Wildwood Manor Condo Asso
2010-01-19 JCM
Date Received:
Chris~a~erson 0
Christine Fulton ,~
Sue Rose ~
~ / .2) --1L
Town of Wappinger
Agreement for the Use of the Town
Hall Facilities for Meetings
FOR INTERNAL USE ONLY
Received by:
Seri~: if to
~ppJication ~oo.oo ~. ofLl
o Notified Recreation (date1 ~ \ "\ -\ \ )
. ~ WAPp
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Agreement for the Use of the Town Hall Facilities for Meetings
Mil 2>11/ 0 0 I) )1~/// f) I( tit))1) ,1/-;".50 C-
Name of Organization or Group
Phone No.
Name of person epresenting the Organization or Group
tJ /vK v (,$IfTi5
Address
This will confinn 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 e ected to exceed fR 0 persons
Date(s): W 1F- Time:
It should be understood oups using the Buildings' Facilities for evening meetings must select dates when
Town Meetings are nonnally 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.
t, fJ /11
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 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.
Si~ed: ~ J~ 1ft
For: to ~ '^ W f) () JS /I11,1f/ t1,(
(0 /fI)2> 4SS0~ r
(Name of Group or Organization)
Date:
Approved:
Date: --dd II
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Client#: 39175 . WllnMA
/ORD,.. CERTIFICATE OF LIABILITY INSURANCE I D....TE (MMillD/VTVV)
3/08/2011
.1lJClill. THIS CER1'IFICATE IS ISSUED AS A MATJ"ER OF INFORMATION
.ndley & Parker, Inc. - Comml ONLY AND CONFERS NO RIGHTS UPON mE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMENO, EXTEND OR
'320 South Service Road ALTER THE COVEIU.GE AFFORDED BY THE POUCIES BE LOllV.
Melville, NY 11747
INSlIRERS AFFO~DING COVERAGE NAle#
INSURED INSURER A:. Sparta Insurance Company
Wildwood Manor Condo Association INSURER B: Bradlev & Parker, Inc.
c/o River Management Inc INSURER C:
297 Mill Street :NSURER 0:
Poughkeepsie, NY 12601 INSURER E:
COVERAGES
T"iE POlICIES OF INSUR.O,NCE LISTED SELOW HAVE SEEN ISSUE., TO THE INSURED NAMED ftBOVE FOR THE POLICY PERIOD INDICATED. N01WlTHSTANOING
ANY R'EQUIREMaNT TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTI FICATE MAYBE ISSUED OR
MAY pe~TAIN, THE I\ISURANCE AFFORDED BYTH:: POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH
POLICIES. AGGREGATE LIMITS SHOWN MAY H/Wf. BEEN REOUCEO BY PAID CLAIMS.
TR NBR TV' ~ Of' 1"8URANC~ POLICY NUMBl!K ~ " nAT" ~y~ LIMIT!
VYY
A I C_IlAl..LlABlLIrV 0321B00038 1011512010 10/15/2011 EM:H OCCURREr~CE I $1 000 ODD
~_"'.. G'~_ '~m DAMAGE 1"0 RENTEO 150.000
' .
, . ClAIIIIS MADE ~ CCCU'l "'ED EXP (MY on. pel1l0r,) 55 000
t>I:RSONAl. & P<JV IN.JJRY " $0
GENERAL AGGREGATE ! $2 000 ooD
~'L "'GG~nE LMIT APr.!~r PER. PRODUCTS -COMPIOP AGO . $2 000 000
! ?OllC~ ~f~ LOC
~TOMOBII.E Lt.'B1L1T V COM3!NED SiNGLE LIMIT l.
ANY AUTO (e. .....cia.nl)
- I
- ALL OWNED AIJTOS BOOIL Y :N.AJRV is
SCHEDULED AJTOS (P_r p.I"""! I
- Ts
- HIRED AUTOS BeOIL Y ;N.AJRV
!\ION-OWNED AUTOS (P.r oc:li2nt)
- I
PROPERTY QAt,IAOE
(per .a:lclont) '$
~GE LIAIIILlTV AUTO ONl.V -EA...CCIOENr $
ANY"'UTO . OTHER THAN E......CC S
....UTO Or.L Y: AGG! $
B '~ES8 I UMBRELLA LIABILITY AARE06931 10;1512010 1 DI15J2011 EACH OCCUF;:RENCE '$15000000
X OCCUR D CLAIMS I\AADf AOGREI3ATE . $15.000 000
'$ -
==i DEDUCTIBLE : $
RETENTION $ ! $
WORKt:RS CONPENMTlON MD 1...~~y5;r t,"W;. I IOJ~'
EMPLOnU' UABILlTY
AN~ PROPRlElOR/l'ARTNERfEXECUTiVE L:l E.L. EACH ACCIDENT i $
fW'ICER"""'.1B~r f XCLUDED?
\ .ndetory In N E.l. DISEASE. EA EMPLOYEEI $
~~~'~~~~~~~:"S ""lOW E.l DISEASE. !"OLiCY LlMr: t
B 01lteR 0&0 CAP1017858 10/15/2010 10/15/2011 $1,000,000 ded $1000
DESCIUPTION OF OPERATIONS flOCA TIONS f VEHICU:S I EXClUSIONS ADDED S Y ENDClftIEMENT I SPECIAL PROVISIONS
CERTIFICATF. HOLDER
CANCELLATION
SHOULDAHY OFlH/: ASOVUlESCftBI:D POlXlliiSlIEi CANCELU:Dltl:fOHI: ,Ht; lOO'll<AflON
Town of Wappingers OAT: TH~RCOF, THE ISSUING WSUJU:R WlI.L eNDEAVOR TO "AIL ....3ll.. D....VlJ VJRITTJ:N
20 Middlebush Road NonCE TO THE CERTIFICATE Ha.OER NAMED TO THE LEFT, BUT FAILURF TO DO liO llllAU.
Wappingers Falls, NY 12590 IMPOSE NO OBUGAilON ORLlABIUTY OF ANY KINO UPON THE INSURER, ITS AQ~"TS OR
REPRESENT'" lIVES.
AUT~IUZZ,REPRESENT"'l1VE
'..A ~_
ACORD 25 (2009101) 1 of 2
#S1113450/M167773 IS 1988.2D09 ACORD CORPORATION. All rights reserved,
Tne ACORD name and logo are registered marks of ACORD LJC
. .
... ...
'Wildwood Manor
c/o River Management, Inc.
297 Mill Street
poughkeepsie, NY 12601
.. . I' :
Mutual of Omaha
Phoenix, AZ 85082
. . .
. .
00000348
91-575/1221
Check Date
Apr 11, 2011
Check Amount
One Hundred Domus and Zero Cents ****************************************************11*********~
Pay to the order of
Town Of Wappinger
20 Middlebush Road
Wappinger Falls, NY 12590
111000 ~ ~ B u- I: ~ 2 2 ~ OS? 5 ? I:
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