2019-6 Town of Wappinger Little League 2010-01-19 JCM
FOR INTERNAL USE ONLY Town of Wappinger
Received by: Joseph FRECI EN Agreement for the Use of the Town
Grace Robinson Hall Facilities for Meetings
Date Received: r �� 1 3 2019
Serial #: °t 0� `
I OWN-OF WAPPIN EP ;
�A r-nor
Application $100.00 Cert. of Ll
Notified Recreation (date:___) ;" r
F
Agreement for the Use of the Town Hall Facilities for Meetings f
LL
Name of Organizatio Group
Name of person representing ihe Organization or Group 3d2
Address Phone No.
I
This will confin-n the arrangements being requested for your groups' use of the Wappinger Town Hall Facilities, as
noted below:
O Senior Citizens Room
Large Meeting Room
( ) Other: Specify:
The group is not expected to exceed a5---persons
Date(s): I-- Time: /0 —1P , 16 --
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 infonned 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 fnust 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 Wapp inger Town
Hall, and will comply with these requirements.
Signed: d"41
J:��//,,1 :,7
For: rC3lJl)
(Naive of Group or Organization)
Date: !r l 3 "- I
Approved:
Town Clerk
Date:
CERTIFICATE OF LIABILITY INSURANCE Dn1122x11119/11119
PRODUCER CERTIFICATE#; 2321716-2020-2 2 32 17
Keystone Risk Managers, LLC
1995 Point Township Drive
Northumberland, PA 17$67 INSURERS AFFORDING COVERAGE:
ADDITIONAL NAMED INSURED: INSURER A: Lexington Insurance Company
TOWN OF WAPPINGER AMERICAN LL INSURER B: National Union Fire Insurance Company of
.teff Torlins (Non-Liability) Pittsburgh,PA
10 SCRIBO LN
Wappingers Falls,NY 12590 INSURER C: AIG Specialty Insurance Company
COVERAGES
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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR ADD'L POLICY EFFECTIVE POLICY EXPIRATION
LTR NAMED TYPE OF INSURANCE POLICY NUMBER INSRD IYDATE(MM DDNYYY) DATE(MMDDYYY) LIMITS
GENERAL LIABILITY EACH OCCURRENCE $1,000,000
A X X 091405740 01!0112420 01/0112021 $2,440,000
OCCURRENCE GFNERALAGGRFGATE
INCL PARTICIPANTS Pro PRODUCTSICOMP OPS
X Property Damage Deductible:$250 AGGREGATE $1,000,000
Sexual Abuse $1,000,000
X SEXUALABUSE OCCURRENCE
SexualAbuso $1,000,000
AGGREGATE
MEDICAL PAYMENTS Any One Person
EACH LOSS $1,000,000
C X DIRECTORS&OFFICERS 018251940 01/01/2420 01/01/2021 AGGREGATE $1,000,000
G }( CYBER LIABILITY COVERAGE 019642676 01/01/2020 011011202'1 LIMIT OF LIABILITY $100,000 PER
CLAMS MADE LEAGUE AGGREGATE
S&P SECURITY AND PRIVACY LIABILITY $ 00,000 PER LEAGUE SUBLIMIT OF LIA131LITY RETROACTIVE DATE CONTINUITY DATE
INSURANCE $1,000 PER LEAGUE RETENTION
POLICY INCEPTION POLICY INCEPTION
REGULATORY ACTION SUBLIMIT OF $100,000 PER LEAGUE SUBLIMIT OF LIABILITY
LIABILITY $1,000 PER LEAGUE RETENTION
EM EVENT MANAGEMENT INSURANCE $100,000 PER LEAGUE SUBLIMIT OF LIABILITY NOT APPLICABLE POLICY INCEPTION
$1,000 PER LEAGUE RETENTION
CRIME COVERAGE EACH LOSS $35,000
Crime Deductible:$250 Propertyf$1,000 Money AGGREGATE NONE
As in Master Policy'
ps in Master Policy
B X SPORTS EXCESS ACCIDENT SRG9105434 01/01/2020 01/01/2021 Med.Max,$100,000 Excess
I t I . Deductible $50
11X"INDICATES COVERAGES1 SELECTEP EOR ADDITIONAL NAMED INSURED
ADDITIONAL INSURED
Who Is an Insured(SECTION II)of the General Liability policy is amended to include as an insured the person or organization shown In the schedule,but only w[th respect to
liability arising out of the above named Little League's maintenance or use of ball fields,or other premises loaned,donated,or rented to that Little League by such person or
organizations and subject to the following additional exclusions:
1,Structural alterations,new construction,maintenance,repair or demolition operatlons performed by or on behalf of the person or organization designated in the Schedule andlor
performed by the above named Little League;and
2. That part of the ball field or other premises not being used by the above named Little League.
NAME AND ADDRESS OF PERSON OR ORGANIZATION:
1.Town of Wappinger 2,Wappingers Central School District
INSURED CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE
Little League Baseball Risk Purchasing Group, Incorporated WITH THE POLICY PROV 5.
539 U.S. RT.15 Highway
South Williamsport, PA 17702
AUTHORIZED PRESENTATIV5