23
2010-01-19 JCM
Date Received:
Chris Masterson 0
Christine Fulton 0
Sue Rose ~
LL/ 3-/ 12-
Town of Wappinger
Agreement for the Use of the Town
Hall Facilities for Meetings
"\
/1 3/1(.)
FOR INTERNAL USE ONLY
Received by:
Serial #: -# d ,'~
~~lication 0 $100.00 ~. ofLl
o Notified Recreation (date: II. 310 )
Agreement for the Use of the Town Hall Facilities for Meetings
\ o\.:>..:J ~ ~?-;:>'\ ~Li!- ~ L.it\r
Name of Organization or Group
~ . \ ~Dt0 ~0 Su\t, AN
Name of person representing the Organization or Group
\<\l h "' s --<_\ QA~") . r- t\\ 1
Address a...., t ~ ~~ ~\ \..) s+ \....-:AW, ~- Po... \\~
~IA l){'
\
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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 50 persons
Date(s):-11{ 'i \ lD . .J Time: "'7 pm oJ--.' I J In "......r"'"
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 been submitted to the Town Clerk for review and
Clearance.
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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.
I 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.
Signed:? d>..~ -
For: --t N ,:::WO ~ i ,-,1\:;>;:> '106 La ~ ,) 1+:8 [ L- ~~ ,,<-
(Name of Group or Organization)
Date: \\\~\P
APproVed: \ ~o~~
Date: \{ ( 'Z II'"
II </ /0 _ (IFF,
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I..) /,'1
CERTIFICATE OF LIABILITY INSURANCE DATE :t.2/04/09
.
K~ystone Risk Managers, LLC CERTIFICATE # 2::1::'::':1. '72:1.....:1.
1995 Point Township Drive
I'~ ':)") :l. './
Northumberland, PA 17867 ,:.. '...',;.,
ADDITIONAL NAMED INSURED: INSURERS AFFORDING COVERAGE:
T Cll..j t..! DF Ut,PPINGE:R r.! A T I Cl r,! A i... l...!... INSURER A: LEXINGTON INSURANCE COMPJ
F<CJB IAlf...~;)CJN
:I. ~:i r'iIn[)L.FElUE1H HI) INSURER B: NATIONAL UNION FIRE INSURAr
(Non-Liability) COMPANY OF PITTSBURGH, PA
\..1 i~\ P P :r. N (3 E: 1:~ ~:; F~\LL.~3 NY 1 :,:?, \:.~ ~) <)
INSURER C: LANDMARK INSURANCE COMPt
COVERAGES
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED NOTWITHSTANDIf\
ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR Mi
PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF sue
POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
.SR ADD'L TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS
.TR INSRD DATE MMlDDIYVYY DATE MMlDDIYYYY
GENERAL LIABILITY EACH OCCURRENCE '1;:l.,000,OO
" >< X OCCURRENCE 94'7:1.477 1/01/2010 :1./0:1./201 :I. GENERAL AGGREGATE $2,000,00
("1
X INCL. PARTICIPANTS Property Damage Deductible: $250 PRODUCTS/COMP OPS ;1;:1. ,000,00
AGGREGATE
SEXUAL ABUSE ;t> :I. ,O()() ~ O()
X SEXUAL ABUSE OCCURRENCE
SEXUAL ABUSE ~;:;~ ,000,00
AGGREGATE
EACH LOSS $1,000,000
A X DIRECTORS & OFFICERS ~?4;~ 14~:~()? l/O:l./;ZO:l.O :I. /0:1. / :~?O 11
AGGREGATE $1,000,000
r; >~ 0:1. OOOB::l'?B 1/01/;"?OlO 1/Ol/::?O11 EACH LOSS $35,000
CRIME COVERAGE
Crime Deductible: $250 Property/$1,000 Money AGGREGATE NONE
B As in Master Policy As in Master
SPORTS EXCESS ACCIDENT Med. Max. $100,000 Policy Excess
. . ~::; r..'G9 :1, O'::.i4 34 l/l()l/:~~O:f.O :I./0:1./;;:'Ol:l. Oed. $50
"XU INDICATES COVERAGE SELECTED FOR 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 with respect t
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 (
organizations and subject to the following additional exclusions:
1 Structural alterations, new construction, maintenance, repair or demolition operations performed by or on behalf of the person or organization designated in the Schedule unles
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:
l'OWN OF WAPPINGERS FALLS
OF WAPPINGERS FALI..S
2.
WAPPINGFRS CENTRAl... SCHOOL. DISTRICT
:L
\) I l...Lr'lC'lE
INSURED
CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES TO tHE ABOVE'NAlVIED LITTLE LEAGUE BE CANCELED BEFORE THI
EXPiRATION DATE THEREOF, THE iSSUING INSURER OR THEi EP TATIVE WILL MAIL 30 DAYS WRITTEN NOTICI
TO THE DESIGNATED PERSON OR ORGANIZATION AT THEi R 0 ADD T S.
r~)
Little League Baseball Risk Purchasing Group, Inc.
539 U.S. RT. 15 HIGHWAY
South Williamsport, PA 17702
CERTIFICATE OF LIABILITY INSURANCE DATE 'f ':j /(',.,\ /(,(')
.
Keystone Risk Managers, LLC CERTIFICATE # ':;';~:j ;;:::l.'7:!. (!.) .... J
1995 Point Township Drive
Northumberland, PA 17867 . , :::12 1 '7
.:..
ADDITIONAL NAMED INSURED INSURERS AFFORDING COVERAGE:
T Cl !,.J f.j CiF L.i(',PPINUFry~ '~~, h F F{ I C I~:'I 1'.1 LL.. INSURER A: LEXINGTON INSURANCE COMPA!
ReiB LJ I l... nCii'l
:1. ~:) i'i :r: n [) L. F El U ~;; if RU INSURER B: NATIONAL UNION FIRE INSURANC
(Non-Liability) COMPANY OF PITTSBURGH, PA
U(, P PI 1'-1 U I::: Fi.~:) F' "'Il...l... ~;) 1'1Y :1.2:'j90
INSURER C: LANDMARK INSURANCE COMPAt
COVERAGES
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED NOTWITHSTANDINC
ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MA'
PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF suer
POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
SR AOO'l TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS
rR INSRO DATE MM/DDIYVVY DATE MM/DDIVYVY
GENERAL LIABILITY EACH OCCURRENCE 'I; t non O()()
("t .- X OCCURRENCE O:Y'4'?:i.47'? :1./0:1./20:1.0 :l./O:L/20:l.'.l. GENERAL AGGREGATE 11;2 ,000 .000
X INCL. PARTICIPANTS Property Damage Deductible: $250 PRODUCTS/CaMP OPS ;1:. :1 (JOt) non
AGGREGATE
SEXUAL ABUSE ;1;:1. .. ()OO O\)<::
X SEXUAL ABUSE OCCURRENCE
SEXUAL ABUSE
AGGREGATE ~!; ~? }OOt);OOO
EACH LOSS $1,000,000
(., X DIRECTORS & OFFICERS ~\~~ 4 ::.~ :I. 4 :3 0 .7 :1./0:1./20:1.0 :I./O:l./~'::'O:J. :J.
AGGREGATE $1,000,000
(.1 0:1. OOO{:?~:~(:;f:~ :l/Ol/~.~OlO :J./Ol/~,?Ol:l. EACH LOSS $35,000
. . CRIME COVERAGE
Crime Deductible: $250 Property/$1,000 Money AGGREGATE NONE
3 As in Master Policy As in Master
SPORTS EXCESS ACCIDENT Med Max $100.000 Policy Excess
" E; F((:J91. O~:jA ::l A 1/0:L/~:.O:l.O :l. /O:t. /2():1.:!. Oed. $50
"XU INDICATES COVERAGE SELECTED FOR 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 with respect te
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 DI
organizations and subject to the following additional exclusions:
1. Structural alterations, new construction, maintenance, repair or demolition operations performed by or on behalf of the person or organization designated in the Schedule unles<
performed by the above named Little League and
2. That part of the ball field Dr other premises not being used by the above named Little League
NAME AND ADDRESS OF PERSON OR ORGANIZATION:
! U '.J ,; Ci F' LJ (.;, F' P T 1'1 C) E F~ ~:; F ti i..l... B
Of WAPPINGERS FAl..l...S
r}
..... .
LJ ,:'. P P I f,j (;j F P ~:) C F f,j T F! (." L (:) C H () C) !... D I ~:; T F~ leT
~:j ,
I) T L..Lt",UC
INSURED
CANCELLATION
Little League Baseball Risk Purchasing Group, Inc.
539 U,S. RT. 15 HIGHWAY
South Williamsport, PA 17702
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES TO THE ABOVE NAMEG blTTLE LEAGUE BE CANCEcED BEFORE THE
EXPIRATION DATE THEREOF THE ISSUING INSURER OR THEIR ~EPR TATIVE WILL MAIL 30 DAYS WRlrrEI~ NOTICE
TO THE DESIGNATED PERSON OR ORGANIZATION AT THEIR ';JI!!)<.. ~~D'Y') J~
~t:;h~~~~~. '.
AUTHORIZED REPRESENTATI ~)