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White Gate Condo
2010-01-19 JCM FOR INTERNAL USEONLY Town of Wappinger Received by: Joseph P. Paoloin ment for the Use of the Town Grace Robinson 415acifitlesfor Meetings Date Received: AR 2 3 2016 Serial #: TOWN OF WAPPINGS' E] Application X1.00.00 Cert. of LI TOWN CLERK Notified Recreation (date:_) Agreement for the Use of the Town Hall Facilities for Meetings Name of Organization or Gro --C-- .) "?0( It )I/vt (/vl o C LA-n� � -- � --c" 61 'I'l t'l V 14 Name of person representing the Organization or G�ou`p V t(A S '3 Address Phone No. 2) 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 expected to, exceed--I��—persons Dates ; S. -- Z/ (,(/ Time: 0 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 Clerk at the time this form is submitted. No application shall be considered approved until it has been submitted to the Town Clerk for review and Clearance. 1 a CERTIFICATE OF LIABILITY INSURANCE 4/ 2i; oi5YY' 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 Julie Lombardo NAME: Gerelli Insurance Agency, Inc. PHONE (845 265-2220 FAX A1C No;("51265-1759 Corporate Park West @ Route 9 ADDRESS:Jlombardo@Gerelli-Insurance.com P.O. BOX 362 INSURERS AFFORDING COVERAGE NAIC# Cold Spring NY 10516 INSURER A:Philadel hia Indemnity Ins Co INSURED INSURER B:Greenwich Insurance Com an White Gate Condominium Association INSURER CFederal Insurance Company C/O Associa NY INSURER D: 297 Mill Street I INSURER E; Poughkeepsie NY 12601 1 INSURER F: COVERAGES CERTIFICATE NUMBER:2015-16 blaster 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 TYRE OF INSURANCE ADDL POLICY EFF POLICY EXP LIMITS LTR POLICY NUMBER MMIODIYYYY MMMD1YYYY GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DA AGE TO RENTED X COMMERCfAL GENERAL LIABILITY PREMISES Ea occurrence) $ 11000,000 A CLAIMS-MADE [i]OCCUR FHPK1316451 /3/2015 /3/2016 MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GENT AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGG $ 2,000,000 X I POLICY P"_ LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE UMI Ea',,,"dent $ 1,000,000 AANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED PHPK1316451 /3/2015 /3/2016 BODILY INJURY(Per accident) $ AUTOS AUTOS X X NON-OWNED PROPERTY DAMAGE HIRED AUTOS AUTOS Peracciden! $ I X UMBRELLA LIARX OCCUR EACH OCCURRENCE $ 15,000,000 B EXCESS LIAB CLAIMS-MADE AGGREGATE $ 15,000,000 DED I X I RETENTION$ 1()'00C PPP7444319 /3/2015 /3/2016 $ WORKERS COMPENSATION INC STATU- OTH- AND EMPLOYERS'LIABILITY Y f N TORY LIMITS ER ANY PROPWIETORWARTNER/EXECUTIVEEl NIA E.L.EACH ACCIDENT $ OFFICERIMEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYE $ If yes,describe under DESCRIPTION OF OPERATIONS below RL,DISEASE-POLICY LIMIT $ C Directors & Officers PHPK1316451 /3/2015 /3/2416 Limit 1,000,000 Deductible 2,500 DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES (Attach ACORD 101,Additional Remarks Schedule,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 Proof of Coverage ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Gregg Gerelli/JCMIE y'S�O V. ACORD 25(2010105) O 1988-2010 ACORD CORPORATION. All rights reserved. INSn25oninnn)m Tha Ar'-r%pn nnma enrl Inn^aro ronin+nrnr+mor4a of Artripn ACORD CERTIFICATE OF PROPERTY INSURANCE 4/21DATE /2015 PRODUCER PH (845)265-2220 FAX (845)265-4754 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Gerelli Insurance Agency, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE Corporate Park West @ Route 9 COVERAGE AFFORDED BY THE POLICIES BELOW. P.O. Sox 362 COMPANIES AFFORDING COVERAGE Cold Spring NY 10516 COMPANY A Philadelphia Indemnity Ins Co INSURED - COMPANY White Gate Condominium Association B c/o Assoc:ia NY COMPANY 297 Mill Street C Poughkeepsie NY 12601 COMPANY D COVERAGES 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, CO TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION COVERED PROPERTY LIMITS LTR DATE MM1DDfYy DATE MMfDDlYY X PROPERTY X BUILDING $ 28,409,783 CAUSES OF LOSS PERSONAL PROPERTY $ BASIC X BUSINESS INCOME $ 614,333 BROAD X EXTRA EXPENSE $ Included A X SPECIAL PHPK1316451 4/3/2015 4/3/2016 BLANKET BUILDING $ EARTHQUAKE BLANKET PERS PROP $ FLOOD BLANKET BLDG&PP $ X Deductible $ 5,000 $ -_ INLAND MARINE $ TYPE OF POLICY $ CAUSES OF LOSS $ NAMED PERILS $ OTHER A X ICRIME PHPK1316451 4/3/2015 4/3/2016X Limit $ 275,600 TYPE OF POLICY X Deductible $ 2,500 Employee Dishonesty A X I BOILER&MACHINERY PHPK1316451 4/3/2015 4/3/2016 1I Mechanical Breakdown $ Included A X OTHER Limit Deductible Flood PHPK1316451 4/3/2015 4/3/2016 1,000,000 25,000 Earthquake 1,000,000 25,000 LOCATION OF PREMISESIDESCRIPTION OF PROPERTY Valuation- Extended Replacement Cost Employee Dishonesty includes Managing Agent Rider Building Ordinance or Law included SPECIAL CONDITIONVOTHER COVERAGES CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE Proof of Coverage EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE Gregg Gerelli/JUI�TE r _ ACORD 24(1/95) © ACORD CORPORATION 1995 INS(17d rniasf ` i r White Gate Condominium 11 Raymond Avenue Suite 32 Poughkeepsie,NY 12603 MAR 2 3 2016 TOWN OF WAPPINGER TOWN CLERK Questions?Contact; Associa New York www.associa.com 182839 v.17 Payor Name Payee Name Check Number Check Date White Gate Condominium Pay _ _ __ Payor Note; Town Of Wappinger 1000672 03/11/2076 Invoice paid; Account Number: Amount: Remittance Note: 03172p1b100 $100.00 i 1 I