Wildwood Manor Condo Asso (2)
Date Received:
Chris Masterson 0
Christine Fulton 0
Sue Rose W
L/JQ)~
;lho)//- A It) U<- J-> ~ -
kJ J2>>f- ~ Juno oj
oPfMufLIJ ~ riB . 2010-01-19 JCM
Town of WappInger
Agreement for the Use of the Town
Hall Facilities for Meetings
b,' ~M'- .J.jJ.:.JJ t - vf\o~,J Jwmo..~~
FOR INTERNAL USE ONLY
Received by:
Serial #:
~Plic.tion 0 ~.oo 9 ~ ofL!
o Notified Recreation (date: /- II
Agreement for the Use of the Town Hall Facilities for Meetings
W / t.. iJ fA) /1 "JJ /1).4 If) 0 It t~ I'V /J 0 A:sS-tJ C --
Name of Organization or Group
Name of p~ representing the Organization or Group
~;v1l fie/rodS (ll)<I"-9PO/)
Address
~.Jl- f1 q 1 -0 '-1ST!
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
C Large Meeting Room
) Other: Specify:
.50 persons
Time:
6:]DfJP1
00
- 9 ff>1.
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 ofthe
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.
?/;l _ ,
/ ~4 ~"- ~ft17cA.t:v ~ -~~~~/j?7--tJ~yk ~/JI f2'UJor~
..
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:
~::J ~ {h~bo ~rJoG
(Name of Group or Organization)
For:
Date:
8/'tD~1
, r
~r:;z-CiJf)-~~
o Town Clerk
7/ ~t:ll ,
Approved:
Date:
~ _...... YV. .....1.1..
,
/
~lient#: 3917!io . WILDMA
. I
JORDn, CERTIFICATE OF LIABILITY INSURANCE DATE (I'AMiUDIYYVY/
.. 310812011
.oUCI!Il THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
~ . ONLY AND CONFERS NO RIGHTS UPON'THE CERTIFICATE
/radley & Parker, Inc. - CommJ HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
'320 South Service Road ALTER THE COVERAGE AFFORDED BY THE f>>OUCIES BEL.OW.
Melville, NY 11747
INSURERS AFFORDING COVERAGE NAIO'
IIlSllftED INSURER k Sparta Insurance Company
Wildwood Manor Condo Association INSURER S; Bradley & Parker, Inc.
CIO River Management Ine INSURER C:
297 Mill Street :NSURER D:
poughkeepsie, NY 12601 INSURER E:
/
/
COVERAGES
T"iE POLICIES OF INSURP.NCE L.ISTED BELOW HAVE BEEN ISSUEO TO THE INSURED !llAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHST,ANDING
ANY R,!QUIREMENT TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECTTO WHICH THIS CE~FIC.ATE MAY BE ISSUED OR
MAY PE~TAIN, THE NSURANCE AFFORDED BYTH:: POLICIES DESCRIBED HEREIN IS SUBJECT TO AU. THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH
POLICIES. AGGREGATE L.IMITS SHOWN MAY HpM: BEEN REDUCED BY p....ID CLAIMS.
TR NBRn TYpeClf INSURANce PDUCY NUMIleK ~VVVlnAt" I~ LIMITS
A~",""" .321000031 . Ill'''''.'. .0I.5I2ll11 EACH OCCURREf.oe I $1 000 000
X COUMERClAl. GENERAl. LI....IlILm DAMApE ,'n RENTED $50.0013
, ' ClJ.ItIlS MADE ~ OCCU'l "'ED EXP (Ar.y 0"" pel1lonJ 15 1300
t>t:RSONAI. & N)V INJURY '1$13
GENERAL ....OOREC'JA If ! $2 000 000
~'LAOGRnE ;~IT Al'flSPER. PRODUCTS. COMPIOP AGO $2 000 000
! POLIO':' :..RT LOC
I~OIllOBILE LII'BIUT Y COMB!NED SiNGLE LIMIT 5
AN'" AUTO (En ....,;cl8nll
-
- ALL OWNED AUTOS BODILY!N.k.lRY i $
aCHE OULED AiSTOS (P",plSillOl,1 I
-
- HIRED AUTOS BOOI\. Y lNJURY ! $
NON-OWNED AUTOS (Por Ie_I)
-
PROPERTY DAMAGE I
I)
(plr la;ldenlj I.
~GE ~ILITY AUTO ONly. fA ...COIDEN r $
ANY AUTO . . OTHER 'THAN EAACC; $
AUTO Or,L Y: AGO! $
B I ~E8S I UMBRELLA UABlLnV AARE06931 '10;151213113 10/15/2011 E.llCM OCCU~RENCE 1$15000.000
X OCCUR D CLAIMS 1IAAOE AGGREGATE ! $15 0013 0013
~$ .
==J DEDUCTIBLE : $
RETENTION $ !$
WORKERS CONPERM-TION /\ND I T~~J;r~~ I IOJ~'1
EMPLOYERtl' UABIUTY
AN':' PROPRIETORIPMiNERJt:XECUT,VE Ll E,L. EACH ACCIDENT '5
OFFI:::ERNErAB~r E XClUtJEO" E.L. DISEASE. EA EMPlOYEEi $
{M8ntlllary In N
~.:~.~~~~~~"x;;"'s ""lOW E.L DISEASE, ",OLICY UMr: $
e OTHEII 0&0 CAP1017858 10115/2010 10/1512011 $1,000,000 ded $1000
DESCIIFT1:)N OF OPEIlATlONS I LOCA TlONS J VEHIClJ:S I EllCLUlllONS ADDED B'I' eNDORSEMENT IIPECIAL PROVISIONS
CERTlI=ICATF. HOL.DER
CANCELLATION
Town of Wappingers
20 Mlddlebush Road
Wappingers Falls, NY 12590
SHOULD ANY OF 1 HIi ABOVE llESCKIIED POU::IES lIE CANCeL\..liD ItE~ClI<<!; (HI: CXl'IKA (ION
DATi THI:;R\lOF, THI:; ISSUING "SURER WILl.. ENDEAVOR TO "AIL -3ll.. DAVE VJRITItiN
NonCE YO lH. CERTlFlCAT'E HOI.DIiRNANED TO lHE LEF1, BUT FAIUlRf TO DO SO ~1IAl.l.
IMPale NO OSUGA'fION Oft I......SIUTY :IF """ KIND UPON T1te INSURER, ITS AGlmTS OR
REPRESENTA l1IIES.
AU1HOlUZED REPRIlSENT"l1\IE
ACORD 25 (2009101) 1 of 2
#S183450/M167773 Ii 1986.2009 ACORD CORPORATION. A.II rights reserved.
The A.CORD nerne and logo are registered mams of A.CORD LJC
..
. .
... ....
. . .
. .
Wildwood Manor
clo River Management, Inc.
297 Mill Street
Poughkeepsie, NY 12601
00000415
Mutual of Omaha
Phoenix, AZ 85082
91-575/1221
Check Date
Aug 23, 2011
One J:iundred. Dollars and Zero Cents **~~*************~*********~~~~~...It*~*",****",~****.*~**'1",********'
Check Amount
~J!1
Pay to the order of
Town .Qf vvapplnger
20 Middlebush Road
Wappinger Falls, NY 12S!J0
r,-<J,~ f' 1
fl~.....'.~
M>
II"ODD~ ~.511' 1:~22~05'i'5'i'1:
M>
2 I; 5 .~ I; ... 21; III
. .
. . . .. ... . ..
. .. . .
f
-
Town of Wappinger
20 Middlebush Rd
Wappingers Falls, NY 12590
(845) 297-5771
RECEIPT
#44570
08/26/2011
Manor, Wildwood
Biding Usage 10/12/2011
Received $ 100.00 for Building Use Fee, on 08/26/2011. Thank you for stopping by the Town
Clerk's office.
As always, it is our pleasure to serve you.
John C. Masterson
Town Clerk