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RB25-0019
PERMIT# RJIQ5�001q DATlE:_.,,!D 5 EXPO )0/74,242 PARCEL TYPE OF JOB LOC OWNER: (- EST. COST: $ /Lo I / FEE: $ Or OL/ vCo %r' : -ll c L (f FEE:$ D DAT E -•"P`CTION RECORD DATE INSPECTION FOOTING FOUNDATION FRAMING ROUGH FRAMING INSULATION PLUMBING ROUGH PLUMBING GAS SPRINKLER ELECTRIC LOW VOLTAGE ALARM ❑ AS BUILT ❑ : FINAL � ` xr s- ` : ❑ PAID DATE:_ PERMIT #: yE f3R i >� 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.ryebrookny.rgoov TRUSTEES BUILDING& FIRE INSPECTOR Susan R. Epstein Steven E. Fews David M. Heiser Donald T. Krom,Jr. Salvatore W. Morlino CERTIFICATE OF COMPLIANCE January 20,2026 Michael Rifelli&Lauren Webber 43 Rock Ridge Drive Rye Brook,New York 10573 Re: 43 Rock Ridge Drive, Rye Brook,New York 10573 Parcel ID#: 135.27-1-65 Building Permit#RB25-0019 issued on 10/7/2025 for Basement Waterproofing This certifies that the basement waterproofing,under the above captioned permit,has been satisfactorily completed. Sincerely, Steven E. Fews Building&Fire Inspector /to BUILDIN(. 1UPA' UTMFNT PERMT# VI1 1 A(i), OI. IIVF,4 sQ )k ISSUED: -; L 938 KING ST'RF R1.1t\t III(t)t►k.NY.W VORk 10573 DATE-j (Q14)9 -t166lt FF:W.: PAID APPLICATION FOR('FRTIFICATF.OF OCCII)PANCY,CF.RTIFI('A•rF:OF COMPLIANCE, AND CFRTIFI('A I-ION OF FIN At,('(ISTS TO BE SUBMITTED ONLY UPON COMPLETION OF ALL WORK AND PRIOR TO THS FINAL INSPECTION ........)).......�.............................................�.../...........................1....................................... Address:_1LiISt3L I/ �u/ ^Q -�r� _ Occuparcy l)sr n _Parcel Tf)#: I��J.� `lIJ S Zone: O-Amet �r; l C tr _Address:yf_Lc�r1 P.E.R.A or Contractor: Address: /7 69^k&3 spo g ,Jp�cu, _ Address: — LT OG i :3 Person in re. nsihle charge: . .� -� Application is hereby made and submitted t the Building Inspector of the Village of Rye Brook for the issuance of a Certificate of Occupancy i Certificate of Compliance for the structure/construction/alteration herein mentioned to accordance with law-: STATE OF NEW YORK,COUNTY OF WESTCHESTER as: ,1 �4 L.iyay� I/j t.baae'V- being duly swom,deposes and says that helshe resides at tPnni Nime of Applicant) in rN, D.,06 k in the County of W S ( (f ✓ in the Statc of that ,Cit,Town Villagcl he she has supervised the work at the location indicated above,and that the actual total cost of the work.including all site improvements. labor.materials,scaffolding,fixed equipment,professional fees,and including the monetary value of any materials and labor which ma} ha%a been donated gratis was:S for the construction or alteration of. _- Deponent further states that he/she has examined the approved plans of the structure/work herein referred to for which a Certai,ate of Occupancy/Compliance is sought,and that to the best of his,her knowledge and belief,the structure/work has been erected.colnpieteu in accordance with the approved plans and any amendments thereto except in so far as variations therefore have been legallc authorized,and as erected/completed complies with the laws governing building construction.Deponent further understands that it shall be un:a,.nil for an owner to use or permit the use of any building or premises or part thereof hereafter created,erected,changed,converted or enlarecd.wholly or partly,in Its use or structure until a Certificate of Occupancy or Certificate of Compliance shall have been duly issued by the Building Inspector as per§250-IO.A,of the Code of the Village of Rye Brook. / Swum to before me this Sworn to before me this day of ay 20 �� day of_ _ — — Signature of Applicant — -- — signature of Propeny Owner - -- ♦�*�l(►tt,('/t <<� Print Name of kpphcant Pi*" Ownent Name ofr r '1 4. t �1. �� Nwan Pubhc —-- — Nutary Public s ;bk6nn F-oriels Henry .' Jackson Francis Henry Notar Public-Connecticut tar, , ,,'- ,C t•, ,,, r cr cul v ( t My Commission Expires Pebruar 28,2029 r,. �yE ak(�k• Q � O` ' 19t32 BUILDING DEPARTMENT ❑BUILDING INSPECTOR 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.ryebro_ o_k Ord - - - - - - - - - - - - - - - - - - - - INSPECTION REPORT - - - - - - - - - - - - - - - - - - - - ADDRESS : e4� -- DATE' PERMIT#__�& q -- �� QO ` --.--ISSUED: 0.7- SECT: - 'Z7 BLOCK: _LOT:-AS LOCATION: — 0_6 SE mea - OCCUPANCY: ❑ VIOLATION NOTIii) THE WORK IS... 2 ACCEPTED ❑ REJECTED/ REINSPECTION ❑ SITE INSPECTION REQUIRED ❑ FOOTING ❑ FOOTING DRAINAGE ❑ FOUNDATION ❑ UNDERGROUND PLUMBING NOTES ON INSPECTION: ❑ ROUGH PLUMBING ❑ ROUGH FRAMING ❑ INSULATION ❑ NATURAL GAS ❑ L.P.GAS ❑ FUEL TANK ❑ FIRE SPRINKLER ❑ FINAL PLUMBING ❑ CROSS CONNECTION Z FINAL OTHER WAN&'an�� Q.{ BRnv� Village of Rye Brook £ Building Department-Inspections 938 King St Rye Brook,NY 10573 1 Phone:(914)939-0668 Fax:(914)939-5801 7 1902ROUGH PLUMBING Permit number: RB25-0019 Permit type: Residential—Stormwater Management Municipal address: 43 ROCK RIDGE DR Legal address: Status of inspection: Completed Issue date: 10/07/2025 Deficiencies No deficiencies or remarks noted. Visits VISIT DATE INSPECTOR VISIT RESULT SITECONDITIONS 12/01/2025,2:00 PM Alfredo(Freddy)DiVitto Passed SUMP PUMP DRAINAGE FROM BASEMENT TO THE OUTSIDE. +19149390668 Parties NAME AND COMPANY • ROLES 43 Rock Ridge Drive,Rye Brook Lauren Webber +14138964116 Property owner 33 Progress Ave,Rye Brook Jackson Henry +112038028840 Applicant C O 0 N c y CV o „ m fLm a� a ErO N i C 41 C 0! C i ra a N N � G1 LL � p � blo C aa- v L v m E v v_ a 3 a w 1 � 0 LL +-, X o a o W N L c m a, f° L n > -0c a > F- W M O W u ^ � y ti Wr- W F- r �c O N O H N Y 3 �' Q o O 1- O Z N > c } N L Q O r t a Z 0 ^ > O - -8d Ec c ou cWY Q � W , co F- Y -C E0 Q O V) O Z a LLJ Cp Z (DO v uy 'a > J cn m e m o E o J W L 3 Y O o O N $ Q C, L y c u L a c > o Y w — W o ca M >' Z �n +' N V 0Wao Ca � a JAM UQ Qaw E c Q �O J C O ro E 0No N � canes w ° � 7v Cl W 00� O 9 NO Zp WLLJ ~ y ara } Z O` �- O > ,� c - aui = 3 YY5 L- pM w � o� 0 E c c > LL Co e- O U N � E a 0 M O' m `ti O a� E W p� �i u 10 F- a dJ Zi r x f0 w C� a UN NQ � Hc °cvc W o00 ip � W 0 Z Q y >- E = O O a - a cn C: U � � W > _ > ° m= p C6 �o a) N E a O v v v to Y _ � 0 c W � acV) o y c c ao o a a- E < - E � O cN O O (A cn O a o „ W O a v a ) 0) = U Q� X i m Lll M M a ca M 'u Q W N (U a>i = r rl Q -n M a J 14 CV c r o N :. E o •N o m 2 a-0 v v Y $ o a n E rC W at ; V m " ` � O `p v c #t co $ � _ E N a i+ N O a = c N J of cz O } E � CC) C W W W Q •- v 0c7 of G Q U F- 0 0 L u ^ u N C . 0 w Y yp�9d1��C a Q a a = Q � a u. Stormwater Management Control 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 Parcel I.D. #: Zone R-15 Proposed Work Basement Waterproofing System to Sump Pump with Battery Backup. Exterior Discharge Line discharging to daylight with SoakAway Catch Basin installed along the line to allow stormwater to dissipate into soil before reaching daylight. Estimated cost of site work: (NOTE: The estimated cost shall include all labor, material, 10273.3 USD scaffolding,fixed equipment, professional fees, backfill, grading, site restoration, carting/tipping fees and material & labor which may be donated gratis.) Stormwater Management Control Permit Application,page 1/1 C BRnUk VILLAGE OF RYE BROOK 938 King St Rye Brook,NY 10573 �' W 4E Q Phone:(914)939-0668 1 www.ryebrook.gov �O lit ��• 02• i Building Department Residential/(Stormwater Management) Permit Permit Set 43 ROCK RIDGE DR P#RB25-0019 R#135.27-1-65 PERMIT INFORMATION Address Permit number Date issued 43 ROCK RIDGE DR RB25-0019 10/07/2025 REVIEWED BY If you have any questions regarding the review of these drawings please contact: Application in general Alfredo(Freddy)DiVitto adivitto@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 4-6 Application Materials 7 Application Materials 8-11 Application Materials 12-14 Property Owner/Homeowner Government ID,and/or Proof of Ownership 15-16 Application Materials 17 Application Materials 18-50 Application Materials 51 Application Materials 52 General Contractor's Home Improvement License-Westchester 53 Application Materials 54-61 Application Materials 62-63 Stormwater Management Control Permit Application 64 Building Department.938 King St Rye Brook,NY 10573/Phone:(914)939-0668 BR(�v� VILLAGE OF RYE BROOK 0 938 King St Rye Brook,NY 10573 W � Q Y Phone:(914)939-0668 1 www.ryebrook.gov �O 82 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 ❑� L 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. L ID IceGuard SpecMIDSHON Manufacturer Product Basement Systems Inc. IceGuard® 60 Silvermine Rd. 4" Part#02074 Seymour, CT. 06483 3" Part#02073 800-640-1500 The IceGuard®system allows water to escape from a sump pump discharge line if the pipe Applications freezes or becomes blocked for any reason.When the discharge pipe thaws or the blockage removed, the water will automatically run along it's normal route. • Dimensions: 5.75"H Diameter at top:2.170", Diameter at base:4.240" • Material: Rigid PVC Features Color:White • Pipe collar gives a nice finished look to the pipe penetration of the discharge line. Comes in 1'/2" Part#02610 and 3" Part#02611 Installation Procedures IceGuard®is installed immediately after the 1'/2"discharge line exits the rim joist of the house.A 1'/2"900 Street fitting is installed at the end of the pipe penetration and glued to the IceGuard®using PVC glue and cleaning solvent. IceGuard®can be used with a 3"or 4"discharge line buried a minimum of 4" under the soil. The length of the 3"or 4"discharge is determined by the topography of the yard, and should be run to a downhill grade away from the structure Version 2 3/18 LS IMES Legacy Report 98-63 Reissued May 2020 This report is subject to renewal May 2021. www.icc-es.orq 1 (800)423-6587 1 (562) 699-0543 A Subsidiary of the International Code Councils Legacy report on the BOCA®National Building Code/1999 and the 1997 International Plumbing Code® DIVISION: 33 00 00—UTILITIES supplementary to a foundation drain. In applications where Section: 33 46 00--Subdrainage water permeates through the rubble stone, brick or cast-in- place concrete foundation wall, the drainage system is REPORT HOLDER: intended to discharge the water as described above for concrete masonry unit foundation walls. BASEMENT SYSTEMS,INC. WaterGuard®Subfloor Drainage System Components EVALUATION SUBJECT: ■ Drain channel: A 0.1-inch-thick (2.54 mm), one-piece construction of extruded, solid polyvinyl chloride (PVC). WATERGUARD®SUBFLOOR DRAINAGE SYSTEM Drainage holes, 0.75-inch-diameter (19.1 mm) and 3 EVALUATION SCOPE: inch (76 mm) on center, are located at the base of the channel on the side facing the foundation wall. Compliance with the following codes: The component cross section is a 3.13-by-1.85 inch BOCA®National Building Code/1999 (80X47 mm) rectangle with a 2.43 inch (62 mm) flange Section 1710.1 General on top. Two 0.35-inch-long (8.89 mm) spacers are attached to the flange on the side facing the foundation SUBSOIL DRAINAGE SYSTEM wall. The spacers are intended to provide a means of 1997/ntemationa/Plumbing Code® directing the flow of moisture which may penetrate the foundation wall.See Figure 3 at the end of this report for ■ Section 105.2 Alternative materials, methods and an illustration of the drain channel component. equipment ■ Drain outlet: A 0.1-inch-thick (2.54 mm), one-piece ■ Section 1111.1 Subsoil drains construction of extruded, solid polyvinyl chloride (PVC) ■ Section 1111.2 Building subdrains that is friction-fit to the drain channel component. The component cross section is a 3.13-by-1.85 inch (80x47 BOCA'National Building Code/1999 mm) rectangle with a 2.43 inch (62 mm) flange on top. ■ Section 106.4 Alternative materials and equipment The component extends at the base to accommodate a ■ Section 1813.5 Subsoil drainage system 4-inch-diameter (102 mm) drain opening. The drain opening is intended to be located at the point where the DESCRIPTION WaterGuard®Subfloor Drainage System is attached to a WaterGuard® Subfloor Drainage System is a subsurface drain or sump. See Figure 4 at the end of this report for drainage system, consisting of a polyvinyl chloride (PVC) an illustration of the drain outlet component. drain pipe, a PVC drain outlet, and crushed stone. The ■ Crushed stone: Minimum 0.5-inch-diameter(12.7 mm) system is located below the interior concrete slab of a below crushed stone shall be placed on one side of the drain grade story or basement floor and on top of the foundation channel with the side facing the footing left free of stone wall footing. The WaterGuard®Subfloor Drainage System is to allow an air space to exist between the footing and intended for use with foundation walls of concrete masonry channel. units, rubble stone, brick or cast-in-place concrete construction. See Figures 1 and 2 of this report for CONDITIONS OF USE illustrations of the Water-Guard® Subfloor Drainage System This report is limited to the applications and products as when used with a concrete masonry unit foundation wall and stated in this report. The ICC-ES Subcommittee on National a cast-in-place concrete foundation wall, respectively. Codes intends that the report be used by the code official to When used with a concrete masonry unit foundation wall,the determine that the report subject complies with the code system functions by collecting water or moisture permeating requirements specifically addressed, provided that this through the wall assembly or through weep holes placed on product is installed in accordance with the following the inside face of concrete masonry units. The water is then conditions: discharged from the system by gravity or mechanical means. ■ The WaterGuard® Subfloor Drainage System shall be When used with rubble stone, brick or cast-in-place concrete installed in accordance with the manufacturer's foundation walls, the drainage system is to be installation instructions and the limitations of this report. !CC-ES Evaluation Reports are not to be construed as representing aesthetics or any other attributes not specifically addressed,nor are they to be construed as an endorsement of the subject of the report or a recommendation for its use.There Ls no warranty by ICC Evaluation Service,LLC,express or implied,as to any finding m-other matter in this report,or as to any product covered by the report. m s Copyright 0 2020 ICC Evaluation Service,LLC.All rights reserved. Page 1 of 4 98-63 1 Most Widely Accepted and Trusted Page 2 of 4 ■ The footing shall not be undermined under any INFORMATION SUBMITTED circumstances during the excavation required for the ■ VTEC Laboratories, Inc., Test Report No. 100-886, installation of the WaterGuard8 Subfloor Drainage dated October 22, 1998, containing results of physical System. testing performed in accordance with Section 1710.3 of ■ The WaterGuard® Subfloor Drainage System shall not the BOCA®National Building Code/1999. be installed where the load-resisting capability of the ■ VTEC Laboratories, Inc., Test Report No. 100-950, wall is not adequate or is jeopardized by the excavation dated March 11, 1999, containing results of structural and/or installation. testing performed on concrete masonry units with and ■ Evaluation of the WaterGuard® Subfloor Drainage without drainage holes. System when utilized with a rubble stone, brick or cast- ITEMS REQUIRING VERIFICATION in-place concrete foundation wall is limited to installations that comply with Section 1813.5.2 of the ✓ Water which drains into this drainage system shall be BOLA®National Building Code/1999. collected and disposed of in accordance with the 1997 ■ The WaterGuard® Subfloor Drainage System is limited International Plumbing Code®. The collection and to applications where the ground water table disposal system shall be installed i®accordance with investigation determines that a subsoil drainage system the 1997 International Plumbing Code . is required by the code. ✓ The floor shall be resurfaced with concrete meeting the ■ For installation with foundation walls constructed of minimum requirements as set forth in Sections 1905.0, concrete masonry units, a maximum of one 5/8-inch- 1906.0, 1907.0, and 1908.0 of the BOCA® National diameter (15.9 mm) weep hole shall be drilled in each Building Code/1999. core of every block in the bottom course of blocks. ✓ Methods required to enhance the capacity or stability of ■ This report is subject to periodic re-examination. For the foundation system, including modifications and information on the current status of this report, contact repairs of structural cracks in existing foundation walls, the ICC-ES. shall be determined by a registered design professional and are outside the scope of this report. APPLICATION FOR PERMIT PRODUCT IDENTIFICATION To aid in the determination of compliance with this report, All Basement Systems Inc., WaterGuard®Subfloor Drainage the following represents the minimum level of information to System components, or their packaging, manufactured in accompany the application for permit: accordance with this report shall bear the following ■ The language "See ICC-ES Legacy Report No. 98-63" identification: or a copy of this report; ■ "See ICC-ES Legacy Report No.98-63." ■ Type of foundation wall construction; ■ Manufacturer's name and product name. ■ Method for disposal of water from the system; The report holder's contact information is the following: ■ Instructions regarding investigations of the load carrying BASEMENT SYSTEMS,INC. capacity of the wall to determine adequacy; 60 SILVERMINE ROAD ■ Specifications for all destructive operations;and SEYMOUR,CONNECTICUT 06483 ■ Specifications for location, number, and size of weep www.basementsystems.com holes in concrete masonry unit foundations. 98-63 1 Most Widely Accepted and Trusted Page 3 of 4 I11 —111� Concrete Concrete Poured Ali Block Wall Concrete Floor Wall d Concrete Floor J�L��� Crushed a a Stone ° Crushed Stone Footing WaterGuard WaterGuard \�Ilhltl��au� Footing FIGURE 1*—WATERGUARD$SUBFLOOR DRAINAGE FIGURE 2*—WATERGUARD�SUBFLOOR DRAINAGE SYSTEM CONCRETE MASONRY UNIT FOUNDATION WALL SYSTEM CAST-IN-PLACE CONCRETE FOUNDATION WALL ± 020 �---350 ± 100 4.275 �± 075 1.850 ± 075 3.125 For SI: 1 inch=25.4 mm FIGURE 3*—DRAIN CHANNEL COMPONENT 98-63 1 Most Widely Accepted and Trusted Page 4 of 4 Mates to WaterGuard \ Male to 4" PVC pipe to sump FIGURE 4'—DRAIN OUTLET COMPONENT 'THESE DRAWINGS ARE FOR ILLUSTRATION PURPOSES ONLY.THEY ARE NOT INTENDED FOR USE AS CONSTRUCTIONDOCUMENTS FOR THE PURPOSE OF DESIGN, FABRICATION OR ERECTION. .Batt isW4 TripleSafe- SUMrPUMP SYSTEM Specifications Manufacturer Product Basement Systems Inc. TripleSafe Sump System 60 Silvermine Rd. Seymour, CT. 06483 Part#02040B 800-640-1500 The TripleSafe is a combination of patented and custom components which make up a highly Description efficient and reliable pressure relief system and water evacuation system for basement water controls stems. Utilizing 2 120v pumps and 1 12v battery backup system. Use TripleSafes are designed to relieve sub floor water pressure and evacuate water from the basement water control system. TripleSafe Height: 22 3/8" Physical TripleSafe Width: 18"- Length 24" Capacity 23 Gal. Properties TripleSafe Shipping Weight: Approx. 80 Lbs.(No BBU.) Components The Liner has a 24"X18"dual liner configuration, is 22"deep and made of structural Liner Polyethylene foam. The liner also features exclusive pump stand locator tabs, which ensures proper pump location to prevent the pump float switchs from hanging up on the sidewalls of the liner by k eping the pump properlypositioned in the liner. Two-piece structural polyethylene foam lid that bolts down to the liner. Lid has floor drain with a Lid ball float and rubber grommets for the electrical cord and discharge lines. Hex Indented Screws for Lid 5 Part#02012 (1)Zoeller M-53 1/3hp. Part#02201 and (1)Zoeller M-98 1/2hp. Part#02202 Cast iron submersible pump with non-clogging vortex impeller and a automatic mechanical float switch. Pump(s) The Primary 1/3 hp. pump will pump 2240 gallons per hour at an 8' head, Startup Wattage:2980w, Run Wattage:1115w.The secondary% hp. Pump will pump 3900 gallons per hour also at an 8' head start up Wattage:3360w, run wattage:1 080w. The UltraSump 3 Battery Backup Unit has a pumping capacity of 1970 gallons per hour at an 8' head. WaterWatch alarm system,which sounds off when water rises above the point where the pump Alarm should normally turn on. The WaterWatch alarm runs on a 9V battery and sounds off when the water level is within 6" below the sump lid and before any water can reach the floor. Part# 02400E Check Valve A full flow 1-1/2"check valve that screws directly into the pump with a rubber hub to help control noise and vibration. Part#02290 Cord Made of PVC, Yellow in color. Comes with a hose clamp, mounts on discharge line to keep Captain TM cords neat. Service log envelope ties to Cord Captain TM to hide pump and charger cords. Part# 02093 CleanPump The CleanPump stand is designed to fit in the bottom of all of our sump liners, insuring that silt Stand and sediment build-up without affecting the pumps performance. Part#02013 TripleSafe bridge is added to provide support to the center of the 2-piece lid, discharge lines Bridge and also has cutouts to provide wire management of the sump pump and UltraSump power cords. Part#02014 Accessories What you need each year to service a system that already has the service envelopes Part#02087S includes: Annual • (2)Screw-in check valves Service Kit • 9v Battery • 2 Wire Ties • 2"Next service due" labels • 1 `This basement protected by" label System Comes with each complete sump package.Attach the envelope to the top of the Cord Service Captain with the included wire tie. Part#02082S Includes: Envelope • Service Envelope • Wire tie (8") • Owner's Manual • 2 "Next service due" labels • 1 'This basement protected by" label • 1 Condensation indicator strip • 2 Electrician notes Electricians Lists electrical requirements for Basement Systems products, leave with the homeowner to Notes give to their electrician. Part#02038 No-Hub Rubber fitting serves as a quick release point or vibration suppressor on 1 Y2'discharge line Fitting Part#02300 2-Piece Patented 2-piece lid with floor drain and check ball included. Part#02012 Sump lid Sump Lid Grommets Kit Part#02601 Includes: Grommet • 1 Blue pipe grommet Part#02601 Set • 1 Yellow cord grommet(Single hole) Part#02602 • 2 Wire ties 2" Part#02605 Discharge 1 Grommet Black 2" Grommet Installation Procedures Create a hole in the floor approximately 27" in diameter and excavate down 24"from the floor surface. Set the liner in the hole with the lid approximately'/<" below the surface of the floor and back fill with clean stone. First install 1 pump stand into the positioning tabs at the base of the liner then install the primary pump with Ultrasump pump preinstalled;with check valve and section of 1-1/2" pvc discharge pipe that extends above the floor. Next position 2 pump stands stacked on top of each other into the other set of positioning tabs and set the secondary pump . Slide the lid around the discharge pipe and pull the electrical cord through the top and then bolt the lid into place. Install airtight grommets and WaterWatch probe alarm. Mount CordCaptain to the 1'/2" discharge line using supplied pipe clamp for wire management, hang system service envelope using 8"wire tie supplied and fill out all information on labels. Version 6 3/18 .Basemen U2 La wnScape TM Outlet Specifications Manufacturer Product Basement Systems Inc. LawnScapeTM Outlet 60 Silvermine Rd. Part#06031 Seymour,CT.06483 800-640-1500 LawnScapeTm Outlet is designed to terminate discharge lines or gutter downspout extension in a yard with Description very little grade or flat landscape. LawnScapeTm Outlet will accept a 3"or 4"PVC Pipe.The lid has 2 screws to remove the cover if cleanout is necessary.Drains out completely so it is not nearly as prone to freezing. LawnScape"m Outlet Color Green: Physical LawnscapeTm Outlet overall length: 11.250" Properties LawnScape'rm Outlet overall height:4.250" Lawnscapelm Outlet lid nominal wall thickness:0.25" LawnscapeTm Outlet body nominal wall thickness:0.25" LawnScapeTM Outlet pipe configuration:accepts 3"or 4"thin wall PVC LawnScapeTA° Outlet material:structural foam(Polyethlyne) Installation Procedures Dig a hole approximately 12"-14"in diameter and 14"deep. Pour a 6"bed of crushed stone in the hole and install LawnScapeTm Outlet into hole,so the lid is level with grade of surrounding soil and grass. LawnscapeTm Outlet is designed to accept 3"and 4"PVC connection can be made friction fit or by using PVC/ABS glue and solvent.Take additional stone and fill around LawnScapeTM Outlet to 2"below grade and lid. Fill in remainder around well with soil and cut turf so that only the lid is visible. Version 1 6/20 v ZZ v vi --r, Cs 71i I! CP r rn a � a � 13p p0 CO a m� � rn� p LO � N O. o � to c Q, _ Y C. L GG S t. o i � rn� Y (V M en Docusign Envelope ID:E3E495C2-23F2-447D-BDE9-EDB240002710 �IY 7�,��a�,� Prepared by: Prepared for: Proposal Tony VanDeusen Lauren Webber (OIYI@ ed, C (866)829-9123 lewebber@icloud.com Since 1987 SOS Ms tvandeusen@Ijctbs.com C (413)896-4116 waterproofing to finishing! P (413)896-4116 Connecticut Basement Systems Inc. CT#0526823 WC#0644- PR532002 H94PC5504MA147215 Job location: con necticutbasementsystems.com 43 Rock Ridge Dr TF (800)541-0487 Rye Brook,NY 10573 F (203)463-9339 License#CT:0526823 WC:06440-H94 MA:147215 RI:38081 Prepared on: 9-3-25 Product List WaterGuard 47 ft Feed Line 15 It Interior Discharge Line buried parallel to 15 WaterGuard Triple5afe — — — 1 IceGuard .... 2 LawnScape outlet 1 Exterior Discharge Line 50ft CleanSpace 1/2 Wall System 47 ft Project Summary My Basement .................................................. $10,814.00 Total Investment $10.814,00 -•.- r m•N- Pref.Cust Disc.(no credit card payments) ....................... $540.70 Z= 1 Total Contract Price ................................. $10,273.30 � Deposit Required-30% .... $3,081.99 Deposit Paid .. .. .. ..._................................... .... .. $0.00 Amount Due Upon Installation $10,273.30 Customer Consent Company Representative Signature Date Customer fully understands and accepts the transferable warranty provided,which covers only the areas of the basement addressed and does not cover water damage to home,property or personal items.Partial perimeter systems carry a limited warranty.Unless in the notes,installation of the system does not include painting,finished carpentry,electrical work,or replacement of floor tile or carpeting.Contractor cannot be responsible for frozen discharge lines without an IceGuard.Warranty does not cover condensation,damp spot discoloration and window well flooding.Customer shall grant contractor a 60-day right to remedy any problem after reported.Homeowner responsible for moving objects away from walls and back again.Some dust should be expected from work.Additional work needed will be at customer expense.Homeowner assumes all responsibility for damages due to breakage of any hidden(unmarked)fuel/water/utility service lines on surface or below. Any alteration from the above specifications and corresponding price adjustment(if necessary)will be made only at the Customer's request or approval. Completing the work in this Proposal at the time scheduled may be impacted by accidents,weather or delays beyond our control.This Proposal is based primarily on the Customer's description of the problem.This Proposal is valid for 30 days. Acceptance of Contract-I/we acknowledge and agree to the contents of this Proposal and the attached Limited Warranty(together,the"Contract").You are authorized to perform the work as specified,and payment will be made as outlined above.I/we understand that all deposits are non-refundable after the three-day right of rescission.By signing below,I/we confirm that I/we have read,understood,and accepted all pages and items contained in this Contract. Docusigned by: F V Customer Signature Date 9/5/2025 1 4:50 AM PDT For repair plans to address ground water intrusion,we recommend a full-perimeter Initial (� waterproofing system equipped with a Triple5afe@ sump for maximum protection. Initial �(A�• Sales Tax is not included and will be billed separately,if applicable. Connecticut Basement Systems Inc. Job Location Page 2/7 33 Progress Ave Seymour CT 06483 43 Rock Ridge Dr Rye Brook NY 10573 9-3-25(8) Docusign Envelope ID:E3E495C2-23F2-47D-BDE9-EDB240002710 Job Details aw"ra. Front of fame w ��' d forme to Front pads 7C to Ix DrrJOrd kmTreaAkish drab 4' ;,�sue,, Beds Patio (memory) 27 b*0M Ir a vtYIra p"w r, O 1'r to side ® O Typeof Wall ...................................................... ........................................................................................ Block ExistingWall Finish ....................................................................................................................................... Plain ExistingFloor Finish ..................... ........................................................................................................... Concrete Discharge line length away from house ................................................................................................................. 50 Connecticut Basement Systems Inc. Job Location Page 3/7 33 Progress Ave Seymour CT 06483 43 Rock Ridge Dr Rye Brook NY 10573 9-3-25(8) Docusign Envelope ID:E3E495C2-23F2-447D-BDE9-EDB240002710 Job Details (Continued) Specifications 1)Install WaterGuard sub-floor drainage system as indicated injob drawing. 2)Install feed line as shown on drawing. 3) 4)Install TripleSafe pump system with twin liner,1/3 hp cast iron primary AC pump,1/2 hp cast iron AC back-up pump,and UltraSump battery back-up pumping system with charging/control box with alarm,and 120 amp sealed maintenance free battery.Includes 3 CleanPump stands,airtight lid with airtight floor drain,and WaterWatch alarm system. 5)Install IceGuard to prevent floods from clogged or frozen discharge line. 6)Install LawnScape outlet at end of discharge line. 7)Install discharge line as shown. 8)Install CleanSpace 1/2 Wall System on walls as shown on drawing. Contractor Will 1.)Obtain all necessary permits for our work and schedule the initial inspections.Local permit fees,a$250 permit administration fee,and —where applicable in certain New York State jurisdictions—a$1,750 fee for architectural consultation and drawings will be billed separately to the custo . ermit fees are non-refundable.All foundation support projects using PIERS require the above architectural fee.--Customer Initials Customer Will 1.)Provide proper dedicated electrical outlets for all pumps,and other electrical devices after the completion of the installation. 2.)Customer to move all items 4 feet away from perimeter walls BEFORE INSTALLERS ARRIVE,including washer and dryer.Customer to restore. 3.)Remove and replace any landscaping that is in the work area.Customer to restore. 4.)Mark any private lines that may be hidden underground,and assumes all liability if damage should occur to such lines. 5.)Customer understands that there may be ponding of water in discharge area under certain conditions. 6.)Complete and agrees to any items mentioned in this Contract under"Customer Will"and/or"Additional Notes"that apply. --Customer Initials: Additional Notes 1) Customer understands that this is a Partial System(solution)and as such,the lifetime Dry Basement Warranty against ground water seepage does not apply.Connecticut Basement Systems will provide a limited warranty covering the WaterGuard and Two-Stage systems in the areas where they are installed. r— Additional work maybe required at added costs.Initial (UP 2) No warranty exists with regard to water entering the basement through the window. Customer has been offered the Window Well Duct Drain and has declined at this time. All jobs are subject to Production review.In the unlikely event a job is not approved,the job will be canceled,and deposit will be returned to customer without penalty. Promo financing available through Regions Home Improvement Financing for those who qualify.Ask your representative for more information or call 203-463-9508. NOTES TO CREW: Access will be through the garage. Easy access. Connecticut Basement Systems Inc. Job Location Page 4/7 33 Progress Ave Seymour CT 06483 43 Rock Ridge Dr Rye Brook NY 10573 9-3-25(8) Docusign Envelope ID:E3E495C2-23F2-447D-BDE9-EDB240002710 Products WaterGuard 1ripleSafe IeeGuard I awnSrapc O,.tlet r__ I M f/flll! ' I Connecticut Basement Systems Inc Job Location Page 5/7 33 Progress Ave Seymour CT 06483 43 Rock Ridge Dr Rye Brook NY 10573 9-3-25(8) Docusign Envelope ID:E3E495C2-23F2-447D-BDE9-EDB240002710 Limited Warranty The warranty is considered in effect whenjob is completed and paid in full. If water from the walls or floor/wall joint passes through the perimeter water control system and onto the basement floor,we will provide the additional labor and materials to fix the leak at no additional charge to the homeowner.This warranty applies to WaterGuard and Two Stage systems,along with the specific areas where the system is installed.Said warranty will be in effect for the lifetime of the structure.This warranty may be transferred to future homeowners provided we are notified within 30 days of the real estate transfer. The water control system shall not rust,rot,or corrode for as long as you own the home. If the entire perimeter of the basement was not treated,then additional work at an additional charge to the customer could be necessary to extend the system or treat other areas or other problems not addressed by this work.Pump or power failure may be possible, therefore this warranty is not a guarantee of a dry basement,as the scope of this work cannot guarantee that in all circumstances. This warranty shall not apply to;condensation,or any system that has been altered in any way,water vapor transmission,concrete discoloration from capillary action,water squirting out of the walls over the system,window well flooding,plumbing leaks,surface water flooding,leaks from chimneys or garages,or efflorescence(white powder)on concrete.Contractor cannot be responsible for peeling paint,water that has been pumped from the house,dust created from installation,damage to hidden fuel lines or plumbing,or frozen discharge lines without an IceGuard.A DryTrak system alone will not eliminate seepage from floor cracks.Floor cracks are warranted against leakage with full perimeter WaterGuard or full perimeter Two Stage systems. Primary AC operated sump pumps are covered under a separate manufacturer's warranty which is 36 months from date of installation. DC operated back-up pumps are covered under a separate manufacturer's warranty which is 36 months from date of installation.Failure of any pump for any reason is outside the scope of this warranty.Back-up pumps that run off a battery,if not maintained,or that are called on to run beyond the current life of the battery,can fail.These systems are very much recommended but cannot be relied upon to work in every situation.Annual maintenance is recommended to find potential problems,but not required for this warranty to be in effect.Electrical work is not included in the contract and problems from electrical connections or lack thereof are disclaimed. Drainage systems clogging or malfunctioning from iron ochre,iron gel,or iron bacteria from the soil are rare,the contractor cannot be responsible for these situations,and that system will require cleaning,flushing,or other service as necessary to keep it functioning for that particular situation. A CleanSpace crawl space encapsulation system will isolate the home from the earth.The humidity level in the air will be lowered, reducing moisture needed for mold growth,however the encapsulation system does not claim to be a mold mitigation system.Wet crawl spaces require a drainage system,and a SmartSump system to remedy the problem with water below the CleanSpace liner.CleanSpace has a transferable 25-year warranty—there will be no charge for service calls on any tears or holes in the CleanSpace liner,in the unlikely event this occurs.Sump pumps are covered under a separate manufacturer warranty.Installation of the system does not include extending discharge lines,or electrical work unless specified.Contractor is not responsible for frozen discharge lines without an IceGuard,water once it is pumped from house,or condensation. THIS WARRANTY DOES NOT COVER,AND THE CONTRACTOR SPECIFICALLY DISCLAIMS LIABILITY FOR WATER DAMAGE TO FLOOR COVERINGS,FURNITURE,STORED ITEMS,FINISHED WALLS,AND OTHER OBJECTS INSIDE THE FOUNDATION.Contractor will not be responsible for any damages caused by mold;to include,but not be limited to,property damage,personal injury,loss of income, emotional distress,death,loss of use,loss of value,any adverse health effects,or any other effects.Homeowner agrees to keep area dry and report all other obligations on contractor's part.There are no other warranties verbal or written. Items For Which Customer Is Responsible-Customer is responsible for: 1)making full payment to the crew leader upon substantial completion of the work;2)preparing the work area for installation;3)any finish carpentry,painting,paneling,landscaping,etc.that may be necessary after Contractor's work is finished;4)marking any private lines such as satellite cables,propane lines,sprinkler system lines,etc.;and 5)any items mentioned in this Contract under"Customer Will"or"Additional Notes." Connecticut Basement Systems Inc. Job Location Page 6/7 33 Progress Ave Seymour CT 06483 43 Rock Ridge Dr Rye Brook NY 10573 9-3-25(8) Docusign Envelope ID:E3E495C2-23F2-447D-BDE9-EDB240002710 Notice of Right to Cancel PLEASE REVIEW IMPORTANT INFORMATION ABOUT YOUR RIGHTTO CANCELTHIS AGREEMENT IN THE'NOTICE OF CANCELLATION'BEING PROVIDED TO YOU. You are entering into a contract.If that contract is a result of,or in connection with a salesman's direct contact with,or call to you at your residence without your soliciting the contractor call,then you have a legal right to void the contract or sale by notifying us within three business days from whichever of the following events occurs last: 1.The date of the transaction,which is: 9/5/2025 4:50 A orPDT 2.The date you received this notice of cancellation. How to Cancel If you decide to cancel this transaction,you may do so by notifying us in writing at: Connecticut Basement Systems Inc. TF(800)541-0487 F (203)463-9339 con necticutbasementsystems.com 33 Progress Ave Seymour,CT 06483 You may use any written statement that is signed and dated by you and states your intentions to cancel,or you may use this notice by dating and signing below.Keep one copy of the notice because it contains important information about your rights. I wish to cancel. Owner's Signature Date Owner's Signature Date The undersigned acknowledges receipt of the two copies of the Notice of Right to Cancel. Docuftned by: O 9/5/2025 4:50 AM PDT E)E)84 SE04E)2451... Owner's Signature Date Owner's Signature Date Connecticut Basement Systems Inc. Job Location Page 7/7 33 Progress Ave Seymour CT 06483 43 Rock Ridge Dr Rye Brook NY 10573 9-3-25(8) Docusign Envelope ID:E3E495C2-23F2-447D-BDE9-EDB240002710 NEW Department of Taxation and Finance S T-� 24 NEWYOR New York State and Local Sales and Use Tax STATE Certificate of Capital Improvement {12f15) After this certificate is completed and signed by both the customer and the contractor performing the capital improvement, it must be kept by the contractor. Copies of this certificate must be furnished to all subcontractors on the job and retained as part of their records. Read this form completely before making any entries. This certificate may not be used to purchase building materials exempt from tax. Name of contractor(print or type) Name of customer(print or type) Connecticut Basernent Systems -auren Webber Address(number and street) Address(number and street) 33 Progress Ave City State ZIP code City State ZIP code Sales tax Certificate of Authority number(if any)NY 10573 To be completed by the customer Describe capital improvement to be performed: Permanent Perimeter Waterproofing System Project name Waterproofing System Street address(where the work is to be performed) City Slate ZIP code 43 Rock Rhdae DR Rye Brook NY 10573 1 certify that: • I am the(mark an X in one) ❑ owner ❑ tenant of the real property identified on this form; and • the work described above will result in a capital improvement to the real property as outlined in the instructions of this form; and • this contract(mark an X in one) ❑ includes ❑ does not include the sale of any items that will not become a permanent part of the real property(for example,a free-standing microwave or washing machine). I understand that: • I will be responsible for any sales tax, interest, and penalty due on the contractor's total charge for tangible personal property and for labor if it is determined that this work does not qualify as a capital improvement;and • I will be required to pay the contractor the appropriate sales tax on tangible personal property(and any associated services)when the property installed by the contractor does not become a permanent part of the real property; and • I will be subject to civilpu&W pWalties(or both)under the Tax Law if I issue a false or fraudulent certificate. Signature of customer 7�_ Date eaaasee4 9/5/2025 4:50 AM PDT To be completed by the contractor 1,the contractor, certify that I have entered into a contract to perform the work described by the customer named above, and that I accept this form in good faith. (A copy of the written contract, if any,is attached.) I understand that my failure to collect tax as a result of accepting an improperly completed certificate will make me personally liable for the tax otherwise due, plus penalties and interest. Signature of contractor or officer Title Date This certificate is not valid unless all entries are completed. Docusign Envelope ID:E3E495C2-23F2-447D-BDE9-EDB240002710 Page 2 of 2 ST-124(12115) Instructions When the customer completes this certificate and gives it to the Temporary facilities at construction sites contractor,who accepts it in good faith, it is evidence that the Subcontracts to provide temporary facilities at construction sites work to be performed will result in a capital improvement to real that are necessary for the construction of a capital improvement property. are considered to be part of the capital improvement project. A capital improvement to real property is an addition or alteration Examples of temporary facilities include temporary: to real property that: • heat, electric, or plumbing services; (a)substantially adds to the value of the real property or protective pedestrian walkways;and appreciably prolongs the useful life of the real property, and scaffolding services. (b)becomes part of the real property or is permanently affixed to the real property so that removal would cause material A primary contractor purchasing qualifying temporary facilities damage to the property or article itself, and from a subcontractor must give the subcontractor a copy of (c)is intended to become a permanent installation. Form ST-124 issued to the primary contractor by the customer (including a customer that is an exempt organization)to The work performed by the contractor must meet all three of purchase the subcontractor's services exempt from tax. these requirements to be considered a capital improvement. A certificate is accepted in good faith when a contractor has no This certificate may not be issued unless the work qualifies as knowledge that the certificate is false or is fraudulently given, a capital improvement. See Tax Bulletin Capital Improvements and reasonable ordinary due care is exercised in the acceptance (TB-ST-104), of the certificate. If a contractor performs work that constitutes a capital If a contractor gets a properly completed Form ST-124 from the improvement, the contractor must pay tax on the purchase customer within 90 days after rendering services, and accepts it of building materials or other tangible personal property, but in good faith, the customer bears the burden of proving the job is not required to collect tax from the customer for the capital or transaction was not taxable. improvement. No credit or refund is allowed for the tax paid on the cost of materials by the contractor. See Tax Bulletin If you are a contractor who installs items such as washing Contractors—Sales Tax Credits(TB-ST-130). machines, clothes dryers, dishwashers, refrigerators,furniture, For guidance as to whether a job is a repair or a capital etc.,which when installed or placed in real property do not improvement, see Publication 862, Sales and Use Tax become part of the real property, you must collect tax on your Classifications of Capital Improvements and Repairs to Real charge for the installation.The individual charge for any of these Property. items is also taxable as the sale of tangible personal property. A contractor, subcontractor, property owner,or tenant, may If a contractor does not get a properly completed Certificate of not use this certificate to purchase building materials or other Capital Improvement within 90 days, the contractor bears the tangible personal property tax free.A contractor's acceptance burden of proving the work or transaction was a capital of this certificate does not relieve the contractor of the liability for improvement.The failure to get a properly completed certificate, sales tax on the purchase of building materials or other tangible however,does not change the taxable status of a transaction; a personal property subsequently incorporated into the real property contractor may still show that the transaction was a capital as a capital improvement unless the contractor can legally issue improvement. Form ST-120.1, Contractor Exempt Purchase Certificate. (See Contractors and subcontractors must keep any exemption Publication 862 for additional information.) certificate for at least three years after the due date of the last The term materials is defined as items that become a physical return to which it relates, or the date the return was filed, if later. component part of real or personal property, such as lumber, The contractor must also maintain a method of associating an bricks,or steel.This term also includes items such as doors, exempt sale made to a particular customer with the exemption windows, sinks, and furnaces used in construction. certificate on file for that customer. Floor covering Need help? Floor covering such as carpet, carpet padding, linoleum and Visit our website at www.tax.ny.gov vinyl roll flooring, carpet tile, linoleum tile,and vinyl tile installed www as the initial finished floor covering in new construction,a get information and manage your taxes online new addition to an existing building or structure, or in a total check for new online services and features reconstruction of an existing building or structure, constitutes a capital improvement regardless of the method of installation.As Telephone assistance a capital improvement,the charge to the property owner for the Off installation of floor covering is not subject to New York State and Sales Tax Information Center: (518)485-2889 local sales and use taxes. However, the retail purchase of floor covering (such as carpet or padding)itself is subject to tax. To order forms and publications: (518)457-5431 Floor covering installed other than as described above does Text Telephone(TTY) Hotline(for persons with not qualify as a capital improvement.Therefore,the charges for hearing and speech disabilities using a TTY): (518)485-5082 materials and labor are subject to sales tax. The contractor may Persons with disabilities: In compliance with the apply for a credit or refund of any sales tax already paid on the Americans with Disabilities Act,we will ensure that our materials. lobbies, offices, meeting rooms, and other facilities are accessible to persons with disabilities. If you have questions The term floor covering does not include flooring such as about special accommodations for persons with disabilities.call the ceramic tile, hardwood, slate, terrazzo, and marble.The rules information center, for determining when floor covering constitutes a capital improvement do not apply to such flooring.The criteria stated in Privacy notification (a), (b), and(c)above apply to such flooring. See our website or Publication 54, Privacy Notification. m� 3esemen _Lw �Uo C le a n Crawl Space Encapsulation System` Specifications Manufacturer Product Basement Systems Inc. 60 Silvermine Rd. CleanSpace TM Liner Seymour, CT. 06483 Part# 500 800-640-1500 Part# 5001 CleanSpaceTm Liner is a white/blue seven-layer reinforced laminate containing no adhesives. The outer layer consists of high-strength polyurethane film manufactured using virgin grade resins and containing UVI and thermal Description stabilizers. CleanSpace TM is reinforced with two separate plies of a 900 denier polyurethane reinforcement laid in a diagonal pattern spaced 3/8" apart with an additional machine direction polyester every 3" across the width. The individual lies are laminated together with molten polyethylene. The CleanSpace TM liner is used to isolate the home from the earth completely Use and permanently. This dramatically reduces the humidity levels In the air which, when combined with sealing outside air and dehumidification, will eliminate mold growth and rot from the crawls ace. CleanSpaceTm Roll: 24' x 50' (1200sgft) Part# 5000 Physical 6'. 2" x 200' 1200s ft Part# 5001 Properties CleanSpaceTm Roll Weight:1 14lbs. 16 rolls per pallet. CleanSpaceTm Appearance: White/Blue CleanSpaceT"" Thickness: 20mil max./16mil min. CleanSpace TM Construction: 7 layer extrusion laminate w/2 layers polyester reinforcement. CleanSpaceTm Tensile strength 1": 1051bf CleanSpaceTm Grab tensile: 1501bf. CleanSpaceTm Elongation at peak strength: 20% CleanSpaceTm Trapezoid tear: 1101bf. CleanSpace TM Maximum use temp: 180°F. CleanSpace TM Minimum use Temp: -70°F CleanSpace TM Perm Rating: 0.0023 CleanSpaceTm Fire Spread: 10 CleanSpace TM Smoke Density: 105 CleanSpaceTm Fire rating: Class A Installation Procedures The CleanSpaceTM liner is carefully cut and installed in sections. Small holes will be drilled into the crawl space walls approximately 6" below the wood sill plate and every 3' along the wall. Nylon fasteners are installed to permanently secure the CleanSpaceTM liner to the wall. The top edge of the liner is sealed to the walls with polyurethane sealant. All seams are sealed with special 4" wide sealing tape and/or sealant. The CleanSpaceTM liner is also sealed around other objects, such as pipes, columns and piers with any combination of sealant of concrete. Version 3 12/18 Sl 'Y Y'k�^i ^3 N dL'r i-Y/y1+9yw"� / and" 1\ +� 55`r'!r .. y •;}h}f r!•'C h� rAl�F r �1• tl���1�'}Nt� f). �J rW5, 1• rye r. j1 r^) \ t ;l�'�IIj1111�, Tellt;ri��11/11i��` `3 Vol•,11/5 zi�e,c��,/d/11`1,1 s��t tt�i1, ���11/11/�i ; 115 .;.,iNl�,i ._,_ ;�,1!.L�d _ •,4i11J. :4RI,N� . I,�.IId. ..i,►1i� ;4,IIIp _•,. .;do- �k �i'— ❑ �'•• 4 ej vs 04 0 y CN LLI • ,t: a C, W �o � W �• Y M i W cn U N 1 LU M .. LLI •3 a r,••, ,?fir/f ci cn z „_ .• : Ucn CD o r 11��,�.. — A, oll�/lll v�a,a i�111�,`;a sf!',i111 i ! 1111/11�i`t »• �A �I LINO`1 I ,\TM# 1//� �i �1H1 41/11� i 1i �► � 11111 �I/i►� a / 1 ,3 A QY A 7A t A �� f A !r ♦♦ ^ M`'.'' '7 1 ter a .v `�... - i4'`�a "' - � w�:s�4!,'J C„+,.r^J'"•'i Jl','.a\�k,+" •-�tc�' - �.�} '". , .- - aim ����� • <y��a C�® r ATE(MM/DD/YYYY) A C" CERTIFICATE OF LIABILITY INSURANCE 9/10/2025 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 CONTACT NAME: Liz FOX Arthur J. Gallagher Risk Management Services, LLC PHONE 518-556-3113 ac No:518-869-3580 30 Century Hill Drive E-MAIL Suite 200 ADDRESS: Liz Fox@ajg.com Latham NY 12110 INSURERS AFFORDING COVERAGE NAICf1 INSURERA:CUMIS Insurance Society Inc 10847 INSURED INSURERB:Core Pointe Insurance Company 10499 Connecticut Basement Systems, Inc. 33 Progress Ave INSURERC:Milford Casualty Insurance Company 26662 Seymour CT 06483 INSURER D:Travelers Property Casualty Co of America 25674 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:2067957653 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDL SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE POLICY NUMBER MM/DD/YYYY MM/DD/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY Y 325361 5/1/2025 5/1/2026 EACH OCCURRENCE $1,000,000 CLAIMS-MADE L X OCCUR DAM AG EN ED PREMISES Ea occurrence $1,000,000 X PD Ded$1.000 MED EXP(Any one person) $10,000 X Contractual Liab PERSONAL&ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 POLICY PRO- JECT LOC PRODUCTS-COMP/OP AGG $2,000,000 OTHER: I $ A AUTOMOBILE LIABILITY 325362 5/1/2025 5/1/2026 COMBINED SINGLE LIMIT $1,000,000 Ea accident X ANY AUTO BODILY INJURY(Per person) $ X OWNED Ix SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS XHIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per accident A X UMBRELLA LIAB X OCCUR 325363 5/1/2025 5/1/2026 EACH OCCURRENCE $5,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE $5,000,000 DED I X I RETENTION$in non $ B WORKERS COMPENSATION CPW1003758 5/1/2025 5/1/2026 X I SPER OTH_ TATUTE ER C AND EMPLOYERS'LIABILITY YIN MWC1039077 5/1/2025 5/1/2026 ANYPROPRIETOR/PARTNER/EXECUTIVE M E.L.EACH ACCIDENT $1,000,000 OFF ICER/MEMBER EXCLUDED? NIA (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,000 D Leased/Rented Equipment QT6302T247171TIL25 5/1/2025 5/1/2026 $100.000 Special Form DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Job Location:43 Rock Ridge Dr.Rye Brook,NY 10573 The Village of Rye Brook is added to the General Liability as an Additional Insured if required by written contract. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. The Village of Rye Brook .938 King St. AUTHORIZED REPRESENTATIVE Rye Brook, NY 10573 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD _J YYO K Workers' CERTIFICATE OF STATE Compensation NYS WORKERS' COMPENSATION INSURANCE COVERAGE Board 1 a.Legal Name&Address of Insured(use street address only) 1 b.Bus ness Telephone Number of Insured Connecticut Basement Systems, Inc. 800-541-0487 33 Progress Ave Seymour, CT 06483 1c.NYS Unemployment Insurance Employer Registration Number of Insured Work Location of Insured(Only required if coverage is specifically limited to 1 d.Federal Employer Identification Number of Insured or Social Security certain locations in New York State,i.e.,a Wrap-Up Policy) Number 061240272 2.Name and Address of Entity Requesting Proof of Coverage 3a.Name of Insurance Carrier (Entity Being Listed as the Certificate Holder) Milford casually Insurance company The Village of Rye Brook 938 King St. 3b.Policy Number of Entity Listed in Box"1 a" Rye Brook, NY 10573 MWC1039077 3c.Policy effective period 05/01/2025 to 05/01/2026 3d.The Proprietor,Partners or Executive Officers are y❑ included.(Only check box if all partners'officers included) N❑ all excluded or certain partners/officers excluded. This certifies that the insurance carrier indicated above in box 'T'insures the business referenced above in box"l a"for workers' compensation under the New York State Workers'Compensation Law.(To use this form,New York(NY)must be listed under Item 3A on the INFORMATION PAGE of the workers'compensation insurance policy). The Insurance Carrier or its licensed agent will send this Certificate of Insurance to the entity listed above as the certificate holder in box"2". The insurance carrier must notify the above certificate holder and the Workers'Compensation Board within 10 days IF a policy is canceled due to nonpayment of premiums or within 30 days IF there are reasons other than nonpayment of premiums that cancel the policy or eliminate the insured from the coverage indicated on this Certificate. (These notices may be sent by regular mail.)Otherwise,this Certificate is valid for one year after this form is approved by the insurance carrier or its licensed agent, or until the policy expiration date listed in box"3c",whichever is earlier. This certificate is issued as a matter of information only and confers no rights upon the certificate holder.This certificate does not amend, extend or alter the coverage afforded by the policy listed, nor does it confer any rights or responsibilities beyond those contained in the referenced policy. This certificate may be used as evidence of a Workers'Compensation contract of insurance only while the underlying policy is in effect. Please Note: Upon cancellation of the workers'compensation policy indicated on this form, if the business continues to be named on a permit, license or contract issued by a certificate holder,the business must provide that certificate holder with a new Certificate of Workers'Compensation Coverage or other authorized proof that the business is complying with the mandatory coverage requirements of the New York State Workers'Compensation Law. Under penalty of perjury, I certify that I am an authorized representative or licensed agent of the insurance carrier referenced above and that the named insured has the coverage as depicted on this form. Approved by: Arthur J.Gallagher Risk Management Services.LLC (Print name of authorized representwive or licensed agent of insurance carrier) Approved by: 9/10/2025 (Signature) (Date) Area President Title Telephone Number of authorized representative or licensed agent of insurance carrier: 518-556-3113 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