2019-3 Montclair Townhouse Condominiums 2010-01-19 JCM
FOR INTERNAL USE..ONLY Town of Wappinger
Received by: Joseph P. Paoloni " lI Agreement for the Use of the Town
Grace Robinson D Hall Facilities for Meetings
Date Received:
OWEDSerial #:
Application C $100.00 -1 Cert. of LI SEP 0 9 2019
--i Notified Recreation (date:
TOWN OF WAPPI'NGER
Agreement for the Use of the Town Hall Facilities for Meetings
mAwi-C.&A
Name of Organization or Group
Ckf-v, Co'u-,il+Y11
Name of person representing the OrgaAization ol Group J
2? NtVj-UfV . 11joia 10(k.6, ( N,� -
Address J 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
Large Meeting Room
Other: Specify:
The group is not expected to exceed L40 ersons
Date(s): CL,4(
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 b :,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.
T 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.
6
Signed; A AP
pp �
For: . VC ►kl o
(NamcIf Gro4 or Organization)
Date: °
Approved:
Town Clerk
Date:
DATE(MM/DOrY
ACCWLX YYY)
CERTIFICATE OF LIABILITY INSURANCE
08/29/2019
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 CONTACTDonn Gerelli
NAME:
DONN GERELLI ASSOCIATES ArcNNo Ext: (914)271-6600 Fvc No: (914)271-3598
INSURANCE AGENCY INC E-MAIL Certificates@DGAlnsuranee.com
ADDRESS:
1 Croton PQlnt Avenue INSURER(S)AFFORDING COVERAGE NAIC#
Croton-on-Hudson NY 10520 INSURERA: Philadelphia Indemnity Insurance Company 18058
INSURED INSURER S; Merchants Mutual Insurance Company 23329
Montclair Townhouse Condominium INSURER C; Greenwich Insurance Company 22322
c/o Town&Country Prop Mgmt INSURER D: Federal Insurance Company 20281
3 Neptune Road,Ste Al 9A INSURER E:
Poughkeepsie NY 12601 INSURER F:
COVERAGES CERTIFICATE NUMBER: MASTER LIAR 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 ADUL SUBIC POLICY EFF POLICY EXP
LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER MWDD MWDD LIMITS
X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000
DAMAGE TO RENTED
CLAIMS-MADE � OCCUR PREMISES Ea occurrence $ 100,000
MED EXP(Any one person) $ 5,000
A Y PHPK1885974 10/0112018 10/01/2019 PERSONAL&ADV INJURY $ 1,000,000
GENT AGGREGATE LIMIT APPLIES PER! GENERAL AGGREGATE $ 2,000,000
X POLICY E]JECT LOC PRODUCTS-COMPlOPAGG $ 2,000 000
OTHER: $
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000
Ea accident
ANY AUTO BODILY INJURY(Per person) $
B OWNED X SCHE=DULED CAP1072011 1010112018 10/01/2019 130DILYINJURY(Por accident) $
AUTOS ONLY AUTOS
HIRED �/ NON-OWNED PROPERTYQAMAGE
AUTOS ONLY Peraccdent $
X AUTOS ONLY X
X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 15,000,000
C EXCESSLIAB CLAIMS MADE PPP7451789 10/0112018 10/01/2019 AGGREGATE $ 15,000,000
DEC) I X RETENTION$ 10,000 $
WORKERS COMPENSATION PER OT
AND EMPLOYERS'LIABILITY YIN STATUTE ER
ANY PROPRIFTORIPAHTNERIEXECU I W1 ❑ NIA E.L.EACH ACCIDENT 5
OFFICER)M£MBER EXCLUDED?
(Mandatory in NH) E L.DISEASE-EA EMPLOYEE $
If yes,dascdbe under
DESCRIPTION OF OPERATIONS below - E.L.DISEASE-POLICY LIMIT $-
Directors and Officers Each Occurrence 1,000,000
D 8235-6665 10/01/2018 10/01/2019 Deductible 2,500
DESCRIPTION OF OPERATIONS 1 LOCATIONS f VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required!
The Town of Wappingers-20 Middlebush Road,Wappingers Falls,NY 12590 is listed as Additional Insured on the General Liability policy as respects to the
Annual Meeting.
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
THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN
Town of Wappingers ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
20 Middlebush Road
Wappingers Falls NY 12590 ;,,r r .. .._
0 1988-2015 ACORD CORPORATION, All rights reserved.
ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD
Montclair Townhouse Condominiums Murun�of OMAHA BANK
005959
�. $86-951-6846
c/o Town&Country Property Mgmt. 27_28911040
3 Neptune Road,Sune Al 9A
Poughkeepsie,NY 12601
(845)462-2270 09/04/19
ORDER OHE
FE TOWN OF WAPPINGERS
ONE HUNDRED AND 001100 DOLLARS**********`******************************""** DOLLARS
TOWN OF WAPPINGERS r
20 MIDDLEBUSH ROAD
WAPPINGERS FALLS, NY 1259
MEMO
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H!s ppcUMElvT cONThl FIS A COLA co egcicc wU—`E aq FEa,wrylcgopq IN TG, L,_
Montclair Townhouse Condominiums/c/o Town&Country Property Mgmt.
9104119 59
Account#: TOWWAF TOWN OF WAPPINGERS Check#: 005959
Voucher invoice# Invoice Date Invoice Amount Amount Paid Discount Taken
5039 MTG ROOOM 10/30 9/04119 100,00 100.00 .00
Ref:Annual mtg room 10/30
Montclair Townhouse Condos Check Total 100.00