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Home My WebLink AboutRP25-010PERMIT # &Q6 0/ 0 DATE: 3/ �S EXP: / `3 / SECTION J�� O BLOCK LOT % TYPE OF WORK e - X/ ,n / /. JOB LOCATION cz;) 3�7alco7V leoci& - �.rei-c.7 /CLicz/ ��GL3� 388-5555 EST. V/co # TCO # INSPECTION RECORD I DATE INSP FOOTING FOUNDATION FRAMING RGH FRAMING INSULATION PLUMBING ED RGH PLUMBING GAS 0 SPRINKLER ELECTRIC O LOW -VOLT ALARM AS BUILT 0 FINAL �• spimf� OTHER APPROVALS ARB BOT PS ZBA OTHER BR 19 tl `�V JJ V � O VILLAGE OF RYE BROOK MAYOR 938 King Street, Rye Brook,N.Y. 10573 ADMINISTRATOR Jason A. Klein (914) 939-0668 Christopher J. Bradbury www.iyebrookny.gov BUILDING& FIRE INSPECTOR Susan R. Epstein Steven E. Fews David M. Heiser Donald T. Krom,Jr. Salvatore W. Morlino CERTIFICATE OF COMPLIANCE June 3,2025 Longfei Wu&Jiahui Fu 23 Talcott Road Rye Brook,New York 10573 Re: 23 Talcott Road, Rye Brook,New York 10573 Parcel ID#: 135.50-1-77 Roof Permit#25-010 issued on 1/31/2025 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 D� For office use only-: 3BUILDING DEPARTMENT PERMIT# s /O MAY 16 2025 VILLAGE OF RYE BROOK ISSUED:1-3 938 KEG STREET,RYE BROOK,NTEw YORK 10573 DATE: —/ VILLAGE OF RYE BROOK (914)939-0668 FEE: j(�— PAID® BUILDING DEPARTMENT www'.rygbrook.orp- 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 Address: 23 Talcott Rd Rye Brook NY 10573 Occupancy/Use: Z Parcel ID#: / 3S, SCE —/— 7 Zone: R-12 Owner: Vera Fu Address: 23 Talcott Rd Rye Brook NY 10573 P.E./R.A.or Contractor: Gunner LLC Address: 78 Halloween Blvd Stamford, CT 06902 Person in responsible charge: Andrew Prchal Address:78 Halloween Blvd Stamford, CT 06902 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 stnlcttlre/constniction/alteration herein mentioned in accordance with law: STATE OF NEW YORK.COUNTY OF WESTCHESTER as: Andrew Prchal being duly swom.deposes mid says that heisheresidesat23 Talcott Rd (Prat Name of Applicant) (No.and Street) in Rye Brook intheCounryof Westchester intheStateof NY that (Ciw/ o%,n/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 airy materials and labor which may have been donated gratis was:S 15,000.00 forthe construction oralterationof: Roof Replacement, GAF Asphalt Roof 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,die structure/work has been erectedicompleted 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 rise 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 y250-10.A.of the Code of the Village of Rye Brook. Sworn Swo to beforeW � me this � ^ Sworn to before me this day of 20 day of Q 20 Signature of Property Owner Signature of Applicant Vera Fu Andrew Prchal Prm Name of Property Print Name of Applicant AAA I I/ I ) Zrt ZANjS�`,iiinnrrrrrgrrr blic �, / blic ,Y O�ARY �o•' n P110 UBS-\ ^h',',L c o • 'tii4 EXP SON N EGA\'' �E BR . O� Zm cu � '9a2 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 : G. OA A DATE: PERMIT# V ISSUED: '1 S SECT:/3S- BLOCK: e LOT:2_ LOCATION: �� OCCUPANCY: ❑ VIOLATION NOTED THE WORK IS... ❑ ACCEPTED ❑ REJECTED/ REINSPECTION ❑ SITE INSPECTION REQUIRED ❑ FOOTING ❑ FOOTING DRAINAGE ❑ FOUNDATION ❑ UNDERGROUND PLUMBING NOTES ON INSPECTION: ❑ ROUGH PLUMBING ❑ ROUGH FRAMING ❑ INSULATION ❑ NATURAL GAS ❑ L.P. GAS ❑ FUEL TANK - , ❑ FIRE SPRINKLER //" ❑ FINAL PLUMBING ❑ CROSS CONNECTION ❑ FINAL ❑ OTHER s s s O 0 0 4-4 0-4 ? Ln u r M a u O a O WLn CA c C h '"1 t v 'o en O o W � �3 Q y ■ WO M r� W f� C7 cn s y " (� A (300 ry�'1 c,r) W 10. ;� r _ u o � b � � y O z o ovo� � y H 0-0 u O E y e r O O x y N Z W w w � off := 5 � A z 0 x G u e � W a e BuIL NIENT JAN 2 9 2025 V E OF RYE OK 938 KING �,ET RYE Bx ; NY 10573 VILLAGE OF RYE BROOK BUILDING DEPARTMENT FOR OFFICE USE ONLY: Approval Date: yp it# �j Application# Approval Signature: ARCHITECTURAL REVIEW BOARD: Disapproved: Date: BOT Approval Data: Case# Chairman: PB Approval Date: Case# Secretary: ZBA Approval Date: Case# Other: \\ Application Fee> 60' AA& Permit Fees: c- ROOF PERMIT APPLICATION Application dated: r — is hereby made to the Building Inspector of the Village of Rye Brook,NY,for the issuance of a Permit to Re-Roof an Existing Building,as per detailed statement described below. 1. Job Address: 23 Talcott Rd Rye Brook, NY 10573 SBL: 135.50-1-77 Zone: R-12 Property Owner: Vera Fu Address: 23 Talcott Rd Rye Brook, NY 10573 Phone#: (315) 450-2011 cell#: email: minijiahui@gmail.com 2. Applicant: Andrew Prchal Address: 78 Halloween Blvd Stamford, CT 06902 Phone#: 203 388 5555 Cell#: email: kauanny.zanetti@gunnerroofing.com 3. Roofing Contractor: Gunner LLC Address: 78 Halloween Blvd Stamford, CT 06902 Phone#: 203 388 5555 Cell#: email: kauanny.zanetti@gunnerroofing.com 4. Job Description,list all Methods&Materials: Remove&replace existing roof. Inspect roof deck to verify that all all sheathing is suitable. Install seam tape per CT Code Install water and Ice barrier,underlavment asphalt shingles and proper ventilation. 5. Estimated Cost of Job: $ 15,000.00 (NOTE:The estimated cost shall include all site improvements,labor,material.scaftblding,fixed equipment pmfessional fees,and material and labor which may be donated gratis.) 6. If comer property,indicate street frontage: 7. Construction Type: Roof Replacement, GAF Asphalt Roof NYS Construction Class: 8. Number of stories: 2 stories Height: 9. Is garage being re-roofed:No:( )•Yes: (N/rAttached No: O•Yes:VNiunber of Cars: 10. Is roof peaked,hip,mansard,flat,etc: Pitched 11. Estimated date of completion: Feb/March 10/3012023 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. WW WWW WWW WWWW*W WW WW Wa!•W WRW WWW WWW WWW WWWW*WWWWW*MWW*WWWWMWkW WWWW*WWW*WWWW MWWW WW WWWW WWWRWMRWWWWW WWnWW WWWWW Wnp STATE OF NEW YORK,COUNTY OF WESTCBESTER ) as: Andrew Prchal ,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 contractor for the legal owner and is duly authorized to make and file this application. (indicate architect,contractor,agent,attorney,ere.) 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 . C7 1 kr Sworn to before me this 0�q 4" day of (/1 q , 20 025 day of Ida[�SA , 20 &'Ioj Signature of Property wner Signature of Applicant Vera Fu Andrew Prchal Print Narpc of Property Owner Print Name of Applicant Notary Public tan lic \,\\a n n II r rnq•�• .•'''��JP�'NY Zg �': �y. Igy o _ ,� 01 pSA/� \�� o pUB1-yG � r� y �, •.� C ,EXP•°. � ' rrrrrllli 11i11\\\ 2- 1 013 0/2 0 2 3 Docusign Envelope ID:C29A8163-EAEC-0uNNnKCDisLL%_/ %juNNER NY LLC /GUNNER LLC National Headquarters: 78 Halloween Boulevard, Stamford,Connecticut 06902 Phone: 866-262-6005 License No.: CT-0653672 NY-WC32180H19 Yonkers,NY License No.- 7592 Rockland County,NY License No. 20118 NJ HIC- 13VH10245900 RI HIC-GC-44886 Gunner NY LLC Federal EIN No. 92-3168370. RRP License-R-1-18342-21-00015 www.gunnerroofing.com PROPOSAL/ CONTRACT This construction agreement(the"Agreement")is made and entered into this I Day of January.2025 by and between(a)if the Project is located in New York, Gunner NY LLC, (b) if the Project is located in New Jersey, Gunner NJ LLC, and(c) if the Project is located in Connecticut, Gunner LLC (hereinafter referred to as "Gunner Roofing" or "Contractor") and Vera Fu (hereinafter the "Owner" or "Customer")whose address is 23 Talcott Road,Rye Brook,NY, 10573(the"Project").Contractor and Owner hereby agree as follows: Contract Documents:The contract documents consist of this Agreement,and any exhibits attached hereto,Terms and Conditions,Notice of Cancellation, Statutory Warnings, and limited workmanship warranty (if any) and all modifications and change orders issued after execution of the Agreement(the"Contract Documents").Owner represents that it has read,reviewed,analyzed and become familiar with all of the Contract Documents and the identified and included costs in the Contract Price(as defined below),subject to any manifest errors, inconsistencies,omissions,or discrepancies.These contract documents represent the entire agreement of both parties and supersede any prior oral or written agreement. Scone of Work:The scope of work is contained and limited to the work contained on Exhibit"A"—Scope of Work.The scope of work does not include any engineering or design professional work,which engineering or design professional work shall be engaged and/or paid for separately by the Owner. All work shall be performed by Contractor in a workmanlike manner and shall meet or exceed all state and local building codes. Contractor shall obtain all permits necessary for the work to be completed.Contractor shall remove all construction debris and leave the project in a broom clean condition. Contract Price:The labor and materials required for this job will be furnished by Gunner Roofing or its subcontractors,including necessary equipment, and the services performed for a total of$15,000 (the "Contract Price"). Owner shall pay Contractor the Contract Price in accordance with Exhibit"B"-Schedule of Progress Payments. Each progress payment of the Contract Price shall be paid by Owner to Contractor within seven(7)days of receipt of Contractor's invoice. If Owner disputes any portion of an invoice for the Contract Price,then (a)Contractor shall be entitled to stop work on the Project without penalty or liability until payment in full is received or such dispute is settled to the mutual satisfaction of the parties and(b)Owner shall pay the undisputed portion of any such invoice, such payment to be made without prejudice to Owner's position. If Owner cancels this Agreement other than pursuant to a Notice of Cancellation validly and timely delivered within three(3)business days after the date hereof,then Owner shall pay Contractor each of the following: (a)an amount equal to ten percent(10%)of the Contract Price(including any Change Orders thereto)plus the full amount of any Permit Costs;and(b) for any special orders or non-returnable materials (including, without limitation, synthetics, cedar, slate, metal roofing, custom-colored items,windows,etc.),an amount equal to the cost thereof plus twenty percent(20%). In the event of cancellation by Owner,Owner shall have the option to either surrender any materials to Gunner Roofing or to take delivery thereof. (In Rockland County,New York: any deposit charged hereunder shall be the lesser of$1,000.00 or 15%of the Contract Price.Upon satisfactory payment being made for any portion of the work performed,the contractor shall,prior to any further payment being made,furnish to the person contracting for the work a full and unconditional release from any claim of a mechanic's lien by the contractor or by a person entitled to enforce a mechanic's lien for that portion of the work for which payment has been made.) Estimated Date of Commencement/Comoletion: The estimated start date of the Work is February 20th, 2025 and the estimated completion date is February 27th,2025,these dates are subject to change due to delays caused by weather,shortage of materials or labor, Acts of God,riots,revolutions,strikes,pandemics,medical emergencies that have resulted in a local,state,or federal state of emergency, COVID-19 or viruses/illnesses requiring quarantine,or other causes or factors beyond Gunner Roofing's reasonable control.Time is not of the essence for all purposes of this Agreement unless expressly provided to the contrary. Unless otherwise specified,there is no specific completion date for Contractor's work.Contractor shall use good faith,diligent efforts to complete all work in a reasonable amount of time. If Owner fails to timely pay the deposit due hereunder,then the foregoing estimated start date and completion date for the Work may be delayed until such time as such deposit is paid to Contractor and taking into account Contractor's schedule for other projects and work. Chance Orders: All changes to the plans, specifications or selection of finished materials which may be requested in writing by Owner("Change Orders"), shall be submitted to Contractor using Exhibit "C" — Change Order and are subject to Contractor's approval.A Change Order is any change in work from the original,permit set,plans and specifications.Each Change Order shall only be incorporated into the Agreement if signed by both Owner and Contractor prior to the commencement of any work covered by said Change Order.In the absence of an express lump sum agreement with respect to any Change Order,any work covered by such Change Order shall be billed to the Owner at the direct cost to the Contractor plus twenty percent(20%). Additional time needed to complete change orders shall increase the time needed for Project completion. Docusign Envelope ID:C29A81 B3-EAEC-463A-A33F-4CDA93BBBDA5 I HAVE READ AND UNDERSTAND THIS CONTRACT, THE TERMS AND CONDITIONS, AND ALL APPLICABLE CONTRACT DOCUMENTS AND AGREE TO BE BOUND BY THEIR TERMS. ACCEPTANCE OF CONTRACT: The above prices, specifications and conditions are satisfactory and are As Applicable:Gunner NY u�ner NJ LLC/Gunner LLC hereby accepted. Contractor is authorized to do the work as specified. By signing below, Customer N"IA acknowledges that Customer is the owner(or authorized Authorized Signature: agent of the owner)of the property where the work is to Ni chol l a Zanetti be performed. Contractor will provide Customer with a copy of this Contract after it is signed by both parties. By. Its: DocuSigned by: Customer Signature: Date: 1/8/2025 1/8/2025 40AEPD77F4D498... Date: CONSUMER'S RIGHT TO CANCELLATION.CUSTOMER MAY CANCEL THIS CONTRACT WITHOUT ANY PENALTY OR FURTHER OBLIGATION WITHIN THREE(3)DAYS FROM THE DATE OF THIS TRANSACTION. SEE THE ATTACHED NOTICE OF CANCELLATION FORM FOR AN EXPLANATION OF THIS RIGHT. Docusign Envelope ID:C29A81B3-EAEC-463A-A33F-4CDA93BBBDA5 EXHIBIT A—SCOPE OF WORK DESCRIPTION OF THE WORK TO BE PERFORMED: ROOFING ASPHALT -$15,000 • Tear off existing shingles (2 asphalt layers included) • Inspect plywood and replace damaged plywood as needed (8 sheets included, additional sheets of/2" $105 per sheet or 3/4" plywood or$4/If for batten replacement) • Install Standard Aluminum Drip Edge F5: White • Install GAF Weather Watch Ice and Water Shield -6' along eaves. 3' along valleys, and 3' along rake edges. • Install GAF Synthetic Tiger Paw Underlayment • Install underlayment using galvanized T50 Staples • Install GAF Weather Blocker Starter Strip Shingle • Install GAF Architectural Timberline HDZ Asphalt Shingle -COLOR: CHARCOAL, PEWTER GRAY, WEATHERD WOOD • Install Shingles using Galvanized Roofing Coil Nails - 1 1/4" • Install GAF Cobra Snow Country Advanced Ridge Vent • Install GAF Timbertex Hip & Ridge Shingles-COLOR: CHARCOAL, PEWTER GRAY, WEATHERED WOOD • Install Copper Chimney Flashing &Cricket and Solder all joints • Install Aluminum Pipe Flashing Combo 1''-4" • Valleys will be woven using shingles if applicable • Use Elastomeric/Caulk (Clear) where applicable • Use Dynamoic Caulk (Limestone) where applicable • Gunner will provide job related materials • Gunner will provide dumpster to clean site and remove job related debris • Magnetic sweep property for nails • Crews will maintain safety requirement at all times during the construction process • Provide GAF Golden Pledge Warranty (50 Years on materials and 25 years on labor) upon completion and final payment • Gunner will pull permit for owner(and subsequently close) and save receipt for reimbursement from customer(if needed) MISC - • Gunner will provide 15 LF of step/counterf lashing if needed, additional step/counterflashing will be charged at$30/1-F • Gunner will provide emergency tarp over leaking area upon signing of contract w a \ DS_ Initial Docusign Envelope ID:C29A81 B3-EAEC-463A-A33F-4CDA93BBBDA5 EXHIBIT B—SCHEDULE OF PROGRESS PAYMENTS Payment shall be made to (a) if the Project is located in New York, Gunner NY LLC, (b) if the Project is located in New Jersey, Gunner NJ LLC, and (c) if the Project is located in Connecticut, Gunner LLC. Checks are to be mailed to 78 Halloween Boulevard, Stamford, Connecticut 06902. Work or Services Performed and Materials Amount Due:$15,000 to be Supplied: 20% Deposit $3,000 50% On Start $7,500 30% On Completion $4,500 "(Payment terms are not applicable if approved for a financing plan for full project)" Customer agrees to pay $20 fee for any bounced check for any reason, including Not Sufficient Funds. If Customer elects to pay by credit card, then the Contract Price will be increased by a three percent(3%) and will total $15,450. GUNNER NJ LLC/GUNNER NY LLC /GUNNER LLC will void the contract if home sale falls through. Deposit will be refunded to the customer within 10 business days. DS_ Initial �C t\h 1�1► s ��.hl 1�,. �i''�VI 1►1►1 f►1i�:;.i r i + l � ^� •W � c c G � X " Bob— IF 5'N u� O •'.7 � CS �. "�t CJ Gi rA L V a "'" 0 N U V +� C� w U ' o�e�tion �,• �- 4NP O Z O y A v it U' Q y h C ~ o °z v CN 00 �•. V LO qu c> {lAK taq ' ��,• •i ►5\'"�?d�:�'s`�,0�►f�l��y:�► "r,-�:rt;�,��,�� ...�?�Jd�l��►;u:`r'a .�rs311.�i�17�i;.`tl'{*'• {pa`s)!�. • :...��...�a. ,:...,y�,�� " •,yAlBir�iNr- .;?"�L O'�6' ,��R� •'— iw��e; -. y,,�,A,�:•3�, _ .� t. Client#: 1952221 HOMEEN ACORD CERTIFICATE OF LIABILITY INSURANCE DATE TE(MM025YYv 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(les)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 any rights to the certificate holder In lieu of such endorsement(s). PRODUCER CONTACT NAME: _ Jennie Foster USI Insurance Services LLC Pn/"c°No Ert:855 8740123 FA/C No:203 634-5701 530 Preston Avenue E-MAIL usictcertificates@usl.com ADDRESS: Meriden, CT 06450 INSURER(S)AFFORDING COVERAGE NAIC;t 855 8740123 INSURER A:Admiral Insurance Company 24856 INSURED Gunner LLC INSURERS:Liberty Mutual Insurance Company 23043 78 Halloween Blvd INSURERC:Selective Insurance Company of America 12572 Stamford, CT 06902 INSURERD: INSURER E: 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. TL pR TYPE OF INSURANCE ADDL UBR POLICY EFF POLICY EXP INSR WVD POLICY NUMBER MM/DD/YY MM/DD/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY CA00004513602 4/21/2024 04)21/2025 EEAACMMHppOEECTCURgqRENCE $1 000000 CLAIMS-MADE ❑X OCCUR PREMIES REoocurrence $50 OOO MED EXP(Any one person) $5 000 PERSONAL&ADVINJURY $1 000,000 GEN'L AGGREGATE DMITAPPUESPER:PRO- GENERAL AGGREGATE $2,000,000 POLICY X JECT D LOC PRODUCTS-COMPIOP AGG $1 000 000 OTHER: $ C AUTOMOBILE LIABILITY S2579842 9/27/2024 09/27/202 Eo axideent, LE LIMIT 1,000,000 X ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY(Per accident) $ HIRED AUTOS NON-OWNED PROPERTY DAMAGE $ X AUTOS ONLY X Per accident UMBRELLA LIA OCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS-MADE AGGREGATE $ DIED RETENTIONS $ B AND EMPLOYERS' YERS'LIABILITY IONILIT WC533S381014053 1/19/2025 01/19/202 X PER oTH- AND EMPLOYERS'LIABILITY ANY PROPRIETOR/EXCLU R/EXECUTIVE Y/N E.L.EACH ACCIDENT $1 000 000 OFFICERMIEMBEREXCLUDED? � N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $1 OOO OOO If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1 00O 000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Village of Rye Brook is included as an Additional Insured under the General Liability policy,for ongoing and completed operations,when required in a written agreement in accordance with policy terms,conditions,and exclusions regarding services provided by the Named Insured. CERTIFICATE HOLDER CANCELLATION Village of Rye Brook SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 938 King St ACCORDANCE WITH THE POLICY PROVISIONS, Rye Brook, NY 10573 AUTHORIZED REPRESENTATIVE cc,1988-2015 ACORD CORPORATION.All rights reserved. ACORD 25(2016/03) 1 of 1 The ACORD name and logo are registered marks of ACORD #S43188187/M42873328 SZBZP •4 \\ NYSI F New York State Insurance Fund PO Box 66699,Albany, NY 12206 1 nysif.com CERTIFICATE OF WORKERS' COMPENSATION INSURANCE "^^^^^ 832024199 GUNNER LLC r 78 HALLOWEEN BLVD STAMFORD,CT 06902 ❑� " SCAN TO VALIDATE AND SUBSCRIBE POLICYHOLDER CERTIFICATE HOLDER GUNNER LLC VILLAGE OF RYE BROOK 78 HALLOWEEN BLVD 938 KING STREET STAMFORD, CT 06902 RYE BROOK NY 10573 POLICY NUMBER CERTIFICATE NUMBER F POLICY PERIOD DATE VV2485 011-7 336017 09/12/2024 TO 09/12/2025 1/29/2025 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE NEW YORK STATE INSURANCE FUND UNDER POLICY NO. 2485011-7. 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:/IWWW.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 THE SOLE PROPRIETOR, PARTNERS AND/OR MEMBERS OF A LIMITED LIABILITY COMPANY. THE POLICY INCLUDES A WAIVER OF SUBROGATION ENDORSEMENT UNDER WHICH NYSIF AGREES TO WAIVE ITS RIGHT OF SUBROGATION TO BRING AN ACTION AGAINST THE CERTIFICATE HOLDER TO RECOVER AMOUNTS WE PAID IN WORKERS'COMPENSATION AND/OR MEDICAL BENEFITS TO OR ON BEHALF OF AN EMPLOYEE OF OUR INSURED IN THE EVENT THAT, PRIOR TO THE DATE OF THE ACCIDENT, THE CERTIFICATE HOLDER HAS ENTERED INTO A WRITTEN CONTRACT WITH OUR INSURED THAT REQUIRES THAT SUCH RIGHT OF SUBROGATION BE WAIVED. 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 STAT SU NCE FUND /�Y �V DIRECTOR,INSURANCE FUND UNDERWRITING VALIDATION NUMBER: 898437915 U-26.3