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Nature Preserve
I 2010-01-19 JCM FOR INTERNAL USE ONLY Town of Wappinger Received by: Joseph P. Paoloni c Agreement for the Use of the Town Grace Robinson gal I Faci lities for Meetings Date Received: I 1 �� Serial #: AUG 19 2015 L1 Application N100.00 L7 Cert. of Lt IT 11 Notified Recreation(date:__ T WN OF WAPP TO; All\l ir.I F!P t Agreement for the Use of the Town Hall Facilities for Meetings ��r✓ <�---flnr.L �� w Name of grg4nization or Qro4p Name o�pe o�.t�ptoscrtt�ing:the Oregaiza.tion or Gr Address Phone No. This will confirm the arrangements being requested for your groups' use of the Wappinger Town Hall Facilities, as noted below: Senior Citizens Room ( ) Large Meeting Room ( ) Other: Specify: The group is not p tact toe cee persons Date(s): . 91a S Time: It should be understood that groups using the Buildings' Facilities for evening meetings must select dates when Town Meetings are normally scheduled (i.e., Justice Court,Planning Board, etc.) Special requests will be considered upon their own merit,and arrangements can be made for access to, and closing, the building at the close of your meeting. You and your Organization hereby agree to adhere to the rules set forth on the attached page by signature of an authorized member of your Organization or group, The Town of Wappinger reserves the right to suspend temporarily this agreement should the Town have need of the facility for its own purposes. Advance notice will be given as soon as possible on such occasions. The Town Clerk should be informed promptly of any schedule change or cancellation of your group activities. Arrangements for access to specific area to be used should be made with the Town Cleric at the time this form is submitted. No application shall be considered approved until it has been submitted.to the Town Cleric for review and Clearance. 2010-01-19 JCM Terms of the agreement must be strictly adhered to by the contracting group as any disregard or abuse of the rules for use of the facilities will result in termination of use by the offending group, and they will not be granted reinstatement. I have read and understand the rules and regulations for the use of the Facilities in the Town of Wappinger Town Hall, and will comply with these requirements, Signed: For: h1 (Name of Group or Organization) Dater .� Approved.' kw� own Clerk Date: . STRONGROOM EMERGENCY PAYMENTEgg AssoCi t� REQUEST FORS Client Shared Services Use this form when an invoice requires expedited payment processing. Emergency requests are processed and sent for branch approval within 24 hours of receipt. Branch Name; Date of Request: &W , Payment FROM association: Natueereserve.L10A Payment payable TO: T w.n ofWaorain.aers WNDOR IIS-1(605 Vendor address< City:. State: ,. Zip: Ship to address: City: State: Zip,• Payment FROM bank account, CAB 92BA Department: Reason for payment request: Rental fee for annual meeting Payment due date: =0�/1015 Invoice amount. MOM Amount and GL Code: 100.00c1..521.5 Amount and GL Code: Amount and GL Code: Amount and GL Code: NOTE:ACH payment information must be sent using the Vendor Master Maintenance Form located on the intranet under Client Accounting *- Client Shared Services Center. Requester name: KgXW Kilhou Requester phone,. R45-473-3711 Requester email: Special Instructions: .Submit fnrm tn- CliPntAP.PmPrvpnry a5asenria_iic v oahslsa�� ACC)R" 8/19/CERTIFICATE OF LIABILITY INSURANCE D/19/rDD 2015 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 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 NAMEACT Mary Burlingham Gerellx Insurance Agency, Inc. PHONE (845)265-222D FAAI� No.(845)265-4754 DpRIL5S; c:: corporate Bark West Q Route 9 A P.o. Box 362 INSURERS AFFORDING COVERAGE NAIC# Cold Spring NY 10516 INSURERA:Erie Insurance Company of NY 16233 INSURED INSURER B: NATURE PRESERVE HOMEOWNERS ASSOCIATION INC INSURER C: C/O ASSOCIA RIVER MGT INC INSURER 0: 297 MILL STREET INSURER POUGHKEEPSIE NY 12601 INSURER F: COVERAGES CERTIFICATE NUMBER.QL OnlY 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. INSRTy PE OF INSURANCE ADD UBR POLICY EFF POLICY EXP LIMITS LTR POLICY NUMBER MM/DDIYYYY MMIDDIYYYY GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED 1,000,000 PREM SES Ea occurrence $ ACLAIMS-MADE OCCUR 97-0845579 12/21/2014 2/21/2015 MED EXP(Any one perscn) $ 5,000 PERSONAL 8 ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER, PRODUCTS-COMPIOP AGG $ 2,000,000 }C POLICYPRO LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident 1 000 000 ANY AUTO BODILY INJURY(Per person) $ A ALL OWNED SCHEDULED 97-0845579 12/21/2014 12/21/2015 BODILY INJURY(Per accident) $ AUTOS AUTOS HIRED AUTOS X NON-OWNED PROPERTY DAMAGE $ AUTOS Per accident $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS UAB CLAIMS-MADE U �' AGGREGATE $ DED RETENTIHON $ WORKERS COMPENSATION Nub WC STATU- Y 1 N OTH_ AND EMPLOYERS'LIABILITY r` ANY PROPRIETOR/PARTNERtEXECUTIVE pp�NG F.L.EACH ACCIDENT $ OFFICERIMEMBER EXCLUDED? NIA W (Mandatory in NH) X11�O`^I t4 C �e, � E.L.DISEASE-EA EMPLOYE $ If-yes;describe under 1 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIP'nON OF OPERATIONS I LOCATIONS 1 VEHICLES IA@ach ACORD 101,Additional Remarks Schedule,if more space is required) Town of Wappingers is listed as additional insured with respect to the meeting being held on 9-2-15 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Town of Wappingers y ACCORDANCE WITH THE POLICY PROVISIONS. 20Middlebush Road Wappingers Falls, NY 12590 AUTHORIZED REPRESENTATIVE Gregg Gerelli/JULIE ACORD 25(2010/05) ©1988-2010 ACORD CORPORATION, All rights reserved. - --'PNSY17?S"T7n�nnR�n� - - - Thn ❑Cl117 r1 n�mn nnri-tnnn�rorcnim4n rnA m�r4�-nf-ArT-flr7rl - " /4C 11® DATE 3MMlDDIYYYY) r CERTIFICATE OF LIABILITY INSURANCE 8/19/2015 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 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 Ma Burlingham NAME: Gerelli Insurance Agency, Inc. PHONE , (845)265-2220 FAX IA/C.Nok(845)265-4754 Corporate Park West @ Route 9 AIDDRL .MBurlingham@Gerelli-Insurance.com P.O. BOR 362 INSURERS AFFORDING COVERAGE NAIC 0 Cold Spring NY 10516 INSURERA:Erie Insurance Company of NY 16233 INSURED INSURER B: NATURE PRESERVE HOMEOWNERS ASSOCIATION INC INSURER C: C/O ASSOCIA RIVER MGT INC INSURER D: 297 MILL STREET INSURER E: POUGHKEEPSIE NY 12601 INSURER F: COVERAGES CERTIFICATE NUMBER:GL Only 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 AODL UBR POLICY EFF POLICY EXP LIMITS LTR POLICY NUMBER MM/DDffYYY MMIDICEM Y GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY RNTED PRAEMGES =.E aEoccurrence $ 1,000,000 A CLAIMS-MADE ExI OCCUR 97-0845579 12/21/2014 12/21/2015 MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGG $ 2,000,000 R POLICY PRO LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident 1,000,000 ANY AUTO BODILY INJURY(Per person) $ A ALL OWNEDSCHEDULED 97-0845579 12/21/201412/21/2015 BODILY INJURY(Per accident) $ AUTOS AUTOS X HIRED AUTOS X NON-OWNED PROPERTY DAMAGE $ AUTOS Per accident UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS-MADE AGGREGATE $ DED I I RETENTION$ - $ WORKERS COMPENSATIONWC STATU- OTH- AND EMPLOYERS'LIABILITY Y I N ANY PROPRIETORIPARTNERIEXECUTiVE❑ MIA E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? {Mandatory in NH) E.L.DISEASE-EA EMPLOYE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks Schedule,it more space is required) Town of Wappingers is listed as additional insured with respect to the meeting being held on 9-2-15 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Toren of Wappingers ACCORDANCE WITH THE POLICY PROVISIONS. 20 Middlebush Road Wappingers Falls, NY 12590 AUTHORIZED REPRESENTATIVE Gregg Gerelii/JULIE u' ACORD 25(2010/05) ©1988-2010 ACORD CORPORATION. All rights reserved. INSn7S l?ninn.41 ni Thai At'nQR Home on'I I---oro rnniQF&r A-4r.nF Artnon Questions?Contact: AUG 2 4 2015 Associa New York www,associa.com -rOw N OF W ApplNGF 120841 payor"Name Payee Name Check Number Check bate The Nature Preserve Town Of Wappinger 1000142 08/19/2015 Payor Note: Invoice Paid: Account Number: Amount: Remittance Note: 081915100 $100.00 MUMMMIMT• a • �•• :j I=K1111 10-4 .! • .... The,Nature;Preserve: Mutual gfDrrv�he .297Nii3l8treet .1.b65 W.Alameda Dr Ste 101. 00.41 42 Pou `hkee 5.1@ NY 12661 3empe AZ 85280. 9 p 08/1 0/2015 DATE- 21 p7P 21 4=, $ 160.00 PAYTO Town-Of Wapping.er THE`ORDER`OF One:Hundred Dollars grid Zero.Cents DOLLARS memo: Inv:081915100 Town.Of WaPpinger 20 Middlebush'Rd . Wappingers Falls,NY 12590-4004Ap„ II■ LOODLL, 2111 1221057'571: 1127751998411 �_�