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Town of Wappinger Little League (2)CERTIFICATE OF LIABILITY I SU Keystone Risk Managers, LLC 2012 5995 Point Township Drive SEP ~' $ Northumberland, PA 17867 OWN pF wA',P_{LP~~~I~JN~1,(G------E ADDI710NAI. NAMED INFURED. TO • • N C- TQWN OF WAPPINGER AMERICAN Ll. ROB WILSON 25 MIDDLEBUSH RD WAPPINGERS FALLS NY 12590 COVERAGES DATE 2!02!12 CERTIFICATE ;t ~ 321716~ 1 2 a2 17 NSURERS AFFORDING COVERAGE: i INSURER A: '~, LEXINGTON INSURANCE COMPANY INSURER B: i NATIONAL UNION FIRE INSURANCE (Non-Liability; ~ COMPANY OF PITTSBURGH, PA INSURER C" ~iCHARTIS SPECIALTY INSURANCE COMPANY 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 CONTRAS ~ :1R OTHER DOCUMENT WITH RESPECT 70 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 ., ..nv unvc assn! ccnl ICl=fl RY PGIf) fl AIMS SR rR ADO'L MSRD TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE MM/DD/YYYY POLICY EXPIRATION DATE MM/DD/YYYY LIMITS _ ___ GENERAL LIABILITY EAC~1ocCURRENC:E + + 20 3 ~ A X X OCCURRENCE 1 9472464' 1 f31 f2O12 1 /01 / GENERA, AGGREGATE + ?RODUCTS~COMP' OPS ~j~ 0 + QQ X INCL. PARTICIPANTS Property Dama a Deductible: $250 AGGREGATE SEXUA! ABUSE + + occuRR Nc - X SEXUAL ABUSE _ SEXUAL ABUSE A~[GATE _ ~t~7~ }~~ i~a"+ VVV~ _. ANY ONE MEDICAL PAYMENTS _ PERSON _ E~LOSS I $1,000,000 ~ ~ DIRECTORS & OFFICERS 24214367 1 /O1 /2012 1 /01 /2023 I r--- ~, AGGREGATE $1,000,000 A X 0100(35411 If01f2012 il01/2013 ICI EAChLOSS ~ $35.000 CRIME COVERAGE ~ Crime Deductible: $250 Property/$1,000 Money AGGREGATE _ NONE - '~ A^ ire Master Poliq, As in Master 3 X SPORTS EXCESS ACCIDENT SRG9105434 1 f O 1 / 2~ 1 2 s ~ ~ j :' ~ ~ ~ ,^a ' Mer Max 500.000 Ded 550 Policy Excess __ - "X" INDICATES COVERAGE SELECTED FOR ADDITIONAL NaMtu irvaurstu ___ _____ _ ADDITIONAL INSURED Who is an insured (SECTION II) of the General Liability policy is amended to include as an insured the person or organization show-n in the schedule, but only with respect to liability arisino out of the above named Little League s maintenance or use of ball fields, or other premises loaned. donated. or rented to that Little League by such person or organizations and subject to the following additional exclusions: 1. Structural alterations. new construction, maintenance. repair or demolition operations performed by or on behalf of the person or organization designated in the Schedule unless performed by the above names Little League and 2. That part of the baD iie!d or other premises not being used by the above named Little League NAME AND ADDRESS OF PERSON OR ORGAN{ZATION T©WN OF WAPPINGER 2. WAPPINGERS CENTRAL SCHOOL DISTRICT ~. '~ILLAGl; QF WAPP I NG~RS F'P+LLS INSURED Little League Baseball Risk Purchasing Group, Inc. 53S U.S. RT. 15 HIGHWAY South Williamsport, PA 17702 CANCELLATION SHOULD ANY OF ~"HE ABOVE DESCRIBED POLICIES TC THE ABOVE NAMED Lr^tE LEAGUE BE CANCELED BEFORE THE EXPIRATION DATE THEREOF. THE ISSUING INSURER OR THEIR REPR)r.'±•ENTAT!VE WILL MAIL 3L DAYS WRI''i EN NOTICE TO THE DESIGNATED PERSON OR ORGANIZATION AT THEIR LAST KNO\N!U ADDRESS TO A1S. AUTHORIZED REPRESENTATIVE 2010-01-19 JCM FOR INTERNAL USE ONLY Received by: Christine Fulton ~ Jessica Fulton ^ Date Received: Q~ / (,P / ~~' Serial #: pplication ^ $100.00 Cvl Cert. of LI ,Notified Recreation (date: 11 1 G4 ) Agreement for the Use of the Town Hall Facilities for Meetings /ayJ o F L. rrl.E 1.~1 ~ ~ Name of Organization or Group ~~ Name of person repr se Ming the Organization or Group / ~ /~ aG 1~t,J vs 4 ~C d ir' . ~ 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 's not expe ted to exc ed persons Q 3 r,y` Date(s): l t ~ 2 'f t ~ Time: / 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. Town of Wappinger Agreement for the Use of the Town Hall Facilities for Meetings 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. Signed: ~~ ~ For: ~ ~ ~ L'' (Name of Group or Organization) Date: // G'~/ a Approved: Town Clerk Date: ~~~ ~ CERTIFICATE OF LIABILITY INSURANCE ~', DATE + n ~ ~ ; ~~~.~, ~~ Keystone t2isk Managers, L,LC l~g~ 1'oint'I'o~~nsllip Drive '~orthna~nberlancl, PA p?86? _1p;;10"lAL NAMED INSU RED. TO~~ JF ~1APPI~Vt~r~ AMEPTCAN LL ROi~ Gdli.St~~l ~.S Ni~i~L'LHBi.sS~ Fc :~~~?~G.~R~ Ai1L,~ PiY ~.a"'.59C INSURER A: (LEXINGTON INSURANCE COMPANII INSURER B: ~ NATIONAL UNION FIRE INSURANCE (Non-Liabiiityy j COMPANY OF PITTSBURGH, PA INSURER C: %iCHARTIS SPECIALTY I INSURANCE COMPANY ®VERAGE~ ~:E POLC!ES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED NOTWITHSTANDING NY REOJIRciJE:tiT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY ERT,vIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEfiEiN iS SUBJECT TO ALL THE TERMS, EXCL'vSIONS AND CGNDI I IONS OF SUCH ,-~I ;r.IFC nrr;Rr~aTP 1 IMiTS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. I TYPE OF INSURANCE I POLICY EFFECTIVE POLICY NUMBER ~ POLICY EXPIRATION I LIMITS ' ;nsac DATE MM/DD/YYYY DATE MM/DO/YYYY I GENERAL LIABILITY ~ T ( EAGHOGGURP.ENCE; a a ;-il ~ , yy I 'OCCURRENCE I I /` n -r /~ n[~v ~ / /~ / ? y~ ~L! < 3 :]tt:1 u J ~t3. ..4,: ~ ~ / ^~ + '~ ',> C.Y ). ! '-'I ~ ~ GENERA! AGGREGATE ~ '+ '~ ~.! 9 1.~~ 1 i ~ ~ ;f9 3i X' WCL PARTICIPANTS Pro ert Dama a Deductible: $250 p y g aROD'.rTSOG.,POas~ I GREGAT- i ~e ryry ~~ryy ,,ry~} Y ~) L~t~l~ d ~~V '~, SEXL'ALABUSE j I OCCURR~\CE I '~'i l +~l~i~r Of01fJ ' ~SEXUALABUSE ~~ ~~ X ~ i SEXUAL ABUSE . . , AGGREGATE ~ s 4' ~~ I ; I i ~ EACH Loss ~, ~1,000,OOC j D?RECTORS & OFFICERS I ~'~ ' L:/€G1~436'7 1/'~? ?`?~ix'i l .~ t'Cii ~'20i~ • I I AGGREGATE i $1,000.C00 X ~ i .:;Js'sL~S~^~35 ! ~.~I~s.r2~3.~Ij s>/<~?O~:L~12~1 EACH LOSS x35,000 ~' CRIME .,OVERAGE i ? - ~, ~ Crime Deductible: $250 Property/$1,000 Money ~ AGGREGATE NONE I Assn Master Poilcy ' As in Masier SRORTS EXCESS ACCIDENT ~ _ I Med. Max. 5~00.000I POIiCy EXGess ,~i ~ __ ~-, z{ r _ ~ .~ ~i } ~ •1 ~ ' x aC i~ i ?"~ v ~..~ ~ 1 .'' i~ i r ~ G .~. w ~ Deb, S56 "X" INDICATES COVERAGE SELECTED FOR ADDITIONAL NAMED INSURED ADDITIONAL INSURED Nho is an insured (SECTION I!) of *.he General Liability policy is amended to include as ar. insured the person or organization shown in the schedule, bui only with respect to lability arising out cf the above named Little League's maintenance or use of ball fields. or other premises loaned, donated. or rented to that Little League by such person or xganizatiens and subject to the following additior:al exclusions: ',. Structural alterations, new construction, maintenance. repair or demolition operations performed by or on behalf of the person or organization designated in the Schedule unless performed by the above named Little League and ?. That parf of ±he ba!I field or other premises not being used by the above named Little League NAME AND ADDRESS OF PERSON OR ORGANIZATION: ~~"~~ .~'1 ~f:t~i~=~~.5~".~.>w.. ~1)1Gd~.~Z~17~"~.:f "~.iL'i"+I~~Lt~,~ SC'z~t-~;..;;: ~.T'.~J~~S~C~ ~~.. ~r~S..Lsi.,A''.ti i c.% 'VSURED _ittle League Baseball Risk Purchasing Group, Inc. i39 U.S. R~: 15 :HIGHWAY ;ot;~'~r, 4~rilliamsport, PA 17702 INSURERS AFFORDING :;OVERAGE: CERTIFICATE n u~Z?71b-i ;~ Sy 1~ CANCELLATION I SHOULD ANY OF -HE ABOVE DESCRIBED POLICIES TO THE ABOVE NAMED LITTLE L=AGUE BE CANCELED BEFORE THE i EXPIRATION DATE THEREOF, THE ISSUING INSURER OR THEIR REPRESENTATIVE ~"JIL'_ MAIL 30 DAYS WRITTEN NOTICE I TO THE DESIGNATED PERSON OR ORGANIZATION AT THEIR LAST KNOWN ADDRESS TO'JS. AUTHORIZED REPRESENTAT;VE