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HomeMy WebLinkAboutBP25-022SECTION /cBLOCK / LOT. TYPE OF WORK JOB LOCATION Co EST. A # 2. I•� fKACTOR�//ChPSL2t k 'ao LUIOPJ & /V/? COST WZ2 FEE FEEV DA FEE DATE INSPECTION RECORD DATE I NSP FOOTING FOUNDATION FRAMING RGH FRAMING INSULATION PLUMBING 0 RGH PLUMBING GAS SPRINKLER ELECTRIC O LOW -VOLT O ALARM AS BUILT 0 FINAL 6e� 10 w)a&a - 0AY95 � lsnj OS o/J 003N)`/9-- / 5,g& OTHER APPROVALS i DRY t t�4.JJ,�y L7 ct��i` t Q V1.�4 yu`iw+ 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 June 3,2025 Paul Rosenberg&Deborah Crystal-Rosenberg 43 Country Ridge Drive Rye Brook,New York 10573 Re: 43 Country Ridge Drive, Rye Brook,New York 10573 Parcel ID#: 129.51-1-5 Building Permit#25-022 issued on 2/5/2025 for Replacement Windows This certifies that the five new windows,installed under the above captioned permit have been satisfactorily completed. Sincerely, Steven E. Fews Building&Fire Inspector /to -- 3 BUILDING IDEPARTMENT For office use only: VILLAGE OF RYE BROOK PERMIT# BP 25-022 APR 2 1 2025 ISSUED: 02/05/2025 938 KING STREET,WE;BROOK,NEW YORK 10573 DATE: VILLAGE OF RYE BROOi< � (9�4)9 .-0668 FEE: PAID11L BUILDING OF ARTM;Pr ,!TrF�okn�.Ro� 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 ittrttsspsatsratrrrtssrrrssrarrsarrssrtsssrtsrrrsrrs♦s.rrsssrrarrrsrsssrrrrsssarrrra.rssrrssrrrrrsrr«rr«♦«r«rrr«««rrssrrsu Address: 43 Country Ridge Drive Occupancy/Use: 1-Fam Parcel ID#:129.51-1-5 Zone: R-3 Owner: Paul & Deborah Crystal ROSENBERG Address: P.E./R.A. or Contractor: Renewal by Andersen Westchester Address: 421 West Avenue, Stamford CT 06902 Person in responsible charge: Franklin Barahona Address: 421 West Avenue, 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 structure/construction/alteration herein mentioned in accordance with law: STATE OF NEW YORK,COUNTY OF WESTCHESTER as: Franklin Barahona being duly swom,deposes and says that he/she resides at 421 West Avenue (Print Name of Applicant) iNo and',tree() in Stamford in the County of Fairfield in the State of CT ,that >wn,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:S 17,501.00 for the construction or alteration of Installation of( 5 ) reaplcement Andersen Acclaim Windows 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/leer 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 ereLted/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 ziS1r r Sworn Z to before me this 13 day of AP17i . 20�Z_ day of f •;l ,20Z-5 Signature of Property Opt er Signature 'Applicant �ayl 2o5P-n�J2�q Franklin Barahona Print Name of Propery Owner Priut Name of Applicant Notary Public Notan Public BwNNE P BMAN MACDONALD VLJC NOURYwisuc State ofConnecdcus t gfco ne'd=* my COMMISSION EXPIRES 312926 �' DES 04 312= QyE aR�� 1932 BUILDING DEPARTMENT V'5 ILDING INSPECTOR SISTANT 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 • DATE: J w VL S PERMIT# ` 2 S Z ISSUED:2'Y2S/ SECT: I 5•S l BLOCK: / LOT:J LOCATION: r' 7�-�� OCCUPANCY: ❑ VIOLATION NOTED THE WORK IS... ❑I ACCEPTED ❑ REJECTED/ REINSPECTION ❑ SITE INSPECTION REQUIRED ❑ FOOTING ❑ FOOTING DRAINAGE ❑ FOUNDATION ❑ UNDERGROUND PLUMBING NOTES ON INSPECTION: ❑ ROUGH PLUMBING ❑ ROUGH FRAMING ❑ INSULATION ❑ NATURAL GAS V / ❑ L.P. GAS too ❑ FUEL TANK❑ FIRE SPRINKLER 4e ❑ FINAL PLUMBING ❑ CROSS CONNECTION ❑ FINAL ❑ OTHER - a = N a 0 LO N ►n o a �RM+ � N k N F+N N 1 T HI M 99 4-4 t w O w � 7r'4 o W = �I try ai � ° bD ° x � y 00 i—i O o 0 72 00 cu U p .,e, F F w r / w A � Z -4 z w s+ W GO Q w ° v p 0 V o� U Z a�f o O O h+y en ^ W G.7 GrG w � �a y a R Q U 00 ►-n Q w H F x o cy " � -2 A. C7 a z U g� Q A b o c ° o � w w � v �� � � Z o H - ai a _ z zao . � v � W _ O .A v 14 It i--i W O F v 'a A Omni � � F O � z � �' O o o —o U �y V C7 O A W o � � � W � 0 a a s a �. BUILDINC.fiV-ENT D v Vr>L J(;F 0 RV OOK FEB - 2025 938 KING ET RN BR ,NY 10573 I4)939-Qb VILLAGE OF RYE BROOK av BUILDING DEPARTMENT ADMINISTRATIVE EXTERIOR BUILDING PERMIT APPLICATION FOR EXTERIOR WORK WHICH DOES NOT REQUIRE VILLAGE ARCHITECTURAL REVIEW BOARD APPROVAL FOR OFFICE USE ONLFY: ��yp ,Q r� n APPROVAL DATE: �` U P IT ! r© APPLICATION F/EE: 00� *� APPROVAL SIGNATURE: PERMIT FEES: 's �l/? H.O.A.APPROVAL: DATE: DISAPPROVED: OTHER: Application dated: 01/27/2025 is hereby made to the Building Inspector ofthe Village of Rye Brook,NY,for the issuance of a Permit for the construction of buildings,structures,additions,alterations or for a change in use,as per detailed statement described below. 1. Job Address: 43 Country Ridge Drive, Rye Brook, NY 10573 2. Parcel ID#: 10, /r 5/ —I—- Zone: 3. Proposed Improvement(Describe in detail): Installation of (5 ) replacement Andersen Acclaim Casement Windows into existing openings with no structural alterations. 4. Property Owner: Paul Rosenberg Address: 43 Country Ridge Drive, Rye Brook, NY 10573 Phone# (914)262-0495 Cell# e-mail paulsrosenberg@hotmail.com List AI I Other Properties Owned in Rye Brook: Applicant: Lindsay Loson Address: 2261 Market Street STE 10301, San Francisco, CA 94114 Phone# 315-335-8730 Cell# e-mail lndsay@permitflow.com N/A Architect: Address: N/A Phone# N/A Cell# N/A e-mail N/A Engineer: N/A Address: Phone# N/A Cell# N/A e-mail N General Contractor: Renewal by Andersen- Fairchester Custom Windows LLC Address: 421 West Ave, Building 11 Stamford, CT 06902 203 249-1986 PERMITS@RBAWestchester.com Phone# � ) Cell# e-mail fl) 6/1/2024 M 5. Occupancy;(1-Fam.,2-Fam..Commercial.,etc...)Pre-construction: N/A Post-construction: NIA 6. Area of lot: Square feet: NIA Acres: NIA 7. Dimensions from proposed building or structure to lot lines: front yard: NIA rear yard: NIA NIA right side yard. NIA left side yard: N/A other: 8. If building is located on a corner lot,which street does it front on: NIA 9. Area of proposed building in square feet: Basement:NIA I,fl: NIA 2°d fl: N/A 3`d fl: NIA 10, Total Square Footage of the proposed new construction: NIA 11. For additions,total square footage added: Basement: N/A I'fl: NIA 2"d fl: NIA 311 fl: N/A 12. Total Square Footage of the proposed renovation to the existing structure: 13. N.Y.State Construction Classification: NIA N.Y.State Use Classification: N/A 14. Construction Type& Location:( )Typical Western Lumber Frame;()Timber Frame[TC];()Wood Truss[TT]; O Pre-engineered wood[PW];Located;O Floor Framing[F];(}Roof Framing[R];O Floor& Roof Framing[FR]:Other: NIA 15. Number of stories: NIA Overall Height: NIA Median Height: NIA 16. Basement to be full,or partial: NIA finished or unfinished: N/A NIA 17, What material is the exterior finish: 18. Roof style: peaked,hip,mansard,shed,etc: NIA Roofing material: N/A 19. What system of heating: NIA 20. If private sewage disposal is necessary,approval by the Westchester County Health Department must be submitted with this application.NIA 21. Wil I the proposed project require the installation of a new,or an extension/modification to an existing auto fire suppression system?(Fire Sprinkler,ANSL System,FM-200 System,Type I Hood,etc...)Yes: No: (if ves,applicant must submit a separate Automatic Fire Suppression System Permit application&1 sets oftletailed engineered plans) 22. Will the proposed project disturb 400 sq.ft.or more of land,or create 400 sq.ft.or more of impervious coverage requiring a Stormwater Management Control Permit as per§217 of Village Code? Yes:—No-.—Area: N/A 23. Will the proposed project require a Site Plan Review by the Village Planning Board as per§209 of Village Code? Yes: No: IA (if ves,applicant must submit a Site Plan Application,c&provide detailed drawings) NIA 24, Will the proposed project require a Steep Slopes Permit as per§213 of Village Code Yes: No: (if yes,you must submit a Site Plan Application,&provide a detailed topographical survey) 25. Is the lot located within 100 ft.of a Wetland as per§245 of Village Code? Yes: No: NIA (if yes, the area ofwetland and the wetland buffer zone must be properly depicted on the survey&site plan) NIA 26. Is the lot or any portion thereof located in a Flood Plane as per the FIRM Map dated 9128/07? Yes: No: (if yes, the area and elevations of the flood plane must be properly depicted on the survey&site plan) NIA 27. Will the proposed project require a Tree Removal Permit as per§235 of Village Code?Yes: No: (if yes,applicant must submit a Tree Removal Permit Application) 28. Does the proposed project involve a Home-Occupation as per§250-38 of Village Code? Yes: No: NIA Indicate:TIER 1: TIER II: TIER III: (ifyes,a Home Occupation Permit Application is required) 29. What is the total estimated cost of construction: $ 17,501 Note:estimated cost shall include all site improvements, labor.material,scaffolding:fixed equipment,professional fees,including any material and labor which may be donated gratis. If the,final cost exceeds the estimated cost,an additional fee will be required prior to issuance of the CIO. NIA 30. Estimated date of completion: (2) 611/2024 BUILD e MENT D [E C E � V E 938 K G Fr RYF- ONY 10573 OK FEB ' 2�2� DD) VILLAGE OF RYE BROOK IYU w ov I BUILDING DEPARTMENT AFFIDAVIT OF COMPLIANCE VILLAGE CODE §216 • STORM SEWERS AND SANITARY SEWERS THIS AFFIDAVIT MUST BEAR THE NOTARIZED SIGNATURE OF THE LEGAL PROPERTY OWNER AND BE SUBMITTED ALONG WITH ANY BUILDING OR PLUMBING PERMIT APPLICATION. ANY BUILDING OR PLUMBING PERMIT APPLICATION SUBMITTED WITHOUT THIS COMPLETED AND NOTARIZED FORM WILL BE RETURNED TO THE APPLICANT. STATE OF NEW YORK, COUNTY OF WESTCHESTER ) as: Y, PAUL ROSENBERG , residing at, 43 Country Ridge Drive,Rye Brook,NY 10573 (Print name) (Address where you live) being duly sworn, deposes and states that(s)he is the applicant above named, and further states that(s)he is the legal owner of the property to which this Affidavit of Compliance pertains at: 43 Country Midge Drive, Rye Brook, NY 10573 , Rye Brook,NY. (Job AddICSs,) Further that all statements contained herein are true, and that to the best of his/her knowledge and belief,that there are no known illegal cross-connections concerning either the storm sewer or sanitary sewer, and further that there are no roof drains, sump pumps, or other prohibited stormwater or groundwater connections or sources of inflow or infiltration of any kind into the sanitary sewer from the subject property in accordance with all State, County and Village Codes. Pad V_C4 & (Signature of Propenv ON�ner(s)) P'AUL ROSENBERG {Print Name oi'Property O��ner(s)I State of Florida County of Miami Dade Sworn to before me this 29th by Paul Rosenberg produced Ny drivers license day of January 20 25 �v'ay poe/y� EDGY SLANDEL€LIACA Notary PUNK-State of Ftorida r co'a-a HH bsa 27 Edgy Slandel Eliacin %l�✓,a Q E.Pi--N.,..b•.=2029 !iq,oifl�MO� (Nouar~ I1ui11ic) HH 610722 11/07/2028 Notarized remotely online using communication technology via Proof. (3I 0 1 21124 This application must be properly completed in its entirety by a N.Y. State Registered Architect or N.Y. State Licensed Professional Engineer & signed by those professionals where indicated. It must also 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. Please note that application fees are non-refundable. >E:, ��>411 ���*�**� �*x,��***,��,�*************,���**,�***�,���*�**,��*xxx*x;.,.x*�x*xx�x�xxx>ti>�xxx>�xx*K*R���,�t*>eK>4 ST L O,,jj ZK,,�OL NTY OF WESTCHESTER ) as: t� 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 Agent 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 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. By signing this application, the property owner further declares that he/she has inspected the subject property, and that to the best of his/her knowledge there are no roof drains,sump pumps or other prohibited stormwater or groundwater connections or sources of infiltration into the sanitary sewer system on or from the subject property. State of Florida County of Orange County Sworn to before me this 29th Sworn to before me this 27th day of January , 20 25 day of 20 January 2025 , by Paul Rosenberg produced NY drivers license Lindsay Loson DRIVER LICENSE Signature of Property Owner Signature of Applicant PAUL ROSENBERG LINDSAY LOSON Print Name of Property Owner Print Name of Applicant Edgy Slandel Eliacin �( Sherrieanna R Webb Notary Public State of Floria County of Miami Dade Notary Public HH2O3014 \a�����NY6tlN,1/hh !\\,t�`1dRlvldPpp/`!�/ SHERRIEANNA R WEBB pv n ���iii EDGY SLANDEL ELIACIN <P 6e\ry oar u4 HH 610722 0 Notary Public-State of Florida Notary Public-State of Florida Commission itO HH 610722 a f Commission Al HH2O3014 Expires On November 1.2020 11/07/2028 Expires on November 29,2025 Notarized remotely online using communication technology via Proof. Notarized remotely online using communication technoiegy via Proof. (d) 611/2024 A4,4C�1 Home Improvement Agreement and Payment Terms tDBA:RENEWAL BY ANDERSEN OF WESTCHESTER AND FAIRFIELD COUNTY Paul Rosenberg Legal Name:Fairchester Custom Windows LLC 43 Country Ridge Drive RE N E WA L CT HIC#.0667292,WC-35743-H22,Putnam#51220 Rye Brook,NY 10573 bYANDERSEN 421 West Ave,Building 1 1 Stamford,CT 06902 Year Built: 1963 1WVMWWt10� Phone:203-406-0545 1 Fax:203-406-0828 1 sales@rbawestchester.com H:(914)262-0495 C:(914)262-0495 Paul Rosenberg 01/15/25 BUYER(S)NAME CONTRACT DATE 43 Country Ridge Drive, Rye Brook,NY 10573 (914)262-0495 (914)262-0495 BUYER(S)STREET ADDRESS PRIMARY NUMBER SECONDARY NUMBER paulsrosenberg@hotmail.com PRIMARY EMAIL SECONDARY EMAIL NOTES: Buyer(s)hereby jointly and severally agrees to purchase the products and/or services of Fairchester Custom Windows LLC d/b/a Renewal By Andersen of Westchester and Fairfield County("Contractor"),in accordance with the terms and conditions described in this Home Improvement Agreement and Payment Terms,any documents listed in the Table of Contents,and any other document attached to this Home Improvement Agreement,the terms of which are all agreed to by the parties and incorporated herein by reference(collectively,this"Agreement").Buyer(s)hereby agrees to sign a completion certificate after Contractor has completed all work under this Agreement. TOTAL CONTRACT PRICE: $17,501 By signing this Agreement,you acknowledge that the Balance Due,and the Amount Financed must be made by personal check,bank check,credit card,or cash. DOWN PAYMENT: $1,500 BALANCE DUE: $16,001 We schedule installations based on the date of the signed contract and secondarily on the date in which we complete the technical measurements.The installation date that we are providing at AMOUNT FINANCED: $16,001 this time is only an estimate.We will communicate an official date and time at a later date. Rain and extreme weather are the most common causes for delay. METHOD OF PAYMENT: Credit Card Financing NOTES: Buyer(s)agrees and understands that this Agreement constitutes the entire understandings between the parties and that there are no verbal understandings changing or modifying any of the terms of this Agreement. No alterations to or deviations from this Agreement will be valid without the signed,written consent of both the Buyer(s)and Contractor. Buyer(s)hereby acknowledges that Buyer(s)1)has read this Agreement,understands the terms of this Agreement,and has received a completed,signed,and dated copy of this Agreement,including the two attached Notices of Cancellation,on the date first written above and 2)was orally informed of Buyer's right to cancel this Agreement. NOTICE TO BUYER: Do not sign this contract if blank.You are entitled to a copy of the contract at the time you sign. YOU, THE BUYER, MAY CANCEL THIS TRANSACTION AT ANY TIME NOT LATER THAN MIDNIGHT OF 01/18/2025 OR THE THIRD BUSINESS DAY AFTER THE DATE OF THIS TRANSACTION, WHICHEVER DATE IS LATER. SEE THE ATTACHED NOTICE OF CANCELLATION FORM FOR AN EXPLANATION OF THIS RIGHT. SIGNATURE OF SALES PERSON: SIGNATURE OF CUSTOMER 1: SIGNATURE OF CUSTOMER 2: Amy Stein Paul Rosenberg PRINT NAME OF SALES PERSON PRINT NAME PRINT NAME 01/15/25 Page 2 / 30 OWAL Itemized Order Receipt DBA:RENEWAL BY ANDERSEN OF WESTCHESTER AND FAIRFIELD COUNTY Paul Rosenberg RENELegal Name:Fairchester Custom Windows LLC 43 Country Ridge Drive byAN E CT HIC#.0667292,WC-35743-H22,Putnam#51220 Rye Brook.NY 10573 byAN ERSEN 421 West Ave,Building 1 I Stamford,CT 06902 Year Built:1963 Phone:203-406-0545 1 Fax:203-406-0828 1 sales@rbawestchester.com H:(914)262-0495 C:(914)262-0495 ROOM: SIZE: DETAILS: PRICE: 0 W Misc: Misc, Miscellaneous Job Items, Lead Safe Work 0 H Practices, Quantity 1, EPA requires contractors that disturb painted surfaces in homes, built before 1978 to be certified and follow specific work practices. 0 W Misc: Misc, Permit Fees, Town of Rye Brook- Estimated 0 H Permit Fees, Quantity 1, Renewal by Andersen will facilitate the application of the building permit to the Town of Rye Brook. Homeowner is responsible for any outstanding permit applications or code violations that may prevent Renewal by Andersen from procuring permit. Renewal by Andersen is not responsible for any historical or architectural review applications and approvals that may be required as pre- requisite for a building permit. 0 W Misc: Misc, Miscellaneous Job Items, Miscellaneous, 0 H Quantity 1 103 Sunroom 34 W Window: Acclaimlm Casement Single Right Base Frame 57 H Exterior White Interior White Performance Calculator: PG Rating: 40 1 DP Rating: + 40 / - 40 Glass: All Sash: High Performance SmartSun with HeatLock Glass, No Pattern Hardware: White Screen: TruScene Full Screen Grille Style: No Grille Misc: None 104 Sunroom 34 W Window: AcclaimTM Casement Single Right Base Frame 57 H Exterior White Interior White Performance Calculator: PG Rating: 40 1 DP Rating: + 40 / - 40 Glass: All Sash: High Performance SmartSun with HeatLock Glass, No Pattern Hardware: White Screen: TruScene Full Screen Grille Style: No Grille Misc: None 105 Sunroom 34 W Window: AcclaimTM Casement Single Right Base Frame 57 H Exterior White Interior White Performance Calculator: 01/15/25 Page 3/ 30 Itemized Order Receipt DBA:RENEWAL BY ANDERSEN OF WESTCHESTER AND FAIRFIELD COUNTY Paul Rosenberg Legal Name:Fairchester Custom Windows LLC 43 Country Ridge Drive R E N E WA L CT HIC#.0667292,WC-35743-H22,Putnam#51220 Rye Brook.NY 10573 brANDERSEN ..oa..roe■nrFrn 421 West Ave,Building 1 1 Stamford.CT 06902 Year Built:1963 Phone:203-406-0545 1 Fax:203-406-0828 1 sales@rbawestchester.com H:(914)262-0495 C:(914)262-0495 ROOM: PG Rating: 40 1 DP Rating: + 40 / 40 Glass: All Sash: High Performance SmartSun with HeatLock Glass, No Pattern Hardware: White Screen: TruScene Full Screen Grille Style: No Grille Misc: None 106 Sunroom 34 W Window: AcclaimTM Casement Single Right Base Frame 57 H Exterior White Interior White Performance Calculator: PG Rating: 40 1 DP Rating: + 40 / - 40 Glass: All Sash: High Performance SmartSun with HeatLock Glass, No Pattern Hardware: White Screen: TruScene Full Screen Grille Style: No Grille Misc: None 107 Kitchen 69 W Window: Acclaim'"^ Casement Double Vented EJ Frame 57 H Exterior White Interior White Performance Calculator: PG Rating: 40 1 DP Rating: + 40 / - 40 Glass: All Sash: I ligh Performance SmartSun with HeatLock Glass,No Pattern Hardware: White Screen: TruScene Full Screen Grille Style: No Grille Misc: None WINDOWS: 5 PATIO DOORS: 0 ENTRY DOORS:0 SPECIALTY: 0 MISC: 3 PROJECT TOTAL $17,501 Renewal by Andersen is committed to our customers'safety by complying with the rules and lead-safe work practices specified by the EPA. 01/15/25 Page 4/ 30 Wag Order Summary dba:RENEWAL BYANDERSEN OF WESTCHESTER AND FAIRFIELD Paul Rosenberg COUNTY 43 Country Ridge Drive RENEWAL Legal Name:Fairchester Custom Windows LLC I License#CT HIC#.0667292, Rye Brook,NY 10573 brANDERSEN" wC-35743-H22,Putnam#51220 Year Built: 1963 421 West Ave,Building1 1 Stamford,CT 06902 H:(914)262-0495 Phone:203-406-0545 1 Fax:203-406-0828 1 tech@rbawestchester.com C:(914)262-0495 •• NOTES Additional Guidelines • Follow RBA installation, waterproofing and insulation guidelines. Estimated Duration: 1 days •• •• UNIT NOTES EPA requires contractors that disturb painted surfaces in homes,built before 1978 to be certified and follow specific work practices. Renewal by Andersen will facilitate the application of the building permit to the Town of Rye Brook. Homeowner is 107 106 105 104 1.03 JOBPHOTOS 01/17/25 Page 5 / 24 RENEWAL Technical '�A byANDERSEN ca Data UIL-SERVI f WINDOW&DOOR REPIXEMENT r SPECIRCATIQN AND TECHNICAL MANUAL all -w v , Fairchester Custom Windows is not using an Engineer / Architect due to installation of replacement windows and doors into EXISTING openings with NO structural alterations . RENEWAL BY ANDERSEN SPECIFICATION&TECHNICAL MANUAL TECHNICAL INFORMATION PERFORMANCE RATINGS AND ► ► NFRC Total Unit Performance r Andersen'Product Air Ar e r Without Grilles 0.42 0.41 0.51 0.51 .82 Clear Full Divided Light Grilles 0.43 0.41 0.46 0.46 Low-E4• Without Grilles 0.31 0.28 0.28 0.27 .72 Full Divided Light Grilles 0.32 0.29 0.25 0.25 Without Grilles 0.32 0.29 0.17 0.17 .40 Low-E41 Sun Casement Full Divided Light Grilles 0.33 0.30 0.16 0.15 Without Grilles 0.31 0.28 0.19 0.18 .65 Fixed Low-E4•SmartSun" Full Divided Light Grilles 0.32 0.29 0.17 0.17 Low-E4•SmartSun WithoutGrilles j 0.26 r 0.24 0.18 0.18 .63 with Heati-ocke Full Divided Light Grilles 0.26 0.24 0.17 0.16 Enhanced Tdple Pane WithoutGriiles n/a 0.20 n/a 0.25 .42 Enhanced Triple pane with SmartSunTM Without Grilles n/a 0.19 n/a 0.17 .37 Without Grilles 0.43 0.41 0.51 0.51 .82 Clear Full Divided Light Grilles 0.43 0.41 0.46 0.46 Without Grilles 0.31 0.28 0.28 0.27 .72 Low-E4° Full Divided Light Grilles 0.32 0.29 0.25 0.25 Without Grilles 0.32 0.29 0.17 0.17 .40 Low-E4'Sun Full Divided Light Grilles 0.33 0.30 0.16 0.15 Without Grilles 0.31 0.28 0.19 0.18 .65 Low-E411 SmartSunTM Full Divided Light Grilles 0.32 0.29 0.17 0.17 Low-E4•SmartSun Without Grilles 0.27 0.25 0.18 0.18 .63 with HeatLock• Full Divided Light Grilles 0.27 0.25 0.17 0.16 Enhanced Triple Pane Without Grilles n/a 0.20 n/a 0.25 .42 Enhanced Triple pane with Without Grilles n/a 0.20 n/a 0.17 .37 SmartSunTM Clear Without Grilles 0.46 0.58 .82 Full Divided Light Grilles 0.46 - 0.52 - Low-E4® Without GnIles 0.33 0.30 0.31 .72 Full Divided Light Grilles 0.34 0.31 0.28 0.28 Low-E471 Sun Without Grilles 0.33 0.30 0.20 0.19 .40 Full Divided Light Grilles 0.35 0.31 0.18 0.17 EIG Double-Hung (All Frames) Low-W SmartSunTM WithoutGhlles 0.32 0.29 0.21 0.21 .65 Full Divided Light Grilles 0.34 0.30 0.19 0.19 Low-E40SmartSun Without Grilles 0.27 0.25 0.20 0.20 .63 with HeatLock® Full Divided Light Grilles 0.30 0.27 0.18 0.18 Enhanced Triple Pane Without Grilles n/a 0.20 n/a 0.29 .47 Enhanced Triple pane Without Grilles n/a 0.20 n/a 0.19 .43 with SmartSunT11 ldw- - Ow E4.T.Sun-and HeVLocs11D are Andersen trademarks for•Low-P class. 1)U-Factor defines Ufa amount of heat loss through the total unit in BTU/hr/r12.•F.The lower the value•one less heat is lost through the entire product Window values represent non-tempered glass.Use of tempered glass can increase ILFactor ratings.See andersenwrindmvs.com/nfrc fors fic performance values. 2)War Heat Gain Coe"dent(SHGC)der1res the fracuor of solar radiation admitted through the pass born d recdy transmitted and absorbed and suosequentry releaxd inward.The lower the value•the less heat Is transmilted through the product. 3)Visible Tiansmttanx(vr)measures tow much light cones through a product(pass and Game).The higberthe value,from 0 to 1•the more daylight the product Irts mover the pratuct's total unit area.Visible Light Transmittance is measured wet the 380 to 160 nanometer portion or the solar spectrum. •NFRC ratings are based on modeling by a thi d-party agency as validated by an independent test lab in compliance with NFRC program and procedural requirements. •This data is accurate as of Apnl 2021.Due to ongoing product changes.updated test results,or new industry standards or requ rements,U¢s data may change over oche.Ratings are for sizes spedfi d by NFRC for testing and ceto9cauon.Ratings may vary depending an use of tempered pass,deferent gnoe options.pass witn capillary breather tubes for high al6ades,etc."Low-E4.T••Low•E49 SmartSun"anti-Low-E4T Sun' 09-9 COMPANY CONFIDENTIAL-REVISION AA-01 RENEWAL BY ANDERSEN SPECIFICATION&TECHNICAL MANUAL TECHNICAL INFORMATION PERFORMANCE RATINGS AND TEST DATA NFRC Total Unit Performance (continued) Product Witho(2tGrilles 0.46 0.44 0.57 0.57 .82 Clear Full Divided Light Grilles 0.46 0.44 0.51 0.51 Without Grilles 0.33 0.30 0.31 0.31 .72 Low-E4* Full Divided Light Grilles 0.34 0.31 0.28 0.28 Without Grilles 0.33 0.30 0.19 0.19 .40 Low-E4"Sun Full Divided Light Grilles 0.35 0.31 0.18 0.17 D8 Double-Hung Without Grilles 0.33 0.29 0.21 0.21 .65 (Full Frame) Low-E4"SmartSunTM Full Divided Light Grilles 0.34 0.30 0.19 0.19 Low-E4a Smart Without Grilles 0.28 0.25 0.20 0.20 .63 with HeatLocke Full Divided Light Grilles 0.28 0.25 0.18 0.18 Enhanced Triple Pane Without Grilles n/a n/a n/a n/a n/a Enhanced Triple pane with SmartSunTM Without Grilles n/a n/a n/a n/a n/a Without Grilles 0.46 0.44 0.57 0.57 .82 Clear Full Divided Light Grilles 0.46 0.44 0.51 0.51 Without Grilles 0.33 0.30 0.31 0.31 .72 Low-E4' Full Divided Light Grilles 0.35 0.31 0.28 0.28 WithoutGrilies 0.34 0.30 0.20 0.19 .40 Low-E41 Sun Full Divided Light Grilles 0.35 0.31 0.18 0.18 y: t. Without Grilles 0.33 0.29 0.21 0.21 .65 Low-E4"SmartSunTM Full Divided Light Grilles 0.34 0.30 0.19 0.19 Low-E411SmartSun Without Grilles 0.27 0.25 0.20 0.20 .63 with HeatLock" Full Divided Light Grilles 0.27 0.25 0.18 0.18 Enhanced Triple Pane Without Grilles n/a n/a n/a n/a n/a Enhanced Triple pane with Without Grilles n/a n/a n/a n/a n/a SmartSun' Without Grilles 0.47 0.45 0.59 0.59 .82 Clear Full Divided Light Grilles 0.47 0.45 0.53 0.53 Without Grilles 0.34 0.30 0.31 0.31 .72 Low-E4" Full Divided Light Grilles 0.35 0.32 0.29 0.28 Without Grilles 0.34 0.30 0.20 0.19 .40 Low-E411 Sun Full Divided light Grilles 0.35 0.32 0.18 0.18 Without Grilles 0.33 0.29 0.21 0.21 .65 Low-E4"SmartSunTM Full Divided Light Grilles 0.34 0.31 0.19 0.19 Low-E4"SmartSun Without Grilles 0.27 0.25 0.20 0.20 .63 with HeatLockQD Full Divided Light Grilles 0.27 0.27 0.18 0.18 Enhanced Triple Pane Without Grilles n/a 0.20 n/a 0.28 .47 Enhanced Triple pane with Without Grilles n/a 0.19 n/a 0.18 .43 SmartSunTM 'LrAv E4®SdarlSm",'low-E40.6Ldw.E4,&sun-and HeatLeU?i are Andersen trademads for'Lam F glass. 1)U-factor defirsesthe miount of neatbss m(b4gh the total un2,n BTU/hr/ft2.°F.The lower the value,the less heat is lost through me entre product.wndow values represent non;,empered glass.Use of tempered eass can inerease U-Factor ratings.See andeniffmilindows.com/rifi:for spechc pet formancevalues- 2)Solar Kea;Gain Coeffictent(SHGQ deny es me fraction of sctar radiation aenetted tt^bugh the Cass Dot11(lit"transmitted and ab5grbed and%osequendy released irnazd.The lower the value,the less neat is transmited through the product. 3)visible Transmdtance(VT)measures haw much light comes through a product(glass and frame).The higher mevalue.fmm 0 to 1,the more daylrgrd me product lets in aver the product's total unit area.Vdble Light Transrruttance is measured a+cr the 380 to 760 nanometer portion of Liu solar spectrum. •NFRC ratings arc based on modeiing by a mud parry agency as validated by an independent test lab in compliance with NFRC program and procedural requirements. •This data Is accurate as of April 2021.Due to ongoing produc:changes.updated test results,or new industry standards or requirements.Ws data may change men time.Ratings are for sires specified by NFRC nor testing and ceroficabon.Ratings may vary depending on use of tempered glass.d perent grille options.®ass wim capillary breather tubes for hie a'atudes.etc.-Low-E4T•-Low-E4r9 SmarlSun"and-Low{rill)Sun- k,_10 COMPANY CONFIDENTIAL-REVISION AA-01 RENEWAL BY ANDERSEN SPECIFICATION &TECHNICAL MANUAL TECHNICAL INFORMATION PERFORMANCE . • RATINGS • TA NFRC Total Unit Performance (continued) Renewal by Andersen L-Factor (BTU/(hrft2oFj)I1_ Product High Performance Glass Type :- - - �M= Clear WlthoutGrilles 0.44 0.42 0.61 0.61 .82 Full Divided Light Grilles 0.45 0.43 0.55 0.55 Low-E41 Without Grilles 0.31 0.27 0.33 0.32 .72 Full Divided Light Grilles 0.32 0.28 0.29 0.29 Low-E4°Sun VlithoutGrilles 0.31 0.27 0.20 0.20 .40 Picture Full Divided Light Grilles 0.33 0.29 0.18 0.18 (Full Frame) Without Grilles 0.30 0.26 0.22 0.22 .65 Low-E4'SmartSunTM Full Divided Light Grilles 0.32 0.28 0.20 0.20 Low-E41SmartSun Without Grilles 0.25 0.22 0.22 0.21 .63 with Heatt-ock° Full Divided Light Grilles 0.25 0.22 0.20 0.19 Enhanced Triple Pane Without Grilles n/a n/a n/a n/a n/a Enhanced Triple pane with Without Grilles n/a n/a n/a n/a n/a SmartSun'' Clear Without Grilles 0.45 0.43 0.64 0.64 .82 Full Divided Light Grilles 0.46 0.44 0.57 0.57 Low-E41 Without Grilles 0.31 0.27 0.34 0.34 .72 Full Divided Light Grilles 0.33 0.29 0.31 0.31 Without Grilles 0.31 0.28 0.21 0.2 .40 Low-E4°Sun Full Divided Light Grilles 0.33 0.29 0.19 0.19 Picture (Insert Frame) Without Grilles 0.30 0.27 0.23 0.23 ES Low-Ed°SmartSun' Full Divided Light Grilles 0.32 0.28 0.21 0.21 Low-E4°SmartSun Without Grilles 0.25 0.22 0.22 0.22 .63 with HeatLock° Full Divided Light Grilles 0.25 0.22 0.20 0.20 Enhanced Triple Pane Without Grilles n/a n/a n/a n/a n/a Enhanced Triple pane with SmartSunn' Without Grilles n/a n/a n/a n/a n/a Clear Without Grilles 0.44 0.42 0.61 0.61 0.82 Full Divided Light Grilles 0.45 0.43 0.55 0.55 Low-E41 Without Grilles 0.31 0.27 0.33 0.32 0.72 Full Divided Light Grilles 0.32 0.28 0.29 0.29 Low-E4°Sun VrrthoutGrilles 0.31 0.27 0.20 0.20 0.40 Full Divided Light Grilles 0.33 0.29 0.18 0.18 Picture (Universal Frame) Low-E4°SmartSun' WithoutGrilles 0.30 0.26 0.22 0.22 0.65 Full Divided Light Grilles 0.32 0.28 0.20 0.20 Low-E40SmartSun Without Grilles 0.25 0.22 0.22 0.21 0.63 with HeatLock° Full Divided Light Grilles 0.25 0.22 0.20 0.19 Enhanced Triple Pane Without Grilles n/a 0.16 n/a 0.30 .50 Enhanced Triple pane with Without Grilles n/a 0.16 n/a 0.20 .45 SmartSunTM 'Low-E4(&SmartSurP••'Low E40,*Low E4T Sun'and HeatLods are Andersen baarnarks for'lmv.E'glass 1)Ilfactor defnestlle amount of heat loss through the total umtm 8ru/hr/ft2.'F.The lower the value.the less heat is lost through the a t,re product.wndow clues represent naimempered glass.Use of tempered glass can.increase U-Fac:nr raunes_ See andersenwindows.com/nfrc for speatic performance values. ` 2)Sitar Heat Gam Coeffident(SHGC)defines the traction of solar radiation acmhted through the glass both directly transmitted and absorbed and subsepuendy,released inward.The lower the value,the less heat is transmitted through IfK product. 3)Vmble Transmittance(VT)measures how much tight comes through a product(glass and frame).The h!gher the value,hom o to 1,the mole daylight the product Ices In over me product's total unit area.visible Light Transmivunce is measured over the 380 to 760 nanometer portion of the solar spectrum •NFRC ratings are based on modeling by a cord parry agency as validated by an mdepe dent lest lab in compliance win Nf RC program and procedural requirements •This data is accurate as of Apnl 2021.Due to ongoing product changes,updated test results,or new industry standards or requirements.ma data may change aver bme.Ratmts are for sizes specified by NFRC for testing and ceti6ca,,on.Ratings may vary depene:ng on use of tempe•ed glass,different grille optioos,glass win capillary breather tubes for hir altitudes,etc.'Low E40'.'Lmw E40 SmarlSun-and'Low-E4r9 Sun- 09-11 COMPANY CONFIDENTIAL- REVISION AA-01 r� k 6 F y , i 1, ` � ar�xx:c x•anastcxusssxpccy.�s s ' ':t� r _.� r..2 r 1 :ry d ar lk 281 �� rs�/`�°'�f�f! � i � � o .�ll e+� i, �� C��4•"� `. ` +�hlY�` ''r�'�si �' ����: r , vI,«..�{� / IVIO ti ay.. ti r�iTIC y♦ 5 lye Ova +� Aft 04 \ ` , pi WWI .. g. r r Am .F, c i. ' s a 1 L` 6' t I t *- e a�04, :S f 44 S°I v e+ A .T F S�i^y1 mod' R F 'k . , 7f� f ,1 - • t'• ,ro y� A 1 .r yj t i F i t P / ^I I N , t 0 h - cy a3� Ir t TT66 p ;l Ill, a 4 1; ;>* ��' Ott. W , � � � >,• 'mot► a ,.+ter.+-.� - { _K s It VA r.. .'!�, r t� Wit. �{Xt-�F�:.�, r 1` 'r .c 'k� t��xY'a'•'�t `1 ,. Il,s r, 'r'f, ,�x --s °sa:", j.1;�. a d s r f •, r�uY r.rY �of o'i t r t,y r k� +, -�'• e� 7� KZ�� � a x- •t /x t .i 44 �ok Hj, ! fro . r ! ! 'f ��' Y; #, Js,:j yr l� v .:.i,a,.'...�{ ..],.L. _.. 1•. `1.v }� y { ilk''� Tc1 .. Y �, .�- -. .M .. ,.. �� .� _ } `, _ w , i �� ,` ,, ��.� 4:�4 " _�. P .9 '' c^ '�.�a`f '� _. ��N�� ` �' ` �� Nt- 1 §� __ _- > '��� , . .� , � f �_'�\ ' � \1 � ` J r � I f ' ,� tr ��, 4 z-_ � _ ��,\ t ���i ��� � Y`rt, a `s � �_- t -' \\\\\\ �-... t.' f WA '"MAR •�,4 �� � ,'lr�-/►i. 4 _ b�. r - rxp ,'v f1 3 y 1 '. Kb i , ram. t ate• - r � I •fF' 3 Al t ,a •i q t 1 +-1 r y }Y A 'II , n � lit � r ,, ,.• :. e �1�� .', � 7'. ^'•,.�'.Y, ' .,a ". fir. +A ^,,,y `.,�` �, M � • vs ;y' 1S +� �► O K v c i �.. CN o N • 06 C `• rn h � w o i E � � o N :' •:rr •�'" O N U c° cn (D � •� � Qcatection � ..i I 1 F a v rc C C., w v~j ow ��d��e a •�ley�G >� �` w u1 a z • A S aCL \`\ � N • s ►t N id v N - s. W i E �' 8 LO ' o 40 h to a� U u .` w �j e 11 A • A '1 FAIRCUS-01 PSMITH ACORO CERTIFICATE OF LIABILITY INSURANCE DATE,MM,°°/YYYY, 8/12/2024 ' 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 NOMTACT Theresa Brandon MBI Company Group LLC. PHONE 280 State Street (A/C,No,Ext): (203)288-3401 a,c,No):(203)281-0414 North Haven,CT 06473 E-MAIL .theresa.brandon@mbi-ins.com INSURERS AFFORDING COVERAGE NAIC# INSURER A:Selective Insurance Company of America 12572 INSURED INSURER B: Fairchester Custom Windows LLC dba: Renewal by Andersen INSURERC: Fairchester 421 West Ave Building 1 INSURER D: Stamford,CT 06902 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. INSR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF POLICY EXP LTR INSD WVD MMIDD/YYY MM/DD,YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE FX] OCCUR X S 2516791 8/12/2024 8/12/2025 DAMA GE SESO R ONT ante $ 500,000 PREMVIED EXP(Any oneperson) $ 15,000 PERSONAL&ADV INJURY $ 1,00000 GEML AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $ 3,000,000 POLICY 1 JECT � LOC PRODUCTS-COMP/OP AGG $ 3,000,000 OTHER $ A AUTOMOBILE LIABILITY CO aBIINdEDtSINGLE LIMIT $ 1,000,000 ANY AUTO S 2516791 8112/2024 811212025 BODILY INJURY Perperson) $ OWNED X SCHEDULED AUTOS ONLY AUTOS BODILY INJURY Per accident $ X HIRED X NON-OWNED PROPERTY DAMAGE AUTOS ONLY AUTOS ONLY Per accident $ X Comp Ded$500 X Collision Ded$500 A X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 4,000,000 EXCESS LAB CLAIMS-MADE X S 2516791 8/12/2024 8/12/2025 AGGREGATE $ 4,000,000 DED I X I RETENTION$ 0 $ A WORKERS COMPENSATION AN X TA T T XD EMPLOYERS'LABILITY PER OER TH- ANY PROPRIETOR,PARTNER/EXECUTIVE Y/N WC 9099063 8/12/2024 8/12/2025 500,000 OFFICER/MEMBER N N/A EXCLUDED? E.L.EACH ACCIDENT $ (Mandatory in NH) E.L.DISEASE-EA EMPLOYE $ 500,000 If yes,descnbe under 500,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101.Additional Remarks Schedule.may be attached if more space is required) Village of Port Chester is Additional Insured as required by written contract per the endorsements included with this certificate. I CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Village of Port Chester THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN g ACCORDANCE WITH THE POLICY PROVISIONS. 222 Grace Church Street Port Chester,NY 10573 AUTHORIZED REPRESENTATIVE ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD DESIGNATED CONSTRUCTION PROJECT(S) GENERAL AGGREGATE LIMIT POLICY NUMBER: S 2516791 COMMERCIAL GENERAL LIABILITY CG 25 03 05 09 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Designated Construction Project(s): ALL CONSTRUCTION PROJECTS OF YOURS AND LOCATIONS AT WHICH YOU ARE PERFORMING SERVICE WORK FOR WHICH COVERAGE IS PROVIDED UNDER THIS POLICY. V_ Information required to complete this Schedule, if not shown above,will be shown in the Declarations. A. For all sums which the insured becomes legally 4. The limits shown in the Declarations for Each obligated to pay as damages caused by Occurrence, Damage To Premises Rented To N "occurrences" under Section I — Coverage A, and You and Medical Expense continue to apply. U) for all medical expenses caused by accidents under However, instead of being subject to the o Section I — Coverage C, which can be attributed General Aggregate Limit shown in the only to ongoing operations at a single designated Declarations, such limits will be subject to the construction project shown in the Schedule above: applicable Designated Construction Project 1. A separate Designated Construction Project General Aggregate Limit. General Aggregate Limit applies to each B. For all sums which the insured becomes legally designated construction project, and that limit is obligated to pay as damages caused by equal to the amount of the General Aggregate "occurrences" under Section I — Coverage A, and Limit shown in the Declarations. for all medical expenses caused by accidents under 2. The Designated Construction Project General Section 1—Coverage C, which cannot be attributed Aggregate Limit is the most we will pay for the only to ongoing operations at a single designated sum of all damages under Coverage A, except construction project shown in the Schedule above: damages because of "bodily injury" or"property 1. Any payments made under Coverage A for damage" included in the "products-completed damages or under Coverage C for medical operations hazard", and for medical expenses expenses shall reduce the amount available under Coverage C regardless of the number of: under the General Aggregate Limit or the a. Insureds; Products-completed Operations Aggregate b. Claims made or"suits"brought;or Limit, whichever is applicable;and c. Persons or organizations making claims or 2• Such payments shall not reduce any Designated bringing"suits". Construction Project General Aggregate Limit. 3. Any payments made under Coverage A for C. When coverage for liability arising out of the damages or under Coverage C for medical "products-completed operations hazard' is provided, any payments for damages because of "bodily expenses shall reduce the Designated Construction Project General Aggregate Limit injury" or "property damage" included in the for that designated construction project. Such "products-completed operations hazard" will reduce payments shall not reduce the General the Products-completed Operations Aggregate Aggregate Limit shown in the Declarations nor Limit, and not reduce the General Aggregate Limit shall they reduce any other Designated nor the Designated Construction Project General Aggregate Limit. Construction Project General Aggregate Limit for any other designated construction project shown in the Schedule above. Copyright, Insurance Services Office, Inc., 2008 CG 25 03 05 09 Page 1 of 2 INSURED'S COPY i RK Workers' CERTIFICATE OF ATE Compensation Board NYS WORKERS' COMPENSATION INSURANCE COVERAGE 1 a.Legal Name 8 Address of Insured(use street address only) 1 b.Business Telephone Number of Insured Fairchester Custom Windows LLC. 203-406-0545 dba:Renewal by Andersen Fairchester 1c.NYS Unemployment Insurance Employer Registration Number of 421 West Avenue,Building 1 Stamford,CT 06902 Insured Work Location of Insured(Only required if coverage is specifically limited to 1d.Federal Employer Identification Number of Insured or Social Security certain locations in New York State,i.e., a Wrap-Up Policy) Number 88-2855660 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 Village of Port Chester 3b.Policy Number of Entity Listed in Box"1a" 222 Grace Church Street WC9099063 Port Chester, NY 10573 3c.Policy effective period 08/12/2024 to 08/12/2025 3d.The Proprietor, Partners or Executive Officers are QX 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: Patricia Smith (Print name of authorized representative or licensed agent of insurance carrier) Approved by: Pa&� 8-12-2024 (Signature) (Date) Title: Agent Telephone Number of authorized representative or licensed agent of insurance carrier: 203-288-3401 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