Wildwood Manor Condo
03/07/2011
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Received by:1
23:45 8452977214
COMPTROLLER
PAGE 01/G3
2010-01-19 JCM
ITE N lJ
Chris MastersJ 0
Christine FuItoh 0
Sue Rose J ~
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21.5100.00 :J:ort, ofL!
mon (date~
Town of Wappinger
Agreement for the Use of the Town
Hall Facilities for Meetings
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Address
Agreem..nt fi r the lIRe of the Town Hall FaeWties for Meetings
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This will co the anugements being requested fot your groups' use oftb.e Wapf'inger To"," Halt Facilitie5. a.c;
noted below: I
( ) Senior itizens Room
v1 Large eeting R.oom
( ) Other: pecify.
The group is nl t expected to exceel Sf) pc;noWli
Date(s): /lC # D ~ Time: ~; j 0 - 9 p?e:c..,
rstood that group USiDi the Buildings' Facilities for evening meetinp must select dates when
I are nonnalIy sch led (i.e., Justice Court. Planning Board, etc.) Special requests will be
considered their own merit, d arrangements can be made for access to, and olosin&, the building at t'le close
ofyourm . . l
You and your I, ganization hereby, gree to adhere to the rules set forth on the attached page by signature of an
authorized m ber of your Organi~tion or group.
The Town of I appiDgor reoorvcs J. right to ouopcod tcmpororily this _ sbouId th. Town have need of the
facility for its purposes. AdvaJce notice will be given as soon as possible on such occasions.
The Town Cl should be informeh promptly of any schedule change or cancellation of your group activities.
Arrangements r access to specifi area to be used should be made with the Town Clerk at the time this fonn is
submitted.
NO applicatio
Clearance.
proved until it has been submitted tel the Town Clerk for review and
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03/07/2011 23:46
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Terms of the a ent must be s ' Y' adhered to by the contracting gruup l:Ib l;l,ny diSl'cgard Or abuse of the rules
for use of the fl, ilities will result in termination of use by the offending group, and they will not be granted
reinstatement. i
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I have read an~ . derstand the rule 'and regulations for the use of the Facilities in the Town of Wappinger Town
Hall, 8rln will mply with these uirements.
\
Signed:
8452977214
COMPTROLLER
PAGE 02/8?
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20l0-01-191CM
Date:
For:
~t~CJC /
Approved:
Fl
Date:
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til 3{8{~O~1 Tlme. 3.b~ ~M ~O,
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CIiAntli: ~9115 WILOMA
, CERTIFICATE OF LIABILITY INSURANCE \ 0" TE (MMiUo/VYYV)
ACORD,,, 310812011
PRODuceR THIS CERTIFICATE 15 ISSUED AS A MATJ"ER OF INFORMATION
Bradley & Parker, Inc. - Comml ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
320 South Service Road ALTER THE COVERAGE AFFORDED BY THE ftOUCIES BEL.OW.
Melville, NY 11747
INSURERS AFFORDING COVERAGE NAIC l#
Ii'lIURED INSURER'" Sparta Insurance Company
Wildwood Manor Condo Association INSURER B: Bradley & Parker, Inc.
C/O River Management loc INSURER C:
297 Mill Street :NSURER D:
poughkeepsie, NY 12601 INSURER E:
T"'II: POlICIES OF INSURANCE LIS1ED BELOW HAVE BEEN ISSUE" TO THE INSURED NAMED I'SOVE FOR THE POLICY PERIOD INDICATED. N01'vVITHSTANDING
ANY R'EOUIREM;NT TERM OR CONDITION OF Jt.K'( CONTRACT 0 R OTHER DOCUMENT WITH RESPECT TO WHIC"t THIS. CERTI FICATE MAYBE ISSUED OR
tit!>. Y PE~TAIN, THE NSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT fa ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH
POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
TR ,N8RC TYP~OfINSURANC~ POUCYNUNIEK ~YYY InAT"'M.>M) ~W' LIMITS
A I GalERALLIABlLrrV 0321 B00038 10/15/2010 10/15J2011 EACH OCCURREI~C.E i $1.000,000
~_""-M~~"~'m 2~~1U9.RENT~D $50.000
! a.A'!\lS MALlE ~ OCCU~ MEO EXP (""yon. pttl1lor.1 $!5000
f'l:'RSONJlo.l. &. ADV INJURY sO
GENERAL AGGREOA,-f $2.000,000
~'L "'GG~En LMIT !>.PAS PER. PRODUCTS -COMP/CP AGG . $2 000 000
I POLICY :;:gi LOC I
~TOMOBIl.t: LtHllUl V CCMI3!NEO S,NGLE LIMIT \ ~
f-- A.N.,. AUTO (En .....ciaont)
'_ "'LL OWNED AUTOS BCIOIL V !N.IURV I
i$
SCHEDULEO AUTOS (P",r Pef:iOl" i
-
I-- HIRED AUTOS BCOll'lf iNJURY 1$
'1-- NON-OWNED ....UTOS (Per "c:.cide-(ltJ
!
I- PROPERTY CAlMGE '$
(pm na;ident)
RGE Uo\llILlTY AUTO OND' . EA "'CCIOE:N r $
I ANV AUTO OTHER THAN EA ACe $
AUTO or,L V; AGG '$
B ~..,-~~"' AARE06931 10;1~2010 10/1512011 EAC'1 OCCU"RENCE . i $15,000,000
X OCCUR 0 CLAIMS IIAAOE AGGREGATE $15000000
i$ .--
, DIWUCTiBLE :$
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RHENTION $ : $
WORKtRS CONPENS.t.TION AND TT~~.,s~!';J;.1 IO;~',
ENPLOYEIlS' UABIUTY
ANY PROPRIETOR/P!\RTI'ERlEXECUT,VE L:l E.L. EACH ACCIDENT :$
~ ICERiIIfE.lo\BEr E XCl \.iDEO? E.l. ::lISEASE - EA EMPlOVEEi $
\ Imlalory in NH
~~~~':~';'''!~I~~';\'''S ""low E.l DISEASE. ;>OU::V lIM": I $
B OTItt:R 0&0 CAP1017858 10/15/2010 10/15/2011 $1,000,000 ded $1000
DESCIUPTlON Of OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS AtIDED IY ENDORSEMENT I SPECIAL PROVISIONS
SHOULD ANV Of T HI: ABOVE IlESCftI5ED POU::IES lIE CANCt:LLI:O IlE~ORI: rHti ::.xI'IMA rIOi'!
Town of Wappingers DATI: TlIIOlU:Of, THE .SSU'MG I'ISURliR WILL ENDEAVOR TO (SAIL -3lL. D."VS WRITTEN
20 Middlebush Road IWTICt: TO THt: CERTlflCA a MOLDIiR r4ANED TO THE LifT, BUT fAILURE TO DO SO llAAL.L
wappingers Falls, NY 12590 IMPOSE NO OBUGAT'ON OI'l.llABlUTY :>F ANt KIi'ID UPON TIE INSURER. IT S AGEHTS OR
REPRt:SIiNTA T1\IES.
AUTH~IUZ;;~SEI'ITA1I\IE -.-
.-
l.\CORD 25 (2009101) 1 of 2
t5183450/M167773 (i 1988-2009 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered mari<s of ACORD LJC
COVERAGES
CERTIFICATE: HOLDER
CANCELLATION
tel 3/8/2011 Time 1 3159 PM TOI
@ 918458966410
PaQ61003-003
IMPORT ANT
If the certificate holder is an ADDITIONAL INSURED, the POllcY(les) must be endorsed. A statement
on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
If SU8ROGA TION 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).
DISCLAIMER
The Certificate of Insurance does not constitute a contract between the issuing insurer(s), authori.led
representative or producer, and the certificate holder, nor does it affirmatively or nega;ivaly amend,
extend or alter the coverage afforded by the policies listed thereon.
ACORD 25 (2009101)
2 of2
#S183450/M167773
Wildwood Manor
c/o River Management, Inc.
297 Mill Street
Poughkeepsie, NY 12601
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00000330
Mutual of Omaha
Phoenix, AZ. 85082
91-575/1221
Check Date
Mar 10, 2011
One Hundred Dollars and Zero Cents "''''***'''***''''''********'''***************'''*********'''***************"'*~
Pay to the order of
Town Of Wappinger
20 Middlebush Road
Wappillger.Falls,NY t2590
T ..
111000 ~ ~Ollll: .2 2.05'751'1:
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Check Amount
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