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Woodhill Green Condominium
Aug, 2., 2011_ 1; 50PM 's ~,~,No, O1$0-=--,P, 1 ~~ ~/~~~ 2010-01-14 JCM i~OR XNT'EItNAL L1SE ONLY Received by: Chris Masterson ^ Christine F~Iton ^ Sue Rose Date Received: ~ l ~ / ~ Serial #: ~~~ ~f Applicatiom ^ $100.00 [Cert. of LI ^ Notified Recreation (dater Town of Wappinger Agreement for tie Use of the Town I~axl Facilities for Meetings Agreement fox the Use of the Town Sa1~ Facilities far Meetings This will confirm the arrangements being requested for your groups' use of the Wappinger Town Ha11 Facilities, as noted below: () Senior Citizens Room Large Meeting Room () Other. Specify: The group is not xp to exceed -T ersons Date(s): ~' Time: D '...~(~~ It should be understood that groups using the Buildings' ]~8eilities for evening meetings must select dates when Town Meetings are norAnally scheduled (i.e., Justice Court, planning Board, etc.) Special requests will be considered upon their awn merit, and at~angements can be made for access to, aad 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 Heed of the facility far its awn 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 far access to specific area to be used should be made with the Town Clerk at the time this form is submitted. No application sha11 be considered approved-until it has been submitted to the Town Clerk far review and CIearance. Address Phone No. ~„~Aug. 2,_ 2011_ 1; 50PM No. 0180 P, 2 2010-O1-19 7CM 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 faciiities will result in termination of use by the offending grog, and they will nat be granted reinstatement. I have z~ead and understand the rules anal regulations for the use of the Facilities in the Town of Wappinger Town Bali, and will comply with tlxese requirements. Signed: For: d;~ ~ ~~ ~ (Name of Group or Qrganization) Date: ~ o~i -...,.. Approved: Town Clerk Date: Q 1 0 a 0 z ~, ~, WOOQHIL~. Gi~EEPt CONDO ASSOC~AT~ON 1688 ROiJTE 9, BLDG.1 OFFICE WAPPJNGERS FALLS, NY 12590 PAY FOTHB QRDCR ~111~&TBan1c FOR ~ ' b0 L 2u^ ~: 2 200Q046~: DOLLARS ~ ~'o~ r ~ ~ L2~23254~6u' GATE ~ ~V ! 6012 104.220 - ~ ~ ~~ d~ Q M ` ~~ ~ - ,_;--,~ ~. ; . ~ _ _ ~,~. ~~~, - ,, 13,. 2011 12:41 - P INSURA NC~'BINQER DATE{MMlDDNYYj~:J •,~~ , 7/1 3/2011 ~S:'~BINDER IS A T$MPORARY lNSURAiNCE CONTRACfi; 3UBJECT~'TQ THE CONDITIQNS SN~WN ON REVERSE SIbE OF THIS FORM ,QGEHC.Y MPA 'Travelers Iademn~,ty of Amer BINDER # NaocarAto Insurance 1171319715 100 t71EtEr Avenue ~ ~ EFFECTNE E ExPIRAnoN DA ME P0. Sox 263 ~ X AM ~ x i2'o~AM sa>xgert:iGB NY 12477 7/12/2011 12:01 PM 8/12/2011 NDON aCNNE `EXt: (845)245-7134 PC No: (8~k5)246-x852 .. THI381NAERIg163UEDT0EX7ENDCOVERAGEINTHEABDVENAMEDCDMPANY CODE, •: 8U8 CDDE: • •~ " ~ PER~EXPIRING POLlGY #; LINABSZGGbYRb i AG N 0 0 017 07 0 •r; QES('iR[P~710N bF ORERAT1oNSNEH1CLESlPROPERTY (InGudng Location} ~ COST RID: ~ INSURED ,' LOC# 00001 oodhiil Green Caadominium Association 1668 Rouke 9 1668 R4uke 9 t~appiagera Falls, NY 12590 • sae Aktached Cnrertlow Pages Wappiagera Falls NY 1259b ' COVERAGES LIMITS ' TYPE OF INSURANCE COVERAOEIFORAl18 DEDUCi1SLE COIN9'X AMOUNT 54 D 17 ,191 ~~0 0 0 PRDPBRTY CAUSES OF LOBS _ BA51C ~ BROAD ^X SPEC ' GEN ERgLUA91uTY EACHDCCU RENCE 5 1,•004.1;©00 •u~:, ~ , r ~ " ' ~ • + ~ DAMAGE TD R S ~ , ,., ,' L`OMMERGIAL UENERAL UA8ILITY , . , . , , $ - ""'~~• ' '" MEO EXP An ane ~raon , ~ CLAIMS MADE ~ OCCU y R , ~ ' ,\• ~ 5 1. • Q ;~0'd ~ ~ • ~ • PER50NAL S AOV INJURY ~1 • ,_ • i'r~ ~ ' ~ GENERAL AGGREGATE ~ 2.0 0 0 ; 0 0 _,~', ti~ PRODUCTS - COMPlOP AGG 2, 000,000 RETRO DATE FOR ELAIM3 MADE : :,rn~ COMBINED SINGLE UMR VEHICLE LIABILITY • ~- aODILY INJURY (Per pereon} qNY AUTO y •• BODILY INJURY (Per accidvntl 6 , . +i; .•;ALL OWNED AU7bs ~ PROPERTY DAAAAGE' •. y;u- ~. $CFIEDULED AUTOS [,. - ~ ~ ~ ~ (- ~ ~=4 ~ ~ • ~ + '• ~• ~ MEDIGAL PAYMENTS !- --•-- • ~ • PERSONAL INJURY PROT . •, . ~~•,; , ;tYC,YN=OWNED AUTOS . y • UNINSURED MDTORIST VEFIICI.E PHYSICAL DAMAGE CED ALL vEIiICLBB SCHEDULED VEHICLES ACTUAL CA6H VALUE S STATED AMOUNT ~- . fl7tiER TMAN COL; ' , . AUTO ONLY - EA ACCIDENT $ • ., ' ..._... ~. GA'AACiE'TJpBILITY - OTHER THAN AUTO ONLY - gNY•AUTO EACH ACCIDENT . • AGGREGATE $ • EACH OCCURRENCE EXt~ESB LIAB•1LRY . AGGREGATE 9 _-.--- ."" ': ' ,~lR~RELLAFORM SELF-INSURED RETENTION ".t'C'v'`>- - .O.THER THAN UMBRELLA FORM RETRO DATE FDR CLAIMS MADE : ' ~• WC STATUTORY UMR$ ,<. L .' . r" ~`~ . ~• , • • EACH ACCIDENT L E $ ^,s'~;r~ ~,~„ NIORXER'SCOMPENSATION C~N• . . - ~' AND ' E.L. DISEASE - BA EMPLOYEE _ '~' EMPLOYER'S LIABILITY L. 015EA$E -POLICY LIMIT $ FEE6 .. ~ SPECIA '~~ CONDI~DNS1 E TAXES $ ESTIMATED TOTAL PREMIUM - ~ •~ 26•r4C OTH R. COV4R#~GEB ~ - • - N/ANCE,&ADDRESS ADDmoyAL INSURED ~pRjCiAG~E , ~-r - . :~ : t r.~-. I • h IDES P~4YEE I . . r . ~- LOAN # _ _ .. ~ AUTNORTBED REPREbENTATIVE •". r ~ Page 1 of 2 ORQ CORPO ION 19x3-ZD07. AI! rights; reser~rl ACOFtD 76 (2007!01} IN$0'~,~,L~0070~}a The ACORD Warne and Togo are registsrsd marks o4 AGOFtti Town of Wappinger 20 Middlebush Rd Wappingers Falls, NY 12590 (845) 297-5771 RECEIPT #44302 08/09/2011 Condo Association, Woodhill Green Ck # 6012 Received $ 100.00 for Building Use Fee, on 08/09/2011. Thank you for stopping by the Town Clerk's office. As always, it is our pleasure to serve you. John C. Masterson Town Clerk