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MP25-071
BR, 4' . 19 4 `ot LtK,�W�vJ �`C VILLAGE OF RYE BROOK MAYOR 938 King Street, Rye Brook,N.Y. 10573 ADMINISTRATOR Jason A. Klein (914)939-0668 Christopher J. Bradbury wwwryebrookny.gov TRUSTEES BUILDING& FIRE INSPECTOR Susan R. Epstein Steven E. Fews David M. Heiser Donald T. Krom,Jr. Salvatore W. Morlino CERTIFICATE OF COMPLIANCE January 5, 2026 Matthew Rosen&Alyse Rosen 175 Ivy Hill Crescent Rye Brook,New York 10573 Re: 175 Ivy Hill Crescent, Rye Brook,New York 10573 Parcel ID#: 129.76-1-38 This document certifies that the work done under Mechanical Permit #25-071 issued on 5/19/2025 for the installation of a new condenser and a new air handler has been satisfactorily completed. Sincerely, Steven E. Fews Building&Fire Inspector /to C.BR , 4 ,r BUILDING DEPARTMENT �I li I.UISV(;1NSPI-CTUk :1&BINTAN'1'BUII DING INSIPI;:Truk 1.AGE OF RYE BROOD ❑c'uur.I:Nrukcralu>N'1 01+1(:e11 938 1\ING STREET • Ryi., BROOK, N)' 105 3 (91.1)939-0(*8 PAX (9111)939-5801 %V_%V!!.r)ichrl ok.or9 ADDRL'SS j� S T v Id ► l.L -- of r HATE:LZ- 22-• 2 PPRAII I.: VIP �- b � 7 y. Issc1 u:S 1°►. 2,Stirr'r' /L'I•_-So-BI.ocK:___L LOT:.,? OCCIJI'Al\CY: ❑ VIOI.ATIO1 Narui) Tllr MINI% I,,... r�(;Clil�'1'Lil) ❑ I(fitticTEI)i 1(EINSI,I:(TiON ❑ SITE INSPECTION ❑ FOOTING Rlil2Ulitli!! ❑ FOOTING DRAINACU, ❑ FOUNDATION ❑ UNDERGROUND PLUMBING tiOTFS ON INSPF.('TION: ❑ ROUGH PLUMBING ❑ ROUGH FRAMING 11 INSULATION NATURAL GAS ❑ L.I' GAS ❑ Fuh-L'IANK ❑ HIRE SPRINKLER ❑ FINAL PI,UMIiING ❑ CROSS CONNECTION —_—_ iQ FINAL ---_ M'0TH14R IF At 0 ►n � �J, -d � - N N N ap Ln o Ln 00 c , :8 o, W a ~ O [� N z Sp. m o > CA it -] C] O 5 O y r Q - � � g oo a °� GO 04 fil 0 W Q; O O ff - o 14 �. 0 o 0 U W00 W ��j� UZ � .ti - 1� a �.acn 00 CA >Yi W A E w t" u P4 w H �j2 E" �C'i! z z o C p u 47 a w c V W. o � „ �, v � W 0 O O z m U U c7 q z © � � a v, > a'v o .. A rT� z w o v ucl O W of � �' r BUILD NG DEPARTMENT D C C IE � V E VILLA�E OF RYE E6 00K 938 KING STREET RYE BRoak,NY 10573 MAY 15 2025 (914)939-066$ wwwxyebrookuy.l:ov VILLAGE OF RYE BROOK BUILDING DEPARTMENT APPLICATION FOR PERMIT TO INSTALL AND/OR REMOVE �. HEATING,VENTILATION AND/OR AIR CONDITIONING EQUIPM/E�NT FOR OFFICE USE ONLY: PERMIT Approval Date: Permit Fee: $ 3�jO ',� 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 ilia OF THE TOTAL COST OF CONS T RU TiON WiTH .A NIININIUM FETE QF S7501.00 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#t U26.3/or NY State Workers Compensation Waiver) 4. Payment of Fees/Unit: RESIDENTIAL=S 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. Application dated, 5�Ss 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. Q 1. Address: Zone: 2. Property Owner: �' r? i t' �3e�1 Address: Phone#: / ' �Y57? C Cell#: email:MNA,4 4-t, 3. Contractor: A,,ri G- Address: 76; v we/, S'l .--:"C fT j' Phone#:—f!Y 9!�, / Cell#: email: J a T t —,0I 4. Scope of Work:New Installation( )•Replacement 06•Removal O.Other( ): 5. List Equipment: C,rrrJ.^+to� -t- 04111 5-16P Q �I 6. Location of Equipment: C 7. Method of Installation/Removal(list all equipment needed to perfoun job): ��^'��.-i fi ��� /'zw C-0.� t 6/1/2024 STATE OF NEW YORK,COUNTY OF WESTCHESTER ) as: ,being duly sworn,deposes and states that he/she is the applicant above named, (print name of individual signing as the applicant) and further states that(s)he is the 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 Sworn to before me this N 20 day of C'�v 20f of Owner S' n e of Applicant dlriqt Name of Property Wrier P ' ame of Applicant Notary Public Notary Public SHARI MELILLO Notary Public,State of New York SHARI MELILLO No.01ME6160063 Notary Public,State of New York Qualified In Westchester county,-7 No.OIME6160063 Commission Expires January 29.20_ Qualified In Westchester County Commission Expires January 29,20 2 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 spares 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 �o c � 0 a y N o � x N o Lo ��.. i� O •� LL1 O (U in O L c C C (Um c (� a'N y LL -D 0 LU v o CL a to c Cl a Lu m E LU N i z 4A m ff0a y c `° v n 3 a w Ln o Li X a > °' > ui a a v 0 > 0 'r ~ W u_ LAc N 3 Y Y W O N SLn L O � M Z Y H 3 L v o m > c 3 er do N u p Q 0 "° - u -C Z L V) H o > U a O C � `'� p a o L o0 WYY � � Ww a 0Yoc O $ N O O U Z U') Y $ w v 0 0 > v � = Y 0Lu .� � > 3E0 Z � o am 0CDu ;, -ov Om > o a� H ivy v a � } 3 � m Nj o° Qf° ° � o W — Ln QI p O u a > .0 a` 2 � � ON , r oa m Y W — W p Z H u CA C c > O W L0 a D U Q a w E f° Q c a 0o vNi Lama Lu ° � � � CL LLI 6, Y Z p W � � o $c Z CV) 0 w � s u c YV LU0 °p 0o Ln j ov LL M vL>�u 0 � umo �a- ztt W v �• Li N 0- Gr 1 5 O N w Z Q J LN C LU � O w Ln � LL W � E � E L m „ Nc .ct U J =VJ � o = _ 0vn =w � _ > m00 UM Na Q M Lm � � 0 � � v � Lu 0 W S �+ U > C Ln Y C } r+ � UU Jp as °1Q � o > v_ w •� Q Ln 0 ao ; � 3 m' O >> '5 z v O I� N a m w H Q W V) Lu = '> r N CN L � — l� a m � I o c Q Lt N Z r+ cV g - o ° N t E 0 0 m � o-0 E N o o a <�o E a_ W o 0 a 0 c m V omo � � c CD * — 292 c E v tN a I > co CIA J O } a� O C co � CC w LU W - a E = a a) c7 L U F p 0 . v v+ u CA yd w p Q Q off a CU u 'a u a��9d1 d Q a a x Lan ►_- a� /�4p 0.CK E Electrical Permit Application Village of Rye Brook 938 King St Rye Brook, NY 10573 Phone: (914)939-0668 1 www.ryebrook.gov Building Department Project Information SBL Zone 175 Ivy Hill Crescent PUD Proposed Electrical Work/Fixture Count 3rd Party Electrical Inspection Agency Master Electrician/Licensed Installer Information Name Lic# Address email Phone# Cell# Company Name Francisco Barajas 1868 info@jbgelectriccorp.com 9144380282 JBG Electric Corp. Company Address 24 Walnut st. New Rochelle, New York,10801 Address of Work? Homeowner Information 175 Ivy Hill Crescent. Electrical Permit Application,page 111 �y BRnvk VILLAGE OF RYE BROOK 938 King 5t Rye Brook,NY 10573 Q Y Phone:(914)939-0668 1 www.ryebrook.gov 1982'� Building Department Electrical/Service(Remodel)Permit Permit Set 175 IVY HILL CRIES P#RB25-0041 R#129.76-1-38 PERMIT INFORMATION Address Permit number Date issued 175 IVY H I LL CRES RB25-0041 10/01/2025 REVIEWED BY If you have any questions regarding the review of these drawings please contact: Application in general Steven Fews stevefews@ryebrook.org INSTRUCTION AND ATTENTION It is the responsibility of the Applicant to print full size the entire approved permit package and provide at the time of inspection. TABLE OF CONTENTS Cover page 1 Building Permit 2 Required Inspections 3 3rd Party Electrical Inspection Form 4 Copy of Electrical License 5 Electrical Permit Application 6 Building Department.938 King St Rye Brook,NY 30573/Phone:(914)939-0668 4�y BRnv� VILLAGE OF RYE BROOK W 938 King St Rye Brook,NY 10573 � Q Y Phone:(914)939-0668 1 www.ryebrook.gov > �O ��• 02• f Building Department INSTRUCTIONS THE PERMIT HOLDER AND/OR PROPERTY OWNER IS RESPONSIBLE FOR ENSURING THAT ALL REQUIRED/APPLICABLE INSPECTIONS ARE SCHEDULED AND THAT THE PERMIT IS COMPLETE ❑. ❑@ ❑0 REQUIRED INSPECTIONS Name Description Final Inspection Completion of all required items under the permit including the site grading and the surveyor's final grading certificate. INSPECTIONSTATE WIDE set-vice With Integiii'), 0•0 • • SWIS • - APPLICATION .2.7224 1 fax 914.219.1062 1 SWISNYcoml SWISTRAINING.COM Office Use Elect. Permit # Date Bldg Permit is me 25 —0:14 Sq Ft Plumbing Permit# Final Certificate# City/Village Yw 20�y -YW Zip Building Dept. County Address ��� a t Co-sW i Cross Street Section Block Lot Owner Name/Address(If different than above) (natfi r' Contact Number 14)g332��S ❑Basement ❑1st Fl. ❑2nd Fl. ❑3rd Fl. ❑More Than 3 Fl. ❑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 I 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 ]unction Box Combiner Box Load Center PV Monitor Energy Storage System DC Disconnect ❑Legalization ❑ Safety Inspection ❑Consultation Scope of Work I ��5 P6(Z ha0c� � CA Cb_� Qe�j�CcCQ�. I his 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 anytime of inspection additional items have been installed,you are authorized to make the inspection and adjust the fee for the additional items inspectedThe 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 11 1�� / ko 6 W ` ,`t 1(1 Name _:F� 5L S License# Date Signattilfej Address �A w 110� City/State Zip Code lO��, Co many 6 G Co" Phone# Q l{ 3g �Z p State Wide Inspection Services 1080 Main Street ' Fishkill, NY 12524 ts%V U 5 � f 845 202-7224 Phone VILLAGE OF RYE BRCO'- 914-219-1062 Fax STATE WIDE INSPECTION SERVICES BUILDING DEPARTMENT Email: office@swisny.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: JBG Electric Corp Mathew Rosen Francisco Barajas 175 Ivy Hill Crescent 24 WALNUT STREET Rye Brook, NY 10573 NEW ROCHELLE, NEW YORK 10801 Located at: 175 Ivy Hill Crescent, Rye Brook, NY 10573 Section: Block: Lot: Electrical Permit Number: RB25-0041 129.76 1 38 Certificate Number: 2025-8728 Building Permit Number: MP 25-071 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: 175 Ivy Hill Crescent, Rye Brook, NY 10573 The Attic, Patio& 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 12"'day of December 2025. Name Quantity Rating Circuit Type HVAC System 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. N Ln LIr N v` ,. arA u a a v W f m H O Z o > z z N $ H oo � O Ln v, w00, a v CA ON V ao C!) Q - ., CISiil C7 o w 4 1.4 ? � x a z c `j c h v: 0 ° a � �I a °c z w ae BUILDING DEPARTMENT p E C E V E VILLAGE OF RYE BROOK DD 938 MNG STREET RYE BROOK,NY 10573 MAY 15 2025 (914)939-0668 www.ryebrookny. VILLAGE OF RYE BROOK ELECTRICAL PERMIT APPLICATIQ BUILDING DEPARTMENT Westchester Cou aster Electricians License Required FOR OFFICE USE ONLY EP#: Approval Date: MAY 2 Permit Fee: $ 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, 5-1 S-�)� 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 wt It all applicable Federal,State,County and Local Codes. r 1.Address: —�-5 IL/ V1 o t"jr SBL: /c:) /,71e —1-3 Zone:/ c^ 2.Property Owner: &N Addressl?-5 14 t Phone#: Cell#: email: —7 3.Master Electrician/Licensed Installer /�/�'<<� r� �/ L7 AddrOe�ss:, / Lic.#?��ft'C Phone#:W��ffgy'lf b Cell#: 3s��.r32' etail:, 2I-C -"Cr, Company Name: G f, t1fu1-fqW "� Address:7 o S a41- 4.Proposed Electrical W rk/Fixturc Count: 5.Yd Party Electrical Inspection Agency: STATE OF NEW YORK,COUNTY OF WESTCHESTER ) as: .being duly swom,deposes and states that he/she is the applicant above named,and does further (print name of individual signing as the applicant) state that(s)he is the 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 bef e this day of ,20 der ,20 Signature of Property Owner Si a of Appli/ Print Name of Property Owner Pri Name o App"cant ALEJANDRA LARIZZA6 �� Notary Public NOTARY PUBLIC,STATE OF NEW YORK o Public Registration No.OILA63831 18 6/l/2024 Qualified in Westchester County Commission Expires 0312712027 STATE WIDE INSPECTION SERVICES, INC. Service With Integrity 0•0 • • swis JOB APPLICATION0. • Office Use Elect. Permit# a— Date Bldg Permit# 71 Scl Ft 71 Plumbing Perm&&A %J Final Certificate# City/Village Zip Building Dept. '- Y, fr7)') County Address Cross Street Section Block Lot Owner Name/Address(1f different than above) Contact Number ❑Basement ❑ 1st Fl. ❑2nd Fl. ❑3rd Fl. ❑More Than 3 Fl. ❑Garage ❑Attic ❑Outside ❑Residential ❑Commercial Receptacles Special Recept GFCI AFCI Switches Dimmers Smoke Alarms C/0 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 /r / �(t ( Z 1 (2v D CC� C �M� [MAY 15 2025 DD VILLAGE OF RYE 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 anytime 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 Name License# Date Signature Address City/State Zip Code Company Phone# lvy llIvY Nill crescent Hi crescent �,.•� � olaa�l t dL 4�-4�1 . It ` O r p �f � - Ni + H •,� a • ���`� lot Ju,J AIR HANDLERS CBK45UHPT MERIT" Series LENNOX Upflow/Horizontal I PSC Motor I Quantum'" Coil I TXV Furnished / i 60Hz RESIDENTIAL 1.5to3.5Tons PRODUCT SPECIFICATIONS (EHB) Optional Electric Heat - 4to15 kW MERIT° �r SERIES i, 0. Nox QUANTLIK COIL N011:--riflUffidlers are furnished with a factory . . . expansion ... componentsNME---See R-454B Refrigerant Conversion Table on page 8 for additional -. for MODEL NUMBER IDENTIFICATION CBK45UH PT- 036 - 230 - 01 Unit Type----------------• •-----------Revision Level CB=Air Handier ; ; ; 01 =R-410A TXV installed Refrigerant Compatibility•---------- ---Voltage K= R-454B Compatible 230=208/23OV-1 phases e�-6_0h • -----•Nominal Cooling Capacity Series---- 45=Merit''Series,Quantum'"Coil ' `018=1.5 tons 024=2 tons ' 030=2.5 tons 036=3 tons Position-------- 042=3.5tons UH=Upflow/Horizontal ------Metering Device Blower Motor-------- T=Factory installed Check/Expansion Valve P=Permanent Split Capacitor(PSC)E for R-410A refrigerant(non-bleed port) Form Number 211067 1 July 2024 Supersedes all previous versions FEATURE HIGHLIGHTS on 1. Quantum" Coil 2. Refrigerant Line Connections 3. Check and Expansion Valve 4. PSC Blower Motor 5. Heavy Gauge Steel Cabinet �\ 6. Anti-Microbial Dual Position Drain Pans 7. Air Filter 8. Transformer and Blower Relay 9. Electric Heat (option) r • t� W040,1: ® ® 0o CONTENTS Approvals And Warranty . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .3 BlowerData . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .9 Dimensions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16 Accessories . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18 Unit-Horizontal Position . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17 Unit-Upflow Position . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16 Electrical Data. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .7 Electric Heat Data. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 Features . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .3 Installation Clearances With Electric Heat . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .8 Model Number Identification. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1 Optional Accessories-Order Separately . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .7 Optional R-454B TXV Substitution . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .8 Replacement Circuit Breakers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .8 Specifications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .7 CBK45UHPT(-01)1 R-410A 11.5 to 3.5 ton Air Handlers I Page 2 APPROVALS AND WARRANTY APPROVALS • Tested with matching air conditioners and heat pump units in the Lennox Research Laboratory environmental test room in accordance with AHRI Standard 210/240-2023 • AHRI Certified system match-ups and expanded ratings,visit www.LennoxPros.com • ETL Listed to US and Canadian safety standards and components within are bonded for grounding to meet safety standards for servicing required by NEC and CEC • Optional electric heaters are ETL listed and rated in accordance with US Department of Energy(DOE)test procedures and Federal Trade Commission(FTC)labeling regulations • Blower performance data according to unit tests conducted in Lennox air test chamber • Approved for installation in manufactured housing and mobile homes • ISO 9001 Registered Manufacturing Quality System NOTE-Air handlers can be field configured for use with R-454B refrigerant during the initial installation only.Air handlers may not be modified after initial installation. WARRANTY • All covered components • Limited five years in residential applications • Limited one year in non-residential applications NOTE-Refer to Lennox®Basic Limited Warranty at www.Lennox.com for additional details. FEATURES APPLICATIONS ®Refrigerant Line Connections • 1.5 to 3.5 ton nominal sizes • Copper refrigerant sweat connections on both liquid and • Upflow or horizontal applications suction lines for easy brazing NOTE-Downflow applications require optional conversion ' Lines extend outside of the cabinet for ease of kit. connection • Applicable to expansion valve systems in cooling • See dimension drawings for locations applications and check and expansion valve systems in ®R-410A Check and Expansion Valve heat pump applications • For use with R-410A systems • Wide-range check and expansion valve is factory • Wide range valve with Chatleff style fitting installed • Factory installed on all models,internal to cabinet • Optional field installed electric heaters available in several sizes for additive heating capacity REFRIGERANT SYSTEM OQuantum- Coil • Lennox designed and fabricated coil • Enhanced aluminum alloy tube/enhanced fin coil for superior corrosion resistance • Aluminum tubing,hairpins,distributor and header tubes • Ripple-edged aluminum fins • Twin coil construction assembled in a'A'configuration for large surface area • Provides excellent heat transfer and low air resistance for maximum efficiency • Precise circuiting for uniform refrigerant distribution • Lanced fins provide maximum exposure of fin surface to air stream • Helical grooved tubing provides superior heat transfer • Coil thoroughly factory tested under high pressure to ensure leakproof construction CBK45UHPT(-01)1 R-410A 11.5 to 3.5 ton Air Handlers I Page 3 FEATURES R-454B REFRIGERANT CONVERSION • On system start-up blower will run for five minutes and Additional Components are required for conversion to any thermostat demands are disabled R-454B Refrigerant: - Dimensions(H x W x D):7-7/16 x 7-7/16 x 2-1/2(189 x • Refrigerant Detection System(RDS)Air Handler Sensor Kit 189 x 127 mm) • Refrigerant Detection System(RDS)Non-Communicating • See R-454B Refrigerant Conversion Table on page 5 Blower Control Board NOTE-Refer to the Installation Instructions for additional • R-454B Check and Expansion Valve information. Optional Accessories R-454B Check and Expansion Valve • For use with R-454B systems Refrigerant Detection System(RDS)Air Handler Sensor Kit . Wide range valve with Chatleff style fitting • Complies with UL 60335-2-40 approved standard • Required for all systems using R-454B refrigerant • Replaces factory installed TXV,internal to cabinet • Consists of Refrigerant Detection System(RDS)sensor, ' See Optional R-454B TXV Substitution table on page 8 mounting brackets and A2L labeling BLOWER • Sensor ensures safe operation for systems equipped ©permanent Split Capacitor(PSC)Motor with R-454B refrigerant • Mufti-sped PSC motor • Indoor sensor will detect any R-454B refrigerant • Choice a blower speeds • See R-454B Refrigerant Conversion Table on page 8 • Speed changes easily accomplished by a simple wiring Refrigerant Detection System(RDS)Blower Control Board change Communicating Blower Control Board(Universal) • Blower is easily removed from unit for servicing • Communicating Blower Control Board and Sensor can Time Delay Blower Relay be used universally with any Lennoxe'communicating - Relay allows one second blower"on"delay before air handler or any non-communicating 24 volt air continuous fan or cooling operation and 45 second handler blower"off"delay after continuous fan or cooling Non-Communicating Blower Control Board operation • Non-Communicating Blower Control Board and Sensor can be used with any non-communicating 24 volt air handler Standard Features • Complies with UL 60335-2-40 approved standard • Required for all systems using R-454B refrigerant • Connects to the RDS sensor furnished with the RDS Air Handler Sensor Kit • Supports up to two RDS Sensors(factory setting) • Used as interface between indoor unit and thermostat to control system • Ensures safe operation for systems equipped with R-454B refrigerant • If R-454B refrigerant is detected,the refrigerant detection system will stop compressor and/or heating operation and operate the blower to reduce concentrations in the conditioned space • Once safe levels are reached the HVAC system will resume normal operation • Multi-color LED for system status and as an aid in troubleshooting - Flashing LED codes for system status(Green/Blue) and diagnosing Sensor errors(Red) • Alarm relay can trigger an external alarm if R-454B refrigerant is detected • Zone relay opens all zone dampers(if part of a zoning system)if R-454B refrigerant is detected • Power is disabled to non-communicating thermostats to prevent demand if R-454B refrigerant is detected CBK45UHPT(-01)1 R-410A 11.5 to 3.5 ton Air Handlers I Page 4 FEATURES CABINET Wall Hanging Bracket Kit(Upflow Only) ®• Constructed of heavy gauge galvanized steel • Allows unit to be hung on wall at any height • Pre-painted cabinet finish • Consists of heavy-gauge steel support brackets(one for • Completely insulated with foil faced fiberglass insulation air handler,one for wall mount) • Removable panels provide complete service access ' Screws furnished for fastening one bracket to unit • Filter access door for easy filter replacement • Bolts for fastening one bracket to wall are field provided • Thumbscrews hold filter door in place High Performance Economizer • Electrical inlets provided in sides and top of cabinet (Commercial Applications Only) • Designed for applications requiring outdoor air to be • See dimension drawing for locations utilized in a commercial HVAC system • Plugs in cabinet for drain connections for upflow(left • Allows the entry of fresh outdoor air for free cooling, and right)and horizontal applications reducing the requirement for mechanical cooling • See dimension drawing • Heavy gauge galvanized steel cabinet lined with thick Low Leakage Cabinet fiberglass insulation • All models have less than 2%air leakage and meet • Mixed air sensor,outdoor air sensor and 24VAC ANSI/ASHRAE Standard 193-2010"Method of Test for transformer furnished Determining the Air Tightness of HVAC Equipment • Approved for California Title 24 building standards Upflow/Horizontal Capability(Optional Downflow) • ASHRAE 90.1-2010 compliant • Shipped for upflow and horizontal right-hand discharge • See separate Product Specifications document for • May be field converted to horizontal left-hand air additional information and available control and sensor discharge by repositioning horizontal drain pan options • Optional downflow kit required for field conversion FILTER ®Anti-Microbial Dual Position Drain Pans ®• Disposable 1 inch filter is furnished • Anti-Microbial additive resists growth of mold and • Filter rack furnished in cabinet for easy filter installation mildew on drain pan which improves indoor air quality • See Specifications tables for filter sizes and reduces drain line blockage • Drain pans designed for upflow or horizontal applications • Deep,corrosion resistant high temperature engineered polymer drain pans have dual pipe drains • See dimension drawing Optional Accessories Downflow Conversion Kit • Required for field conversion to downflow position • Kit consists of insulated downflow drain pan,insulated drain pan drip shields,coil drip shields,seal plates and support brackets for repositioning coil and drain pan Horizontal Support Frame Kit • Provides support of unit in horizontal applications • Consists of(2) 1 x 1-1/2 x 32-5/8 in.and(2) 1 x 3 x 53-7/8 in. painted heavy gauge cold rolled steel support channels with assembly and suspending holes • Bolts and nuts furnished for field assembly • Suspending rods must be field provided Side Return Unit Stand(Upflow Only) • Raises unit 16 in. above floor for side return air duct connection • Eliminates need for wooden platform construction • All aluminum construction • Two adjustable frames fit all sizes COK45UMPT(-01)1 R-410A 11.5 to 3.5 ton Air Handlers I Page 5 AIR CONDITIONERS ML14KC1 MERIT' SERIES LENNOX Single-Stage I Quantum- Coil I 1 1-Phase 1 60Hz a RESIDENTIAL 1.5to 5Tons PRODUCT SPECIFICATIONS (EHB) SEER2 up to 17.0 Cooling Capacity 117,000 to 60,000 Btuh MERIT" SERIES zz NNOX QUANTUM COIL �ZZ �... r- �- --^"' 2025 COMPLIANT REFRIGERANT ra , . MODEL NUMBER IDENTIFICATION ML14KC1 - 036 - 230A01 ; Product Tier----------- ; ; ; ; ;-------- Revision Level ML=Merit'Series •-------- Ratings Revision Level Nominal SEER2 x----- 14=14.0 to 14.9 SEER ----- --Voltage 230=208/23OV-1 phase-60Hz Refrigerant Type----------- K=R-4546 , , ----- Nominal Cooling Capacity 018=1.5 tons 024=2 tons 030=2.5 tons Unit Type-------- ; 036=3tons C=Air Conditioner(Condenser) 041 =3.5 tons 042=3.5 tons 047=4 tons 048=4 tons Cooling Stages------- 059=5tons 1=Single-Stage Compressor :060=5 tons Form Number 2110581 April 2024 Supersedes all previous versions FEATURE HIGHLIGHTS 0 :m i 0 1. Outdoor Coil Fan 2. Quantum" Coil 3. Scroll Compressor 4. Heavy Gauge Steel Cabinet � 5. Refrigerant Line Connections and Access ' CONTENTS Approvals And Warranty . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .3 Dimensions-Unit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .9 Electrical Data. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .7 Expanded Sound Data . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 Features . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .3 FieldWiring . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 Installation Clearances . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 Model Number Identification. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1 Optional Accessories-Order Separately . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .7 Optional Controls-Order Separately . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .7 Specifications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .7 TXV Substitution-R-454B . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 TXV Usage. . . . . . . . . . . . . . . . . . 11 MU 4KC1 11.5 to 5 Ton Air Conditioner I Page 2 APPROVALS AND WARRANTY APPROVALS • AHRI Standard 210/240-2023 certified • AHRI Certified system match-ups and expanded ratings,visit www.LennoxPros.com • ENERGY STAR®Certified • Sound rated to AHRI Standard 270-2008 test conditions • Tested in Lennox'Research Laboratory environmental test room • Rated According to U.S.Department of Energy(DOE)test procedures • Region specific models meet the minimum efficiency requirements for U.S. DOE Federal Regional Standards in that area • Unit and components ETL,NEC and CEC bonded for grounding to meet safety standards for servicing • ETL certified(U.S.and Canada) • ISO 9001 Registered Manufacturing Quality System WARRANTY • Compressor: • Limited five years in residential installations • Limited five years in non-residential installations • All other covered components: • Limited five years in residential installations • Limited one year in non-residential installations NOTE-Refer to Lennox°Basic Limited Warranty at www.Lennox.com for additional details. FEATURES APPLICATIONS a Quantum- Coil • 1.5 through 5 tons • Lennox designed and fabricated coil • Sound levels as low as 73 dBA • Enhanced aluminum alloy tube/enhanced fin coil • Single-phase power supply • Superior corrosion resistance • Vertical air discharge • Ripple-edged aluminum fins • Applicable to indoor air handlers or gas furnaces with • Aluminum tube construction indoor add-on coils • Lanced fins for maximum fin surface exposure • Shipped completely factory assembled,piped and wired • Fin collars grip tubing for maximum contact area REFRIGERATION SYSTEM • Flared shoulder tubing connections R-454B Refrigerant • Factory tested under high pressure • Low GWP(Global Warming Potential) • Entire coil is accessible for cleaning • Zero ODP(Ozone Depletion Potential) High Capacity Liquid Line Drier • Low Toxicity/Lower Flammability-A2L • Furnished with unit for field installation • Unit is factory pre-charged • Traps any moisture or dirt that could contaminate the NOTE-Total system refrigerant charge is dependent on refrigerant system outdoor unit size,indoor unit size and refrigerant • 100%molecular-sieve,bead type line length. High Pressure Switch NOTE-Refer to the unit-mounted charging sticker to • Protects the system from high pressure conditions that determine correct amount of charge required. can be a result of fan failure or a blocked/dirty coil OOutdoor Coil Fan • Automatic reset • Direct drive fan Low Pressure Switch • Vertical air discharge • Shuts off unit if suction pressure falls below setting • Totally enclosed fan motor • Provides loss of charge and freeze-up protection • Ball bearings • Automatic reset • Inherently protected • Motor rain shield • Louvered steel fan guard ML14KC1 11.5 to 5 Ton Afr Conditner l Paya 3 FEATURES REFRIGERATION SYSTEM (Continued) COMPRESSOR Optional Accessories ®Single-Stage Scroll Compressor Expansion Valve Kits • High volumetric efficiency • Field installed on indoor units (if required) • Uniform suction flow • See TXV Usage table • Constant discharge flow • Chatleff-style fitting • Quiet operation Freezestat • Low gas pulses during • Senses suction line temperature compression reduces operational sound levels • Cycles compressor off when suction line temperature • Compressor motor is internally falls below freezestat setpoint protected from excessive current • Opens at 29°F and closes at 58°F and temperature • Installs on or near the discharge line of the evaporator or • Muffler in discharge line reduces on the suction line operating sound levels Loss of Charge Switch Kit • Compressor is installed in the unit on resilient rubber • Protects compressor from damage from low refrigerant mounts for vibration free operation charge conditions Scroll Compressor Operation • SPST,normally-closed • Two involute spiral scrolls matched together generate a • Automatic reset series of crescent-shaped gas pockets between them Refrigerant Line Kits • During compression,one scroll remains stationary while • Refrigerant lines are shipped refrigeration clean the other scroll orbits around it • Gas is drawn into the outer pocket,the pocket is sealed • Lines are cleaned,dried,pressurized and sealed at as the scroll rotates factory • As the spiral movement continues,gas pockets are • Suction line fully insulated pushed to the center of the scrolls.Volume between the • Lines are stubbed at both ends pockets is simultaneously reduced INDOOR REFRIGERANT DETECTION SYSTEM (RDS) • When the pocket reaches the center,gas is now at high pressure and is forced out of a port located in the center • Complies with UL 60335-2-40 approved standard of the fixed scrolls • Required for all systems using R-454B refrigerant • During compression,several pockets are compressed • Factory or field installed on all indoor units simultaneously resulting in a smooth continuous • Consists of a RDS refrigerant detection sensor and a compression cycle mitigation control in the indoor unit • Continuous flank contact,maintained by centrifugal • Ensures safe operation for systems equipped with force,minimizes gas leakage and maximizes efficiency R-454B refrigerant • Compressor is tolerant to the effects of slugging and • Indoor sensor will detect any R-454B refrigerant contaminants. If this occurs,scrolls separate,allowing liquid or contaminants to be worked toward the center • If R-454B refrigerant is detected,the refrigerant and discharged detection system will stop compressor operation and operate the blower to reduce concentrations in the Compressor Crankcase Heater conditioned space (041 through 060 Models) • Once safe levels are reached the HVAC system will • Prevents migration of liquid refrigerant into compressor resume normal operation and ensures proper compressor lubrication • Refer to indoor unit Product Specifications documents Optional Accessories for additional details Compressor Crankcase Heater (018 through 036 Models) • Prevents migration of liquid refrigerant into compressor and ensures proper compressor lubrication Compressor Sound Cover • Reinforced vinyl compressor cover • 1-1/2 inch thick batt fiberglass insulation • All open edges are sealed with a one-inch wide hook and loop fastening tape ML14KC1 11.5 to 5 Ton Air Conditioner I Page 4 FEATURES COMPRESSOR (continued) • Smart Away--Uses geo-fencing technology Optional Accessories (continued) to determine when the homeowner is within a predetermined distance from the home to operate the Compressor Hard Start Kit system when leaving,away and arriving • Single-phase units are equipped with a PSC compressor • Wi-Fi remote monitoring and adjustment through a motor home wireless network for desktop PCs,laptops and • This type of motor normally does not need a potential apps for smartphones or tablets relay and start capacitor • Smart home automation compatible with Amazon • For conditions such as low voltage,kit may be required AlexaO,Google Assistant and IFTTT to increase the compressor starting torque • Service Dashboard features online real-time monitoring Compressor Low Ambient Cut-Off Switch of installed Lennox®thermostats • Non-adjustable switch (low ambient cut-out) NOTE-See the M30 Smart Wi-Fi Thermostat Product Prevents compressor operation when outdoor Specifications document in the Controls section • temperature is below 35°F for more information. Remote Outdoor Temperature Sensor Compressor Time-Off Control • Used with the M30 Smart Wi-Fi • Kit prevents compressor short-cycling Thermostat • Allows time for suction and discharge pressure to • Outdoor sensor allows thermostat to equalize. display outdoor temperature • Permits compressor start-up in an unloaded condition. Thermostat • Automatic reset with 5 minute delay between • Thermostat is not furnished with unit compressor shut-off and start-up • See Lennox Price Book or Lennox Pros for selection CONTROLS Indoor Blower Off Delay Relay Optional Accessories • Delays the indoor blower-off time during the cooling M30 Smart Wi-Fi Thermostat cycle • Wi-Fi-enabled,electronic 7-day,universal,multi-stage, Low Ambient Kit programmable,touchscreen thermostat • Air conditioners can operate down to 45°F outdoor air • 4 Heat/2 Cool temperature without additional controls • Auto-changeover • Allows unit to operate properly down to 30°F • Dual-fuel control with NOTE-Crankcase heater and freezestat should be optional outdoor sensor installed on compressors equipped with a low ambient kit. • Controls dehumidification NOTE-A compressor lock-out thermostat should be during cooling mode and added to terminate compressor operation below humidification during heating mode recommended operation conditions. • Offers enhanced capabilities including humidification/ dehumidification/dewpoint measurement and control, HumiditrolO control,and equipment maintenance reminders • Easy to read 4.3 in. color touchscreen (measured diagonally) • LCD display with backlight shows the current and set temperature,time,inside relative humidity,system status(operating mode and schedules)and outside temperature(optional outdoor sensor required) • Smooth Setback Recovery starts system early to achieve setpoint at start of program period • Compressor short-cycle protection (5 minutes) • Up to four separate schedules are available plus Schedule IQ' • One-Touch Away Mode-A quick and easy way to set the cooling and heating setpoints while away ML14KC1 11.5 to 5 Ton Air Conditioner I Page 5 ACORO® CERTIFICATE OF LIABILITY INSURANCE DATE /1 /2 Y) ��. 1za/ 024oza 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 CON ACI NAME: CLIENT CONTACT CENTER FEDERATED MUTUAL INSURANCE COMPANY PNONr_ HOME OFFICE: P.O. BOX 328 (A/c,No,Ext):888-3334949 JA C,No):507 446 4664 OWATONNA, MN 55060 AODRESs:CLIENTCONTACTCENTER FEDINS.COM INSURERS AFFORDING COVERAGE NAIC# INSURER A:FEDERATED MUTUAL INSURANCE COMPANY 13935 INSURED INSURER B:FEDERATED RESERVE INSURANCE COMPANY 16024 ARCTIC MECHANICAL INCORPORATED INSURER C: 460 N MAIN ST — PORT CHESTER, NY 10573-3310 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:90 REVISION NUMBER:0 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 DMITS LTR INSR WVD MMIDD/YYYY MMIDD/YYYY X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $1,000poo CLAIMS-MADE XI OCCUR DAMAGE TO RENTED PREMISES $1001�p (Ea occurrence) MED EXP(Any one person) EXCLUDED A N N 1887386 01/18/2025 01/18/2026 PERSONAL&ADV INJURY $1,000 ppp GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2 00Q 000 X POLICY �E�T ❑LOC PRODUCTS&COMP/OP ACC $2,000,000 OTHER: LLL.���hP" AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $1 DOp 0op (Ea accident) X ANY AUTO BODILY INJURY(Per Person) A OWNED AUTOS ONLY SCHEDULED N N 1887386 01/18/2025 01/18/2026 BODILY INJURY(Per Accident) AUTOS HIRED AUTOS ONLY NON-OWNED PROPERTY DAMAGE AUTOS ONLY Per Accident X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $5,000,0pp A EXCESS LIAB CLAIMS-MADE N N 9907994 01/18/2025 01/18/2026 AGGREGATE $5,000,000 DED I X RETENTION$10,000 WORKERS COMPENSATION AND EMPLOYERS'LIABILITY YIN X I PER STATUTE I THER ANY PROPRIETOR/PARTNER/EXECUTIVE B OFFICER/MEMBER EXCLUDED? N/A N 9298530 01/18/2025 01/18/2026 E.L EACH ACCIDENT $1,ppp,ppp (Mandatory in NH) s, E.L DISEASE EA EMPLOYEE $1,000,000 If ye describe under DESCRIPTION OF OPERATIONS below E.L DISEASE-POLICY LIMIT $1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION VILLAGE OF RYE BROOK 90 0 938 KING ST SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED RYE BROOK, NY 10573-1226 BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE © 1988-2015 ACORD CORPORATION.All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD o K Workers' CERTIFICATE OF STATE Compensation NYS WORKERS' COMPENSATION INSURANCE COVERAGE Board la.Legal Name&Address of Insured(use street address only) 1b.Business Telephone Number of Insured (914)934-8301 Arctic Mechanical Incorporated 286-468-4 460 N Main St Port Chester, NY 10573-3310 1c.NYS Unemployment Insurance Employer Registration Number of 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 06-1596446 2.Name and Address of Entity Requesting Proof of Coverage 3a.Name of Insurance Carrier (Entity Being Listed as the Certificate Holder) Federated Reserve Insurance Company Village Of Rye Brook 938 King St 3b.Policy Number of Entity Listed in Box"1 a" Rye Brook,NY 10573-1226 9298530 3c.Policy effective period 01/18/2025 to 01/18/2026 3d.The Proprietor,Partners or Executive Officers are QX included.(Only check box if all partners/officers included) all excluded or certain partners/officers excluded. This certifies that the insurance carrier indicated above in box"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, 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: Melissa Kopperud (Print name of authorized representative or licensed agent of insurance carrier) Approved by: 2� /1B4A492zd� 12/14/2024 (Signatu )V (Date) Title: Authorized Representative Telephone Number of authorized representative or licensed agent of insurance carrier: 888-333-4949 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