12
2010-01-19 JCM
FOR INTERNAL USE ONLY
Town of Wappinger
Agreement for the Use of the Town
Hall Facilities for Meetings
Received by: Chris Masterson 0
Christine Fulton ~
Sue Rose 0
Date Received: 0 l(J / ':J) / 10
Serial #: -=*!=-l d.
~pplication ~OO.OO ~ert. ofL!
crnotified Recreation (date:(PJ 5u/1Q
Agreement for the Use of the Town Hall Facilities for Meetings
/v/?.);t.)po2> Jt1,dA)j)~ d,v/)o ~S('oG
Name ofOr~ation or Group
-/~4';vI.e ~b#d.s
Name of person representing the Organization or Group
,5' W/Gbtv~oA ~, ~~on
Address '
IJ-l-
I
~y
/2J--~rV
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:
,'.0
The group is not expected to exceed II persons
Date(s): ,/;./ / /0 Time: & " "3 :;;
, {
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.
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 ofthe 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:
.M () 11- (p,.v -1 D .#-SS DC-
(Name of Group or Organization)
For:
IV /~ IJ W{)o/j
Date: /,
Approved:
Date: ~( 10
.JUN, 30, 2010 3:09PM
GERELLI INSURAi~CE
NO, 9676
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6/30/2010 I
THIS CERTIFICA n; IS ISSUED AS A MA TIER. OF INfORMATION I
ONLY AND CONFERS NO RIGHTS UPON THE CE.RTIFICATE
HOLDER- THIS CERTIFICATE DOES NOT AMEND, EXTEND OR I
ALTER THE COVERAGE AFFORDED BY THE POLICIES BEl01W,
\ INSURERS AFFORDING COVERAGE NAIC #
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CERTIFICATE OF LIABILITY INSURANCE
pRODUCER (645) 265-2220 F1\X: (El45) 265-4754
Gerell.i Insurance Agency I Inc.
Cor;porate Park West @ ~oute 9
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Cold Spr.i..ng
INSURED
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c/o River Manageroent, InC.
297 Mi.ll street
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COVERAGES
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ANY REQUIREMENT. TERM OR CONDITION OF ANY CONTAACT OR OTI-IER DOCUMENT WlTH RESP~CT TO WHICH THiS CERTlFlCATl;: MAY BE IssuED OR
MAY PERTAIN, THE INSURANCE AF~ORDED BY THE POLICIES DEsCRIBED H~REIN IS SUBJECT TO ALL THE TERMS. EXCI,..USIONS ANO CONOiTIONS OF SUCH
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CERTIFICATE ~mlOER ,
\(a45)29a~1478 At~n:
I Town of Wappinger
20 Middlebush Road.
\ Wappinger Fa~lsr NY
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cANCEl.LA TION
ACORD 25 (2009101)
INS025 (2000011
stiOuLD ANY OF TIlE ABOVE DESCIltElED POLICIES BE CANCElLED BEFOIlE mE EXPlRA. TION
DATE TI1EREOF. THE IS$I,IING INSURER w..L. ENDeAVOII: TO ~All ,~L DAYS Io\IR!TTf.N
NOTICE. TO TilE CERTIFICATE HOL.DER NAMED TO THe LEFT. BuT FAILURE TO DO SO SHALL
IMPOSE NO OElLIGAlION OR llAtllUTY OF ANY KIND UPON THE INSURER, ITS AGENTS OR ,
REPReEN1ATIVES. j'
AUTIiORlZED RePRESIiNTA TIVE. - '
Gregg Gerelli/LRQ ..J1~~ v. ~~.\
@ 1988.2009 ACORD CORPORATION. All rights reselVed.
'. The ACORD name and logo are registered marks of ACORD
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