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Montclair Townhouse / Condo 2010-01-19 JCM FOR INTERNAL USE ONLY Town of Wappinger Received by: Joseph P. Paoloni ❑ 11FOREment for the Use of the Town WO(/02a+ R son 11 a acilities for Meetings Date Received: AR 0.8 2017 Serial#: TOW OF WAPPINGE ❑ Application ❑ $100.00 ❑ Cert, of LI TUWN CLERK t ❑ Notified Recreation(date:_} Agreement for the Use of the Town Hall Facilities for Meetings Mon+ r r 76"hou� Co N me of Organization or Group 00 To + n- t M Mf, OVC-H-C PC r-Cz Name of person representing th rganization or Grou Ajqi 13 Key)+( yAr "PoUn�)"r 34 Id b bl /4,�,,3-5�370 Address rPhone No. This will confirm the arrangements being requested for your groups' use of the Wappinger Town Hall Facilities, as noted below: O Senior Citizens Room Large Meeting Roomr ( ) Other: Specify: C Cw C L annual H cmCc Drc The group is notxoect d to exceed �� Uersons Date(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 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. 2010-01-19 TCM 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 co ly with these requirements. Signed: For: �1"4-CIOVI 5r 1-ondom)inium (Name of Group or Organization) Date: A) Approved: Town Clerk Date: TE CERTIFICATE OF LIABILITY INSURANCE D 2/3/201m7YI 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(les)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 Alana Jessie NAME: DONN GERELLI ASSOCIATES PHONE (914)271-6600 {IA JC.No):(924)271-3698 INSURANCE AGENCY INC E-MAIL ADDRESS: 9 aJ'essie@d ainsuranee.com 1 Croton Point Avenue __.. INSURER(S)AFFORDING COVERAGE NAIC# Croton-on-Hudson NY 10520 INSURER A:Philadelphia Indemnity Ins Co. 18058 INSURED INSURER B:Greenwich Inc _ 22322 Montclair Townhouse Condominium INSURER C Federal Insurance Co_ 20281 C/o Town & Country Prop Mgmt INSURER 3 Neptune Road, Ste A19A INSURER E: Poughkeepsie NY 12 601 INSURER F: COVERAGES CERTIFICATE NUMBER:MASTER Lia 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 AODL SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE POLICY NUMBER MM DIYYYY MM1DD LIMITS JcOM1GLAImS-MAD MERCIAL GENERAL LIABILITY 1,000,000 EACH OCCURRENCE $A E I $ OCCUR DAMAGE TO RENTED 300,000 PREMISES Eaoccurrencs $ .. ._ .._ .. PEPKIBS3620 10/1/2016 10/1/2017 MED EXP(Any one person) _$ 5,000 PERSONAL&ADV INJURY_ $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY 11 PRO- JECT [:]LOC PRODUCTS-COMPIOP AGG $ 2,000,000 OTHER: Non-owned $ 1,000,000 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ 1,000,000 ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED PHPK1553620 10/1/2016 10/1/2017 BODILY INJURY Per accident $ _ AUTOS AUTOS ( ) NON-OWNED PROPERTY DAMAGE $ X HIRED AUTOS X AUTOS Per accident X UMBRELLA LIAB X OCCUR _EACH OCCURRENCE $ 15,000,000 B EXCESS LIAB CLAIMS-MADE AGGREGATE $ 15,000,000 DED I X I REIF ION$ 10.D00 PPP7451789 10/1/2016 10/1/2017 $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y 1 N STATUTE I I ER ANY PROPRIETORIPARTNEPJEXECUTIVE NIA E.L.EACH ACCIDENT $ OFFICERIMEMBER EXCLUDED? - (Mandatory In NH) E.L,DISEASE-EA EMPLOYE $ H yesunder E.6desenbeDRIPTION OF OPERATIONS bekow I E.L.DISEASE-POLICY LIMIT 1$ C Directors & Officers 6235-6665 10/1/2016 10/1/2017 Each Occurence 1,000,000 Deductible 1,000,000 DESCRIPTION OF OPERATIONS 1 LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached H more space is required) Town of Wappinger listed as additional insured for a meeting room rental on Thursday, October 26, 2017 Coverage is provided for thirty-seven two-story brick veneer condominium buildings containing two hundred ninety-six residential units. The premises is located at buildings 1-37 Alpine Drive, Wappingers Falls, Dutchess County, New York 12590. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town Of Wappingers THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Town Hall ACCORDANCE WITH THE POLICY PROVISIONS. 20 Middlebush Road Wappinger Falls, NY 12590 AUTHORIZED REPRESENTATIVE ATana Jessie/MC tfvc . ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD INS025(2n14n1) AC� DATE(MWDDIYYYY) `r CERTIFICATE OF PROPERTY INSURANCE 2/3/2017 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($), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. If this certificate is being prepared for a party who has an insurable interest in the property,do not use this form. Use ACORD 27 or ACORD 28. PRODUCER CONTACT Aiana Jessie NAME: DONN GERELLI ASSOCIATES -- INSURANCE AGENCY INC PHONE (914)271-6600 IF INSURANCE EMAIL 1 Croton Point Avenue ADDRrss:ajess±e@dgainsurance.com PRODUCER 00000030 Croton—on—Hudson NY 10520 ID: INSURERS AFFORDING COVERAGE NAIC N INSURED INSURERA:Philadelphia Indemnity__Ins_ Co. 1.8058 Montclair Townhouse Condominium - c/o Town & Country Prop Mgmt INSURER B: 3 Neptune Road, Ste A19A INSURER C: - Poughkeepsie NY 12601 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER34ASTER Prop REVISION NUMBER: LOCATION OF PREMISES I DESCRIPTION OF PROPERTY(Attach ACORD 107,Additional Remarks Schedule,if more space is required) Loc# 00001: 1-37 Alpine Drive Wappingers Falls NY 12590 See Attached Overflow Pages 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 NUMBER POLICY EFFECTIVE POLICY EXPIRATION COVERED PROPERTY LIMITS LTR DATE(MMIDDIYYY``) DATE(MWDDArfYY) X PROPERTY BUILDING $ CAUSES OF LOSS DEDUCTIBLES PERSONAL PROPERTY $ BASIC BUILDING X BUSINESS INCOME $ 873,792 10,00C BROAD CONTENTS EXTRA EXPENSE $ A X SPECIAL PHPKI553620 10/1/2016 10/1/2017 RENTAL VALUE $ EARTHQUAKE X BLANKET BUILDING _.. $ 39,545,13E X WIND BLANKET PERS PROP $ FLOOD BLANKET BLDG&PP $ X Backup-Sewers and $ Include X Blanket Building Coverage $ 39,545,135 INLAND MARINE - TYPE OF POLICY $ CAUSES OF LOSS $ NAMED PERILS POLICY NUMBER $ A X CRIME PHPK1553620 10/1/2016 10/1/2017 X Employee Dishonesty $ 390,46 TYPE OF POLICY X Computer Fraud $ _ _ 399 46 X Forgery BAEteraticns $ 390,46': A X BOILER&MACHINERY I PHPKI553620 10/1/2016 10/1/2017 X Limit $ 39 EQUIPMENT BREAKDONM ._.. ,54 545_ 13 X Deductible $ 1 0100( SPECIAL CONDITIONS I OTHER COVERAGES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) Town of Wappingers listed as additional insured for a meeting room rental on Thursday, October 26, 2017 The Property Managing ent Rider is included on Crime. 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 ACCORDANCE WITH THE POLICY PROVISIONS. Town Hall 20 Middlebush Road AUTHORIZED REPRESENTATIVE Wappinger Falls, NY 12590 Alana Jessie/MC ACORD 24(2009109) ©1995-2009 ACORD CORPORATION. All rights reserved. INS024(2DO909) The ACORD name and logo are registered marks of ACORD ADDITIONAL COVERAGES Ref# Description Coverage Code Form No. Edition Date Commercial Umbrella Aggregate Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium 15,000,000 10,000 Ref# Description Coverage Code Form No. Edition Date Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium Ref# Description Coverage Code Form No. Edition Date Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium Ref# Description Coverage Code Form No. Edition Date Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium Ref# Description Coverage Code Form No. Edition Data Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium Ref# Description Coverage Code Form No. Edition Date Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium Ref# Description Coverage Code Form No. Edition Date Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium Ref# Description Coverage Code Form No. Edition Date Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium Ref# Description Coverage Code Form No. Edition Date Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium Ref# Description Coverage Code Form No. Edition Date Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium Ref# Description Coverage Code Form No. Edition Date Limit 1 Limit 2 Limit 3 Deductible Amount 76eductible Type Premium Fo FAI)TLCV Copyright 2001,AMS Services,Inc. 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