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HomeMy WebLinkAboutRP25-0015PARCEL TYPE OF 308 LOi CONTRACTOR: EST. C/O/SS•T& S_ .� V c%O:S1� fOOTING FOUNDATION FRAMING ROUGH FRAMING INSULATION PLUMBING ROUGH PLUMBING GAS SPRINKLER ELECTRIC LOW VOLTAGE ALARM AS BUILT FINAL EXP: / Ut7 � �� �� . r r r v � FEE: PAID S � --- s FEE:S It/AID DA7Ee_iIL FEE:$ ❑ PAID DATE: PERMIT p: �yE 4R 4 CpC�u o;j j C j �a'a'th,y V 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 January 15,2026 Jose Godoy&Luciana Godoy 127 Brush Hollow Crescent Rye Brook,New York 10573 Re: 127 Brush Hollow Crescent, Rye Brook,New York 10573 Parcel ID#: 129.76-1-133 Roof Permit#RP25-0015 issued 12/4/2025 to Re-Roof Existing Building This certifies that the new roof,installed under the above captioned permit has been satisfactorily completed. Sincerely, Steven E. Fews Building&Fire Inspector /to BUILDING DEPARTMENT ❑BUILDING INSPECTOR O'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.or,- - - - --- - - - - - - - - -- - - - - INSPECTION REPORT - --- -- - -- -- - --- - - --- ADDRESS :—t2- / —6 s S�\ k LLo(---) Co DATE'_- 07042 PERMIT#?ptg-oo /J ISSUED: Z!Y•� SECT: •7 BLOCK: LOT:3 LOCATION: OCCUPANCY: ❑ VIOLATION NOTui) THE. WORK IS... ACCEPTED ❑ REIECTED/ REINSPF,CTION ❑ SITE INSPECTION REQUIRED ❑ FOOTING ❑ FOOTING DRAINAGE ❑ FOUNDATION ❑ UNDERGROUND PLUMBING NOTES ON INSPECTION: ❑ ROUGH PLUMBING ❑ ROUGH FRAMING ❑ INSULATION ❑ NATURAL GAS /V C� �j ❑ L.P.GAS ❑ FUEL TANK _ ❑ FIRE SPRINKLER ❑ FINAL PLUMBING ❑ CROSS CONK I t TION FINAL 10'-OTHER f� Certificate of Occupancy,Certificate of Compliance, Village of Rye Brook and Certification of Final Costs Application 938 King St Rye Brook, NY 10573 Phone: (914)939-0668 1 www.ryebrook.gov Building Department Project Information Address of Project Parcel ID# Zone 127 Brush Hollow Crescent, Rye Brook NY 10573 129.76-1-133 Description of Work Performed on Permit Remove existing shingles and dispose. Inspect and replace any rotted sheathing as needed with CDX to match existing and then tape all seams in the plywood. Install ice&water barrier 2'in from the warm wall, also on all eaves, rakes and valleys. Install new Stormtite synthetic underlayment, leading edge starter shingle, drip edge, ridge vent and flashing as required. Install new asphalt shingles. 9 Squares IKO Dynasty Shingle Occupancy/Use (1 Family, 2 Family 3 Family, Commercial? Town House Owner Address P.E./R.A. or Contractor Address Person in responsible charge Address Final Total Cost of Project 8365 Certificate of Occupancy,Certificate of Compliance,and Certification of Final Costs Application,page 111 E O ] CN k © � O \ / u 0 ( [ $ k ; % c / % �£ e _ \ 77 / # � E }w .. / 7 g /\ E _ ± x © % \ \ LJ uj V) § z & § 7 \ E 2 w kLLI w q 522 = c - O Z / : � � O 2 / o / w o 2 G Lu ^ O w � E fco: oc o e m' E R ° � CN / 0 w § = § 2 § 0 Z � � V a CO 2 © Sb = W D ° En e Eo2 £ § o 0 � d q § 2 � / m \ 0 7q R 2 � £ 2M =J o «§ kLU ƒ0 � Z � 2A - 0 & § k [ ƒ r ƒ § j / \ / f 2 c LU § 2ooc k % q t m OL 2u2 w & ° r, Q U > c u $ # ± o0 wO 6 ) 0JELL cml 0 � � � � ^ q tmZ / / \ \ oo m '0 � ± oa % o w ° a E § R D \ � w � � m --j A = 0 M E U m C 0 / I ; ° 2A ƒ : 0 = E � r 2 § 0 = CL q Q E < E2-= 0 \ o � M » < 3 = O ® � 0Ln \§ ) / f2 g q o u o — e « o u ® / Q q Q w & % - { 0 / \ 5 � a u A ME 00a _ 3 2 f ] ; % k o ± ° 2 _ c o ® q] cc 29gSE § ¥�« Y¥ � % � j ƒ 2 / ICU,(A@2 (z ■ 2 / 2 0k \ m » O E% _ �0a��� 2 a a 0 \ / ƒ � \ Roofing 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: Construction Type: NYS Construction Class: 129.76-1-133 If corner property, indicate street frontage Job Description, list all Methods & Materials: Remove existing shingles and dispose. Inspect and replace any rotted sheathing as needed with '/2" CDX to match existing and then tape all seams in the plywood. Install ice &water barrier 2' in from the warm wall, also on all eaves, rakes and valleys. Install new Stormtite synthetic underlayment, leading edge starter shingle, drip edge, ridge vent and flashing as required. Install new asphalt shingles. 9 Squares IKO Dynasty Shingle Number of stories Height Roof Type Is garage being re-roofed: attached? Yes 0 No ❑ Yes ❑ No Number of Cars: Estimated Cost of Job: (NOTE: The estimated cost shall include all site improvements, 8365 abor, material, scaffolding,fixed equipment, professional fees, and material and labor which may be donated gratis.) Estimated date of completion: 12/17/2025 Roofing Permit Application,page 1/1 #BR VILLAGE OF RYE BROOK938 King St Rye Brook,NY 10573KPhone:(914)939-06681 www.ryebrook.gov O Building Department Residential/(Roofing)Permit Permit Set 127 BRUSH HOLLOW CRES P#RP 25-0015 R#129.76-1-133 PERMIT INFORMATION Address Permit number Date issued 127 BRUSH HOLLOW CRIES RP 25-0015 12/04/2025 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 Application Materials 4 Application Materials 5 Roof Work Proposal 6-14 Application Materials 15 Certificate of Occupancy,Certificate of Compliance,and Certification of Final Costs Application 16 Roofing Permit Application 17 Building Department.938 King St Rye Brook,NY 10573/Phone:(914)939-0668 BR(1V� VILLAGE OF RYE BROOK 938 King St Rye Brook,NY 10573 W Q Phone:(914)939-0668 1 www.ryebrook.gov >���• b2•'f�O Building Department INSTRUCTIONS THE PERMIT HOLDER AND/OR PROPERTY OWNER IS RESPONSIBLE FOR ENSURING THATALL REQUIRED/APPLICABLE INSPECTIONS ARE SCHEDULED AND THAT THE PERMIT IS COMPLETE 3t Ell 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. Certificate of Occupancy Completion of ALL Work,All fees Paid and Final Survey in if required) 29 Northridge Dr. North Windham,CT 06256 Arlo ■ Office:860-563-7661� 9 A Fax:860-455-4300 KLAUSLARSEN owwklkfslarsen,comm www.klauslarsen.com R O O F I N G To Whom It May Concern: This letter will authorize the following person(s) to act as agent(s) on behalf of Klaus Larsen LLC 29 Northridge Drive, North Windham, CT 06256 to pull for permits and inspections with respect to the installation, maintenance and repair of windows, siding, roofing, gutters, entry doors, and insulation. Authorized person(s) Go Permits LLC Scott Doughman Klaus Larsen 01 V Scope of Work 29 Northridge Drive, KLAUSLARSEN Nora Windha 1,CT 06256 Roof Replacement Contract ID 4258757 Customer Name Jose Godoy Created Date Nov 10, 2025 Expiration Date Nov 24, 2025 Job Address 127 Brush Hollow Crescent, Rye Brook, NY 10573 Sales Representative Billing Address 127 Brush Hollow Crescent, Rye Brook, NY 10573 Christopher Dee Phone (914)263-3146 Remove and dispose of all debris generated during project from premises. ❑ Tear off one layer of existing roofing materials. Clean up debris, including using a magnetic roller for nail clean-up. Load debris into dumpster(supplied by contractor)and haul material to plant. Install a Price Assurance Roofing System: ❑ Dedicated Project manager available the day of install to answer any questions and handle any issues they may arise to ensure a smooth installation of your project. Initial ❑ Replace or install over damaged decking with new 1/2"CDX plywood at cost of$99.00 per Quantity: 1 sheet.Thicker plywood will incur additional cost, if required. Final cost will be adjusted based on number of sheets used. Initial X ❑ Supply and install Ice and Water membrane in accordance with KLR specifications: 6 feet at eaves wrapped onto fascia, 18" in either side of valleys, at all side walls, and around all roof penetrations. Supply and install 4"self adhering modified bitumen deck tape to all plywood joints. ❑ Supply and install KRS Velora 1 synthetic underlayment to any roof decking not covered with ice and water membrane. ❑ Supply and install white Premium F8 painted aluminum drip edge to all eaves sealed to ice and water membrane with 4" modified bitumen tape. C 11/10/2025 2:52:53 PM AV/..V 29 Northridge Drive, Scope of Work KLAUSUR North North Wiridha 766m,CT 06256 Roof Replacement is. Contract ID 4258757 Customer Name Jose Godoy Created Date Nov 10,2025 Expiration Date Nov 24,2025 Job Address 127 Brush Hollow Crescent, Rye Brook, NY 10573 Sales Representative Billing Address 127 Brush Hollow Crescent, Rye Brook, NY 10573 Christopher Dee Phone (914)263-3146 Install white C-4 1/2 Aluminum rake metal along all rake edges of the roof. Install purpose-made Starter Shingles along entire outside perimeter of roof. Initial GAF Timberline HDZ-Hickory ( ❑ All shingles are installed with 6 ring shank roofing nails.This ensures that all shingles are nailed securely to the deck and there will be no nail pops and shingles will not slip, lift,or rip off. Remove and replace flashing on chimney with new lead flashing(aluminum in NY)Brown ❑ Velux Curb Mounted Skylight System: Includes Skylight, Flashing Kit,Solar Powered Shade, Quantity:1 Remote Control and installation.Model:3434 ❑ Install SmartRidge II on the roofs ridge,which is a rigid, corrugated plastic ridge vent with an external baffle that provides maximum air flow with ultimate weather protection. Install purpose-made Hip and Ridge Shingles on all ridges and hips. ❑ Quantity: 1 Remove existing vent pipe boot i�replace with new 3"Perma-Boot.Color: Black. 11/10/2025 2:52:53 PM AV .. �� 29 Northridge Drive, Scope of Work KLAUSLAR North sindha,Cr 06256 Roof Replacement FZ 3-7661 Contract ID 4258757 Customer Name Jose Godoy Created Date Nov 10,2025 Expiration Date Nov 24,2025 Job Address 127 Brush Hollow Crescent, Rye Brook, NY 10573 Sales Representative Billing Address 127 Brush Hollow Crescent, Rye Brook, NY 10573 Christopher Dee Phone (914)263-3146 Secure all required building permits from the local building department as needed. ❑ Please be sure to cover any valuables in your attic area that could be damaged or soiled by dust or debris falling through roof boards.We are not responsible for cleaning of the attic. Klaus Larsen Roofing LLC Roofing Workmanship Warranty:20 years. Initial GAF Manufacturer Warranty as explained on website. L 11/10/2025 2:52:53 PM OZ. Payment � 29 Northridge Drive, KLAUSLARSEN Faso Windham, CT 06256 Roof Replacement Contract ID 4258757 Customer Name Jose Godoy Created Date Nov 10, 2025 Expiration Date Nov 24, 2025 Job Address 127 Brush Hollow Crescent, Rye Brook, NY 10573 Sales Representative Billing Address 127 Brush Hollow Crescent, Rye Brook, NY 10573 Christopher Dee Phone (914)263-3146 ORIGINAL $%896.15 ----------------------------------------------------------------------------------------------- Discount $1 ,530.85 Same Day Discount 5% $445.07 Coupon $500.00 Fall $494.81 Manager Discount $90.97 ----------------------------------------------------------------------------------------------- Sub Total $8,365.30 TOTAL $89365.30 Financing Available: AS LOW AS $101 TO $124 PER MONTH. SUBJECT TO APPROVAL. Fully Financed Final Payment Financed • Not Financed Please Initial The Option That Applies To Your Project 11/10/2025 2:53:11 PM 29 Northridge Drive, Contract Agreement KLF[=AUSLARSEN NNorth orth Windham,CT 06256 Roof Replacement Contract ID 4258757 Customer Name Jose Godoy Created Date Nov 10, 2025 Expiration Date Nov 24, 2025 Job Address 127 Brush Hollow Crescent, Rye Brook, NY 10573 Sales Representative Billing Address 127 Brush Hollow Crescent, Rye Brook, NY 10573 Christopher Dee Phone (914)263-3146 THIS AGREEMENT (the "Agreement"), is made by and between Klaus Larsen LLC, lic./reg NO: 0646137 having his principal place of business at 29 Northridge Dr., North Windham, CT 06256, (the "Contractor")and Jose Godoy (the "Owners")to construct, reconstruct, or rehabilitate, as the case may be, improvements to the property. In consideration of the mutual covenants contained herein, Owners and Contractor hereby agree as follows: ARTICLE 1 -SCOPE OF WORK. The Contractor agrees to furnish all labor, materials, equipment, permits, licenses and services for the proper completion of the work to be performed on the property (the "Work")which is described in the scope of work. All Work shall be completed in a professional manner according to standard practices and as described in the scope of work. ARTICLE 2 -TIME OF COMMENCEMENT AND COMPLETION. Contractor shall commence the Work on or about 12/8/2025 and shall fully complete the Work on or before 12/22/2025 (the "Completion Date"), provided however that the Completion Date shall be extended as reasonably required due to any circumstances outside Contractor's control, including weather and other force majeure. ARTICLE 3 -CONTRACT SUM. This is a fixed sum contract. The Owners shall pay to the Contractor for the performance of the Work: $8,365.30 ARTICLE 4 -PAYMENTS. The Owners shall make payments on account of this Agreement, upon the Contractor's request as follows: Payment Made to Klaus Larsen LLC upon signing contract: $2,509.59 Payment Made to Klaus Larsen LLC on completion of Project: $5,855.71 ARTICLE 5 -CONTRACTOR'S INSURANCE. The Contractor shall be responsible for all damages to persons or property that occur on the job site or adjacent thereto as a result of his fault or negligence in connection with this Agreement. ARTICLE 6 -GENERAL RESPONSIBILITIES OF THE CONTRACTOR. The Contractor shall perform the Work using his best skills and attention. The Contractor shall not employ on the Work any person unfit or not skilled in the task assigned to him. The Contractor shall be responsible for acts and omissions of all his employees and agents, all subcontractors, suppliers and material persons, their respective employees and agents and all other persons performing any of the Work. Photos will be taken throughout the process for documentation of the project and for marketing purposes. ARTICLE 7 -GENERAL RESPONSIBILITIES OF THE OWNERS. The Owners shall permit the Contractor to use, at no extra cost, existing utilities (if available) such as light, heat, power and water necessary for the proper execution and completion of the Work. The Owners shall cooperate and shall cause all occupants to cooperate with the Contractor to facilitate the performance of the Work. The Owners shall provide the Contractor with access to the property during normal working hours on normal working days as agreed to by Owners and Contractor. ARTICLE 8 -GUARANTEES AND WARRANTIES. See warranties in Scope of Work section. ARTICLE 9 -ARBITRATION. In the event of any dispute concerning the Contractor and the Owners, the parties agree to enter into arbitration to resolve their disputes. 29 Northridge Drive, Contract Agreement North 5613-dharn,CT 06256 Roof Replacement KLAUSLARSEN North Contract ID 4258757 Customer Name Jose Godoy Created Date Nov 10, 2025 Expiration Date Nov 24, 2025 Job Address 127 Brush Hollow Crescent, Rye Brook, NY 10573 Sales Representative Billing Address 127 Brush Hollow Crescent, Rye Brook, NY 10573 Christopher Dee Phone (914)263-3146 ARTICLE 10 -CANCELLATION. By New York State law, the customer has an unconditional right to cancel the contract until midnight of the third business day after the contract was signed. Cancellation must be done in writing. The contractor is legally required to deposit all progress payments received prior to completion in an escrow account or post a bond to protect these payments. If the contractor or subcontractor who does the work is not paid, he may have a claim against the customer's property under the Lien Law. r TO MOVE FORWARD WITH YOUR CONTRACT: Call your Sales Representative and set a time to review the contract. This is important because we want to ensure that the scope of work is accurate and meets your needs. All details should be listed on the contract, confirming all communication. Your Sales Representative Will Assist You In: 1. Picking your color. 2. Reviewing and completing the Project Checklist. 3. Deciding where you would like the materials and dumpster placed, as needed for your project. 4. Sign and date the contract with your Sales Representative. 5. Submit down payment to your Sales Representative. Once all the above is completed: 1. There is a 3 day, Right of Rescission Period. 2. At the end of the 3 days we apply for the permit. The permit process varies from town to town and this can take anywhere from 1 day to weeks. 3. The production team reviews the contract and will call to schedule. By signing this document, customer agrees to the terms and conditions of this contract. OWNERS: BY: Date 11/10/2025 X. CONTRACTOR: Klaus Larsen LLC BY: "'` ' Date 11/10/2025 Klaus Larsen, member I. A11111k 29 Northridge Drive, Project Checklist KLAUSLAR EN North Windham,CT 06256 (860)563-7661 Contract ID 4258757 Customer Name Jose Godoy Created Date Nov 10,2025 Expiration Date Nov 24, 2025 Job Address 127 Brush Hollow Crescent, Rye Brook, NY 10573 Sales Representative Billing Address 127 Brush Hollow Crescent, Rye Brook, NY 10573 Christopher Dee Phone (914)263-3146 Thank you for choosing Klaus Larsen LLC as your preferred roofing contractor! We appreciate your business and are enthusiastic about the opportunity to serve you on this important home improvement project. To ensure that your project goes as smoothly as possible, please carefully read over the following information and initial in the spaces provided. If you have any questions, you can address them to your sales representative, and they will be happy to assist you. 1. Project Payments Payment for the project is due immediately upon completion. If you have a material delivery payment, it is due when you meet your project manager the morning of the install. Both the project manager and the installation crews will remain on site until after the walk around is completed and will be ready to address any questions or issues that you may have. Once you are satisfied that the project is complete, the project will collect the final payment by cash, check, or credit card. If you financed your project through Klaus Larsen LLC, your foreman will be able to assist you in finalizing your loan. 2. Scope of Work Please review the Scope of Work on your contract carefully and ensure that you fully understand all of the work being performed. If you have any questions or concerns regarding anything on the scope of work, your sales representative will be happy to assist you. It is important to note that only those items specifically written on the contract will be completed during the installation process. If you would like to add any work to your project after the project has started, either your project manager or your sales consultant will provide you with a detailed written quote for the additional work for your review and approval prior to the commencement of the work. 3. Homeowners Preparation A. Providing for protection Of Items in Unfinished Areas (i.e., attics, garages, eaves, etc.) before the installation date. Often during the installation of a new roof, dust and debris will sift through the small gaps in the decking and into the attic and/or garage. It is the responsibility of the homeowner to cover, move, or protect any items in the attic and/or garage. Klaus Larsen LLC assumes no responsibility for the cleanliness of the attic and/or garage or its contents in the installation of the new roof. B. Items on Walls And/or Shelves The installation of a new roof can cause vibrations throughout the structure of a house that can sometimes cause pictures to fall off the walls or small, unstable items to fall off of shelves against the walls. We recommended that any valuable and/or delicate items be moved to a safe place prior to installation of your new roof. Klaus Larsen LLC assumes no responsibility for any items that fall and are damaged as a result of the installation of the new roof. INITIAL 1 29 Northridge Drive, P 1 Oj G C l Checklist North Windham,CT 06256 KLAUSLARSEN (860)563-7661 Contract ID 4258757 Customer Name Jose Godoy Created Date Nov 10, 2025 Expiration Date Nov 24, 2025 Job Address 127 Brush Hollow Crescent, Rye Brook, NY 10573 Sales Representative Billing Address 127 Brush Hollow Crescent, Rye Brook, NY 10573 Christopher Dee Phone (914)263-3146 C. Cracks in Drywall or Plaster The installation of a new roof can cause vibrations throughout the structure of a house that can, on rare occasion, lead to cracks in drywall or plaster. Klaus Larsen LLC assumes no responsibility for any cracks that appear in walls or ceilings after the installation of the roof. D. Delicate Plants & Landscaping Klaus Larsen LLC diligently makes provisions to protect your home and landscaping; however, we cannot guarantee the safety of delicate flowers, shrubs, decorative grasses, or other landscaping. It is important for the homeowner to understand that a roof replacement is a major home improvement project and there will be some impact on the surrounding areas of the yard. Klaus Larsen LLC assumes no responsibility for incidental damage to plants or grasses in the project area. Items to pay special attention to: AC UNIT 4. REMOVING WASTE Project Debris &Waste Container The waste container delivered to the job is only for the disposal and recycling of roofing debris associated with the completion of the work described on the contract. No other material, household waste, furniture, appliances, flooring, etc., is to be placed in the container. We at Klaus Larsen LLC pride ourselves on our sustainability practices and these types of additional waste will make the entire load non-recyclable. The homeowner will be billed for any extra charges stemming from non-project related debris placed in the waste container. 5. INSTRUCTIONS FOR DELIVERY Waste Container& Roofing Supplies Placement Klaus Larsen LLC will communicate with the material supplier and the hauling company to ensure that both the materials and container are placed in the locations agreed upon by the homeowner and the sales representative. Container and material will be placed in the driveway, unless other arrangements have been made by the Sales consultant and the homeowner. However, if the container and materials are placed on a spot other than the driveway, the homeowner assumes all responsibility for any resulting damages. Waste Container Location: PARKING SPACE 127 AND 128 DIAGONAL Roofing Supplies Location: SAME LOCATION 6. IS THE PROJECT LOCATED IN A HISTORIC DISTRICT? NO 7. IS THE PROJECT GOVERNED BY A HOMEOWNER'S ASSOCIATION? 8. IS THIS AN INSURANCE JOB? NO ---- ------------ ------ ------- Please indicate below your preferred methods of communication (Choose Two) Cell Phone (914) 263-3146 Home Phone Text Message (914) 263-3146 Email jlgodoy@aol.com INITIAL APPENDIX B Contract ID 4258757 NOTICE OF CANCELLATION DATE OF TRANSACTION: YOU MAY CANCEL THIS TRANSACTION WITHOUT ANY PENALTY OR OBLIGATION WITHIN THREE BUSINESS DAYS FROM THE ABOVE DATE. IF YOU CANCEL, ANY PROPERTY TRADED IN, ANY PAYMENTS MADE BY YOU UNDER THE CONTRACT OR SALE, AND ANY NEGOTIABLE INSTRUMENT EXECUTED BY YOU WILL BE RETURNED WITHIN TEN BUSINESS DAYS FOLLOWING RECEIPT BY THE SELLER OF YOUR CANCELLATION NOTICE, AND ANY SECURITY INTEREST OUT OF THE TRANSACTION WILL BE CANCELED. IF YOU CANCEL, YOU MUST MAKE AVAILABLE TO THE SELLER, AT YOUR RESIDENCE, IN SUBSTANTIALLY AS GOOD CONDITION AS YOU RECEIVED, ANY GOODS DELIVERED TO YOU UNDER THIS CONTRACT OR SALE; OR YOU MAY, IF YOU WISH, COMPLY WITH THE INSTRUCTIONS OF THE SELLER REGARDING THE RETURN SHIPMENT OF THE GOODS AT THE SELLER'S EXPENSE AND RISK. IF YOU DO MAKE THE GOODS AVAILABLE TO THE SELLER AND THE SELLER DOES NOT PICK THEM UP WITHIN TWENTY DAYS OF THE DATE OF THE CANCELLATION, YOU MAY RETAIN OR DISPOSE OF THE GOODS WITHOUT ANY FURTHER OBLIGATION. IF YOU FAIL TO MAKE THE GOODS AVAILABLE TO THE SELLER , OR IF YOU AGREE TO RETURN THE GOODS TO THE SELLER AND FAIL TO DO SO, THEN YOU REMAIN LIABLE FOR PERFORMANCE OF ALL OBLIGATIONS UNDER THE CONTRACT. TO CANCEL THIS TRANSACTION, MAIL OR DELIVER A SIGNED AND DATED COPY OF THIS CANCELLATION NOTICE OR ANY OTHER WRITTEN NOTICE, OR SEND A TELEGRAM TO KLAUS LARSEN LLC AT 29 NORTHRIDGE DR., NORTH WINDHAM, CT 06256 NOT LATER THAN MIDNIGHT OF I HEREBY CANCEL THIS TRANSACTION. NAME DATE DATE(MM/DDNYYY) AC" R" CERTIFICATE OF LIABILITY INSURANCE 11/21/2025 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 CONTACT Kelly Forrest NAME: King Risk Partners,LLC PHONE (ggg)377-0420 FAX A/C No Ext: A/C,No): 643 SW 4th Ave Suite 210 E-MAIL Kelly.Forrest@king-insurance.com ADDRESS: INSURERS)AFFORDING COVERAGE NAIC# Gainesville FL 32601 INSURER A: Admiral Insurance Company 24856 INSURED INSURER B: Selective Ins CO of South Carolina 19259 KLAUS LARSEN,LLC INSURER c: PMC Insurance Agency Inc. C00212 29 North Ridge Dr. INSURER D INSURER E North Windham CT 06256 INSURER F: COVERAGES CERTIFICATE NUMBER: CL25112104169 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE POLICY EFF POLICY EXP LTR INSD WVD POLICY NUMBER MM/DD/YYYY MM/DD/YYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGEN 100,000 CLAIMS-MADE OCCUR PREMISES Ea occurrence $ MED EXP(Any one person) $ 5,000 A CA000049658-03 07/05/2025 07/05/2026 PERSONAL&ADV INJURY $ 1,000,000 GEN'LAGGREGATE LIMITAPPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY ❑ PRO ❑ LOC PRODUCTS-COMPIOPAGG $ Included JECT OTHER. BI/PD $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 Ea accident X ANY AUTO BODILY INJURY(Per person) $ B OWNED SCHEDULED S 2443336 05/23/2025 05/23/2026 BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per accident Auto Elite Pac $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB HCLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION /� STATUTE EORH AND EMPLOYERS'LIABILITY YIN 500,000 C ANY PROPRIETOR/PARTNER/EXECUTIVE NIA BNUWC0157170 06/22/2025 06/22/2026 E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? FT1(Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 500,000 if yes,describe under 500,000 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) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN Village of Rye Brook ACCORDANCE WITH THE POLICY PROVISIONS. 938 King St. AUTHORIZED REPRESENTATIVE / Rye Brook NY 10573 Kr rr.1r,)i' ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD NYSIF New York State Insurance Fund PO Box 66699,Albany,NY 12206 1 nysif.com CERTIFICATE OF WORKERS' COMPENSATION INSURANCE (RENEWED) 0 � An A A A A 463131056 f� CHARLES G MARCUS AGENCY INC 842 SILAS DEANE HIGHWAY i PO BOX 290756 WETHERSFIELD CT 06129 SCAN TO VALIDATE AND SUBSCRIBE POLICYHOLDER CERTIFICATE HOLDER KLAUS LARSEN, LLC(A CT LLC) VILLAGE OF RYE BROOK 29 NORTH RIDGE DR. 938 KING ST NORTH WINDHAM CT 06256 RYE BROOK NY 10573 POLICY NUMBER CERTIFICATE NUMBER POLICY PERIOD DATE A2526 609-9 1 817790 10/15/2025 TO 10/15/2026 11/21/2025 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE NEW YORK STATE INSURANCE FUND UNDER POLICY NO. 2526 609-9, 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://VVWW.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 THE SOLE PROPRIETOR, PARTNERS AND/OR MEMBERS OF A LIMITED LIABILITY COMPANY. 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 S7NCE FUND V DIRECTOR,INSURANCE FUND UNDERWRITING VALIDATION NUMBER: 534282419 U-26.3