Woodhill Green Condos2010-01-19 JCM
FOR INTERNAL USE ONLY
Received by: Chris Masterson
Christine Fulton
Sue Rose
Date Received: C~ ~ ~ ~ ~ ~~ a
Serial #:
~7 Application ,~ $100.00 I~ Cert. of LI
i ^ Notified Recreation (date:_~
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
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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 i of exp cted t exceed ~~ P~'sons
ate(s):. / Time:
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It should be unders ood t 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
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.
Sign
For:
Date:
Approved:
Town Clerk
Date:
TRAVELERS
One Tower Square, Hartford, Connecticut 06183
COMMON POLICY DECLARATIONS
"" CONDOMINIUM PAC
BUSINESS: CONDO 1 -4
INSURING COMPANY:
THE PHOENIX INSURANCE COMPANY
1. NAMED INSURED AND MAILING ADDRESS:
WOODHILL GREEN CONDOMINIUM
1668 ROUTE 9 BUILDING 1
POLICY NO.: I-680-3A873647-PHX-11
ISSUE DATE: 07-14-1 1
WAPPINGERS FALLS NY 12590-7400
2. POLICY PERIOD: From 07-06-1 1 to 07-06-1 2 12:01 A. M. Standard Time at your mailing address.
3. DESCRIPTION OF PREMISES:
PREM. LOC. NO. BLDG. N0. OCCUPANCY
ADDRESS
(same as Mailing Address unless specified otherwise)
1668 ROUTE 9 BUILDING 1
WAPPINGERS FALLS NY 12590
01 ALL CONDO 1 -4
4. COVERAGE PARTS AND SUPPLEMENTS FORMING PART OF THIS POLICY AND INSURING
COMPANIES
COVERAGE PARTS and SUPPLEMENTS INSURING COMPANY
Businessowners Coverage Part PHx
Directors & Officers Coverage Supplement PHX
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5. The COMPLETE POLICY consists of this declarations and all other declarations, and the forms and endorse-
ments for which symbol numbers are attached on a separate listing.
6. SUPPLEMENTAL POLICIES: Each of the following is a separate policy containing its complete provisions.
POLICY POLICY NUMBER INSURING COMPANY
DIRECT BILL
7. PREMIUM SUMMARY:
Provisional Premium
Due at Inception
Due at Each
NAME AND ADDRESS OF AGENT OR BROKER
$ 26,301.00
COUNTERSIGNED BY:
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PO BOX 263
SAUGERTIES NY 12477
IL TO 19 02 05 (Page 1 of 02)
Office: ALBANY DOWN
NACCARATO INS AGENCY INC EM004
Author~iz]ed Repres ntative
DATE: ` ~ 1~-~~
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TRAVELERS ~ one Tower square, Hartford, Connecticut 06183
BUSINESSOWNERS COVERAGE PART DECLARATIONS
CONDOMINIUM PAC POLICY NO.: I-680-3A873647-PHX-11
ISSUE DATE: 07-1 4-11
INSURING COMPANY:
THE PHOENIX INSURANCE COMPANY
POLICY PERIOD:
From 07-06-11 to 07-06-12 12:01 A.M. Standard Time at your mailing address.
FORM OF BUSINESS: ASSOCIATION
COVERAGES AND LIMITS OF INSURANCE: Insurance applies only to an item for which a
"limit" or the word "included" is shown.
COMMERCIAL GENERAL LIABILITY COVERAGE
OCCURRENCE FORM LIMITS OF INSURANCE
General Aggregate (except Products-Completed Operations Limit) $ 2,000,000
Products-Completed Operations Aggregate Limit $ 2,000,000
Personal and Advertising Injury Limit $ 1,000,000
Each Occurrence Limit $ 1,000,000
Damage to Premises Rented to You $ 300,000
Medical Payments Limit (any one person) $ 5,000
BUSINESSOWNERS PROPERTY COVERAGE
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DEDUCTIBLE AMOUNT: Businessowners Property Coverage: $ 5,.000 per occurrence.
Building Glass: $ 250 per occurrence.
BUSINESS INCOME/EXTRA EXPENSE LIMIT: Actual loss for 12 consecutive months
Period of Restoration-Time Period: Immediately
Other additional coverages apply and may be changed by an endorsement. Please
read the policy.
SPECIAL PROVISIONS:
COMMERCIAL GENERAL LIABILITY COVERAGE
IS SUBJECT TO A GENERAL AGGREGATE LIMIT
MP TO 01 02 05 (Page 1 of 02)
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