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HomeMy WebLinkAboutMP25-029 DRy to uV . 19 VILLAGE OF RYE BROOK MAYOR 938 King Street, Rye Brook,N.Y. 10573 ADMINISTRATOR Jason A.Klein (914) 939-0668 Christopher J.Bradbun 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 July 15,2025 Jose Javier Bravo-Cordero&Esperanza Arias-Perez 31 Winding Wood Road Rye Brook,New York 10573 Re: 31 Winding Wood Road,Rye Brook,New York 10573 Parcel ID#: 135.26-1-6 As per the Certification letter from Luzon Environmental received July 9,2025,the removal of an underground oil tank under Mechanical Permit#25-029 issued on 3/5/2025 has been satisfactorily completed. Sincerel)-, Steven E. Fews Building&Fire Inspector /to 0 w RUILDINGDE-PARTMENT 7DING INISPEcToR As i'i'MAITY INSPECTOR VILLAGE, 013 RYE BROOK 11 COPE ENVORCAWN'.0 938 EiNG S'XIUMT-ItYv JbtOO.T(,NY10573 (914) 939-0668 F'AIX (914) 939-5801 - - - - - - - -- - -- - - - - -- - - -- INSPECTION REPORT - - - - - - - - - - - - - -- - Ainnuiss 2-oes- S.iwjv; li-,:',-2,(oBLOCK: LOT: Co J-0CANYON: ......... OCCUPANCY:__ 0 VIOLATIONNarm) Dtil walm As... U/A.CCEP11130) ❑ RpLiCTED/REINSPECTION 0 SI'VE INSPECTION REQuiiwi) E-1 FOO-VINE l'TNJ)IPXGlM'(-TNJ)PL(TIMUNG NOI'JiS ON INSPECTION: 0 .1tovol1 PjvmjljT-f(,' 0 IWIT4,11 FICAMING Ul IN-slul')VI'mm. 0 NATUR.A.T.Ca'As (3 Film spiommut n IIINAI P1Altditi-N4, Cuos's('o.N.Niu-'rom FINAL n- �yE BRC�� O�` tim cu � '9a2 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 : ` \ ' l ^� ATE: �' L PERMIT# ! ISSUED: ('� ECT: BLOCK: LOT: LOCATION: -�y J1 / 0 6 l n ou nA j 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 I-C BRC�k 1932 BUILDING DEPARTMENT ❑IjVILDING 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 : DATE: PERMIT# ISSUED: SECT: BLOCK: LOT: LOCATION: OCCUPANCY: ❑ VIOLATION NOTED THE WORK IS... ❑ ACCEPTED [;r REJECTED/ REINSPECTION El SITE INSPECTION REQUIRED ❑ FOOTING ❑ FOOTING DRAINAGE ❑ FOUNDATION ❑ UNDERGROUND PLUMBING NOTES ON INSPECTION: ❑ ROUGH PLUMBING ❑ ROUGH FRAMING ❑ INSULATION �- ❑ NATURAL GAS 1 ❑ L.P. GAS _ ❑ FUEL TANK ❑ FIRE SPRINKLER ❑ FINAL PLUMBING ❑ CROSS CONNECTION ❑ FINAL ❑ OTHER ■ ■ N b �q c,q N CV CL /-. � 'h a� O W ■ qj ■ qj u Y■■I �S cr a a: c > N O cl -v tuo-.'3 " ■ ■ O ■ry n Z a y > H ■ M W N as U �..� ■ O ^ -, z 3 0 o v C f!1 �Q • `� > O p is p v p ,� ■ 00Cop V, 00, vo z 0 + C O �j ' W rj a F W Zb a c Z CA o 00 oa ° U O U C) � a C7 A Z y v pw P4 u 0 G O W 0 � BUILDING DEPARTMENT VILLAIGE OF RYE BROOK 4 2fl25 938 KING SET RYE BROOK,NY 10573 -0668 VILLAGE OF RYE BROOK • °y BUILDING DEPARTMENT Application for Permit to Remove or Abandon Flues Storage Tank (*Storage Tanks in excess of 1,100 gallons require registration with the County of Westchester) FOR OFFICE USE ONLY: PERMIT#: Approval Date: _MAR 5 2 Permit Fee: $ Approval Signature: Other: Disapproved: (fees are non-refundable) *,rw***,rt*,r�*t*w*,r**t********,t,t,trtrtw****wwwwwwww***x***w*+rww*wwxwwwwwwwwwwwwwwwww*wwwwwww*wwwww�wwwwwwwww DO NOT START WORK or CONSTRUCTION UNTQ,A PERMIT HAS BEEN ISSUED BY THE BUILDING INSPECTOR THE ADMINISTRATIVE FEE FOR WORK PROGRESSED OR COMPLETED WITHOUT A PERMIT IS 12%OF THE TOTAL COST OF CONSTRUCTION WITH A MINIMUM FEE OF$750.00 REQUIREMENTS FOR RELEASE OF PERMIT&CERTIFICATE OF COMPLIANCE: 1.Application Completed by Bonded, Licensed Contractor. 2.Your contractor's valid proof of liability insurance. (Village of Rye Brook must be listed as certificate holder) 3. Your contractor's valid proof of workers compensation insurance. (Form#C105.2 or Form#U26.3 /or NY State Workers Compensation Waiver) 4. Fee per Tank: Removal or Abandonment $185.00 per Tank. 5. Dig Safely New York#(dial 811): 6. Inspection by Building Department for removal or abandonment. 7. Submit all Manifests&Reports(after work has been completed). 8. Certificate of Compliance will be provided when all requirements are fulfilled. rww*w**r*r*ra**w***�rwr******r,r**wx*wr,rw+rww*ww*wwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwww*wwwwwwww Application dated,(11 cz rch 3;:1C%1!21S ,is hereby made to the Building Inspector of the Village of Rye Brook for a permit to remove or abandon a Fuel Tank as herein described.The applicant and property owner,by signing this document agree that the subject fuel tank(s)will be removed or abandoned in conformance with all applicable Village,County,State&Federal laws,codes, rules and regulations. wwwwwwwwwwwwwwwwwwwwwwwwwwww,rwww*wwtwwwwwwwwwww#wwww*wwwwwwwwww**ww*wwwwwwwwwww*wwwwwwww*wwwwwwwwwww** Indicate Permit Tvue: Removal 04•Abandonment( )l Above Ground( )•Buried in Ground 1. Address: �V-VA lJdu, �� 2�F �� k—SBL: /351 Zone: �J 2. Property Owner&Address: �QIJ� -1Jw 0211 n Phone#: qN- 5S7-�)o2--TS Cell#: email: Opp' �rxt��. 00✓� 3. Contractocr�&Address: Lu,--,�G n (1 V I f O n >ryl e YTS 3e c y ,c e 3 Phone#: U t�`J't'( tS C}5 1^Cell#:_r email: 4. Applicant: ,?c,-i ,,\ Phone#: 4 W— G5�f`'6 of:T-S Cell#: email: 5. Indicate Fuel Type:Fuel Oil( )•L.P. Gas( )•Gasoline( )•Other{)c}: a uB 0_I I 6. Number and Capacity of each Tank:— 500 q ci` USA— 4 Qej r`? 7. Exact Location(s)of each Tank: U . e— 1 6/l/2024 S• ,ATE OF NEW YORK,COUNTY OF WESTCHESTER ) as. 0,�,o k b i vl being duly swom,deposes and states that helshe is the applicant above named, (print name of individual signing as the applicant) and further states that(s)he is the Tank Remo vaI/Abandonment Contractor for the legal owner and is duly authorized to make and file this application. That all statements contained herein are true to the best of hisiher knowledge and belief,and that any work perfortned.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 It Sworn to before me this-�?r day of MC��C� �,20 7C day of_�g�h_��_,20 96 Si ritAre of Prop"Owner Si'.,tiature of APPlii ant :Print N e of Property Owner Print Name of Applicant �FctrSr v Public Notary Public IV ly t led it ty ITIC11. a th ignature(s) of the legs uwner(sI )f the subject property, and the applicant of record In the l roviaed. Any app icalton nol andlo not properly signed sha tx be OnNnIIE FAY GtJLICK ND plCil}E.uk432, JARED PHQ►NG .Ouolitied in Sul+iv:, aunty NOTARYaPUBUC t..,rry m i s 91 on L b U•)-1.•-'i'J� STATE OF COLORAI)O NOT4IRY ID 20244003346 MY COMMISSION EXPIRES 0112412028 z 6/l/2024 ;jnWviranWmenV P.O. Box 1070,Woodridge NY 12789 services 845-434-7805 Fax 845-434-0307 D AWE, Paul Bookbinder JUL - 9 2025 31 Winding Wind Road N. Rye Brook, NY VILLAGE OF RYE BROOK BUILDING DEPARTMENT Certificate of Tank Removal Tank Removed: One (1) 550-gallon Underground Fuel Storage Tank Location: 31 Winding Wind Road North Rye Brook, NY Date of Removal: March 24, 2025 This hereby certifies that the above-referenced tank has been "Permanently Closed by Removal" in accordance with New York State Building Code. • The tank was previously closed in place by filling with foam. Tank removal procedure was performed as follow: • The tank was excavated and removed from the ground. • All waste was removed and transported for recycling/disposal to our permitted NYSDEC permitted Part 360 Facility. • The tank was removed from the ground and disposed in and approved manner. • A post excavation bottom soil sample was obtained and sent for laboratory analysis. • The analysis is EPA methods for VOCsand SVOCs as specified in NYSDEC CP-51/Soil Cleanup Guidance guidelines table 3 "Soil Cleanup Levels for Fuel Oil Contaminated Soil". • The results of the analysis are all NON-DETECT for the target analytes. • Attached is Table 1 a summary of the laboratory analysis and the laboratory analysis results. • Considering the results of the laboratory analysis of the bottom soil sample, Luzon Environmental Services recommends no further action. 1 certify that the above is true and correct. Respectfully submitted, Robert B. Halprin President 1 P.O. Box 1070.Woodridge N.Y. 12789 Phone: 845-434-7805 Fax: 845�t34-0307 nviron�nenta services February 28, 2025 Quotation/Contract 25.6790-1L Paul Bookbinder 31 Winding Wind Road Rye Brook NY 10573 914-S57-8275 Pbook00@gmail.com Re: Pump Out Existing Oil. Remove Under Ground Storage Tank(UST) Estimated 500-1000 Gallon tank. Collect 1 Soil Sample under tank.Tank was Previously filled with foam by Luzon in 2001. Luzon Environmental Services(Luzon) is a specialty contractor celebrating 50 years in business. References can be provided upon request. Thank you for this opportunity for Luzon to provide a proposal. Luzon Environmental services will provide equipment to remove UST and collect 1 sample. Luzon will back fill seed and hay. Work to Include for the Removal of the UST: • Permits by home owner. • Contact Dig Safe. • Carefully excavate the underground tank by hand exposing the tank top. • Remove The tank. • Provide a Certificate of removal of the UST and provide copy to the contractor in order to close out the permit. Luzon will provide labor, equipment for the above project with the following assumptions: 1. There will be clear access to the work area. 2. There will be access to electric and water. 3. If contamination is detected, Luzon will provide quote for remediation. 4. If contamination is detected Luzon will contact Catskill Construction Consultants and provide a quote for the remediation of the spill detected. If contaminated soil and/or groundwater is discovered, the NYSDEC spill hotline(800-457-7362)must be notified within two hours of discovery. Luzon may make said notification. t Quotation 25.6790-JL Page 1 Initial: .f P.O. Box 1070,Woodridge N.Y. 12789 nvironn�enfa Phone: 84S4347805 Fax: 845�34-0307 services Price Quote as follows: Fee Schedule' Service/ Equipment/Labor Estimated Unit Fee Estimated Quantity' _ Cost Remove 500/1000 Gallon UST, Back Fill 1 $4,550.00 $4,550.00 Seed and Hay with the collection of(1)Soil Plus tax Sample Permit At Cost At Cost TBD Payment Terms: 50%upon Acceptance of Contract, Balance upon completion of the project. Note: Please accept or decline the"laboratory analysis" portion, initial each page and provide a signature. Respectfully Submitted, John Lopez Director of Business Development The undersigned hereby authorizes Luzon Oil Co., Inc. to provide goods and services for the specified work and accepts the terms conditions as set forth. Authorized Signature: Date: Printed Name and Title: Note: This proposal may be withdrawn by us if not accepted within thirty days. Quotation 25.6790-JL Page 2 Initial: P.O. Box 1070,Woodridge N.Y. 12789 Phone: F9x: 845-434-0307 nvironn�enfa Serviee5 Terms and Conditions: Upon customer acceptance of this proposal, please initial, sign and return one complete copy of this proposal to us. Work stoppages occurring as a result of actions beyond the control of Luzon will require payment in full for labor, equipment and materials installed and or delivered to the site. Additional mobilization charges may apply for resumption of work. Unforeseen conditions consisting of but not limited to, contaminated water, contaminated soil, underground utilities, rock, concrete, high water table, shoring requirements, delays or stop work orders, will result (unless otherwise specified) in additional charge. Permit fees, filing fees and/or bonds if needed to be at additional charges. Underground utilities on private property, marked or unmarked, are the responsibility of the owner. Luzon is not responsible for any damage to Black Top/Asphalt and/or concrete areas caused by equipment traffic. All reasonable efforts will be made to restore site to original conditions, however landscaping and/or paving (unless otherwise specified) is to be done by others. Payment is due upon receipt of invoice (unless otherwise specified -see payment terms). Amounts not paid within thirty (30) days are subject to a service charge of two percent(2%) per month (annual rate 24%) or any portion thereof. In the event that payment in full not received within thirty (30) days of the invoice date,the account shall be subject to collection by our attorney's, and the invoiced party shall pay any and all costs of collection, including reasonable attorney's fees. Reports, and/or required paperwork will be released upon final payment. If any payment terms are not met, work will be stopped at that point and will not be continued until payment terms are met. Luzon Oil Co., Inc. will not be liable for any damages due to, or arising from, any work stoppage. All warranties are void until job is paid in full. Once original contract amount and all approved change orders have been paid then the warranty will commence from the original completion date unless otherwise agreed upon in writing. If a tax-exempt certificate is rendered there will be no sales tax collected. Otherwise, sales tax will be additional. In any action by Luzon Oil Co., Inc., based upon breach of this contract the right to a trial by jury will be waived and the same may be tried before a single judge in any appropriate jurisdiction. The parties agree that if any action is brought in regards to any matter having to do with this contract that only New York Court will have jurisdiction with venue in Sullivan County, which is where the main office of Luzon is. Quotation 25.6790-JL Page 3 Initial: UZI P.O. Box I11711.Nkuudridge `.Y. 12789 nvironmenfa Phone: 845-434-'14115 Fay: R45-134-03117 Sep- rice-Price Quote as follows: Fee Schedule' Service/Equipment/Labor Estimated Unit Fee Estimated Quantity2 Cost Remove 500/1000 Gallon UST, Back Fill 1 $ 4,550.00 $ 4,550.00 Seed and Hay with the collection of(1)Soil Plus tax Sample Permit At Cost At Cost TBD Payment Terms: 50%upon Acceptance of Contract, Balance upon completion of the project. Note: Please accept or decline the"laboratory analysis"portion, initial each page and provide a signature. Respectfully Submitted, John Lopez Director of Business Development The undersigned hereby authorizes Luzon Oil Co., Inc.to provide goods and services for the specified work and accepts the terms conditions as set f Authorized Signature: Date: Printed Name and title: L ,bao (C c,t-) eI� Note: This proposal may be withdrawn by us if not accepted within thirty days. Quotation 25.6790-IL Page 2 Inittal: •r P.O. Box 11171),NNoodridgt N.N. 12789 4nvimnmenfa Mine: H45-434-IKII'k Fax: M44-431-0307 Nor-vices Price Quote as follows: Fee Schedule' Service/Equipment/Labor Estimated Unit Fee Estimated Quantit Z Cost Remove 500/1000 Gallon UST, Back Fill 1 $ 4,550.00 $4,550.00 Seed and Hay with the collection of(1)Soil Plus tax Sample Permit At Cost At Cost TBD Payment Terms: 50%upon Acceptance of Contract, Balance upon completion of the project. Note: Please accept or dedine the"laboratory analysis"portion, initial each page and provide a signature. Respectfully Submitted, John Lopez Director of Business Development The undersigned hereby authorizes Luzon Oil Co., Inc.to provide goods and services for the specified work and accepts the terms conditions as set f Authorized Signature: Date: L IZD 2'r- Printed Name and Title: L �as IC Q►r3-D�g— Note: This proposal may be withdrawn by us if not accepted within thirty days. 7e t o o fi 13f' a U U 0 c Quotation 25,6790-JL Page 2 Initial: ��® DATE(MM/DD/YYYY) A CQ CERTIFICATE OF LIABILITY INSURANCE 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). PRODUCERUUNIACI NAME: Shannon Kent Jason D.Hoffman Insurance Agency LLC PHONE 845)239-4787IFAX g Y A/C,No Ext: (A/C,No): 30 Main Street,Suite 2F ADDRESS: shannonGjhoffntaninsuratice.con1 INSURER(S)AFFORDING COVERAGE NAIC 1f Goshen NY 10924 INSURER A: Great Divide Insurance Co 25224 INSURED INSURER B: Key Risk Insurance Co 10558J Luzon Oil Co.Inc. INSURER C: NYSIF DBA Luzon Environmental Services INSURER D: Erie Ins CO 26263 PO BOX 1070 INSURER E: \\OODRIDGE NY 12799-1001 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. LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE F;PI OCCUR PREMISES(Ea occurrence) $ 100,000 X Pollution Liability MED EXP(Any one person) $ 5,000 A X E&O-S l mil/SI Ok ded Y Y ECP2012712-20 09/03/2024 09/03/2025 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY ©PE0 LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY $ (Ea accident) 1,000,000 x ANY AUTO BODILY INJURY(Per person) $ B OWNED SCHEDULED Y Y BAP201267021 09/03i2024 09'03!2025 BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED �/ NON-OWNED $ Vy AUTOS ONLY AUTOS ONLY (Per accident) UMBRELLA LIAB x OCCUR EACH OCCURRENCE $ 2,000,000 X EXCESS LIAR CLAIMS-MADE Y Y FFX2012713-20 09/03/2024 09/03/2025 AGGREGATE $ 2,000,000 DED I I RETENTION$ $ WORKERS COMPENSATION �C STATUTE ER AND EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N E.L.EACH ACCIDENT $ UNLIMITED COFFICER/MEMBER EXCLUDED? �Y N/A Y Z22527501 04/01/2024 04/0L2025 Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ UNLIMITED If yes,describe under ESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ UNLIMITED Limit: 250,000 Blanket Rented/Leased Equipment- I� Q61-0452198 09!03/2024 0903 2025 Deeductible: 1,000 Replacement Cost DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) Certificate holder is additional insured on a primary & non contributory basis with respect to work being performed by the insured as per written contract. Al status is subject to attached policy form ECP12460121. 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 v 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD NYSIF New York State Insurance Fund PO Box 66699,Albany,NY 12206 1 nysif.com CERTIFICATE OF WORKERS' COMPENSATION INSURANCE 0 0 AAA AAA 141577033 LOVELL SAFETY MGMT CO., LLC 22 CORTLANDT STREET 33RD FLR NEW YORK NY 10007 ❑Ih SCAN TO VALIDATE AND SUBSCRIBE POLICYHOLDER CERTIFICATE HOLDER LUZON OIL CO., INC. VILLAGE OF RYE BROOK D/B/A LUZON ENVIRONMENTAL SERVICES 938 KING STREET P.O. BOX 1070 RYE BROOK NY 10573 WOODRIDGE NY 12789 POLICY NUMBER CERTIFICATE NUMBER POLICY PERIOD DATE Z2252 750-1 910053 04/01/2024 TO 04/01/2025 3/03/2025 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE NEW YORK STATE INSURANCE FUND UNDER POLICY NO. 2252 750-1, 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. IF YOU WISH TO RECEIVE NOTIFICATIONS REGARDING SAID POLICY,INCLUDING ANY NOTIFICATION OF CANCELLATIONS, OR TO VALIDATE THIS CERTIFICATE,VISIT OUR WEBSITE AT HTTPS://WWW.NYSIF.COM/CERT/CERTVAL.ASP.THE NEW YORK STATE INSURANCE FUND IS NOT LIABLE IN THE EVENT OF FAILURE TO GIVE SUCH NOTIFICATIONS. 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 STATE INSURANCE FUND �/4 4 DIRECTOR,INSURANCE FUND UNDERWRITING VALIDATION NUMBER:582709911 U-26.3 Laura Petersen From: UDig NY Exactix <tickets@exactix.udigny.org> Sent: Thursday, March 6, 2025 7:02 AM To: Steven Fews Subject: Message from UDig NY ****LATE**** DIG REQUEST from UDig NY for: VIL RYE BROOK Taken: 03/06/2025 07:01 To: VIL RYE BROOK PRIMARY Transmitted: 03/06/2025 07:01 00003 Ticket: 03035-001-279-01 Type: Late Previous Ticket: ------------------------------------------------------------------------------ State: NY County: WESTCHESTER Place: RYE BROOK Addr= From: 31 To: Name: WINDINGWOOD RD N Cross: From: To: Name: Offset: ------------------------------------------------------------------------------ Locate: WHOLE PROPERTY NearSt: LATONIA RD & WINDINGWOOD RD S Means of Excavation: EXCAVATOR, BOBCAT / SKID STEER Blasting: N Site marked with white: N Boring/Directional Drilling: N Within 25ft of Edge of Road: Y Work Type: OIL TANK REMOVAL Estimated Work Complete Date: 03/06/2025 Depth of excavation: Site dimensions: Start Date and Time: 03/06/2025 07:00 Must Start By: 03/20/2025 ------------------------------------------------------------------------------ Contact Name: CASSANDRA BOEHM Company: LUZON OIL CO Addr1: PO BOX 1070 Addr2: City: WOODRIDGE State: NY Zip: 12789 Phone: 845-434-7805 Fax: Email: ar@luzonenv.com Field Contact: JERMAINE AGUILAR Alt Phone: 845-926-0035 Email:jaguilar@luzonenv.com Working for: PAUL BOOKBINDER ------------------------------------------------------------------------------ Comments: Lookup Type: ADDRESS ------------------------------------------------------------------------------ Members: ALTICE USA CONED SUEZ WTR WESTCHESTER TEN GAS-HDS VLY VIL RYE BROOK WESTCHESTER CTY SWR 1 Laura Petersen From: UDig NY Exactix <tickets@exactix.udigny.org> Sent: Monday, March 3, 2025 1:31 PM To: Steven Fews Subject: Message from UDig NY ****REGULAR**** DIG REQUEST from UDig NY for: VIL RYE BROOK Taken: 03/03/2025 13:30 To: VIL RYE BROOK PRIMARY Transmitted: 03/03/2025 13:30 00004 Ticket: 03035-001-279-00 Type: Regular Previous Ticket: ------------------------------------------------------------------------------ State: NY County: WESTCHESTER Place: RYE BROOK Addr: From: 31 To: Name: WINDINGWOOD RD N Cross: From: To: Name Offset: ------------------------------------------------------------------------------ Locate: WHOLE PROPERTY NearSt: LATONIA RD & WINDINGWOOD RD S Means of Excavation: EXCAVATOR, BOBCAT / SKID STEER Blasting: N Site marked with white: N Boring/Directional Drilling: N Within 25ft of Edge of Road: Y Work Type: OIL TANK REMOVAL Estimated Work Complete Date: 03/06/2025 Depth of excavation: Site dimensions: Start Date and Time: 03/06/2025 07:00 Must Start By: 03/20/2025 ------------------------------------------------------------------------------ Contact Name: CASSANDRA BOEHM Company: LUZON OIL CO Addr1: PO BOX 1070 Addr2: City: WOODRIDGE State: NY Zip: 12789 Phone: 845-434-7805 Fax: Email: ar@luzonenv.com Field Contact: JERMAINE AGUILAR Alt Phone: 845-926-0035 Email:jaguilar@luzonenv.com Working for: PAUL BOOKBINDER ------------------------------------------------------------------------------ Comments: Lookup Type: ADDRESS ------------------------------------------------------------------------------ Members: ALTICE USA CONED SUEZ WTR WESTCHESTER TEN GAS-HDS VLY VIL RYE BROOK WESTCHESTER CTY SWR 1