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Wildwood Manor Condo Associatione FOR INTERNAL USE ONLY Received by: Christine Fulton J sica Fulton ^ Date Received: ~ / ~ / ~' cam. Serial #: / a 2010-O1-19 JCM Town of Wappinger Agreement for the Use of the Town Hall Facilities for Meetings ~J Application ~J $100.00 ^ Cert. of LI "~ Notified Recreation (date: 9/ / =~ 1,Ui11 vin ~~~ e. ~~~~ Agreement for the Use of the Town Hall Facilities for Meetings Name of Organization or Group Name of person epresenting th Organization or Group Address 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 Large Meeting Room Other: Specify: The group is not expected to exceed 5"7~ persons Date(s): Q C ~ .Z ~} ~ ,.~t7/3-- Time: ~ ~ 3 ~ 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. ~ i.~ i I I I~~h~c~.l ~~-~~~~~rze.~ie i n mac. y 2O ~ 3 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: ~,f !`~~/,Joo/Su ~,~"/dd<Z ~N/~y ~sSD~ (Name of Group or Organization) Date: ~ ~ I ~-' Approved: Town Cler Date: ~~/ ~~~/',2 o - -- . ~ ~~•,-•~ ~ M SC;HWARTZ PAGE 02 NW-15-281 13:51 Frorn:280~441990 Paoe~i~c~ aC~D~ CERTIFICATE Ot= LlABILtTY INSURANCE ;;;;~"'~°;""~"' ~~C Tr1ti ReRT1R10AY'! 101 R tNNbRN{A K7N A1~dMy ~ Plr11R~r 1116. ONLY ANO iiONFl1p NO NIOMTi t1rOlV TN! CORYIi1CAT! i90 =ou[h irrvior Roed 1106Dd11~ YMIO GCRTIRIGAT>; Doss NOT . cxTeNO 011 MrlWle,141r 11>'p T!R THE C01r'ERAOE AM OY 711! POLICRs! B6Lt7W. ia/ MI.7100 NO{1110R0 AI'PORON4 COVERA¢! t~A1C r I ~~ Ra, AiMfplfa Wlldwood MefiOf ri0-1dV ArsoOieti0el ! l1e Go ~ Cro RJwr Malfeat11p1t i.b ~ fNer~ NMu1~na ~T 111f! OM-NI Ps hulrM Por~1hM1leN~e. NV 8001 rts~o .wuM~ e COVE~-sEil 'r-fe 1'OCICtls OF MI>KJIIANCE ulTr:O bE~OM/MAVf Welt 1esuEO TO THE 111eNRE0 NA11tb govt rp1 Yht rd{,Ky p~Op INDrQATi?0 NDTwIT1tlTANbIMG AN1-RtiQNlte~ferwt. TlRM t7R fiAN011101t OF AN1' CONTIIAC7' oR orr-eA o0Ct1AfE1R WITH RIMRrCT To Yy16oM 1H10 t~llTIFICAT+r wur sE 1/~4E6 OR wY ~uK 711! MluluwoE Al4tOR0ED it THE na~elEr ouolne~ 1tR11l111 ti eulaECT TO ALL TwE TaRws, ixexltstoNSd A11p cao~T+vNe os sun MO1~01 'L6 ttovAMOATE IANITf iF10WN t~1rv 1Mt1s MCx R;oueta rr r~uo oWIwE TMItO/ 11Y1Ne11 i.Y11R~ ~ ~~ ul~looala IOMOl7011 10/101t07Z el oao ~ • aurr wtal~ 0 1n ~ fawn e ~ ~ ~~ e iE urn Apa~torr~ ~RNr ~wt»r 1wR. .._....~- - --- A1M A410 t~I:OMMIDAt>t0e 6a+i~tAaUfOe Mnro tunoe MiMOMMlPAtrtOe wrE 11~eN.IfY n1r ~tRq lei'f I.e~1t oGCUf+ tAAMIRMID! 1N10!l011 ,10lISfZ01~ lete+~ lentpte LMAR lAr~T : t w~~, ;,r"~~:~o " e P'MraMMW1A~~ e r•tµ qqn~r~~ woe e AYTO?ON~ --- NR.OIe/e• tMY1rr ~ilt~~~ ~ Oi1 • r OIlf~fi/ MM- f R ""'" ~t'h- aiZiN0000 1allJno'1/ 10/lOJZ1112 : f 11!14„000 RC r A rgPl prlldnwn O~ZI100010 1ph0R011 IO/1S12617t InNugeO u~~ w.r,_w T~Nt MO-~ enowws rdiass 6t C~MGK4rp ei1gD11C THE f71NIM710 N tCWIR t!f w~lr~A 1t *M~IN~r, TM~ INUIMS ^~~ w4L MK+f~IW~t mlNA0. ~tQ_, oAYi WRIf-[N 20 MiddMbue6 Rued MoneR rp nu ossrlwo~n nrna~~ wtr~o To nu un, rlrr r~uer +ro 00 ~P ~:~ WrpedRR-s ><Nlr, N1`/ 12lf0 ! No oKw~TrfR oft NA1R.fTY es -wr.w t1rOr n11 MrYRrR. rr. Aeenrs ars •.1fe lQOWO/) ~ e/1 N~1+1MOA112"IOOOT • 1gs,EOe! AQORp OORrOMTION. All nOhts rsMrwn. 7hR ACORO +M1ne anM 4N ate Al~N-N trrrke 6f ACORD ~ 11106!2012 12:30 19148966410 M SCHWARTZ PAGE 01 PERSUNAL MEMV Yll !lY A "~~ f i~ ~ti ~7~fYY~N_{!~}lfY:'~11~ :.:~:JL4.. ~Y~,: ~... ~ .'!7G~.!Fe}}!4~l~r~i+r'~.'wtrvvxs ::$ ~r : 7 :titw' '~'-- r{ ~~^~ lssr,^ ~ ~ ~5:~~.:'t~•' y • f.~. 4sM5MA.S~:fa~J^ l%Yr~'r•:rv. ~T`!~M .. ~r u~: •w f .. ~ .. 1~j(z ;w 1.Y: :}i~$'r,::•;-Yrve.:Xr$•+' ~:a:^~'::~:'rii::i=Nv~'scw/R~aY~n~vuEevisinir~Tr3'sifG«:' S:3C'li vs~.$ ~,c,~A~l~ Ind ~~~" ~~-6-2012 FAIL rtr~.r~.rl.~. ~w~ _ ~ nom. ~ ~. later.: a ~..~~.~~ ~-~p~'~ Irene Hughes ' Wildwood Mn. Cando Assoc. Client#_ 39175 WILDMA ACORDT~ CERTIFICATE OF LIABILITY INSURANCE ) 10/12/2012 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Bradley 8 Parker, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 320 South Service Road HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Melville, NY 11747 631 981-7600 INSURERS AFFORDING COVERAGE NAIC # INSURED INSURER A: DOngbU InSUranCe CO Wildwood Manor Condo Association INSURER B: Federal Insurance Co C/O River Management Inc INSURER C: United States Liability Ins Co 297 Mill Street INSURER D: Poughkeepsie, NY 12601 INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE 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 THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. IN LTR NSR TYpE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS A GENERAL LIABILITY NBP122424400 10/15/2012 10/15/2013 EACH OCCURRENCE $1000000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $50 000 CLAIMS MADE ~ OCCUR MED EXP (Any one person) $5 000 PERSONAL & ADV INJURY $0 GENERAL AGGREGATE $2 000 000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMPIOP AGG $2 000 000 POLICY jRa LOC A AUTOMOBILE LIABILITY NBP722424400 10/15/2012 10/15/2013 COMBINED SINGLE LIMIT ANY AUTO (Ea accident) $ ALL OWNED AUTOS BODILY INJURY SCHEDULED AUTOS (Per person) $ HIRED AUTOS BODILY INJURY NONAWNED AUTOS (Per accident) $ PROPERTY DAMAGE (Per accident) $ GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ B EXCESS /UMBRELLA LIABILITY AARE0693102 10/15/2012 10/15/2013 EACH OCCURRENCE $15 000 000 X OCCUR ~ CLAIMS MADE AGGREGATE $1 S OOO OOO DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION AND ' WC STATU- OTH- IQ~'"/'~ EMPLOYERS LIABILITY R/PARTNER/EXECUTIVE ANY PROPR IET O E.L. EACH ACCIDENT $ CC g E E ~ EXCLUDED? n ~a i tory I NH r da E.L. DISEASE - EA EMPLOYEE $ If yes, describe under SPECIAL PROVISIONS below E.L. DISEASE -POLICY LIMIT $ C OTHER D8r0 CAP1017858B 10/15/2012 10/15/2013 $1,000,000 A Crime NBP722424400 10/15/2012 10/15/2013 $ 100,000 DESCRIPTION OF OPERATIONS /LOCATIONS /VEHICLES /EXCLUSIONS ADDED BY ENDORSEMENT /SPECIAL PROVISIONS SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL __3p_ DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVE ACORD 25 (2009101) 1 of 2 #264306 ©1988-2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD SSG