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HomeMy WebLinkAboutBP25-057PERMIT # �% SECTION TYPE OF WORK , JOB LOCATION _ OWNER ,iCbJll'o EST. COST �' ,/CO #.(ac TCO # DATE: �S M(P; a �� BLOCK pooT ke �- d yI P /O •�/JN�l4�/e erve /U /7)Y76-#7Sa ;rc//l-�ensI usfo GCS; a�oa)s 1C - ^i: sQy .i;oSo� Co3)3 7-1'?e6 /CO 7 � FFF A L� Oco �Y FEE �vc� %S I,U DATE FEE DATE - INSPECTION RECORD I DATE I NSP FOOTING FOUNDATION FRAMING RGH FRAMING INSULATION PLUMBING RGH PLUMBING GAS O SPRINKLER ELECTRIC 0 LOW -VOLT ALARM C> AS BUILT [� FINAL 284 70 Z5 Assn OTHER APPROVALS ARB BOT P8 ZBA OTHER DR t tt 4.°JJ�v ur ttt.�it ° VILLAGE OF RYE BROOK MAYOR 938 King Street,Rye Brook,N.Y. 10573 ADMINISTRATOR Jason A. Klein (914) 939-0668 Christopher J.Bradbury www.tyebrookny.gov TRUSTEES BUILDING&FIRE INSPECTOR Susan R.Epstein Steven E. Fews David M.Heiser Donald T.Krom,Jr. Salvatore W.Morlino CERTIFICATE OF COMPLIANCE April 28,2025 William Servedio&Annmarie Servedio 28 Wilton Road Rye Brook,New York 10573 Re: 28 Wilton Road,Rye Brook,New York 10573 Parcel ID#: 135.66-1-46 Building Permit#25-057 issued on 4/2/2025 for Replacement Windows & Door This certifies that the fourteen new windows and one entry door,installed under the above captioned permit has been satisfactorily completed. Sincerely, Steven E. Fews Building&Fire Inspector /to l E W E n> For office use onh BUILDING DEP ENT PERMIT#$P25-_05"- ! APR 2 1 2025 VIL ACE OF RYE 81 OOK ISSUED: A-a- 0"1 I'I938 KING STRE (i?.YE BROOK,NEiv YORK 10573 DATE: VILLAGE OF RYE BROOK 1 °4 9 -0Y6y8o` FEE: PAID K BUILDING MPARP."FNT fff ov APPLICATION FOR CERTIFICATE OF OCCUPANCY,CERTIFICATE OF COMPLIANCES AND CERTIFICATION OF FINAL COSTS TO BE SUBMITTED ONLY UPON COMPLETION OF ALL WORK, AND PRIOR TO THE FINAL INSPECTION atsasstasatsxassssssasssa►as»»»*►ssssttsssst►aaasasssat*sttsssststtxssaat»a»*asa►*►sasssss**stsassas»*s»*a*a►sas►►xasssssssss Address: 1,t1 i�T Occupancy/Use: Q�3 Q?S Parcel ID #: /3S• 64 — - L e ;ioIIC: _e-3 Owner: LJi140m 4 AMh^r.,rie 5;�Zf CU� Address: 20 b.Apo �jG 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 sworn,deposes and says that he/she resides at 421 West Avenue (Print Name ofAppir. , (No.and Street) in Stamford in the County of Fairfield in the State of CT ,that (CiterrowIli V illacC l 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 for the construction or alteration of:1lL��Ct cem e(4- 4 — Fi+4" i t (2ItaCk,3% 7/31 6ma.4� 275. 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,the structure/work has been erected/completed in accordance with the approved plans and any amendments thereto except in so far as variations therefore have been legally authorized,and as erected/completed complies with the laws governing building construction.Deponent further understands that it shall be unlawful for an owner to use or permit the use of any building or premises or part thereof hereafter created,erected,changed,converted or enlarged,wholly or partly,in its use or structure until a Certificate of Occupancy or Certificate of Compliance shall have been duly issued by the Building Inspector as per§250-I O.A.of the Code of the Village of Rye Brook. Sworn to before me this 10t* Sworn to before me this jO ` day oft 20 day of 20 2� Signature of Property Owner Signature of Applicam I7lJia"eje, Franklin Barahona Print Name of Properh Ow ner Print Name of Applicant Notary Public Notary Public ,3RIAN PAACDOPUU-Jr' NOTARYPMIJC �R MACDOWAL0 te Sta of connecdcut 1ANstatNOTARonnectrC state o 04Y COMMISSION EXPIRES Oct.312026 My COMMISSION EXPIRES Oct.3120& QyE BRc�j� 1932 BUILDING DEPARTMENT ❑BVILDING INSPECTOR u 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 : O I ' "�"l�� `C DATE: PERMIT# t`"' �J ISSUED: 7`" Z-Z f SECT: 8L5�&6 BLOCK: r LOT: L� LOCATION: -�- NCI OCCUPANCY: r ❑ VIOLATION NOTED THE WORK IS... 0 ACCEPTED ❑ REJECTED/ REINSPECTION ❑ SITE INSPECTION REQUIRED ❑ FOOTING ❑ FOOTING DRAINAGE ❑ FOUNDATION ❑ UNDERGROUND PLUMBING NOTES ON INSPECTION: ❑ ROUGH PLUMBING ❑ ROUGH FRAMING ❑ INSULATION ❑ NATURAL GAS �F' `4 Q 'a ❑ L.P. GAS ! F-t"3 ❑ FUEL TANK ❑ FIRE SPRINKLER �!- ❑ FINAL PLUMBING ❑ CROSS CONNECTION FINAL 0 OTHER _ Ln 0 LO N N cacq a • Q O a o W V, W n W Rl a v S = Ocn Qco CU 0.64 Lgi Ln ►n 00 a `d a o 0 0 0 g OW °ho v� rJ1 ON w O r en w I �ss O _ p A ro o h wE v ' o lu O o r l w Q: .N. � � L) ' V o w v,-IZ �, W A1-4 o ..� w z ►� FBI W U °00 kn V O H� W oo � v W cz V `-.' a w U W 00 � � � '-� A C� H J M �, 1 cn Q a c x , - � Z z 0?3 A a � � � U O o bb � `oj C7 A � Q �i I o OQ Z W F, � 4 .� N A w z a o5a � .. d © �I a W x � b a BUILDII I3XPARTMENTDD VILLAGE OF RMftOOK RMAR 3 1 2025 938 KING STREET RYE BRq�iC,NY 10573 (914)939-0668 VILLAGE OF RYE BROOK wivwxjebraoltny:�ov BUILDING DEPARTMENT ADMINISTRATIVE EXTERIOR BUILDING PERMIT APPLICATION FOR EXTERIOR WORK WHICH DOES NOT REQUIRE VILLAGE ARCHITECTURAL REVIEW BOARD APPROVAL FOR 01-FICE USE ONLY: _ APPROVAL DATE: APR O R14 ��' APPLICATION FEE: '* 046 APPROVAL SIGNATURE: PERMIT FEES: Id 1 C'Z�' C.UCo�" (>y H.O.A.APPROVAL: DATE.: DISAPPROVED: OTHER: ts*t****s**rtrtrt*rts*****trt*rtrtttrtttttrtrtrtsrtrtrt*rtrtrtsrtrtrtssrtss*stsssrtstssrtrtsrt*rt**s*rt*tsstsst**tsssssstsssrtrtttsttts* Application dated: 03/19/2025 is hereby made to the Building Inspector of the 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:28 Wilton Road Rye Brook, NY 10573 2. Parcel ID#:135.66-1-46 --Zone:- 1 Proposed Improvement(Describe in detail): Installation of(14) replacement Andersen Acclaim Windows and (1) replacement Entry Door into existing openings with no structural alterations 4. Property Owner: William Servedio Address: 28 Wilton Road, Rye Brook, NY 10573 Phone# 917-476-4752 Cell# 914-476-4753 a-malt memee7033@gmail.com List All Other Properties Owned in Rye Brook: Applicant: Lindsay Loson Address: 17 Doral Greens Drive East, Port Chester, NY 10573 Phone# 914-403-5216 Cell# e-mail Iindsay(a-)permitflow.com Architect: N/A Address: N/A Phone# N/A Cell# N/A e-mail N/A Engineer: N/A Address: N/A Phone# N/A Cell# N/A e-mail N/A General Contractor: Renewal by Andersen - Fairchester Custom Windows LLC Address421 West Ave, Building 1, Stamford, CT 06902 Phone#(203) 249-1986 Cell# e-mail PERMITS@RBAWestchester.com (1? 611/2024 Doc ID: 31b9488a459239db132fcedb6dcfdd7cd81bfdd6 5. Occupancy;(1-Fam.,2-Fam.,Commercial.,etc...)Pre-construction: N/A Post-construction: N/A 6. Area of lot: Square feet: N/A Acres: N/A 7. Dimensions from proposed building or structure to lot lines: front yard: N/A rear yard: N/A right side yard: N/A left side yard: NIA other: NIA 8. If building is located on a comer lot,which street does it front on: N/A 9. Area of proposed building in square feet: Basement: N/A I fl: N/A 2"d fl: NIA Yd fl: N/A 10. Total Square Footage of the proposed new construction:-N/A _ 11. For additions,total square footage added:Basement:N/A I-fl: NIA 22d fl: N/A 314 fl: N/A 12. Total Square Footage of the proposed renovation to the existing structure: N/A 13. N.Y.State Construction Classification: NIA N.Y.State Use Classification: NIA 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: N/A 15. Number of stories: N/A Overall Height: N/A Median Height: N/A 16. Basement to be full,or partial: N/A finished or unfinished: N/A 17. What material is the exterior finish: NIA _ 18. Roof style:peaked,hip,mansard,shed,etc: NIA Roofing material: N/A 19. What system of heating: N/A 20. If private sewage disposal is necessary,approval by the Westchester County Health Department must be submitted with this application. 21. Will the proposed project require the installation of a new,or an extension/modification to an existing automatic fire suppression system?(Fire Sprinkler,ANSL System,FM-200 System,Type I Hood,etc...)Yes: No: NIA (ifyes.applicant must submit a separate Automatic Fire Suppression System Permit application&2 sets of detailed 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: (if yes,applicant must submit a Site Plan Application,&provide detailed drawings) N/A 24. Will the proposed project require a Steep Slopes Permit as per§213 of Village Code Yes: No: N/A (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: N/A (if yes, the area of wetland and the wetland buffer zone must be properly depicted on the survey&site plan) 26. Is the lot or any portion thereof located in a Flood Plane as per the FIRM Map dated 9/28/07? Yes : No: N/A (if yes,the area and elevations of the flood plane must be properly depicted on the survey&site plan) 27. Will the proposed project require a Tree Removal Permit as per§235 of Village Code?Yes: No: N/A (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: N/A Indicate:TIER 1: TIER II: TIER III: (if yes,a Home Occupation Permit Application is required) 29. What is the total estimated cost of construction: $ 66,969.00 Note:estimated cost shall include all site improvements,labor,material,scaffolding,fixed equipment,professional fees,including any material and labor which maybe donated gratis.If the final cost exceeds the estimated cost,an additional fee will be required prior to issuance of the CIO. 30. Estimated date of completion: N/A (2) 6/1l2024 Doc ID:3lb9488a459239dbl32fcedb6dcfdd7cd8lbfdd6 BUILDINC D OARTMENT D E C E � V E VILLAGE OF RYE$ROOK MAR 3 1 2025 ID 938 KING STRFET RYE BROOK,NY 10573 (914)939-0668 VILLAGE OF RYE BROOK www.ryebrookny.Eov 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 I, WILLIAM SERVEDIO residing at, 28 Wilton Road, Rye Brook, NY 10573 , (Prinz nasm:: I i 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; 28 Wilton Road, Rye Brook, NY 10573 ,Rye Brook,NY. (Job Adtirc 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. W"(-A 1 "I'PruPerIN ON%lio(.)1 WILLIAM SERVEDIO I Pzini N,une oS"[,roperly Ownvil 0i G� D Sworn to before me this ;15r ��' day of Phrc#t , 20*.</ i\uz.irr Puhlicl (3) 6/1R024 Doc ID: 31b9488a459239db132fcedb6dcfdd7cd81bfdd6 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. STATE OF NEW YORK,COUNTY OF WESTCHESTER ) as: Lindsay Loson ,being duly swom,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 Texas,County of Bexar Sworn to before me this S Sworn to before me this 19th day of ArA 209�' day of March ,20 25 off° X.ct'e at., Signature of Property Owner pItl�s�" 'N Signature of Applicant WILLIAM SERVEDIO LINDSAY LOSON Print Name of Property Owner Print Name of Applicant —r9/YAW-i j� v,,3.gcJwaSk-r Notary Public Notary Publicu Ashley N Bywater 13432614-8 �uWy pA --11 \`O; 11 "�RY pfi,: Ashley N Bywater ID NUMBER �;rf or tt}t� COMMISSION EXPIRES 4ryflryUpnOqpC'�e, ARrd 19.2027 Electronically signed and notarized online using the Proof platform. 141 6,1'2024 Doc ID: 31b94B8a459239db132fcedb6dcfdd7cd81bfdd6 Renewal Renewal by Andersen of Westchester -_ ,:,, ��i� 2041 West Main St byAndersen �� Stamford CT 06902 WINDOW REPLACEMENT an Andersen Company SUPPLEMENTAL . ORDER Date: 3/4/2025 Original Contract Date: 2/28/2025 56,392 Name: AnnMarie and William Servedio Original Contract Price: 4,063 Address: 28 Wilton Rd Additional Cost: Cost Reduction: (negative amount) City: Rye Brook NY Current Adjustment: Phone Number: 60,455 917-4764752 Total Amended Contract Price: Total Deposits Received: i Total Balance Outstanding: 60,455 Payment Method: Check Credit Card Finance CLARIFICATION OF CONTRACT F7 CHANGE OF PAYMENT METHOD MORE WORK = LESS WORK = PRICE ADJUSTMENT SPECIFIC DETAILS & MEASUREMENTS CASH DEPOSIT(1) TECH MEASURE PROGRESS INSTALLATION PROGRESS FINAL PAYMENT 14) PAYMENT(2) PAYMENT(31 CASH CHECK CREDIT CARD FINANCING 33250 21160 6045 0 0 0 0 2505901989 2531 F 71000017681 Application ID Finance Program Finance Plan# Expiration Date Adding Master Bedroom window#203 Glider.Matching window#202 0 Greg Sotire r Company Representative 4r/2 ese ativ Ow 0 3/4/2025 Date Date Home Improvement Agreement and Payment Terms DBA:RENEWAL BY ANDERSEN OF WESTCHESTER AND FAIRFIELD COUNTY AnnMarie&William Servedio Legal Name:Fairchester Custom Windows LLC 28 Wilton Rd RENEWAL CT HIC#.0667292,WC-35743-H22,Putnam#51220 Rye Brook.NY 10573 byANDERSEN- 421 West Ave.Building i 1 Stamford.CT 06902 Year Built:1950 Phone:203-406-0545 1 Fax:203-406-0828 1 sales@rbawestchester.com H:(917)476-4752 C:(914)476-4753 AnnMarie &William Servedio 02/28/25 BUYER(S)NAME CONTRACT DATE 28 Wilton Rd, Rye Brook ,NY 10573 (917)476-4752 (914)476-4753 BUYER(S)STREET ADDRESS PRIMARY NUMBER SECONDARY NUMBER memee7033@gmaii.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: $56,392 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: $0 BALANCE DUE: $56,392 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: $56,392 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: 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 03/04/2025 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. 41�17-�- -- --—0,X,)4� — -,� SIGNATURE OF SALESPERSON: SIGNATURE OF CUSTOMER 1: SIGNATURE OF CUSTOMER 2: Greg Sotire AnnMarie Servedio William Servedio PRINT NAME OF SALES PERSON PRINT NAME PRINT NAME 02/28/25 Page 2 / 36 Addendum Cost Responsibility dba:RENEWAL BY ANDERSEN OF WESTCHESTER AND FAIRFIELD COUNTY ANNMARIE&WILLIAM SERVEDIO Legal Name:Fairchester Custom Windows LLC I License#CT HIC#.0667292,WC-35743+122,Putnam#51220 28 Wilton Rd RENEWAL 421 West Ave,Building 11 Stamford.CT 06902 Rye Brook.NY 10573 bYANDERSEN Phone:203-4060545 1 Fax:203-40608281 tech@rbawestchesteccom H:(917)47647521 C:(914)476-4753 +oynxr..oa�aeu ennrrw Measure Tech:Thomas Moore, Sales Rep:Greg Sotire, AnnMarie Servedio, William Servedio 03/04/25 BUYER(S)NAME ADDENDUM DATE 28 Wilton Rd Rye Brook , Rye Brook 10573 BUYER(S)ADDRESS (917)476-4752 (914)476-4753 PRIMARY TELEPHONE NUMBER SECONDARY TELEPHONE NUMBER memee7033@gmail.com PRIMARY EMAIL SECONDARY EMAIL LINE ITEMS CHANGED AFTER PURCHASE D. ROOM _- LITY:OTHER 203 Masterbed 59-3/4" 41-3/4" Window:AcclaimTm Gliding Double,1:1,Active/ Passive, EJ $4.074.49 Frame, Exterior White, Interior White,Performance Calculator: PG Rating: 30 1 DP Rating: + 30/-30,Glass:All Sash: High Performance SmartSun with HeatLock Glass. No Pattern, Hardware: White, Standard Color Hand Pull,Screen: Fiberglass, Full Screen,Grille Style: No Grille, Misc: None 03/04/25 Page 1/ 1 Itemized Order Receipt DBA:RENEWAL BY ANDERSEN OF WESTCHESTER AND FAIRFIELD COUNTY AnnMarie&William Servedio RENEWAL Legal Name: Fairchester Custom Windows LLC 28 Wilton Rd CT HIC#.0667292,WC-35743-H22,Putnam#51220 Rye Brook,NY 10573 M_ANDERSEN' 421 West Ave.Building 11 Stamford,CT 06902 Year Built:1950 Phone:203-406-0545 Fax:203-406-0828 1 sales@rbawestchester.com H:(917)476-4752 C:(914)476-4753 ROOM: ow 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. 101 Entry 34 W Window: Acclaim'm Gliding Double 1:1 Active / Passive EJ 39 H Frame 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 Standard Color Hand Pull Screen: Fiberglass Full Screen Grille Style: No Grille Misc: None 102 Entry OW Misc: Misc, Miscellaneous Job Items, Pro-Via Door, Quantity 0 H 1, Legacy Single Entry Door in FrameSaver Frame 36" x 80" Nominal SizeUnit Size: 37 9/16" x 81 11/16"Sizing to be Verified by Remeasure Tech ***Frame Depth: 4 9/16"2" Standard BrickmoldRight Hand Inswing- Inside Looking Out002 Style 20-Gauge Smooth Steel DoorWith High- Definition EmbossingCoal Black Inside and OutsideHardwareAll Hardware in Black FinishAddison Grip Entrance Handle Outside Accent/Addison Handle InsideAddison Thumbturn DeadboltKey Order AlikeFrameTextured Coal Black Aluminum Frame CladdingCoal Black Inside FrameMill Finish ZAC Auto-Adjusting Threshold (5 5/8" Depth) Black Ball Bearing HingesSecurity Plate 104 Bar 87 W Window: Acclaimlm Gliding Triple 1:1:1 Base Frame Exterior 49 H White Interior White Performance Calculator: PG Rating: 30 DP Rating: + 30 / - 30 Glass: All Sash: High Performance SmartSun with HeatLock Glass, No Pattern Hardware: White Standard Color Hand Pull Screen: Fiberglass Full Screen Grille Style: No Grille Misc: Remove and Re-install Window Treatments Remove shades and hardware and re-install 02/28/25 Page 3/ 36 Itemized Order Receipt DBA:RENEWAL BY ANDERSEN OF WESTCHESTER AND FAIRFIELD COUNTY AnnMarie&William Servedio RENEWAL Legal Name:Fairchester Custom Windows LLC 28 Wilton Rd CT HIC#.0667292,WC-35743-H22,Putnam#51220 Rye Brook.NY 10573 HANDERS_-- 421 West Ave,Building 11 Stamford.CT 06902 Year Built:1950 Phone:203-406-0545(Fax:203-406-0828 1 sales@rbawestchester.com H:(917)476-4752 C:(914)476-4753 ROOM: SIZE: DETAILS: PRICE: 105 Bar 87 W Window: Acclaim",' Gliding Triple 1:1:1 Base Frame Exterior 49 H White Interior White Performance Calculator: PG Rating: 30 DP Rating: + 30 / - 30 Glass: All Sash: High Performance SmartSun with HeatLock Glass, No Pattern Hardware: White Standard Color Hand Pull Screen: Fiberglass Full Screen Grille Style: No Grille Misc: Remove and Re-install Window Treatments Remove shades and hardware and re-install 106 Laundry 58 W Window: AcclaiMTm Gliding Double 1:1 Active / Passive Base 33 H Frame Exterior White Interior White Performance Calculator: PG Rating: 30 1 DP Rating: + 30 / - 30 Glass: All Sash: High Performance SmartSun with HeatLock Glass, No Pattern Hardware: White Standard Color Hand Pull Screen: Fiberglass Full Screen Grille Style: No Grille Misc: Remove and Re- install Window Treatments Remove shades and hardware and re-install 107 Laundry 28 W Window: AcclaimTm Double-Hung (DG) 1:1 Flat Sill, Insert 33 H Frame Traditional Checkrail Exterior White Interior White Performance Calculator: PG Rating: 40 1 DP Rating: + 40 / 40 Glass: Sash 1: High Performance SmartSun with HeatLock Glass No Pattern Sash 2: High Performance No Pattern Hardware: White Standard Color Recessed Hand Lift Screen: Fiberglass Full Screen Grille Style: No Grille Misc: Remove and Re-install Window Treatments Remove shades and hardware and re-install 02/28/25 Page 4/ 36 Itemized Order Receipt DBA:RENEWAL BY ANDERSEN OF WESTCHESTER AND FAIRFIELD COUNTY AnnMarie&William Servedio RENEWAL Legal Name:Fairchester Custom Windows LLC 28 Wilton Rd CT HIC#.0667292,WC-35743-H22,Putnam#51220 Rye Brook.NY 10573 MANDERSEN' 421 West Ave,Building 11 Stamford,CT 06902 Year Built:1950 Phone:203-406-0545 1 Fax:203-406-0828 1 sales@rbawestchester.com H:(917)476-4752 C:(914)476-4753 ROOM: SIZE: DETAILS: PRICE: 201 MB Bath 34 W Window: AcclaimT"' Gliding Double 1:1 Active / Passive EJ 39 H Frame Exterior White Interior White Performance Calculator: PG Rating: 40 j DP Rating: + 40 / - 40 Glass: All Sash: High Performance SmartSun with HeatLock Glass, No Pattern Tempered Glass Hardware: White Standard Color Hand Pull Screen: Fiberglass Full Screen Grille Style: No Grille Misc: None 202 MB 58 W Window: Acclaim'" Gliding Double 1:1 Active / Passive EJ 41 H Frame Exterior White Interior White Performance Calculator: PG Rating: 30 1 DP Rating: + 30 / - 30 Glass: All Sash: High Performance SmartSun with HeatLock Glass, No Pattern Hardware: White Standard Color Hand Pull Screen: Fiberglass Full Screen Grille Style: No Grille Misc: Remove and Re- install Window Treatments Remove shades and hardware and re-install 204 MB Changing Room 58 W Window: AcclaimT"' Gliding Double 1:1 Active / Passive EJ 41 H Frame Exterior White Interior White Performance Calculator: PG Rating: 30 1 DP Rating: + 30 / - 30 Glass: All Sash: High Performance SmartSun with HeatLock Glass, No Pattern Hardware: White Standard Color Hand Pull Screen: Fiberglass Full Screen Grille Style: No Grille Misc: Remove and Re- install Window Treatments Remove shades and hardware and re-install 02/28/25 Page 5/ 36 Itemized Order Receipt DBA:RENEWAL BY ANDERSEN OF WESTCHESTER AND FAIRFIELD COUNTY AnnMarie&William Servedio Legal Name:Fairchester Custom Windows LLC 28 Wilton Rd R E N VEWA L CT HIC#.0667292,WC-35743-1-122,Putnam#51220 Rye Brook,NY 10573 byANDERSEN 421 West Ave,Building 11 Stamford,CT 06902 Year Built:1950 nu�a noo..sse+imen Phone:203-406-0545 1 Fax:203-406-0828 1 sales@rbawestchesteccom H:(917)476-4752 C:(914)476-4753 ROOM: SIZE: DETAILS: PRICE: 205 MB Changing Room 58 W Window: Acclaim'"' Gliding Double 1:1 Active / Passive EJ 41 H Frame Exterior White Interior White Performance Calculator: PG Rating: 30 1 DP Rating: + 30 / - 30 Glass: All Sash: High Performance SmartSun with HeatLock Glass. No Pattern Hardware: White Standard Color Hand Pull Screen: Fiberglass Full Screen Grille Style: No Grille Misc: Remove and Re- install Window Treatments Remove shades and hardware and re-install 206 Kid's Room 28 W Window: Acclaim'"' Double-Hung (DG) 1:1 Flat Sill. Insert 33 H Frame Traditional Checkrail 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 Standard Color Recessed Hand Lift Screen: Fiberglass Full Screen Grille Style: No Grille Misc: Remove and Re-install Window Treatments Remove shades and hardware and re-install 207 GR 58 W Window: AcclaimTm Gliding Double 1:1 Active / Passive EJ 41 H Frame Exterior White Interior White Performance Calculator: PG Rating: 30 1 DP Rating: + 30 / - 30 Glass: All Sash: High Performance SmartSun with HeatLock Glass. No Pattern Hardware: White Standard Color Hand Pull Screen: Fiberglass Full Screen Grille Style: No Grille Misc: Remove and Re- install Window Treatments Remove shades and hardware and re-install 02/28/25 Page 6/ 36 ARM Itemized Order Receipt Aff DBA:RENEWAL BY ANDERSEN OF WESTCHESTER AND FAIRFIELD COUNTY AnnMarie&William Servedio Legal Name:Fairchester Custom Windows LLC 28 Wilton Rd RENEWAL CT HIC#.0667292,WC-35743-H22,Putnam#51220 Rye Brook.NY 10573 byANDERSEN 421 West Ave,Building 1 I Stamford.CT 06902 Year Built: 1950 wum.unoo.ieaeen,mer Phone:203-406-0545 1 Fax:203-406-0828 1 sales@rbawestchesteccom H:(917)476-4752 C:(914)476-4753 ROOM: SIZE: DETAILS: PRICE: 208 Nursery 58 W Window: AcclaimT" Gliding Double 1:1 Active / Passive EJ 41 H Frame Exterior White Interior White Performance Calculator: PG Rating: 30 1 DP Rating: + 30 / - 30 Glass: All Sash: High Performance SmartSun with HeatLock Glass, No Pattern Hardware: White Standard Color Hand Pull Screen: Fiberglass Full Screen Grille Style: No Grille Misc: Remove and Re- install Window Treatments Remove shades and hardware and re-install 209 Nursery 58 W Window: AcclaimT"' Gliding Double 1:1 Active / Passive EJ 41 H Frame Exterior White Interior White Performance Calculator: PG Rating: 30 1 DP Rating: + 30 / - 30 Glass: All Sash: High Performance SmartSun with HeatLock Glass, No Pattern Hardware: White Standard Color Hand Pull Screen: Fiberglass Full Screen Grille Style: No Grille Misc: Remove and Re- install Window Treatments Remove shades and hardware and re-install 210 ow Misc: Misc, Permit Fees, Town of Rye Brook - Estimated 0 H Permit Fees *HeatLock Required*. 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. WINDOWS: 13 PATIO DOORS: 0 ENTRY DOORS:0 SPECIALTY: 0 MISC: 3 PROJECT TOTAL $56,392 Renewal by Andersen is committed to our customers'safety by NWAWcomplying with the rules and lead-safe work practices specified by the EPA. 02/28/25 Page 7 / 36 „ . Order Summary dba:RENEWAL BY ANDERSEN OF WESTCHESTER AND FAIRFIELD AnnMarie&William Servedio COUNTY 28 Wilton Rd RENEWAL Legal Name:Fairchester Custom Windows LLC I License#CT HIC#.0667292, Rye Brook,NY 10573 bYANDERSEN WC-35743-H22,Putnam#51220 Year Built: 1950 421 West Ave,Building 1 1 Stamford,CT 06902 H:(917)476-4752 Phone 203-406-05451 Fax:203-406-08281tech®rbawestchester.com C:(914)476-4753 Exterior trim to be wrapped in white coil All units to receive white coil capping to match their other replacement units Remove and replace all shudders on from of home Estimated Duration: 3 days •• FLOOR UNIT NOTES 105 106 _ EPA requires contractors that disturb painted surfaces in homes,built before 1978 to be certified and follow specific work practices. 1 0 2 Legacy Single Entry Door in FrameSaver Frame 36' x 80' Nominal Size 107 Unit Size:37 9/16” x 81 11/16' 2 1 0 Renewal by Andersen will facilitate the application of the building permit to the Town of Rye Brook. Homeowner is 104 102 101 -� FRONT 03/04/25 Page 10 / 38 Order Summary dba:RENEWAL BYANDERSEN OF WESTCHESTER AND FAIRFIELD AnnMarie&William Servedio COUNTY 28 Wilton Rd RENEWAL Legal Name:Fairchester Custom Windows LLC I License#CT HIC#.0667292, Rye Brook,NY 10573 byANDERSEN WC-35743-1-122,Putnam#51220 Year Built: 1950 421 West Ave,Building 1 1 Stamford,CT 06902 H:(917)476-4752 Phone 203-406-0545 1 Fax:203-406-0828 1 tech®rbawestchester.com C:(914)476-4753 •• •• UNIT NOTES 207 .. 208 i i 209 206 201 205 202 204 .. 203 JOBPHOTOS 03/04/25 Page 11 / 38 r mar r..r.r.. .. •f,!ram r� .1 6 neap wALoom YOUR PROFESSIONAL-CLASS PRODUCT rdf PIVM�.. t tyoF.2dZn�:Y•uatl+liww finery Door t7r 0000"T" MTApS Loom SM40W smyow 1!Awma~ra,fa re'.tr %" - Wdr W II!*No"M 6lwi/a I N N i VMMYMM�fw�,rM ow%4m ypu" .wama U"D.- MM it@.7.AW+ ;.rf 1Rr�ftW!raaf-�1iaYd Illr/mlll� M eyll.ln ♦•pri W.ryo! ky♦.r6�rtY k M—!•WTI OytfH1 l..tn:h�r7FMw Wf+�la�Ma� f!j Qwdw*Am - Rai Wmr - `wssltf►W Mr��►l�./.h7+r i3�AF7 �i�►w1W ti.wa YR r�ilrl tf�4 j�rt►'4y1Wr.�T►*rrhnttl lat'CrIOYf� �iw-. rRw.wlYrlfMt f'W! -. GAllQN AMD*"MOM ♦+f �.l`/ 'MYtlIlW1f�1 the�lAr HlrvYlfr� oioo cm 0.04 .i fir.♦♦J�f 4 AiMiYr►�i Y.illll��w!! i....�-.-�....._..a a..a.J _._..qty.t MM�� . 202 MO Acclaim"" Gliding-Double 58.00W z 41.001­1 a 1 I' 1 i �. 107 Lsuixkq Acclaim'" Double-Hung(DG)-28.00W x 33.001-1 i 7 C+ ! t d _------- r TILT ' ExtER A C3,Z) itfTER�A �,r •• 104 Bar Acclaim"' Gliding Triple 87.00W x 49.00H r t T ' ExfER►OA t36 ltiTER►�A ii RENEWAL Technical Data �� brANDERSEN FULL-SERVICE WINDOW&DOOR REPLACEMENT SPECIFICATION AND TECHNICAL MANUAL A G. �z- lkt1d., _ AIM RENEWAL BY ANDERSEN SPECIFICATION &TECHNICAL MANUAL TECHNICAL INFORMATION PERFORMANCE RATINGS AND TEST DATA NFRC Total Unit Performance (continued) Renewal by Product GlassType Air Gas Blend Air 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 0.34 0.31 0.28 0.28 Low-E4`Sun WithoutGrilies 0.33 0.30 0.19 0.19 .40 Full Divided Light Grilles 0.35 0.31 0.18 0.17 r• Double-Hung (Full Frame) Low-E41-'SmartSunTM Without Grilles 0.33 0.29 0.21 0.21 .65 Full Divided Light Grilles 0.34 0.30 0.19 0.19 Low-E41'SmartSun Without Grilles 0.28 0.25 0.20 0.20 .63 with HeatLock° 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 Without Grilles n/a n/a n/a n/a n/a SmartSunt" 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 Without Grilles 0.34 0.30 0.20 0.19 .40 Low-E4'Sun Full Divided Light Grilles 0.35 0.31 0.18 0.18 r• Double-Hung (insert Frame) Without Grilles 0.33 0.29 0.21 0.21 .65 Low-E41 SmartSunt" Full Divided Light Grilles 0.34 0.30 0.19 0.19 Low-E4"SmartSun Without Grilles 0.27 0.25 0.20 0.20 .63 with HeatLocks 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" WlthoutGrilles 0.4-1 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-E41 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`SmartSun" Full Divided Light Grilles 0.34 0.31 0.19 0.19 Low-E46SmartSun Without Grilles 0.27 t 0� 2� 0.20 0.20 .63 with HeatLockl 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 SmartSunt" 'Low-E40 SmartSun"'."Low-E40,"Low-E4 D Sun-and HeatLdckOw are Andersen trademarks for"Low-E-glass. 1)U-Factor defines the amount of heat loss through the total unit in BTU/hr/ft2.'F.The lower the value,the less heat is lost through the entire product.Window values represent non-tempered glass.Use of tempered glass can increase U-Factor ratings.See andersenwindows.com/nfrc for specific performance values. 2)Solar Heat Gain Coefficient(SHGC)defines the fraction of solar radiation admitted through the glass botf-directly transmitted and absorbed and subsequently released inward.The lower the value,the less heat is transmitted through the product. 3)Visible Transmittance(VT)measures how much light comes through a product(glass and frame).The higher the value,from 0 to 1,the more daylight the product lets in over the product's total unit area.Visible Light Transmittance is measured over the 380 to 760 nanometer portion of the solar spectrum. •NFRC ratings are based on modeling by a third-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 product changes,updated test results,or new industry standards or requirements.this data may change over time.Ratings are for sizes specified by NFRC for testing and certification.Ratings may vary depending on use o`tempered glass,different grille option s,glass with capillary breather tubes for h.gh altitudes,etc.'Id.-L40,`Law-L41-)SmartSun'""and-Low-L4R Sun- 09-10 COMPANY CONFIDENTIAL- REVISION AA-01 i A i g tj 1 i 1� y6Y4 f r _ a i G1 0 1 z 06 PW a ._ 1w •All .... - - �A rr � . x s/ r� i �,s,� � - 4�; - � �,� i �- ��4 -+. _r�- A � � � r, �r i�. L , .. � �_. i �� � x _ N rrw ��� = s. �i _..:�. �i � �► r . . .. . __� �� �� . ,��? r r��li�j%���f�i�u�iiltl � `h•I .....f f. Y $ �1 .... �� .. Y� �! -. L._ .., y. .a i. .. ♦ __ ..... _ —_- .�y'} '; 1 -- ►'"' � .; .,., � t _. ���� �� �i fp i },, J/ �� .. ►- .. 'r a e - ' n r� -. -i..� fit... if . 4 A i } - h * //�� ���.. •� / . ��� �if�y� { � .. �<� ,� r ,,' � 1 • ���� ..� � I[�. '� r _ - ��� �� ��� w - ----_---_--- �. \� _1 �.F / `S � � - I I ,- ' �•__ w NOW - - f 11,AV -r_ � � � ��flr. � ;; �� �r � � �, '� �-�. t� ' � I fF it � f ! __ ' I f t J; � � ` � `�ft f. t�� � � :i�j,(l i � i �. \ _,v. �� _`\� __���1�^ _.. -- - - i _""' l W 1 �\ 1,�•t 1 ��� 1 I� ar �� .. _ ��. , � � � � j 3 4 y. 4*A�` +� I 7 * ` Westc.)Icste'• George Latimer James Maisano (_ 011nty Westchester County Executive Director,Consumer Protection Department of Consumer Protection Home Improvement License ', i FAIRCHESTER CUSTOM WINDOWS, LLC l 421 WESTAVENUE- BUILDING 1 ? \l �\ ( -TE.M FORD,CT-06902 This license is issued in accordance with Article,.l i of the Westchester County Consumer Protection Code and is valid only upon _ presence of the official department seal.Proof of citizenship or immigration status is not required for issuance of this license. % NOT FOR FEDERAL PURPOSES i 1. Mani i °, (Consul Rg o � Il License Number ,� c Date of Expiration Clio " WC-35743-1-122 o y.�. 09/20l2026 , . ster Co o� I y i FAIRCUS-01 PSMITH AC�RD DATE(MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 8712024 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS j 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). OINTACT Theresa Brandon PRODUCER N MBI Company Group LLC. PHONE FAX 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 0 INSURER A:Selective Insurance Company of America 12572 INSURED INSURER B: Fairchester Custom Windows LLC dba: Renewal by Andersen INSURERC: Fairchester 421 West Avenue, 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 LIMITS LTR INSD WVD MMIDD/YYYY MM/DD/YYYY A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 EM CLAIMS-MADE ] OCCUR X S 2516791 8/12/2024 8/12/2025 DAMAGE TO R(EaENTEDISES occrence $ 500,000 MED EXP(Any oneperson) $ 15,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $ 3,000,000 POLICY�X JJECT FX LOC PRODUCTS-COMP/OP AGG $ 3,000,000 OTHER _ $ A AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000,000 IEac n g ANY AUTO S 2516791 8/12/2024 8/12/2025 BODILY INJURY Perperson) $ OWNED SCHEDULED AUTOS ONLY X AUTOS BODILY INJURY Per accident $ X HIRED X NON-AWNED PeOac%d ,DAMAGE $ AUTOS ONLY AUTOS ONLY X Comp Ded$500 X Collision Ded$500 A X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 4,000,000 EXCESS UAB CLAIMS-MADE X S 2516791 8/12/2024 8/12/2025 AGGREGATE $ 4,000,000 DED I X I RETENTION$ 0 $ A WORKERS CMPESATION AND EMPLOYOERS'LIABILIITY X ISTPER T X ERH v/N WC 9099063 8/12/2024 8/12/2025 500,000 ANY PROPRIETOR/PXCLUDElEXECUTIVE � N/A E.L.EACH ACCIDENT $ OFFICER/M�MgER EXCLUDED? (Mandatory m NH) E.L.DISEASE-EA EMPLOYEE $ 500,000 It yes.describe under 500,000 DESCRIPTION OF OPERATIONS below I E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Village of Rye Brook is Additional Insured as required by written contract per the endorsements included with this certificate. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Village of Rye Brook THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 9 Y ACCORDANCE WITH THE POLICY PROVISIONS. 938 King Street Rye Brook,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 YORK Workers' CERTIFICATE OF STATE Compensation Board NYS WORKERS' COMPENSATION INSURANCE COVERAGE 1 a.Legal Name&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 Rye Brook 3b.Policy Number of Entity Listed in Box 1a" 938 King Street Rye Brook, NY 10573 WC9099063 3c.Policy effective period 08/12/2024 to 08/12/2025 3d.The Proprietor, Partners or Executive Officers are ❑X 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"3"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, 1 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: � �� 1:5mzi4i 8-9-2024 (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