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HomeMy WebLinkAboutMP25-114 BRA � �' 19 VILLAGE OF RYE BROOK MAYOR 938 King Street, Rye Brook,N.Y. 10573 ADMINISTRATOR Jason A.Klein (914) 939-0668 Christopher J. Bradbury www.iyebrookny.gov TRUSTEES BUILDING& FIRE INSPECTOR Susan R. Epstein Steven E. Fews David M.Heiser Donald T.Krom,Jr. Salvatore W.Morlino CERTIFICATE OF COMPLIANCE August 14,2025 Federico De Bediaga Gomes 81 Greenway Close Rye Brook,New York 10573 Re: 81 Greenway Close,Rye Brook,New York 10573 Parcel ID#: 129.84-2-70 This document certifies that the work done under Mechanical Permit#25-114 issued on 7/18/2025 for the installation of a new above-ground oil tank has been satisfactorily completed. Sincerely, Steven E. Fews Building&Fire Inspector /to �E BRnUk O� �m BUILDING DEPARTMENT ❑BUILDING INSPECTOR AssISTANT BUMMING INSPECTOR VILLAGE OF RYE BROOK ❑CODE ENFORCEMENT OFFICER 938 King Street• Rye Brook,NY 10573 (914)939-0668 FAx (914)939-5801 www Uebrook.org - - - - - - - - - - - - - - - INSPECTION REPORT - - - - - - - _ - _ - ADDRESS:--aI — �5� F3 — -- �W� — -- DATE:_ _�Z 7 2Ozj�' PEItMI'i'# 1nP.-- -�+ ___ISSUED:7.�9_�SEC�I:��I;LocI:: �LOT: LOCATION: 2AA OCCUPANCY: ❑ Violation Noted THE WORK IS... WePASSED ❑ FAILED REINSPECTION ❑ SITE INSPECTION REQUIRED ❑ FOOTING ❑ FOOTING DRAINAGE ❑ FOUNDATION ❑ UNDERGROUND PLUMBING NOTES ON INSPECTION: ❑ ROUGH PLUMBING ❑ ROUGH FRAMING ❑ INSULATION ❑ Natural Gas ,p� � � ��. �� O— � r Z O ❑ Gas FUEL TANK —.- ❑ I"IRE SPRINKLER �LL __����P 0• t - �� ❑ .FINAL PLUMBING ' _ ❑ CROSS CONNECTION —�j•el,L� C ❑ FINAL � '— ❑ OTIIER '----- --- — E RRC�� O� tim BUILDING DEPARTMENT ❑BUILDING NNW iCTOR WA.SSIS'I'A.NT BUILDING INSVII(TI'M VILLAGE OF RYE BROOK ❑Cotm ENFORCEMENT 01TICEI.I 938 King Street. Itye Brook,NY 1.0573 (914) 939-0668 FAX (914) 939-5801 www rxe_Uroo_— k.or - - - - - - - - - - - - - - - - - - - - INSPECTION REPORT - - - - - - - - - - - - - - - - - - - - DATE: 48' / —_.OZS— PERMI'i'# 1" 11 �SI / O -------- _C.i- -_----ISSL�EI):T-�$n C'[':. /� • O BLOCK: 0 LOT: 0 .LOCATION: � Qr _ OCCUPANCY: ❑ Violation Noted TIIE WORD IS... ��ASSI?D ❑ FAILED /REINSPECTION ❑ SITE INSPECTION REQUIRED ❑ FOOTING ❑ F0O'.r1NG DRAINAGE ❑ FoUND.ATION ❑ UNDFRGROUND PLUMBING NOTES ON INSPECTION: ❑ ROUGH PLUMBING ❑ ROUGH FRAMING ❑ INSUL.A'i'ION ❑ Natural Ciw% Z • S ❑ L.R Gas ;a—FUEL TANK: RS2 '� • ❑ FIRE SPRINKLER ❑ FINA_L PLUMBING ❑ CROSS CONNECTION — � l �c �V ❑ FINAL � T� Q ❑ O'.1'Hlilt D• �yE BRC�k. BUILDING DEPARTMENT ❑BBUILDING INSPECTOR b ASSISTANT BUILDING INSPECTOR VILLAGE OF RYE BROOK ❑CODE ENFORCEMENT OFFICER 938 King Street • Rye Brook,NY 10573 (914) 939-0668 FAx (914) 939-5801 www ryebrook.ore - - - - - - - - - - - - - - - - - - - - INSPECTION REPORT - - - - - - - - - - - - - - - - - - - - ADDRESS:- C� l�rl� �� C DATE: PERMIT# M P ZS -1 ISSUED: 7-/C9-j� SECT: 21f.3`1 BLOCK: LOT: LOCATION: CJ • OCCUPANCY: ❑ Violation Noted THE WORK IS... ❑ PASSED ❑ FAILED /REINSPECTION ❑ SITE INSPECTION REQUIRED ❑ FOOTING ❑ FOOTING DRAINAGE ❑ FOUNDATION ❑ UNDERGROUND PLUMBING NOTES ON INSPECTION: ❑ ROUGH PLUMBING ❑ ROUGH FRAMING ❑ INSULATION n ❑ Natural Gas �'� 5��. ( o CL Z ZS- 44o--/ F❑ P.Gas 26 T , s. Al m UEL TANK ❑ FIRE SPRINKLER ❑ FINAL PLUMBING . ❑ CROSS CONNECTION ❑ FINAL ❑ OTHER .it L 7f►��+ �• a � o N ■ N C N i N00 V 19 _ W or 04 N a E W L N 00 �� cud • c s�, O pF/� Ln ` O �q[1 3 U 0 W I ;� M O W � 0 Q W � uZ a o404 O zCIS w IO -7 'y� Y3 C, oz 0-4 O Z UZ W �0 0 PQ00 W - 1� - 11 �Q C\ P4 of ►-� Po © 3 V. z z mow ' W z x � vc� .bo o . ULn v04 �I a 441 x �.m 71 a BumL Y 0 D-- =P TMENT VIL�,a E OF RY '#i�00K .1 U L 18 2025 938 KING S`irR ET RYE BR0 ,NY 105'73 1I.A'Q19-066$`� VILLAGE OF RYE BROOK ebtV ©v BUILDING DEPARTMENI Application for Permit to Install Fuel Storage Tank (*Storage Tanks in excess of 1,100 gallons require registration with the County of Westchester) FOR OFFICE USE ONLY: � PERMIT fl: / -� 1Q`s Approval Date: JUL 2 1 Permit Fee: $ � 5-P Approval Signature: ` Other: Disapproved: (fees are non-refundable) **********,►*artttttttar**ttttar*r�**,r,�w�x*,r�rsrx*x*re,rwar***,rx**,a*******�r*****#*******t******,r*�r***�*ar*�r*�r*et*t DO NOT START WORK or CONSTRUCTION UNTIL A PERMIT HAS BEEN ISSUED BY TffE BUILDLNG INSPECTOR.THE ADMINISTRATIVE FEE FOR WORK PROGRESSED OR COMPLETED WITHOUT A PERlIIT IS 12%OF THE TOTAL COST OF CONSTRUCTION WITH A MINIMUM FEE OF$750,00 REQUIREMENTS FOR RELEASE OF PERMIT&CERTIFICATE OF COMPLIANCE: 1.Application Completed by Bonded,Licensed Contractor. 2. Your contractor's valid proof of liability insurance. (Village of Rye Brook must be listed as certificate holder) 3.Your contractor's valid proof of workers compensation insurance. (Form#C105.2 or Form#U26.3/or NY State Workers Compensation Waiver) 4.Fee per Tank: installation: $225.00 per Tank. 5. Dig Safely New York#(dial 811): 6. Inspection by wilding Department for installation. T'Submit all Manifests&Reports(if applicable,after work has been completed). 8. Certificate of Compliance will be provided when all requirements are fulfilled. tttttt**tar*tttttttt*ttartttttttar*ttartttte*,rar*trtrtrtr,kx*,r*t*arar,t,tt*ar**ar�r*�r***•k*>k*****t***,r�r*t*,t**xar**,k*t:taa:at Application dated, ��� �cs ,is hereby made to the Building Inspector of the Village of Rye Brook for a permit to install a Fuel Tank as herein described.The applicant and property owner,by signing this document agree that the subject fuel tank(s) will be installed in conformance with all applicable Village,County, State&Federal laws,codes,rules and regulations. Indicate Permit Type: Above Ground(p)•Buried in Ground{ ) 1. Address: 81 Greenway Close, Rye Brook NY 10573 SBL:A) 70 zone: U 2. Property Owner&Address: FrederiCo Bediaga - same Phone#: Cell#:_ 3 d S C9q 91 -I�} G email: fredbediaga@hotmail.com 3. Contractor&Address: New England Environmental Services,lnc. 420 S Riverside Ave,#305.Croton On Hudson NY 10520 _ Phone#: _ Cell#: 914-879-0170 email: 4. Applicant: Contractor — Phone#: Cell#: email: 5. Indicate Fuel Type:Fuel Oil }•L.P.Gas( )•Gasoline( )•Other( ): 6. Number and Capacity of each Tank: 1 -275 Roth tank 7. Exact Location(s)of each Tank: Install in rear of house next to patio on concrete pad t 6/1/2025 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 Tank Installation 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. 1 Sworn to before me this Sworn to before methis day of (Vi- ! 20 Z 9' day of UL 1 ,20 z S A ��---_ �Signature ofProperty(Owner i a e f ant 160 Print Name of Property 0 r amee of Applicant CkA ASANDRA M CARRERA Notary Public WTARY PUBLIC,STATE OF NEW YORK Notary Public ,ndmy name Registration No.01 CA6367493 WARY rusuc,srArsof IMW you Qualified in Westchester County RBGX ►TMRM0tW+» QuAunra1#xoc=AW c0WM Commission Expires NOVEMBER 20,2025 Cronin This application must he proper}- coniPICICU III IL,, t . 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. a 611/2025 L O +�Lo C �04 O U) O O L � a) L :3 oL- o m 0o cory O W O U) O p U = rLn V r oo D CE� [lwEE I , J U L 18 2025 VILLAGE OF RYE BROOK BUILDING DEPARTMENT The Arbors Homeowners' Association s j 173 '/2 Ivy Hill Crescent Rye Brook, NY 10573 I July 15th, 2025 JUL 18 2025 Frederico De Bediaga Gomes VILLAGE OF RYE BROOK Heloaa BUILDING DEPARTMENT 81 Greenway Close Rye Brook, NY 10573 Re: Above Ground Oil Tank Dear Fred and Helozia , The Architecture and Grounds Committee (A&G) and the Board have reviewed your application for the above-named work. The application is approved and might require screening or painting of your tank. The paint color would match the house color. This will be determined after installation. This project requires a permit from The Village of Rye Brook. You are approved to get a permit from the Village of Rye Brook. You are directed to submit this letter to the Village along with your permit application. Once the permit is obtained, a copy must be provided to A&G. Work on the project may not begin until you receive written notice of receipt of your permit from A&G. If any changes are made to the original plans submitted to A&G, due to input from the Village or arising during construction, the Committee must be notified in writing. Work cannot proceed until you receive written approval for those changes. Failure to comply with these procedures will result in fines and/or work stoppage. If you have any questions, please contact me at: Property Manager. Sincerely, Nicholas Salzarulo Property Manager The Arbors Homeowners' Association 173 '/z Ivy Hill Crescent Rye Brook, NY 10573 IL y August 8t'' , 2025 9 ��AUG - 8 2025 1 L Frederico De Bediaga Gomes ' VILLAGE OF R BROOK BBY RYE Helozia Bediaga BUILf�I\►�= 'DEPARTMENT Rye Greenway Close — Rye Brook, NY 10573 Re: Above Ground Oil Tank Frederico and Helozia, The Architecture and Grounds Committee (A&G) and the Board have reviewed your application for the above-named work. The application is approved and might require screening or painting of your tank. The paint color would match the house color. This will be determined after installation. An inspection of your tank location reveals no screening is required and based on location no painting of the tank is required. This project requires a permit from The Village of Rye Brook. You are approved to get a permit from the Village of Rye Brook. You are directed to submit this letter to the Village along with your permit application. Once the permit is obtained, a copy must be provided to A&G. Work on the project may not begin until you receive written notice of receipt of your permit from A&G. If any changes are made to the original plans submitted to A&G, due to input from the Village or arising during construction, the Committee must be notified in writing. Work cannot proceed until you receive written approval for those changes. Failure to comply with these procedures will result in fines and/or work stoppage. If you have any questions, please contact me at: Property Manager. Sincerely, Nicholas Salzarulo Property Manager Roth double-walled oil tanks offer the highest level of safety and. environmental protection. Rom, Unique double-walled construction Our uniquely designed oil tanks are the safest and most reliable on the market. The outer tank is made of leak-proof,weld-free galvanized steel and rollseamed with an oil and fire-resistant seal.It can contain at least 110 percent of the capacity of the inner tank for maximum protection.The inner tank is made of blow-molded, high-density,seamless polyethylene that is leak proof and will never corrode.Roth tanks are easier and faster to fill thanks to their unique expansion system,all but eliminating the possibility of spills by home heating oil professionals.And,our compact tanks are available in several different sizes,providing more flexibility for placement in any home. . 7 5 Built with safety and the environment in mind a Roth oil tanks exceed the industry standard safety regulations.They are rust resistant 6 inside and out and are designed to prevent spills,leaks and fires caused by defective pipes,couplings or fittings located underneath the tank. In fact, it is the only tank on 3 the market with no fittings below the oil line.Each tank undergoes thorough testing, 2 a including ultrasound and pressure testing,to ensure optimal thickness and sealing. DIESEL ANDw Roth Eco DWT PLUS 3 Features 1 - BID FUELS A - 1 Weld-free galvanized steel outer tank that can hold 110 percent of the primary tank 2 Seamless high-density polyethylene inner tank \ 3 Highly visible optical leak alarm 4 Up to 50 percent lighter than a 12-gauge steel tank with larger storage capacity 5 Noncorrosive steel filling system that provides an even level in each tank when installed in groups 6 Burner feeding system with a Duplex bushing installed directly into the opening. (- Available with 3/8"or 1/2"compression fittings for copper tubing.Fittings can be removed for a threaded opening of either 3/8"or 1/2". NPT on top and bottom for black iron pipe oil lines. 7 Cover for outside use C&UB ® „„.-„.= Mom+ GREAT CONSUMER WEBSITE FREE INSTALLATION TRAINING 'r.l� % In an effort to help consumers become We offer free,one-hour installation .a more aware of the safety and reliability training sessions on a regular basis. <.c7 Say good-bye to worry... Roth oil tanks offer,we have designed Additionally,if you have multiple a micro website specifically for this trainees,we are available to provide product.It is loaded with valuable training at your location.To learn more information and can be found at or arrange a training session,call your u�vcti-.heati»�oilstor'agetanks.com sales representative or a Roth wholesaler in your area. Key Benefits Leak-proof and will not corrode u�`dT n':r:T DvVT DA DNT TankM00e1 400L. 620L 1000L 1000LH 1500L • Outer tank holds 110 percent of inner tank for maximum protection Nom.capacity US gal(liters) 110(400) 165(620) 275 0000) 27500001, 400 0500) Up to 50 percent lighter than Length inches(cm) 29(74) 29174) 43(110) 51 130) 64(163) conventional steel tanks Width inches(cm) 28(72) 28 n2) 2a(72) 30(76) 30(77) Can use for heating oil,diesel Height inches tcm) 44(112) 61(155) 61(155) 54(137) 68(173) and bio fuels Min.height required inches(cm) 49(125) 66(168) 66 Oft 60 052) 76(193) Compact,economical design ! Tank weight lbs.(kg) 106(48) 132(60) 167(76) 208 t94) 333(151) (8 sq.ft.for 1000L) Shipping weight Ihs.(kg) 115(62) 143165! 185(84) 230(104) 358(162) Provides maximum storage safety with minimum space requirements DWT DWT DINT DWT DWT Removable base facilitates access to Tank Model 400L 620L - 1000L 1000LH 1500L • tight spaces and greater stability 2 tanks in inches 29 x 60 29 x 60 43 x 60 51 x 63 64 x 63 (side by side) (74 x 152) (74 x 152) 110 x 152) 030 x 160) (163 x 160) Wide handles on each end allow you — to transport and handle with ease 3 tanks in inches 29 x 92 29 x 92 43 x 92 51 x 96 64 x 96 (side by side) (74 x 234) (74 x 234) 10 x 234) (130 x 244) (163 x 244) Unique expansion system ensures 4 tanks in inches 29 x 124 29 x 124 U43x156 51 x 129 increased storage capacity and (side by side) (74 x 315 (74 x 315 (130 x 328) N/A faster,easier fill-ups 5 tanks in inches 29 x 156 29 x 156 51 x 162(side by side) (74 x 397) (74 x 397) (130 x 4111N!A Quality control and testing exceeds industry standards 2 tanks in inches N/A N/A N/A N/A (end to end) All DWT PLUS 3 oil tanks come with a generous 30-year limited warranty, as well as an insurance policy worth up to $2 million. Rest easy knowing Roth energy storage 4. products �� the most durable on the market and they are guaranteed to last. Roth Eco DWT PLUS 3 Accessories Roth provides the additional components you'll need to install and operate our oil tanks to their full potential. Duplex Bushing, 1/2" or 3/8" Expansion Kits Fuel Oil Gauge (for multiple tanks) Ventalarm Tie Down Kit(for near water) • Leak Indicator • Tank Cover (for outdoor install) z ,6 4�oo� ="w"'s . Call 1.888.266.7684 or visit www.roth-america.com for additional information and product lines. R a RR q q p p p • z - k U k tl y n 11 �f�,�* f �It' 1� t� irl"r 1+ at7 r ) �i ltl �l�ii>� `�!F �'• r v/ � .s • � - '. Ir. r rll ti11�)N�l� _ f � 1'�i1111 r Ij t'1�11 - ,lrrf � t ; ' � .;:F^:�"k::".i-':Z.ri.r""` ,..�.�•.....n.., ...r:R "'n� � r-1.. � 3 !jff ! d t 7 .n AOL N ) w '- v O i y L V ,J eN— .4s /� O � •J � t 1 �c��pd/J� ! U o , 'S <t�s>► L< � lam-+� ��" � Z Q p LU Mr,i Z (n 2 ` ti cr 4.., C Q p o Z r --i co C7 0 � 0 w 'T c a<ca)> CCU C7 61 V �Cv as)>. � •� G :l.' _4 Ca aai)>;•' U it �., r s t ��^.-, i l r l w _ ..•'fti,Yr l e s, r i �� 'y fr ' t> 1- a q •a+• ! ..� a ',� mod.K • ice_/ l `\�'��.�-' ``�^.�...--' ---.�� ......• env_ ��\..."...r+-.'�/' `'t'/� v•-."'„�� ACOROa DATE(MMIDD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 07/10/2025 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 NAME: RICHARD INSLEY FREE FROM RI SK LLC a/c°No Ext: 914-500-9508 (ac,No): 844 217-1700 8 MILL PLAIN RD STE 7 AaDRESS: RICHARD@FRfEFROMRISKLLC.COM DANBURY CT 06811 INSURER(S)AFFORDING COVERAGE NAIC# INSURER A: Benclynark Specialty insurance INSURED INSURER B: Progressive Comm ercial NEW ENGLAND ENVIRONMENTAL SERVICES INC INSURERC: 420 S RIVERSIDE AVE#305 INSURER D: CROT ON NY 10520 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 POLICY EFF POLICY FXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MM/DDNYYY) (MMIDD LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE 5—C]OCCUR PREMISES(Ea occurrence) $ 50,000 MED EXP(Any one Person) $ 10,000 A X MNGR P-2001735 12/05/2024 12/05/2025 PERSONAL 8,ADV INJURY $ 1,000,000 GENT AGGREGATE LIMIT APPLIES PER- GENERAL AGGREGATE s 2,000,000 x POLICY JEC7 LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: PolhtlionLiabilit $ 1,00,000 AUTOMOBILE LIABILITY (Ea accident) $ 1,000,000 ANY AUTO BODILY INJURY(Per person) $ B OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY /� AUTOS 0831702B 10/30'2024 10/302O25 HIRED �/ NON-OWNED $ )c AUTOS ONLY /► AUTOS ONLY (Per acddenl UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EX CESS LIAB HCLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION IR - AND EMPLOYERS'LIABILITY Y/N STATUTE I ER ANY PROPRIETOR/PARTNER/EXECUTIVE� E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? NIA (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ A Professional Liability X MNGR P-2001735 12/05/2024 12/05/2C25 1,000.000 Each Claim DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) VILLAGE OF RYE BROOK 938 KING STREET RYE BROOK NY 10573 Ce tifica to ho Ider is als o listed as addi tiona I insu red. CERTIFICATE HOLDER CANCELLATION VILLAGE OF RYE BROOK SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 938 KING STREET THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN RYE BROOK NY 10573 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE © 88-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD 1r \\ NYSIF New York State Insurance Fund PO Box 66699,Albany,NY 12206 1 nysif.com CERTIFICATE OF WORKERS' COMPENSATION INSURANCE (RENEWED) F A A A A A A 472242944 �� _ NEW ENGLAND ENVIRONMENTAL SERVICESF.,'�14r ' INC � {}i i 420 S RIVERSIDE AVENUE#305 CROTON NY 10520 SCAN TO VALIDATE AND SUBSCRIBE POLICYHOLDER CERTIFICATE HOLDER NEW ENGLAND ENVIRONMENTAL SERVICES VILLAGE OF RYE BROOK INC 938 KING STREET 420 S RIVERSIDE AVENUE#305 RYE BROOK NY 10573 CROTON NY 10520 POLICY NUMBER CERTIFICATE NUMBER POLICY PERIOD DATE W2348 994-1 294430 11/28/2024 TO 11/28/2025 7/17/2025 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE NEW YORK STATE INSURANCE FUND UNDER POLICY NO. 2348 994-1, COVERING THE ENTIRE OBLIGATION OF THIS POLICYHOLDER FOR WORKERS' COMPENSATION UNDER THE NEW YORK WORKERS' COMPENSATION LAW WITH RESPECT TO ALL OPERATIONS IN THE STATE OF NEW YORK, EXCEPT AS INDICATED BELOW, AND, WITH RESPECT TO OPERATIONS OUTSIDE OF NEW YORK, TO THE POLICYHOLDER'S REGULAR NEW YORK STATE EMPLOYEES ONLY. IF YOU WISH TO RECEIVE NOTIFICATIONS REGARDING SAID POLICY,INCLUDING ANY NOTIFICATION OF CANCELLATIONS, OR TO VALIDATE THIS CERTIFICATE,VISIT OUR WEBSITE AT HTTPS://WWW.NYSIF.COM/CERT/CERTVAL.ASP.THE NEW YORK STATE INSURANCE FUND IS NOT LIABLE IN THE EVENT OF FAILURE TO GIVE SUCH NOTIFICATIONS. THIS POLICY DOES NOT COVER CLAIMS OR SUITS THAT ARISE FROM BODILY INJURY SUFFERED BY THE OFFICERS OF THE INSURED CORPORATION. PRESIDENT JEFF HAIG VICE PRESIDENT JAMIE HAIG NEW ENGLAND ENVIROMENTAL SERVICES 1 2OF2 THE POLICY INCLUDES A WAIVER OF SUBROGATION ENDORSEMENT UNDER WHICH NYSIF AGREES TO WAIVE ITS RIGHT OF SUBROGATION TO BRING AN ACTION AGAINST THE CERTIFICATE HOLDER TO RECOVER AMOUNTS WE PAID IN WORKERS'COMPENSATION AND/OR MEDICAL BENEFITS TO OR ON BEHALF OF AN EMPLOYEE OF OUR INSURED IN THE EVENT THAT, PRIOR TO THE DATE OF THE ACCIDENT, THE CERTIFICATE HOLDER HAS ENTERED INTO A WRITTEN CONTRACT WITH OUR INSURED THAT REQUIRES THAT SUCH RIGHT OF SUBROGATION BE WAIVED. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS NOR INSURANCE COVERAGE UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICY. NEW YORK STAT SUR NCE FUND T �V DIRECTOR,INSURANCE FUND UNDERWRITING VALIDATION NUMBER: 708558204 U-26.3