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HomeMy WebLinkAboutMP25-076 DR1 � �i`cwnU JJv tta JJCx,Vu W J 190 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 July 24,2025 Clifford Silverman&Francesca Silverman 23 Woodland Drive Rye Brook,New York 10573 Re: 23 Woodland Drive, Rye Brook,New York 10573 Parcel ID#: 135.36-1-40 This document certifies that the work done under Mechanical Permit #25-076 issued on 5/29/2025 for the installation of a new condenser and a new air handler has been satisfactorily completed. Sincerely, Steven E. Fews Building&Fire Inspector /to BRI O �m ID cu 1989 BUILDING DEPARTMENT ❑BUILDING INSPECTOR ,�ASSIs'rnN,r BUILDING INSPECTOR VILLAGE OF RYE BROOK ❑Cojn?ENFORCEMENT OUFICER 938 King Street• Rye Brook,NY 10573 (914) 939-06681 FAx (914) 939-5801 www rycbrook.org - - - - - - - - - - - - - - - - - - - - INSPECTION REPORT - - - - - - - - - - - - - - - - - - - - ADDRESS : 2 ✓Voo C� C�,� _ Dle_I✓e, DATE: Z 70 er PI;ItMI'r#__ P-asp ------ISSU1?D:5-2I'4r SECT: /3J•3Ci BLOCK:_L LOT: YV LOCATION: ` �G 4 S OCCUPANCY: ❑ Violation Noted THE WORK IS... Ef PASSED ❑ FAILED REINSPECTION ❑ SITE INSPECTION REQUIRED ❑ FOOTING ❑ FOOTING DRAINAGE ❑ FOUNDA'CION ❑ UNDERGROUND PLUMBING NOTES ON INSPECTION: ❑ ROUGH PLUMBING ❑ ROUGH FRAMING ❑ .INSULATION ❑ Natural Gas S l- [(2 C NCO A 1r, kkAa d 1 A� ❑ L.P. Gas ❑ FUEL TANK Op Z �'`� .P_ti1 ❑ FIRE SPRINKLER ❑ FINAL PLUMBING ❑ CROSS CONNECTION FINAL ❑i OTHER cu a ~N 4 V 4�1 M co Q }-1 ■ Z 1 a W = ui y v . p ►p. w o bA G. , Cd IL 14 R4 C00 �j �W/ Q ca a O ✓ v a �T7 M z a q w - .y-� F Q }} w w O C) E 0W © w a OLr) �`i 14 � u Ln O GS ,N y w a FTL� � .. �i K � a� � a d 0 ^2 g O ^2 w : 0�3 5 w " Cl) 0 O w a o a V = Woo Q z U V Aoo � U a _ z ,� .b ow fn p C7 U a3 zQ � OAQ `� ■ pq00 C' W U di o W x 'f� W O zzb H O Cn z z C c� V FU ►� O cduo ? a" • Q w w o V o o C O U O U o M � � � � s N g a z a 0 '8o � W aa4: a q � � O W � E• .N �.� .�° �I as a _ ■ BUIC_'t4 MENT VIL >� OOK 938 KINGBR NY 10573 MAY :2:20]25 0 . ov VILLAGE OF RYA BROOK BUILDING DEPF�RTNfENT APPLICATION FOR PERMIT TO INSTALL AND/OR REMOVE HEATING, VENTILATION AND/OR AIR CONDITIONING EQUIPMENT FOR OFFICE USE ONLY: PERMIT 9: Approval Date: MAY 3 0 25 Permit Fee: $ Approval Signature: Other: Disapproved: (fees are non-refundable) DO NOT START WORK or CONSTRUCTION UNTIL 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. -"'Properly completed& Signed Application. 2. Site/Staging Plan if Required by the Building Inspector. 3.✓Copy of Licensed Contractor's Liability Insurance. (Village of Rye Brook must be listed as certificate holder) & Workers Compensation Insurance on a NYS Board form(Form#C105.2 or Form#U26.3/or NY State Workers Compensation Waiver) 4./Payment of Fees/Unit: RESIDENTIAL =$150.00/unit •COMMERCIAL =$450.00/unit. 5. Complete specifications for each unit being installed. 6. Inspection by the Building Department for removal and/or installation. (48 hour notice required) 7. Electrical work requires a separate Electrical Permit&Electrical Inspection. 8. Plumbing/Gas work requires a separate Plumbing Permit& Plumbing Inspection. arar*arararatarararar*arar**ar ararataratar**atat,tar,t*,t*>k�,�r*tat,tatat�at*at at*at+�*:t*at at+at,tat*#atat*,tatat at atat,t*,taut*ar*�:txx�r:r*�rxat�rt:�xa:�*a< Application dated, 1c_)Q c4 is hereby made to the Building Inspector of the Village of Rye Brook for a permit for the installation and or removal of the HVAC equipment as listed below.The applicant and property owner,by signing this document agrees that said equipment will be installed and/or removed in conformance with all applicable Local,County, State&Federal laws, codes,rules and regulations. / r, 1. Address: 2� �tW)0 ' d\t � �•1n SBL:� � 1p�"��' 0 Zone: 2. Property Owner: 1 C� �c�.. Gt ��e,�(�fl(x� Address: 2-16 �_Qloodk \& zx- Phone#: 'ekb - 0";)9 '04bt) Cell#: email: 3. Contractor: �,,�,, \* v,�ffY-c iCrA Address: 26 \Jme\c 6 (�Ve_ Phone#: CIA- (390 1000 Cell#: email: Wyi Q.phuen t X N -CZ 4. Scope of Work:New^Installation(>�•tReplacement( )f•Removal( )•Other( ): 5. List Equipment: t�E�� ��(1 ya`S�P 111 R wn - 6ow-b' M 20-,� 6. Location of Equipment: 4 W��\ �CCJ C)n -0� 6,q* `cam-crc- + _ Octfs- Nc, A"k& 10 U•tile . 7. Method of Installation/Removal(list all equipment needed to perform job): t 6/l/2024 STATE OF NEW YORK,COUNTY OF WESTCHESTER ) as: ion 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 Heating,Ventilation and/or Air Conditioning 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 his/her knowledge and belief,and that any work performed,or use conducted at the above captioned property will be in conformance with the details as set forth and contained in this application and in any accompanying approved plans and specifications,as well as in accordance with the New York State Uniform Fire Prevention&Building Code,the Code of the Village of Rye Brook and all other applicable laws,ordinances and regulations. Sworn to before me this 9 )tF, Sworn to before me this1 61 day of MUN 20 25 day of 20 Z7) S' ature o roperty Owner Signature of Applicant FrcAn(kscck S,1 V-e( m a Y) -3. „rt, •t..� Print Name of Property Owner Print Name t Notary Pub c Notary JENNIFER RIVERA JENNIFER RIVERA Notary Public-State of New York Notary Public-State of New York NO.01 R16388056 No.01 R16388056 Qualified in Bronx County Qualified in Bronx county My Commission Expires Feb 25, 2027 My Commission Expires Feb 25,2027 This application must be properly completed in its entirety and must 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. 2 6/1/2024 N N • I . � W `. A c, - W to k "'"'"' z is � � � ■ ac M Ln 00 ►� .� M �' W l y cn x � (' _ x S C%(30 N � _ A — W � Fil C v x cn 00 x z ^ oc cn CA i J U z rA 4414444 4449tot4A4A46444644&9441i:4:f:44A414Q4:4A4A41+4&46441464146 BUILDING ARTMENT C EIENED VILLA E OF RYE BROOK 938 KiN61 ET RYE BI o ,NY 10573 ��N - 2 2025 - VILLAGE OF RYE BROOK w n v BUILDING DEPARTMENT ELECTRICAL PERMIT APPLICATION Westchester County Master Electricians License Required / r FOR OFFICE USE ONLY 7� EP#: Approval Date: JUN I I Permit Fee: S Approval Signature: Other: ************************************ ******** **************************************************** DO NOT START WORK or CONSTRUCTION UNTIL 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 Application dated, 6- �)-c)'� is hereby made to the Building Inspector of the Village of Rye Brook NY,for the issuance of a Permit to install and/or remove electrical equipment, wiring, fixtures,or to perform other high or low voltage electrical work as per the detailed statement described below. By signing this document, the applicant & property owner agree that all electrical work performed will be in conformance with allapplicable Federal,State,County and Local Codes. I / p 1.Address: 2 J WogL I j&' "'' D K SBL: 13J-r 3(/D -/ '-`y V Zone: 2.Property Owner: ��tF�DQd S�L �c-QmAn Address: Phone#: Cell#: I)- O L 6 3AI —email: 3.Master Electrician/Licensed In aller:: (Ve-11I nfj 4N QIW Address: 313 F w /� ✓� Lic.#:2CJ Phone#:/� � �� Cell#: email: JS14VA Wi Company Name: (1P8 UJI (ny JFQV(UY -10CAddress: 4.Prop ed Electrical Work/Fixture Count: NEB 5Cu Ec on 400 01��T of A Q1F� o Q r'c� PI R VW Q P \C oc,o o4 5.3`d Party Electrical Inspection Agency: [A NEIV YOR ,COUNTY OF WESTCHESTER ) as: we n`/r`11 P/ being duly sworn,deposes and states that he/she is the applicant above named,and does further (print name of individual si in the applicant) state that(s)he is the Z7 t((,A ti for the legal owner and is duly authorized to make and file this application. (Master Electrician/Licensed Installer) The undersigned further states that all statements contained herein are true to the best of his/her knowledge and belief,and that any work performed,or use conducted at the above captioned property will be in conformance with the details as set forth and contained in this application and in any accompanying approved plans and specifications,as well as in accordance with the New York State Uniform Fire Prevention&Building Code,the Code of the Village of Rye Brook and all other applicable laws,ordinances,and regulations. Sworn to before me this Sworn to before me this day of 120 day of ,20 Signature of Property Owner Si li 14 ���A Print Name of Property Owner Prin Name of Applicant IyJ7�,,/M by&) Notary Public Ac WERA Notary Public,State of New York 6nn024 No.01RWA413" Qualified In Westchester County nn Commission Expires September 26,20d� STATE WIDE INSPECTION SERVICES, INC. 0•• • • swis JOB APPLICATION tel 845.202.72240. • Office Use Elect. Permit# = M Date ! J (p Bldg Permit# — Sg Ft Plumbing Permit# Final Certificate # City/Village Zip Building Dept. Ilk County Address `2 r i� �-� a Cross Street Section Block Lot Owner Name/Address(If different than above) L i �E ILS�L vF R I(11 n Contact Number ❑Basement ❑ 1st FI. ❑2nd FI. ❑3rd Fl. ❑More Than 3 FI. ❑Garage ❑Attic ❑Outside ❑Residential ❑Commercial Receptacles Special Recept GFCI AFCI Switches Dimmers Smoke Alarms C/O Detector Hood Trash Compact Amt Amps Range(s) Cooktop(s) Oven(s) Dishwashers Refrigerator Disposal Microwave Luminaires Generator Transfer Switch SERVICE Amperage #Panels 1P 3P # Meters # Disconnect ❑Underground ❑ New ❑ Reconnect ❑ Repair ❑Overhead ❑ Upgrade ❑ Disconnect Utility ID# ❑Con Ed ❑ NYSEG ❑Central Hudson ❑ Orange/Rockland PHOTOVOLTAIC SYSTEM PV Modules Inverters AC Disconnect Junction Box Combiner Box Load Center PV Monitor Energy Storage System DC Disconnect ❑Legalization ❑ Safety Inspection ❑Consultation �� I��� �n� ��CW►r2< <`i�Cv�nEc� ��2 n nF � �c�� �ei�)J � In PARID���f��t2 �� }ttC �oca�t�h � p ❑� � ��1 � JUN - 2 2025 VILLAGE OF : E BROOK BUILDING DEPARTMENT This application is valid for one(1)year from the date received by SWIS.This application is intended to cover the above listed items to be inspected,if at any time of inspection additional items have been installed,you are authorized to make the inspection and adjust the fee for the additional items inspected.The applicant declares that there is no open applications for the above address with any other inspection company.The applicant, owner or authorized agent agrees to all the above terms and conditions as set forth for the application. Email Address A`V n C S (/� I I<'{ ('�;�1 Name License# Z D 1 Date U 2 SignatureadoK=7 Address _ 3 J 6 City/State I ) n (e . 1� p Code N Company ' n S to I R { n S E V Vi C(— T Phone# 1 3 co DC State Wide Inspection Services CAS 1080 Main Street JUN 2 3 2025 Fishkill, NY 12524 TbWUS 1 __ 845 202-7224 Phone VILLAGE OF RYE BROOK 914-219-1062 Fax STATE WIDE INSPECTION SERVICES BUILDING DEPARTMENT Email: office(abswisny.com Service With Integrity Website: www.swisny.com BY THIS CERTIFICATE OF COMPLIANCE STATE WIDE INSPECTION SERVICES CERTIFIES THAT: Upon the application of: Upon Premises Owned by: JPS Wiring Services Clifford & Francesca Silverman Jose Silva 23 Woodland Drive 313 Elmwood Avenue Rye Brook, NY 10573 Hawthorne, NY 10532 Located at: 23 Woodland Drive, Rye Brook, NY 10573 Section: Block: Lot: Electrical Permit Number: EP25-145 135.36 1 40 Certificate Number: 2025-4180 Building Permit Number: MP25-076 A visual inspection of the electrical system was conducted at the Residential occupancy described below.The electrical system consisting of electrical devices and wiring is located in/on the premises at: 23 Woodland Drive, Rye Brook, NY 10573 The Basement,Attic, and Exterior were inspected in accordance with the NYS and NFPA 70-2017 and the detail of the installation, as set forth below,was found to be in compliance on the 19th day of June 2025. Name Quantity Rating Circuit Type Air Handler 01 AC Condenser 01 Officer: Frank J. Farina This certificate may not be altered in any way and is validated only by the presence of a seal at the location indicated.This certificate is valid for work performed on the date of inspection only. 0 i I oui 0U.0 ti'� O 0 bra-ON w Wz V �� aypVN Bn0 tom- C7� m N O � �J Q C J U O Q•., V . 0 = _q) -fte, ^i rr.w. py p3 y„ C YJ .ft ° .0 E o 10, �k G- 3 Ig �� � � Q a / �•y ��hal �6�9 ��j O a N°k 910 X.e60d '"o� mod,���, `ry �• ��� � $ � � � a`0 a° It v>� o IDS Premium Connected System & Technical Information r INDOOR AIR HANDLER .. ERZOR .• MODEL ® I . :+BOVA-36RT8-M20S BrVA 24RGB M2OX 24000 i f 20 24000 9.5 224f•-, 1F BOVA 36RTO M20S EilVA 361,117,13 M20X 342(K' i<' 1 q 34200 95 29000 R 80VA-0URTB-M20S 81VA•488CO-MM 47000 12 18.5 48000 95 40000 rY 80VA480RT8 M20S 81VA-ORC9•M20X 62000 11.7 18 55000 9-5 44000 &w l•at kVt :.5-,..t„�L.rt;trtt'+[•.1 10 iN14.:i;'Ae;i",IUT•1l.rrr1rWALMHLY:IAAVti.lceRMC.,])Fret{}t(lr..R�rr/kiitm.tertltrd ptt A1+Ji:r-1'13li..,Ak Y_wcna:mro Eitci.vwl ..;. --.r�r'•+�iv4fif171!'�!!�+ 1`rkY�' •»wlrrt;i+s.u••tikfirmma• *rarirr,frrsry.tp•rAM2IN740tk& Alwrr.:tog k live tairgltkphxrkn Iva wl<U1L-.41 If*awl i.ari„ TN --i'.ttd;faa i s hf,Mrs!rr:a cnN i?^s a Lemi!'r wrr.brr t7 h rtw..nMa't v.hx i4itlef W41t.:Veit was batch►aexc:mbr!.mbMd tM aysgtM.eNciericr returtm in VW 3 IDS PREMIUM CONNECTED OESCRIPI ION&DIMENSIONS :• OUTID0051 w• BOVA.laRFO-M20S 38 k9TU/hr(3 Dori) 8733966410 29.125 24.9375 29AM BOVA-6 RTEI-IM20S 60 k8TU1hr(5 ton► 8731965411 ".125 33.1975 79.125 BiVA•24RC8 M2Wt 24 kBTU/Ar(?tool 873396S415 19.625 46.5 21.875 —`-► Cw�o.r Sc.••• N 61VA-36RCO M20X 36 k8TU/hr(3 tan), 8733W,416 19.625 46.5 21-625 8(VA•4BRCB-M20X 48 kBTUAw(4 ton) 8733966417 22.0 54.5 24.0 BIVA ro(W B-M20X 60 kBTU/lw(5 tonl 8733966418 220 545 24 0 Ai Nrwr IDS PORTFOLIO PAIRING IDS Portfolio Pairing BIVA20 �r Refer to the chart on the left for 0 Cased Coil Onl product combination availability. BGH96 Cased Coil DrSCRIPTION PART NUM1BFR I�Ilirr EHK-06C 8733877739 5 k1N Electric Strip Heater ENK-0F3C 8733977740 7 5 kW EWIttic Slim Heater EH*10C OT339TTY41 10 kW Electric Sumo Heater ENK•15C 8733977742 15 kW Electric Strip Heater EHK-20C 8TJXM43 20 kW Electric 54rio Neater A21-ACCESSORY BOX AZl ACCESSORY BOX The A21-accessory Box is required PART NUMBER DESCRIPTION I when pairing the Bosch Low GWP 8T33%7005 Alt Ai.N cc>ry R.r• Cased Coil with a 31d party furnace. d IUffO�pil�[�Q[ 6 , Y f[[[[ •� ROM 19 NAM m� RON�f�Q[f� fKOM fC19�Vr �Ull(6Cp�1[6f I{Ifllll l"��� Bosch BOVA20 Split System Heat Pump Condensing Units Up to 20.5 SEER 2-3-4-5 Ton Capacity BOSCH Product Specifications 6 1 Bosch IDS BOVA20 Product Specifications 3 Product Specifications :/ Cooling capacity Nominal Cooling(BTU/h) 34,600 54,500 Nominal Heating(BTU/h) 34,200 56,000 Decibels([dB(A)] Max @ 100%load 77 79 Min @ min load 56 60 Compressor RLA 19 29 Condenser Fan Motor Horsepower(HP) 1/3 1/3 FLA 2.5 2.5 Refrigeration System Refrigerant Line Size' Liquid Line Size(OD) 3/8" 3/8" Suction Line Size(OD) 3/4" 7/8" Refrigerant Connection Size Liquid Valve Size(OD) 3/8" 3/8" Suction Valve Size(OD) 3/4" 7/8" Refrigerant Charge(R410-A,oz) 7 lbs.9 oz. 11 lbs.5 oz. Expansion Device EEV EEV Maximum Line Length 150 FT 150 FT Maximum Elevation Difference 50 FT 50 FT Operating Range Cooling 15-1257 Heating -4-86°F Electrical Data Voltage-Phase-Hz 208/230-1-60 208/230-1.60 Minimum Circuit Ampacity' 26.3 38.8 Max.Overcurrent Protection' 45 60 Max Fuse Size 45 60 Min/Max Volts 172Y/270V Weight Net Weight(without packaging) 150 220 Gross Weight(including packaging)' 180 253 DimmWens Unit L x W x H(in.) 29-1/8 x 29-1/8 x 24-15/16 29-1/8 x 29-1/8 x 33.3/16 Outdoor Coil Net face area-sq.ft.Outer Coil 13.6 18.4 Tube diameter-in. 9/32"(7mm) 9/32"(7mm) No.of rows 2 2.8 Fins per inch 17 19 Table 1 'Tested and rated in accordance with AHRI Standard 210/240. 'Wire size should be determined in accordance with National Electrical Codes; Always check the rating plate for electrical data on the unit being extensive wire runs will require larger wire sizes. installed. 'Must use time-delay fuses or HACR-type circuit breakers of the same size as Unit is factory charged with refrigerant for 15'of"liquid line. noted. System charge must be adjusted per Installation Instructions Final 'Weight values are estimated. Charge Procedure. TXV is required at indoor unit to match our outdoor unit. Data subject to change 02.2023 1 Bosch Thermotechnology Corp. 9 BOSCH Product Specifications Bosch IDS Heat Pump Premium Series Air Handler 2-3-4-5 Ton Capacity R454B ®BOSCH 0 0 m r V N O N co O a N O M co O O N CERTIFIED ti L mH11 C E I US Intertek Product Specifications ® BOSCH 3 Product Specifications Coding Capacity Nominal Cooling(BTU/h) 24000 34200 47000 52000 Nominal Heating(BTU/h) 24000 34200 48000 1 55000 Blower Diameter(mm) 10-5/8"(270) 10-63/64"(279) 10.63/64'(279) 10-63/64"(279) Width(mm) 8-5/32"(207) 10-43/64"(271) 10-43/64"(271) 10-43/64"(271) Fan Motor Horsepower(HP) 1/3 1/2 3/4 3/4 Full Load Amps 2.6 3.3 4.5 5.6 Refrigeration System Refrigerant Line Size' Liquid Line Size(O.D.) 3/8" 3/8" 3/8" 3/8" Suction Line Size(O.D.) 3/4" 3/4' 7/8" 7/8' Refrigerant Connection Size Liquid Line Size(O.D.) 3/8" 3/8' 3/8" 3/8" Suction Line Size(O.D.) 3/4" 3/4" 7/8" 7/8" Expansion Device[TXV=Thermal Expansion Valve] TXV Decibels dB(A) Low Speed 55.8 59.7 65.3 68.5 Medium Speed 62.5 66.1 71.4 70.8 High Speed 66.9 70.4 75.4 I 73.7 Electrical Data Voltage-Phase-Hz 208/230-1-60 208/230-1-60 208/230-1-60 208/230-1-60 Minimum Circuit Ampacity 2 3.3 4.2 5.7 7.0 Max.Overcurrent Protection 15 15 15 I 15 Min/Max Vohs 187V/253V Air Filter Air Filter Sizes 18"x 20" 18"x 20" 20"x 22" 20"x 22" Weight Net Weight(without packaging)(lbs) 118 121 151 160 Gross Weight(including packaging)(lbs) 146 149 184 193 Dimensions Un it D x W x H(in.) 21-5/8"x19.5/8"x46-1/2" 21-5/8"x19-5/8"x46.1/2" 24"x22"x54-1/2" 24"x22"x54-1/2" Unit D x W x H(in.)(with pallet and packaging) 25-3/8"x22.5/16"x52.9/16" 25-3/8"x22-5/16"x52 9I16" 27.11/16"x24.11/16"x60 5/8" 27-11/16"x24-11/16"x60.5/8" Indoor Coil Net face area sq.ft. 4.02 4.02 5.99 5.99 Tube diameter 9/32"(7 mm) 9/32"(7mm) 9/32"(7mm) 9/32'(7mm) No.of rows 4 4 4 5 Fins per inch 17 17 17 17 Table I ' Tested and rated in accordance with AHRI Standard 2101240. ' Wire size should be determined in accordance with National Electrical Codes; extensive wire runs will require larger wire sizes. ' Must use time-delay fuses or HACR-type circuit breakers of the same size as noted. 4 Weight values are estimated. co) � + : 21 M" 57 CN p f„ O w r E c c o o . cz �.: . E L � 4. •Fes. 0J%/�='f1� /, \ En c 1 tcf ti:i FBI •� O W M U CA ROM `. Q W O *C� / w U_ > U ,,,�• L" G� U Q � U W c �`�— n Wmoo a� Q W J a, flats r U > _ N awedaQ �y W (0 W o :cl F a� ♦ t 0 > d CL � v • J � [[r!r lw�yne.rRe • d o N OJ cd 3 Q ,%: i I\ ♦ 1-= N pp SW 3,sgij;� 2 r,,�,!,,�1�,�," j'�'b"',�'�y��'s n M► 'N,. PHOEMEC-03 FHOLZHAY ACORO CERTIFICATE OF LIABILITY INSURANCE DATE(MYYY) 3119/2022025 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Luann Silano NAME: Acrisure Insurance Partners Services of NY, LLC AICONNo,Ext: 914 937-1230 FAX 90 S. Ridge Street ( ( ) (A/C,No): Rye Brook, NY 10573 ADDRE :lsilano@acrisure.com INSURERS AFFORDING COVERAGE NAIC# INSURER A:Starstone National Insurance Company 25496 INSURED INSURER B Phoenix Mechanical Corp INSURERC: 26 Vreeland Avenue INSURER D Elmsford,NY 10523 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 ADDL SUBR POLICY EFF POLICY EXP LTIRTYPE OF INSURANCE INSD WVD POLICY NUMBER MM/DD/YYY MMIDD/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE a OCCUR XREVISES(Ea occurrence) MPGR3802-03 3/16/2025 3/16/2026 DAMAGE TO RENTE $ 100,000 MED EXP(Any oneperson) $ 10,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICYA IJE LOC PRODUCTS-COMPIOP AGG $ 2'000,000 OTHER $ A AUTOMOBILE LIABILITY COMBINdEeDtSINGLE LIMIT $ 1,000,000 X ANY AUTO BAGR3802-03 3/16/2025 3/16/2026 BODILY INJURY Perperson) $ OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY Per accident $ HIRED NON(WNED PROPERdenTY DAMAGE AUTOS ONLY AUTOS ONLY Per accit $ A X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 5,000,000 EXCESS LIAB CLAIMS-MADE XSGR3802-02 3/16/2025 3/16/2026 AGGREGATE $ 5,000,000 DED I X I RETENTION$ 10,000 $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY YIN T T ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Village of Rye Brook is included as an additional Insured when required under written Contract or Agreement.; 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 NEW Workers' YORK STATE Compensation Board CERTIFICATE OF NYS WORKERS' COMPENSATION INSURANCE COVERAGE 1 a.Legal Name&Address of Insured(use street address only) 1 b.Business Telephone Number of Insured 914) 690-1000 Phoenix Mechanical Corp 6 Vreeland Avenue 1 c.NYS Unemployment Insurance Employer Registration Number of Elmsford, NY 10523 Insured 1d.Federal Employer Identification Number of Insured or Social Security Work Location of Insured(Only required if coverage is specifically limited to Number certain locations in New York State,i.e.,a Wrap-Up Policy) 13-3934943 2.Name and Address of Entity Requesting Proof of Coverage 3a.Name of Insurance Carrier (Entity Being Listed as the Certificate Holder) Indemnity Insurance Company of North America Village of Rye Brook 3b. Policy Number of Entity Listed in Box"1 a" 38 King Street C72673621 Rye Brook, NY 10573 3c.Policy effective period 09/30/2024 to 09/30/2025 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"I a"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: Lynne Boone (Print name of authorized representative or licensed agent of insurance carrier) Approved by: ,LyOw"2 10/02/2024 (Signature) (Date) Title: Assistant Program Manager Telephone Number of authorized representative or licensed agent of insurance carrier: 214-721-6248 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