TOW Little League (2)
~
2010-01-19 JCM
Date Received:
Chris Masterson 0
Christine Fulton 0
Sue Rose . ~
lL/di/JLP
Town of Wappinger
Agreement for the Use of the Town
Hall Facilities for Meetings
FOR INTERNAL USE ONLY
Received by:
Serial #:
-#L)
~ert.OfLl
)
'&"Application 0 $100.00
~Notified Recreation (date:
Agreement for the Use of the Town Hall Facilities for Meetings
--- . .
/tJw~ 0 F ul4fPJ'i" LI'T/l/i.. L~'1vC
Name of Organization or Group ~ . /
^o (J tf,///JDt..J
Name of person repre~eI}\ing the Organiza~ion or Group
/ /H/dcJle,..bvcI- "ed. W. F.
Address
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:
The group is not expected to exceed
Date(s): AI OV, I ~ L.JO I (
,
~o
persons
Time:
~ ~ - 9 /:-2-
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
Tenns 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:
:2L! t-Y___
For:
~
-; Otu L-L
(Name of Group or Organization)
Date:
APr=Ved:L!Ju~?p .dr7J--
Town Cl
Date: /0 /3J / /,1
TlFICATE OF LIABILITY INSURANCE
DATE
eystone Risk. Managers, LLC
1995 Point Township Drbe
Northumberland, PA 17867
CER1\F\C~TE #
232172.1-1
2 32 17
ADDITIOHAI. NAMED INSURED;
INSURERS AFFORDING COVERAGE:
TOWN OF WAPPINGER NATIONAL LL
ROB WILSON
15 MIDDLEBUSH RD
INSURER A: LEXINGTON INSURANCE COMPAN'
INSURER B: NAnONAL UNION FIRE INSURANCI
(Non-Uabillty) COMPANY OF PITTSBURGH, PA
WAPPINGERS FALLS.
NY 12590
CHARnS SPECIALTY
INSURER c: INSURANCE COMPANY
COVERAGES
THE POUCIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR lHE POLICY PERIOD INDICATED NOTWITHSTANDING
ANY REQUIREMENT, TERM OR CONDITION 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 lHE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH
POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. .
~ :0 TYPE OF INSURANCE POLICY NUMBER ~..=
GENERAL LIABILITY ,:' \:'. .
X X OCCURRENCE
X INCL. PARTICIPANTS
POLICY EXPIRA1IOH
DATE rMI/DDIVYVY
EACH OCCURRENCE
UMITS
811 000, 000
$2,000,000
$1,000,000
$1. 000, 000
$2,000,000
2012
X SEXUAL ABUSE
EACH LOSS
$1,000,000
x
DIRECTORS & OFFICERS
242J.4367
1/01/2011
1/01/2012
AGGREGATE
$1,000,000
x
CRIME COVERAGE
010008406
1/01/2011
1/01/2012
EACH LOSS
$35,000
Crime DeducUble: $250 PropertyI$1,OOO Money
AGGREGATE
NONE
iB
j
I
I
I
I
i
I
SPORTS EXCESS ACCIDENT
1/01/2012
As In Maller Policy
MIld. lotlIX. $100,000
Oed. S5ll
As In MastBr
Policy Excess
X SRG9105434 1/01/Z011
"X" INDICATES COVERAGE SELECTED FOR ADDmONAL NAMED INSURED
ADDmONAL INSURED ..' . "
Who is an insured (SECTION 11). of the General Uablllty pQlicy is amended to. include as aJ:Il~ ~ ~ or ~atIon shown In the $Chedule, but only with respect to
liability arising out of the above named UtIle League's maintenance or use of bill fields, or oIh8r pieniiseS lOaned, donated, or rented to that UttIe League by such ptlrson or
organizations and subject to the following additional exclusions:
1. Structural a1terallons, new construcllon, maintenance, rapair or demolition operations performed by or on behalf of the person or organization designated In the Schedule unless
performed by the above named UttIe League and
2. That part of the ball field or other premises not being used by the above named UtIle League
NAME AND ADDRESS OF PERSON OR ORGANIZATION:
1. TOWN OF WAPPINGER Z. WAPPINGERS CENTRAL SCHOOL DISTRICT 3. VILLAGE
OF WAPPINGERS FALLS
Little League Baseball Risk Purchasing Group, Inc.
539 U.S. RT. 15 HIGHWAY
South Williamsport, PA 17702
CANCELLATION
SHOULD AHV OF THE ABOVE DESCRIBED POLICIES TO lHE ABOVE NAMED LITTLE LeAGUE BE CANCElED BEFORE THE
EXPIRATION DATE THEREOF, THE ISSUING INSURER OR nlEIR ~~~"'TIVE WILL MAIL 30 DAYS WRITTEN NOTICE
TO THE DESIGNATED PERSOHOR ORGANIZATION ATTHEI~~ ~ADDR
""i..._/~~' ~
AlITHORIZED REPRESENTATI
INSURED