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Wildwood Condo 2010-01-19 JCM FOR INTERNAL USE ONLY Town of Wappinger Received by: Joseph P. Paoloni ❑ Agreement for the Use of the Town Grace Robinson ElC[E m"Facilities for Meetings Date Received: I I - M Y042op ; . Serial#: � TOWN CF WAPPINGER IJ Application ❑ $100.00 ❑ Cert. ofLTO N CLERK = ❑ Notified Recreation (date: ) Agreement for the Use of the Town Hall Facilities for Meetings IL i) t�J 0 0�) (141 Z)�— 0_0 tib 6 ri i ,j i u H 7e of Orga zation or Group 6L-!> N me of person representing the Organization or Group "3 Z- ��u N��'�'s� z: c�3 E 3-3'11 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 (vlf Large Meeting Room ( ) Other: Specify: The group is not expected to exceed 106 persons Date(s): Z 1 J 7 Time: P 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 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: - (Name of Group or Organization) Date: Approved: Town Clerk Date: ACO DATE(MMIDDIYYYY) � CERTIFICATE OF LIABILITY INSURANCE 4/19/2017 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(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 CONTACTMaryBurlingham Gerelli Insurance Agency, Inc. PHONE (845)265-2220 FAXC.Nol-(845)265-4754 Corporate Park West @ Route 9 EAI -ML .MBurlingham@Gerelli-Insurance.com P.O. BOX 362 INSURERS AFFORDING COVERAGE NAIC 0 Cold Spring NY 10516 INSURERANorthern Security Insurance 25992 INSURED INSURER B Greenwich Insurance Company 2322 WILDWOOD MANOR CONDOMINIUM ASSOCIATION INSURERc:United States Liability Ins Co C/O ASSOCIA NEW YORK INSURER 117 EXECUTIVE DR INSURER E NEW WINDSOR NY 12553-5547 INSURER F: COVERAGES CERTIFICATE NUMBER:2016-17 Master 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. INSIR ADOTYPE OF INSURANCE L e POLICY EFF POLICY EXP LIMITS LTR POLICY NUMBER MMIDD1YYYY MWDDIYYYY GENERAL LIABILITYEACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED 50 OOO PREMISES Ea occurrencer $ A CLAIMS-MADE ❑X OCCUR BP21043522 0/15/2016 10/15/2017 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 POLICY PRO LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident 1,000,000 ANY AUTO BODILY INJURY(Per person) $ A ALL OWNEDSCHEDULED P21043522 0/15/2016 0/15/2017 AUTOS AUTOS BODILY INJURY{Per accident) $ NON-OPROPERTY X HIRED AUTOS X AUT SEED Perr ac cident AMAGE $ $ X UMBRELLA UAB OCCUR EACH OCCURRENCE $ 15,000,000 B EXCESS LIAR CLAIMS-MADE AGGREGATE $ DED X RETENTION$ 10,00C PPP7459175 0/15/2016 10./15/2017 $ WORKERS COMPENSATION WC STATU- I FIR OTH- AND EMPLOYERS'LIABILITY YIN �M ANY PROPRIETOWPARTNERIEXECUTIVEF__] N f A E.L.EACH ACCIDENT $ OFFICERIMFMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYE $ H yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ C Directors & Officers 1017858E 10/15/2016 10/15/2017 Aggregate 1,000,000 Deductible 1,000 DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more spate is required) Certificate Holder is listed as additional insured. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Wappingers Town Hall ACCORDANCE WITH THE POLICY PROVISIONS. 20 Middlebush Road Wappingers Falls, NY 12590 AUTHORIZED REPRESENTATIVE Gregg Gerelli/MVB V. ACORD 26(2010/06) 01988-2010 ACORD CORPORATION. All rights reserved. INs.n95 ranimsi n+ Tha Arnwn n. ma a-A I--- —..I.Q.,f ernon STRONGROOM EMERGENCY PAYMENT rgAssvcia' REQUEST FORM 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: RMI Date of Request: Payment FROM association, Wildwood Manor Condominium Payment payable TO: `lawn of Wavpin er Vendor address: 20 . i I rRoad . City: Middletown State: NY Zip: 12590 Ship to address: City. State: Zip' Payment FROM bank account: Department: Reason for payment request: .Renting of Town hall for annual 3neetinp- (¢ 22.11 7 Payment due date; f Invoice amount: 100.00 Amount and GL Code: 670 © � 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: Requester phone: 845.564.2831 Requester email: Special Instructions: Submit form to: ClientAP-emergency@associa.us 0 03/=512014 � > o m -< C + a O -1 LQ rD a. b 0 77 Q m rD 0 in_ a O CL m n � o o z ro. o D D ZY- ren ° O D � CL �Q o + Ln z rD o Ln < N AA Ln d - O d N rD O rD ru n rij ro W- 0 Ln Ln :. �7 ru 3 0 G -3 O� m Y D Lri w O N 3 m 0-3 [ o a � fl ' j" rn J ru _ o 3 J O m 4 :s O N fl H Ln y Q Ul 3 :..... ......: (o i