brook, NY 10573 P.E./R.A.or Contractor: Franzoso Contracting, INC Address: 33 Croton Point Avenue Croton on Hudson NY 10520 Person in responsible charge: Peter Klat/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 a Certificate of Occupancy/Certificate of Compliance for the structure/construction/altemtion herein mentioned in accordance with law: STATE OF NEW YOM COUNTY OF WESTCHESTER as: Peter Klatt 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:$ $12,505.00 for the construction or alteration of: Roof Removal/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 belies;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 ofOccupancy or Certificate of Compliance shall have been duly issued by the Building Inspector as per §250-1 O.A.of the Code of the Village of Rye Brook. Sworn to before me this Z Swom to before me this2 his I day of 3ftV CW`I , 20 a� day of lanycky 7 , 20 al A IVaeo L n - - Signature of Property Owner 7gonature oAa ve Prinmlarnt f Property Owner Print Name of Applicant lo;cup( 13�ec 7�r� SO4� Notary Public Notary— Public Michael Baba Michael Babit Notary Public,State of New York Notary Public,State of New York No.01 BA6331102 No.01 BA6331102 Clualllled in Westchester County Oualifled in Westchester County Commission Expires September 28,2023 Commission Expires September 28,2023 QyE BR(��• O� 2m cu � • 1982 BUILDING DEPARTMENT ❑BUILDING INSPECTOR .�IASSISTANT 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: Tfk LCCo}� �� L DATE: L �� PERMIT# `\ �� O ) Z ISSUED: 'I(.`Z J SECT: �S BLOCK: LOT: -31 LOCATION: '� OCCUPANCY: ❑ Violation Noted THE WORK IS... PASSED ❑ FAILED REINSPECTION ❑ SITE INSPECTION REQUIRED ❑ FOOTING ❑ FOOTING DRAINAGE ❑ FOUNDATION ❑ UNDERGROUND PLUMBING NOTES ON INSPECTION: ❑ ROUGH PLUMBING ❑ ROUGH FRAMING ❑ INSULATION ❑ Natural Gas ❑ L.P. Gas / ❑ FUEL TANK ❑ FIRE SPRINKLER ❑ FINAL PLUMBING ❑ CROSS CONNECTION �] FINAL ❑''OTHER _ �E BRC��, cu � BUILDING DEPARTMENT ❑BUILDING 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:- �I J C C� DATE: 2 PERMIT# 1` 2 0 - 0 1 Z— ISSUED: b Z� Z G SECT: S� BLOCK: LOT: 31 LOCATION: Ie O J r OCCUPANCY: ❑ Violation Noted THE WORK IS... ❑ PASSED ❑ FAILED REINSPECTION AT SITE INSPECTION REQUIRED ❑ FOOTING ❑ FOOTING DRAINAGE ❑ FOUNDATION ❑ UNDERGROUND PLUMBING NOTES ON INSPECTION: ❑ ROUGH PLUMBING ❑ ROUGH FRAMING ❑ INSULATION ❑ Natural Gas ❑ L.P. Gas ❑ FUEL TANK - ❑ FIRE SPRINKLER ❑ FINAL PLUMBING ❑ CROSS CONNECTION ❑ FINAL ❑ OTHER Work Scope JOB: PRJ #367351arrain, Alvaro: Partial Roof Replacement ADDRESS: 43 Talcott Road, Rye Brook, NY 10573 CONTACT: Mr. Alvaro Larrain, 43 Talcott Road, Rye Brook, NY 10573 USA PHONE WS: (646)705-6664 Roof Replacement: • Roof Area Covered in Scope of Work: MAIN HOUSE ROOF/EXCLUDING GARAGE & BREEZEWAY • Install permanent OSHA approved stainless steel single D-Ring fall protection anchor. • Loosen or remove existing gutters and leaders, as necessary. • Remove existing roofing (1 layer) down to the wood deck. • Inspect, remove and replace any damaged or rotten plywood with new comparable thickness CDX plywood sheathing @$70.00 per 4'x8'x1/2", @$80.00 per 4'x8'x 5/8", @$90.00 per 4'x8'x 3/4" sheet installed; only as necessary. • Install GAF@ Weather Watch@ leak barrier protection "Ice and Snow Shield" impervious rubber membrane behind gutters on the fascia board, continuing up onto the entire low slope roof area. • Install all new perimeter drip edge. Color: Brown • Install GAFO Pro-Start starter shingles to roof area. • Install GAF@ Timberline HD shingles, Lifetime manufacturer warranted architectural shingles to roof area according to manufacturer's specifications. Color: • 'Includes a GAF "Golden Pledge" limited warranty which gives you 100% repair coverage for any • defect in materials for a full 50 years non-prorated coverage and contractor application for the natural like of the product. Factory Inspection: A certified roofing technician will inspect your GAF roofing system. Non-Prorated Coverage, which is a no reduction of coverage during the full protection period. Also includes a Franzoso Contracting, Inc. 25 year workmanship warranty. • Roof to Wall Flashing: • Remove Wood Boards at all roof meets wall locations then cut siding above roof line 5 '/2" and run leak barrier protection up onto wall. Install all new prime painted 1x6 with a "Z" bend flashing. • Install new step and apron flashing at roof meets wall locations. • Install 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 copper chimney flash ings/counter-flashings. • Cut and install GAF@ Snow CountryTm ridge vent to peak(s) of building. • NOTE: DURING RIDGE VENT INSTALLATION OPERATIONS, SAW DUST WILL BE INTRODUCED TO ATTIC SPACE; HOMEOWNER SHOULD TAKE PRECAUTIONS AS REQUIRED TO PROTECT ITEMS STORED IN ATTIC SPACE. • Install GAFO TimbertexTm ridge hips to peaks. • Inspect, remove and replace any rotten or damaged fascia with new 1x6 primed pine fascia @$6.00, 1x8 @$8.00 or 1x10 @$10.00 per foot installed, only as necessary. • Repitch, rehang or tighten existing gutters. • Proper disposal of debris; complete site restoration. Printed 06/02/2020 Alfredo DiVitto From: Ashley Schupbach <aschupbach@franzoso.com> Sent: Wednesday, February 7, 2024 10:30 AM To: Alfredo DiVitto Subject: COC Application-43 Talcott Road Attachments: 43 Talcott COC App.pdf Good morning, Assistant building inspector Freddy called our office on Friday and the permit for the roof replacement at above address is still open. Freddy asked for the COC app that we mailed to the building department in January 2021 to be emailed over.After it was mailed we received a call from Tara at the building department that there is a$110.00 close out fee due. I did speak with the homeowner that week and he said he would be mailing in the close out fee, I am not sure if he did or not. Please let me know if anything else is needed on our end.Thank you! Thank you, Ashley Schupbach Administrative Assistant Frwizoso Contracting, Inc. n a 33 Croton Point Avenue 3 a e Croton-On-Hudson, NY 10520 0: (914) 271-4572 F: (914) 271-8644 Q / Email: aschupbach(d)franzoso.com Q� \ AFRANZO,(.30 M Beat of Westchester 2018-2023 1 Alfredo DiVitto From: Alfredo DiVitto Sent: Tuesday, March 19, 2024 12:58 PM To: 43talcott@gmail.com Subject: EXPIRED RE-ROOF PERMIT Attachments: expired permit Ietter0001.pdf, CO-CC-Application-8.2021.pdf,43 Talcott Road expired re-roof permit 0002.pdf,43 Talcott Road expired re-roof permit 0001.pdf Good afternoon,Alvaro Larrain our records show permit RP20-012 that is for a new roof at 43 Talcott has expired on 6- 16-2021 please see attached permit, expired letter,and co-cc application. I spoke to the contractor regarding this, and they emailed a letter saying homeowner will take care of all the fees associated to the C.O and expired permit fee. I also attached the letter from Franzoso Contracting. I will also mail and stop by property with all attached paperwork. If you have any questions,feel free to give us a call. Thank you, Alfredo (Freddy) DiVitto Assistant Building Inspector Village of Rye Brook 938 King St. Rye Brook,N.Y. 10573 Office:914-939-0668 1 I 3D DATE: 3/21/2024 MAR 282024 TO: Mr. Steven Fews, Biulding& Fire Inspector VILLAGE OF RYE BROOK BUILDING DEPARTMENT FROM:Alvaro Larrain � '- " Re: 43 Taclott Road (Permit#RF 20-012) Dear Steve, We were informed that a$110 fee and a$500 fee is due to the Village for a Building Permit and an expired Building Permit related to the replacement of our roof at 43 Talcott Road. Enclosed please find the check for$110, and you can expect to receive a separate check for$500 from the roof contractor, Franzoso. Thank you again for your assistance with this matter. Sincerely, Alvaro Larrain (646) 705 6664/43talcott@gmail.com 3/21/247, 11:36 PM Gmail-EXPIRED RE-ROOF PERMIT Gma i i Alfonzo-Larrain Bilman Family <43talcott@gmail.com> EXPIRED RE-ROOF PERMIT Steven Fews <SteveFews@ryebrook.org> Thu, Mar 21, 2024 at 2:38 PM To:Alfonzo-Larrain Bilman Family <43talcott@gmail.com>,Alfredo DiVitto <adivitto@ryebrook.org> Yes,that would be fine. Thank You. Steven E. Fews Building Inspector& Fire Inspector Office (914) 939-0668 From: Alfonzo-Larrain Bilman Family<43talcott@gmail.com> Sent:Thursday, March 21, 2024 11:28 AM To: Steven Fews<SteveFews@ryebrook.org>; Alfredo DiVitto<adivitto@ryebrook.org> Subject: Fwd: EXPIRED RE-ROOF PERMIT Good morning Steve/Freddy, please see below. You will be receiving two checks for the closing of this permit. Should I make the check payable to Village of Rye Brook and mail to your department? I will include a brief cover letter for reference. Thank you, Alvaro. Sent from my iPhone Begin forwarded message: From: Alfonzo-Larrain Bilman Family <43talcott@gmail.com> Date: March 21, 2024 at 11:25:53 AM EDT To:Ashley Schupbach <aschupbach@franzoso.com> https://mail.google.com/mail/u/0/?ik=8f9Occcc55&view=pt&search=all&permmsgid=msg-f:1794162120470458426&dsqt=l&simpl=msg-f:17941621204... 1/9 3/21/24, 11:36 PM Gmail-EXPIRED RE-ROOF PERMIT Cc: Jimelle Gile<Jimelle@franzoso.com> Subject: Re: EXPIRED RE-ROOF PERMIT Dear Ashley, thank you for the quick response. I am glad this is the outcome as I am satisfied with Franzoso's work and I've recommended your company to dozens of clients,friends and family. I will let the Building Department know that they will be receiving two checks in the mail. I will be mailing the $110 fee. Sincerely, Alvaro. Sent from my iPhone On Mar 21, 2024, at 8:19 AM,Ashley Schupbach <aschupbach@franzoso.com>wrote: Good morning, I have spoken with management, since you claim you never spoke with me in 2021 and even though your job was already discounted we will be mailing the check for the expired permit fee only of$500.00 to the building department. Please follow up with the building department to ensure your permit is closed. Once they received the expired permit fee payment they will have everything they need on our behalf,thank you! Thank you, Ashley Schupbach Administrative Assistant Frnizoso Coauracung,Inc. 33 Croton Point Avenue Croton-On-Hudson, NY 10520 0: (914) 271-4572 F: (914) 271-8644 Email: aschupbach@franzoso.com <image001.jpg> https://mail.google.com/mail/u/0/?ik=8f90cccc55&view=pt&search=ali&permmsgid=msg-f:1794162120470458426&dsqt=1&simpl=msg-f:17941621204... 2/9 1577371118263000.J PG PROJECT:[PRJ#36735(Larrain,Alvaro: Partial Roof Replacement)] 1577371118264466.J PG PROJECT:[PRJ#36735(Larrain,Alvaro: Partial Roof Replacement)] 1577371118265897.JPG PROJECT:[PRJ#36735(Larrain,Alvaro: Partial Roof Replacement)] , r0j Q 1577371118270652.JPG PROJECT:[PRJ#36735(Larrain,Alvaro: Partial Roof Replacement)] 1577371118273416.JPG y PROJECT:[PRJ#36735(Larrain,Alvaro: Partial Roof 1 Replacement)] I L 1577371406955181.JPG PROJECT:[PRJ#36735(Larrain,Alvaro: Partial Roof Replacement)] ` 1C4 4 00 OF v 4� GAF Fiberglass • • lt ShingleSpecifications* APPROXIMATE PHYSICAL ATTRIBUTES GOOD WARRANTY2 NOUSEKEEDING E Z� — Stain ------------- i Camelot Guard " ""-"-"-" " ]1 d]]JJ]y 56 7 230 zs• Wx 34Y; .�,�.�. oW Country Mansion G 8�d -'--"""- I�j��]J]]� 43 6 192 1.5• 1r'x4o' Z Stain W Grand Slate"' I rJ as 6 192 75' Wx4o' G.W ��� 7 sr c - _ j1 7 ` Grand Canyon' Guarrd --------- �]1�]]J]]� n 6 m 51 Wx4o' Stain• 3 Grand Sequoia Guard --------- �.]1��]J]]'d 12 5 360 s 12 x4o• W s6 a 230 i O 2 ----- Z Z Camelot II s n x 3a;; W Stain 00z Country Mansion'11 �]1bjj]J]]jj' 18 1 192 1.5 11 /40 W W -- --- _ y ?-( a Lu Grand Slate-11 Guard J1 0SJJJ] 13 1 192 1 S">^ nxa0 WtW N We- Slateline Guam =-----=====- Timberline"'Ultra HD"' G tan, F" ---------- I 61 1 256 S I 3911 �r Timberline°American I-laruest'" Stain nn _____________ I ;� 61 3 256 s;; 13;', x39;; w Gua i ] ��]JJ]� Z -- - W W Timberline®ArmorShleld"'II GUail ------------- I] y��J]]� 65 3 264 SY,' 13%x3er• CO J � G GUattj ------------- 1J 1 Lu Timberline®Cool Series Stain I W�_�] 64 4 ash sr W LL 3 — Timberline®HD'" Stain I-��- --��--�� J i-3 61 3 256 ST 13;5 x 39;; Gua ]��]]J]] Stain ' ----- ---_-- Timherline°Natural Shadow"' Guarli � ��fy]�Jj]� 61 3 256 s;; 13;Sx39; m � Stain ' - -- - A��� �j ------- 19Erg 316IN S'Ing 12'x36'1ng 7 2 Hoyal Sovereign' h�!M aru 64"k 3 2S6Ve�rit S"rys,(4 13Y,,'x39Y'W.Irc M = l'•�. �.�. N •For the current specifications on TruS!ate',which Is genuine slate(rat an asphalt shingle),visit vnnv.gaf.com. Perodically tested by independent and internal labs to ensure compliance%nth ASTI.1 D3462 at time of manufacture. 3 All shingles with a lifetime Itd.warranty also have a 110 mph wind warranty. However.it the shingles are(a)installed with six malls per shingle and(b)installed using GAF starter strip products installed at the eaves and rakes,the%•rind speed coverage is 130 mph.The word*Lifetime"means as long as the original individual o•uner of a single family detached residence(or the second owner in certain circumstanc- es)o./nc IM nrnnorty.•:/wra th>chlru•.o<am•nctaltn.l F... ..--- r....w.../r./-....................nlntn Accessory Paint CODES SPECIAL WE1'IIIID IIA1I011A1 REGIONALFEATURES TM f E-o ?4 5 o uo _ tn 4 sa aS >-6 • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • . . . . . . . . . . GAF ShinglelvlatchT" Roof Accessory Paint will help to . . . . . . . . . . hide unsightly :)rotruslollS Oil the roof, inclu ing vent pipes, 8 exhaust vents and [lashings. PRODUCT SPECIFICATIONS • • • • • • • • • • Can Size: 12 oz. Cans Per Case: b 4 s 5 Cases Per Pallet: 128 • • • • • • • • • • • • Colors: 7 4 Barkwood, Birchwood, Charcoal, Drihwood, • • • • • • • • • • Fox Hollow Gray, Hickory, Hunter Green, Mission Brown, Pewter Gray, Shokewood, Slate, and Weathered Wood • • • • • • • • • • • 7 • • • • • • • • • • • • 7 4 5 5 • • • • • • • • • • • • - - ■ ► ■ � 7 4 5 �tA1�N. 4 4 Applies to some plants(that make referenced product).5 Applies to white only. _�► Sleeper slopes and maximum vend warranties may require more nails. 7 , J 7 Applies to product sold in Canada onnly. 8 Application submitted and approval is pending. 45 I/ ..q�'A�R;;.,.. �/�'.`�[;�/1?yl�, sr�; •,S A, .7t�T'' ':�k F` A'^�''� ./A.l'l' -�SA�Agl�° . 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U ' y 57, }�(0)io_d' •-`Il�fl tdv.�.'f 'N 11 s; .>11 1iteE- Fs_ti'11 11 i:e-'% 11 j •1.- j' 1 <-��ar t(0)>`1� Ifil 111 I�llll `�If11�yj _, `-III/I�IIf4; FIff111/114 '•► :" ;;(\ /": : ��I�w�1�� l�// f►laA� III ��y r III III ;� 1 1 1 1 1 # \ �Ip Y A � •1• V lA�� ••♦ r ^� r <I���A r /</ A �IfI/ �Al��, Ii1<I �'��i7�A � '7 � ��� lY�Q� �'S���o ��_1' O � O �'4� �� •�•i--• ur � arti1 t-n �`� �..,,,� � .,,'� .;. ���W>y -.'_\• vlr�� �'G�V-�a- "s ��3�✓, ,,.""� v�1t�,�/ �wri� � ACOos/04/2020 Y) ® CERTIFICATE OF LIABILITY INSURANCE DATE( / ozo 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. Certlfiwte Team ROBERT T KIRKWOOD,INC AHONv Ext: (914)769-9070 FAX No): (914)769-4706 91 Washington Avenue E-MAIL certificates@kirkwoodinsurancecom ADDRESS: INSURER(S)AFFORDING COVERAGE NAIc e Pleasantville NY 10570 INSURERA: Selective Insurance Company of the Southeast 39926 INSURED INSURER 8: Merchants Mutual 23329 Franzoso Remodeling Corp.,DBA Franzoso Contracting INSURER C Selective Insurance Company of America 12572 33 Croton Point Ave. INSURER D: Shelter Point Life Insurance Co. 00049 INSURER E: Croton On Hudson NY 10520 INSURER F; COVERAGES CERTIFICATE NUMBER: 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. TR TYPE OF INSURANCE INSO WVD POLICY NUMBER MWDD/YWY MWDD/YYYY LIMITS X COMMERCIAL GENERAL LIABILITY 1,000.000 EACH OCCURRENCE S CLAIMS-MADE DAMAGE TO RENTED FX OCCUR PREMISES Ea occurrence) s 500,000 MEO EXP(Any one person) s 15,000 A S2332054 04/01/2020 04/01/2021 PERSONALSADVINJURY S 1,000,000 GEN'LAGGREGATE LIMITAPPLIES PER. GENERAL AGGREGATE 5 2,000,000 POLICY X JECT JECT LOC PRODUCTS-COMP/OPAGG 5 2,000,000 OTHER 5 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 5 1,000.000 Ea accident X ANYAUTC BODILY INJURY(Per person) 5 A OWNED SC,"EDULED S2332054 04/01/2020 04/01/2021 BODILY INJURY(Per accident) 5 AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE AUTOS ONLY AUTOS ONLY Per accident S c X UMBRELLA LIAB X OCCUR EACH OCCURRENCE S 4.000,000 8 EXCESS LIAB CLAIMS-MADE CUP0000898 04/01/2020 04/01/2021 AGGREGATE 5 4,000,000 DED I XJ RETENTION S 10,000 S WORKERS COMPENSATION X SPER TATUTE ER AND EMPLOYERS'LIABILITY Y/N C ANY PROPRIETOR/PARTNERIEXECUTIVE E.L.EACH ACCIDENT S 1,000,000 OFFICER/MEMBER EXCLUDED? N/A WC9082556 04/01/2020 04/01/2021 (Mandatory In if yes,describe under E.L.DISEASE-EA EMPLOYEE S 1,000,000 und DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT S 1,000,000 NYS Statutory Disability D DB L226176 01!01/2020 12/31/2020 Statutory DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,maybe attached if more space 15 required) Village of Rye Brook is included as an additional insured under general liability per blanket endorsement as respects work performed by the insured 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 t- YORIC Workers' CERTIFICATE OF STATE C0111POIlSatiOn ,_ Board NYS WORKERS' COMPENSATION INSURANCE COVERAGE 1a.Legal Name 3 Address of Insured(use street address only) Ib. Business Telephone Number of Insured Work Location of Insured(Only required if coverage is specifically limited to (9.14)271-4572 certain locations in Nev.,York State,i.e a Wrap-Up Policy) 1c.NYS Unemployment Insurance Employer Registration Number of Franzoso Remodeling Coll).,DBA Franzoso Contracting Insured 33 Croton Point Avenue Cl-oton on Hudson,NY 10520 Id.Federal Employer Identification Number of Insured or Social Security Number 47 1320 112 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"1a" 938 King Street WC9082556 Rye Brook, NY 10573 3c.Policy effective pe,icd 04/01/2020 to 04/01/2021 3d.The Proprietor,Partners or Executive Officers are X included.(Only check box if all partnerslofficers included) l:_ all excluded or certain partnerslofficers excluded. This certifies that the insurance carrier indicated above in box '3"insures the business referenced above in box"ta"for workers' compensation under t,ie 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 canoe ed 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. I his 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. Ap,rroved by: Robert Kirkwooc (Print name of aulhorizea reoresentatwe or'iccnsed agent of nsurance carrier) Approved by: / te; /��1' 4 h/( o/4J2020 (Signawre) --- (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