Carnwath Emergency Repairsn n A. -
NEW YORK STATE INSURANG" FUND
199 CHURCH STREET, NEW YORK, N.Y. 10007-1100
1-888-997-3863
CERTIFICATE OF WORKERS' COMPENSATION INSURANCE
LOVELL SAFETY MGMT CO L L C
125 MAIDEN LANE
NEW YORK NY 10038
PERIOD COVERED BY THIS CERTIFICATE
3/31/2002 TO "1/01/2004
POLICY NUTAE EER
G 1317 095-6
DATE
11/08/2002
CERTIFICATE NUMBS
312-394
POLICYHOLDER CERTIFICATE HOLDER
MID -STATE INDUSTRIES LTD CERNIGLIA & SWARTZ,PC.
1105 CATALYN ST 134 ACADEMY STREET
SCHENECTADY NY 12303 POUGHGKEEPSIE NY 12601
U-26.3
THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE STATE
INSURANCE FUND UNDER POLICY NO. 1317 095-6 UNTIL 1/01%2004 , COVERING THE ENTIRE
OBLIGATION OF THIS POLICYHOLDER FOR WORKERS' COMPENSATION UNDER THE NEW YORK WORK-
ERS' COMPENSATION LAW WITH RESPECT TO ALL OPERATIONS IN THE STATE OF NEW YORK.
IF SAID POLICY IS CANCELLED, OR CHANGED PRIOR TO 1/01/2004 IN SUCH MANNER AS
TO AFFECT THIS CERTIFICATE, 10 DAYS .WRITTEN NOTICE OF SUCH CANCELLATION
WILL BE GIVEN TO THE CERTIFICATE HOLDER ABOVE. NOTICE BY REGULAR MAIL SO
ADDRESSED SHALL BE SUFFICIENT COMPLIANCE WITH THIS PROVISION. THE STATE INSURANCE
FUND DOES NOT ASSUME ANY LIABILITY IN THE EVENT OF FAILURE TO GIVE SUCH NOTICE.
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS
NOR INSURANCE COVERAGE UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT
AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICY.
THE STA E INSURANCE FUND
DIRECTOR, INSURANCE FUND UNDERWRITING
11!13/2002 17:41 5183816820
November l3, 2002
Town of Wappinger
20 Middlebusb Rotad
PO Box 324
Wapptngcrs Fells, NY 12590
Attn: Joseph Ruggiero, Sap uvIsor
MIDSTATE
PAGE 02
Mw
d -State _
Re: Greystone Est&WCamwath Marnmorn Emergency Stabilization
Dea Mir. Ruggiero;
1, Michael W. Lacey, Preeidernt ofhCid-State Industries, Ltd., 1105 Catalyn Stere,,
Schenectady, NY 12303, am the sole &&dor, sole shareholder and president of
Mid -State badust ws, Ltd. I hereby authorize Frank .1_ Lama to mpresent
Mid-StateWustrieS, Ltd. and sign the contract for QMstotne EsWelCamwath Mansion
Emergency StabiliEstion on my behalf.
Sincerely
MII3-S TRIS , - A
Michael W. Lucey
President
Corporate Seal
STATE OF NEW YORK
COUNTY OF Schenectady } ss
On this 130- day ofNovember 2042 W.fom me personally appeared Michael W. Lucey to
be knOwn, who, being by Inc duly sworn, did depose and say, that he is the President of
Mid State Industries, Ltd. F f
P HOURIQAAI
NON" Public. $tate of Now VA
41 HO4524309
Gafffffed in Sehenwtady.
Co lora Expires NCv@mbs�jpi0 to
1105 CATALYN STREET - SCHENECTADY, NEIN YORK 12303 • (518) 374-1461 • FAX (518) 351.6820
r�T7CTII-1 _"�i (P
> VVE ARE SENNNG YOU ZAttached
Shop dravyings I
I. , unueu separa e c—e,
Prirrts
Copy cat letter 1 Change order
PlSpecihca
ansas
c7 Snples
SUPERVISqp-�
F,.a
'TOWN-GFWAPpINGE11
11 j
THESE ARE Tp ANSUIP'TED as, checked below:
REMARKS
_1 For approval
Zr C,)r 'r Use
AS requested
_
J_
" revIeW and comment
; I FOR BIDS DUE.
Li Approved as subr-nitted
I I Resubmit ._--__copies for approval
-1_; Approved as noted
i...I SLjbrnt . . .. . .... copies for distribution
_1 Returned for corrections
1 1 Return corrected prints
PRI N"I _S RE FURNED AFFER LOANI TO US
. .. . ...... _1 , I
. .......... .
. . ........ . . ......... .
COPY TO . . ...........
SIGNED�...........
. . ..
otity is
if enctasures are nt rrot
oas ed, kindly # P ;
STATE OF NEW YORK
WORKERS' COMPENSATION BOARD
CERTIFICATE OF PARTICIPATION IN WORKERS'COMPEN
GROUP SELF-INSURANCE VEC
NOY' n2042
Ia. Legal Name and Address of Business Participating in Group Self-
Id. Business Telephone Number of Buin box "Ia"
11W"'T6MS
Insurance (Use Street Address Only)
ORI -CE
T0WN0FWAPPft6i
Superior Walls of Hudson Valley
Fairview Majestic Fireplace Corp.
68 Violet Avenue
(845) 485,4033
Poughkeepsie, NY 12601
le. NYS Unemployment Insurance Employer Registration Number of
Business referenced in box 'Ia"
1b. Effective Date of Membership in the Group —6/9
Valid till: 1/1/2003.
66-43066
1c. The Proprietor, Partners or executive Officers are
If. Federal Employer Identification Number of Business referenced in Box
El Included in the coverage provided by this group self-insurance.
Excluded. Form C-105.51 must be filled with the Self insurance
Office.
Superior Walls: 14-1716591
Fairview Majestic & Fireplace: 14-1794212
2. Name and Address of the Entity Requesting Proof of Coverage (Entity
2. Name and Address of Group Self- Insurer
Being Listed as Certificate Holder)
Manufacturing Industry WC Self -Insurance Trust
Town of Wappingers
C/O Consolidated Risk Service, Inc.
55 Gold Road
985 Old Eagle School Road
Wappinger Falls, NY 12590
Suite #504
Wayne, PA 19087
This certifies that the business referenced above in box "Ia" is complying with the mandatory coverage
requirements of the New York State Workers' Compensation Law as a participating member of the Group Self -
Insurer listed above in box "3" and participation in such group self-insurance is still in force. The Group Seif-
Insurer's Administrators will send this Certificate of Participation to the entity listed above as the certificate holder
in box "2".
The Group Self -insurer's Administrator will notify the above certificate holder within 10 days IF the membership of
the participant listed in box "Ia" is terminated. (These notices may be sent by regular mail.), Otherwise, this
Certificate is valid for a maximum of one year from the date certified by the group self -insurer.
If this certificate is no longer valid according to the above guidelines and the business referenced in box "la"
continues to be named on a permit, license or contract issued by the certificate holder, the business must provide
the certificate holder either with a new certificate or other authorized proof the business is complying with the
mandatory coverage requirements of the New York State Workers' Compensation Law.
Under Penalty of perjury, I certify that I am an authorized representative of the Group Self -insurer referenced
above and that the business referenced in box "Ia" has the coverage as depicted on this form.
Certified by:
(Print name of j6)ho
,4jpd repreWtative,of the GrouVSeff-Insurer)
Certified by:
Title: Administrator
Telephone Number: (610) 687-3869
(Date)
NEW YORK STATE INSURANCE FUND
199 CHURCH STREET, NEW YORK, N.Y. 10007-1100
1-888-997-3863
CERTIFICATE OF WORKERS' COMPENSATION INSURANCE
LOVELL SAFETY MGMT CO L L C
125 MAIDEN LANE
NEW YORK NY 10036
PERIOD COVERED BY THIS CERTIFICATE
3/31/2002 TO 1/01/2004
POLICY NUMBER
G 1317 095-6
DATE
11/08/2002
CERTIFICATE NUMBER
312-393
POLICYHOLDER CERTIFICATE HOLDER
MID -STATE INDUSTRIES LTD TOWN OF WAPPINGER
1105 CATALYN ST MIDDLEBUSH ROAD
SCHENECTADY NY 12303 WAPPINGER NY 12590
THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE STATE
INSURANCE FUND UNDER PO-LICY NO. 1317 095-6 UNTIL 1/01/2004 , COVERING THE ENTIRE
OBLIGATION OF THIS POLICYHOLDER FOR WORKERS' COMPENSATION UNDER THE NEW YORK WORK-
ERS' COMPENSATION LAW WITH RESPECT TO ALL OPERATIONS IN THE STATE OF NEW YORK.
IF SAID POLICY IS CANCELLED, OR CHANGED PRIOR TO 1/01/2004 IN SUCH MANNER AS
TO AFFECT THIS CERTIFICATE, 30 DAYS WRITTEN NOTICE OF SUCH CANCELLATION
WILL BE GIVEN TO THE CERTIFICATE HOLDER ABOVE. NOTICE BY REGULAR MAIL SO
ADDRESSED SHALL BE SUFFICIENT COMPLIANCE WITH THIS PROVISION. THE STATE INSURANCE
FUND DOES NOT ASSUME ANY LIABILITY IN THE EVENT OF FAILURE TO GIVE SUCH NOTICE.
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS
NOR INSURANCE COVERAGE UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT
AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICY.
RECEIVED
140V 2 0 73"
-TOWN CLERK
THE STA E INSURANCE FUND
U-26.3Tp
(�
DIRECTOR, INSURANCE FUND UNDERWRITING
From: Patricia C. Crayford At: Rase a Kieman. Inc. Fa>: D: Rose and Kjernan To: }Caren HLlyd Case: 1 Ile= 05:01 PM Page: 2 of 3
LATE {MMIDDITY Yj
AC RDCERTIFICATE OF LIABILITY INSURANCE OP ID FC1
LUDST-2 1 11/11/02
PRODUCIR
Rose and Kiernan, Inc-
P 0 Box 640
99 Troy Road
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO R;GHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
INSURERS AFFORDING COVERAGE NAIC
East Greenbush NY 12061
Phone: 518-244-4245 Fax: 518-244-4262
D 'L
—Type
NiuvsD
114s_ITE:A ACE Property & Casualtj Ins Cc��
Mid -State Industries Ltd.
Michael W. Lucey
[A RER5. National Union Fire Insurance
Rc
;,REScottsdale
------
I'a3'R
1105 Catalyn Street
Schenectady NY 12.303-1836
rAVGD6ltFC
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSUiREO NAMED ABOVE FOR -HE CIOLICY PERIOD INDICATED. NOTN;T!{STANCING _7
ANY REQUI REM ENT. TERM OR CONDITION OF ANY CONTRACT CR 07HER OOCURAENT WITH RESPECT TO WHICH THIS CERTI FICATE MAYBE IS-sUED OR
MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRI BED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH
POLICIES. AGO REGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS
---i
SR
D 'L
—Type
POLICY EFFECTIVE-�-�PJLICY
ENPIRATIOH
LTR
NSRO
OF INSURANCE
AOLIC7 NUMGER DATE (MM13DlYY)
I DATT ! IfdnV00tIY' LIh71'FG
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A D R�REs rlvE lI
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"I! EFUL LIABILITY
!
I
I j FAC - OL C':�RiGE i 5 1, 000, 000 _ .
f h �FGA:GE TC�ITE�
RS/30/03 ;I s 50, 000.
A
Y
Z C*MM=RCI.4LGeNeR�LrUABrrrr
(:MMS rrR-CE 3CCLF
1620521600 05/30/02
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=Gc^s=s(Eac.L"cn%e)
MEU E:iP'Mry s"sa persnr) 5 5, 000.
1.1
I cASOULs:Dyo.LPV ',s 1,000,000.
I r.�
�_s 2,000.000.
I {;EN'LA3�,r�EG+r LIMITf�PLES PEP.
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FOOU':IL78- _-_VRI:° Ii; 1 5 2 i100
PgLJCr i Pkv- .IEC
AUTOMCIBILE
LN&LITY
{
C� ��S. J_U Sjfl L _itZ
s 1,000,000.
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I E08054757 05/30/02
05/30/03�J'
ALL C�^Av=7hUl'r)S
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11 YORKERS COMPENSIAmON 11VO
EMPLOYERS'LIABIu7Y
1,-CCIDEIVT I S
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! SPECIAL PR_+"`=IONS n-ZlrLUIeF;,SE-P^.
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OTHER
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iExcess Umbrella
XLSE1520022 I 09/18/02 05/30/03 each occ. $4,000,000.
aacrreoate $4,000,000.,
DESCRIPTION OF OPERATIONV 1 LOCA -IONS J VEHICLES 1 EXCLUSIONS ACCED SY ENDORSEMENT, SPECIAL PROVIS!CNS
The Town of Wappinger is additional .insured under the general liability but
solely with respects to the work performed by the Named Ins,=ed on the
Greystone EstatejCarnwath bfansion.
46![1 Ir I1rMl G n LW
-
T01 -W,104
SNoJL3ANYOFTHE ABOVECESCRIIJUD POLICIES BECANCELLEO BEFORE THE EYPIRI.TI�N
UA-ETHUFEOF,YHEIJUJffIGIN;URE:TW7LLertlGEAMORI O MAIL 30 DAYS WRITT%N
NOTICE TO THE CERTIFICATE HOI-DER NAMED TO TH^e LEFT. BUT F41LLlRE TD DO SO SHALL
Town of Wappinger
EdPOW NO OBLIGATION OR LAGILIT OF ANY FIND UPDli TFEE INSURER. [TS AGENTS OR
20 Middlebush Road
Wappinger Falls DIY 12590
REPRES8N7AnlES.
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A D R�REs rlvE lI
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Amnon rnoanoerinu iea
ACORN 25 (2001108)
From: Patrfc;a C. Crawford At: Rose & Kiernan, Inc. FaxID: Rose and K;eman To: Karen Hurd Date: 1118102 05:14 PAR Page: 3 of 3
IMPORTANT
If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A. s-atement
on this certificats does not confer rights to the certificate holder in I eu of such endorsement(s).
If SUBRCGA7i4N IS WAIVED, subject to the terms and conditions of the po icy: certain poiicies may
require an endorsement. A statement on this certificate does not confer rights to the certificate
holder in ?ieu of such endorsement(s).
DISCLAIMER
The Certificate of Insurance on the reverse side of this form does not constitute a contract be -'Ween
the issuing insu-er(s), authorized representative or producer, and the certificate holder, nor does it
affirmatively or negatively amend. exzerd or alter the coverage afforded by the pokiE�s listed thereen.
RECEI '
NO ' -,)�
TOWN CLEF
25
VERGILIS, STENGER, RoBERTS, PERGAMENT & VIGLOTTI, LLP
ATTORNEYS AND COUNSELORS AT LAW
1136 ROUTE 9
WAPPINGERS FALLS, NEW YORK 12590
(845) 298-2000
GERALD A. VERGILIS*
FAX (945) 298-2842
OF COUNSEL:
KENNETH M. STENGER
IRA A. PERGAMENT
e-mail: VSRPa]3estVRECEF1
ALBERTP.ROBERTS
LEGAL ASSISTANTS:
LOUIS J. VIGLOTTI
VE
AMY E. DECARLO
JOAN F. GARRETT"
LISA MARTELL
THOMAS R. DAVIS
#POUGHKEEPSIE
OFFICE
PHILIP GIA.MPORTONE276
S(JPERVisop's
MAIN MALL
KAREN P. MACNISH
TO Wly C)F tZ OFF7(1
, E,
POUGHKEEPSEE, NY 12601
(845), 452-1046
*ADMITTED TO PRACTICE
IN NY & FLA.
ADDRESS REPLY TO: I POUGHKEEPSIE
**ADMrITEDTOPRACTICE
WAPPINGERS
IN NY & CONN.
VIA FACSIMILE 297-4558 AND REGULAR MAIL
November 13, 2002
Hon, Joseph Ruggiero, Supervisor
Town of Wappinger
20 Middlebush Road
Wappingers Falls, New York 12590
Re: Emergency Repairs for Camwath Mansion
File No. 12951.0607
Dear Joe:
I am in receipt of a Certificate of Liability Insurance issued on behalf of ACE Property &
Casualty Ins. Co., National Union Fire Insurance, and Scottsdale Insurance on behalf of
Mid -State Industries, Ltd., a copy of which is affixed hereto. I have reviewed same and
find the limits of liability acceptable for this project. Also, please note that the Town of
Wappinger has been named as a Certificate Holder.
It is my understanding Don Swartz is attempting to arrange for a contract signing
tomorrow morning. I will make myself available at your office at approximately 9 a.m.
Very truly yours,
VERGILIS, STENGER, ROBERTS, PERGAMENT & VIGLOTTI, LLP
RECEIVED
ALBERT P,ROBERTS
APR/bg
Enclosure "I(D)WN CLER�,',"
0:\WAPP1NGE\Town Board\Greyston61I 1302-.1R.doc
Cc W/ enclosure: Hon. Gloria Morse, Town Clerk
Town Board File
0AWAPPINGE,\Town Board\Greystme1 111 302-JR.doc