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2019-2 White Condominium 2010-01-19 JCM FOR INTERNAL USE ONLY Town of Wappinger Received bJoseph P. Paoloni i-.Tent for the Use of the Town y: FF, I kIrT, Grace Robinson ��'acilities for Meetings Date Received: —/ —/ I I APR 14 2019 SerialWARING TMAM CLERK Application $100.00 Cert. of L Notified Recreation (Date: Agreement for the Use of the Town Hall Facilities for Meetings Name of Organization or Group: White Gate Condominium Name of person representing the Organization or Group: Scan McPhail Address: C/o 11. Raymond Avenue, Suite 32, Poughkeepsie, NY 12603 Phone No: 845-473-3711. This will confirm the arrangements being requested for your groups' use of the Wappinger Town Hall Facilities, as noted below: Senior Citizens Room (X) Large Meeting Room Other: Specify: The group is not expected to exceed 120� ersons. Date(s): Thursday, May 30, 2019 GPAL, 3� Time(s): 7:00 p.m. I V I 1*�A 01 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 Wapp,inger 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. Aw i �6 - V 30W --f- 2010-01-19 JCM No application shall be considered approved until it has been submitted to the Town Clerk for review and Clearance. 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 react 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: As agent for White-_ Nate Condominium (dame of Group or Organization) Date: 4.5.19 Approved: Town Clerk Date: AlII�" F04/488/2019/2019 CERTIFICATE OF LIABILITY INSURANCE DATEIMY) 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 have ADDITIONAL INSURED provisions or 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 Ma Burlingham NAME: g Gerelli Insurance Agency,Inc. PHONE (645)265-2220 FAX {845)265-4754 AIC Na Ext: A!C No Corporate Park West @ Route 9 E-MAIL MBurling ham@Gerelli-lnsurance.00m ADDRESS: P.O.BOX 362 INSURER(S)AFFORDING COVERAGE NAIC,N Cold Spring NY 10516 INSURER A: Philadelphia Indemnity Ins Co 18058 INSURED INSURER B: Greenwich Insurance Company 22322 While Gate Condominium Association INSURER C: Travelers Insurance Co 19038 C/o Assocla New York INSURER D: ! I 11 Raymond Ave.,Ste 32 INSURER E: Poughkeepsie NY 12603 INSURER F: COVERAGES CERTIFICATE NUMBER: 2019-2020 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, LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER MMID Y MMICY EFF UDNYYCY YY LIMITS X COMMERCIAL GENERAL LIABILITYEACH OCCURRENCE $ 1,000,000 CLAIMS-MADE Fx_]OCCUR PREMISES Ea occurrence $ 1,000,000 MED EXP(Any one Person) $ 5,000 A PHPK1964509 04/03/2019 04/03/2020 PERSONAL&ADV INJURY $ 1,000,000 GENT AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY 0 PET El LOC PRODUCTS-COMPlOPAGG $ 2,000,000 OTHER: Employee Benefits $ 1,000,000 AUTOMOBILE LIABILITY COMBINEDSINGLE LIMIT $ 1,000,000 Ea accident ANY AUTO BODILY INJURY(Per person). $ A OWNED SCHEDULED PHPK1964509 04/03/2019 04/03/2020 BODILY INJURY(Peraccidert) $ AUTOS ONLY AUTOS X HIRED Ix NON-OWNED PROPERTY DAMAGE $ AUTOSONLY AUTOS ONLY Peraccident X UMBRELLA LIAR X OCCUR EACH OCCURRENCE $ 15,000,000 B EXCESSLIAB CLAIMS-MADE PPP7444319 04!0312019 04/03/2020 AGGREGATE $ 15,000,000 DED I X1 RETENTION$ 10,000 $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY �,I N STATUTE ER ANY PROPRIETORIPARTNERIEXECUTNE ❑ NIA E.L,EACHACCIDENT $ OFFICERIMEMBER EXCLUDED? {Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ Directors&Officers Limit 1,000,000 C 107071277 04/03/2019 04/03/2020 Deductible 2,500 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) The certificate holder is listed as an additional insured with respects to the annual meeting being held. 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 Middle Bush Road AUTHORIZED REPRESENTATIVE Wappingers Falls NY 12590 V �. ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD White Gate Condominium 11 Raymond Avenue Suite 32 Poughkeepsie,NY 12603 Questions?Contact: Associa New York www.associa.com 16818617 V.18 Payor Name Payee Name Check Number Check Date White Gate Condominium Town Of Wappinger 1001325 04/09/2019 Payor Note: Invoice Paid: Account Number: Amount: Remittance Note: ER0405i910o $100.00 APR 17 2oig TOWN OF WAPPINGERTOWN (71i'71-11111 : VOID AFTER 90 DAYS _ ma a tsanKv { - _ t zU-5 Rrma Road Sut32— _ - Rlcliardson 1X 75081= P�hkeeps[e, 13?4fi12844 PAY TO 100 00 T€�wn Of Wappinger HEQRDI;RQF pne ndred Dollars and Zero Cents T 1f•' Ai' - I hjll:.::.. �,In �:,. .:. .gill tl�,r II. .111d11111111<IVI - -,111111tl1191111�'ltll,:l:.�- ,111,.�Ij1 1..' II°'IL 3,�i', 111 P I,I�j 1111i Da �ni�s. : _n„' �I :.•'.,:,. III 1114 ...�:� „N:G.,�, ... �,::. . ;�:..; i;v,:, 1..1,;. �.. 1 Ill ....:. 4111 llt ..,.,all 1...:I I I-Ill r ,_ ...... 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I III 11,11111 Ilal 11 I � ..111111- �Town Of'Wapptrger ,� ° l�r1. 11. 20.MiddlebushRd Or Waplsl- ers Failk NY 12590-4004 _ ' ii`" li'00 2 5ii' 1EM 040€] 2i894�: =��E, 5 2 2 3 5 iii• 11IL111335 H7114 . ,