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TOW Little League .. 2010-01-19 JCM IJ-\\"5\/b C'0o.A~ C6\ _'"" , - ,D . :.J C €r+ "Y (p /o.../O;/tt ~ ~ ~I/ ~1W Agreement for the Use of the Town Han Facilities for Meetings .--- " / t//A/,J of W,4ff,ivJ~ Ii "/TLk.- L{Ajl/l[.. Name ofOrganizati~r ofoup ~ OtJ~,... WI Name of person repre rntjng the gr~anization or Group IS- /JJ'~ 'MJI s f<.J. I I!.. Address Serial #: ~lication 0 $196':00 ~ert. of Ll o Notified Recreation (date: ) ChrisMa~erson 0 Christine Fulton - 0 Sue Rose ~ tQ.) 12-/ ~ ' if} Town of Wappinger Agreement for the Use of the Town Hall Facilities for Meetings f' ' UJ 'I eO .. FOR INTERNAL USE ONLY Received by: Date Received: 'I/~-I 37 " 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 6' , Other: Specify: If).} rrA7l~ - / The group is not ex ted to exceed ~ersons ~ Date(s): ~ ~ 5-tJ') , I to Time: j}/rf - 3/,.... tU' .D,-S )) o.:t.Q. cv-J+o -J 1t;J "8;?,... 0 ",,' 'If should be undtrstood 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. ( ) ( ) {I} 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. 1_ / 't -/ () - ).J.(;L..j) &fd- 1-0 lLP./- JJYJ 2/' o - cr j -3 it- S poJU ~ Ro b- h-JA ad- ./LVAJ uJ. '1 (/, h . ~ 0 .. ~ ~" . ~ - -, . 201Q-Ol-191CM T enns of the agreement most be strictly adhered to by the contractlng group as any disregard or abuse of the roles for ose of the facilities will result in termination ofose by the offending group, and they will not be granted reinstatement. I have read and understand the roles and regulations for the use of the F aeilities in the Town of Wappinger Town Hall, and will comply with these requirements. Signed: ?l!d~J/ ~ /bWL-L (Name of Group or Organization) For: Date: ~ I Approved: '1 ~J)i:i.--~ Date: -=- ~ . CERTIFICATE OF LIABILITY INSURANCE DATE 1/'tJtt ; :\ Keystone Risk Managers, LLC CERTIFICATE II 2321721-1 1995 Point Township Drive Northumberland, PA 17867 z 32 17 ADDI'lIONAI. NAMED ~ED: INSURERS AFFORDING COVERAGE: , . TOWN OF WAPPINGER NATIONAL LL INSURER A: LEXINGTON INSURANCE COMPAN'1 Roa WILSON ~ 15 MIDDLEBUSH RD INSURER B: NAnONAL UNION FIRE INSURANCE j (Non-Uabillty) COMPANY OF PmSBURGH, PA WAPPINGERS FALLS. NY 12590 INSURER C: CHARnS SPECIALTY INSURANCE COMPANY THE PQUCIES OF INsuRANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POUCY PERIOD INDICATED NOlWlTHSTANDING ANY REQUIREMENT. TERM OR CONDmoN 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 UtoAlTS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. . . ~ = TYPE OF INSURANCE POUCY NUMBER :::V..=. GENERAL LIABILITY ' .:; ',:' . X X OCCURRENCE X INCL. PARTICIPANTS X SEXUAl ABUSE POUCY EXPIRATION DAlE JIMIr1O/'f'(YY COVERAGES EACH 0CClIlfIENCE UMITS III 000, 000 .2.,000,000 $1. 000, 000 11. 000, 000 .2.,000,000 EACH LOSS $1,000.000 X DIRECTORS & OFFICERS 24214367 1/01/2.011 1/01/2.012 AGGREGATE $1.000,000 x CRIME COVERAGE 010009405 1/01/2011 Crime 1)edUCtIbIe: $250 ProperlyJ$1,000 Money 1/01/2012 EACH LOSS $35,000 AGGREGATE NONE jB J SPORTS EXCESS ACCIDENT 1/01/2012 As 111 M8tIlIlr PolIcy MId. MIX. 110?,?oo DecL 1160 As In Masl8r Policy ExcelI8 X SRG9105434 1/01/2011 "X" INDICATES COVERAGE SELECTED FOR ADDITIONAL NAMED INSURED ADDmONAL INSURED . . . '. . . WhO is an Insured (SECTION II) 01 the General liability poUey 18 emended to. ineIUde 88 &r:I1~ ~ ~ Or ~ shown In the ~Ie. but only with nllIp8Ct 10 liability arising out 01 the aboVe named UtIle L.eague's malntananC80r use 01 b1111 fields. or olh8r p'rerriIseS lOaned. donated. or rented to that UtIle League by such J*.$On or organizatIonS and subject to the followlng add1I\Onal exdusloll8: 1. Structural aIt8ra1Ions. new construction. malntenanC8. repair or demoIllIon operaIIons performed by or on behalf 01 the person or organization designated In the Schedule unlees pertormed by the aboV8 named UtIle Leegue and 2. That part 01 the ball field or other premiseS not being ull8Cl by the abOVe named Little League NAME AND ADDRESS OF PERSON OR ORGANIZATION: 1. TOWN OF WAPPINGER 2. WAPPINGERS CENTRAL SCHOOL DISTRICT 3. VILLAGB OF WAPPINGERS FALLS little League Baseball Risk Purchasing Group, Inc. 539 U.s. RT. 15 HIGHWAY South Williamsport, PA 17702 INSURED