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White Gate 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 Robinsons 11 Facilltles for Meetln S Date Received: I I _....._.,..,. g Serial #: APR d 7 201$ __... Ll Application $100.00 E ",WWOF WAPPINGER 3 k Notified Recreation (date: ) TOWNCLERK Agreement for the Use of the Town Hall Facilities for Meetings V441 ;—% F— A► CW4b0M11N Ulr" Name of Organization or Group G ePrN Mc-P41 Ari L- Name of person representing the Organization or Grou ` PrS��G1A ��cti-1 .-to RV- 11 kwlfly N r�UlQ-- Address 3 $y 5 W+3e 3�I 1 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 exec � persons Date(s):_`- "� _ S- 110 , �[ 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 inforined 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 Terns 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 Mall, and will comply with these requirements. Signed: _ For: Avs Ac�, 1y12- 1 i 'L pFy- Cc;cm i t4iKro (Name of Group or Organization) Date: 4 . Approved: Town Clerk Date: Ac" DATE IMMIQDIYYYY) ��. CERTIFICATE OF LIABILITY INSURANCE 4/12/2018 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 Mar Burlingham NAME: y Gerelli insurance Agency, Inc. PHHO No Ext) (845)265-2220 FAX Ai ,Ne): (845)265-4754 Corporate Park West @ Route 9 AIL ADDRR$g.MBurlingham@Gerelli-Insurance.com P.O. Sox 362 INSURER(S)AFFORDING COVERAGE� NAIC k Cold Spring NY 10516 _ INSURER A:Philade 1phia indemnity Ins Co 18058 _ INSURED INSURERB:Greenwich Insurance Company 22322 White Gate Condominium Association INSURER C:Federal .Insurance Company 20281 C/o Associa New York INSURERD: 11 Raymond Ave., Ste 32 INSURER E Poughkeepsie NY 12503 INSURER F: COVERAGES CERTIFICATE NUMBER:2018-19 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. �ADDL SUER' POLICY EFF POWCY EXP (NSR TYPE OF INSURANCE LIMITS LTR POLICY NUMBER MMIDMYYYY MM1DDlYYYY X COMMERCIAL GENERAL LIABILITY _EACH OCCURRENCE $ 1,000,000 i DAMAGE V RPNTED T` '— A CLAIMS-MADE �OCCUR PREMISES Ea occurrence $ 1.000,000 PHPK1794623 4/3/2018 9/3/2019 MED EXP(Any oneperson) $ 5,000 PERSONAL&ADV INJURY S 1,DOD,000 GEN'L AGGREGATE LIMIT APPLIES PER: j GENERAL AGGREGATE $ 2,000,0 00 PRO- �� 2,000,000 _XPOLICY I--] JECT ! LOC PRODUCTS-GOMPlOPAGG $ OTHER, $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 1 ��Eaccid_ ANY AUTO ILYINJURY(Perperson) $ALL OWNED SCHEDULED PHPK1799623 4/3/2018 4/3/2019 ILY INJURY(Per accident) $ (AUTOS AUTOS NON-OVVNED :. PROPERTY DAMAGE X HIRED AUTOS X AUTOS ',(Per accident) $ i li $ X UMBRELLA LIAB X OCCUR EACH OCCURRENCE j$ 15,000 000 _ --.... ................ .__.....,...-- __-. _ )3 EXCESS LIAB CLAIMS-MADE AGGREGATE 5 15,000,000 DED I X RETENTION$ 10,000 PPP7494319 4/3/2018 4/3/2019 $ 1WORKERSCOMPENSATION PERI OTH- AND EMPLOYERS'LIABILITY YIN STATUTE ER MANY PROPRIETORIPARTNERIEXECU71VE ❑ E.L.EACH ACCIDENT $ OFFICERIMEMBER EXCLUDED? N f A; - (Mandatory in NHI EL,DISEASE-EA EMPLOYEE $ Ifes,describe under -- DESCRIPTION OF OPERATIONS below EI DISEASE-POLICY LIMIT $ C Directors & officers I ( 8227-3322 4/3/2018 4/3/2019 Limit 1,000,000 Deductible 2,500 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Certificate holder is listed as additional insured with respects to the annual meeting CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Wappingers Town Hall THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 20 Middle Bush Road ACCORDANCE WITH THE POLICY PROVISIONS. Wappingers Fails, NY 12590 AUTHORIZED REPRESENTATIVE Gregg Gerelli/MVR ©1968-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD I NS025(2D140 1) White Gate Condominium 11 Raymond Avenue Suite 32 Poughkeepsie,NY 12603 Questions?Contact: Associa New York www.associa.com 420720 v.18 Payor Name Payee Name Check Number Check Date White Gate Condominium Town Of Wappinger 1001136 04/24/2018 Payor Note: Invoice Paid: Account Number: Amount: Remittance Note: ER042018100 1100,00 THIS CHECK CO NTAI NS KANT KDPY" .D SECURITY FEATURE AND OTHER SECURITY FEATURES. - - — - = ;. _ ❑QI�9FTER9d-DAYS - -_ - - White Gate Condolrnmium = _ 'klu�ual of4tnaha Bank T57 - - � _ - 11 WA "2 = _ - 115V Atansedasteil- _ - 116 = _ Poughkeepsie;NY 12663 m" :DATE• 'x:915751.221 PAYkTO Town 0f wappinger ... ..... $ 100 00 THE'ORDE OF -' R One Hundred Dollars.anc!Zero Cents "��i`i G pOLIJk�Z$ w iu �11U '� memo• Inv:ER04201.8100 Town OfWappinger 2Mdeuh id Wap�ingers Falls NY F2590-4004 = - � fig LOO L436111 1: 122L0S ? S7l: 276S223S311'