Woodhill Green Condominium (2)FOR INTERNAL USE ONLY
Received by: Chris Masterson ^
Christine Fulton ^
Sue Rose ~'
Date Received: 1~ / ~`/ ! ~
Serial #: ~, ~
^ Application ^ $100.00 ^ Cert. of LI
^ Notified Recreation (date:
2010-O1-19 JCM
Town of Wappinger
Agreement for the Use of the Town
Hall Facilities for Meetings
Agreement for the Use of the Town Hall Facilities for Meetings
~rs~,~~i~y-~~ `~~r~
(~ Senior Citizens Room
J~ Large Meeting Room
() Other: Specify:
~5g~o
The group is t expected to exceed ~~ persons
Date(s):~~' '~~~~
Time: ~p ; ~~ ~~
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
Cleazance.
This will confirm the arrangements being requested for your groups' use of the Wappinger Town Hall Facilities, as
noted below:
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:
For:
Date: /
Approved:
Town Clerk
(Name of Cne4p or Organization)
Date:
,.`..~~ (~ ~+~ ~u i i ~: u4rivi iuaccarato No, 5850 P, 1
E DATA (MIN/DD/yyyY)
ORa® CE~T~~~CAT~ 0~ ~.~AB~L~TY INSURANC
10/4/2011
HIS CERTIFICATE 15 ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIQHTS UPON THE CERTIFICATE HOLDER, THI$
~ERTIFtcATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED 8Y THE POLICIES
BELOW. THIS CER7IFICATI: OF IIV3URANCE DOES NOT CONSTITUTE A CONTRACT BETWEi:N THE ISSUING INSURER(S), AUTHORRED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER,
IMPORTANT: If the cerllflcate holder Is an ADDITIONAL INSURED, the poilcy(tes) must be endorsed. If SUBROGATION IS WAIVED, subJect to
the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certlflcatA does not confer rights to the
cartlflcale holder In Iteu of such endorsement(s).
PRODUCER
Naoaarato Insurance NAME: Insurance Naccarato
PHONE (945)246-7x34 FA
100 Ulster Avenue e,MaIL . (Bi512A6-oesz
PO Box 265
Saugerties TTV ~ o~ ~~ INBUREIi 8 AFFOROINO COVERAGE NAIL 1
INSURED rndvRERA;rravalars J:naemrit of Amer 5666
WOODHILL GREEN CONDOMINItlM Associtaion INBURI?ae;
1,668 ROUTE 9 BUILDING 1 1 RERC:
1 URERD:
WAPPINGERS FALLS NY 12590--7900 INSURERE:
COVERAGES INSURER F :
CERTIFICATE NUMBER(Town of aappingers REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUEO TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INOlCATEO. NOTIMTHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT Vu17H RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFi=0RDE0 BY THE POLICIES DESCRIBEO HEREIN IS SUBJECT TO ALL THE TERMS.
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED 9Y PAID CLAIMS.
DNS
LTR TYPE OF INSURANCE PODGY NUMBER POLIpY EFF MMlDON P LIMIT8
GENERAL LIABILITY
IaCW OCCURRENCE S 1, 000, 000
X COMMERCIAL GENERAL EDIBILITY AMA E R N~D~ S 300, 000
A CLAIMS.MAD£ ~ OCCUR 6803A873647 /6/2013 /6/2012 MEO EXP (Any moporson) S 5, 000
PERSONAL 8 AOV INJURY ; Y ,GOO , OOO
GENERALAGGREGATt: S Z, 000, 000
GEN'LAGGREOATELIMRAPPLIESPER PROOUCT8-COMP/OPAGG S 2 000,000
X POLICY PRO LOC
a
AUTOMOBILE LIABILITY M 1
ANY AUTO BODILY INJURY (Per person) ;
ALL OVtiNED SCHEDULED
AUT08 AUTOS BODILY INJURY (Per eccideN) S
MIRED AUf03 NON-OWNED PROPER D GE
auros s
3
UMBRELLA UAB OCCUR EACH OCCURRENCE. S
EXCE$$ LIAR CWMS-MADE
AGGREGATE S
DED RETENTION S
a
WORKERS COMPENSATION NA.` BTATU- OTH-
AND EMPLOYERS' 11A61LITY
ANY PROPRIETOR/PARTNER~(ECUTIVE Y J N '
OFFICER/MEMBt3R EXCLUOED7 ^ N/A E.L EACW ACCIDENT
(ManGelory In NH) E.L DISEASE - EA EMPLOYE S
II yes, desalDe order
DESCRIPTION OF OPERATIONS beloro E.L DISEASE -POLICY LIMIT S
oESCRIPTION OF OPERATIONS I LOCATIOHB /VEHICLES (Attach ACOR0101, AdQllloml Remarks Svhodvlrr, II more spree Ia.ieQvlreB)
CERTIFICATE HOLDER CANCELLATION
632-2249 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
Tovln of Wappingers ACCORDANCE WITH THE POLICY PROVISIONS.
20 Middiebush Road
Wappingers FaJ~18, NY X2590 AUTHORI2EDREPREBENTA E
Ann Bruno
ACORD 26 (2010/06) ®10613• 1 ORD CORPORATION. All rlghls reserved.
INS025 (zoloos).o~ The ACORD name and logo are registered marks of ACORD
Town of Wappinger
20 Middlebush Rd
Wappingers Falls, NY 12590
(845) 297-5771
RECEIPT
#47362
12/19/2011
Condo Association, Woodhill Green
Ck # 6136
Received $ 100.00 for Building Use Fee, on 12/19/2011. Thank you for stopping by the Town
Clerk's office.
As always, it is our pleasure to serve you.
Christine Fulton
Town Clerk
6136
PAY
TO THE
~~ ~ 10-4-220
DATE
~$~~,~
DOLLARS LJ ~" °~~
I~1M&TBanlc
fiahkill Main Street Ofice
FOR , /
u'006 L 3611 ~:0 2 2 00046:
- --- --- - -- Nr
1 2 ~ 23 2544611'
WOODHILL GREEN CONDO ASSOCIATION
1668 ROUTE 9, BLDG. 1 OFFICE
WAPPINGERS FALLS, NY 12590